The American Cancer Society recently updated its colonoscopy guidelines for men and women, regardless of family history. Visit cancer.org for details.
Chocolate-laced drool trickling down your preschooler’s chin. A demonic clown with green nubs for teeth. Or that eerie scene from Ghostbusters when the gentle librarian’s spirit hovers in the stacks and transmogrifies into an evil zombie.
These days, and especially as Halloween draws near, a lot of creepy concepts are top-of-mind no matter your age. But to some folks approaching fifty, nothing is as scary as the thought of a colonoscopy. What if colon polyps run in your genes? And hey, what if they don’t? In fact, no one in your family has ever had a benign polyp removed, let alone a cancerous one, and still your primary physician is strongly suggesting, urging, almost insisting that you have a colonoscopy. The very thought of it sends chills down your spine. You remember the story your uncle shared – at the dinner table no less – about his experience with the procedure.
It’s an important test performed in doctors’ offices and ambulatory surgery centers worldwide to screen for colon cancer, which is the second leading cause of cancer death in the United States. Does that stat surprise you? You’re not alone.
Paul Charron, MD, with Colon and Rectal Specialists of Richmond, says many people are misinformed when it comes to the relevancy of colon cancer. “They think colon cancer isn’t common, or that because it doesn’t run in their family, they won’t get it,” says Dr. Charron. “But people have a one in seventeen lifetime risk of getting colon cancer.” What’s more, the doctor says, the most common form of colon cancer is sporadic, or the kind that it is not inherited, with no changes in bowels, and no symptoms at all. This makes following the American Cancer Society’s (ACS) recommendations for regular screening – colonoscopy every ten years starting at fifty – even more important.
Research has shown that nearly every case of colon cancer can be diagnosed early and quickly treated by following ACS guidelines. The very nature of the disease, in fact, means opportunity for detection is abundant. Colon cancer usually takes years to develop. Most cases start with what’s known as a benign polyp, or small growth, arising from the lining of the colon. The typical cancer will take about seven years to develop within a polyp, and will then gradually grow into the bowel wall and possibly spread to other parts of the body. The larger the tumor and more widespread the disease, the more likely it is to be fatal. Early detection, as in most kinds of cancer, is vital to survival.
“The simple and non-scary fact is that if polyps are removed before they can become cancerous, colon cancer will not happen,” says Dr. Charron. It’s this long natural history of cancer formation in a polyp that has lead to recommendations For regular screening. Colonoscopy is the most effective screening procedure there is.
So where’s the disconnect?
People put off plans to have this life-saving test performed for a number of reasons. Primary among them is the colonoscopy’s reputation. Dr. Charron, who performs the procedure at his Stony Point office, says in the past colonoscopies were a lot more frightening and uncomfortable than they are today. Fortunately, the science has evolved: the equipment is smaller, streamlined, and more effective; The preparation is easier; and sedation is much more gentle. It’s sedation and anesthesia that have a lot to do with the poor standing of the colonoscopy. Says Dr. Charron, “People used to be awake during the procedure – or in a sort of twilight state.” These days, many physicians choose to administer propofol for the procedure. If that sounds familiar, it’s because propofol received unwanted attention for its association with Michael Jackson. Despite this press, Dr. Charron says the anesthesia is completely safe and highly effective. The specialist also reassures patients that they will be asleep for the duration of the colonoscopy. “One of the things I hear a lot is ‘Am I going to be awake again for this procedure?’ And I am quick to tell them that they will not wake up until it’s over.”
A colonoscopy is performed in your doctor’s office or in an outpatient surgery center, using a form of anesthesia. During the procedure, the doctor will gently insert a soft, flexible, lighted tube, called the colonoscope, into your large intestine. The doctor will be able to move the lighted end of the scope to the very beginning of your bowel, where the small intestine empties into the colon. The examination is done by slowly pulling the scope toward the end of the colon, carefully checking the entire lining as the scope is withdrawn.
The lining will be visible directly through the scope and on a video monitor. The lens on the scope is finely engineered so that every fold and surface of the inside of your colon can be clearly examined as the doctor is looking for any change in the lining. There may be areas of inflammation, ulcerations or polyps, all of which can be sampled, or biopsied, to rule out serious disease. Dr. Charron says it’s typical for most patients to have a normal colon lining that will not require further diagnostic or therapeutic procedures.
