Don't Fear Your Colon Cancer Screening (or the Prep, Either)

March is Colon Cancer Awareness Month. Are you 50 or older? If you do nothing else today, pick up the phone and schedule a colonoscopy. If you are younger than 50, and a family member has had colon cancer, pick up the phone and ask your doctor when you should schedule your colonoscopy.

Dr. Arun Sachdev is a board certified gastroenterology physician whose office at INTEGRIS Deaconess Gastroenterology South is a busy one. On some days, Dr. Sachdev performs upwards of 15 colonoscopies. He is passionate about colon cancer screening, and with excellent reason. “Colon cancer is a very common cancer but it is also one of the most preventable cancers,” he says.

Colon cancer is preventable because precancerous polyps are easy to spot, easy to remove and once they are removed, so is their threat. “We will find precancerous polyps in about 25 percent of men we screen, and about 15 percent of women,” Dr. Sachdev says. “The earlier we find a lesion, the easier it is to treat.”

For many years, 50 has been the recommended age for a first colonoscopy; however, the American Cancer Society changed that recommendation to age 45 in May of 2018. This is due in part to more people being diagnosed at younger ages than in past decades. Some insurance companies don’t yet cover a screening before 50 without symptoms or family history, so check with them to make sure you are covered before you get a colonoscopy.

“If your colonoscopy is normal, and you have no family history of colon cancer, you won’t need another screening for ten years,” Dr. Sachdev says.

Don’t fear the colonoscopy (or the prep)

There is a scene in “Harry Potter and the Half-Blood Prince” in which Harry must force Dumbledore to consume the entirety of a large basin of the ‘Potion of Despair.’ For many, that’s what they fear a colonoscopy prep to be. Don’t worry, it’s not!

Reality check: prepping for your colonoscopy is easy. Dr. Sachdev says that the day before, you’ll stick to a clear-liquids diet (7-Up, Jello, clear broth). The evening before, you’ll drink two liters of Gatorade mixed with Miralax. Why Gatorade? Because you’ll need to keep your electrolyte levels up. You may also be asked to take an oral laxative pill such as Dulcolax. Yes, this will shake everything loose, but that is the goal. By morning, you’ll be clean as a whistle and your colon will be ready for its close-up.

Once you’re at your doctor’s office, you’ll be given a sedative via an IV, and you’ll lie of your left side, knees drawn up a bit, and you’ll drift off for a 30-minute, potentially life-saving power nap. During your nap, the doctor will look at your colon with a small-diameter colonoscope that is 10 millimeters or smaller. Some perspective: that’s about half the size of a normal stool. 

“After the colonoscopy the medicine wears off very quickly, usually within 15 minutes,” Dr. Sachdev says. “You’ll be talking and feeling normal, but we won’t want you to drive that day. Otherwise, you’ll be able to go home, eat, and be back to normal.”

Should your doctor find a polyp, he or she will remove it right then, it will be analyzed and next steps (if any) will be discussed.

What’s that new test, where you mail in your sample?

It’s called Cologuard, and it’s touted as an alternative to traditional colonoscopy. “It’s a test that checks for the presence of DNA from colon cancer in the stool,” Dr. Sachdev says. “It tends to have a very high false-positive rate.” A recent study of 397 patients who used Cologuard showed that 49 received positive results for the presence of colon cancer. Of those 49, only four actually had colon cancer.

If you use Cologuard and your result is positive, you’ll need a colonoscopy. “For patients who have either heard horror stories or who refuse to get a colonoscopy, this is a still good alternative. We want people to get screened with either test, as long as they are doing something,” he adds.

The statistics

Among non-smokers, colon cancer is the leading cause of cancer deaths in Americans. The American Cancer Society’s publication, Colorectal Cancer Facts & Figures, tells us that one in 22 males and one in 24 females will be diagnosed with colorectal cancer in their lifetimes.

In 2017, there were some 95,520 new cases of colon cancer diagnosed in the U.S. 

Colorectal cancer often has no or few early symptoms. This is why screening is crucial. From the American Cancer Society: As a tumor grows, it may bleed or obstruct the intestine. In some cases, blood loss from the cancer leads to anemia (low number of red blood cells), causing symptoms such as weakness, excessive fatigue, and sometimes shortness of breath. Additional warning signs include:

• Bleeding from the rectum
• Blood in the stool or in the toilet after having a bowel movement
• Dark or black stools
• A change in bowel habits or the shape of the stool (e.g., more narrow than usual
• Cramping or discomfort in the lower abdomen
• An urge to have a bowel movement when the bowel is empty

Preventive measures are the same as for general good health: eat plenty of fiber and less red meat. Drink plenty of water. Exercise and keep your weight in a healthy range. “Obesity is one reason we are seeing an increase of younger people with colon cancer,” says Dr. Sachdev.

To schedule your colonoscopy, call your primary care physician who can refer you to a gastroenterologist.