• Colon Cancer Screening: Why is this important for me even though I feel fine?
  • Who should have colorectal cancer screening?
  • What if I have symptoms like constipation/diarrhea, pain or bleeding?
  • What screening tests are available?
  • Does colonoscopy hurt?
  • Is colonoscopy safe?
  • Who does the screening exam?
  • Why should I go to Dr. Chodos for my colonoscopy as opposed to someone else?
  • What procedures are covered by my insurance?
  • What else beside colon cancer screening can be done to prevent colon and other cancers? Role of diet, weight and exercise.

Colon Cancer Screening: Why is this important for me even though I feel fine?

Colon cancer, the number two cancer killer in America, is a genuinely preventable disease. The lifetime risk of colon cancer is estimated at 6%. It is unlike breast cancer, for example, which can be early detected by mammogram screening, but not prevented by it. Colon cancer is actually preventable with screening. The reason for this is that almost all (over 95%) of colon cancers in the Western world arise from benign colon polyps called adenomas which exist for years before a cancer develops and can be easily removed before colon cancer has a chance to develop. These polyps can be detected and removed with colonoscopy, a fairly simple 40-minute outpatient procedure that is done under intravenous sedation (a type of "anesthesia") with just one day lost from work.

Colon cancer or polyps can occur without symptoms. Most polyps produce no symptoms and most colon cancers produce few if any symptoms until they are advanced-when care is more difficult.

Constipation or diarrhea is not a good predictor of colon cancer or polyps and is usually due to causes other than cancer. You don't have to have rectal bleeding to have a colon problem.

Rectal bleeding often occurs from causes other than cancer.

All rectal bleeding should be investigated with a physician, but you should not assume that rectal bleeding is necessarily due to cancer.

Who should have colorectal cancer screening? What is involved?

Firstly a "screening exam" refers to an exam for person without gastrointestinal symptoms. For those with symptoms see the question below.

All individuals above the age of 50 who are in reasonable good health. For those with a family history of colon cancer or adenomatous polyp in a first degree relative (i.e. parent or brother/sister/child) screening should begin at age 40.

What if I have symptoms like constipation/diarrhea, pain or bleeding?

When you have symptoms the exam you need is not called a screening exam, but rather a diagnostic exam. The type of exam(s) you need will need to be discussed with a physician and tailored to your individual care. The proper evaluation of any patient's symptoms starts with your doctor getting a detailed history (story) of your symptoms then examining you and then deciding what tests to do next.

What screening tests are available?

Fecal Occult Blood (guaiac testing "hemoccult testing") - testing of stool sample for hidden blood. Simple and inexpensive, but can have many false positives and false negatives. Commonly performed, but value is limited due to lack of specificity.
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Flexible Sigmoidoscopy - a short thin flexible scope (like a short colonoscope) is inserted into the rectum and advanced part way up the colon (the "sigmoid" colon) to examine it. Done in a doctor's office after taking a laxative or Fleets enema at home. Takes 10 minutes and is done lying on your left side, awake. Somewhat uncomfortable for some. It is a good test, but limited in that it only looks at part of the colon. A reasonable test for average risk individuals, but not as good as colonoscopy.
Colonoscopy - a long thin scope that looks at the entire colon. Done in an out-patient hospital (GI Lab) or surgicenter, endoscopy center type setting with intravenous sedation ("sleepy medication", "anesthesia"). Takes about 40 minutes or so and about 30 minutes to recover. Laxatives (oral) are taken the night before and early in the morning day of the exam. No enemas are needed. Colonoscopy is considered the most accurate of the available screening tests on the colon and is the only one where colon polyps can be removed at the time of the procedure.
X-ray exams - Barium enema or virtual colonoscopy (a special CT scan of colon ) are alternatives that are not invasive but give only an indirect view of colon and do not allow for tissue sampling or polyp removal. Some X-ray radiation exposure is involved.
Cologuard - A stool based test that looks at abnormal DNA in cells sloughed off from colon and for blood in stool. Easy to do but costs a few hundred dollars. Is covered by Medicare. Can help detect if colon cancer is present or if have an advanced polyp that is close to becoming cancerous. Has false positives (up to 40%) and negatives. Unlike colonoscopy does not prevent cancer. A positive Cologuard will usually result in needing to have a colonoscopy done.

Does colonoscopy hurt?

Almost no pain or discomfort is felt with colonoscopy since it is done under intravenous sedation with "sleepy medication" consisting of a sedative (Propafol), narcotic (Fentanyl), and a valium like drug (Versed), which together cause you to be a "twilight sleep" and to have amnesia for the procedure. Most people have very little or no recall of the procedure and feel as if they were "totally out" even if they were not. Some bloating and gas may be felt temporarily after the procedure, but this is minimized by the use of carbon dioxide gas rather than air being inflated into the colon during colonoscopy. Intravenous sedation is simpler and safer than general anesthesia.

Is colonoscopy safe?

In experienced, trained hands, colonoscopy is a very safe procedure. Like all procedures involving something inserted temporarily into the body, there are always some risks but these are very small (risk of serious complications estimated to be less than 1 in 1000) and the benefit (preventing colon cancer and diagnosing disease) is felt to clearly outweigh the small risk.

Who does the screening exam?

Fecal occult blood testing and flexible sigmoidoscopy are available through your internal medicine or family physician. In some cases your family physician may not do sigmoidoscopy and refer you to aspecialist for this.

Colonoscopy is done by a specialist, usually a gastroenterologist, but some surgeons also do colonoscopy.

Why should I go to Dr. Chodos for my colonoscopy as opposed to someone else?

There are many physicians in the area qualified to competently do colonoscopy. Dr. Chodos' practice style however is different than many other physicians in that he makes more time than most other doctors with each patient before the procedure and after.

Each patient is seen in the office first before any procedures are decided on and there is an opportunity to take a careful history that may uncover other problems or considerations, review the procedure, risks involved with the procedure (all procedures have some risks although small in frequency) and to answer any questions before you commit to having a procedure. Dr. Chodos also meets with you after your procedure briefly that day and in the office later date so that findings can be reviewed including results of biopsies.

Dr. Chodos also is one of the few physicians who calls each patient at home the night before and the night after each procedure to check on how you are doing. There is no extra charge for this service. Dr. Chodos has a special interest in colon cancer screening. He has been involved in colon cancer prevention and early detection projects and education for many years. Dr. Chodos has given lectures to other physicians on this topic and written articles on cancer prevention in medical journals.

What procedures are covered by my insurance?

This varies by insurance company and specific policy, but most major insurances like Medicare, Blue Cross, Aetna, Cigna, and other cover colonoscopy and flexible sigmoidoscopy for average individuals over age 50 (younger in some cases depending on patient risk factors like family history of colon cancer). If not sure you should check with your specific insurance carrier for your particular policy.

What else beside colon cancer screening can be done to prevent colon and other cancers? Role of diet, weight and exercise.

Studies of large populations have shown that being overweight and having a high fat diet are risk factors for colon and other cancers such as breast and uterine cancers. A high fiber, low fat diet that is rich in fruit and vegetables with sparing use of foods like red meat is felt to be of benefit in long-term cancer prevention. Regular exercise is also thought to have protective effects probably through its help in controlling weight.