If biopsies are performed through the scope, bleeding or other complications are rare. There won’t be any discomfort during or after the procedure.
But before the procedure comes the preparation – and another reason people aren’t enthusiastic about scheduling a colonoscopy. Obviously, your colon needs to be empty so that the entire lining can be seen during the colonoscopy. “In the past, bowel preps involved drinking four liters of liquid to clear the body prior to the colonoscopy,” Dr. Charron says. “Now, the bowel-prep liquids are administered in much smaller volumes, and for those patients who have no kidney issues, there is a pill and even smaller volumes of prep are suggested.”
For those patients who are having a procedure in the afternoon, prep is easier too. “There is now a two-day prep that is split in half so patients can have something to drink – even though it is the prep – the morning of the colonoscopy And they aren’t completely starving.”
You also may be advised to modify your diet in the days before the procedure. Your doctor will decide which method is best for you to eliminate or minimize cramping and discomfort.
After the procedure, colonoscopy patients will want someone else behind the wheel since slight grogginess may linger after anesthesia, but according to Dr. Charron, “The patient has had a nice, comfortable experience, and he or she awakens with a good feeling.”
Colonoscopy may be performed for diagnosis of other colon problems, such as inflammatory diseases, unexplained rectal bleeding, or unexplained anemia. The procedure will be the same as the Screening procedure used for polyps.
What about potential risks? Like any medical procedure, there is a risk of complications, although they are extremely rare with colonoscopy.
Your doctor will discuss what to look for and how to handle any complications, should they occur. Most complications can be handled with bowel rest. Your doctor will provide all of the information required to make informed decisions both before and after the procedure.
The American Cancer Society currently Recommends colonoscopy for men and women, no matter their family history, every ten years, starting at age fifty. Other options include sigmoidoscopy – similar to a colonoscopy but examining only the last portion of the colon – every five years, double-contrast barium enema every five years, or what’s known as a virtual colonoscopy done with a CT machine every five years.
About the colonoscopy, Dr. Charron says, “I hear patients say if they had known it was this easy, they would have done it five years ago. It’s certainly okay to be afraid of Halloween ghosts and goblins, and even apprehensive about doctors and hospitals, but when it comes to having a colonoscopy, we like to tell people that they shouldn’t be scared to death of a test that can save your life.”
SCARY, FUNNY – OR BOTH? YOU DECIDE…
When Cary Gentry, MD, donned his Elvis costume a few years back (yes, it was the jumpsuit!) And cruised into his Stony Point office in Richmond, it didn’t occur to him that his wardrobe decision that day could save lives.
The Halloween fan from way back was seriously pumped when the holiday fell on a weekday. “When I get the chance to dress up for Halloween, I take it!” He says.
Dr. Gentry, who has been with Colon and Rectal Specialists in Richmond since 2001, knows well that appropriate screening is paramount to early detection and timely treatment of colon cancer. When that happens, he notes that survival rates for colon/rectal cancer patients are close to 90 percent. The key is encouraging people to have a colonoscopy performed.
So is that why he stepped into the shoes of America’s rock legend for work that day?
Not exactly. But the doctor, who at 43 has never had a colonoscopy, will tell you that his slightly offbeat approach to the dreaded test made a difference in at least one patient’s outlook.
“I had a patient email me recently about her upcoming colonoscopy,” Dr. Gentry said, noting that the woman’s last screening was performed by none other than Dr. Gentry as Elvis. Because she had relocated to another area, she was concerned about the details of the procedure. The patient told him that while she was relatively sure the specialist performing the colonoscopy would not be dressed as Elvis, she was anxious about the two things that worry most people before colonoscopy: sedation and prep.
“It was good to hear that the last procedure she had done at our office was a positive experience, but she was obviously concerned about having a colonoscopy with a different provider,” said Dr. Gentry. He added that it’s always advantageous for the patient to have a clear picture of the kind of sedation that will be used as well as the preparation that will be necessary.
“The anesthesia we use is fast-acting, has a short half-life, and offers quick recovery,” Dr. Gentry says, which means the chances of waking during the procedure are decreased. About prep, the doctor said: “Knowing that you can do a pill prep and avoid drinking the liquid really breaks down the barriers for people who are worried about colonoscopy.”