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Screening for Colon Cancer

If you are over 50, or are over 40 and at increased risk for colon cancer because you have a family history of colon cancer, your doctor should screen you for colon cancer during your yearly examination by conducting a digital rectal examination (DRE), a fecal occult blood test (FOBT). In addition, a sigmoidoscopy (or colonoscopy) should be performed every three to five years.

The Digital Rectal Examination (DRE)

The DRE can result in testing of the rectum as well as the lower portion of the signoid colon. An infiltrating cancer can generally be felt as a hard and irregular polyp. A benign polyp, on the other hand, is more likely to be felt as soft and pliable. By performing a DRE on a yearly basis, your physician can increase the likelihood of detecting rectal (and some colon) cancers early.

Fecal Occult Blood Test (FOBT)

Colon cancers sometimes bleed, and the blood may be hidden in the stool. The Fecal Occult Blood Test uses a card on which samples of stool can be smeared and analyzed for the presence of hidden blood. Typically, two smears are collected from different parts of the stool each day for three consecutive days. The samples are then analyzed with a chemical to determine whether hidden blood is present in the samples. A similar test can now be performed by a doctor by taking a samply of stool during the DRE, then smearing the sample onto a card that uses a color system to indicate whether there is blood in the sample. If blood is found, further testing, such as a barium enema, a sigmoidoscopy, or a colonoscopy should be performed.

Sigmoidoscopy

This procedure uses a flexible fiberoptic proctosigmoidoscope - which is approximately 1.5 to 2 feet long and has a camera to allow visualization of the sigmoid, or left side of the colon. If a polyp is found during a sigmoidoscopy, a colonoscopy is normally recommended so that the entire colon can be inspected. During the colonoscopy, the initial polyp and any other polyps found in the rest of the colon can be removed and biopsied.

Barium Enema X-Ray

This procedure is sometimes used in place of, or in conjunction wih a sigmoidoscopy. Unlike a sigmoidoscopy, this procedure allows physicians to view the entire colon. The proceudre uses an inert substance containing barium that is inserted into the rectum and colon though the anus. A camera then watches under fluoroscopic guidance and X-ray pictures as the barium fills the colon and rectum. Some air might also be pumped to expand the colon, making it easier to see small tumors.

Colonoscopy

The colonoscopy is the most accurate tool for examining the entire colon, and has the added benefit of allowing the physician to remove and/or biopsy any polyps that are found. The colonoscopy uses a fiberoptic tube that is approximately 6 feet long, and can have other instruments attached, such as a snare or wire loop to remove polyps. Forceps can also be passed through the colonoscope to remove tissue for biopsy. Similarly, a small brush can be used with the colonoscope to collect epithelial cells for microscopic examination.

If polyps are detected and can be removed by the use of a colonoscope, the patient may not require surgery or other treatment. If cancer is detected that cannot be removed with the colonoscope, however, then a cancer diagnosis work-up is required to determine the nature of the cancer and whether it has spread beyond the colon.

Virtual Colonoscopy

This procedure combines X rays and computers in a new form of X-ray technology called spiral CAT. The examination is less invasive than a Colonoscopy. It takes only a brief amount of time and requires no sedation. With a virtual colonoscopy, the entire colon can be viewed without inserting anything but air into the rectum and colon.






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