Early detection of cancer is a worthy goal; even better is early detection that keeps you from having cancer at all. For that, colonoscopy is our best friend. “With high definition images, enhanced scope handling, better preps, and I.V. sedation, it is about as comfortable as it can be, and very accurate,” says Dr. David Benage with Gateway Gastroenterology. He says in deadly cancers, colon cancer is second only to lung cancer. That doesn’t have to be the case.
“What makes colon cancer different is that it starts as a polyp and grows slowly over eight to 10 years,” explains Benage. “While other screening tests find the cancer, colonoscopy removes the polyp and you never get the cancer. It’s the only preventable cancer we deal with that has a lag phase in which to catch it. No one would let something grow on their arm, face or neck for 10 years that can kill them, but we do it with our colon because we can’t see it.”
He says board-certified gastroenterologists painstakingly examine every nook and cranny of the colon and remove any polyps. Another screening test, often called virtual colonoscopy, is really just a CAT scan with software. “Patients still have to do the prep, but they are awake for the discomfort,” Benage says. “In addition, virtual colonoscopy misses 90 percent of polyps under one centimeter, so if a polyp is discovered, a colonoscopy is still needed to remove it. And a CAT scan throws off a lot of radiation, so it’s not a benign test.”
Dr. Christine Hachem of Saint Louis University School of Medicine says her field has been working hard on making the preps safer, more palatable and more effective. She says the favored protocol for cleaning out the colon now is Miralax, a powder that mixes with 64 ounces of Gatorade. “Many people won’t have a colonoscopy because of the preps,” Hachem admits. “Some of the earlier ones were taken off the market because they were so hard on the kidneys and heart.”
Hachem says two new procedures show great promise. Small bowel capsule endoscopy involves a camera capsule that is swallowed and takes pictures as it goes down the GI tract. The patient is awake and goes about his daily activities over the eight hours it takes to pass through the small intestine, an area that isn’t visualized in a colonoscopy.
A new version, the capsule colon endoscopy, has a longer battery life, enabling it to take pictures of both the small intestine and the colon. Hachem says it is being piloted in the U.S. and is in wide use in Europe. If you have this procedure done and it doesn’t see any polyps, you don’t need a colonoscopy. For the capsule endoscopies to be effective, however, good bowel prep is even more important.
Dr. David Lotsoff with Endoscopy Center of St. Louis and Digestive Disease Medical Consultants says the main risk factor for colorectal cancer is age. Even without a family history, if you’re over 50, you should get screened. Because polyps take about 10 years to turn into cancer, the current recommendation for low-risk people with no polyps on the initial exam is a colonoscopy every 10 years. Finding polyps would change the recommended frequency to every three to five years. If you have a near relative with colon cancer, your screening should start at age 50 or 10 years prior to that relative’s age at diagnosis, whichever is earlier. African-Americans should be screened starting at age 45 because they have a higher incidence of colon cancer.
Lotsoff says colonoscopy and polyp removal is like weeding your garden. If you pull out the weeds as they arise, they won’t take over. “People are embarrassed to talk about it because it’s the colon. The worst part of my job is to find a colon cancer I knew could have been prevented. My advice is: Don’t be embarrassed to death”