Colorectal Cancer Screening (Colonoscopy)
A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum.
A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.
Equipment
The flexible endoscope is a remarkable piece of equipment that can be directed and moved around the bends in the colon and rectum.
The image in the bowel is transmitted through the endoscope either to the eyepiece or a video screen. An open channel in the scope allows other instruments to be passed through it to take tissue samples (biopsies) or to remove polyps.
Reasons for the Exam
A colonoscopy is performed to diagnose the cause of certain symptoms. It is also used as a preventative measure to detect problems at an early stage, even before the patient recognizes symptoms. The following are some reasons for performing a colonoscopy:
Bleeding
Rectal bleeding is very common. It often is caused by hemorrhoids or by a small tear in the anus, called a fissure. However, more serious problems can cause bleeding. Benign polyps can bleed.
It is important to identify and remove polyps at an early stage before they can become cancerous. Rectal and colon cancers bleed and require immediate diagnosis and treatment. Finally, various forms of colitis and inflammation can cause bleeding.
Diarrhea
Persistent diarrhea should always be evaluated. There are many causes of diarrhea and the exam is of great help in tracking down the specific cause.
Pain
Hemorrhoids and fissures are some causes of pain around the anus or the rectum. Discomfort in the lower abdomen can be caused by tumors. Diverticulosis can occur in the lower bowel. With this condition, small pockets or sacks project from the bowel.
X-Ray Findings
A barium enema x-ray may show abnormalities that need to be confirmed or treated by a colonoscopy.
Detection
Colon cancer is one of the most common cancers in the country. It is highly curable if it is found early.
This cancer usually begins in the colon as a polyp that remains benign for many years. Therefore, it is generally advisable to have a colonoscopy after age 40 or 50.
If parents, brothers, or sisters have had colon polyps or colon cancer, it is even more critical to have this exam. The tendency to develop colon cancer and polyps can be inherited.
Preparation for the Test
To obtain the full benefit of the exam and allow a thorough inspection, the rectum and the entire colon must be clean. Preparation usually involves drinking clear liquids the day before along with taking laxatives or an enema. Specific instructions for preparation are provided beforehand.
The Procedure
Colonoscopy is usually performed on an outpatient basis. It is performed with the patient lying on the left side with the legs drawn up. A sheet is placed over the lower body. A finger or digital exam of the anus and rectum is performed. The patient will be sedated. Then the endoscope is gently inserted in to the rectum. Air is inflated into the bowel to expand it and allow for careful examination. The endoscope is advanced under direct vision and moved around the various bends in the lower bowel.
Benefits
The benefits of a colonoscopy can include the following: It is often possible to determine the specific cause of symptoms. Conditions such as colitis and diverticulosis can be monitored to determine effectiveness of treatment. Polyps and tumors can be discovered at an early stage.
Alternative Testing
Alternative testing includes barium enema x-ray exams. Additionally, the stools can be examined in a variety of ways to uncover or study certain bowel conditions. However, a direct look at the lower rectum and colon by colonoscopy is by far the best method of examining this area.
Side Effects and Risks
Bloating and bowel distension are common due to air inflated into the bowel. This usually lasts only 30 to 60 minutes. If biopsies are done or if a polyp is removed, there may be some spotting of blood. However, this is rarely serious. Other uncommon risks include a diagnostic error or oversight, or tear (perforation) of the wall of the colon which might require surgery. Due to sedation, the patient should not drive or operate machinery for the remainder of the day following the exam.
Summary
Colonoscopy is a simple outpatient exam which can uncover a serious medical problem. Specific diagnoses can be made. Treatment programs can be evaluated, or reassurance can be provided when the exam is normal. It is one of the most useful and simple exams in medicine.