Colorectal Cancer (CRC) which develops in the colon or the rectum, (also known as the large intestine) is the third most commonly diagnosed cancer and the third leading cause of death among both men and women in the United States. In 2015, an estimated 135,000 new cases of CRC will be diagnosed and about 50,000 deaths due to this disease will occur in the United States. On an average, the lifetime risk of developing this condition is 1 in 20 and this is somewhat higher in men than women. The potential risk factors include age, genetics and lifestyle factors such as diet, smoking, obesity or alcohol use.
Even though there are different signs and symptoms associated with this condition in most cases, people in the initial stages of this disease do not experience any specific symptoms. However, as the disease advances the severity and intensity of symptoms may also change. Some of the main symptoms include abnormal bowel habits, bleeding from the rectum, decreased appetite, unintentional weight loss, cramping or stomach discomfort, constipation and weakness or fatigue.
Early Detection and Screening of CRC – Why Is It Crucial?
Colorectal cancer is a curable disease that often goes undiagnosed due to lack of regular screening. In many cases, regular screening helps in the detection and removal of pre-cancerous growths as well as help to diagnose the disease at an early stage, when treatment is most effective. Screening reduces CRC mortality by reducing the incidence of the disease and by increasing the likelihood of survival. As per reports, the survival rates of people diagnosed with primary stages of this severe disease is 90 percent whereas only 10 percent survives when diagnosed at a later stage when it has spread to other organs.
It is important for people (who have no identified risk factors other than age) to begin their regular screening for this disease at an early age. Conversely, people having a family history of colon cancer and other risk factors must discuss with their physicians about the need for routine screening.
Oncologists must educate their patients about the various risk factors associated with this disease and recommend good treatment modalities. Physicians conduct different screening tests such as colonoscopy, sigmoidoscopy, guaiac-based fecal occult blood test (gFOBT) fecal immunochemical test (FIT), CT colonography (virtual colonoscopy), and stool DNA test to detect the symptoms in its primary stages.
The American Cancer Society recommends that both men and women (at the age of 50 years) who are at the average risk of developing CRC should perform one of the screening tests given below
- Colonoscopy every 10 years
- CT colonography (virtual colonoscopy) every 5 years
- Double-contrast barium enema every 5 years
- Flexible sigmoidoscopy every 5 years
Oncologists while administering different treatment modalities should have up-to-date knowledge about the latest guidelines or practices for medical billing and coding for CRC screening services provided. Accurate diagnostic and procedure codes are to be reported on the claims to receive the correct reimbursement. The ICD codes for colorectal cancer include:
- V10.0 – Personal history of malignant neoplasm of large intestine (high risk screening code)
- V10.06 – Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus (high risk screening code)
- V12.72 – Personal history of adenomatous colonic polyps (high risk screening code)
- V16.0 – Family history of malignant neoplasm of gastrointestinal tract (first degree relative-sibling, parent, child) (high risk screening code)
- V18.51 – Family history, adenomatous colonic polyps (high risk screening code)
- V76.41 – Special screening for malignant neoplasms of rectum
- V76.51 – Special screening for malignant neoplasms of colon
- V84.09 – Genetic susceptibility to other malignant neoplasm (not covered by all payers)
- Z12.11 – Encounter for screening for malignant neoplasm of colon
Teenage Obesity Linked to Increased Colorectal Cancer Risk – Finds Study
A new study indicates that men who are overweight or obese during late adolescence have twofold chance of developing colorectal cancer during middle age. The study conducted by researchers at the Harvard School of Public Health in Boston, Massachusetts was published in the Gut, a Journal of the BMJ. The study reveals that those men with a high level of systemic inflammation during late adolescence are also at increased risk of developing this type of cancer.
Even though several studies in the past have associated obesity and systemic inflammation in adults with a higher risk of CRC, very few studies have indicated how these conditions during adolescence affect later-life risk of the disease.
As part of the study, researchers analyzed the health of 239,658 men who underwent a compulsory health assessment (for Swedish military) between 1969 and 1976 when they were aged 16-20 years. They analyzed the BMI (Body mass index) and ESR (erythrocyte sedimentation rate) – a measure of inflammation in the body, as determined by the rate of fall in red blood cells (erythrocytes). The key findings of the study include
- It was found that at the time of health-assessment, about 81% of young men reported a normal weight, 5% were moderately overweight, 1.5% were overweight and about 1% were obese. It was found that about 12% of men were underweight.
- When combining these findings with the cancer registry data, it was found that about 885 men developed CRC and out of these cases, 384 were rectal cancers.
- It was found than men who were overweight (BMI of 27.5-30 kg/m2) at the time of enlistment were twice as likely to develop CRC during middle age as those with normal weight (BMI of 18.5-25 kg/m2) at enlistment. On the other hand, men who were obese (BMI greater than 30 kg/m2) were 2.38 times higher chances of developing bowel cancer.
- When compared to men with a low ESR, men with a high ESR (above 15mm/hour) who had no diagnosed inflammatory bowel disease at the time enlistment reported 63% higher risk of developing CRC.
The study suggests a graded association between adolescent inflammation and even a stronger association between adolescent BMI and CRC risk. Furthermore, the study suggests that BMI and inflammation, as measured by ESR, in early life may be important to the development of colon cancer.