Somewhere along the way, a perception that colon cancer is more of a man’s disease has surfaced and become a prevalent way of thinking. But in fact, the numbers tell a different story. In both men and women, colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of death. “Colon cancer is very aggressive, so we want to catch it early,” says Jyoti Bhatia, M.D., a specialist in a specialist in gastroenterology at Mercer Gastroenterology.
But the good news is that there are reliable tools and tests to help doctors do just that. Several screening exam options, including colonoscopy and sigmoidoscopy (sig-moid-ah-skuh-pee), are eminently accessible and highly effective. “Colonoscopy is a test that is helpful in finding polyps, which lead to cancer,” Bhatia says. A colon polyp is a growth on the lining of the colon that can become malignant. Since only a small number of polyps cause symptoms or signs, screenings are a crucial tool to detecting them before they can become cancerous.
After sedating the patient, the doctor will insert a thin, flexible tube called a colonoscope into the rectum. The colonoscope is equipped with a small video camera to take pictures or video of the large intestine, Dr. Bhatia says. The colonoscope can be used to look at the entire colon and the lower part of the small intestine, or, in the case of a sigmoidoscopy, shows only the rectum and the lower part of the colon. The physician can also remove or biopsy polyps during the examination, which makes it an incredibly useful tool.
However, because the intestine must be empty for the doctor to examine it properly, the preparation for colonoscopy can be unpleasant, leaving many people to put off the test or avoid it completely.
Prior to a colonoscopy, patients need to be on a pure liquid diet for the entire day leading up to the procedure. “Split-dose bowel preparation works best, which means one laxative is given the day before the test and then another six hours before,” Dr. Bhatia says. “Colonoscopy preparation has come a long way. Nowadays, one can always change the bowel preparation to suit their needs. There are different volumes available, so as to make this cleansing easier. For example, Miralax preps have 64 ounces available.” Physicians often recommend eating small meals leading up to the cleanse to make the process less difficult (less coming in means less going out). “Once you’ve done the bowel preparation, the hard part is done,” Dr. Bhatia says. “Then you come in and gets intravenous sedation. The exam itself is about 2-3 hours, and then you probably need a ride home.”
And for most people, a clear exam means you don’t need another colonoscopy for another decade. “On the other hand, if there is a colon polyp found, then we determine how quickly we should survey them. Usually it’s every five years,” Dr. Bhatia explains. She recommends getting screened every 10 years starting at age of 50, especially if you have risk factors.
While there are other tools for colon screenings, the most effective and widely used tool is colonoscopy, and Dr. Bhatia recommends women take advantage of it. “Colonoscopy is a wonderful tool because it can be used for diagnosis and precursor but also to remove polyps, so it’s a therapeutic tool in addition to a diagnostic tool,” Dr. Bhatia says.
“That’s why a colonoscopy is the gold standard procedure for finding polyps.”
Menu of Options
While colonoscopy is the preferred method, it isn’t the only option for colon screenings. Sigmoidoscopy, which is usually done in conjunction with a stool test, is an examination of just the left side of the colon, so preparation is not as intense, Dr. Bhatia says. “You eat a liquid diet the evening before the test, and then an enema will work or a smaller volume of a laxative before the test,” she says. One positive is that most patients tolerate the sigmoidoscopy without sedation, although, since it doesn’t see the entire colon, it’s recommended that’s it’s done every five years.
Another option is CT colonoscopy, sometimes called a virtual colonoscopy, is performed by a radiologist and uses low dose radiation CT scanning to obtain an interior view of the colon. “It’s only a diagnostic tool, so a patient would have to come back if there are an polyps found,” Dr. Bhatia says. Other tests include fecal immunochemical test (FIT), a test detects hidden blood in the stool, which can be a sign of precancerous polyps or colon cancer. Lastly, patients can opt for Fecal DNA testing, a newer approach for colon cancer screening. A stool DNA test is designed to identify recognizable DNA changes (DNA markers) in cells that are continually shed from the lining of the colon through stool.