March is National Colorectal Cancer Awareness Month, a good time to take a look at warning signs and concerns related to the disease, which is increasing in prevalence among younger individuals. The Colorectal Cancer Alliance has some great information I encourage you to check out. One topic I thought was interesting was the idea of sidedness, or the differences in cancer of the right or left side of the colon.
The first place to start is to review colon anatomy. In their information, the Alliance notes that the colon is divided into four sections: ascending, transverse, descending, and sigmoid. As coders who are familiar with the Neoplasm Table, we know there are specific codes for each. Malignant neoplasm of the ascending colon or right colon would be assigned to C18.2. Transverse colon malignant neoplasm would be assigned to C18.4. For malignant neoplasms of the descending colon, or the distal or left colon, we would assign C18.6. Sigmoid colon malignant neoplasms would be assigned to C18.7. These would be code assignments for primary-site cancers. The right side of the colon would include the cecum, the ascending colon, and the hepatic flexure. The left side would include the splenic flexure, the descending and sigmoid colon, and the rectum.
For any of us who have had the pleasure of having a colonoscopy done, your results will identify any area(s) of the colon that have findings. The side of the colon does make a difference. The Alliance notes that research is indicating that there are definite biological differences between cancers of the right and left side of the colon. These may include biomarkers that might be present, how the cancer grows, and most importantly, treatment response.
What are some differences between right-side and left-side colon cancers? Left-side colon cancers occur more in men, and are more likely to be diagnosed at an early stage. We know how important that is in initiating treatment for the best possible outcome. While overall, cancers of the left side of the colon have a better overall prognosis than those of the right side, they occur more often. Left-sided colon cancers are also more associated with those symptomatic findings of constipation or obstruction. Right-side colon cancers occur more often in women and are more likely to be diagnosed at a later stage. Right-sided colon cancers often start in sessile polyps, making it harder to detect in that earlier stage. In right-sided colon cancers, rather than bowel changes or symptoms, early signs may be fatigue or anemia.
The United States Preventative Services Task Force (USPSTF) recommends that screening for colon cancer start at age 45 for those at average risk. They note the increasing rates of colon cancer among younger people. The Colorectal Cancer Alliance says that 10 percent of the colorectal cancers in the U.S. are in people under the age of 50. Furthermore, by 2030, researchers predict that colorectal cancer will be the leading cause of cancer deaths in people ages 20-49.
Do not let the dread of the colonoscopy preparation keep you from scheduling this examination. With easier SUTAB tablet prep for colonoscopies, the Cologuard test, and now even a new Shield blood test for colon cancer, it is important that we take care of our health and the health of the ones we love by not missing these vital screenings.
Colorectal Cancer Awareness Month | Colorectal Cancer Alliance
