Colonoscopy.
Many people hate the word. They hate the meaning of the word — an invasive examination that inspects the colon for small growths called polyps.
They aren’t crazy about the procedure, which usually involves sedation, and they really aren’t crazy about the night before the colon test, hours of drinking chemically enhanced fluids designed to purge the digestive system.
But people might really be crazy if they decide against colonoscopies. Gastrointestinal doctors say the 30-minute procedures, which most people should begin at age 50, are ideal ways to find and remove polyps before they turn into cancer.
March is Colorectal Cancer Awareness Month, and doctors are making extra efforts to tell people about the potentially life-saving tests. Dr. Brian F. Steckel, who practices with Capital District Colon & Rectal Surgery Associates in Albany, has answers for people thinking about their first procedures. And some words of advice for people who don’t think they want to undergo the test.
Here’s the set-up. During a colonoscopy, a doctor uses a small lighted tube about as thick as a human finger that has a tiny video camera on the end. The colonoscope is gently eased inside the colon and sends pictures to a TV screen for inspection. Special instruments can be passed through the colonoscope to remove small polyps or take tissue samples.
Q: Why is this important to start at age 50?
A: It actually varies for recommendations who should have a screening and when. An average-risk American, meaning no family history of significance, a first-degree relative — mother, father, sister, brother — not less than 60 developing colon cancer or no history of any symptoms — bleeding, change in bowel functions, constipation, weight loss, no family history — should have screening at 50. That all changes if you have a family history or if you have any symptoms. Standard recommendation is 50 for an asymptomatic person. The reason why it’s important is because the most common symptom of colon cancer is nothing. So there are no symptoms for the majority of people with colon cancer.
Q: Is there still a sense of nervousness about this procedure?
A: Yes. I think it’s because the colon and stool are taboo. People don’t like to talk about it. Twenty years ago, nobody probably talked about it at parties, but now people do talk about it because everyone has probably had a friend or family member who’s been affected by it. So as that taboo kind of breaks down, people are a little bit more willing. It is an invasive test; it’s not getting a blood test, it does take time to do the procedure, it does take time off of work, it does take time the night before to take the prep. Most people seem to be concerned about the prep being the worrisome thing, and that’s to try to clean out your colon so we can visualize it. A lot of people get turned off by that.
Q: Has it been easier or harder to get the word out about colonoscopies these days?
A: It’s been easier, ever since probably Katie Couric’s husband died from colon cancer and she had her colonoscopy on the news (in March 2000, NBC’s Couric underwent a colonoscopy on-air). Since then, a lot of people started talking about it. I assume the numbers of people getting screened probably went up around that time. It was also the time Medicare approved screening for colon cancer that it really took off. You’re already seeing a decrease in the number of people dying of colon cancer.
Q: How can people spread the word?
A: Like anything, once the stigma goes away and people can talk about things today they didn’t talk about 30 years ago. If colonoscopy could be one of those things, which I think it is becoming — people are laughing about their colonoscopies and people are thankful they had them. Like anything in life, the more you talk about it, the more commonplace it becomes to be talked about.
Q: What are the sedations like?
A: There are various different ways to put people to sleep, but generally it’s a pain medicine and a short-acting valium-type drug. There are other medications like Propofol for deeper anaesthesia, but most people don’t usually remember the procedure itself, they just remember the night before.
Q: Do some people choose to remain awake for their procedures?
A: It’s like snowflakes, no two are alike. Most people want to be asleep because sometimes it is a little uncomfortable. Having said that, I’ve done many, many, many colonoscopies without sedation. I wouldn’t recommend it. It’s a much more pleasant experience to get a little sedation and go home afterward.
Q: If people in their 20s or 30s read this, have no family cancer history and are decades away from their colonoscopy at 50, can they take steps to be kind to their colons?
A: Don’t smoke. Exercise, eat fiber, keep yourself fit, normal body weights, not sedentary, be aware of symptoms such as bleeding, change in bowel functions, weight loss, anything that’s different or unique, they’re not feeling quite right. The main thing is, everyone at 50 should have a colonoscopy. Unfortunately, we are seeing a lot more cancer in younger people now … they may even be changing the guidelines in the future to start even younger than 50.
The main thing is they don’t ignore symptoms, so if they have rectal bleeding for a couple weeks, that sometimes happens, but if it keeps persisting, they should really see their doctors.
Q: My father died in 2012 at age 91, and I can’t recall any times during his 50s, 60s, 70s when he had a colonoscopy. Why would that have been?
A: It was very uncommon for our parents or grandparents to have even talked about this. I wish my mother-in-law and father-in-law had both done it, because my father-in-law died at 54 from colon cancer, my mother-in-law died at 63 from colon cancer. If they had just had colonoscopies at age 50, they probably would still be alive today. This was the 1980s, and the technology wasn’t there, the data wasn’t there, nobody knew who should have it, when it should be done, how often it should be done. By the time people presented back then, the symptoms were usually far advanced. Of all the things in medicine that’s changed life expectancy, for medicine this is up there amongst the greatest screening programs ever. It’s more effective than mammography, it’s more effective than PSA testing, its more effective than just about any screening program we have for cancer.
Q: What are the risks involved with colonoscopies?
A: There can be small incidents of people having trouble with the prep. Some people can get dehydrated, some people can have problems with the sedation, which is fairly rare, some people can have bleeding afterward, some people can get infections afterward, some people can get a perforation or a hole in the colon. Finally, like any test, it’s not a perfect test. Some people can have polyps missed or tumors missed that can’t be seen or are obscured by something. So it’s not a 100 percent guaranteed test, but clearly it’s the best test we have.
Q: Any final words for the holdouts?
A: Just do it. Don’t think too much about it, don’t get scared. If you’re scared, go talk to a doctor who’s willing to work you through it.
Dr. Steckel will discuss colorectal health on Monday, March 28, at 6 p.m. at the American Cancer Society, 1 Penny Lane, Latham.
Reach Gazette reporter Jeff Wilkin at 395-3124 or at [email protected] or @jeffwilkin1 on Twitter. His blog is at www.dailygazette.com/weblogs/wilkin.
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