Matthew J. McKinley, M.D. and Gary S. Weissman, M.D.
Co-Chiefs of Gastroenterology at ProHEALTH Care Associates
Co-Chiefs of GI Endoscopy and Clinical Gastroenterology at North Shore University Hospital & LIJ
Utilizing a colonoscopy to screen for the early detection of growths in the colon has become the gold standard in caring for patients. This modality entails examining the rectum and colon (the large bowel) with a flexible videoendoscope. This enables the physician to directly visualize the lining of the bowel where these growths can develop. Identifying these growths and sampling (biopsy) them can lead to early detection of cancer. If caught at an early stage, treatment of colon and rectal cancer has a much better prognosis and many patients can be cured. In addition, colonoscopy presents the opportunity of preventing colon cancer from developing by allowing the doctor to detect and remove small benign growths (polyps) before they can develop into cancer.
Although colonoscopy is a valuable tool in our fight against colon cancer, the procedure is not perfect. There are parts of the large bowel that are difficult to visualize because of natural folds, twists and turns commonly found in the bowel. Also, if there is suboptimal cleaning out of the colon prior to the colonoscopy, cancers and polyps can be hidden from view by retained stool.
However, we can significantly reduce the number of polyps and cancers that are missed by the use of a relatively new technique called the Third Eye Retroscope. Pre-cancerous polyps in the colon are especially likely to be missed if they are located behind these folds, where they are often hidden from the forward view of the colonoscope. The Third Eye Retroscope is a novel device that provides a second, retrograde (backward) view that allows physician to evaluate those difficult to see areas.
Preparation for colonoscopy is one of the most important and, for some patients the most difficult aspect of the procedure. We are continuing attempts to develop cleanouts that are effective, safe, and easy to use by our patients. However it is important to remember that because of the diarrhea associated with the cleanouts, it is very important for patients to maintain hydration and follow the instructions regarding intake and timing of these liquids and solutions. We have tried various preps over the years and found that patients respond differently to different preps, so at the time of your consultation, your physician will discuss which “prep” will work best for you.
The proper assessment of your risk for colorectal cancer is extremely important. Some patients are at a higher risk than others. Although most colon cancers are sporadic and have no strong family history associated with it, approximately 35% of cases are based upon inheritance. Providing your physician with a detailed family history can be most useful. An individual’s risk of colon cancer increases if there is a family history of colon cancer, especially if the relative is first degree (i.e. parent, sibling or child). Some types of genetic syndromes do exist and were once thought to be rare. An example of this is Lynch syndrome, which is an inherited condition that increases your risk of colon cancer and other types of cancers. It accounts for 3-5% of all colon cancer.
You should be concerned about Lynch Syndrome when you have:
1. A family history of colon cancer that occurs at a young age.
2. A family history of endometrial cancer.
3. A family history of other related cancers, including ovarian cancer, kidney cancer, stomach cancer, small intestine cancer, liver cancer, bile duct cancer and special types of skin cancer.
If you have concerns about your family history of colon or other types of cancer, bring it up with your doctor. There is an excellent tool that can be employed in the creation of a family’s medical history, “My Family Health Portrait – A tool from the Surgeon General”. You can access this tool by visiting https://familyhistory.hhs.gov.
Understandably, some patients will refuse to undergo colonoscopy or cannot undergo colonoscopy for some reason. In these cases, other options can be considered. Though colonoscopy is the gold standard, alternative colon cancer prevention tests include:
1. Flexible sigmoidoscopy every 5 – 10 years.
2. CT colonography (Virtual colonoscopy) every 5 years.
3. Annual Hemoccult (stool test for blood.)
4. Fecal DNA testing every 3 years.
5. Annual fecal immunochemical test (FIT) to detect occult bleeding. This test should be offered to patients who decline colonoscopy or another cancer prevention test.
Clearly a complete history and routine examinations are essential and needed to maintain good health. Having the proper evaluation and scheduling a physical with your primary care physician and a colonoscopy with you gastroenterologist can save your life. To find out more from the CDC about colorectal screening, please visit http://www.cdc.gov/cancer/colorectal/basic_info/screening/