I remember my first colonoscopy. Who doesn’t? When their patients get to a certain age – 50, to be exact – doctors start recommending periodic checks for colon cancer. This, in and of itself, is a great idea to avoid a very serious disease. But no one wants to have this test – go figure.
Perhaps it’s because people facing a colonoscopy have to alter their eating habits for a few days to clear the colon. My doctor told me to go on a low-fiber diet for the 48 hours before my trip to the hospital’s imaging department. The day before the exam, I could drink only clear liquids (no vodka, though) to stay hydrated and flush my inside out.
My doctor prescribed me a gallon jug of some of the nastiest-tasting liquid I ever poured down my gullet – “bowel prep” – which has a laxative effect. I took half of this vile stuff the night before C-Day and the other half the following morning.
After being delivered to the waiting area – it’s always good to arrange for round-trip transportation – I sat around with a bunch of other folks also looking forward to experiencing the thrill of having a long, flexible tube inserted into the place where the sun don’t shine until it’s their turn.
A nurse gave me a hefty dose of prescription-strength ibuprofen before the procedure to reduce pain and inflammation from irritated bowel tissues. My case was typical: I was put under partial sedation so I could respond to instructions from the technicians and physician performing the delicate maneuvers. Then, I was given not one, but two, enemas to remove all fecal matter from my colon. The hard part was holding the solution between clenched cheeks for five minutes.
After that delightful experience, I was told to lie on my left side. From time to time, the doctor would ask me to shift my body position as the scope through my innards to provide a clearer view.
The colonoscope is small, about a half-inch in diameter, and takes pictures of the lining of the colon between its entry at the rectum as far as the end of the large intestine, at which point it is retracted (pulled back out). The flexible scope can follow the bending curves of the colon.
The scope expands the colon by blowing air to give the camera a better view as the doctor pushes the instrument carefully through the colon.
A colonoscopy lasts from 30-60 minutes, on average. If the doctor spots an abnormality during the camera sweep, a small tissue sample can be removed for laboratory analysis. This is called a biopsy and is very effective in determining if a troublesome polyp is benign (harmless) or malignant (cancerous).
Pre-cancerous growths in the colonic tract revealed by examining the images captured by such a colorectal cancer screening can be removed before progressing to a more advanced stage that would require a major surgery.
As I said before, the average Joe or Josephine would rather rake acorns than willingly submit to having a tube shoved up their butt (it had to be said). So, I was intrigued when a close friend confided that she had just mailed in a stool (poo) sample to avoid undergoing a colonoscopy.
My friend works and said it had taken a month to time everything so she was at home “at the right time” with the do-it-yourself sample collection kit which had arrived by mail from the testing facility. “Mission accomplished,” she beamed, “I just mailed back my testing kit. Now, all I have to do is wait.”
Within two weeks, my friend should get the inside skinny on her colonic health. The stool DNA test prescribed by her physician to screen for bowel problems is far less expensive than a colonoscopy. The results will show if there is any blood in the stool sample, a common symptom of colon cancer or pre-malignant polyps. Changes in cellular DNA linked to cancer will also be reported.
A colonoscopy is a visual test for cancer. Alternative imaging procedures include:
CT colonography (virtual colonoscopy) – a scan that shows detailed cross-sectional images of the colon and rectum to check for polyps or cancer. This diagnostic test also requires bowel prep but no sedation. As with a colonoscopy, the CT scanner pumps air to expand the colon for better imaging. If anything looks suspicious, a follow-up colonoscopy will be ordered.
Flexible sigmoidoscopy – rarely used in the U.S., the procedure is much less intrusive but also less informative as the scope inspects only a specific part of the colon and rectum rather than the entire tract. A milder bowel prep is needed and typically no sedation is administered. If polyps are identified, they may be removed on the spot. A colonoscopy is typically scheduled to examine the rest of the colonic system for abnormalities.
My friend’s test was a stool test for cancer. Other stool tests that can be mailed to a testing lab include:
Fecal immunochemical tests (FIT) – approved by the Federal Drug Administration (FDA), these stool sample tests come in wet and dry versions and are repeated annually. A FIT test detects about 73 percent of colorectal cancers. Used every year, 10 screenings over 10 years make it just as effective as one colonoscopy every 10 years, the standard medical recommendation.
One way or the other, colo-rectal exams are important for detecting cancerous growths early. If you are 45 or 50 years old, talk to your healthcare provider about colon cancer screening.