Colon Cancer (cont.)
Francis W. Nugent, MD
Francis W. Nugent, MD
Dr. F.W. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer. Dr. Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.
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What tests can be done to detect colon cancer?
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When colon cancer is suspected, either a lower GI series (barium enema X-ray) or colonoscopy is performed to confirm the diagnosis and locate the tumor.
A barium enema involves taking X-rays of the colon and the rectum after the patient is given an enema with a white, chalky liquid containing barium. The barium outlines the large intestines on the X-rays. Tumors and other abnormalities appear as dark shadows on the X-rays. For more information, please read the Barium Enema article.
Colonoscopy is a procedure whereby a doctor inserts a long, flexible viewing tube into the rectum for the purpose of inspecting the inside of the entire colon. Colonoscopy is generally considered more accurate than barium enema X-rays, especially in detecting small polyps. If colon polyps are found, they usually are removed through the colonoscope and sent to the pathologist. The pathologist examines the polyps under the microscope to check for cancer. Colonoscopy is the best procedure to use when cancer of the colon is suspected. While the majority of the polyps removed through colonoscopes are benign, many are precancerous. Removal of precancerous polyps prevents the future development of colon cancer from these polyps. For more information, please read the Colonoscopy article.
Recently, "virtual colonoscopy" (computerized tomographic or CT colonography) has been utilized as a screening technique for colorectal cancer (Screening is not done in individuals in whom colorectal cancer is suspected. It is done only for individuals at risk for colorectal cancer.). Virtual colonoscopy employs a CT scan using low doses of radiation with special software to visualize the inside of the colon and look for polyps or masses. The procedure typically involves a bowel preparation with laxatives and/or enemas (although not always) followed by a CT scan after air is introduced into the colon. Because no sedation is necessary, individuals can return to work or other activities upon completion of the test. Virtual colonoscopies appear to be equally able to detect larger polyps (over 1 centimeter in size) as regular colonoscopies.
In studies comparing virtual colonoscopy and standard colonoscopy, patients seem to prefer virtual colonoscopy especially if no bowel preparation is required. The CT scan can also find other abnormalities outside the intestine in a small number of people, an added benefit. On the other hand, if a larger polyp is found, a standard colonoscopy is required for removal of the polyp. It is unclear at this time whether virtual colonoscopy for the screening of colorectal cancer will become a standard approach, but it is likely to become increasingly common, especially in areas where gastroenterology doctors (the ones who perform standard colonoscopies) are in short supply.
If cancerous growths are found during colonoscopy, small tissue samples (biopsies) can be obtained and examined under the microscope to determine if the polyp is cancerous. If colon cancer is confirmed by a biopsy, staging examinations are performed to determine whether the cancer has already spread to other organs. Since colorectal cancer tends to spread to the lungs and the liver, staging tests usually include CT scans of the lungs, liver, and abdomen. Positron emission tomography (PET) scans, a newer test which looks for the increased metabolic activity that is common in cancerous tissue, also are employed frequently to look for the spread of colon cancer to lymph nodes or other organs.
Sometimes, the doctor may obtain a "tumor marker" blood test called a carcinoembryonic antigen (CEA) if there is a suspicion of cancer. CEA is a substance produced by some colon and rectal cancer cells as well as other cancers. It is sometimes found in high levels in patients with colorectal cancer, especially when the disease has spread. However, not all patients with colorectal cancer will have an elevated CEA even if their cancer has spread. (Some colorectal cancers don't produce it.) Additionally, some patients without cancer can have an elevated CEA blood test. About 15% of smokers, for example, will have an elevated CEA without colon cancer. So the CEA is not used to diagnose colorectal cancer but rather to follow the effects of treatment of colorectal cancer in someone with a known history of the disease since in some patients the amount of cancerous tissue correlates with the level of CEA.
Reviewed by Jay W. Marks, MD on 10/4/2012
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