Colon Screening for Life

Screenings

We all know the excuses for why not to have a colonoscopy, “I hear it hurts”, “the prep is bad”, “I don’t want to miss work” or “I’m afraid of what they may find”. But deep down we all know there isn’t a good excuse. The fact is: colonoscopies save lives.

Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease. Regular screening can often find colorectal cancer early, when it is most likely to be curable. In many people, screening can also prevent colorectal cancer by finding and removing polyps before they have the chance to turn into cancer.

Routine colonoscopies are a must in the prevention of colorectal cancer. The simple test, can save your life! The American Society for Gastrointestinal Endoscopy (ASGE) screening guidelines recommend that, beginning at age 50, both men and women at average risk for developing colorectal cancer should begin screening. People with known risk factors or a family history should begin screening at an earlier age.

Though there are a number of screening methods, the colonoscopy is the gold standard of screening. It is the only screening test in which we can both find and remove precancerous polyps at the same time. With the other tests, if a polyp is found, the test must then be followed by a colonoscopy anyway to remove the polyp, so the patient may have to undergo two procedures instead of one.

The vast majority of patients find a colonoscopy much easier than they expected.

Are you at risk for colon cancer?

Hint: The answer is yes.

Unfortunately most individuals are at risk for developing this deadly disease. However, the good news is that colon cancer is preventable and treatable through colon cancer screening.

Did You Know?

Colon Cancer…

  • Colorectal cancer is the third most common cancer diagnosed in men and women in the United States, excluding skin cancers.  It is the third-leading cause of cancer-related deaths in the United States in both men & women and is expected to cause about 50,310 deaths (26,270 men and 24,040 women) during 2014.  The good news is that this number has decreased.  In 2005, approximately 56,000 people died from colorectal cancer.
  • The death rate from colorectal cancer has been dropping for the past 15 years.  One reason for this is probably because polyps are being found by screening before they can develop into cancers.  Also, colon cancer is being found earlier when it is easier to cure, and treatments have improved.  There are approximately one million survivors of colorectal cancer in the United States, and this number continues to grow.
  • Ninety percent of people whose colorectal cancer is found at an early stage are alive five years after the diagnosis.  However, once the colorectal cancer has spread to nearby organs or lymph nodes, the likelihood of remaining alive five years after the diagnosis is much lower.  Only 39 percent of colorectal cancers are found at that early stage.

What African-Americans Should Know About CRC:

Although all men and women are at risk for CRC, some people are at higher risk for the disease because of age, lifestyle or personal and family medical history. According to studies, African-Americans are at a higher risk for the disease than other populations. Starting at age 50, everyone should begin routine screening tests. Research shows that African-Americans are being diagnosed at a younger average age than other people. Therefore, some experts suggest that African-Americans should begin their screening at age 45.

  • The incidence of CRC is higher among African-Americans than any other population group in the United States.
  • Death rates from CRC are higher among African-Americans than any other population group in the United States.
  • There is evidence that African-Americans are less likely than Caucasians to get screening tests for CRC.
  • African-Americans are less likely than Caucasians to have colorectal polyps detected at a time when they can easily be removed.
  • African-Americans are more likely to be diagnosed with CRC in advanced stages when there are fewer treatment options available. They are less likely to live five or more years after being diagnosed with CRC than other populations.
  • There may be genetic factors that contribute to the higher incidence of CRC among some African-Americans.
  • African-American women have the same chance of getting CRC as men, and are more likely to die of CRC than are women of any other ethnic or racial group.
  • African-American patients are more likely to have polyps deeper in the colon (on the right side of the colon).

What Hispanics Should Know About CRC:

  • Hispanic Americans are less likely to get screened for the disease than either Caucasians or African-Americans. Starting at age 50, everyone should begin routine screening tests.

Symptoms

Colorectal polyps and colorectal cancer don’t always cause symptoms, especially at first. Someone could have polyps or colorectal cancer and not know it. That is why getting screened regularly for colorectal cancer is so important.

