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“НАШЕ ЖИТТЯ”, ЖОВТЕНЬ 2015 WWW.UNWLA.ORG 33 That Dreaded Test—The Colonoscopy by Ihor Magun, MD, FACP You definitively know that you should do it and you know why. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The lifetime risk of developing colorectal cancer is about one in twenty. The risk is slightly lower in women than in men. What are the risks for colorectal cancer? As with all cancers, not everyone who has certain risks will progress to cancer; however, certain facts are well established. Consuming a diet that is high in red and pro- cessed meat increases the risk. Cooking meats at extreme temperatures (grilling, broiling, and frying) can play a role in producing chemicals that increase the cancer risk. Obesity, physical inactivity, and ex- cessive alcohol intake are all risk factors. Personal history of polyps, cancer, inflammatory bowel dis- ease and family history increase risk for this cancer. Individuals with non-insulin dependent (type 2) diabetes also have an increased risk, primari- ly because of the risk factors listed (obesity, inactivi- ty). The major premise for screening is prevention, rather than establishing a cancer at an early stage. Finding and removing polyps prevents individuals from getting the cancer in the first place. Younger adults can develop colon cancer but statistically speaking, the chances markedly increase after age 50, hence the screening commences at this age (unless other factors prevail). There are several screening tests available, but colonoscopy is usually the gold standard. There is required bowel cleansing preparation and sedation involved, but the test may be both diagnostic as well as therapeutic. If a polyp or abnormality is found, it is removed (if possible) and evaluated for any pa- thology. The follow-up time frame (for another co- lonoscopy) depends on what was found—quantity, type of abnormality, and whether it was completely removed. Most individuals follow up in ten years. A virtual colonoscopy is another option. The bowel cleansing preparation is identical to the one preceding regular colonoscopy, but there is no seda- tion. Most procedures are done at a radiology facili- ty. A tube is inserted into the rectum to pump in air for better visualization during the usual CAT scan. The images are provided and interpreted by the radiologist. The advantages are: no sedation, no down time (one can return to work/go home right after the test), and there can be an added benefit of visualization of areas outside the colon (issues that can be incidentally noticed). The disadvantages are radiation exposure, inability to visualize small polyps, inability to take any biopsies if any abnor- mality is found (now needing a regular colonosco- py), and if everything appears normal this test is recommended every five years. There is an MRI virtual colonoscopy that can be done, which elimi- nates the radiation exposure; however, it primarily detects large neoplasms and is not as sensitive as a colonoscopy. Flexible sigmoidoscopy is another option, but it is less utilized since it evaluates only a small termi- nal portion of the colon. It is recommended every five years. Double-contrast barium enema is yet another option, but it is not as routinely recommended. The bowel prep is the same as for the colonoscopy or the virtual colonoscopy. There is radiation exposure with this procedure, as well as inability to get biop- sies. Once again, this form of testing should be done every five years. There is a new noninvasive test for colon can- cer that is done at home. It uses a stool DNA test for people at average risk for colon cancer. It boasts a ninety-two percent success rate in detecting colon cancer. This test is called Cologuard and it does not require any preparations, nor invasive procedures. The disadvantage of this test is that there is a thir- teen percent false-positive result—people without cancer or pre-cancer testing positive. This can cause significant anxiety, and a regular colonoscopy is indicated to confirm or deny the problem. What about the digital rectal examination? This test can detect masses in the lower rectum. The test is not sufficient to detect colon cancer be- cause of the limited amount of colon that is exam- ined. The fecal occult blood test has not been an ac- ceptable method for colon screening. It has been shown to miss up to ninety percent of colon abnor- malities. No one looks forward to these screening proce- dures, but given the fact that one out of twenty indi- viduals may have a problem, all of us should take the time to have this evaluation done. If you are younger than fifty and have no issues, share this information with your family and friends—who knows, you may become a lifesaver!
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