Colon Cancer Update with The Cleveland Clinic (cont.)

Gastric bypass surgery, as well as hiatal surgery, may predispose to the development of gastrointestinal symptoms. There is no evidence to suggest that gastric bypass surgery is associated with colorectal polyps and cancer.

"Colonoscopy is usually the preferred screening test."

Let's talk about testing.

There are screening tests, which are used in people without symptoms to prevent cancer by finding and removing polyps or to detect cancer at an early (asymptomatic) stage. There is also another group of tests, which are often the same as used for screening, that are used in symptomatic patients to diagnose an existing cancer.

The most common test used to diagnose colon symptoms that suggests a cancer may be present is colonoscopy. Colonoscopy is also the most accurate screening test for colon and rectal cancer, although its use as a screening test is limited by its expense, the perceived discomfort associated with it and its relative lack of availability.

Other screening tests include fecal occult blood, flexible sigmoidoscopy and barium enema.

New screening tests still under investigation include virtual colonoscopy and genetic testing of DNA in the stool.

The virtual colonoscopy -- is it as accurate as the real thing?

Virtual colonoscopy is a novel technique to screen the colon for colon polyps and cancer. Currently it is considered a research tool, and not approved by any major medical societies or reimbursed by insurance.

The majority of studies looking at the accuracy of colonoscopy versus virtual colonoscopy show that virtual colonoscopy is not as accurate. With innovations in software and other imaging techniques, the potential for virtual colonoscopy to be standardly as accurate as colonoscopy is possible.

I read recently that fecal occult blood tests aren't much use because many doctor offices aren't doing them right. Could you comment?

Fecal occult blood testing has been shown in the most stringent of study designs in large populations to decrease colon cancer mortality by up to 33%. However, the accuracy of colonoscopy is much greater than fecal occult blood testing. Colonoscopy is usually the preferred screening test.

If fecal occult blood testing is the strategy used by an individual, it should be done on a yearly basis with the use of three individual cards on a specified diet. If fecal occult blood testing is obtained by a finger examination in the doctor's office, and negative, it should be followed up with the fecal occult blood testing cards done at home as recommended. If the fecal occult blood test is positive on a finger examination, a colonoscopy is indicated, not retesting for fecal occult blood.

What is involved in getting a colonoscopy?

In general, a referral for colonoscopy from the primary physician is required. This is made usually to a gastroenterologist who will usually want to see the patient in consultation first before scheduling the examination. In some areas of the country "open access" colonoscopies are used. This means the family physician can schedule the colonoscopy without seeing the gastroenterologist.

It is essential the colon be completely clean for colonoscopy to have the best chance of finding anything significant and for the patient to have the most comfortable experience possible.

There are four alternatives for cleaning the colon:

  • The first is to drink a gallon of slightly salty liquid which flushes the colon out. The advantage of the gallon preparation is that no fluid is absorbed or lost from the body. The disadvantage is that many people find that a gallon is a lot to drink, even spaced out over two hours.
  • The second most common bowel preparation is with two small glasses of sodium phosphate (Fleet's). This is much less to drink, although it tastes extremely bad and it is advised to put it in ginger ale to help with the taste. It cleans the colon very well but patients lose fluids and electrolytes. Patients whose kidney or cardiac function is impaired or who are taking water pills (diuretics) should not have Fleet's phospho-soda prep.
  • The third option is by taking Fleet's phospho-soda tablets (Viscol). Generally four tablets are taken every 15 minutes the evening before the procedure for a total of 20 tablets and the next morning four tablets are taken twice about three hours before you leave for your procedure.
  • The fourth alternative is to take a half a gallon of the salty solution preceded by four laxative tablets.

My primary reason for avoiding a colonoscopy is my adverse reaction to the enema requirement prior to such an exam. Enemas make me tired from being up all night, sore and worn out. I would most sincerely appreciate your suggestions on how I can remedy to this situation.

There are a variety of preparations, none of which include an enema. If patients are completely intolerant to the prep, a three-day liquid diet is occasionally used.

"The only way to cure colon cancer is to remove it."

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