Tuesday, November 21, 2006

Colonoscopy to Detect Colon Cancer

Colorectal cancer is second only to lung cancer as the most common cause of cancer death. While many cancers are difficult to screen or prevent, colon cancer can be easily detected in its early stages by a colonoscopy. The American Cancer Society recommends that beginning at age 50 a colon cancer screening test should be done. If there is a family history of colorectal cancer in a first degree relative, then the test may need to be done sooner than age 50, usually about 10 years before the age of diagnosis of the family member. For details of the recommendations see here.

There are several colon cancer screening tests that are available. My preferences and the standard of care in my community are to do the following tests:
--Fecal occult blood tests every year. A card is given to the patient and the test is done at home.
--Colonoscopy may be the most effective screening test for colon cancer. It is recommended every 10 years if the initial colonoscopy is normal. For a first hand personal experience of the procedure by a blogger read here.

Other tests which are also available and recommended by ACS, but which I do not suggest for my patients are:
--Flexible sigmoidoscopy every 5 years. This tool examines the lower 60 cm of the large intestines. However, it may miss cancers that are higher up in the intestine.
--Double-contrast barium enema every 5 years. A chalky substance, barium, and air is inserted into the large intestine and then xrays are taken. This test can be painful and exposes you to some radiation without giving the operator of the procedure a chance to remove a suspicious lesion or polyp if seen. If any abnormalities are seen with either of these procedures, a colonoscopy would then be indicated.
--Virtual colonosocpy is still under investigation. It allows visualization without access to the polyp for removal.

"Bottom" line: colonoscopy is still considered the gold standard for detection of colon cancer. If you have concerns regarding the procedure discuss it with your doctor. And remember like most things in life, the anticipation is worse than the deed.

References: please see specific links.