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Lourdes Gastroenterologist Gives Options for Colon Cancer Screening, Says Best Test is the One that Gets Done

Colorectal cancer is second-leading cause of cancer-related deaths in the United States. The American Cancer Society estimates there will be nearly 137,000 new cases of colorectal cancer this year and that the disease will cause 50,000 deaths.

So how do you know if you’re at risk and if so, what can you do to prevent it? While you cannot control your age and family history, you can reduce your risk with regular screenings for colon cancer, says a Lourdes gastroenterology expert.

“Regular screening is the most powerful weapon for preventing colorectal cancer,” said chief of Gastroenterology at Lourdes Medical Center of Burlington County Dr. Donald Petroski. “Early on, colorectal cancer does not cause any symptoms, so many people don’t go to the doctor until their disease has reached a late stage. Colon screening can detect cancer early, when it is most treatable.”

Some people develop polyps–small clumps of cells on the lining of the colon or rectum. While most polyps are harmless, some can become cancerous and spread to other parts of the body, said Dr. Petroski.

To detect polyps early and possibly prevent colon cancer, experts recommend men and women get their first colonoscopy at age 50. African-Americans should begin screenings at age 45. For those with a prior or family history of colorectal cancer or polyps, screenings should begin earlier–at age 40 or 10 years before the family member had the disease, whichever is sooner.

Colonoscopy is the gold standard for both diagnosis and prevention of colon cancer, said Dr. Petroski. “Colonoscopy has a two-fold benefit.   It allows doctors to identify polyps and remove them.   It’s the most effective tool we have. It offers diagnostic screening and therapeutic treatment. Accuracy and safety depends on a careful investigation of the entire length of the colon in a properly cleansed patient.”

With a colonoscopy, the rectum and entire colon are examined using a flexible lighted instrument called a colonoscope.   Colonoscopy includes sedation as well as a bowel prep.   For these reasons, Dr. Petroski said some patients put off colonoscopy. “Having no screening greatly reduces our chances of detecting colon cancer.   For patients who do not want a colonoscopy, there are other several other colorectal screening options.”

Like colonoscopy, other screening tests begin at age 50, and for people at increased risk because of family history of colorectal cancer or polyps, screenings should begin earlier–at age 40 or 10 years before the family member had the disease, whichever is sooner.

In addition to colonoscopy, other colorectal screening options include:

  • Fecal occult blood test (FOBT):    FOBT checks for tiny amounts of blood in feces that cannot be seen.   Guaiac FOBT (gFOBT) testing requires multiple stool samples to be collected by a patient using a kit then returned to the doctor. No colon cleansing is necessary. Yearly testing is recommended if FOBT is the only screening test performed. False-positive test results are possible with FOBT. Additional procedures, such as colonoscopy, may be needed if the test result shows blood in the stool. Unfortunately, it is the least accurate study we have available.
  • FIT (Fecal Immunochemical Test or iFOBT): Detects blood via stool sample more accurately than FOBT to help find precancerous polyps or colorectal cancers. Small amount of blood leaks into the colon and is detected upon sampling. Easy to do, done in the privacy of the home, and not effected by diet or medicines since it only detects human blood. It is   more accurate than the FOBT, inexpensive, is covered by Medicare insurance, but must be done annually.
  • ColoGuard: First noninvasive screen for colorectal cancer that involves stool DNA and blood so that its accuracy is increased. If positive, the patient will undergo colonoscopy and if negative will be retested every three years. It was FDA-approved in 2014 and Medicare recently has approved it. The U.S. Preventive Services Task Force  has not added it to its recommended national guidelines to date. It costs up to $600 and not all insurances have agreed to cover it as of yet.
  • Sigmoidoscopy: In this test, the rectum and sigmoid colon  are examined using a flexible lighted instrument called a sigmoidoscope. During the procedure, abnormal growths in the rectum and sigmoid colon can be removed for analysis. The lower colon must be cleared of stool before sigmoidoscopy, but the preparation is less involved than that required for colonoscopy. Most people are not sedated for the procedure. It is recommended every five years along with FOBT every three years for people at average risk who have had negative test results. Due to its limitations of the study only of the left side of the colon, most physicians are suggesting other tests that check a larger area of the colon.
  • Double-contrast barium enema (DCBE):   In this test, a series of x-ray images of the entire colon and rectum is taken after the patient is given an enema  with a barium solution. A bowel prep must be done for this test. The barium helps to outline the colon and the rectum on the images. Radiation exposure occurs and the patient is not sedated. DCBE is not widely used because it is less sensitive than colonoscopy for detecting small polyps and cancers. However, it may be used for people who cannot undergo standard colonoscopy–for example, because they are at particular risk for complications.
  • Virtual colonoscopy (CTC — CT Colonography):  A fairly new method of screening, this test uses special  x-ray  equipment to produce pictures of the colon and the rectum from outside the body. A computer then assembles these pictures into detailed images that can show polyps and other abnormalities. Virtual colonoscopy does not require sedation. As with standard colonoscopy, a thorough cleansing of the colon is necessary before this test. If polyps or other abnormal growths are found during a virtual colonoscopy, a standard colonoscopy is usually performed to remove them.
  • PillCam COLON:   Available on a limited basis colorectal screening exams is PillCam COLON.   Approved by the FDA in 2014, a ¾-inch long plastic capsule with a tiny wireless camera is swallowed by the patient. The pill takes high-speed photos as it slowly passes through the intestinal tract over eight hours. Bowel prep is required and if a polyp is seen, then a regular colonoscopy might be needed. Patients do not need sedation for this test. The PillCam passes out of the body within 24 hours. Insurance approval may be available if a colonoscopy cannot be done but the test itself is not widely available in the community.

Dr. Petroski said the decision about which test to have usually takes into account several factors including patient’s age, medical and family history, and overall general health.

“The best test is the one that gets done,” said Dr. Petroski.   “A large percentage of population numbering in the millions is not getting tested. Some think because they have no symptoms and no family history, ‘why get screened?’   Or ‘if I have colon cancer, there’s nothing I can do, so why bother getting screened.’ But there is something that can be done. Early detection can save your life.   Colon cancer is the second leading cause of death in the U.S. It’s not a disease of older people or of men alone. It’s easy to want a shortcut, but there is none. I can’t stress enough how important it is to be screened for colon cancer.”

Dr. Petroski urges people to talk with their health care provider about when to begin screening for colorectal cancer, what tests to have, the advantages and disadvantages of each test, and how often to undergo screening.

“Polyps do not fall off or take care of themselves,” added Dr. Petroski. “The steps you take now can lead to a longer, healthier life.”

To schedule a screening appointment with a Lourdes colorectal specialist, please call 1-888-LOURDES or visit www.lourdesnet.org.

 

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