Colonoscopy Is Start to Next Stage of Life

By David W. Croy, MD
department chair
Mercy Clinic Oncology and Hematology

Certain milestones in life are causes for celebration, with some of them eagerly anticipated. At age 5, you enter kindergarten. At age 16, you can get a driver’s license. At age 21, you can have your first legal drink.

After 21, it all seems to go downhill until age 45, when it’s time for a colonoscopy.

It’s kind of like being 21 all over again. You get to spend a night out drinking (GoLytely), it requires a designated driver, for several hours the commode becomes your best friend, and there is always the possibility that something you say or do while “under the influence” could end up on YouTube.

What’s not to like? Apparently, there’s quite a bit.

A survey published in GI and Hepatology News canvassed 997 middle-aged adults and revealed that only 38 percent of those advised by a primary care doctor to get a colonoscopy did so. There are many excuses: cost, inconvenience, taking time off work, the preparation and thoughts like “I feel good, why do I need a colonoscopy?”

I’ve heard all the excuses. Every day I treat advanced colon cancer patients. Each one represents a life cut short by a disease that easily could have been prevented. We aren’t kidding when we claim this screening procedure can save your life; yet, resistance to the procedure remains high.

A colonoscopy utilizes a thin, flexible tube with a video camera that allows the operator to see the colon to detect, biopsy and often remove abnormalities such as polyps. Certain polyps have the potential to evolve into a cancer over time. If removed during a colonoscopy, they don’t have the opportunity to degenerate into a cancer that could take your life.

The screening test is recommended at age 50 for patients with standard risk for developing colon cancer. Patients at higher risk (such as family history, Lynch syndrome, inflammatory bowel disorders, etc.) may need earlier screening.

The procedure requires a prep that clears the colon and often involves a liquid diet followed by an agent that creates loose stools or diarrhea. The prep is needed to empty the colon for the test. Many patients claim the prep is the least desirable part of the process and a reason to procrastinate or avoid the test.

The following day, you arrive at the endoscopy suite, sedation is utilized to make the test comfortable, and you leave after awakening, provided there are no complications. You will need a driver to take you home, and you should stay home the remainder of the day to allow any residual sedation to clear.

While there are other options, a colonoscopy remains the gold standard. There are non-invasive tests based on detecting blood or cancer-related DNA in stool samples.

Many are familiar with the “stool card test” (guaiac fecal occult blood test) method, which uses a chemical indicator to detect the presence of blood in the stool. The downside to this test is that recent ingestion of a rare steak can cause a positive reaction.

The fecal immunochemical test (FIT) uses antibodies and detects only human blood, decreasing false positives. A recent statement by the U.S. Multi-Society Task Force on Colorectal Cancer recognizes that FIT is an excellent alternative to screening colonoscopy, but does not replace it.

This test is approximately 80 percent sensitive for detecting cancer and 20 percent to 30 percent sensitive for detecting pre-cancerous conditions when used as a single event test. FIT also was found superior to guaiac-based fecal occult blood testing.

Additionally, stool DNA testing is available. This test looks for certain alterations in DNA shed from cancer cells into the stool. Unfortunately, if any of these turn positive, the next step involves a colonoscopy.

It seems colonoscopy is the final common pathway. The procedure is needed to directly visualize the colon and identify the source of the positive test.

While there are a variety of tests to detect colon cancers early, none of them work if they are not used. It’s relatively easy to prevent an unnecessary death from advanced colon cancer. At most, it’s a day or two of inconvenience.

Get screened. There really is no valid excuse for waiting.

David W. Croy, MD, is department chair of Mercy Clinic Oncology and Hematology, 100 Mercy Way, Joplin, and can be reached at 417-782-7722. The department is part of the Mercy Cancer Center.