Taking Charge of Your Health: The Case for Early Colon Cancer Screening

Does a patient need a referral in order to schedule a colonoscopy?

If they’re having symptoms, we would prefer they see their primary care physician or a walk-in clinic first to get evaluated and know how quickly they need to get a test done.

Screening is considered the test to look for colon cancer when it isn’t causing symptoms. Alarm symptoms would be abdominal pain, change in bowel habits with more constipation, change in size of stool, or blood in stool. Those are signs you would need to get a colonoscopy, but it’s different than a screening colonoscopy.

Patients that aren’t having symptoms and are above the age of 45 can go through their primary care physician or through the online scheduling portal. That’s for patients that don’t have a lot of extra medical conditions that we would need to plan how to do their procedure safely.

What can a patient expect when it comes to colonoscopy preparation?

The preparation for a colonoscopy is really the hardest part and is what patients tend to not look forward to because you have to clean the colon out of any residual stool. It’s a good idea to get instructions at least a week ahead of time so you know how to alter your diet so that you can have the most comfortable experience in the preparation of it. There are certain medications that can be used to clean the colon of the stool and, depending on what type of medication they are, there’s different volumes of material. Some are a lot of volume, like a gallon jug of medication, while others are low volume. That choice of what to use is really dependent on the patient and their doctor.

For those who have heard horror stories about colonoscopy preparation, what tips could you offer to make that drink taste better, go down easier, or generally be more tolerable?

Planning ahead of time and getting the drink refrigerated or drinking it on ice tends to make it more palatable. There are different flavoring options that are available, whether they’re diluted in Gatorade or Crystal Light or some other drink flavorings, that can all be very helpful. Spacing out when to do the first half of the drink and the second half of the drink so that you don’t feel too full can be very beneficial in making it tolerable.

How long does a colonoscopy procedure take?

Typically, a colonoscopy takes between 15 and 20 minutes. It’s variable. If we find something we need to remove, like a polyp, then it takes a little bit longer. But otherwise, a 15 – 20-minute timeframe is typical.

Most patients prefer sedation for their colonoscopy. There’s a tendency to have a bloated sensation if you have a colonoscopy without sedation. Patients come in before the scheduled procedure to get an IV placed. That way we can give IV medications that will allow patients to feel sleepy, be sedated, and not feel pain, and then we start the colonoscopy once they’re asleep. We monitor their blood pressure and vital signs to make sure they’re in a normal range during the procedure. Once done, then they recover from 30-60 minutes, and we make sure they’re steady on their feet from the sedation. They need a driver to go home with them because they’re not safe to drive behind the wheel.

Should a patient expect to feel any pain?

That all depends on a patient’s anatomy. If they’re not sedated, some patients feel absolutely no discomfort. Others would feel discomfort due to extra loops in the colon or other conditions that would create discomfort. Without knowing ahead of time what a colon is going to be like, we typically recommend sedation so that patients are comfortable and not having a negative reaction to the test.

After the procedure, are patients able to go about their day or will they need significant time to recover?

We recommend that patients don’t plan to do their normal job activities the day of the procedure because, after sedation, they tend to be tired, somewhat lethargic, or not feeling up to speed. Some patients feel back to normal, but their judgment may be impaired. So, we recommend staying away from obligations that involve finances, posting on social media, or things that may get them into trouble or have regrets as they don’t have quite as many of their typical faculties for inhibition.

Are there any side effects a patient may experience after the exam?

The sedation has the main side effects. It can create forgetfulness around the time of the procedure as the medicine sometimes has an amnesia effect. They may not remember the drive home afterwards, and that’s quite common. Other than that, no there’s not typically any side effects of significance. We give a checklist of things to watch for, but colonoscopy is very safe and it’s very uncommon to have significant problems with abdominal pain or other problems after the procedure.

When people think of colonoscopies, they may be embarrassed or concerned about getting an exam like this. How do you reassure patients that this is perfectly normal, and they have nothing to worry about?

There are misconceptions about colonoscopy. Patients tend to think we are examining their rectum and taking a close-up look at that. And that’s not the case. Patients are covered essentially the entire time, and we are doing the colonoscopy on a video screen away from the patient’s body. It is sterile, it is as comfortable for the patient as we can make it, and we protect their privacy by covering the patient and making sure that they are not exposed at all.

What would you say to someone who thinks they're perfectly healthy and they can put off a colonoscopy?

It’s tempting to put off things that aren’t causing problems, as busy as we are in life. Colon cancer doesn’t cause symptoms until late in its course when it has typically invaded into the inner lining of the colon or even spread somewhere else.

If you get symptoms of colon cancer, it’s frequently late in the course and requires much more treatment that can be much harder to live through than if you can catch colon cancer early. The goal is to screen everyone and then reduce their risk of colon cancer in their lifetime by doing that screening.

Along with screenings, what other recommendations do you have for people to help prevent colon cancer?

It’s important to have a healthy lifestyle overall for a healthy mind, health of your heart, health of every other organ in your body. A lot of that goes in conjunction with colon health. Having a lifestyle that involves physical activity, a diet that doesn’t have too much rich red meat consumption or processed foods is important. A diet that has more of the standard food pyramid type of concept, such as a mediterranean diet with fruits, vegetables and grains, tends to be the healthiest diet for our colons. Coffee may be beneficial for the colon, so if you’re a coffee drinker, you can continue to drink coffee. Don’t avoid that. But alcohol and tobacco tend to increase your risk for cancers and colon cancer is included in that.

If a polyp is discovered during a colonoscopy, is that automatically a sign of cancer or are they fairly common?

It is common for people to have colon polyps at some point during their lifetime. About 40% of people will have a colon polyp at some point. It’s not rare and not every colon polyp becomes colon cancer. We remove the polyps that look like they could be pre-cancerous. By doing so, we reduce the patient’s risk of developing colon cancer by up to 90% for their lifetime.

When colon cancer is found, is it typically in patients who were experiencing symptoms, or do you see a lot who would never have guessed anything was wrong?

There’s a wide spectrum of stages of colon cancer that we find on colonoscopy. If patients are not having symptoms, it tends to be an early colon cancer that has not spread to other parts of the body and can more easily be treated and eradicated with surgery. Colon cancer that’s causing symptoms tends to be more advanced and can have more stages of required treatment.

What would you say to encourage someone to schedule a colonoscopy?

Colonoscopy has been proven to reduce colon cancer risk significantly. It is very effective in protecting a patient throughout their entire lifetime and it can be done safely. It doesn’t need to be done frequently and can be spaced out every ten years, giving patients significant reassurance that the second-leading cause of cancer death in the U.S. is not going to be a problem that they deal with. Because of that reassurance, colonoscopy is the best test for most patients.