Hearing that you need a colonoscopy can be scary and preparing for it may seem like a tough task. But remember that Colon Cancer is one of the few cancers we can prevent successfully with a colonoscopy. Don’t wait for symptoms or problems, colorectal cancer screening is about the power of prevention.

What is colorectal cancer?

Colorectal cancer is the second leading cause of death from cancer in the United States, after breast cancer in women and prostate cancer in men.. The risk of the average person between the ages of 50 to 80 developing colon cancer is about six percent or almost 1 in 20. Family history of colorectal cancer, and certain other cancers (ovarian, uterine, breast and other GI cancers), inflamatory bowel disease (Ulcerative and Crohn’s Colitis), Obesity, and smoking, significantly increase this risk. Colorectal cancer arises when cancer cells form in the lining of the colon or rectum. The colon and rectum make up the large intestine, which is the last part of the body’s digestive system. Food enters the stomach by way of the esophagus, passes through 20 feet of small bowel, where most absorption of nutrients occur, and the remainder traverses the large bowel where excess water is absorbed, ultimately becoming stool which exits the rectum. Colon cancer can occur anywhere in the large bowel or rectum and usually begin as a small growth called a polyp. At first, a polyp is small and harmless, and causes no symptoms. Over times polyps gets bigger, which can lead to bleeiding, or blockage of the colon. By the time these symptoms occur, the polyp most likely has developed into a cancer that continues to grow and spread to other organs (metastasize.)

“One of the big myths is that if you feel well, you are well.” That’s not true with colon cancer. Precancerous polyps are found in 25 percent of average patients screened.

What is colorectal cancer screening?

Colorectal cancer screening looks for polyps and cancer in the colon and rectum in their early stages, before they cause any symptoms. Detecting cancers earlier reduces the liklihood of spread, overall survival rates increase, and the need for chemotherapy decreases. It usually takes about 5 to 10 years for a small polyp to develop into a colon cancer. This gives us a great window of opportunity to screen, as well as the abiliy to prevent new polyps from forming. Screening is most commonly accomplished with the help of an instrument called a colonoscope, which allows us to find polyps and remove them before they have a chance to develop into cancer. By detecting polyps in their early stages, they are usually smaller, and their removal becomes easier and safer.

Other modes of detection include barium enema and virtual colonoscopy. These are x-ray methods of detection that involve inserting contrast media such as barium through a tube placed into the rectum similar to an enema. These tests are done without sedation, have a lower polyp detection rate than colonoscopy, and expose the patient to radiation. In addition, if a polyp is detected, a colonoscopy will be required for removal, subjecting the patient to a second test.

What is a Colonoscopy?

Colonoscopy is the vehicle by which colorectal cancer screening is performed. The colonoscope is a soft flexible tube; about the thickness of an index finger, with a light and video lens on the tip. Images are viewed on a high definition television monitor. After the patient is sedated, the colonoscope is inserted into the rectum and passed to the very beginning of the large intestine, where the small intestine ends. Air is used to inflate the colon which in its natural state is like a deflated balloon. Inflation is important in order to get a good view of all the walls of the colon and rectum, so as not to miss any polyps hiding in the deflated creases. Instruments can be passed through the colonoscope for removing polyps and sampling tissue (biopsy). Any polyp or tissue removed is then sent to a pathologist for review under a microscope.

What happens before and after the colonoscopy?

In order to achieve the best chance of finding small polyps, the stool needs to be cleared from the colon. This process is referred to as the “colon prep” (preparation). The colon prep generally begins 2 days prior to the procedure with a low residue diet (avoiding fibrous food, nut, seeds, vegetables and fruits), and ends the night before with gentle laxatives. This process is important because if there’s stool in the way, the camera will not be able to get a good look at the walls of the colon and rectum, resulting in missed polyps or cancers, and usually necessitating a repeat procedure.
Sedation with intravenous medications will be administered by an anesthesiologist before and during the colonoscopy. These medications will make you sleep, resulting in no memory, or feelings of discomfort. Patients generally wake up in the recovery room with no recollection of the procedure. The most common question patients have after the procedure is “when are we going to start?” Arrangements must be made for someone to drive you home because the sedative used by the anesthesiologist impairs driving ability.

When should I have a colonoscopy?

The American Cancer Society recommends colon cancer screening to begin at the age of 50. Recent literature documents that African- Americans develop larger polyps earlier and therefore should start screening at the age of 45. If there’s a family history of colon cancer, multiple colon polyps, or related cancers like ovarian or uterine cancer, screening should start at age 40 or 10 years younger than the earliest family member who had that cancer. Obesity and smoking can also increase the risk of colon cancer and polyps.

Conclusion

In conclusion, colorectal cancer is the second leading cause of death from cancer in the United States. Early diagnosis of colon cancer, and removing polyps before they have a chance to turn into a cancer, has been shown to save lives and as a result save the healthcare system money. Colonoscopy is the gold standard in polyp and colon cancer detection, and the only detection mode that allows removal of the polyp at the time of the test. Colonoscopy is safe when performed by a skilled colonoscopist, as well as painless thanks to advances in outpatient sedation. Please make sure you talk to your family and friends about having a colonoscopy. Don’t take no for an answer, as there is no excuse for missing a potential colon cancer.