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Let’s talk about colorectal cancer

man on toilet (legs only)

What’s Your Poo Telling You?

Everybody Poops.

How to S*** in the Woods.

All great books about bowel movements. (Or BMs, or number twos, or poop. Or stool.)

And all just merely a way to get us all in the headspace to talk about this month’s health topic: colorectal cancer.

Colorectal cancer is when cancer cells begin to grow in the colon or rectum, parts of the digestive system. The colon takes in water and nutrients from the food we eat and then passes the waste to the rectum (and voila – poop).

Because of its location in the body, colorectal cancer is an oft-shied away from topic. It’s certainly not the first thing people want to talk about at a dinner party, but it should be, says Dr. Shady Ashamalla, surgical oncologist at Sunnybrook and head of the colorectal program.

“We know that early detection is key,” Dr. Ashamalla says. “So, talking to your family and friends about this disease – and the screening program that’s in place for it – could help save a life.”

Who is at risk?

“Familial risk depends on what age the immediate family member was diagnosed,” Dr. Ashamalla says. “The Ontario screening program starts at age 50. So if your immediate family member was diagnosed before age 60 it’s important to tell your doctor.”

If your immediate family member was diagnosed at age 54, for example, your screening should start when you are 10 years younger than that. You should start getting screened at age 44.

“We know there are genetic/hereditary disorders that put people at increased risk of colon cancer,” Dr. Ashamalla says. “But the majority of cases are sporadic, meaning there’s no specific genetic association.”

What’s the cause?

“It’s important to remember there’s no good evidence for cause,” Dr. Ashamalla says. “There is evidence of association, but that’s not the same as cause.”

So, alcohol-use, obesity, red meat consumption, low fitness levels have all been found to be associated to an increase in risk. But that doesn’t mean those things cause colon cancer.

You can make healthy lifestyle choices to help reduce your risk, he adds.

“Eat a healthy diet with lots of fruits and vegetables and not too much red meat, be physically active, don’t drink too much – they can make a difference in your risk,” he says. “That said, you could check off all those lifestyle boxes and still get colon cancer.”

Also important to remember, Dr. Ashamalla says, is that there’s no scientific evidence that probiotics or colonic cleanses do anything to reduce your risk.

You can check your risk at – it’s a site run by Cancer Care Ontario.

Get screened.

Cancer cells in the colon and rectum can be present long before you have any symptoms. The symptoms don’t present themselves until the disease is advanced.

“That’s why it’s important to get screened starting at age 50 – or earlier if you have immediate family history,” Dr. Ashamalla says.

In Ontario, you can actually do a fecal occult blood test to screen for colorectal cancer from the comfort of your own bathroom. Talk to your family doctor or call TeleHealth at 1-866-828-9213.

Screening doesn’t prevent colon cancer. But it catches it early, before you would notice any symptoms. And catching it early means better outcomes.

What to watch for?

There are some symptoms to watch out for:

  • Changes in bowel habits, including changes in frequency or in the shape of the stool
  • Black stool
  • Blood in your stool
  • Unexplained fatigue, or a feeling of unwellness that can’t be explained
  • Unexplained weight loss.

If you have any of those, go see your family doctor. Don’t be shy or delay – early diagnosis is key to better treatment outcomes.

Explore your options

Dr. Ashamalla says treatments for colorectal cancer have come a long way in the past few years, meaning less treatment side effects and better outcomes for patients.

“The treatments for colon cancer can have effects that last a whole lifetime, even if your disease is cured. But there are a lot of new minimally invasive techniques that really are better for patients. It’s not a one-size-fits-all treatment approach anymore.”

Be sure to talk to your specialist about all your options.

And talk to your family and friends about getting screened. (C’mon you can do it!)


(This column also appears in the March edition of Toronto’s Streeter Newspaper)

About the author


Alexis Dobranowski

Alexis Dobranowski is a Communications Advisor at Sunnybrook.

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