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Medical Edge Newspaper Column from Mayo Clinic
THE BEST WAY TO PREVENT COLON CANCER
DEAR MAYO CLINIC: One of my parents died of colon cancer and I know that I should get a colonoscopy. The problem is that I can’t fast for 24 hours because of other health problems. Are there any other screening options I could pursue? — Fort Wayne, Ind.
ANSWER: Colonoscopy requires preparation, or cleansing of the stool from the inside of the colon, so that all surfaces can be seen. However, none of the various ways to prepare the bowel requires a 24-hour fast. And, yes, other screening options are available.
It’s great that you are considering a screening test for the early detection or prevention of colorectal cancer, which is the third most common cause of cancer deaths in the United States. Because colorectal cancer develops from noncancerous growths (polyps), if everyone age 50 or older had screening tests to check for them, most cases of this disease could be prevented.
A person’s risk is higher than average if a close relative has had colorectal polyps or cancer. Because your parent was affected, you should definitely be screened. If he or she developed cancer at a relatively young age, you may need to have your colon examined before age 50.
Other screening options are available, but colonoscopy is currently the “gold standard.” This test, which most people are able to undergo, allows a doctor to examine the lining of the entire colon using a tiny camera on the end of a thin, flexible, lighted tube (colonoscope) that is steered through the colon. Intravenous medications are given to prevent discomfort. If polyps are found, they can be removed through the colonoscope, thereby preventing the development of cancer. Colonoscopy, which is covered by Medicare and many insurance plans, carries a very small risk of complications such as bleeding or damage to the colon wall.
Typically, to prepare for a colonoscopy, a person begins a clear-liquid diet the day prior to the procedure. These liquids, such as juices or broth, can contain calories, and they can be taken until four hours before the test. During the afternoon or evening before the colonoscopy, a special laxative solution is taken. Most people — even those, such as diabetics, who may have special dietary requirements — are able to safely proceed with such bowel preparation. In any case, an advance meeting with the doctor who will perform the test could identify any special adjustments in diet or medications that you might require.
Other tests can screen for colorectal cancer. Fecal occult blood testing checks samples of stool for hidden blood that may come from cancers or large polyps, but not all can be detected with this test. Flexible sigmoidoscopy — a shorter version of a colonoscopy — sees only the lower third of the colon. And a barium enema uses X-rays to outline the colon and detect polyps.
Bowel preparation is required for sigmoidoscopy and barium enema, however, and the finding of polyps on either test will lead to colonoscopy in order to examine the entire colon and remove all polyps.
A new test, “virtual colonoscopy,” allows doctors to examine your colon without going inside with a colonoscope. After a bowel cleansing similar to that used for standard colonoscopy, a computed tomography, or CT, scan of the abdomen and pelvis is performed. To aid in this scan, the colon is inflated with air through a small tube placed in the rectum. The CT images are then examined to detect any polyps and tumors.
Although it is a promising new tool, virtual colonoscopy is not currently recommended for general use, and it is not covered by Medicare and many insurance plans. If polyps are found on this test, it is followed by standard colonoscopy to remove them. Another new test under development checks a stool sample for genetic material (DNA) from cells that are shed from tumors or polyps.
Bottom line: Everyone age 50 or older should undergo a screening test for colorectal cancer or polyps every three to 10 years, depending on one’s personal and family medical history. We recommend colonoscopy as the best test for most people, but having any screening test is better than doing nothing. Almost everyone can safely have colonoscopy, but consultation with your physician will help determine which test is best for your situation.
— Mark E. Stark, M.D., Division of Gastroenterology and Hepatology,
Mayo Clinic, Jacksonville, Fla.
Additional Resources:
Colon Cancer
Appointment Information
More Information on Colon Cancer
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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