Screen Gems – You’re Turning 50; That Means It’s Time for a Colonoscopy

Q. Several of my friends are turning 50 and have all scheduled their first colonoscopy together. But I’m just too scared to join them. They tell me the worst part is the preparation the night before. Can you help me to get over my fears of the test?

A. Sure. First, I am so glad you are considering having this screening test done. Colorectal cancer affects 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of our population and is the second-leading reason for cancer-related death in our country. Colonoscopy has been shown to stop polyps from becoming cancers and to detect cancers earlier than they might have been detected. This all translates to a longer, healthier life.

The procedure itself is easier than the bowel preparation because you are in a light sleep. I won’t lie — the bowel preparation is not pleasant and involves passing a lot of bowel movements to get the lining clean so that the doctor who does your colonoscopy can inspect it. You can get through it without too much trouble if you have a positive attitude and a sense of humor.

It is very important to drink a lot of fluid during your bowel preparation to stay hydrated. Take it slow, follow the instructions for the prep carefully, and call the doctor’s office if you are worried or concerned about anything.

Remember, the bowel preparation only lasts for about half a day — you can get through it! And you are making the best decision for your overall health.

Q. What happens during a colonoscopy?

A. You arrive at a procedure center and get checked in. You will dress in a gown, and an IV will be placed in your vein. Your heart may be monitored. You will have done your bowel preparation the night before or even that morning if your procedure is in the afternoon. You lie on a stretcher and get wheeled into the procedure room. Everyone on the team verifies who you are and why you are there. You are given sedating medications, and you fall into a gentle sleep. The doctor then places the colonoscope into the rectum and inflates air. The colonoscope is then passed around your colon to where it starts. As the scope is slowly pulled back, the lining of the colon is examined. Once the inspection is done, you are awakened and brought to a recovery area.

Q. How long is the recovery after the test?

A. Recovery is about an hour, but can vary for patients depending on how well they feel after waking up.

Q. What might you find during a colonoscopy?

A. We look for polyps, cancers, diverticulosis, problems with the lining of the colon, and other, less-common findings.

Q. I’m scared that the doctor might find something. What is the likelihood? Then what happens?

A. The average 60-year-old has a 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} chance of having a polyp found on colonoscopy. If you have a polyp, it can often be removed without need for further treatment during the colonoscopy. A little device called a snare is used to ‘scrape’ or cut the polyp from the colon lining. If the polyp is large, sometimes it cannot be completely removed. This can result in needing a second colonoscopy to check up on it, and sometimes specialized procedures are done to remove it and avoid surgery.

In other cases, surgery is required to remove a section of the colon so that the polyp can be completely removed to avoid developing into a cancer.

Finding a cancer is much less likely, but remember, colon cancer is the third-most-common cancer diagnosed in our country, and about one in 20 people (5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) will develop colon and rectal cancer. If a cancer is found, a biopsy will be taken to confirm that the cells are cancerous. Treatment of cancer depends on a lot of factors, including the initial stage of the cancer when diagnosed. For colorectal cancer, treatment can include any or all of the following: surgery, chemotherapy, and radiation.

Q. My grandmother had colorectal cancer. Does that mean my chances of developing it are greater?

A. This is an interesting question. You may have an increased risk of developing cancer, but there are many factors that play into this. Your grandmother’s age and the rest of your family history might give us some clues. Any family history of colon cancer means you should talk to your doctor and consider colonoscopy. In some circumstances, colonoscopy is recommended earlier than age 50, and some people need to have their colonoscopy more frequently than every 10 years, even if they don’t have polyps found at their most recent colonoscopy.

Q. Is there anything I can do to reduce my risk of developing colon cancer?

A. The short answer to this is to live a healthy lifestyle, which includes eating a diet high in fiber and low in fat and red meat, along with routine exercise. The single most important thing you can do other than living healthy is to have your colonoscopy when your doctor recommends it. For most people, that will be at age 50. You also need to be sure you have your repeat colonoscopies when the doctor recommends it — once is not enough. People usually have colonoscopy screening until around the age of 80.

Q. Are there any other screening methods I could consider other than colonoscopy?

A. Some people will have a chemical test for blood in the stool (fecal occult blood testing), and others will have a partial colonoscopy, called a flexible sigmoidoscopy, combined with the blood testing. There are various reasons why this might be done instead of a full colonoscopy.

Radiology tests such as barium enema and virtual colonoscopy can be used as well. People tend to like the idea of an X-ray because they think it is less invasive, but both these tests also require a bowel preparation prior to being done. However, if a polyp or mass is found, you still need to have a colonoscopy.

Cologuard is the latest way for people to be evaluated for colorectal cancer. It is a home test that evaluates your stool for specific DNA found in large polyps and colorectal cancers. This is available by prescription only and does not replace colonoscopy. There are false positives and false negative results, however, so it is best to talk with your doctor about this before deciding if it’s right for you.

Colonoscopy is the most thorough test because we look directly at the lining of the colon, and we can do biopsies and polyp removal right then and there.

Q. What treatments and surgery are available today?

A. Surgery has come a long way for colorectal cancer. A lot of people associate colorectal cancer surgery with an ostomy bag, but the truth is, most patients don’t need these. Those that do need an ostomy bag can live very full lives and participate in just about any activity someone without a bag might enjoy.

The exciting news in colorectal surgery is that even our biggest and most complex surgeries are being done in a minimally invasive fashion. We can use laparoscopy and robotics to remove cancers so that patients have less pain and a shorter recovery. Some early rectal cancers, which lie lower in the GI tract, can be removed with specialized techniques to help remove the cancer without the need for extensive abdominal surgery.

Make sure you ask your surgeon if they perform minimally invasive surgery and how often they perform surgery for colorectal cancer each year. Surgeons that are most experienced in these techniques often have lower complication rates and better outcomes.

Dr. Kelly M. Tyler is chief of the Division of Colorectal Surgery at Baystate Medical Center.

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