“We are ready to have you come back with us. Your family member will be invited to come and be with you in just a few minutes.” Jeanette took a deep breath and followed the nurse with uneasy tension. She had never had a colonoscopy. Although her friends had told her there was nothing to worry about, it was still something new.

Forty minutes later, Jeanette opened her eyes, feeling like she had only been asleep for a few moments, but having had the most restful sleep she could remember in years. Her family member was sitting next to her, smiling happily at Jeanette’s groggy, sedation-induced ramblings. “The doctor says you look great…no signs of cancer or pre-cancerous polyps. We can leave in a few minutes.”

As Jeanette walked out the door a short time later, she thought, “Amazing. This colonoscopy thing is so simple, and it is heartbreaking that my aunt didn’t get this done. She went through so much pain during her 14-year battle with colon cancer!”

What are the symptoms of colon cancer or rectal cancer?

The true story told above quickly sums up the simplicity of choosing to get a colonoscopy procedure (a simple, medical screening of your large intestine that will be discussed later). It also emphasizes the terrible cost of choosing to avoid the mild inconvenience of scheduling a colonoscopy. Tragically, there are no symptoms of the earliest stages of colon or rectal cancer (often referred to as colorectal cancer), which, if caught early, is typically survivable.

Equally tragic is that colorectal cancer is the second leading cause of death (after lung cancer) in the United States, according to the Journal of the American Medical Association (JAMA). Colorectal cancer starts in the large intestines, or at the rectum and studies by JAMA show when this cancer spreads (metastasizes), it often metastasizes to the brain, lungs, and/or liver.

What is a colonoscopy and when should I have one?

A colonoscopy is a medical screening that involves taking pictures of the inside of your large intestines. The procedure is done while you are under sedation, and a flexible tube camera looks in your large intestines for areas of abnormality, such as lumps (also known as polyps) and cancerous flat lesions. Polyps can often be removed during this procedure. The polyps can be non-cancerous (benign), or they can be cancerous (malignant). Your doctor will have the polyps tested to find out which type of polyps you have. If they are malignant, treatment for the cancer will begin, and if the cancer is in its early stages, your survival rate is very high.

If the doctor finds a flat lesion (a spot of diseased, cancerous tissue), the doctor will take a biopsy of the area, and when possible, remove the entire area. However, in this case, your doctor will schedule you for a follow-up consultation, because flat colon lesions must be treated.

A colonoscopy is recommended for all persons when they turn 50 years old, and every 10 years thereafter, unless the first test finds pre-cancerous polyps. Then, the doctor will recommend follow-up screenings more often. Additionally, there are groups of people who are at a higher risk of getting colon cancer and should get their screening done when they are younger than 50. Those who fit into the high-risk category should follow the American Cancer Society guidelines; the following is a list of the more common, high-risk groups, as posted on sites such as the Hopkins Colon Cancer Center’s website. Those who have a high risk include those who:

• Have a family history of colorectal cancer, or breast, ovarian, or uterine cancer
• Have a personal history of colon polyps
• Have a history of inflammatory bowel disease
• Have a history of smoking
• Have high alcohol use (according to American Cancer Society: one alcoholic beverage per day for women, two for men)
• Are overweight and/or inactive
• Are of African-American or Eastern-European Jewish decent

What are the symptoms of colon cancer?

According to the Mayo Clinic, signs and symptoms of colon cancer include:

• A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool, that lasts longer than four weeks
• Rectal bleeding or blood in your stool
• Persistent abdominal discomfort, such as cramps, gas or pain
• A feeling that your bowel doesn't empty completely
• Weakness or fatigue
• Unexplained weight loss

If you have these colon cancer symptoms, schedule an appointment as soon as possible. Even if you only have colon polyps, the sooner they are removed, the greater is your chance of recovery from this very common type of cancer.

What is a colonoscopy? What can I expect before, during and after my colonoscopy?

In order for a colonoscopy to be effective, your entire large intestine needs to be cleaned out. In this way, your doctor can get a good look at all the interior surfaces of the entire large intestine, and the rectum.

