Colon cancer screening… Why is it important! Dr. Stefan Mitev in front of FACT

Colon cancer is one of the most common oncological diseases worldwide. Every year, millions of people are diagnosed with colon cancer. Often, those suffering from this serious oncological disease are diagnosed in the late stages, due to the lack of symptoms at the beginning of the disease. Why is it good to visit a gastroenterologist… Dr. Stefan Mitev from the University Hospital “St. Ivan Rilski“ speaks in front of FACT.

- Dr. Mitev, let's start like this. Why is it important for a person to have regular check-ups with a gastroenterologist?
- It is important for a person to visit a gastroenterologist on time. This includes two main situations. The first is when “alarming” symptoms appear. These may indicate a serious underlying disease. They include blood in the stool, vomiting blood, difficulty swallowing, pain when swallowing, unexplained loss of appetite with weight loss, as well as iron deficiency anemia on laboratory tests. The second important reason for visiting a gastroenterologist is colon cancer screening. Screening is a preventive measure. It is applied to people who have no complaints. Screening has been proven to save lives and save the system money. Screening prevents the development of colon cancer and does not lead to surgery and expensive subsequent chemotherapy.

- After what age should a person pay more attention to their gastrointestinal tract? When do more symptoms of problems begin to appear?
- Now the recommended age to start colon cancer screening is 45 years. Screening can be done by fecal occult blood test or colonoscopy. Almost everyone over the age of 45 should be screened for colon cancer, even if they have no abdominal symptoms. Gastrointestinal symptoms can occur at any age. For example, inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and irritable bowel syndrome usually occur in young people. Abdominal complaints are common and their cause should be clarified after an examination by a gastroenterologist.

- Is there a hereditary factor when it comes to problems with the gastrointestinal tract?
- Yes, family history is an important factor in digestive system diseases. Screening for colon cancer starts earlier in people with a family history. If you have a parent, sibling or friend with colon cancer, you should start screening at age 40 or 10 years before the age of diagnosis in your first-degree relative, whichever comes first.

- Colon cancer is known as the “silent killer“. Why is it that the problem is most often discovered quite late?
- Colon cancer is a silent killer because it has no early symptoms. It is entirely possible for patients to have metastases and not have any symptoms. Unfortunately, the first symptoms usually indicate advanced disease. Cancer develops slowly, most often based on pre-existing polyps, which also progress asymptomatically. Therefore, it is important to conduct screening on time, regardless of the absence of complaints.

- Explain what polyps in the colon are and how to deal with them?
- Polyps are small formations that form in the colon, with a variety of structures, shapes and sizes. A large number of them have malignant potential, i.e. they can progress asymptomatically to cancer. The process of transformation from a polyp to cancer usually takes many years, which allows for effective screening.

- When a polyp is seen, is it mandatory to remove it. Is there a standard regarding the size of the polyp, according to which it is determined whether to remove it or not?
- When a polyp is detected during a colonoscopy, it must first be characterized according to standardized criteria. The process is called “optical diagnosis”. The underlying structure of the polyp is judged by its external characteristics. The examination report should describe the location, size, shape and surface characteristics of the polyp. It is recommended to take a picture before removing the polyp. The majority of polyps are up to 1 cm in size. They can be removed easily, quickly and painlessly using the so-called “cold” technique. Larger polyps require more complex methods for their removal. This cannot always be done during the first colonoscopy. Sometimes removal is necessary at a later stage after a detailed discussion of the benefits, risks and possible complications of the respective manipulation.

- Can a polyp be missed. How important is it that the doctor we trust does his job responsibly?
- Unfortunately, polyps are missed more often than we imagine. According to world scientific data, adenomas (a type of potentially dangerous polyps) are missed in 22% of cases. Or every fifth adenoma is missed. Thus, the polyp can continue to develop and over time transform into interval cancer. In order to reduce the risk of such unwanted development, the criteria for high-quality colonoscopy must be strictly observed. These include optimal cleansing of the colon, reaching its end, examination time of at least 7 minutes and sufficiently frequent detection of adenomas. The quality of colonoscopy can vary widely. It matters a lot which doctor performs the procedure.
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Dr. Stefan Mitev graduated from the Medical University – Sofia.
Won competition for specialization in Gastroenterology in Sofia.
Won competition for assistant in Gastroenterology.
Member of the Bulgarian Society of Gastroenterology.
Member of ECCO (European Crohn's and Colitis Organization).
Medical interests: functional gastrointestinal diseases, hepatology