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Gastroenterology
Screening Colonoscopy



Screening Colonoscopy
What is a screening exam?

Medical screening exams are commonly performed on healthy individuals to search for potential problems before they become serious. It is like having your car inspected before your brakes fail. A common example is the Pap Smear which is now a well accepted screening tool. If a Pap smear shows pre-cancerous cells, they can be destroyed and cancer is prevented. This simple procedure has reduced a woman's risk of cervical cancer to 1/50th of the previous levels. The basic premise of screening is that it is much more rewarding to prevent a cancer than find one, even in early curable stages.

The same principle holds true for colon cancer. Most people don't realize that colon cancer has become the second leading cause of cancer deaths in this country, second only to lung cancer. In fact, in non-smokers, colon cancer is the number one cancer killer - over 56,000 Americans will die this year alone. That's the bad news. The good news is that colon cancer is also one of the most preventable. This is because the majority of colon cancers begin as a small non-cancerous growth called a polyp. Over time, polyps grow silently and eventually can turn to cancer. This transformation may take as long as ten years during which time you feel perfectly fine, oblivious to what danger awaits you.

How can I tell if I have polyps?

Small Polyp on Stem

You can't. That is the very problem. There are no symptoms of colon polyps and really no early warning symptoms of colon cancer. By the time a colon polyp turns into colon cancer and that cancer causes rectal bleeding or change in bowel habit, it has often already spread to the liver and other organs. This is why over 60% of cases are incurable at the time of diagnosis.

Who Is At Risk?

You are. We all are. While there are certain risk factors, such as family history of colon cancer, that may increase your personal risk, the truth is that over 75% of cases have no unusual risk factors to warn them. In fact, about 1 in 20 adult Americans now develop cancer of the colon in their lifetime. As an example, if you went to a Penguin's hockey game and saw about 16,000 other cheering fans there, realize that about 800 of them would have colon cancer in their future. It is very common. Despite a popular misconception, colon cancer is also an equal opportunity disease - men and women are equally affected. Most cases occurs after the age of 50 and the risk increases with age.

What Are The Warning Symptoms?

The most common symptom of colon cancer is no symptom at all. That is the problem. You could have a polyp, or even an early cancer, growing in your colon right now as you read this and feel perfectly fine. There are no symptoms such as pain, bleeding, or change in bowel habits to warn you - until it is too late. By the time that a colon cancer is large enough to change your bowel habits, it may already be too late. Left undetected, colon cancer eventually penetrates through the outer colon wall and spreads to other organs, most often lymph nodes and the liver. Then you have symptoms and real trouble. That is why, despite the development of modern surgical techniques and new medical treatments, the death rate of colon cancer has not improved in decades - less than half are cured. The key concept is - Don't wait for warning symptoms.

Where's The Good News?

It has been well demonstrated that if colon cancer is caught in the earliest stages, the cure rate could be increased to 90%. Even better, it has been repeatedly shown that by detecting and removing colon polyps before they develop into cancer, colon cancer can be prevented. Most polyps can now be painlessly removed during a simple 20 minute outpatient "scope" procedure called colonoscopy. To decrease your risk of colon cancer, you need to have any colon polyps found and removed before they become cancerous. Early detection and destruction of any colon polyps must be your goal.

Screening Exams

The problem is how do you know if you have a polyp? Good question! You don't. Since colon polyps, and even early colon cancer, are usually silent, you cannot rely on symptoms. To reduce your personal risk, you must undergo an active program of periodic colon checkups, before you have symptoms - just as you would for routine mammograms and prostate exams. You must go see your doctor when you feel well. Here are three different situations that might arise:

    1. If You Have Symptoms - Screening programs for colon polyps and cancer are designed for patients who have no symptoms. If you have symptoms such as rectal bleeding, altered bowel habit, or have been found to have unexplained iron deficiency anemia or a positive test for hidden blood in your stool (Hemoccult), you need to see your doctor for a full investigation, not a screening exam.

    2. Average Risk Individuals - No Symptoms Most people fit into this category. For those with no symptoms or high risk factors, screening exams should begin at age 50. They should include a 3-day Hemoccult card test for hidden blood in the stool every year and a flexible sigmoidoscopy, "short scope test," every 5 years. If hidden blood or polyps are found, then a colonoscopy, or "full scope" exam should be done.

    3. High Risk Individual - While we are all at risk, some of us have a higher risk than others because of certain factors in our medical history. Those who fall into a high risk category should also be screened, but at an earlier age such as 40. The appropriate test should be chosen by your physician depending on the circumstances. Most often, a colonoscopy "full scope" exam is done.

High risk factors include:
  • Personal past history of colon polyps
  • Personal past history of colon cancer
  • Ulcerative or Crohn's colitis
  • Personal history of breast or uterine cancer
  • Family history of colon cancer
  • Family history of precancerous polyps
If you fall into one of these high risk categories, it is even more important the you begin a regular screening program.

Other Ways To Reduce Risk

Hemoccult card stool tests and screening "scope" exams are the cornerstone of colon cancer prevention. In addition, you may be able to further reduce your risk by eating a diet that contains more fruits, vegetables, whole grains and less fat. Trim the fat from your diet. Eat more fish and chicken and less beef, pork, and lamb. Supplementing your daily diet with 400 mcg. folic acid and 1000 mg. of calcium may also be helpful.

Fiber and Colon Cancer

One area of prevention that was recently disputed it the benefit of a high fiber diet and the prevention of colon cancer. Many prior studies have demonstrated the protective effect of a high fiber diet in prevention of colon cancer. However, a large 16 year national study of 88,757 women found that a high fiber diet was not protective against colon cancer. This does not mean that a high fiber diet is not beneficial in many other ways. But, it apprears that the best way to help avoid colon cancer is periodic screening exams of the colon.

Just Do It

Colon cancer is one of the most curable and preventable forms of cancer. When detected early, more than 90% of patients can be cured. Sadly, recent studies show that only about 12% of adults ever bother to have a colon examination. As an individual, you can dramatically reduce your risk of getting colon cancer by having regular examinations before symptoms develop. Following the simple guidelines can keep you healthy to enjoy the good life you have worked so hard to create. Take charge of your health.

Just do it....

Click here for more examples of colon polyps and cancer.


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved





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