In order for your colon is ready for some good photographraphs, you will be doing what the medical profession calls a colonoscopy preparation, or bowel prep. This means you will be drinking lots of water as well as taking some laxatives during the evening prior to your scheduled colonoscopy. You will also be asked to limit your solid-food intake for approximately 24 hours prior to the colonoscopy. This means you will be consuming clear liquids, such as chicken and beef broth, clear “sports drinks,” soda, coffee (black) and tea with honey. (Check with your doctor for their specific list of do’s and don’ts). 

Your doctor will likely have written instructions that outline these instructions, but if you wouldl like to look through a great booklet, UCLA Division of Digestive Diseases has produced a very instructive online booklet. NOTE: Be sure you are detailed in telling the doctor what types of medicines you use, as well as nutritional supplements, such as fish oil. Some medicines and supplements will need to be discontinued prior to the procedure.

on the day prior to your procedure, plan on spending the evening relaxing at home, because the prescribed laxatives work very well and you will want to have convenient access to a bathroom. Most people say this is the only part of scheduling a colonoscopy that causes some discomfort. But, if you thoroughly clean out your bowel, the doctor will be able to see everything that he/she needs to see, and will be able to remove any developing polyps. Otherwise, if you have not done a good job in your bowel prep, you will get to repeat the procedure again, as soon as possible. If you do a good job and everything looks healthy, you will probably not have to schedule another colonoscopy for about 10 years.

The day of your colonoscopy, you will have a period of time when you will not be able to consume anything. After you arrive and fill out your paperwork, you will wait until the nurse calls you back for your test. Does a colonoscopy hurt? Most people report there is no pain involved in the procedure; you will be given an IV, and then you will have a lovely nap that will last from 30 – 60 minutes due to the colonoscopy sedation. When you wake up, the person who you have asked to drive you home will be waiting by your bedside. You will likely feel the effects of the sedation for several hours, and you will likely not be able to go back to work that day (or night) if you will be required to operate heavy machinery (including driving a car).

Immediately after the procedure, you may spend some time at the doctor’s office trying to expel some of the gasses that were gently blown into your intestine so the doctor was able to insert a small, flexible tube camera up through the rectum, and around the length of your large intestine. Amazingly enough… here is a place where it is socially acceptable to let go with your longest, loudest ….. fart. Expelling as much of this gas as possible will help you later in the day not experience the very human feeling of being “gassy.”

When you feel like you are done passing most of the gas out of your intestines, you get to go and EAT! Your doctor will give you some recommendations on what you can eat. If the results of the screening showed there were no concerns, you can rest assured your colon is healthy. If the results are not good, you can start treatments to help you have the best chance of living a long life.

I don’t want to do a colonoscopy.

There are some people who are suffering from physical ailments would prohibit having a colonoscopy without an urgent cause, or some people who struggle with the fear of going through the colonoscopy. Additionally, because the cost of colonoscopy is expensive, some insurances will cover the cost of a federally-approved alternative, call a FIT screening. The National Cancer Institute says the FIT (fecal immunochemical test) tests for blood in the stool. Blood in the stool can come from polyps which have bled, or it can come from cancerous tissue in the bowel. However, it can also come from something as simple as hemorrhoids. The FIT can be completed in your home in only 5 minutes time, and then the sample is sent to your doctor. However, because this test might not catch the earliest stages of cancer, it should be completed every 1-2 years.

There are several other non-colonoscopy tests for colon cancer, but if the tests indicate a problem, you will end up needed to have the colonoscopy anyway, either to remove the polyps, or to see what is happening in the colon. Additionally, some of these tests require the same bowel prep, which is the most talked-about part of the colonoscopy, because the actual colonoscopy does not hurt, in the majority of cases.

Conclusion

The most accurate way to know if your colon is healthy is to schedule a colonoscopy. It’s a simple and safe way to help avoid colon cancer by having any pre-cancerous polyps removed before they turn into cancer. There are very few type of cancer that have such a wonderful survival rate when caught early. It’s an easy decision, no ifs, ands, or butts about it.