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Colorectal Cancer: The Importance of Screening and Early Detection

Tuesday, Mar 07, 2017

A cancer that doesn't have to kill

Colorectal cancer, including colon and rectal cancers, is the second leading cause of cancer death in men and women in the United States after lung cancer. Colorectal cancer happens most often in people aged 50 years or older, and the risk increases with age.

Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. During a screening procedure, a physician can remove polyps before they turn into cancer.

"Screening via colonoscopy in particular is powerful as it not only detects colorectal cancers but also prevents it by finding polyps," said Doylestown Health colorectal surgeon Robert Akbari, MD. "No other cancer screening method I'm aware of is both diagnostic and preventative."

Screening can also find cancer earlier, when it is most effectively treated. Precancerous polyps and early-stage colorectal cancer don't always cause symptoms. That is why having a screening test is so important.

Screening recommendations

Regular screening, beginning at age 50, is the key to preventing colorectal cancer. The U.S. Preventive Services Task Force (USPSTF) recommends that adults age 50 to 75 be screened for colorectal cancer, and that adults age 76 to 85 ask their doctor if they should be screened.

But if you are at higher risk, you may need to be tested earlier than 50, or more often than other people.

The case for colonoscopy

"The gold standard is really colonoscopy at this point in time," said Dr. Akbari. "The other methods can be useful in certain circumstances, but if they are positive (for example if a stool test shows blood), a colonoscopy is usually the next step."

Research suggests that colonoscopy reduces deaths from colorectal cancer by about 60 to 70%.

In this test, the doctor uses a colonoscope (a flexible lighted tube with a lens for viewing and a tool for removing tissue) to look at the rectum and entire colon. Air (or carbon dioxide) is pumped into the colon to expand it so the doctor can see the colon lining more clearly.

During colonoscopy, any abnormal growths in the colon and the rectum can be removed. The colon needs to be completely cleared out so the doctor can get the best look at it.

For people with average risk, colonoscopy is recommended every 10 years.

Don't be afraid of colonoscopy

Unfortunately, only a little more than half of people who should get tested for colorectal cancer get the tests that they should, according to the American Cancer Society.

The procedure is usually covered by insurance. "Insurers understand that screening saves them money in the long run and are generally willing to cover the test," said Dr. Akbari.

You'll be given detailed instructions about preparing for the test (bowel prep), which includes fasting and taking laxatives.

"Today's bowel preps are less volume and easier to tolerate than the older ones," Dr. Akbari said. "They are simply laxatives that clean your system out. Sure, they don't taste great, but they are certainly worth the benefits. Remember, some people pay for similar treatments at spas."

During the actual exam, which takes about 30 minutes, you'll most likely be sedated and kept comfortable.

"The colonoscopy itself is a breeze to most people," added Dr. Akbari. "It's not uncommon for people to say," So when do we start?' when they are waking up afterwards."

Other types of screening tests

There are other tests that find polyps and cancer. Talk to your doctor about which test is right for you.

Stool tests

A sample is collected and sent to the lab to look for blood in the stool. These include Guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT).

A stool DNA test (FIT-DNA) checks for abnormal sections of the genetic material DNA from cancer or polyp cells.

Stool tests are recommended every one to two years.

Double-contrast barium enema

This is an x-ray test of the colon and rectum.


A flexible, lighted tube is put into the rectum and lower colon to check for polyps and cancer. Air (or carbon dioxide) is pumped into the colon to expand it so the doctor can see the colon lining more clearly. The lower colon must be cleared of stool before sigmoidoscopy, but the preparation is less extensive than that required for colonoscopy. People are usually not sedated for this test. Abnormal growths can be removed for testing (biopsied).

Sigmoidoscopy is recommended every five years (with or without stool tests).

CT Colonography (Virtual colonoscopy)

A procedure that uses a series of X-rays called computed tomography to take a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show abnormalities on the inside surface of the colon.

CT colonography is recommended every five years.

About Doylestown Health

Doylestown Health is a comprehensive system of inpatient, outpatient and community services connected to meet the health and wellness needs of all members of the community. Our independent and nonprofit system is dedicated to healthcare excellence from childbirth to end-of-life care.

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