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Colon Cancer Screening

Dr. Shahla Rah, MD, FACG




Colon cancer is the cancer of the large intestine, also called the colon. It is the second leading cancer killer in the USA and third most common cancer, after breast, lung and prostate. It is equally common in males and females. This is a preventable cancer, as colonoscopy can detect polyps that are precancerous growths and removal of these growths prevents the development of cancer and provides early detection when it is curable. It does not always cause symptoms and so it is important to get screened even without any complaints. 

Q: What is the recommended age for colon cancer screening?

A: American Cancer Society recently lowered the screening age to 45. 

Q: Do some people need screening at an earlier than recommended age?

A:Yes, people who have a strong family history of colon cancer, their first screening should be 10 yrs earlier than the age their first degree relative was diagnosed with colon or rectal cancer. Some people who don't have a family history but have symptoms of rectal bleeding, constipation, nausea or abdominal discomfort may need a colonoscopy for the possibility of precancerous polyps or rectal cancer. 

Q: Are certain ethnicities more prone to cancer?

A: Yes African Americans are at increased risk.

Q: Is it true that lifestyle factors play an important role? A: Absolutely, obese people are at incraesed risk. People with poor lifestyles, who smoke and drink heavy and consume a high fat, high red meat and low fiber diet are at increased risk. 

Q: Does it run in families?

A: Yes it runs in families and so it is important that you get a good family history. If someone is your family has multiple polyps you may be at increased risk. Conditions such as FAP- Familial adenomatous polyposis, or Hereditary non polyposis colorectal cancer or Lynch syndrome. 

Q: Are their other conditions besides cancer that may lead to early cancer?

A: Yes patients with long standing history of Colitis or Crohn’s disease may have an increased risk of colon cancer. In these patients cancer may not arise in a polyp but a flat non polypoidal lesion can be precancerous, for that reason these patients need to have regular colonoscopies and multiple samples need to be taken to find these non polypoid lesions. It may be a flat abnormality in the lining of the colon, a careful colonoscopy in experienced hands and with good technology would detect these abnormal areas. 

Q: What are the recommended tests for colon cancer screening?

A: There are several tests that can be performed but the gold standard is Colonoscopy. The other tests aid in the diagnosis and early detection. 

  1. The fecal occult blood test (FOBT) uses the chemical to detect blood in the stool. It is done once a year. For this test, you receive a test kit from your doctor. At home, you use a stick or brush to obtain a small amount of stool. You return the test kit to the lab, where the stool samples are checked for the presence of blood.
  2. The fecal immunochemical test (FIT) uses antibodies to detect blood in the stool. It is also done once a year in the same way as a FOBT. The FIT-DNA test (also referred to as the stool DNA test) combines the FIT with a test that detects altered DNA in the stool. For this test, you collect an entire bowel movement and send it to a lab, where it is checked for cancer cells. It is done once every one or three years.
  3. CT Colonography (Virtual Colonoscopy): is an X-ray where after the colon preparation or cleaning as for colonoscopy, a CT scan is performed, if any abnormality is noted such as a suspicion of a polyp, a colonoscopy is then needed to remove that polyp.

Q: How do I know which test is right for me?

A: It depends on your health condition and resources available. 

Q: What is colonoscopy?

A: Colonoscopy is the procedure of choice, as it helps us remove polyps ( growths) that lead to cancer, also other abnormalities can be detected not otherwise detected on other tests. A flexible lighted tube is advanced through the rectum while you are asleep and advanced all the way to the first portion of the colon on the right side, also called cecum. Air or CO2 gas is put inside the colon through the scope, to open up the lumen so we can get a good look, otherwise it is collapsed. The colonoscope is then slowly withdrawn closely inspecting the lining and checking for polyps behind any folds. If any abnormality is noted the polyps are removed at the same time and sent to a lab for pathology, a microscopic examination of the tissue. 

