A Check-Up You Have Missed: Colonoscopy For a Long Life

In our lives, we have all known or heard about people who have had a cancer of the colon or rectum. We see celebrities and national figures who have battled this disease. The most recent being Tony Snow, Press Secretary for President George W. Bush, and now a national political commentator on radio and television. As Tony battles his colon cancer and discusses it openly on national media, each of us should think how we can prevent colon cancer or detect it in its earliest most curative stage.

So just how does cancer of the colon form? A small genetic mutation occurs in the nucleus of a cell in the large intestine which turns on a switch telling this cell to continue to grow. These mutations are not at all uncommon, since many foods contain ingredients that can cause mutations. Most of these mutations just simply get repaired by our own cellular repair enzymes. But occasionally the persistence of more than one of these genetic mutations can result in uncontrolled growth of the cell. The first result is a polyp, a small growth that usually appears like a grape at the end of a stalk, or a small broccoli, or a larger cauliflower. As this continues to grow, more mutations develop and this slow growing polyp turns into cancer! The cancer becomes larger, begins to partially block the bowel, may produce bleeding, and then begins to spread to lymph nodes and then to distant organs. But these cancers, just like the one that Tony Snow had, can usually be prevented. It's time for you to start your prevention.

The first step in prevention is a colonoscopy. In a colonoscopy, the physician removes all polyps that may have started BEFORE they turn into cancer. Doctors and medical associations throughout the country recommend starting colonoscopy at age 50. If you have a history of colon polyps in your family or colitis in your family, you need a colonoscopy earlier. Discuss with your physician how early this is, but it should be at least 5 years less than the age of the youngest person in your family when they first had polyps, cancer, or colitis.

Let's get the fear of colonoscopy behind us! As all of my patients tell me, they do not fear the colonoscopy, they just don't like the preparation for it. The first phase of the "prep" is a clear liquid diet. You will learn to love Jell-O, clear juices, coffee, tea, and soft drinks. The part of the regimen that "clears you out" is taking medication that gives you about 12 hours of diarrhea. Stay close to the toilet, but the end result of preventing cancer is well worth the discomfort of the prep.

The next day you will arrive at the colonoscopy center (in a hospital, surgery center, or free-standing colonoscopy unit). The nurses will get you dressed in your fashionable gown, and then the doctor will give you "conscious sedation" a medication that instantly puts you in a light sleep. The next moment you wake up with the colonoscopy already completed, and hopefully the good news that everything looked clear, or the better news that you may have had a polyp, but they have taken it out and prevented a colon cancer.

A colonoscopy is not the only approach that physicians have used to diagnose polyps and cancers in the colon or rectum. Some physicians have recommended a sigmoidoscopy, which examines only the final 2 to 4 feet of the colon. It is useful when an abnormality is suspected in the rectum or the last part of the colon, the sigmoid colon. For a complete checkup of the large intestine, sigmoidoscopy is felt by many doctors to be the same as doing a mammogram on only one breast, because it does not examine all of the colon, it only examines the final portion. So, most physicians today recommend a colonoscopy rather than sigmoidoscopy. Check with your doctor to see what's best for you.

In addition, examination of your stool for evidence of blood ("occult blood" test) can be performed every 12 months, but is not as reliable in detecting polyps or cancer. But it may be helpful in watching you for any danger signs.

So the take home lesson from today's column is: always be certain after the age of 50 (or even earlier) you have a colonoscopy so you have the greatest chance for a long and healthy life. Above all, if you have symptoms of colon disease (this includes pain in the abdomen, swelling, lump, bloating, or a change in weight) get to your physician's office right away!