No buts About It: A colonoscopy can save your life

You want to do what? I'm not old enough. That's a man's problem. I've never had a problem … down there.

This list could go on and on. As a gastroenterologist these are a few of the things that I have heard when suggesting that a patient should have a colonoscopy for colon-cancer screening. So why do I do it? The simplest and most important reason is because it can help prevent colon cancer from occurring.

Colon cancer is a cancer that develops in the colon and rectum. It occurs in both men and women. It usually progresses from a polyp; a benign, or noncancerous, growth on the inside of the colon wall. During a colonoscopy polyps can be found and removed. Once removed they will no longer grow and thus cannot turn into cancer. This is one of the reasons that colonoscopy is used as a screening tool for colon cancer.

What is a colonoscopy exactly?

A colonoscopy is a direct visualization examination of the entire colon. The test is both diagnostic (it finds the polyps) and therapeutic (it removes the polyps). It happens like this: The day prior to the evaluation the colon must be cleaned out. This is the part of the exam that everyone seems to know about. The good news? Enemas are no longer required for the cleansing process. One must consume only clear liquids for the entire day before the examination. The night before, and the morning of the test, one must drink a gallon jug of "delightfully" flavored solution that briefly causes some temporary diarrhea.

Patients then come to the surgery center or the hospital. An IV is started and sedation is given. The test occurs while under sedation. The test involves guiding a thin, flexible, lighted tube through the colon to look for any abnormalities. The newest generation of colonoscopes uses HD optical sources that makes lesion detection very reliable. Once the test is completed the patient typically rests and recovers for about an hour and then goes home. All specimens obtained during the examination are sent to the pathologist for evaluation.

So who should be tested?

Everyone should be tested. The question is only when. General screening for everyone is suggested to begin at age 50. This age is chosen because about five percent of people will develop colon cancer during their lifetime; 90 percent of those cancers that do occur will develop after the age of 50.

There are certain conditions for which it is preferable to start screening at an earlier age: if your family has a history of colon cancer (especially a mother, father or sibling); onset of symptoms (such as rectal bleeding, a change in bowel habits, unexplained weight loss, to name a few); having a hereditary condition that can predispose you to colon cancer (a polyposis syndrome, for example); having other illnesses that are associated with a higher rate of developing colon cancer, such as Crohns disease or ulcerative colitis.

Post Exam

The next question arises: When do you have to come back? That time interval depends on why you had the test done and what was found.

In general, a low-risk person (without any added risk factors) who has a normal exam will have a 10 year follow-up interval. For people who have polyps removed at the time of the colonoscopy, a three- to five-year follow-up is typical. This variance depends on the number of polyps removed and the type of tissue that is seen by the pathologist when the polyp is examined under a microscope. If someone has another illness that is associated with colon cancer, then a two- to five-year follow-up is typical.

For hereditary conditions, a one- to two-year interval is recommended. Surgery is often needed to remove the entire colon for the most aggressive of these conditions, because the chance of developing cancer in those cases is 100 percent.

Practicing preventive medicine is the most beneficial and desirable way for your doctor to help you keep you – and your colon – healthy.

Goldman is a gastroenterologist with Digestive Health Associates of Northern Michigan.