Chicago's

Colon & Rectal Screening

WHAT IS THE RISK OF COLON AND RECTAL CANCER?

Colon and rectal cancer is the second most common cause of cancer in America.  1 out o20 people will develop colon and rectal cancer.  The risk increases if there is a family history of polyps or cancer.  It is still higher for those with a personal history of: polyps, colon and rectal cancer, prostate cancer, breast cancer, uterine cancer, or ovarian cancer.

WHAT IS SCREENING AND SURVEILLANCE?

Screening identifies people who have no symptoms associated with colon and rectal cancer.

Surveillance is for people who have had polyps or cancer, because their risks are higher.

WHY SHOULD PEOPLE BE TESTED?

Colon and rectal cancer is known as the ‘silent’ cancer.  Symptoms are often seen too late. 

Cure for pre-cancerous polyps is about 100%.

Cure for early cancer (before symptoms) is about 90%.

Cure for late staged cancer (after symptoms) is only about 50%.

WHAT SCREENING TESTS ARE THERE?

Fecal occult blood test uses a chemical to test blood in the stool.  It is inexpensive and simple to perform.  The problem is that the polyp or cancer needs to bleed at the time of the test.  This happens in only 10% of polyps and 50% of cancer.

If this test is positive, a colonoscopy is recommended.

Flexible sigmoidoscopy is a test where a physician can look at the last 12-18 inches of the colon and rectum.  This test can miss up to 75% on the colon, thus missing many polyps or cancers.

Colonoscopy is similar to flexible sigmoidoscopy, but longer.  With colonoscopy, the physician can examine the entire length of the colon and rectum.  Drinking a ‘prep’ the day before, will clean the stool from the colon.  The procedure itself is done under a ‘twilight’ anesthesia.  Most people are asleep and do not remember the colonoscopy.  The major benefits of colonoscopy are evaluation of the entire colon and rectum and removal of small and medium polyps, if found. 

A barium enema or air-contrast emema, is a radiologic test that looks at the entire colon.  It is less accurate thatn colonoscopy and is usually performed when colonoscopy cannot be done.

Virtual colonoscopy uses a CAT scan to evaluate the colon.  This test is usually more accurate than barium enemas, but still lacks the quality to make it a screening tool.

WHEN AND HOW OFTEN SHOULD TESTING BE DONE?

Screening.

For people of routine risk, a colonoscopy should be done at the age of 50.  If no disease, polyps, or cancer is found, the colonoscopies every 5 years should be done.

For people with a family history of polyps or cancer, the first colonoscopy should be done at age 40, or 10 years before the diagnosis of that relative.

For people with Hereditary Non-Polyposis Colon-rectal Cancer (HNPCC), a genetic condition with a strong family trend of colon and rectal cancer, urinary and gynecologic cancers, especially at a young age, colonoscopies should start at age 20-25, then have them every 1-2 years.

Familial Adenomatous Polyposis (FAP) is a familial condition where colon and rectal polyps form at a very young age.  The risk of cancer is extremely high.  Flexible sigmoidoscopy should start at puberty.

Women with a personal history of ovarian or uterine cancer before the age of 60, should have a colonoscopy at the age of 40.

Surveillance.

People who have pre-cancerous polyps, should have a colonoscopy every 3-5 years. 

If a polyps is incompletely removed, then repeat colonoscopy in 3-6 months. 

People with a personal history of colon and rectal cancer should have a colonoscopy 1 year from surgery.  If negative, then colonoscopies every 2-3 years.

People with extensive colitis (Crohn’s disease or Ulcerative colitis) should have colonoscopies every 1-2 years.

WHO DOES SCREENING AND SURVEILLANCE?

Colonoscopies are performed by specially train physicians, usually gastroenterologists or colon and rectal surgeons.