When to seek medical advice
If you notice any symptoms of colon cancer, see your doctor as soon as
possible. Keep in mind that colorectal cancer can strike younger as well
as older people. If you're at high risk, don't wait until symptoms
appear. See your doctor for regular screenings.
Screening and diagnosis
Most, if not all, colon cancers develop from polyps. Screening is
extremely important for detecting polyps before they become cancerous.
It can also help find colorectal cancer in its early stages when you
have a good chance for recovery.
Like many people, you may be embarrassed by the screening procedures,
worried about discomfort or afraid of the results. Try not to let these
concerns stand in your way. Most procedures are only moderately
uncomfortable, and working with a doctor you like and trust should help
ease your embarrassment. If you question the results of your screening,
ask for a second opinion. Keep in mind, however, that risks are
associated with the more invasive screening procedures.
Common screening and diagnostic procedures include the following:
In this office exam, your doctor uses a gloved finger to check the
first few inches of your rectum for large polyps and cancers.
Although safe and painless, the exam is limited to your lower rectum
and can't detect problems with your upper rectum and colon. In
addition, it's difficult for your doctor to feel small polyps.
(hidden) blood test.
This test checks a sample of your stool for blood. It can be
performed in your doctor's office, but you're usually given a kit
that explains how to take the sample at home. You then return the
sample to a lab or your doctor's office to be checked. The problem
is that not all cancers bleed, and those that do often bleed
intermittently. Furthermore, most polyps don't bleed. This can
result in a negative test result, even though you may have cancer.
On the other hand, if blood shows up in your stool, it may be the
result of hemorrhoids or an intestinal condition other than cancer.
For these reasons, many doctors recommend other screening methods
instead of, or in addition to, fecal occult blood tests.
In this test, your doctor uses a flexible, slender and lighted tube
to examine your rectum and sigmoid — approximately the last 2 feet
of your colon. Nearly half of all colon cancers occur in this area.
The test usually takes just a few minutes. It can sometimes be
somewhat uncomfortable, and there's a slight risk of perforating the
This diagnostic test allows your doctor to evaluate your entire
large intestine with an X-ray. Barium, a contrast dye, is placed
into your bowel in an enema form. During a double contrast barium
enema, air is also added. The barium fills and coats the lining of
the bowel, creating a clear silhouette of your rectum, colon and
sometimes a small portion of your small intestine. This test
typically takes about 20 minutes and can be somewhat uncomfortable.
There's also a slight risk of perforating the colon wall. A flexible sigmoidoscopy is often done in addition to the barium enema to aid
in detecting small polyps that a barium enema X-ray may miss,
especially in the lower bowel and rectum.
This procedure is the most sensitive test for colorectal cancer and
polyps. Colonoscopy is similar to flexible sigmoidoscopy, but the
instrument used — a colonoscope, which is a long, flexible and
slender tube attached to a video camera and monitor — allows your
doctor to view your entire colon and rectum. If any polyps are found
during the exam, your doctor may remove them immediately or take
tissue samples (biopsies) for analysis. This is done through the
colonoscope and is painless. If you have adenomatous polyps,
especially those larger than 5 millimeters in diameter, you'll need
careful screening in the future. A colonoscopy takes about a
half-hour. You may receive a mild sedative to make you more
comfortable. Preparation for the procedure involves drinking a large
amount of fluid containing a laxative to clean out your colon —
enemas are no longer necessary. Major risks of diagnostic
colonoscopy include hemorrhage and perforation of the colon wall.
But these risks are rare. Complications may be somewhat more
frequent when polyps are removed.
If you have a family history of colorectal cancer, you may be a
candidate for genetic testing. This blood test may help determine if
you're at increased risk of colon or rectal cancer, but it's not
without drawbacks. The results can be ambiguous, and the presence of
a defective gene doesn't necessarily mean you'll develop cancer.
Knowing you have a genetic predisposition can alert you to the need
for regular screening. Still, you'll also want to consider the
psychological impact of what the test may reveal. Knowing you may
develop cancer affects not only your own life, but the lives of
everyone close to you. Genetic testing for children is even more
complex and problematic. It's best if you discuss all of the
ramifications of genetic testing with your doctor or a medical
In the future, new technologies, such as virtual colonoscopy, may
make colon screening safer, more comfortable and less invasive. In
virtual colonoscopy, you have a two-minute computerized tomography
scan, a highly sensitive X-ray of your colon. Then, using computer
imaging, your doctor rotates this X-ray in order to view every part
of your colon without actually going inside. Before the scan, your
intestine is cleared of any stool, but researchers are looking into
whether the scan can be done successfully without the usual bowel
preparation. Although virtual colonoscopy potentially is a
tremendous step forward, it's not as accurate as regular colonoscopy
and doesn't allow your doctor to remove polyps or take tissue
samples. This test is also not widely available. Another new test
checks a stool sample for DNA from abnormal cells. In preliminary
studies, the test has proved to be so accurate it may eventually
eliminate the need for more-invasive examinations such as
colonoscopy, at least in average-risk circumstances.
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