Colon cancer: many ignore the alarm signals

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Blood in your stool or persistent abdominal pain - these symptoms can be harmless. But they can also be signs of colon cancer. Nevertheless, many patients do not have such alarm signals cleared up by the doctor.

Dorte Jarbøl from the University of South Denmark in Odense wanted to find out what is keeping people from going to the doctor, which may be life-saving.

Data for the analyzes was provided by a nationwide online survey conducted by the Danish Personal Register, in which more than 37,000 people took part. Among other things, they were asked about 44 different symptoms of the disease. It was also recorded whether those affected had consulted their family doctor about this and how long the symptoms had healed.

Jarbøl and colleagues agreed on four possible symptoms of colon cancer: rectal bleeding (437 cases), changed stool frequency (931 cases), changed stool consistency (917 cases) and abdominal pain (2386 cases). Most of those affected did not see a doctor because of this.

Despite blood in the stool, do not see a doctor

The researchers rate it as particularly alarming that two out of three patients did not have this checked by a doctor, even with blood in their stool. This can also have harmless causes, such as bleeding hemorrhoids, but should always be taken seriously as an alarm signal. Because apart from colon cancer, other serious problems such as ulcers can also be the cause.

Then the researchers clarified why those affected were not against to the doctor. They gave four possible answers: "I would have been embarrassed", I was concerned about wasting the doctor's time "," I was afraid of the diagnosis "and" I was too busy to go to the doctor ".

Lack of time, shame and fear

Worrying about wasting the doctor's time turned out to be the most common obstacle to a doctor's visit. The second most common reason was lack of time. This fits in with the fact that especially younger participants between 20 and 50 years of age gave this as a reason - i.e. the predominantly working part of the population.

Feelings of shame and finally fear of the diagnosis follow as obstacles. The latter was particularly often the reason why patients with blood in their stool did not go to the doctor: one in five was fearful of seeing the doctor.

The result is all the more worrying given that colon cancer is the second most common cancer in both men and women. If diagnosed early, colon cancer has particularly good chances of recovery - those who do not go to the doctor in time will lose them.

Colon cancer screening is also not used

Lack of time, shame and fear of the diagnosis may also prevent many from making use of the preventive care. A recent UK study shows that half of people over 60 in the UK miss colorectal cancer screening. The risk of illness is particularly high in this age group. The hurdles were even low: the candidates had previously received a test set to check the stool for hidden blood (haemoccult test) along with a return envelope.

Early detection by colonoscopy is particularly reliable

The haemoccult test is also used in Germany and is an early diagnosis of cancer from the age of 50. A colonoscopy is much more reliable, but also considerably more time-consuming. This is offered routinely from the age of 55. If the results are normal, the follow-up examination is not due until ten years later.

The advantage is that intestinal polyps, which could degenerate, are removed immediately, or tissue samples are taken from suspicious structures for examination.

Blood in the stool - manifestations and main causes

Blood in stool can look very different. Quantity, color and consistency allow initial conclusions to be drawn about the causes:

Color, consistency	origin	root cause
Tarry stools (sticky, discolored black, shiny, smelly)	Bleeding in the upper digestive tract (stomach, esophagus, duodenum), blood is colored by stomach acid	Ulcers, diaphragmatic hernia, varicose veins in the esophagus, inflammation of the stomach lining, stomach cancer
light, low levels of blood	minor injuries to the intestinal mucosa	i.a. hard chair
bloody, slimy stool	colon	inflammatory bowel disease
fresh, bright red bleeding, superimposed	Bleeding from the anal area	Hemorrhoids, anal fissures
occult (invisible blood) blood	minor, invisible bleeding in the intestine	Intestinal polyps, injured intestinal lining
bright red blood, mixed	Injuries in the upper areas of the small intestine	Vascular malformations, ulcers, polyps, colon cancer
dark red blood, mixed	major bleeding in the colon	Ulcers, polyps, colon cancer
false alarm: discolored stool	Consumption of large amounts of certain drugs or foods	Charcoal tablets, iron supplements, beetroot, blueberries, red wine