Getting Over It: Why You Should Get a Colonoscopy
Facing the discomfort of a colonoscopy is a sure way to avoid the greater discomfort and danger of colon cancer
By Rhonda Alexander
Colorectal cancer—or colon cancer, as it is more commonly referred to—is the third most common type of cancer in the United States, according to the National Cancer Institute. Unfortunately, it’s also one of the deadliest forms of cancer.
While colon cancer can be deadly in its advanced stages, it’s also quite preventable with proper screening. However, many people still put off screenings. The problem with avoiding them is that “by the time patients come in with symptoms and the cancer is discovered, it’s too far advanced to cure,” says Andrew Albert, MD, gastroenterologist and medical director of the Digestive Health Institute at Advocate Illinois Masonic Medical Center.
“Once it has spread beyond the confines of the colon, it is very often deadly,” echoes Barbara Jung, MD, gastroenterology specialist in colon cancer prevention and the genetics of colon cancer at University of Illinois at Chicago.
Many people with colon cancer don’t have symptoms in the early stages. When symptoms appear, they can vary, based on the cancer’s size and location. “Rectal pain, change in bowel habits, rectal bleeding and unexplained weight loss—those are symptoms patients shouldn’t ignore,” says Mitchell Bernsen, MD, gastroenterology specialist and partner at Illinois Gastroenterology Group in Arlington Heights.
Even if a patient does get the worst-case scenario of a colon cancer diagnosis, that’s not the end of the road. In actuality, colon cancer is one of the most curable forms of cancer. That cure, however, starts with detection.
Patients avoid screenings for many reasons, Albert says. Some say they have no symptoms and feel fine. Some women believe that colon cancer can’t happen to them. Some are well aware that the necessary prescreening cleanse is going to demand that they are near a toilet, or in many cases, on the toilet for the majority of the day before. Some hate the idea of a camera snaking its way through their bowels.
But the cancer can be there before the symptoms. And women are at an almost equal risk as men in getting colon cancer. And yes, the cleanse is an unavoidable and magnificently unpleasant experience. But it’s just for one day. And the snaking camera? You really won’t even feel it. During a colonoscopy, a scope with a camera on its end is inserted into the colon to look for signs of cancer, which come in the form of polyps. Polyps, or growths on the inner lining of the colon, take about 10 years to grow and can possibly become cancerous, though some are benign.
Even though the colonoscopy is the most definitive test to diagnose colon cancer, “People simply aren’t comfortable with having a camera stuck in places it shouldn’t be going,” says Blase Polite, MD, gastroenterologist and colon specialist at University of Chicago Medicine.
Alternate screening tests, such as stool tests, X-rays and CT colonography screenings, can help determine whether someone has colon cancer. But these tests are recommended only if a patient is unable to do a colonoscopy due to physical hindrances, such as hip pain that prevents them from lying on their sides long enough for the procedure to take place, or a weak heart or lungs that can increase risks during sedation.
And these alternate screenings are recommended less and less because they are not as accurate as a colonoscopy. However, thanks to the ever-evolving science in medicine, there is now an alternative that provides more accuracy than its counterparts. The Cologuard fecal test is what primary care physician Kenneth Tomchik, MD, who is affiliated with Centegra Hospital in McHenry County, will recommend to his patients when a colonoscopy is not possible, or when a patient is not willing to go through the procedure.
“Because the oldest stool tests could only detect blood … they weren’t very specific. [Finding blood in the stool] could be for a lot of reasons other than colon cancer. Oh, you had filet mignon or rare meat for dinner? Well, that could be the reason for finding blood, which might misrepresent the results,” Tomchik says.
“The Cologuard test is the only [fecal] test that detects cancer DNA. It’s not [meant] to replace the colonoscopy; it is recommended for [average risk] patients who cannot or will not get a colonoscopy.”
The Cologuard test requires no prep and can be done at home. And it can detect 92 percent of colorectal cancers, according to Tomchik. This is only slightly less effective in detecting cancer than a colonoscopy.
With all of the screening options, it is important to get screened for colon cancer, regardless of the trepidation. And if you’re at high risk—meaning you have a first-degree relative who has had colorectal cancer or polyps—physicians recommend you get checked even sooner than 50, preferably via a colonoscopy since it is still the most accurate method.
Avoiding a colonoscopy as a way to avoid discomfort could well be the first step to even greater and longer lasting discomfort.
The discomfort that comes from having colon cancer. The discomfort that comes from the possible surgery, chemotherapy and radiation needed to remove it. The discomfort that comes from dying from colon cancer.
It’s best to not fear a little discomfort if it means preventing more later on.
Originally published in the Spring 2016 print edition.
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