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Together, cancers of the colon and rectum are the second leading cause of cancer death in the U.S., with an estimated 56,000 lives claimed by the diseases in 1999, according to the American Cancer Society. It is the fourth most common cancer, behind lung, breast and prostate, and around 139,400 new cases were diagnosed in 1999. If men and women are considered separately, however, colorectal cancer ranks third in both number of new cases and deaths.

But colorectal cancer can be prevented, and lives can be saved, says Dr. Kirk Ludwig, assistant clinical professor of surgery. "Colon cancer has been termed a silent disease because it doesn't cause many symptoms until its later stages," he says. "That underscores the need for people to follow the screening guidelines."

Screening procedures include a test for blood in the stool and an outpatient exam called a flexible sigmoidoscopy, which uses a tiny camera to visually examine the lower third of the colon. A colonoscopy, which looks at the entire colon, may be considered for higher risk patients or if the standard exams indicate a need for further investigation, he says.

The frequency of screening depends on each patient's risk factors. Usually, routine screening begins around age 50, but patients can discuss with their doctors what is right for them. Ludwig also stresses that just because you're under 50 doesn't mean you can ignore your colon.

"Ninety percent of colon cancer cases are in people older than 50, but it's important to catch the disease early," he says. Screening can catch colon changes before they become cancerous and removing polyps - non-cancerous tissue growths in the colon - can help prevent progression to cancer, he says.

It's also important to keep possible symptoms in mind, he says. The most important symptom is blood in the stool. While a screening test looks for less blood than can be seen by the naked eye, visible amounts of blood with bowel movements should cause a person to head to the doctor as soon as possible.

"The worst thing people can do is assume that blood in the stool is due to hemorrhoids," he says. "Blood in the stool should be evaluated by a physician no matter what."

Changes in bowel habits can also indicate a problem, and in late stages of colon cancer, abdominal pain can become a factor, he says.

"Many people avoid colorectal cancer screening because they don't want to have a permanent colostomy," says Ludwig. "The truth is that most patients won't need a permanent colostomy."

A permanent colostomy includes removal of the anal sphincter and with it goes control of the bowels. A bag is attached to the colon to collect the body's waste as a result of this procedure.

At Duke, almost all patients are eligible for what is called sphincter-preserving surgery. Instead of removing the affected colon and entire rectum including the anal sphincter, doctors here specialize in preserving a functional sphincter and connecting the colon to it after cancerous segments are removed. As a result, the patients are returned to normal health and have bowel movements the same way they always have.