Don’t fear the colonoscopy

Dr. Telciane Vesa on five frequently asked questions

If you only had to do something every five or 10 years and it could help stop one of the most commonly diagnosed cancers wouldn’t you do it?

Then it may be time for you to schedule a colonoscopy. 

A colonoscopy is a test that allows doctors to look at the inner lining of your large intestine (the rectum and colon). The screening helps find polyps, or small growths, that are typically not cancerous but over time can become malignant and lead to colorectal cancer, says Dr. Telciane Vesa, gastroenterologist with The Center for Digestive & Liver Health and The Endoscopy Center.

Colorectal cancer, also known as colon cancer, rectal cancer or bowel cancer, is any cancer of the colon or rectum. This year, an estimated 135,430 people will be diagnosed with colorectal cancer and about 50,260 people will die from the disease, according to the American Cancer Society. Colorectal cancer is the third most commonly diagnosed cancer in both men and women, with one in 22 men and one in 24 women being diagnosed with the cancer at some point in the lifetime.

The majority of colorectal cancers and deaths could be prevented through colonoscopies because of the slow cancerous growth in polyps. Noncancerous or even precancerous polyps can be removed during colonoscopies.

These screenings take approximately 20 minutes and are proven to prevent cancer and save lives. However, there’s a portion of the public that should be getting routine colonoscopies but ignores the screening due to fear or the stigma associated with it.

“The beauty of the colonoscopy, if you think about it, is it’s the only test that stops cancer from happening,” Dr. Vesa says. “There is a stigma that unfortunately comes with colonoscopies. You are going to have a device going up your colon, and especially for men, a lot of people don’t like the idea of that.”

To help better understand the screening process and its importance, Dr. Vesa answers five frequently asked questions by her patients:

1. Why do I need a colonoscopy?

“People will ask, ‘Why do I need a colonoscopy? I’m doing so well. I don’t have any pain. No one in my family had cancer, so why do I need to submit myself to this humiliating test?’” Dr. Vesa explains. “It’s because the cancer will not show itself until it’s too far out. Polyps do grow to be cancer over time. Polyps are nice and dormant for an estimated five to 10 years until they become cancer and that’s when they start bleeding, hurting or spreading to the bone, liver or anywhere.”

The average recommendation is for any male or female to begin colon screenings at age 50. If there are no polyps, then screening should be repeated every 10 years, Dr. Vesa says. If polyps are present, screenings should be repeated every three to five years depending on the number, size and location of polyps. Dr. Vesa adds that it is recommended African Americans begin screenings at 45. If you have a family member that has a history of colon cancer or even noncancerous polyps, Dr. Vesa says you should start screenings 10 years prior to your family member’s diagnosis age if that puts your age under 50.

New studies have shown an increase in colon cancers in people much younger than 50. If you are considered about your risks, talk to your primary care physician about colon care.

2. Is there an alternative to the bowel preparation?

Dr. Vesa admits the bowel preparation is the worst part of the colonoscopy. The bowel preparation begins the day before your scheduled screening and consists of drinking a prescribed medicated liquid that will cause you to have numerous bowel movements. A bowel prep is required to completely clean out your GI tract, which is about 16 feet long.

“I usually describe to my patients that the clean out is so important and that you know you are completely clear when you know what is coming out is yellowish liquid,” Dr. Vesa says. “If you put that in a glass jar on top of a book, you should be able to read that book. That’s how clear it needs to be.”

A lot of folks find the bowel preparation humiliating and some may experience abdominal discomfort or nausea. There is no alternative to the bowel preparation as it is so important to have a clear GI tract so physicians can clearly see the entire intestine and any polyps on the lining of the colon.

There is, however, an alternative to the prescribe bowel prep liquid, which many find has a very unpleasant taste. Some doctors may suggest you take a mixture of Miralax and Gatorade. Some doctors do not like this method, however. Dr. Vesa recommends this combination only if the prescription option fails.

3. What happens if you find a polyp during the colonoscopy?

The majority of polyps are very small and are removed before they have a chance to grow and become cancerous. Polyps are removed during the colonoscopy as long as they aren’t too large, Dr. Vesa says. This surprises a lot of patients, especially those getting a colonoscopy for the first time.

“The whole point of the colonoscopy is to remove any polyps before they have a chance to grow,” Dr. Vesa says. “A lot of people are surprised that I am going to take any out during the screening, but I don’t want them to stay.”

4. Is it over?

A colonoscopy takes approximately 20 minutes. The patient will be sedated and sleep through the entire screening. Your heartbeat and blood pressure will be monitored while the gastroenterologist uses a colonoscope – a thin, flexible tube with a tiny camera – to take images of the large intestine looking for polyps.

Dr. Vesa assures patients the anesthesia works very well, and they won’t feel anything. Most patients wake up not realizing the screening was even performed.

“It’s a relatively simple task,” Dr. Vesa says. “The sedation is wonderful. Most patients wake up and they ask, ‘Did you really do it?’ Or they will say, ‘Oh my goodness that was so fast. I can’t believe I’ve been asleep for 20 minutes.’”

Following the screening, patients are taken to a recovery room. Dr. Vesa says the anesthesia wears off pretty quickly and patients can return to their normal self – and get something to eat.   

5. What causes colon cancer?

Dr. Vesa says there is personally nothing worse than finishing a procedure and then delivering bad news, especially when a screening done a few years earlier would have found a polyp before it became cancer.

A lot of patients are shocked and confused and want to know what caused this, Dr. Vesa says. There may not be a specific answer to that question, but there are colorectal cancer risk factors including weight, diet (one full of saturated fats and processed foods rather than fruits, vegetables and fiber), environmental  and heredity.

“It’s a tough thing,” Dr. Vesa says. “Twenty, 30 years ago people would just die. Cancer of the colon was a death sentence. Things have changed a lot. Incidents have reduced because of colonoscopies, but also the treatments available are much better nowadays.”

For more information about colonoscopies or colorectal cancer, talk to your primary care physician or schedule an appointment with a gastroenterologist. Learn more about Dr. Vesa and The Center for Digestive & Liver Health and The Endoscopy Center here

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