Information About Screening Colonoscopy From SAGES

8/7/2019 Information About Screening Colonoscopy From SAGES

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Screening ColonoscopyA simple guide to help answer your

questions

2002 Society of American Gastrointestinal Endoscopic Surgeons.

This content was approved by the SAGES Board of Governors in October, 2002 and may not bealtered or reproduced in any way without the express written permission of SAGES.

http://www.sages.org/


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What is the colon?

The colon or largeintestine is wherewater is reabsorbed

by the body and stool(feces) is held until itis eliminated. Itmeasures on average4-6 feet in length,

and extends from theend of the smallbowel (intestine) tothe rectum.


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What is the rectum?

The rectum is theholding tank for

the bodys solidwaste. It is about10 inches in length.It connects the

colon to the anus.


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What is a screening colonoscopy?

The term screening refers to examiningor testing a patient who currently has

no symptoms. Doctors use screeningtests to detect diseases early in theircourse in patients who are at high riskfor developing a particular illness or

disease. Detecting a disease beforesymptoms occur may improve apatients chance for cure.


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Colonoscopy is a test used by doctors tolook for colon and rectal cancer and

other abnormalities of the intestinaltract. It is the best and most accuratetest for this purpose (even moreaccurate than x-rays or CAT Scans).

Colonoscopy can also be used to biopsyan abnormality or to remove (treat) apolyp if these are found on the exam.


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So a screening colonoscopy is used to:

1) identify colon and rectal cancers intheir early stages

2) identify and remove polyps(precancerous growths) before theydevelop into a cancer.


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Why perform a screening

colonoscopy?

By screening patients with colonoscopy,polyps (precancerous growths) can bedetected and removed, therebyeliminating the possibility that they

will become a cancer.


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Why perform a screening

colonoscopy?

In addition, it is also believed that earlydetection of colorectal cancer will leadto a higher rate of cure and a betterquality of life for those who are found

to have cancer by colonoscopy.


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What is colonoscopy?

A colonoscope is a long,flexible instrument witha video camera and abright light built into it.

It allows a physician toplace it within the boweland closely examine thelining of the colon(large intestine) and

rectum.


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The colonoscope

Flexible tip

Controls

Biopsy device


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The colonoscope


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How does the colonoscope work?

The colonoscope isconnected to acomputer and video

screen. This allowsthe doctor toexamine the insidelining (lumen) of the

colon as well as totake photos of whathe/she sees.


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2 dials allow the doctor tomove the tip of thescope up & down (bluearrow) as well as left

and right (green arrow).Other buttons allow thephysician to suctionfluid from within the

bowel (red arrow) andblow air or water intothe colon (purple arrow)so the view will be clearand unobstructed.


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The end (tip) of theinstrument isinserted into therectum and

maneuvered toexamine the entirelarge intestine(colon) and rectum.

The tip is flexibleand bends easily.Biopsies can betaken of abnormalareas.

Light Camera

Biopsy

channel

Flexible tip


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How is colonoscopy performed?

The procedure isperformed in an

endoscopy suite

which is speciallydesigned for patientsafety and comfort aswell as so the doctor

has everything heneeds close at hand


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The colonoscope isplaced through therectum and is

advanced to thebeginning of thelarge intestine(colon). The scopeis then removedslowly to obtain agood view of thelining of the entirelarge bowel.


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Patients are sedatedwith intravenous

medication duringthe procedure sothat there is little tono discomfort.


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What preparation is necessary for the

procedure?The colon must be cleansed prior to the

exam so that the doctor has a clear

view of the intestinal lining. This isusually performed 1 to 2 days beforethe examination. There are severalcommon methods of preparing the

colon your doctor give you exactinstructions when he schedules yourprocedure.


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What preparation is necessary for theprocedure?

Your doctor willprescribe one of the

medications picturedhere. These allinvolve drinking alarge quantity ofliquid in order to flushthe fecal materialfrom the colon.


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What preparation is necessary for theprocedure?

In addition to taking this medication, youwill be asked to eat only clear liquids

(water, broth, apple juice, jello, etc.) forthe 24 hour period before theexamination. Medications such asaspirin, Motrin, ibuprofin and other anti-inflammatory drugs will also need to bestopped 5-10 days before theexamination.


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Are there risks to this procedure?

