What is colon cancer?

Colorectal cancer (also referred to as colon cancer) is cancer that develops in the colon (large intestine) or the rectum.  Before cancer develops, it usually begins as a non-cancerous growth often referred to as a polyp. A polyp is an abnormal growth of tissue lining the colon or rectum.  Over time, polyps have a risk of turning into cancer.

Why should I be checked?

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer related death among males and females in the U.S. and is the second leading cause of cancer related deaths when both sexes are combined. Both men and women have a lifetime risk of approximately 1 in 20 of developing colon cancer. It is estimated that approximately 1 in 20 Americans will develop colon cancer.

• The death rate from colorectal cancer has been dropping for the past 15 years. Early detection of polyp is one of the main reasons for the decreased death rate. Also, colon cancer is being found earlier when it is easier to cure, and treatments have improved. Only 39% of colorectal cancers are found at an early stage. There are approximately one million survivors of colorectal cancer in the United States, and this number continues to grow.
• 90% of those diagnosed in the early stages are still alive five years following their diagnosis. However, once colorectal cancer has spread to nearby organs or lymph nodes, the likelihood of remaining alive five years after diagnosis significantly decreases.

With regular screening, colorectal cancer can be detected early making treatment most effective. In many cases, screening can prevent colorectal cancer by finding and removing pre-cancerous polyps before they become cancer.

When should I be screened for colon cancer?

There are no strict guidelines on when colon cancer screening should begin.  However, all average-risk individuals should be screened no later than age 50. The American Cancer Society recommends commencing screening for average-risk individuals at age 45.

Those with a family history of colorectal cancer should start the screening by age 40 or ten years before the index case (if the father has cancer at age 46, screening should begin at 36 for all children).  Some guidelines recommend African-Americans should be screened by age 45 as colon cancer tends to strike this sector of the population at an earlier age.

What symptoms does colon cancer cause?

Your doctor will likely order a colonoscopy or other screening tests for colon cancer if you are 50 or older, even if you have no symptoms because pre-cancerous polyps and even early colon cancer often cause no symptoms.

However, if symptoms are present, they may include:

• Diarrhea or constipation
• Nausea or vomiting
• Feeling that your bowel does not empty completely
• Finding blood (either bright red or very dark) in your stool
• Finding your stools are narrower than usual
• Frequently having gas pains, cramps, or feeling bloated
• Losing weight with no known reason
• Feeling very tired all the time

These symptoms can also be associated with many other health conditions. If you have any of these symptoms, discuss them with your doctor. Only your doctor can determine why you’re having these symptoms. Usually, cancer does not cause pain in its early stages; however, you should not wait until you begin to feel pain to see your doctor.

Are there any screenings available?

There are a number of ways to examine the colon and each method has its advantages and disadvantages. In the past, X-rays were combined with a special dye inserted through the anus (Barium Enema) as the standard test to look for abnormalities inside the colon. This method is still sometimes used, usually when a complete colonoscopy is not possible but has largely been replaced by direct examination of the colon via colonoscopy. A colonoscopy is the only screening method that provides a precise diagnosis by taking a biopsy and reducing the risk of colon cancer by removing polyps. Other tests such as virtual colonoscopy, or CT colonography, a type of CT-scan, are being evaluated for select situations. This test has been shown to miss smaller sized polyps than standard colonoscopy, and experts have not come to a conclusion on its use for routine screening. Also, abnormal results often still require further clarification using a standard colonoscopy. In short, colonoscopies are the gold standard for colorectal cancer screening and the preferred method because of its ability to detect potential colorectal cancer early.

What should I expect with a colonoscopy?

Colonoscopy is an outpatient procedure performed under sedation in which a tube with a light and camera used to examine the lining of the colon. In preparation, your doctor will ask you to undergo a process allowing them to clearly and accurately examine the colon. The goal of a colonoscopy is to evaluate the colon for signs of cancer or pre-cancerous growths (polyps). If pre-cancerous growths are detected or suspected during the procedure, your doctor will remove them at that time, and have them sent for testing.

What preparation is required?

Your doctor will tell you what sort of diet and cleansing routine to follow before the test. In general, the “prep” involves drinking a special cleansing solution, like Miralax along with plenty of clear fluids, such as water and lemon-lime Gatorade and taking special laxatives by mouth. Be sure to tell your doctor about conditions such as diabetes, heart and/or kidney disease,  or if you are taking any blood-thinning medications. You should plan your prep diet ahead of time and check with your doctor if you have any questions.

Is a colonoscopy painful?

A colonoscopy is a very comfortable exam because it is usually done with intravenous sedation. This means that you will be in a very sleepy state during the procedure. Most patients are not even aware that the procedure happened when they wake up.

How long does a colonoscopy take?

On average, the procedure takes about 20 to 30 minutes to perform. However, you will likely need to be at the facility for 2 to 3 hours to allow for pre-procedure and recovery time.

What happens after a colonoscopy?

Your physician will explain the results of the examination, but you will probably have to wait for the results of any biopsies. If you received sedation during the exam, you will need to have a friend or relative take you home. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. Because your doctor used air to inflate the colon when looking at the lining of the colon, you might experience some cramping or bloating. This feeling should disappear once you start passing gas. Although you should be able to eat shortly after the examination, your doctor might restrict your diet and activities if a procedure, such as removing a polyp, was performed.

What are the possible complications or risks of a colonoscopy?

Colonoscopy and the special techniques mentioned above are very safe when performed by specially trained doctors with experience performing these types of procedures. As with any medical procedure, unintended events might happen and you need to be aware of the potential consequences.

There is a small risk of having a reaction to any of the drugs given during the exam. In most cases, medications are available to counteract these side effects. A rare complication is the tearing or perforation of the lining of the intestine. Should this occur, surgery may be needed to seal the injury. Another risk is bleeding, usually at the site of a biopsy or polyp removal. Most cases of bleeding stop without treatment or can be controlled at the time of the procedure.

Will my insurance cover the procedure costs?

Yes, Medicare and most private insurances cover screening colonoscopies as a health benefit. However, if you have any doubts about coverage, please check with your insurance company before scheduling the procedure.

Please take this opportunity to explore your options for colorectal cancer screening. It could save your life.

For more information visit screen4coloncancer.org or contact your health care provider today.