Colorectal Patient’s Advice: Get the colonoscopy

By Kim Hasty

March 2022

Growing up in Panama in a family of 14 children, Maria Iwanski could always find a game of soccer to join in. Later, in high school, she added track and field to her athletic repertoire.


“I’ve been very active all my life,” she said. “I thought I was taking good care of myself.”


But Iwanski, now 64, admits she overlooked a basic preventive procedure that would have proved vital: A regular colonoscopy, as recommended by the American Cancer Society for anyone starting at age 45.


“Now I call everyone I know and tell them, ‘Please, do it,’” she said. “Just do it. I could have avoided a lot of pain and stress.”


Iwanski was diagnosed in November 2021 with Stage 2 colon cancer. She was fortunate that she didn’t ignore her symptoms and that Cape Fear Valley Health Chief of Surgery Ravinder Annamaneni, MD, was able to devise an effective treatment plan. Dr. Annamaneni has specialized training in laparoscopic and robotic colorectal surgery from Memorial Sloan Kettering Cancer Center in New York, and he completed a fellowship in minimally invasive colorectal surgery as well. He performed surgery on Iwanski in January, and she is scheduled to embark on a course of chemotherapy and radiation therapy this month.


March is National Colorectal Cancer Awareness Month, giving healthcare providers an opportunity to educate the community and promote awareness of the importance of colorectal cancer screening, prevention and treatment. Colorectal cancer is the second leading cause of cancer deaths in America, but polyp-related colorectal cancer can be prevented, Dr. Annamaneni said.


The disease develops from benign polyps. He said these polyps are “mushroom-like growths on the lining of the colon and rectum.”


“Removing these polyps before they become cancerous may prevent cancer from developing,” he said. “Between 80 and 90 percent of colorectal cancer patients are restored to normal health if their cancer is detected and treated in the earliest stages.”


Dr. Annamaneni listed six steps to lowering the risks of colorectal cancer:

  1. Eat plenty of fiber, between 20 to 35 grams of fiber each day, from fruits, vegetables, whole grain bread and cereals, nuts and beans.
  2. Eat a low-fat diet.
  3. Eat foods with folate, such as green vegetables. 
  4. Do not drink excessive alcohol or smoke. If you use alcohol, drink in moderation. If you use tobacco, quit. If you do not use tobacco, do not start.
  5. Exercise for at least 20 minutes, three to four days each week. Moderate exercise, such as walking, gardening or climbing steps may help reduce your risk.
  6. Get regular colorectal cancer screening, such as a colonoscopy, beginning at age 45. Earlier if you have personal or family history. 


A colonoscopy is usually performed as an outpatient procedure under sedation. Preparation for the procedure includes emptying the colon by drinking liquid laxatives, the taste of which has improved in recent years. During the procedure, polyps can be detected and removed at the same time, thus preventing them from becoming cancerous.


While at-home tests are growing in popularity due to patients being able to use them on their own in a convenient setting, Dr. Annamaneni advises that colonoscopies are more accurate tests.


“People should remember that the gold standard for colon cancer screenings is still a colonoscopy,” Dr. Annamaneni said. “At-home tests are close to 90 percent accurate, but there are false positives. And a positive reading will necessitate a colonoscopy to confirm.”


Dr. Annamaneni said a diagnosis of colorectal cancer requires first determining its stage to see whether it is confined to the colon and rectum or advanced, which means it has spread to lymph nodes and other organs. The staging, he said, is done by blood tests, CT scan, MRI and PET scan. 


“Surgery is the best weapon to treat localized colon cancer,” Dr. Annamaneni said. “The cure rates drop to 50 percent or less when diagnosed in the later stages. For advanced cancers, chemotherapy and radiation are necessary treatments as well.”


Approximately 4.4 percent of men and 4.1 percent of women will be diagnosed with colorectal cancer in their lifetime. According to the American Cancer Society, the risk of colorectal cancer goes up as you age. Though younger adults can get colorectal cancer, but it’s much more common after age 50. Colorectal cancer is rising among people who are younger than age 50, and the reason remains unclear. Dr. Annamaneni said this is particularly true among African Americans
“If you have symptoms, like blood in stool, change in bowel habits and weight loss,” he said, “call your doctor for an appointment. Early detection is the key!”