These procedures are indeed associatedwith some risks however, they arevery small. Recently 2 very large

scientific studies were performed andpublished which evaluated the exactrisk and frequency of complications

during colonoscopy.Nelson, DB et al, Gastro Endoscopy 01 Mar 2002; 55(3): 307-14

Wexner SD et al. Surgical Endoscopy 01 Mar 2001; 15(3): 251-61


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In over 16,000 colonoscopy procedures,

major complications such as perforationof the bowel (making a hole), heartattack, bleeding requiring bloodtransfusion or hospitalization, or death

occurred in less than 0.3% of patients


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COLONOSCOPY IS EXTREMELYSAFE!!


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Should I be worried about colon/rectal

cancer????More than 135,000 Americans will be

newly diagnosed with colorectal cancer

this year. Each year 56,000 patientsdie as a result of cancer of the colonand rectum. This makes colorectalcancer the SECOND leading cause ofcancer death in the US. In 1998, only55% of those diagnosed with colorectalcancer survived 5 years.


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Should I be worried about colon/rectal

cancer????

Men and women are equally affected.African-Americans have a lower overallsurvival than other racial groups perhaps because of a delay indetection. Colorectal cancer is highly

preventable and treatable if detectedearly. Because of this, screening forthis disease is necessary and important!


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What are adenomatous polyps?

More simply referred to as polyps, theseare pre-cancerous tumors. It isbelieved that most cancers arise from a

pre-existing polyp in the colon/rectum.The larger the polyp, the more likelythey are to contain a cancer. Polyps

can also bleed and obstruct the bowel.Polyps can usually be completelyremoved with colonoscopy.


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Warning signs/symptoms of colorectal

cancer Change in bowel habits (new

constipation, diarrhea)

Blood in stool/rectal bleeding Tarry or dark stools

Unexplained weight loss

Chronic abdominal pain or mass Night sweats

Sensation of rectal fullness


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If any of these symptoms arepresent

SEE YOUR DOCTOR AS SOON ASPOSSIBLE!!!!


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What causes colorectal cancer?

Several factors are felt to play a role inthe development (increase) of cancerof the colon and rectum:

1. DIET high in fats and low in fiberand vegetables

2. LIFESTYLE inadequate exercise,

smoking, excessive alcohol, andobesity

3. AGE over 40 years of age


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What causes colorectal cancer?

4. GENES certain genes have beenlinked to the development of coloncancer. These can be passed along infamilies.

5. INFLAMMATORY BOWEL DISEASElong-standing Crohns Disease and

Ulcerative Colitis

6. POLYPS most cancers arise frompreexisting polyps


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Who should undergo screening

colonoscopy?

Recommendations depend on your level

of risk. Individuals can be divided into2 major groups. Those with:

1. Increased/High risk

2. Average risk


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Who is at increased risk?

People are considered to have a high riskof developing colorectal cancer in thefollowing situations (20%-30% of the

population):1. Those with a first degree relative

(child, sibling, or parent) with ahistory of colorectal cancer or colonicpolyps

2. Those with a family history of FamilialAdenomatous Polyposis


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Who is at increased risk?

3. Those with a family history ofHereditary Nonpolyposis ColorectalCancer

4. Those with a personal history ofcolorectal cancer or adenomatouspolyps

5. Patients who have InflammatoryBowel Disease (Crohns or UlcerativeColitis)


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Who is ataverage risk for developing

colon cancer?

EVERYONE ELSE!!!!


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Who should have a screening

colonoscopy and how often?

This depends on your risk factors and

your age. Recommendations aredifferent for those who are potentiallyat increased risk of developing cancer

(high risk), than for someone with anaverage risk.


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Who should have a screening

colonoscopy and how often?

The simple answer is everyone at somepoint during their lifetime.


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The following recommendations are

supported by the Society of AmericanGastrointestinal Endoscopic Surgeons(SAGES) and constitute the most up to

date and scientific approach topreventing and detecting colorectalcancer


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HIGH RISKPatient Recommendations

People with a family history of Hereditary

Nonpolyposis Colorectal Cancer Colonoscopy every 1-2 years startingbetween ages 20 30 and every yearafter the age of 40


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People with a first degree relative who

has had colorectal cancer oradenomatous polyps screeningcolonoscopy every 10 years starting atage 40


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People with a personal history ofadenomatous polyps screening

colonoscopy should be performed every3-5 years after the procedure whichdocumented the polyps (3 years if the

initial polyps were multiple or >1 cm insize, 5 years if they were small andsingle).


