WHEN STOOLS LOOK FINE BUT ARE NOT
Most men know that blood on toilet paper or in the bowl is a potentially ominous sign and must be checked immediately. Although the blood could be due to many things, such as haemorrhoids, a tear or benign polyps, the possibility of cancer must be considered.
What many don’t know is that laecal matter that looks quite ordinary can contain blood that can’t be seen by the naked eye. Finding these occult traces can mean a substantial survival advantage. When colorectal cancer is found at this early stage, a cure can be achieved in 81 per cent of cases. This compares with a cure rate of 59 per cent among the general Australian population with colorectal cancer. Given that, after lung cancer, colorectal cancer is the second-most-common fatal internal malignancy in Australia, finding occult blood seems worth the effort. But how to find it?
There are a number of tests available in Australia that are suitable for 90 per cent of the adult population over the age of 50. These tests could be used once every 2 years.
Some testing kits come with a paintbrush and a card. After a bowel movement, the paintbrush is used to smear a small amount of faecal matter into a designated square. This is left to dry. The process is then repeated with the two subsequent bowel motions using two other squares. The completed card is given to the family doctor, who sends it to a laboratory where chemicals are added to each smear. If a colour change occurs, it could indicate the presence of blood.
An easy-to-use new test avoids the need to collect a stool sample. Men using this test need only collect a small amount of toilet bowl water, which is brushed onto a card and mailed off for analysis.
This particular test does not require those being tested to restrict their diets in any way, but specific food and drugs can interfere with the results of some other tests.
If a test indicates that blood is present in the stool, the doctor will rule out other causes of bleeding before continuing. A false positive can result when, for example, a woman takes a sample during menstruation, a man takes one while he has a bleeding haemorrhoid or dietary restrictions have been ignored.
Once doctors are certain that no other factors have affected the results, they usually recommend a colonoscopy. Those with positive faecal occult blood test results are 40 times more likely to have bowel cancer than those whose results are negative. If cancer is present, the colonoscopy will find it.
Cancer councils across the country get regular calls from men alarmed at what they have seen on toilet paper or in the bowl. Some have already settled on a self-diagnosis of bowel cancer and are panicking. Others are concerned but want to get a balanced perspective before they approach the family doctor. Some want encouragement or permission to seek further help. These men are usually told that blood can mean other things too, and are asked about their history and whether they have experienced recent changes in their bowel habits. Bowel irregularities that persist over a number of weeks can be a worrying sign.
Some callers have heard of occult faecal testing and want a kit, even though they can see the blood for themselves. They are referred to their family doctors.
After years of debate, opinion on colorectal cancer screening in Australia has finally reached a consensus. Provided there has been a full discussion of the risks involved, guidelines recommend that faecal occult blood testing be performed from the age of 50 on asymptomatic individuals who do not have a positive history. The test should be performed on three serial stools at least every second year and preferably annually.
In an Australian study conducted by Rotary between 1987 and 1996, faecal occult blood testing discovered about 250 people with colorectal cancer. The mean age of the men with the cancer was 65, while the mean age of the women was 63. In follow-up studies conducted in 1998 and 1999, it was a found that 71 per cent were alive. They had all lived at least 5 years beyond their diagnosis. Some had survived for more than 8 years.
This study supported the findings of three independent international trials of large populations of healthy people that showed that regular occult blood screening could reduce deaths from colorectal cancer by up to 33 per cent. For those who faithfully had screenings every I or 2 years for the entire period of the trial – some trials ran for 10 years – the reduction in deaths was 50 per cent.
But faecal occult testing kits are not suitable for everyone.
About 10 per cent of the adult population are at high risk of colorectal cancer and need a different form of testing.
People at high risk are those who have a young relative or two or more older relatives with a history of bowel cancer or have their own history of chronic bowel disease. They need to be part of a regular endoscopic screening program. The good news for them is that researchers are refining a form of virtual colonoscopy. If this is clinically effective, the routine intrusive procedure might eventually be replaced by a 1-minute CAT scan that requires no anaesthesia or sedation – just a mass of air that is pumped into an empty colon.
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