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It may surprise you to find that colorectal cancer is almost as common in women as it is in men. While often thought of as a male cancer, this disease that develops in the colon or rectum is actually the third most common cause of cancer death in women trailing after breast and lung cancer. The symptoms can be tricky to pinpoint in women. Dr. Konika Bose, a gastroenterologist at Summit Medical Group, discusses what every woman should know about this common yet possibly preventable cancer.
Why is there a misconception that colon cancer is a man’s disease?
Women tend to dismiss colorectal cancer as affecting only men and focus more on the traditional female cancers like breast, ovarian, or endometrial cancer. But nearly 1 in every 24 women will be diagnosed with colorectal cancer. It is slightly more common in men, but there is not a significant difference. Both men and women have the same digestive organs including the colon and rectum—we are all at risk and need to be screened regularly.
Should women be screened at the same time as men?
Absolutely, the guidelines say that healthy men and women should start having a colonoscopy at age 50. Many patients can book the procedure directly without a referral from a primary care physician or office visit. Colonoscopy allows us to examine the inside of the colon and at the same time remove any polyps, benign growths that may evolve into cancer. If you have a family history of colorectal cancer or are African American, you may qualify to begin screening at an earlier age. If you have concerning symptoms at any age, please make an appointment with a gastroenterologist and discuss if screening is right for you.
Do men and women with colorectal cancer present with the same symptoms?
Yes, typically the signs and symptoms are the same. What makes it more challenging to diagnose in women is that the female body is quite complex. I like to describe the colon as a “picture frame” that borders the abdomen, and the small intestines are the photo in the middle. In a woman, however, the photo has more players. There are numerous gynecological organs, including the uterus, ovaries, and fallopian tubes in the same space.
What symptoms are you likely to see?
There are usually very few symptoms associated with colon cancer until late in the game. The most common symptom is blood in the stool. In general, and as you get older it is important to be aware of what your “baseline stool” looks like. Another common sign is a change in bowel habits, which is not a result of a lifestyle or diet change. Other less obvious symptoms include bloating, pain, and unexplained anemia.
Is it difficult to distinguish the signs of colorectal cancer from other stomach or gynecologic conditions?
Yes, it can be challenging. Patients that have nonspecific symptoms, such as bloating/gas or a change in bowel habits, may be labeled as having irritable bowel syndrome. Blood in the stool can also be from benign conditions such as hemorrhoids or anal fissures. When I see alarming symptoms, such as unexplained anemia or weight loss, I typically pursue a workup often including endoscopic procedures.
Since the colon and small intestine are close in proximity to the uterus and ovaries, the symptoms can be confusing or overlapping. We look for clues, in history, physical exam, lab work and imaging and work closely with our partners in gynecology. If the patient is menstruating and the pain is cyclical, then it may point to a gynecological etiology. But it is not always straightforward. For example, when a woman hits menopause there are direct effects on not only the uterus and ovaries but also on gastrointestinal motility, often resulting in constipation. Some diseases may involve both systems such as endometriosis.
What is your advice to women who are having vague symptoms?
I find patients are pretty in tune with their bodies. I always encourage them to trust their instinct. If something feels wrong, make an appointment and talk it through with a primary care doctor, a gynecologist, or a gastroenterologist. I see a lot of women who become anemic and assume it is related to their menses when they may actually have a gastrointestinal issue.
There are several risk factors—family history, age, and lifestyle choices—that make you more likely to get colorectal cancer. Are any red flags specific to women?
The risk factors for colorectal cancer are generally the same in men and women. What I often see is a difference in the knowledge of their family history. Most women know their grandmother had breast cancer or their father had a heart attack. But colorectal cancer does not typically get discussed at family gatherings and that is a big problem. It may be because people find topics like bowel movements or colon cancer taboo to talk about.
Are women tentative to speak up when they have symptoms?
Some patients may not mention their bowel movements unless I bring it up. Talking about going to the bathroom or flatulence can be embarrassing. I have some middle age women with chronic diarrhea who have lived with their symptoms for years before they came in to see me. As physicians, we are here to help. Systematically, we can figure out the work-up, the diagnosis and treatment so that patients can lead a better, healthier life.