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People who have a personal history ofcolorectal cancer screeningcolonoscopy should be performed every

3-5 years following treatment (3years ifpolyps found, 5 years if normal). Ifcomplete evaluation of the colon was

not performed before surgery forcolorectal cancer, a colonoscopy shouldbe performed within 1 year followingthe initial surgery


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People with inflammatory bowel disease(Crohns/Ulcerative Colitis) screeningcolonoscopy should be performed every

1-2 years beginning 8 years afterdiagnosis in patients with severedisease (pancolitis) or 15 years afterdiagnosis in patients with

limited/moderate disease (left sidedcolitis). Screening should begin at age40 or younger in all cases.


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People with a family history of FamilialAdenomatous Polyposis (FAP) shouldreceive genetic counseling and considergenetic testing to see if they are genecarriers. Those who have inconclusivetests should undergo screening flexiblesigmoidoscopy every 12 months

beginning at puberty. All who developpolyposis syndrome should undergocolectomy as coloncancer ratesapproach 100%


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AVERAGERISKPatient Recommendations

All people without any of the previously

listed risk factors should undergoscreening colonoscopy every 10 yearsstarting at age 50


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Are other procedures or exams

required to help detect colorectalcancer?

In addition to the previous

recommendations, all people atincreased risk should undergo FecalOccult Blood Testing (testing a sampleof stool for the presence of blood)yearly beginning at age 40. Those whoare ataverage risk should undergo thistesting yearly beginning at age 50.


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Are other procedures or exams

required to help detect colorectalcancer?

In addition, people ataverage risk shouldundergo screening flexiblesigmoidoscopy (a shorter version ofcolonoscopy which only looks at part of

the colon and doesnt requireanesthesia) at 5 year intervals aftercolonoscopy (i.e. age 55, 65, 75 etc.)


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Whose guidelines are these?

All of the recommendations contained inthis program are fully supported by a

host of independent medicalassociations and societies including the

American Cancer Society, the US Center

for Disease Control and Prevention, theAmerican College of Gastroenterology,and the American Society of Colon andRectal Surgeons.


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Will my insurance pay for these tests?

Before undergoing an exam, alwayscheck with your medical insurancecompany, however in most cases,

the answer isYES!!!


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How can I potentially reduce my risk

of developing colorectal cancer?1. Increase fiber intake to 20-30

grams/day

2. Keep fat intake below 30% of totalcalories

3. Stop smoking & excessive alcohol use

4. Exercise regularly5. Follow screening recommendations

6. Avoid being overweight


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of developing colorectal cancer?

There is some evidence that certain foodsand drugs may help prevent colorectal

cancer:

1. Vitamins A, E, C, and folic acid

2. Calcium and selenium

3. Aspirin and NSAIDs

4. Hormone replacement in women


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of developing colorectal cancer?BUT..

Be sure to ask your Primary CarePhysician for recommendations andassistance!!!


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What do some of these problems look

like through the colonoscope?

The following pictures are actual

photographs taken during colonoscopicexams in real patients. They help toillustrate the exceptional detail andaccuracy that colonoscopic exam

affords your doctor in diagnosing andtreating disorders of the large intestine.


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Normal Healthy Colon


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Normal Healthy Colon


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Benign colon pathology

Diverticulum Small polyp

Small polypAnal Fissure


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Hemorrhoids (internal)

Endoscope


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Vascular (blood vessel) abnormality

Malformed blood

vessels


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Colitis (intense inflammation)

Bleeding from pronounced

inflammation of the lining of

the colon


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Large adenomatous polyp undergoingremoval through the endoscope

Large polyp at arrows Snare removal of polyp


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Actual appearance of adenomatous polypin surgically removed section of colon


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Colon Cancer (Left Side)

Adenocarcinoma of the colon


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Actual appearance of colon cancer insurgically removed colon


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Cancer of the Colon (Right Side) arisingfrom a polyp

White arrows denote polyp, Black

arrows denote cancer arising from

polyp


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If you have any questions or

concerns about the role ofcolonoscopy in the care of yourhealth.

Contact your physician or one of the membersurgeons of SAGES for help

THANK YOU

Information About Screening Colonoscopy From SAGES

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