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Pathology

Robert R. Cawley, D.O.

Dover, NH 03802

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03/16/2021

Colorectal Cancer & Screening - Frequently Asked Questions

What is Colorectal Cancer?

The colon is also known as the large intestine or large bowel and is connected to the anus by the rectum. Colorectal cancer, colon cancer for short, is known to affect these areas. Abnormal growths called polyps can form in the colon or rectum and over time, can become cancerous.

What are the risk factors for colorectal cancer?

As you get older, the risk of getting colorectal cancer increases and about 90% of cases are noted in people age 50 or older.

Other risk factors include:

  • History of inflammatory bowel disease, such as Crohn’s Disease or ulcerative colitis
  • Family history of colorectal cancer and/or colon polyps
  • Certain genetic syndromes such as Lynch Syndrome
  • Minimal physical activity
  • A diet that is low in fruits and veggies
  • A diet that is low in fiber and high in fat
  • Obesity or being overweight.
  • High alcohol consumption
  • Use of tobacco products

How can I reduce my risk of colorectal cancer?

The best way to reduce your risk of colorectal cancer is to get screened. The United States Centers for Disease Control & Prevention recommends the following lifestyle changes to reduce your colorectal cancer risk:

  • Changing your diet to ensure more fruits and veggies, as well as increasing fiber intake
  • Exercise
  • Limiting alcohol intake
  • Avoiding all tobacco products

What are the guideline recommendations for colorectal cancer screening?

The U.S. Preventive Services Task Force recommends that adults between the ages of 50 and 75 get screened for colorectal cancer. The Task Force also recommends that individuals younger than 50 with a family history of colorectal cancer and/or colon polyps or have personal history of inflammatory bowel disease be screened as soon as possible. Screening for anyone older than 75 is at the discretion of the individual and their doctor. Any questions as to whether you should be screened needs to be discussed with your primary care doctor.

Further, the American Cancer Society recommends that those at “average risk” start routine colon cancer screening at age 45.

What types of screening are available?

Screening options may include:

  • Stool Tests- these tests involve obtaining a stool sample that is sent to the lab to look for specific markers.
    • Guaiac-based fecal occult blood test (gFOBT)-detects blood in stool (an indicator there may be an issue in the colon).
    • Fecal immunochemical test (FIT)-uses antibodies to detect blood in the stool.
    • FIT-DNA test-combines the FIT test with a test that detects altered DNA in the stool. This test requires an entire bowel movement, rather than a sample and is sent to the lab to look for cancer cells.
  • Flexible Sigmoidoscopy- this test consists of a short, thin, lighted and flexible tube that is inserted into your rectum by a doctor, typically a gastrointestinal (GI) specialist and they review the lower third of the colon to check for polyps or cancer.
  • Colonoscopy- while this test is like the sigmoidoscopy, a longer tube is used to survey your entire colon. During this test, the GI specialist will also remove polyps and take samples of tissue for biopsy if needed. Colonoscopy is known to be the gold standard for colorectal cancer screening, because if there are polyps or cancerous cells noted, they can be removed and/or biopsied immediately.
  • CT Colonography- this test uses x-ray and computers to produce an image of your entire colon that the doctor will assess.

It is important to discuss which test is best or right for you with your primary care provider. There are also some tests that your insurance may not cover, which your provider will also be able to steer you towards.

My primary care provider recommends I get screened for colorectal cancer. Now what?

Now that you have discussed this with your primary care provider and have agreed to screening, they will send a referral to a GI specialist. During your GI specialist appointment, you will have a further discussion regarding your options and what is best for you. After, you will be scheduled for your procedure, either in the GI office or at the hospital.

I know that I need to be screened for colorectal cancer, but I have heard the preparation for a colonoscopy is terrible. What do I need to know?

The preparation or “prep” for colonoscopy or sigmoidoscopy can be unpleasant but is much more tolerable than in the past. There are many different options that you can discuss with your GI specialist. Prep for these procedures consists of cleaning out your bowels, to allow the provider to have a better look at your colon. It is important that the prep is completed based on your doctor’s instructions. Otherwise, you run the risk of having to repeat the “prep” and the procedure.

I am terrified of getting a colonoscopy; what are the risks involved?

While many people have the same feeling about colonoscopies, you will likely agree with others who say that after the procedure is done, the “prep” was the most uncomfortable part. While any procedure performed may have risks, there are minimal risks with colonoscopies.

Minor side effects can include nausea, vomiting, chills and confusion. While these are rare, the nurses involved in your case are prepared with medications to help with the nausea and vomiting feeling. The chills and confusion tend to wear off with time.

As far as risks from the procedure itself, risks include infection, bleeding (are the most common) and intestinal perforation (in which the instruments penetrate the colon) and can be issues, they tend to be rare.
Your GI specialist will address any of these questions both at the pre-operative consult, as well as on the day of the procedure. The anesthesiologist assigned to your case will also be discussing risk factors with you on the day of your procedure.

What protocols does Wentworth Douglass have in place to protect me from COVID-19?

During these uncertain times, many people are afraid to come to the hospital for their care, but rest assured, there are many policies and protocols in place to keep you safe:

  • Pre-procedural COVID testing with negative result required.
  • Hospital-issued masks are required of all individuals on any Wentworth-Douglass property.
  • Hand sanitizer is provided throughout the building.
  • Strict visitor policies enforced.

Learn more about our COVID-19 Safe Care Commitment.

For more information about the Wentworth-Douglass Hospital Center for Advanced Endoscopy Services.

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