Q: How often do I need a colonoscopy?

A: As I mentioned earlier the recommended age now is 45. Some organizations still recommend at the age of 50. A colonoscopy can be performed up to the age of 85 and sometimes beyond depending on the individual's health condition. 

If your colonoscopy revealed polyps you will need a follow up colonoscopy depending on the size, number and type of polyps. After the colonoscopy, once the pathology or biopsy results are back then a decision can be made as to when a colonoscopy needs to be repeated. Also, even in the best of experienced hands some polyps can be missed and a colonoscopy may need to be repeated sooner than as recommended if patients have any symptoms of abdominal pain, bleeding, constipation, nausea or bloating. Your insurance does cover a repeat colonoscopy before the recommended abnormality is noted such as a suspicion of a polyp, a colonoscopy is then needed to remove that polyp. If a patient’s colonoscopy preparation is not optimal for a good exam a colonoscopy may be needed sooner. 

Q: Are patients awake during the procedure?

A: Patients are sedated either with intravenous Propofol with the help of an anesthesiologist, or intravenous Fentanyl and Versed given by a nurse. Patients may be arousable with deep stimulation but are not completely out as in general anesthesia. Mostly patients feel they are out though they are sedated. 

Q: I have heard terrible things about the preparation prior to colonoscopy?

A: I understand that remains a big concern for a lot of patients, but a good prep is essential for any type of colon exam, whether it is imaging or colonoscopy. Without a good preparation polyps and abnormalities can be easily missed. My preparation is very well tolerated and it is a split dose, studies have demonstrated that the split dosing is the best way to get the optimal results. I also allow my patients to eat the day before the procedure that helps them not get too weak. I also let them drink clear liquids upt 2 hours prior to the scheduled procedure time, which keeps them well hydrated. 

Q:Are their any complications associated with the procedure?

A: Unfortunately no procedure is risk free, but the risks are less than the risk of you getting hit by a car while crossing the road. So in short if the procedure is done by a well trained gastroenterologist in the field of Gastroenterology, and who has enough experience the risks are way below the norm. The risks may be an adverse reaction to the medications given for sedation, infection, aspiration, if your stomach is not empty, bleeding,tear or perforation. 

Q: How much time do I need to take off?

A: You need to take off only the day of the procedure, your preparation would start at 5 pm the day prior to so you can work a full day prior to the procedure. Also once you go home you are able to perform light work, but it would be recommended that you avoid working on a machinery, drive, or sign legal or important papers as your memory may be slightly impaired that day because of the medications used for sedation. 

Q: Can I take an Uber home?

A: Yes you can take Uber to the surgery center, but on the way back you would need some one with you to care for you for a few hours after the procedure. If you have a transport issue we have a partnership with a surgery center that does provide transport to and from but you need a friend or relative to accompany you home. 

Q: Do you have a personal story of a colon cancer survivor?

A: I have several patients in my experience who have been diagnosed with early colon cancer, their ages vary from 22 to 42. One of my patient who was 40 yrs old, healthy fitness instructor who came to me because of symptoms of constipation and bloating, though she had no weight loss, or rectal bleeding, was very active and had no family history of colon cancer, I recommended colonoscopy for her symptoms, and finding of tenderness and fullness in the abdomen, at first she resisted as she was not 50 but after a few weeks of consideration, agreed to proceed with a colonoscopy exam. She unfortunately had a large tumor that needed a surgical resection, but early enough to be cured of cancer. Ever since, she is grateful to me for my recommendations, and never missed her next colonoscopy. Similarly I had a medical professional in her 30’s who thought she had hemorrhoids but ended up having a large precancerous polyp. A 40 yr old nurse, mom of 2, had early colon cancer. And so the bottom line is not every one is a classic text book case. 

Colonoscopy saves lives, and covered by Insurance! 

Prevention is better than cure! 

March is the colon cancer awareness month, wear a blue ribbon!

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