March 8, 2021
By David Byrd, MD, family practice physician at Athens Family Practice
My name is Dr. David Byrd and I am a board-certified family physician at Starr Regional Medical Center and Athens Family Practice. I, along with several other physicians, perform endoscopic procedures at Starr Regional.
In observance of Colorectal Cancer Awareness month this March, I want to discuss colorectal cancer and your health, who should be screened and evaluated for colorectal cancer, and how screenings and evaluations are performed.
Why should you be concerned about colorectal cancer?
Colorectal cancer, when males and females are counted together, is the second most common cause of cancer-related deaths in the United States. The Centers for Disease Control and Prevention(CDC) estimates that about 140,000 new cases will be identified each year and about 50,000 people will die from the disease. Fortunately, with various methods, this potentially lethal disease can be identified prior to becoming cancer or at an early stage and treated with success.
Who is at risk?
In the general population, colorectal cancer screening is recommended from age 50 to 75 years old, although there are some groups that recommend screenings begin earlier at age 45. This is a recommendation for all Americans. Some individuals, such as those with a family history of colon cancer prior to age 60 or genetic diseases such as Lynch syndrome or Familial Adenomatous Polyposis, should be screened earlier. Please discuss this with your primary care provider.
What screenings are available?
Screenings can be divided into three categories at present: stool tests for blood or abnormal DNA indicating potential presence of cancer; endoscopy use of an instrument to directly visualize the inside of the colon; and X-ray examinations which include barium enemas and special CT scans.
A colonoscopy is considered the most definitive test. Positive results from any of the other tests generally require a colonoscopy.
How is a colonoscopy performed?
Colonoscopy requires a cleansing of the colon. Most preps require a clear liquid diet the day prior to the exam and drinking a prep solution which will evacuate most or all the stool in the colon. The better the prep is, the better the examination. On the morning of the procedure, an IV will be started and the patient taken to the procedure room. A sedating agent will be given to the patient and once asleep the endoscope will be inserted and passed to the end of the colon called the cecum. It will then be withdrawn, and any abnormal tissue will be removed or if the tissue is too large, pieces of it will be removed for pathological examination. Following the procedure, it is recommended that the patient doesn’t drive or make complex decisions due to the sedation. Intestinal gas may cause cramping and should be expelled without hesitation.
Is the procedure dangerous?
No procedure is without complications. .Risks include bleeding or damage to the colon, but this is very rare.
What happens after the colonoscopy?
Following the procedure, the patient is watched and if there are no problems, the patient is sent home usually within an hour. Any tissue removed will be examined by a pathologist. If cancers or pre-cancers are present, the patient will be notified how and when to follow up.
Are there other conditions that would require a colonoscopy?
Change in stool such as thin stools or pencil thin stools, blood in stool, persistent diarrhea or constipation, unexplained weight loss, and persistent abdominal pain or cramping are all reasons to discuss with a primary care provider for consideration for colonoscopy.
And now it gets personal.
My grandfather died in my third year of medical school and my father is a survivor of Stage 3 colon cancer, which required surgery and chemotherapy. I saw their suffering. I perform colonoscopies to try to prevent needless suffering from a preventable disease. I personally have had screening colonoscopies and will continue. Please don’t put off a colorectal cancer screening from fear or embarrassment. It’s also safe to come to the hospital; don’t delay your care. Starr Regional Medical Center takes extra steps to ensure a safe environment for your visit, including enhanced cleaning and disinfecting procedures, daily staff screenings, mask requirements and social distancing in waiting areas. Get to the bottom of it now if you need colonoscopy.