Colorectal Cancer Screening

• Colorectal cancer (CRC) is the third most common cause of cancer in men and women in the United States and the second leading cause of cancer death.
• Annually, over 150,000 people in the US. are diagnosed with CRC, and over 50,000 will die from the disease.
• CRC screening can help to detect this cancer early and can even prevent it. Finding CRC early makes it easier to treat and potentially cure.
• There are many different types of CRC screening tests (see below).

• Everyone should undergo CRC screening beginning at age 45.
• If you have a family history of CRC, your doctor may recommend that you start CRC screening earlier than 45.

There are two main categories of CRC screening tests:

• Tests that directly look at the lining of the colon, such as colonoscopy.
• Non-invasive stool-based tests.

• A colonoscopy is an examination of the lining of your colon.
• During a colonoscopy, your doctor will insert a scope—a long flexible tube with a camera and light on the end of it—into your rectum and through your colon.
• This procedure is done with sedation, so that you don’t have any discomfort or pain during the procedure.
• The doctor will examine the lining of your colon and can remove colon polyps during the procedure. Biopsies, or small tissue samples, of the colon can be obtained during the colonoscopy.

• A colon polyp is a growth on the lining of the colon, similar to a mole on your skin.
• We care about colon polyps because we know that most colorectal cancers begin as small polyps. Not all polyps will turn into CRC, but there’s no way to predict which ones will and which ones won’t. For this reason, we remove any polyps we find during the colonoscopy.
• By removing colon polyps before they turn into cancer, colonoscopy can decrease your risk of developing CRC in the future.

• Colonoscopy is a safe procedure overall. However, any invasive procedure does have some risk associated with it.
• The sedation used during colonoscopy can cause changes in the heart rate, blood pressure, breathing, and oxygen level. During the colonoscopy, an anesthesia provider will be monitoring your vital signs and giving you oxygen.
• Risks associated with the colonoscopy include a small chance of bleeding or infection.
• There is a less than 1 in 1,000 chance that a small hole or perforation in the wall of colon can happen during the colonoscopy. In some situations, this can be repaired during the procedure. But in some cases, surgery may be needed to repair it.
• There are some limitations of colonoscopy. Even though colonoscopy is the best test to look at the inside of the colon, colonoscopy is not perfect, and things can be missed. The cleaner your colon is and the longer we spend looking at the inside of the colon during the colonoscopy, the lower the chance of something being missed.

• In order to see the lining of the colon clearly during the procedure, you must flush all the fecal material out of your colon before the procedure.
• This is done by following a limited diet the day before your procedure and by taking a laxative solution prior to the procedure. The medication will cause you to have diarrhea, and this is expected.
• Typically, the laxative solution is split up, and we call this a "split prep." You will take the first half of the bowel prep the night before the procedure, and you will take the second half early on the morning of the procedure. This helps to ensure that your colon is as clean as possible when the procedure starts, which makes it easier to find colon polyps.

• On the day of the colonoscopy, you should expect to spend about 3-4 hours at the procedure center.
• When you arrive, a nurse will check you in, have you change into a hospital gown, check your vital signs, and ask you some medical questions.
• You will have an IV placed in your arm. This is for the sedative medication to be given during the procedure.
• You will meet the anesthesia doctor and the GI doctor before the procedure.
• The actual procedure takes about 45 minutes. You will be asleep for this.
• After the procedure is over, most people are awake within 10-15 minutes and feel like they had a nice nap.
• You will recover after the procedure for about 45-60 minutes. You will be able to have a snack in the recovery room, and the GI doctor will come talk to you about the initial findings from the colonoscopy.

• After recovering for about an hour, you will go home. Even though you will feel almost entirely back to normal within an hour of the procedure ending, you need to have someone with you to make sure you get home safely after getting sedation.
• If you do not have a friend or family member who can bring you home after the procedure, there is a service you can use, called Partners in Care. For a fee, they will send someone who can safely escort you home after the procedure.
• You can eat whatever you want after the colonoscopy. We recommend you take it easy that day. You cannot drive that day.
• The following day you can resume your normal activities.
• It is normal to not have a bowel movement for a few days after the colonoscopy. It is also OK if you see a few drops of blood with the first bowel movement.
• Symptoms which you should call your doctor about are uncommon, but include: severe abdominal pain, severe rectal bleeding, or a fever.

• Any specimens removed during your colonoscopy will be sent to the pathology lab. It can take 7-10 days to get the pathology results back.
• The results will be released into the patient portal automatically once they are available.
• Within 1-2 weeks of the pathology report being available, your GI doctor will contact you (either through the patient portal, via phone, or via mail) to explain the results to you and let you know what they recommend in terms of follow-up colonoscopy.

• If you have no family history of CRC and you have no polyps on your colonoscopy, you may be able to wait 10 years before having your next colonoscopy.
• If you have precancerous polyps, your doctor will let you know when you should have your next colonoscopy. This is typically anywhere between 3-7 years after your initial colonoscopy, and depends on the size, type, and number of colon polyps you had.
• If you have a strong family history of CRC, you may need to have your colonoscopy more frequently, like every 5 years. Your doctor will help you determine how often you need to do this.

• There are two main tests for CRC screening that can be done via stool sample (FIT and Cologuard®).
• Keep in mind that stool-based CRC screening tests are not recommended for people who have a history of precancerous colon polyps or a family history of CRC.
• If a stool-based CRC screening test is negative, you don’t need a colonoscopy.
• Depending on which stool-based test you do, you will need to repeat the stool test every 1 or 3 years (1 year for FIT, 3 years for Cologuard).
• If a stool-based CRC screening test is positive, you will need to have a colonoscopy to find out why.
• Stool-based CRC screening tests can’t prevent CRC the way that colonoscopy can, since precancerous colon polyps are not removed. But these tests are much easier than having a colonoscopy and can detect CRC early, when it is easiest to treat, and is potentially curable.

• The best CRC screening test is the one you feel most comfortable doing.
• For most young healthy people, a colonoscopy is a great choice because it allows for both CRC screening and prevention, through the removal of precancerous colon polyps.
• However, if you have concerns about colonoscopy or anesthesia and would prefer to get screened with a non-invasive test, a stool-based test may be a better option.
• If you are not sure and would like to talk to a GI doctor or nurse practitioner, you can call our office to schedule an appointment.
• If you are having any GI symptoms that you are worried about—such as abdominal pain, change in bowel habits, constipation, diarrhea, blood in the stool—see a GI doctor to talk about your symptoms and CRC screening.