Perhaps this is an awkward time to talk about colon cancer, right after this holiday season of eating and celebrating. Actually, any time is an awkward time to talk about cancer, but necessary. Your intestines are a big part of having a happy digestive tract, so it’s important to think about their health. Colonoscopies have a terrible reputation and frighten some people, but colon cancer is the second leading cause of cancer death in the United States – isn’t that more frightening than the test? We know that catching colon cancer and treating it early can allow most people to survive. So, while it may seem unpleasant, the test could save your life.
What is the colon and how does it work? The colon is also known as the large intestine or bowel and is about 5 feet long. At the end of it is the rectum where waste products move from inside the body to the outside when you go to the bathroom. The waste product is called by a variety of names: poop, stool, caca, feces, number two, bowel movement – they all mean the same thing. The colon is where water is reabsorbed from the waste product – what’s left over after all the nutrition is taken out of your food. The nerves in the rectum give you the signal that it’s time to empty your bowel and, if all goes as planned, you go to the bathroom.
Something may go awry, however. It can start with a small growth called a polyp which hangs around in the colon or rectum, sometimes for years, and can eventually become a cancer (or you could have an aggressive cancer from the get-go). For many, there are few symptoms of distress and, without a colonoscopy, it isn’t until they have an advanced cancer that they even realize it. Some people will have some abdominal pain or might have very black stool indicating that there is blood in it, but some will feel nothing out of the ordinary or only vague discomfort.
A colonoscopy is an examination directly into the inside of the colon and rectum. If polyps are found, they can be removed and biopsied – sent to a laboratory to see if they are likely to cause cancer. And, of course, if a tumor is found, that can also be biopsied to see if it is cancerous and, if so, what type of cancer is growing. This is essential to know what treatment would be best to defeat the cancer. This is called “early detection” when you find a disease before it is too advanced and difficult to treat.
Why are people so afraid of a colonoscopy? The idea of someone putting a tube inside you is a little intimidating, for sure. Colonoscopy has come a long way, though, and nowadays is much less unpleasant than before. One of the concerning things is the preparation before the actual procedure. You must take laxatives to clean out the colon so the doctor performing the colonoscopy can see what she/he is doing. If there is a lot of stool left inside it’s not a very accurate test, as polyps or tumors might not be seen, for example, and therefore can’t be removed. The prep may cause you to lose a day’s work, and the day of the procedure must also be left free for the procedure itself and recovering from the anesthesia.
The day before the colonoscopy is scheduled you can only drink clear fluids. The laxatives will make you have to go to the bathroom several times to evacuate your bowel – you definitely don’t want to be driving a truck while you’re doing that. After the procedure, there may be abdominal discomfort from gas, but that, too, will pass. See what I did there? Now the good news: the more you go to the bathroom, the more likely the doctor will get a good look at your colon. If you have a well-prepared colon, your test will be more accurate, and you will know if you have any disease that can be treated and cured early.
The day of the procedure can be tricky because you can’t eat or drink anything usually and you might be hungry and cranky if your procedure is scheduled for later in the day. Rest assured, though, you are going to really enjoy the snacks they give you when it’s all over!
The anesthesiologist or nurse anesthetist is the person who will give you medicine through an intravenous (IV) line to put you to sleep so you don’t feel the tube in the rectum and colon. Generally speaking, the whole test is done in about 20 minutes or so. When you wake up you stay in the recovery area for as much time as you need to wake up, eat a little something and get dressed. Someone will have to accompany you and drive you home since you will not be able to drive safely after the anesthesia.
The price can be another scary factor for people without health insurance. If you have insurance, you don’t have to pay for the procedure because it’s considered prevention, and under the Affordable Care Act (Obamacare) we don’t have to pay for any preventive services. However, if you have no insurance, you should be able to make a payment plan for the procedure. For more information about colonoscopies and how you might be able to get the procedure done for free, visit www.verywellhealth.com and navigate to the pages regarding colon cancer.
Are there risks? Yes. There are risks with any procedure in medicine – infection and bleeding, among others – and all of that is explained to you before you sign on the dotted line to agree to have it done. Are there any options besides colonoscopy? Yes, several. I’m guessing you’ve all seen the commercials for Cologuard on television. While colonoscopy is considered the “gold standard” or the best test, there are others that are less invasive and might be just as good. This is something you can discuss with your primary care provider, the health care provider you see for routine care like annual physicals, immunizations and illnesses.
Is there anything I can do to prevent colon cancer? Obesity is a risk factor for colon cancer, as well as diets high in processed, red and charred meats. Natural foods like fruits, fiber and vegetables are very important in preventing any type of cancer. High alcohol intake, smoking and lack of exercise are also things you can take control of to better your chances of not getting colon cancer. Find out if there’s any history of colorectal cancer in your family, which may cause you to be at a greater risk for it. Start colon cancer screening at age 50 unless you are at very high risk for it – again, a conversation you will have with your health care provider. More good news about colonoscopy is that you will probably only have to repeat it somewhere between every 3-10 years, depending on what’s found, and it is generally not done after age 75.
If you haven’t thought about any of this yet, now is the time to do it – especially if you are getting up in years. After all, a new year is coming – make this one of your resolutions! If you’re too young for your own colonoscopy, encourage those around you who are due for one to get themselves on the road to better health in 2020. It sounds like a gutsy decision, but it really is not!
~ Norma Stephens Hannigan is a Doctor of Nursing Practice who recently retired after a 43-year career providing direct care and teaching future nurses and nurse practitioners. Dr. Norma has treated many truck drivers at the various clinics she has worked. She currently writes for 10-4 from her home in Newburgh, NY.