Let’s talk colonoscopy, or maybe not….since most people fear and avoid the lifesaving screening which is relatively painless, but gets a bad rap mostly because of the bowel prep required the day before your test.
Instead, let’s talk colorectal cancer since March is National Colorectal Cancer Awareness Month, organized each year as a way to raise awareness about colorectal cancer and to encourage people to get screened.
Prevention and Early Detection
Colorectal cancer is the fourth most common cancer in the United States and the second leading cause of death from cancer, with over 56,000 people expected to die from the disease this year.
“Finding cases of colorectal cancer early through screening can dramatically improve your chances for successful treatment,” said Dr. Wilson Mertens, vice president and medical director, Cancer Services, at Baystate Medical Center and its Baystate Regional Cancer Program – chances that are 80% or better.
It is believed that if everyone age 50 and older were screened regularly, 6 out of 10 deaths from colorectal cancer could be prevented. Given those facts and figures, it makes sense to have a colonoscopy. However, some half of those eligible for screening still have not had one, noted Dr. David Desilets, Baystate’s chief of Gastroenterology.
Easier Than You Think
“Contrary to popular belief, although there is sometimes discomfort involved, a colonoscopy is generally not a painful procedure. Patients are given medication to relax and often fall asleep, not waking up until the procedure is over,” said Dr. Desilets.
Colorectal surgeon Dr. Kelly M. Tyler, chief of the Division of Colorectal Surgery at Baystate Medical Center, admits the bowel preparation for a colonoscopy is not pleasant and involves passing a lot of bowel movements to get the lining clean, which is necessary so that the doctor who does your colonoscopy can inspect it properly. It is reported that up to 25% of all colonoscopies are preceded by an inadequate bowel preparation leading to missed precancerous lesions.
“People can get through it without too much trouble if they have a positive attitude and a sense of humor. It is very important to drink a lot of liquid during your bowel preparation to stay hydrated. You also need to take it slow and follow the instructions for the prep carefully,” she said.
In 2014, the U.S. Multi-Society Task Force on Colorectal Cancer released new bowel preparation guidelines with the intent to make it easier for some to tolerate what once required patients to drink a gallon of cleansing solution the night before their procedure. The revamped guidelines seek to raise patient prep compliance to at least 85%.
“The newer split-dosing method allows patients to drink half of the prep solution the night before the procedure, then the second dose to be completed within 2-3 hours from the procedure. We do have evidence that breaking up the bowel prep results in better bowel cleansing with more secretions flushed out closer to the procedure, allowing for greater diagnostic accuracy,” said Dr. Rony Ghaoui of the Gastroenterology Division at Baystate.
Screening Strategies
According to Dr. Mertens, most colon cancers develop from polyps – precancerous growths in the colon and rectum. Risk factors include: age – older than 50, family history of colorectal cancer or colon polyps, a personal history of intestinal polyps or inflammatory bowel disease, a diet high in red and processed meats, obesity, smoking, type 2 diabetes, heavy alcohol use, and physical inactivity.
Among the different screening strategies to discuss with your doctor are: yearly fecal occult blood test, flexible sigmoidoscopy every five years, a barium enema every 5-10 years, and a colonoscopy every 10 years. Most screenings begin at age 50, however, those at greater risk, including African-Americans and American Indians, and those who have a family history of colon cancer, should consider screening sooner.
Improved Surgical Treatment
If cancer is found, Dr. Tyler noted surgery for colon cancer is much more manageable than one might imagine.
“People often have a fear of the unknown and a fear of having to endure invasive procedures and treatments for colon cancer. Because of major advances in technology, we can often offer patients surgery for colon and rectal cancer with minimally invasive techniques which allow for smaller incisions and improved recovery. Even patients who may require more extensive surgery are experiencing improved outcomes and survival from colon cancer with adequate medical and surgical treatment,” said Dr. Tyler.
“Our surgeons recognize the importance of sphincter-sparing treatments that allow most colorectal cancer patients to heal after surgery with the ability to pass bowel movements naturally without an ostomy bag. Doctors have also learned what makes colorectal surgery more successful, such as being sure to remove enough lymph nodes during the procedure,” she added.