A colonoscopy is a common procedure that lets doctors examine the colon and rectum for abnormalities and changes. It’s often used as a screening tool for colon cancer which, is the third leading cause of cancer-related deaths in the United States among men and women, according to the American Cancer Society. Routine testing can help prevent colon cancer or find it at an early, easily treatable stage.
Current guidelines state people should have their first colonoscopy at age 50 and one every 10 years thereafter if they have no special risk factors for colon cancer. If a relative has had colon cancer, or if you have an inflammatory bowel disease such as Crohn’s disease, Lynch disease or ulcerative colitis, you may need a colonoscopy earlier or more often.
Many people avoid colonoscopies for various reasons, but such aversion translates to only four out of 10 people being diagnosed with colon cancer when in its early stages. According to the American Cancer Society, the five-year survival rate is 90 percent for people whose colon cancer is found and treated early. So there’s a big benefit to being tested and catching any cancerous lesions as soon as possible.
Sanjay Ramrakhiani, M.D., a gastroenterologist and interventional endoscopic specialist with the Palo Alto Medical Foundation, says people who are candidates for the test will often place it on the backburner because they are fearful of the procedure and have misconceptions about colon cancer.
“People may not realize that colon cancer is one of the most preventable cancers and that a colonoscopy could save their life,” Dr. Ramrakhiani says. “A colonoscopy is unique in that we’re not only able to find early cancers but also prevent colon cancer. The vast majority of polyps identified during the colonoscopy can be removed at the same time, so the patient doesn’t have to come back for another procedure.”
Here are some of the common concerns and myths associated with colonoscopies:
Myth: “I don’t have time for a colonoscopy.”
Medical appointments do take time out of your daily routine, but they are important to maintain optimal health. During a colonoscopy, your doctor inserts a flexible tube with a tiny video camera at the tip into the rectum and colon. This allows your doctor to visually inspect your colon for precancerous or cancerous lesions. The test only takes about 30 to 45 minutes to complete.
Myth: “A polyp means I have cancer.”
A polyp is actually a noncancerous growth that can develop anywhere in the large intestine. Over time, these growths can develop into colon cancer. Polyps are easily removed during a colonoscopy by using an endoscope, a flexible tube with tiny video camera and light at the tip, and small surgical tools. These polyps are often sent to a laboratory for testing after removal.
“Polyps are very common. At least one-quarter of people who have colonoscopies have polyps. They are the precursors to colon cancer. The idea is to identify these polyps and remove them, reducing the risk of colon cancer,” Dr. Ramrakhiani says.
Myth: “I don’t have symptoms, so I don’t need a colonoscopy.”
Colon polyps often don’t cause any symptoms. It’s not until they’ve transformed into full-blown colon cancer that symptoms may arise. The whole point of a colonoscopy is to remove these polyps before they become cancerous. Schedule an appointment with your doctor if you have rectal bleeding, bloody stool, black stool, prolonged constipation or diarrhea, lower stomach cramping, the frequent urge to have a bowel movement or unintentional weight loss, as these are all possible signs of underlying colon issues.
Myth: “It’s too painful.”
During a colonoscopy, air is used to expand the colon in order to look at all the sides with an endoscope. You may feel some pressure and cramping, but Dr. Ramrakhiani says you will be given medication to make you sleepy and comfortable.
“We use sedatives during the procedure and the great majority of patients wake up having no idea that the procedure was done,” he says. “Luckily, the colon has no nerve endings on the inside, so removing polyps doesn’t cause any pain.”
Myth: “The preparation solution is too hard to drink.”
Until recently, patients were asked to drink a gallon of preparation solution, which induces bowel movements in order to clean out the colon. Drinking that much liquid can be challenging, but these days Dr. Ramrakhiani says it’s standard for a patient to drink one quart of prep solution the night before and a second quart of prep the morning of the procedure. There are four quarts in a gallon, so the new standard requires half the volume of the traditional cleanse.
“If needed, we can even use smaller volumes of the preparation solution. For those who can’t drink fluids, we have pills that can be taken to clean out the colon,” Dr. Ramrakhiani says.
As far as dealing with the typically salty taste of the prep solution, Dr. Ramrakhiani suggests mixing it with 7UP, ginger ale, Gatorade or Crystal Light to make it more palatable. He stresses that it’s very important to finish all of the preparation solution. Research suggests doctors will miss at least one precancerous growth in about one-third of patients who don’t properly prepare, according to a study published in the journal Gastrointestinal Endoscopy.
Myth: “The risks of colon perforation and bleeding outweigh the benefit.”
A colonoscopy is a safe procedure, but in rare cases the endoscope can puncture the wall of the colon or rectum, creating a perforation. This complication usually requires surgery for treatment. Dr. Ramrakhiani says studies have shown that the risk of perforation is less than one in every 10,000 patients, or less than one-tenth of 1 percent.
Rectal bleeding may occur rarely at the site of a biopsy or where a polyp was removed, but it’s usually very minor and goes away after a few days. If the bleeding is severe and persistent, it’s important to contact your doctor right way.
Myth: “Colon cancer only affects men.”
Colon cancer affects both men and women at the same rate. Each year about 140,000 people across the nation are diagnosed with colon cancer and more than 50,000 die from the disease, according to the Centers for Disease Control and Prevention. Dr. Ramrakhiani says the notion that this cancer only affects older men is simply untrue.
“People often mistake colorectal cancer for prostate cancer. Women need to have colonoscopies just as regularly as men,” he says.
