Preventive procedure: Routine colonoscopies can help patients avoid cancer

By Alex Bridges - abridges@nvdaily.com

WINCHESTER - The word colonoscopy makes some people cringe and others snicker.
But doctors say colon cancer is no joke, and the outpatient medical procedure can help save lives.

Colon cancer is the second-leading cause of cancer death for men and women in the United States, according to the latest statistics.
Many people do go for their colonoscopies as recommended, but not as many as experts would like. That number also may have fallen as of late for various reasons.

"We saw 900 colons last year," said Alice Ensogna, director of endoscopy at Winchester Medical Center. "I guess the past year we've seen what I consider a decline in procedures and mostly because of the economics of things.

"People don't want to pay a co-pay," she added. "People in the age bracket may be helping to support their children who've lost their jobs. ... Everything costs something. Companies are changing their insurances so they don't have the coverage they've had and that affects how people take care of themselves as being self-advocates."

People should have their first colonoscopy at 50 years old, and then every 10 years after that.

However, doctors recommend that those people who show signs or symptoms of trouble at a younger age should undergo the test. Likewise, anyone younger than 50 with an immediate family member diagnosed with colon cancer also should receive the screening sooner, Ensogna explained.

"That's where we've seen family members coming in in their 40s, because you are probably growing polyps 10 years before," Ensogna said.

Colon cancer symptoms may include blood in the stool, or sudden weight loss. People later diagnosed with colon cancer often start by experiencing abdominal pain as well as weight loss well before 50, Ensogna said.

Patients as young as 20-something have been diagnosed with colon cancer. But many times if a person experiences bleeding, they chalk it up to hemorrhoids, Ensogna said.

"So they feel comfortable with telling themselves that any reason for bleeding is a natural reason, so they don't go to a doctor, they don't have things checked out until the symptoms are pretty impressive and they have to see somebody," Ensogna said. "Many times that's a bit late."

As Ensogna explained, colon cancer, like others, can metastasize to any other area of the body.

But colonoscopies can help prevent colon cancer through the early detection and removal of polyps. Polyps, like tumors in other parts of the body, can either be benign or turn cancerous.

"The idea of the getting the polyp early allows you to get the source and to determine if that polyp has tissue in it that will grow into cancer," Ensogna said.

Doctors use a colonoscope to see, through a video camera, the inside of the colon in a hunt for polyps.

"It looks scary but it really isn't scary 'cause you're knocked out, essentially," said Grace Shih, a gastroenterologist in the endoscopy center at Winchester Medical Center.

The device, typically 100 centimeters long, "is a very flexible black scope," Shih said.

"Technology has improved vastly over the last two to three decades," Shih said. "It used to be a rigid scope, so imagine having that shoved up your [rectum]."

Imaging has also improved.

"That's one of the biggest things: We're doing colon cancer prevention," Shih said. "We want to be able to see polyps really well."

Narrowband imaging helps doctors find the polyps by allowing them to look at the mucous membrane of the colon using different light bands, Shih explained.

Doctors also now sedate patients for the procedure, Shih noted.

"The procedure itself isn't too uncomfortable," she said.

The specialist explained that doctors do have to puff gas into the colon to dilate it, which allows for better viewing.

The colon can be up to 6 feet long. A hand-held device allows Shih to control the front of the scope's movement. At the front is a camera and a bright, bluish white light.

Gastroenterologists insert the scope into a patient's colon through the rectum and push the device deeper during the procedure. The doctor can see the inside of the colon, view the lining of the intestine and look for polyps.

The device also has a port at the front into which doctors can insert other instruments.

These instruments allow doctors to perform biopsies on tissue and to remove polyps.

A polyp may be pre-malignant but can, over time, turn cancerous.

"That's what we're looking for," Shih said. "If we can catch them at a stage where we can remove them through the endoscopy, the colonoscopy, then we've pretty much done a preventative procedure for you."

Polyps come in different shapes and sizes, the flatter ones being the most difficult to detect. Others appear as bumps on the inside wall of the colon. A doctor will take a piece of a polyp for testing to determine if it is cancerous.

A patient may need surgery if a doctor detects a polyp greater than 3 centimeters or if it tests positive for colon cancer, Shih said. Doctors can remove parts or sections of the colon, which helps excrete and, more importantly, extracts moisture from the waste before the body gets rid of it. Patients can live without their entire colon as well because the small intestine can take over the function of its larger counterpart, Shih explained.
Other screening tests for colorectal cancer include the high-sensitivity fecal occult blood test and the flexible sigmoidoscopy.

People don't usually flock to hospitals to undergo colonoscopies.

"From the patient's perspective I think the most challenging thing about the procedure is that it's embarrassing," Ensogna said. "You have to expose yourself to physicians and you recognize that they're going to go up there.

"I think, as I have seen personal friends and family and co-workers go through this procedure, the best thing I hear is that at the end 'well you know what, that really wasn't a big deal,'" Ensogna added. "'The prep wasn't that bad. I was comfortable. I didn't really know what was going on during the procedure. I wake up. I got treated well.'"

Screening can help prevention, doctors say.

"But again, the biggest stress is this is really what you want to do and get it done at the appropriate age at the right time to prevent you having to get down that pathway and having to have surgery," Shih said. "Prevention of colon cancer is so ideal because it takes some time for a polyp to turn into colon cancer that we have that time to be able to prevent it, and it's a matter of getting people in to get it done and not wait until the very last minute."