Each year, 55,000 people die from colorectal cancer in the United States. Fredrick Ruymann, M.D., Gastroenterologist at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, says routine colonoscopy procedures can significantly reduce the risk for developing colorectal cancer.
People over age 50 and those with a family history of polyps or colorectal cancer are at higher risk. Through colonoscopy, polyps can be detected and removed at the same time. “Polyps can cause cancer and by removing polyps the risk for colorectal cancer is reduced,” says Dr. Ruymann.
A colonoscopy is a quick procedure that allows the physician to examine the entire colon with a flexible, camera-lit scope. Gastroenterologists can view the inside of the colon on a real-time video screen. If a polyp is found, it is removed and sent to a pathologist for evaluation. “There are many different types of polyps,” says Dr. Ruymann. Some do not carry the risk of cancer, while others are cancerous. If the cancerous polyp is detected early enough and the cancer has not spread, surgery can be avoided.
“The patient is sedated and comfortable for the colonoscopy,” says Dr. Ruymann. “The biggest hurdle for most people is the preparation, which is a colon cleansing the night before the procedure.” The most common preparations are gallon sized electrolyte solutions that are ingested. Similar to a laxative, it cleanses the system. Pill tablets and other solutions are also available.
Preparation for colorectal screening also involves meeting with the physician to discuss the benefits of the colonoscopy procedure as well as other screening options. “We discuss risk factors for colorectal cancer, such as family history, smoking and diet. The meeting also gives us the chance to walk patients through the procedure and make sure they are as comfortable as possible,” says Dr. Ruymann.
Although colonoscopy continues to be the best available procedure, Dr. Ruymann says another option includes a fecal-blood analysis. “Many physicians have abandoned this strategy because some complications in the colon don’t bleed,” says Dr. Ruymann. He also says an air contrast enema can also detect the presence of abnormalities, but isn’t as sensitive for polyps, requires follow-up screenings every five years and only serves as a diagnostic tool. Flexible sigmoidoscopy is another screening option. Dr. Ruymann says the flexible sigmoidoscopy is similar to a colonoscopy but only allows physicians to see the first third of the colon. This procedure also requires follow-up screenings every five years.
A colonoscopy, on the other hand, is more accurate at detecting polyps throughout the entire colon, generally requires screenings every ten years and can diagnose and remove polyps at the same time. “In most cases, people say the procedure isn’t as bad as they thought it would be,” says Dr. Ruymann.
Dr. Ruymann says there is also a procedure being researched that doesn’t require any preparation. Since polyps and colon cancer shed genetic material, it is possible to genetically test stool to see if there are polyps or cancer present in the colon. Currently, genetic stool testing only identifies up to 50 percent of polyps or cancer. Dr. Ruymann is optimistic about the emerging screenings and says, “Better genetic markers may develop to make this screening more accurate.”
People over age 50 and those with a family history of polyps or colorectal cancer can protect themselves from cancer by getting a colonoscopy. “Mount Auburn Hospital has a highly-skilled team of board certified gastroenterologists and provides a caring and comforting atmosphere for our patients,” says Dr. Ruymann.
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