Colonoscopy worth un­pleas­ant­ness, time

The Washington Times Daily - - Life - DR. DAVID LIPSCHITZ

March is Col­orec­tal Can­cer Aware­ness Month. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion, col­orec­tal can­cer is the sec­ond lead­ing cause of can­cer deaths in men and women.

The dis­ease is slightly more com­mon in men, af­fect­ing 55 per 100,000, com­pared with 41 per 100,000 women. Of these, 20.7 per 100,000 men and 14.5 per 100,000 women die from the dis­ease. The life­time risk of de­vel­op­ing colon can­cer is 5.1 per­cent.

If the can­cer is di­ag­nosed while it’s lo­cal­ized to the colon, sur­vival rates are 95 per­cent. If it has spread to re­gional lymph nodes, the chance of sur­vival drops to 69 per­cent, and if it has spread more dis­tantly, the sur­vival rate is less than 11 per­cent.

The key to sur­vival is early de­tec­tion. Yet, de­spite the preva­lence of this ill­ness, screen­ing tests for col­orec­tal can­cers are done far too in­fre­quently. I guess we all find the idea of a day and a half of bowel cleans­ing fol­lowed by a visit to a gas­troen­terol­o­gist, se­da­tion and ex­am­i­na­tion just too darn em­bar­rass­ing.

So I will say this as strongly as I pos­si­bly can: Screen­ing for col­orec­tal can­cer saves more lives than any other can­cer­screen­ing pro­gram. Thank good­ness, the mes­sage is get­ting through. Ac­cord­ing to the CDC, the num­ber of Amer­i­cans be­ing ad­e­quately screened for colon can­cer has in­creased from 52 per­cent in 2002 to 65 per­cent in 2010.

Screen­ing in­volves an­nual test­ing for mi­cro­scopic amounts of blood in the stool. This in­volves plac­ing a small amount of stool on a card and mail­ing it back to your physi­cian for test­ing. Although an early fea­ture of can­cer and con­di­tions that lead to can­cer, bleed­ing from the bowel also can oc­cur from hem­or­rhoids, di­ver­tic­u­lo­sis and mal­for­ma­tions of blood ves­sels in the colon.

Any­one who has blood in his or her stool that is ei­ther vis­i­ble or present in mi­cro­scopic amounts must have fur­ther test­ing to ex­clude the pres­ence of can­cer or polyps that have the po­ten­tial of be­com­ing can­cer­ous.

For most peo­ple, a colonoscopy to screen for colon can­cer should be done ini­tially at age 50. I had my first colonoscopy at age 40 be­cause col­orec­tal can­cer is very com­mon on both sides of my fam­ily. Rel­a­tives of colon can­cer vic­tims are at much greater risk of de­vel­op­ing the dis­ease. Many fam­i­lies, such as ours, have genes that pre­dict a high risk. Fur­ther­more, the can­cer tends to oc­cur, on av­er­age, 10 years ear­lier than ex­pected, and con­se­quently, screen­ing should com­mence at a younger age.

The goal is to find and rec­og­nize polyps be­fore they be­come ma­lig­nant. A study pub­lished in the New Eng­land Jour­nal of Medicine showed that iden­ti­fy­ing and re­mov­ing polyps re­duces the risk of death from col­orec­tal can­cer by more than 50 per­cent. It takes three to five years for a polyp to de­velop and an­other five years to be­come ma­lig­nant.

If a colonoscopy is done and polyps are iden­ti­fied and re­moved, the pro­ce­dure should be re­peated af­ter three years. If the colonoscopy is nor­mal, it should be re­peated ev­ery five years. Most polyps that are iden­ti­fied dur­ing the colonoscopy can be re­moved im­me­di­ately and sent to the lab­o­ra­tory for mi­cro­scopic test­ing. Sus­pi­cious-look­ing le­sions also can be biop­sied and an early can­cer di­ag­nosed. In some cases, surgery will be needed to re­move the can­cer.

The worst part of the colonoscopy is the prepa­ra­tion. I have tried them all, and they are no fun. Some rec­om­mend the use of Fleet’s Phos­pho-soda prepa­ra­tion. This in­volves a liq­uid diet for two days and then tak­ing a few ounces of a liq­uid that causes di­ar­rhea. The fol­low­ing morn­ing, you are sup­posed to use a Fleet’s en­ema.

To­day, this ap­proach is not used as much be­cause of a slight risk of kid­ney fail­ure. Most gas­troen­terol­o­gists rec­om­mend drink­ing a liter of Golytely that, rest as­sured, cleans your bowel com­pletely.

Many put off hav­ing colono­scopies be­cause of its un­pleas­ant na­ture. Don’t put it off! Colon can­cer is a killer, and a colonoscopy can save your life.

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