Undergoing a Colonoscopy

Like many people, Nancy Bierley, of Ottawa Lake, Mich., was anxious before undergoing her first colonoscopy to test for colon cancer nine years ago. “I was scared of the actual test and what they may find,” she recalls. But now Bierley, 63, sings the test’s praises due to the peace of mind that followed.

And that is really what this potentially life-saving test is all about, says Dr. James Lynch, a colon and rectal surgeon at William Beaumont Hospital in Troy, Mich. A colonoscopy allows a doctor to examine the inside of the colon—the large intestine—for signs of cancer or polyps, which are abnormal growths inside the colon. If polyps are found, they often can be removed during the procedure, before they become cancerous. “If we find polyps and remove them, you don’t get colorectal cancer,” Lynch explains.

Although most polyps never become cancerous, nearly all colon and rectal cancers start out as these small growths. In Bierley’s case, the doctor removed several polyps; laboratory tests showed they weren’t cancerous, but Bierley had three follow-up colonoscopies in the five years after her first screening. She now plans to have a follow-up every five years.

An ounce of prevention
Colorectal cancer is the third most common form of cancer in the United States, excluding skin cancers. The American Cancer Society estimates that the disease will claim the lives of nearly 50,000 Americans this year.

But there is good news: Colorectal cancer is one of the most preventable types of cancer, and the disease’s death rate has been declining for more than 20 years, thanks to screening exams and better treatments.

While there are several tests that can help screen for the disease, the colonoscopy is considered to be the “gold standard.” The American Cancer Society recommends that men and women who are at average risk for developing colorectal cancer get a colonoscopy every 10 years beginning at age 50. People with certain risk factors, including family history of colon cancer, or symptoms such as blood in the stool, change in bowel habits, unexplained weight loss or abdominal pain, may be advised to have the test at an earlier age and at more frequent intervals.

The procedure
Preparation for a colonoscopy, which starts the day before the test, is designed to ensure that the stomach and colon are empty. “We tell people to consume only clear liquids starting the day before the procedure,” Lynch says.

Most preparation methods involve consuming a large volume of liquid laxative preceded by or followed by laxatives in pill form. The medication takes from 90 minutes to four hours to begin working, and the effects may last for several hours. “We suggest starting to drink the liquid when you get home from work, so it will run its course and you can get a good night’s sleep,” Lynch says.

Most colonoscopies are performed by a gastroenterologist—a doctor who specializes in diseases of the digestive system—or by a surgeon. During the test, the doctor guides a colonoscope—a slender, flexible, lighted tube—into the rectum and through the remainder of the colon. The scope is connected to a video camera, which allows the doctor to see the inside of the colon. Small puffs of air are inserted in the colon to keep it open.

Typically, patients are given a mild sedative and may be given intravenous pain medication to minimize discomfort during the 10- to 20-minute exam.

Immediately after the exam you should be able to discuss the findings with the physician. The doctor will show you photographs of any polyps that were found and removed, and will tell you when to return for another colonoscopy. You probably will be drowsy due to the sedation, so arrange ahead of time for transportation home.

A colonoscopy is considered to be a relatively safe procedure, but there are risks; although unlikely, it’s possible that the colonoscope could accidentally puncture the colon. Studies have shown the risk of perforation vary from one in 500 to less than one in 1,000. About 5 percent of such perforations are fatal.

“This is not usually a complication following a normal colonoscopy,” Lynch says, but the risk increases when polyps are removed.

“Today the scopes we use are smaller and more flexible and the risk of not having a colonoscopy is much greater than the risk of having one,” adds Dr. Mark Fendrick, a professor of internal medicine at the University of Michigan in Ann Arbor.

Bierley is glad she underwent the procedure. “Once you get past the preparation,” she says, “the test is a breeze and it can save your life.”

A colonoscopy typically costs $800 to about $1,500. Some insurance plans cover the procedure, and Medicare recipients are entitled to a colonoscopy screening every 10 years. For more information, contact your doctor or the American Cancer Society at (800) 227-2345 or www.cancer.org.

Other Colon Cancer Tests

While a colonoscopy is the preferred method of screening for colorectal cancer, there are other tests that can be used to detect the disease.

• Flexible sigmoidoscopy. Sedation isn’t required for this test, which allows the physician to look inside the lower portion of the colon using a short, flexible, lighted tube. Small polyps can be removed during the procedure. Because only about one-third of the colon is examined, some potentially cancerous polyps may be missed.
• Barium enema. The lining of the colon is X-rayed during this procedure. Barium sulfate, a chalky liquid, is placed into the rectal area to outline the colon. Air sometimes is used to expand the colon. Polyps cannot be removed during the procedure, and the test may not detect small polyps.
• CT colonography. This test, also known as a “virtual colonoscopy,” uses a computed tomography (CT) scanner and computers to produce two- and three-dimensional images of the colon. Although this test is not as invasive as a colonoscopy, it involves the same type of bowel preparation. Polyps can’t be removed during this test.
• Fecal blood and immuno-chemical tests. These tests look for hidden blood in the stool, which may be caused by colon polyps or cancer, and is sometimes the only warning sign of colorectal cancer. These simple, noninvasive tests can be done with at-home kits that are sent to a laboratory for testing. They can detect some cancers, but also can produce false-positive results.
• Stool DNA test. This newer test, done at home and sent to a lab, is used to find changes in DNA from the cells of cancerous tumors or precancerous polyps. Like the other stool tests, this test may not detect all abnormal growths in the colon, and therefore may not be as effective as more invasive tests.

Story by Denise Mann of New York City.

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