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Monday, February 20, 2012 - Colonoscopy: It's Worth the Prep!


The Endoscopy Center of Greenwich Hospital

Colorectal cancer can be prevented. But how best to raise the topic? Tell a joke to get the chuckles and squeamishness out of the way? Or maybe just start with a few hard-hitting facts – like cancer of the colon or rectum is one of the most commonly diagnosed cancers in the United States, that it’s a leading cause of cancer- related death in our country, and more than 90 percent of cases occur in people age 50 or older.

Clearly, this is no laughing matter, especially because there are no symptoms when colorectal cancer is in its early stage.

There is an important step you can take, however, to protect yourself: Get a colonoscopy when you hit 50.

“For some reason, people are afraid of the colonoscopy, yet the incidents of complication are so low,” said Nelson Bonheim, MD, head of gastroenterology at Greenwich Hospital.

During the procedure, with the patient sedated, the physician uses a flexible lighted tube to examine the entire length of the colon, or large intestine. This last portion of the digestive tract is a five-foot hollow tube that absorbs water and minerals from digested food. At the lower part of the colon is the rectum, which stores undigested solid waste. If, during the colonoscopy, the doctor finds any polyps (growths) on the colon lining, they can be easily removed and then biopsied to determine if they are precancerous.

Polyps are found during 20-25 percent of all colonoscopies, according to Dr. Bonheim. “The majority of these are not precancerous, but until a biopsy is done there’s no way of knowing, so the standard of care is to remove all of them.”

What are the odds?
Some risk factors can’t be controlled, mainly age and race. African-Americans have a slightly higher risk. So do people who have had “adenomatous” polyps – the type that can become cancerous – biopsied previously. Those with inflammatory bowel disease, including Crohn’s disease and ulcerative colitis (not irritable bowel syndrome) are at higher risk, too.

The American Cancer Society says that if you have a family member who had colorectal cancer at a young age, you may have an uncommon inherited gene defect, or mutation, that would signal a need for more frequent screening.

Theories abound about lifestyle factors that increase the chances of getting colorectal cancer – including high-fat diet, obesity, smoking and heavy alcohol use.

And yet, “there’s no direct evidence that these things cause colorectal cancer,” said Dr. Bonheim. “But we do know that certain things are good for your overall health, like eating food low in animal fat and lots of fruits and vegetables, controlling your weight, and being physically active.”

“I tell people to do what they know is good for their overall health. Don’t smoke cigarettes or drink alcohol excessively. Will these things guarantee that you won’t get colorectal cancer? No. Will they keep you healthier overall? Yes, of course.”

Still, he emphasized,“There is no diet that can take the place of screening. Colonoscopy is clearly the best way to prevent colorectal cancer.”

Colonoscopy – how often?
Universal guidelines recommend a first colonoscopy by age 50, and at age 45 for those at higher risk. What happens next is open to debate. Certainly, if you have polyps removed, you should discuss a timeline for future exams with your doctor.

But what if you’re among the majority for whom initial results are clean? Government guidelines suggest that every ten years is sufficient. The American Cancer Society agrees, but many gastroenterologists, researchers and health-conscious patients do not.

Medicare covers one preventive colonoscopy every ten years for most people. Those who are considered high risk, including people who have a sibling, parent, or child who has had colorectal cancer or an adenomatous polyp, are covered for screening every two years.

Many doctors recommend that if a patient has no polyps at age 50, they should have another exam at age 55, and another five years later.

“If you have three clean colonoscopies, chances are you will not get colorectal cancer, but some people are still not comfortable waiting another ten years to find out,” said Dr. Bonheim. “I had one patient with ulcerative colitis who experienced rectal bleeding. She thought she had hemorrhoids, but she really had colorectal cancer. We treated her and she’s okay now, but if she had been tested earlier, we would have been able to remove the polyps before they became cancerous.”

Dr. Bonheim recalled another patient who had a clean colonoscopy at age 50. “I told him to come back in five years. He didn’t come back until the end of the eighth year when he started bleeding. It was cancer and, again, we successfully treated him, but it would have been easier if we caught it in polyp stage.”

Colonoscopy is the only universally recognized test for effective prevention and early detection of colorectal cancer.

The “virtual colonoscopy” – a CT scan that produces 3-D images of the colon and rectum – became available as an alternative a few years ago. But it has its limits. “If polyps are detected, you then need to schedule a traditional colonoscopy to remove them, and because it’s a CT scan, you expose yourself to radiation,” explained Dr. Bonheim, who only uses the virtual procedure for patients who cannot, for medical reasons, have a traditional colonoscopy.

Sigmoidoscopy, another procedure to detect colorectal cancer, is used to examine the lower third of the colon.

Prep for success
“It’s imperative that your colon is clean and empty at the time of the exam,” explained Dr. Bonheim, “because polyps can be flat and difficult to see.” That’s the reason for the preparation, which begins with a clear liquid diet one day before the exam. Today’s preps are highly effective and have become easier to take over the past few years. But the fact is, you will need to drink a lot of liquid and stay near a bathroom.

When the diagnosis is cancer
Surgery, chemotherapy and radiation therapy are the primary ways to treat colorectal cancer. Sometimes chemo-therapy is paired with targeted therapies known as monoclonal antibodies, which are man-made proteins that attack parts of the cancer cells.

Greenwich Hospital physicians have access to the newest techniques and treatments, and clinical trials are available to qualified patients at various stages of treatment.

More people are surviving colorectal cancer than ever before due to the combination of routine screening, improved technology and findings from ongoing medical research.

Take charge!
The American Cancer Society now says the risk of developing colorectal cancer at some point in your life is about 1 in 20, or about 5 percent. The earlier the cancer is found, the easier it is to treat.

Further, government health experts suggest that if everyone age 50 or older got regular screenings, as many as 60 percent of deaths from this cancer could be avoided.

Warning Signs Talk to your doctor if you experience:
• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
• A feeling that you need to have a bowel movement that is not relieved by doing so
• Rectal bleeding, dark stools, or blood in the stool
• Cramping or abdominal pain
• Chronic weakness and fatigue

The Endoscopy Center of Greenwich Hospital
500 W. Putnam Ave., Greenwich
Hours: Monday-Friday, 7am-4pm

Greenwich Hospital’s Endoscopy Center offers colonoscopy and other endoscopic services in a convenient, friendly outpatient setting. Colonoscopy patients typically return home within a few hours.

The Center is fully accredited by the Joint Commission, the nation’s leading healthcare accrediting organization. For more information, visit www.greenwichhospital.org/endoscopy-center.

The following physicians provide colonoscopy services at our Endoscopy Center:

• Alan Selkin, MD 203-661-2277

Center for Gastrointestinal Medicine of Fairfield and Westchester, PC
203-863-2900
• Jennifer Barro, MD
• Neal Schamberg, MD
• Nelson Bonheim, MD
• Felice Zwas, MD
• Neda Khaghan, MD

Sound Shore Gastroenterology Associates, PC
914-253-9252
• Robert Goldblatt, MD
• Neil Shapiro, MD

If you would like to have your procedure at the Endoscopy Center of Greenwich Hospital, please let your doctor know at the time of scheduling.

Are you considering a colonoscopy and have questions about the procedure? Request a phone consultation >>