colon cancer prevention

Colon Cancer Prevention

Colon cancer is often a preventable disease.

Only a small percentage of the population is screened with endoscopic procedures, in spite of widespread availability.

At age forty, in both men and women, stools should be checked for microscopic blood. Admittedly, this is a very inaccurate and unproductive test. People are reluctant to smear stool on the guaiac cards. Theoretically, one has to stop vitamin c, iron, and aspirin, as well as avoid rare meats in order to improve accuracy. Most cases of positive stool turn out to be due to superficial bleeding from hemorrhoids or fissures. Nonetheless, on those occasions where we do find unexplained blood in the stool, which is resulting from leakage from a pre-malignant polyp, or an early colon cancer, early intervention can be life saving.

We often ask you to mail guaiac cards to us with a thin smear of stool from the toilet tissue (as opposed to the Popsicle stick in the toilet bowl routine), in an attempt to identify microscopic unexplained blood. Do not provide a smear with obvious hemorrhoidal bleeding. This will mislead us into thinking you are bleeding from higher up in the colon. We will call you if we identify unexplained blood on the cards.

If there are risk factors for colon cancer, the colonoscopy should be performed, looking at the entire colon.

At age forty-five, in men and women, we believe screening should begin with the flexible sigmoidoscope. The "flex sig" views the bottom one-foot of the colon where forty percent of problems occur. Thus, it is a "good deal" as a screening tool in patients in low-risk groups for colon cancer. A full colonoscopy is indicated in higher-risk groups! Most organizations advocate screening with the flexible sigmoidoscope at age fifty. We have identified enough problems in individuals in younger age groups that we feel we can justify starting screening five years earlier. We generally advocate screening with the flexible sigmoidoscope every three years, only in patients in low-risk groups.

There is no need for pain medication.

The flexible sigmoidoscope (flex sig) takes about sixty seconds to perform. Preparation consists of coming to the office ten minutes before the scheduled appointment and receiving two consecutive Fleet's Enemas. The enema is a small balloon-like contraption that squirts irritating fluid into the rectum, causing evacuation within two to three minutes. After two of these, administered in a quiet, private bathroom in the office, usually one is well prepared. There is no need to fast. There is no need to prepare at home, unless one is constipated. Under those circumstances, starting milk of magnesia, nightly, two days before the procedure might allow for better Fleet's Enema function.

In general, we do not ask you to undress, just to move a few garments and undergarments. The procedure usually only takes a minute. {at most two). While unpleasant, and associated with occasional crampiness, it is usually "not bad".

The colonoscopy evaluates the entire five feet of the large bowel. When an individual has a family history of a first-degree relative with colon polyps or colon cancer, full colonoscopy is warranted.

Colon cancer can occur anywhere in the large bowel, but forty percent tends to be in the bottom eighteen inches.

In other conditions such as ulcerative colitis, breast or ovarian cancers, familial polyp syndromes, etc., early colonoscopy is urged. It should be appreciated that in most cases a colon cancer must first start as a benign polyp. Since it takes between five and ten years to go from normal to polyp to cancer, there is a large window of opportunity for intervention.

We generally advocate full colonoscopy starting between age thirty and thirty-five in individuals who have first degree relatives with polyps or colon or rectal cancer.

In recent years, many prominent physicians have begun advocating one screening colonoscopy in everyone at around age fifty. At the present time, there is still a question as to whether this is a cost-effective way to spend healthcare dollars. Many insurance companies will not cover routine screening colonoscopies unless there is a first degree relative with a polyp or cancer, or unless there is unexplained blood in the stool.

If you want to pursue the prevention of colon cancer, but do not qualify for insurance coverage, please discuss this with your doctor.

The colonoscopy is usually not as difficult as you might expect.

The preparation consists of an eighteen hour clean out, which is the most difficult part of the procedure (see colonoscopy preparation sheet under office information}. Plan on having a light lunch the day before the procedure, a very light dinner, then nothing other than liquids you can see through until the procedure the next day. Click on colonoscopy preparation sheet for details. If you have heart or liver issues or if you are over the age of 65, IT IS IMPORTANT THAT YOU USE THE HALF-LYTELY PREP. If you are unable to follow the fluids preparation, you can use the pill preparation.

The colonoscopy itself is done in the office in the endoscopy suite. It is a quiet room, isolated from the rest of the office, a few steps from a bathroom. For the procedure, you are given a healthy dose of intravenous Demerol, along with intravenous Valium, if necessary. We leave the intravenous in place during the procedure, allowing additional medication if there is significant pain. In most cases, there are two or three minutes of tolerable cramping, and few patients request additional medication. It should be noted that because we have recovery room facilities, it is possible to administer more sedation than we were able to offer in the old office.

In many cases the procedure only takes five or ten minutes.

In many cases the procedure only takes five or ten minutes, though if we find a polyp we will often be able to remove it during the procedure, prolonging the procedure by a few minutes. If we find a polyp, we will remove it with electrocoagulation (painless). For seven days before the colonoscopy, please refrain from blood thinners, including aspirin, as it precludes the possibility of polyp removal due to an increased risk of bleeding.

At the conclusion of the procedure, we can administer Narcan, a narcotics reversing agent, to awaken the patient. Expect to leave twenty to thirty minutes after the procedure feeling like you have had a couple of drinks.

It is a good idea to bring an extra pair of underwear, just in case. It is a good idea to have someone pick you up after the procedure, and that should generally be about one hour after the scheduled start time. Many people are able to rest for a few minutes and then leave on their own, and many are back at work within two hours of the start time. Please do not plan on driving, or on operating heavy machinery, within three hours of the procedure.

In an individual at high risk for developing colon polyps or cancer, we usually repeat the procedure every three years. In some cases, we might look earlier, especially if we remove a polyp.

Polyps are sent to the lab for evaluation, but in most cases, the doctor can tell immediately if there is any risk of cancer in the removed tissue. The pathology report is usually available within three to five working days.

Colon cancer prevention also includes a high fibre, low-fat diet, folic acid supplementation (400 to 800 mcg/day), and perhaps an aspirin daily