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Colonoscopies and Other Options

April 26, 2016

It’s not uncommon for doctors to hear “Not right now” or “I’ll think about it” when they mention to a patient it’s time to have a colorectal cancer screening.

Patients may be anxious about a colorectal screening due to embarrassment or the perceived pain and discomfort.  They may think they are at low risk because they have had no symptoms.  Yet, colorectal cancer is the second leading cause of cancer deaths after lung cancer.  Screening for it is particularly effective at detecting cancer at an early treatable stage and can even prevent it in some cases.

Several Boone County Hospital (BCH) physicians offer colonoscopies.  They are Dr. Jason Sheffler, Boone County Family Medicine (BCFM), Dr. Joshua Anderson, BCFM, Dr. Eric Peterson, BCFM, Dr. Brian Mehlhaus, UnityPoint, Dr. Jeffrey Maire, BCH General Surgery, and Dr. Jay Seligman, General Surgey, who will be joining the BCH Medical Staff later this summer. 

There is really no excuse for not being screened since some options are simple, easy, inexpensive, non-invasive and cause neither pain nor discomfort.  The U.S. Preventive Services Task Force and other groups offer information on three common screening tests.

Colonoscopy is widely recommended as one of the most effective screening tests.  According to studies, it reduces colorectal cancer deaths by 60 to 70 percent.  The advantage of this test is that abnormalities found during the test can be removed so it’s all done during the same procedure.  A flexible lighted tube, or scope, is inserted into the rectum and threaded through the entire length of the colon.  Air is pumped into the colon to expand it and make viewing easier.  Since the patient is given either general anesthesia or sedation, the whole procedure is less uncomfortable than the description suggests.  Many patients, nevertheless, are apparently squeamish.  Even more disagreeable, to some patients, is the need to clear the bowels in preparation.  You need to quit eating solid foods a day ahead, then take a substance that triggers a powerful bowel-clearing diarrhea.

Fecal Occult Blood Testing FECAL (FOBT) and Fecal Immunochemical Testing (FIT) are two simple options.  Both tests require a kit you use in the privacy of your bathroom and you collect samples from several bowel movements.  It’s very private.  FBOT, the older test, requires some minor changes in your diet, such as avoiding red meat, right before the test; FIT does not.  The purpose of the kit is to see if there are small amounts of blood hidden in the stool, suggesting pre-cancerous polyps or cancerous growths.  If results show hidden blood, a follow-up colonoscopy must be performed for diagnosis and treatment.

Sigmoidoscopy is a similar test, with similar effectiveness, using the scope to examine only the lower or sigmoid part of the colon.  Bowel preparation, while still necessary, is less extensive since only part of the colon is involved.  As a mixed blessing, sigmoidoscopy requires little if any anesthesia.  There is no pain, but there is a sensation of the tube traveling through your bowels. When an abnormality is found, a colonoscopy must be performed to remove it.  

Other options have emerged in the past few years.  The Virtual Colonoscopy involves examining the inner bowels using a CT scan rather than a tube inserted into the bowels.  It does not require sedation and takes only about 10 minutes.  The bowels have to be emptied and prepared just as they are for a colonoscopy.  For some, that is the most disagreeable part.

A Stool DNA Test is currently available and is called Cologuard.  It looks for DNA mutations that characterize colorectal cancer cells.  With the stool DNA test, there is no risk of damage to the colon and no dietary restrictions or bowel preparation.  The stool sampling can be done at home, and the test has been found to be sensitive enough to detect most, though not all, polyps and cancers.  The high sensitivity, however, produces many false positive results, nearly all of which require a colonoscopy.  Like colonoscopy and sigmoidoscopy, the stool DNA test is believed to be effective for preventing as well as detecting cancer since it can detect the DNA mutations that suggest precancerous polyps. Colonoscopy, though, is still the bottom line for treating polyps and cancer when they are detected.

If your doctor recommends you have a colonoscopy or you are at the age where you need one, talk to your physician about the different options and which one is right for you.  For more information about each of the BCH physicians that provide colonoscopies, log on to www.boonehospital.com.

 

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