COLONOSCOPY

WHAT YOU NEED TO KNOW ABOUT COLONOSCOPY

Colonoscopy has been proven to prevent cancer. So why haven't you been screened?
Over a lifetime, about 1 in 20 of us will get colon cancer. This year in the U.S., about 150,000 women and men will be diagnosed with colon cancer. And although when found early it is curable over 80 percent of the time, about 55,000 will die of this disease. The reason--people are not getting screened for the disease. Screening colonoscopy is used to detect pre-cancerous colon polyps before it causes symptoms and while it is hightly curable. It takes approximately five to ten years for one of these polyps to become cancerous. By screening people every five to ten years, we can prevent most cancer formation. In fact, having just one colonoscopy decreases your lifetime risk of dying from colorectal cancer by 68 percent.

There are many misconceptions about colonoscopy, so here are some answers to questions patients frequently ask.

What is a colonoscopy?
During colonoscopy the large bowel (large intestine, or colon) is examined using a camera on the end of a long, thin, soft, flexible instrument called a colonoscope (a particular type of endoscope). An IV is started and medication given to prevent pain and relax you so that usually you recall almost nothing of the examination. This is called "conscious sedation." The scope is placed in the rectum and advanced while the doctor is actually viewing the lining of the colon. Cancer can occur anywhere from the end of the colon (the rectum) to the beginning of the colon (the cecum). By using the colonoscope, we can see this entire area. Polyps and even small tumors can be removed painlessly at the time of a colonoscopy so it can be a "therapeutic," and not just a "diagnostic" test.

What is the difference between sigmoidoscopy and colonoscopy?
Colonoscopy enables us to see the entire colon. Sigmoidoscopy is done with a shorter endoscope and only reaches the bottom part of the colon. Sigmoidoscopy will detect only 30 to 40 percent of polyps in the colon. If you have a problem in the other end of the colon, we will not see it. And if polyps or tumors are found during sigmoidoscopy, they cannot be removed.

SIGMOIDOSCOPY VS. COLONOSCOPY

Sigmoidoscopy only examines the bottom part of the large bowel. Colonoscopy allows examination of the whole colon.

Do I have to drink a gallon of clean-out solution beforehand?
Over the last several years the recommendations for the colonoscopy prep have changed. For example, we do not need the patient to drink a whole gallon of clean-out solution. Now we have something called a Fleets Phospho-Soda prep, which involves drinking one and a half ounces of Fleets Phospho-Soda Oral Solution (not the enema type!) twice along with a lot of clear liquids, the day before the test to clean out the colon. Fleets Phospho-Soda is a solution to drink -- please do not confuse this with the enema type of product. There is a new preparation called Visicol, which are tablets (you need to take a total of 40) that are taken with several glasses of water. You and your doctor can decide which preparation you need or prefer.

What can be done during a colonoscopy?
During the colonoscopy a biopsy can be obtained of any area that looks abnormal. In addition, if there are any polyps or growths, these can be removed either with a biopsy forceps that uses a small amount of cautery (an electrical current that stops bleeding), or with a "snare" which is a metal loop that has cautery in it to cut off the polyp. Photographs can also be taken of both normal and abnormal areas.

Are there any risks?
About one out of 20 times after a polyp is removed (polypectomy), there can be bleeding. Therefore, patients should not take aspirin, or other non-steroidal anti-inflammatory drugs like ibuprofen, for about five days prior to the procedure. Infrequently, something called a perforation can occur, which means that a small hole is created in the colon. This can be treated medically by admitting the patient and administering IV antibiotics, or surgically by repairing the perforated area through a small incision in the abdomen. This happens very, very, rarely.

What if I have cancer?
If the colonoscopy reveals cancer, a consultation with a surgeon will be obtained. Sometimes a colon tumor can be removed very easily through a small incision. You may also be sent for a CT scan of the abdomen and blood tests may be needed, so that the proper surgery can be performed. The earlier we find a cancer, the higher the cure rate. In some cases, chemotherapy might not even be necessary.

Warning signs of colon cancer include: blood in the stool, darkening of the stool, a change in bowel habits, anemia, abdominal pain with either constipation or diarrhea, or any abdominal symptoms that begin after age 40. If you have any of these or other unusual symptoms, talk to your doctor.

When should I begin screening?
For patients with no gastrointestinal problems and no risk factors for colon cancer, the American Cancer Society recommends a first screening colonoscopy at age 50. Ninety percent of people who get colon cancer are age 50 years and older. However, if you have seen blood in your stool, you should see your doctor right away. If you have any risk factors for colon cancer, such as a personal or family history of colon polyps, your doctor may want to order the colonoscopy long before you turn 50. If you have a first-degree family member, such as a sibling or a parent, with colon cancer, you should begin screening at ten years before the age your relative was when diagnosed, or at age 40, whichever is earlier.

If you have not had a colonoscopy, every year beginning at age 50 you should have three stool specimens tested for blood (called fecal occult blood testing). If blood is ever detected in the stool, you should definitely have a colonoscopy to see where the blood is coming from.

Although not as effective in detecting polyps or cancer, alternatives to colonoscopy are a flexible sigmoidoscopy or a barium enema (an x-ray with contrast material that is injected through the rectum into the colon). The flexible sigmoidoscopy should be repeated every five years.

Who pays for colonoscopy?
As of 2001, Medicare pays for a screening colonoscopy in patients 50 years and older. In North Carolina insurance plans are required to cover colon cancer screening; check with your insurer.

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