If you have symptoms, they may include:

  • a change in bowel habits
  • diarrhea or constipation
  • narrower than normal stools
  • unexplained weight loss
  • constant tiredness
  • blood in the stool
  • feeling that the bowel does not empty completely
  • abdominal discomfort: gas, bloating, fullness, cramps
  • unexplained anemia
  • vomiting

If you have any of these symptoms talk to your doctor. They may be caused by something other than cancer. The only way to know what is causing them is to see your doctor.

Consider Your Risks

While colorectal cancer screening is recommended for most adults beginning at age 50, certain risk factors may indicate a need for early screening. Talk to your doctor about the best screening plan for you.

Average Risk Individuals

You have an average risk of developing colon cancer if the following are true:

  • No one in your family has had colon cancer, colon polyps, ovarian or uterine cancer
  • You are age 50 or over (age 45 if African American)
  • You do not have a history of colon polyps, ovarian/endometrial cancer, ulcerative colitis or Crohn’s disease.

Recommendations:

  • Complete colon evaluation every 10 years starting at age 50 (age 45 if African American)

High Risk Individuals

You have a higher risk of developing colon cancer if ANY of the following are true:

  • Someone in your family has had colon cancer, uterine cancer, ovarian cancer or colon polyps
  • You have a previous history of colon cancer or polyps
  • You have a history of ulcerative colitis or Crohn’s disease
    • You have inflammatory bowel disease or genetic syndromes like familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (also known as Lynch syndrome)

Recommendations:

  • Start colon evaluation at age 40 or 10 years before the age of the affected family member’s diagnosis, whichever is earlier.

Screening Options

Complete Colon Evaluation – Colonoscopy: Gold Standard

Using a slender, flexible, lighted instrument called a colonoscope, a doctor (a gastroenterologist) looks at the inside walls of the full length of the colon. If abnormalities are found, they can be removed or biopsied during the same procedure.

Recent advances in technology and medications have made this procedure easy and comfortable for patients.

The preparation for the procedure has changed. Patients are no longer required to drink a gallon of liquid medication (Golytely) before colonoscopy. Patients with congestive heart failure or kidney disease may still need this preparation.

The majority of patients can either drink a Gatorade based preparation that is very easy to take with no medication taste and is only half a gallon or take a pill preparation that consists of 28 pills. Other options including fleet phospho-soda preparation are also available.

Sedation is given to patients during the procedure. We have Certified Nurse Anesthetists that administer Propofol in order to bring patients to deep sedation. Patients go to sleep and wake up after the procedure is completed with very little lingering effect from the medicine. Generally, patients have no pain or minimal pain. Deep sedation allows for a more thorough exam and polyp detection rates have been found to be up to 40% better than traditional moderate sedation registration.

The scopes have undergone a major change in the past few years. The colonoscopes now are thinner and more flexible with wide angle views. This makes the procedure easier and more effective.

FOBT – Fecal Occult Blood Testing

Tests stool for the presence of blood which can indicate the presence of polyps or cancer. If this test is positive, a colonoscopy is required.

Virtual Colonoscopy

A procedure used to look for signs of precancerous growths, called polyps; cancer; and other diseases of the large intestine. Images of the large intestine are taken using computerized tomography (CT) or, less often, magnetic resonance imaging (MRI). A computer puts the images together to create an animated, three-dimensional view of the inside of the large intestine.

Genetic Stool Testing

Research is underway to improve the sensitivity of DNA stool tests by looking at additional markers and reducing DNA degradation during transportation and handling time.

Glossary

Colon: The part of the large intestine that extends from the end of the small intestine to the rectum.

Colonoscope: Flexible, elongated tube that can be inserted through the anus allowing the inside of the colon to be seen.

Colonoscopy: Visual examination of the inner surface of the colon by means of a colonoscope.

Polyp: Mass of tissue that bulges or projects outward or upward from the surface of the colon.

Polypectomy: Endoscopic removal of a polyp.

Screening: The search for disease, such as cancer, in people without symptoms.

Content Source: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention; American Cancer Society; American College of Gastroenterology