Everything you wanted to know (and more) about a colonoscopy, but were afraid to ask

Your overall lifetime risk of developing colorectal cancer is 1 in 20. This year, the American Cancer Society estimates more than 100,000 new diagnoses of colon cancer, and more than 40,000 new cases of rectal cancer. Of those diagnosed, more than 51,000 are expected to die from this preventable and treatable cancer. Kristin LeGrand, D.O., a family medicine practitioner with Providence Medical Group-Camas in Camas, Wash., sheds some light on why screening for colorectal cancer is important, as well as what to expect when you show up for your appointment. Dr. LeGrand currently is accepting new patients.

  1. Is a colonoscopy the most effective screening test for colon cancer? Yes, colonoscopy is the most recommended and most reliable test for many reasons. It provides the most direct and complete view of the colon, where cancer could be hiding. It allows your doctor to perform a biopsy or to take a sample of any abnormal tissue found during screening. And you need a colonoscopy only once every 10 years, starting at the age of 50, as long as the screen is normal. Other tests, like the flexible sigmoidoscopy, video capsule endoscopy and CT colonoscopy, only look at part of the colon and need to be done every five years in order to ensure adequate screening. The latter two also can miss smaller polyps.
  2. What about a fecal test? Fecal occult blood tests also screen for colorectal cancer. They look for blood in stool, but cancerous polyps do not always cause bleeding, so they are limited in their ability to detect all cancers. These types of tests may be less invasive, but they also are less accurate than colonoscopy.
  3. How bad is the preparation for colonoscopy? The prep is probably nobody's favorite part. Different methods can be used, depending on your health status and preferences. Some involve drinking large volumes of liquid, some use only pills, and some are done with both liquid and pills. The prep is usually done just one day before the procedure, although your doctor may have you start a liquid diet one to three days before to make sure everything is cleaned out. If the taste of the liquid is a big issue, flavored powders can be added to make it easier to swallow. Chilling the liquid with ice also may help.
  4. Will I need to take time off from work? Usually, you do not have to take time off for the preparation - you can start that the night before the procedure. But you will need to take off the day of the procedure, and you'll need someone to drive you home.
  5. Does the prep have any unpleasant side effects? Besides cleansing the colon (Just think - some people pay a lot of money to get their colon cleansed!), you also may experience some cramping and diarrhea. Some preparations also can change your electrolyte balance, but your doctor will make sure the preparation chosen for you does not interfere with any of your medical problems or medications.
  6. What's the recovery time like? After a colonoscopy, most people are back to work and "normal life" within 24 hours, or after the sedation wears off. It is recommended to refrain from flying for 48 hours after the procedure.
  7. Are there any risks associated with colonoscopy? Colonoscopies are generally safe, but like any procedure, there are some associated risks, including bleeding or infection, if a biopsy is taken. The risk of causing a perforation, or hole, in the colon is very, very low, but can be life-threatening if it occurs.
  8. What really happens in a colonoscopy? A flexible scope - about the size of your little finger - with a camera and fiber optic light on its end is passed through the rectum and into the colon. A small amount of air is used to inflate the colon so your doctor can see inside. The scope bends around the curves of the colon, which allows your doctor a 360-degree view all the way to the cecum, where the small intestine meets the large intestine, or colon. The entire procedure takes an average of 20 minutes. If your doctor finds a polyp, or growth, he or she may take a biopsy of the growth and send it off to a laboratory for further testing. Sometimes, there is bleeding after a biopsy, and if this happens, your doctor can use a laser or another heat source, through the colonoscope, to stop the bleeding.
  9. Will I be awake? Your doctor will give you a medication to help you relax, usually through an IV, as well as a pain medication to help with any discomfort. Some people have a vague recollection of moments during the procedure, but you will be sedated and overall, relaxed.
  10. Isn't colorectal cancer something that happens when you're old? Unfortunately, colon cancer is not just an "old-people disease." Each year, close to 13,000 young men and women are diagnosed with colon cancer. It can happen at any age, but the risk increases after age 50.
  11. Why is it recommended that screenings stop at age 75? The U.S. Preventive Services Task Force recommends stopping screening at age 75 only if the patient has had regular screenings up to that point. A 75-year-old who has never had a colonoscopy should talk to their doctor about the risks and benefits of the procedure and make an informed decision about screening.
  12. Are any people at higher risk for complications from a colonoscopy? People on blood thinners, such as Coumadin, or people with heart or kidney problems may require special consideration. These individuals still can get a colonoscopy, but they may require closer observation during the preparation process as well as during and after the procedure itself.
  13. What do you recommend for someone who is adamantly against getting a colonoscopy? Alternatives are available. I recommend at least getting yearly fecal occult blood testing done with a high-sensitivity home test (two to three stool samples are needed). I also would recommend talking to a doctor about other less invasive options, including the virtual colonoscopy. Even though it is not the No. 1 test, it is still better than no screening at all.