Colorectal Cancer Q&A with Dr. Michael Kaczanowski

In the fight against colorectal cancer, knowledge and preventive measures are our strongest allies. Dr. Michael Kaczanowski, a seasoned expert in gastrointestinal health, shares his insights on this pressing issue. From signs and symptoms to the importance of early screening, Dr. Kaczanowski sheds light on how individuals of all ages can take proactive steps towards colorectal health.

Question: What are the signs and symptoms of colorectal cancer?

Dr. Michael Kaczanowski: Colorectal cancer might not cause symptoms right away. In fact, many of the symptoms of colorectal cancer can also be caused by other problems like infections, hemorrhoids, irritable bowel syndrome, or inflammatory bowel disease. The general symptoms include a change in your bowel habit, such as diarrhea or constipation or narrowing of the stool that lasts for more than a few days, a feeling that you need to have a bowel movement that's not relieved by actually having one, blood with your bowel movements, which might make it look dark brown or black or even red, cramping or abdominal pain, weakness, fatigue, and losing weight without trying.

Question: Who is at higher risk of colorectal cancer?

Dr. Michael Kaczanowski:  African American people have a higher risk, as do certain Jewish populations. Also at higher risk are those with a strong family history of colon cancer or certain types of polyps, a history of inflammatory bowel diseases like Crohn's disease or ulcerative colitis, a known family history of hereditary colorectal cancer syndromes like familial adenomatous polyposis or FAP or the Lynch syndrome, as well as people that have a history of radiation to the abdomen or pelvis to treat prior cancer.

Question: At what age should we start regular screening?

Dr. Michael Kaczanowski: All our professional societies, as well as the United States Preventive Services Task Force, agree that for average-risk people, screening should begin at age 45. People at increased or high risk for colon cancer might need to start colorectal cancer screening before 45, be screened more often, and maybe get special tests as well.

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Question: Why are younger people increasingly diagnosed with colorectal cancer?

Dr. Michael Kaczanowski: In general, the risk of colorectal cancer increases as a person gets older, with about 90% of cases being diagnosed in those people over age 50. That said, the incidence of colorectal cancer in people under the age of 50 has steadily increased by about 2% per year since the '90s. And by 2015 or so, there was a 30% increase in colorectal cancer in the 40-year-old age group. Nobody really knows why that's happening. The exact cause of colorectal cancer isn't known, but certain risk factors are strongly linked to the disease, like diet, tobacco smoking, and heavy alcohol use.

Question: What is the best screening method for colorectal cancer?

Dr. Michael Kaczanowski: Talk to your primary care provider about your concerns and your particular risk factors. There are several different ways to be screened for colon cancer, and your primary provider can help you navigate the choices and arrange one that's most appropriate for you.

The primary visual test is colonoscopy, which uses a flexible, lighted tube with a camera at the end to look at the entire length of the colon and the rectum. If a polyp is found, it can be removed during the test itself, potentially preventing future cancer. In order to do a colonoscopy, your colon and rectum must be empty and clean so the doctor doing it can see the entire lining during the test. You'll be given medicine to relax and may even sleep through the procedure. You'll need a ride home afterward. But if you're of average risk and nothing abnormal is found, you won't need another colonoscopy for ten years.
Remember, colorectal cancer is preventable with screening and more treatable when found early.

Dr. Michael Kaczanowski of Foundation Gastroenterology is board-certified in Internal Medicine and Gastroenterology and has served the southern New Hampshire community for the past 15 years. He received his medical degree from St. George’s University School of Medicine, Grenada and completed his residency at Norwalk Hospital, Yale University teaching affiliate, Norwalk, CT. Here he held the position of Chief Medical Resident and obtained a Fellowship in Gastroenterology and Hepatology. Dr. Kaczanowski has published on the use of wireless capsule endoscopy for diagnosis of small bowel neoplasms and his area of special interest is in the detection of colon cancer, esophageal disease and swallowing disorders. He is a Fellow of the American Gastroenterological Association, and has been named Top Doctor in Gastroenterology by New Hampshire Magazine for several years.