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Colon polyps
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Colon polyps

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DIGESTIVE SYSTEM
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From MayoClinic.com

When to seek medical advice

Most polyps don't cause signs and symptoms. But see your doctor right away if you notice blood in your stool, a change in your bowel habits that lasts longer than a week or abdominal pain. And if you're at high risk, don't wait until symptoms appear. See your doctor for regular screenings.

Screening and diagnosis

Nearly all colon cancers develop from polyps, but the polyps grow slowly, usually over a period of years. Screening tests play a key role in detecting polyps before they become cancerous. These tests can also help find colorectal cancer in its early stages, when you have a good chance of recovery. When early-stage cancers are found and removed during routine screening, the five-year survival rate may be as high as 90 percent.

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. What's more, it's likely that the doctor performing your exam has had the test too. 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.

Several screening methods exist — each with its own benefits and risks. Whatever you decide, if you're at average or higher risk of colorectal cancer, evidence suggests that some screening is better than no screening:

  • Digital rectal exam. In this office exam, your doctor uses a gloved finger to check the first few inches of your rectum for polyps. Although safe and relatively 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.

  • Fecal occult (hidden) blood test. This noninvasive 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 it to a lab or your doctor's office to be checked. The problem is that most polyps don't bleed, nor do all cancers. This can result in a negative test result, even though you may have a polyp or 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.

  • Flexible sigmoidoscopy. In this test, your doctor uses a slender, lighted tube to examine your rectum and sigmoid — approximately the last 2 feet of your colon. Nearly half of all colon cancers are found in this area. The test can be somewhat uncomfortable, and there's a slight risk of perforating the colon wall.

  • Barium enema. 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. 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. Air may also be added to provide better contrast on the X-ray. The 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 rectosigmoid area.

  • Colonoscopy. This procedure is the most sensitive test for colorectal polyps and colorectal cancer. Some studies have shown it is better at detecting polyps than is a barium enema X-ray alone. Colonoscopy is similar to flexible sigmoidoscopy, but the instrument used — a colonoscope, which is a long, 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. And if you have adenomatous polyps, especially those larger than 5 mm in diameter, you'll need careful screening in the future.

  • A colonoscopy takes about a half-hour. You're likely to receive a mild sedative to make you more comfortable. The risks of diagnostic colonoscopy include hemorrhage and perforation of the colon wall. Complications are somewhat more likely when polyps are removed.

  • Genetic testing. 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 will affect not only your own life but also the lives of everyone close to you. Genetic testing for children is even more complex and problematic.

  • You may also be concerned about your ability to obtain insurance coverage for yourself or you loved ones if you're found to have a genetic mutation. These issues can be overwhelming, which is why it's always best to discuss the ramifications of genetic testing with your doctor, a genetic counselor or both.

  • New technologies. New technologies such as virtual colonoscopy (CT colonography) 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 and rectum without actually going inside. Before the scan, your large 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 may not be as accurate as regular colonoscopy, and it doesn't allow your doctor to remove polyps or take tissue samples.

  • Another 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. A three-year clinical trial of this test by the National Cancer Institute is under way.

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