Colonoscopy is the gold standard test for screening for cancer of the colon and rectum. This means that colonoscopy is the best proven test to identify pre-cancerous or cancerous lesions in the lining of the colon and rectum.
Pre-cancerous lesions, also known as polyps, are readily identified during colonoscopy and can be removed or biopsied, which helps to prevent them from developing into cancer in the future. The primary goal of performing a screening colonoscopy is to prevent colon and rectal cancer from ever forming in the first place. This can be accomplished by following routine screening guidelines recommended by multiple medical societies, such as the American Cancer Society.
Other than colon and rectal cancer screening, there are additional reasons for colonoscopy recommended by our practice. It may be used to identify a cause for rectal bleeding or chronic issues like constipation or diarrhea. Colonoscopy may also be used to identify an unknown cause of abdominal pain, nausea, or abdominal bloating. A colonoscopy is an effective screening tool to identify changes and catch underlying issues that may have no outward symptoms. One of the primary goals of colonoscopy is to help identify issues in the large intestine that may be difficult to diagnose with physical examination or radiologic studies alone.
To be sure you are starting your colon health screenings at the right time, and with the right screening interval, you should discuss colonoscopy with your primary care physician, gynecologist, or one of our surgeons. Based on new guidelines, the American Cancer Society recommends colorectal cancer screenings begin at age 45 for those individuals who are not at any increased risk. The CDC recommends slightly later at age 50. Increased risk includes individuals that have a family history of colorectal cancer or a personal history of inflammatory bowel disease, past presentation of certain polyps, hereditary colorectal cancer syndrome, or having radiation to the belly or pelvic area. If these risk factors apply to you, a lower age recommendation for screening may be made by your doctor.
Patients who are experiencing symptoms related to the large intestine which include bloody bowel movements, unexpected weight loss or weight gain, chronic nausea, vomiting, abdominal bloating, abdominal pain, or any other noted changes in your GI function should trigger a discussion about colonoscopy, regardless of your age or risk factors.
Due to a combination of factors, we have seen the incidence of colorectal cancers increase in younger patients over the past few decades. Often, concerns such as rectal bleeding or pain are dismissed as hemorrhoids or other benign factors simply because of the patient’s age. However, we cannot take these symptoms for granted and a complete medical workup by an experienced colorectal specialist should be performed, even on younger patients. And while most cases will turn out to be benign, early screening is critical to successful treatment.
One of the most important parts of the colonoscopy is the preparation required to achieve a clean colon to optimize the visualization of polyps and other subtle changes in the lining of your large intestine. A bowel preparation performed one or two days prior to your procedure is necessary. This will involve drinking a flavorless liquid and taking some pills to ensure your surgeon is able to visualize your entire large intestine. We aim to minimize the cost of bowel preparation by using over the counter medications. However, we are happy to work with you and identify the ideal bowel preparation suited for each individual patient.
Your diet day the day before your procedure will consist of clear liquids. We also ask patients who are taking blood thinners such as Aspirin, Plavix, or Coumadin to hold these medications approximately one week prior to the procedure after consultation with their primary care physician or cardiologist.
You should plan to take the day off from work because you will receive intravenous sedation or general anesthesia for your colonoscopy. Patients will also need to arrange for a ride home from the surgery center or hospital.
Your anesthesia provider and nursing team will place an intravenous catheter so that you will be able to easily receive sedation during the procedure. The typical sedation used during a colonoscopy allows your surgeon to visualize your colon without any memory of the procedure and without any discomfort to the patient.
During a colonoscopy, a flexible tube with a very small camera is inserted into the rectum and carefully guided through your large intestine to allow your doctor to visualize the inside of your bowel. Any masses or polyps identified will be removed or biopsied and findings will be discussed with you and your family immediately after the procedure. The whole procedure takes approximately 15 to 30 minutes.
Overall, colonoscopy is a very safe procedure, and the benefits are greatly outweighed by the risks. The two primary risks are bleeding and perforation, or a tear in the wall of the colon. Bleeding can occur after polyp removal or biopsy. If this occurs, patients can sometimes require a repeat colonoscopy to identify and treat the source of bleeding.
Treatment of perforation can require antibiotic therapy or rarely urgent surgery to address the tear in the colon wall.
After your surgeon has discussed your colonoscopy findings with you, you will be briefly monitored in the recovery room at the surgery center or hospital where your procedure has taken place. There are no restrictions on your diet or activity level after your procedure. You may notice that you pass some gas on the day of your colonoscopy as air is used to inflate your colon during the procedure.
There are additional stool tests and radiologic studies that can serve as alternatives to colonoscopy. While colonoscopy remains the gold standard test for screening for colon and rectal cancer, we would be happy to discuss alternative testing based on each individual patient’s medical history and overall health.