Colonoscopy…should you have one?

Colonoscopy…should you have one?
When her doctor suggested that she have a colonoscopy to screen for colorectal cancer, Pam said she wanted time to think about it. Pam has heard all the anecdotes; she's uncomfortable even at the thought of having a camera exploring the inside of her bowels. On the other hand, she has a cousin who was treated successfully for colon cancer and credits colonoscopy as saving his life.

Colonoscopy uses a thin, flexible tube with a light and camera attached to examine the lining of the large intestine. The procedure can be used to help diagnose abnormalities such as ulcers polyps, tumors and areas of inflammation or bleeding as well as screen for cancer.

Not all abnormalities in the colon are cancerous, but all cancers start as adenomatous polyps. If detected early enough, these polyps can be removed before they become cancerous. Generally recognized as the best way of detecting polyps, colonos-copy is one of three widely used and recommended screening tests for colon and rectal cancer.

As opposed to fecal occult blood testing (FOBT) – a simple take-home test that requires collecting stool samples and sending them in for laboratory testing – colonos-copy is more invasive but capable of detecting actual polyps as opposed to hidden bleeding in the bowels that might or might not be caused by a polyp. Compared to sigmoidoscopy, which examines just the rectum and the lower third of the colon, colonoscopy gives a doctor a chance to observe the lining of the entire large intestine.

For persons over age 50, the American Cancer Society recommends either:

  • a yearly FOBT plus sigmoidoscopy once every five years
  • colonoscopy once every 10 years
  • or a barium enema once every five years.

    Persons with a moderate to high risk of colon or rectal cancer are advised to have more frequent screening. Most at risk are persons who have already had a precancerous polyp removed or who have a close relative diagnosed with colorectal cancer.

    To prepare for colonoscopy, it's necessary to clear the bowels. Pam's friends told her about not being able to eat solid foods for a day or two followed by use of laxatives and enemas. In most cases, the preparation has been considerably simplified since that time.

    One method involves drinking a gallon of very salty solution within one or two hours. This does a good job of flushing the colon without adding or subtracting any fluids from the body. Some individuals find it difficult to drink that much fluid, however.

    Alternatives include taking four prescription laxative tablets every 15 minutes – for a total of 20 – the night before the colonoscopy plus additional tablets the next morning about three hours before the procedure or a combination of laxative tablets followed by half a gallon of the salty solution.

    The colonoscopy itself takes about half an hour and is performed under intravenous sedation. Even though you're conscious, you're likely to be groggy and not remember much of the procedure.

    As with bowel preparation, Pam could expect significantly less discomfort than her friends remembered. The trend is toward deeper sedation and, with improving technology; the test can be performed quickly with fewer complications.

    One major advantage of colonoscopy is that when a cancerous or precancerous polyp is detected, it can be removed on the spot. Moreover, if results are normal, it can be performed less frequently. Medicare, Medicaid and most private insurers pay for a colonoscopy once every 10 years for persons who qualify. Deep in her heart, Pam knows it is the right thing to do.

    Colonoscopies as well as other recommended colorectal cancer screenings are available at Sanford Clinic Vermillion. Local surgeon Fernando Escobar, MD, board certified in general surgery is available to perform laparoscopic procedures as well as other common procedures and general surgeries.

    Call Sanford Clinic Vermillion at (605) 624-9111.

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