March is National Colorectal Cancer 
Awareness Month

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March 10, 2014


Preventable. Treatable. Beatable.
Colorectal cancer screening saves lives. It is one of only a few cancers that can be prevented through screening; among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the United States. The risk of developing colorectal cancer increases with advancing age. More than 90 percent of cases occur in people aged 50 or older. Building awareness is an important part of helping to increase screening and decrease mortality rates. Visit the National Colorectal Cancer Roundtable Web site to learn more.

Colorectal Cancer Screening Options

Colorectal cancer screening saves lives in two important ways:
  1. By finding and removing precancerous polyps before they become cancerous
  2. By detecting the cancer early when it is most treatable

Both men and women should undergo testing for the disease beginning at age 50. People with a high risk for colorectal cancer and those with a family history should talk with their doctor about being screened at an earlier age. A study by leading cancer groups found that colorectal cancer deaths have declined nearly five percent (2002-2004), in part due to prevention through screening and the removal of precancerous polyps. Screening tests for colorectal cancer Screening is done on individuals who do not necessarily have any signs or symptoms that may indicate cancer. If symptoms exist, then diagnostic workups are done rather than screening. These are the tests recommended for colorectal cancer screening and some general pros and cons for each:

STOOL BLOOD TEST (FECAL OCCULT BLOOD TEST--FOBT)

This test is used to find small amounts of hidden (occult) blood in the stool. A sample of stool is tested for traces of blood. People having this test will receive a kit with instructions that explain how to take stool samples at home. The kit is then sent to a lab for testing. If the test is positive, further tests will be done to pinpoint the exact cause of the bleeding. A rectal exam in the doctor's office may examine for occult blood, but this is NOT considered adequate for colorectal cancer screening. The test should only be done with a take-home kit. A newer kind of stool blood test is known as FIT (fecal immunochemical test). It is like the FOBT, perhaps even easier to do, and it gives fewer false positive results.

PROS

  • Simple
  • Cost-effective
  • Done at home CONS
  • Must be done yearly
  • Least effective means of detecting cancer
  • Viewed as unsanitary by some
  • Patient must retrieve samples of stool from the toilet bowl
  • All positive results MUST BE EVALUATED WITH A COLONOSCOPY

FLEXIBLE SIGMOIDOSCOPY (FLEX-SIG)

A sigmoidoscope is a slender, lighted tube about the thickness of a finger. It is placed into the lower part of the colon through the rectum. This allows the physician to look at the inside of the rectum and lower part of the colon for cancer or polyps. This exam only evaluates about one third of the colon. The test is often done without any sedation, so it can be uncomfortable, but it should not be painful. Before the test, you will need to take an enema or other prep to clean out the lower colon. PROS

  • Quick - usually a one to five minute exam
  • Does not require a vigorous bowel prep
  • Does not require sedation CONS
  • Can only examine the lower third of the colon. The other two-thirds of the colon are not examined
  • If polyps are found, the patient MUST RETURN FOR A FULL COLONOSCOPY

COLONOSCOPY

Colonoscopy allows for a complete evaluation of the colon and removal of potentially precancerous polyps. It is the only colorectal cancer screening tool that is both diagnostic and therapeutic. A complete bowel cleansing is required before the exam. The procedure uses a colonoscope, a tube with a light and video camera on the end, which allows the doctor to see the entire colon. If a polyp is found, the doctor can remove it immediately. The polyp is usually removed with small biopsy forceps or loop of wire (snare) that is advanced within a channel in the colonoscope. The polyp is then sent to the pathology lab for analysis. If anything else looks abnormal, a biopsy might be done. To do this, biopsy forceps are placed in the colonoscope and a small piece of tissue is removed. The tissue is sent to the lab for evaluation. This test is generally done with sedation and is well-tolerated. You will be given medicine that is injected through a vein to make you feel relaxed and sleepy.

PROS

  • Examines the entire colon, making it the most thorough method for evaluating the colon and rectum
  • High detection rate for polyps, including small polyps, and ability to remove them immediately during the procedure
  • Done with intravenous sedation to assure comfort during the exam
  • Given the "Gold Standard" rating above all other screening options by: American Society for Gastrointestinal Endoscopy (ASGE), American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG).

CONS

  • Requires a complete bowel prep the night before to cleanse the colon
  • Unexpected events or complications are rare, but do occur and may include:
  • Missing a lesion
  • Making a tear in the lining of the colon, which is called perforation
  • Bleeding
  • A bad reaction to the medication used for sedation
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