Why is colorectal cancer screening a major issue? Answer with two gastroenterologists from Puy-de-Dôme

Is it because the topic remains taboo? Because it touches the intimate? Is it because we confuse screening and diagnosis? We are fortunate in France to benefit from organized and free screening for colorectal cancer, and yet, only one-third of people actually undergo this test (34.2% in AURa). This is less than about ten years ago, although this screening has been offered for about 20 years now.
Colorectal cancer is the second deadliest cancer in France (after lung). 47,500 new cases are diagnosed each year, 17,100 people die.

Professor Johann Gagnier, Head of the Department of Digestive Surgery and Digestive Oncology at Esting University Hospital, and Gastroenterologist Doctor Morgan Hellion, enlighten us about this common cancer.

How Colorectal Cancer Develops

The tumor grows on the rectum or in the intestine. It is a polyp that has developed into cancer. When it is found at the polyp stage, we get a 100% cure, because by definition, there is no cancer at this stage. “If the polyp has degenerated into cancer, and it is detected at an early stage without involvement of the lymph nodes and without metastases, there is a 90% cure. So this is a very good model for cancer screening. On the other hand, if detected at an advanced stage, with lymph node involvement and metastasis, the chance of survival is 15 to 20%. This is why the issue of screening is key! »

How does this cancer progress?

Initially there are no symptoms. The disease develops quietly. Hence the interest in screening. The transition from polyp to cancer takes several months or even years. It is a long process. When the cancer is no longer in the early stages, symptoms appear: abdominal pain, blood in the stool, transit disorders (alternate diarrhea and constipation), weight loss, etc. Significant signs of established and more difficult cancers to treat.

How is it supported?

If the screening is positive, a colonoscopy is necessary. During this exam, performed on an outpatient basis under general anesthesia, we make the diagnosis at the same time we treat it using a camera that goes up along the bowel. Then we proceed to remove the polyp.If the cancer is diagnosed at an early stage, surgery removes the cancerous tumor(s), as well as the part of the colon that carries the lymph nodes around the tumor. “At the initial stage it is a simple intervention, which is done using a robot and requires 3 to 4 days of hospitalization. Chemotherapy is sometimes necessary depending on the size of the tumor and the number of lymph nodes affected. If the cancer is more advanced, surgery will take longer with more risks. »

What does a screening test detect?

“The screening makes it possible to identify the presence of blood in the stool. of blood peculiar to humans. The detection threshold has been refined by reducing the number of false negatives. About 4% of tests are positive. That doesn’t mean “cancer” but that additional testing is necessary. 4% of these: 50% are benign polyps; 20% malignant polyps; 30% false positives. Bleeding is caused by something else. »

Why do only a third of affected people get tested?

“It is an area that touches the intimate. Digestive disorders are still taboo. Stool collection is an obstacle for some. While there is no direct contact in this test. In addition, colonoscopy still has a bad image: drinking to wash the colon, rectal Inserting the camera… it’s an intimate test.
A test that can save.

“So far 96% of the tests are negative. But above all, this cancer, detected at an early stage, can be cured! This is a rare cancer that is easily cured. Testing saves lives. »

Where to get colorectal cancer screening in Puy-de-Dôme in March?

She testifies: her last test saved her life.

Sophie
have retired from the hospital environment. So he is aware of systematic cancer screening, especially since he has a family history of polyps, but not colorectal cancer. This is done every two years. “In 2023, I had incredible luck,” she admits. This was the last test for me because organized screening is offered to people between the ages of 50 and 74. »

It is quite simple, easy and you can do it at home.
For the past few weeks prior to her exam, she had experienced no symptoms, no pain. “When it came back positive, I was very surprised, because apart from not feeling anything special, I have a healthy lifestyle, I eat a balanced diet, I walk regularly… I couldn’t believe it. In it,” she admits.So she contacted her GP who was informed. “Everything happened very quickly: my doctor prescribed a colonoscopy which revealed polyps, one of which was cancerous. I got an appointment at Esting University Hospital and within two months, I was treated with surgery. During this operation the surgeons noticed that the lymph nodes were affected so I had to undergo chemotherapy for six months. »
The screening test is for people aged 50 to 74 years.
“Though the treatment was tiring, it didn’t make my hair fall out,” explains Sophie, who always kept her spirits up. “It’s important to keep your morale up and it’s also crucial to be well surrounded. At CHU Estaing, all the staff were very caring and warm. We see that their jobs are close to their hearts. »

Today, Sophie is doing well. He gradually returned to his activities. And recognizes how lucky she was to have access to organized screening for this cancer. “We must do it at all costs! »

First name has been changed.

Manual.