Colonoscopy is not a pleasant subject but since I talk about all things relating to health and fitness, this subject cant be omitted. Why spend hours a day working out and eating right so you can life a long, active life if there is a polyp growing in your colon that will kill before you can retire? When it comes to cancer, colon cancer is in the top 5 killers – and its easy to prevent. By the way, if you are under 50 you can stop reading now and just set popup reminder on your 50th birthday with a link to this post :) Please remember that I am not a doctor nor am I an expert on colon cancer. The reason I know a lot about this subject is because I’m over 50, I have done a lot of research about strategies for colon cancer detection, and I talked to my doctor at length about my options.
Bad news first: 5% chance that you will get colon cancer in your lifetime. Good news: colon cancer is very easy to treat successfully if its found early and with a number of testing methods, its easy to do. The polyps that turn into cancer grow relatively slowly and they are fairly easy to spot, relatively speaking. Other than stopping smoking to prevent lung cancer, colon cancer is probably the next easiest to prevent. Its not just the colonoscopy that can be used, there are a number of other methods and each has drawbacks listed below:
- Colonoscopy – This is what I am having done. Its the gold standard for finding and removing cancerous polyps but carries the risk of perforation, especially in older people. They run a scope all the way up looking for, and removing, any polyps they find. Perforation would then require surgery to fix, not a happy thing. There is about a 0.2% of getting a perforation during the procedure. Typically the first colonoscopy is recommended at age 50, then again 10 years later at 60 if nothing bad was found the first time. Most people realize this already but having a colonoscopy isn’t the most pleasant thing in the world so it requires sedation. Most people now report that the preparation 24hrs before is far more unpleasant than the procedure itself.
- Poop test (Fecal Occult Blood Test)- Pre-cancerous polyps typically bleed so an easy way to find them is to look for blood in your poop. Blood is red, why not just look in the toilet bowl you say? Because the blood we are looking for isn’t visible because its in such trace amounts. The poop test doesn’t catch cancerous polyps as early as colonoscopy and can have false positives because there are a lot of different reasons you might bleed other than polyps. Any positive result means a colonoscopy. A common colon cancer screening procedure is to get the poop test yearly after age 50 and to then do a colonoscopy if a positive result is obtained.
- Sigmoidoscopy – Its like a colonoscopy except it doesn’t go nearly as far in. The good thing is that the part it checks is also statistically the most likely to have the cancerous polyps. What I was told is that it finds about 80% of the polyps. It also has a very low chance of anything going wrong, much less than the colonoscopy.
- Barium Enema – You get a barium enema and then they X-ray you. The polyps absorb the barium and become visible on the x-ray. The main disadvantage is that it misses small polyps so it only finds about 30%-50% as many polyps as a colonoscopy does.
- Virtual Colonoscopy – A new procedure that does a 3D X-ray of your guts to look for polyps. Certainly a lot less unpleasant than a colonoscopy but its not clear yet what percent of the polyps it finds. Personally the main reason that I wasn’t interested in this is the radiation needed for this. For the same reason I don’t want CAT scans unless its a life threatening emergency, I don’t want a virtual colonoscopy. Radiation from x-rays adds up and these 3D scans pummel you a lot more than the basic broken ankle x-ray AND they are irradiating organs and other important soft tissues. I’m a true techie but I wasn’t interested in this.
So where does this leave us? When you are over 50 its really a good idea to do some sort of screening for colon cancer since there is a 5% chance you have it. The easiest is the poop test but it only catches some of the cases. Barium enema is the next easiest but it too misses a fair number of the cancerous polyps. If either of these two tests come back positive then you need to get a colonoscopy anyway. Next in complexity and cost is the flexible sigmoidoscopy, it finds about 80% of the cancerous polyps. Then their is the colonoscopy, finds everything but its a pain in the @ss. No single right answer, you need to talk to your doctor and decide which is the best for you!
EDIT: June 5, 2012 My colonoscopy experience
So since I have just gone thru a colonoscopy, thought I would report on it. Apparently the technology for colonoscopies has gotten much better in the last 20 years because I have to say, this was not at all like the bad stories I remember hearing. So let me describe the procedure I went thru. The prep procedure started about 30 hours before the exam – I had to stop all solid foods. The only acceptable form of nourishment was sugar water, either clear fruit juices or soda pop. Going 30 hours without solid food was very difficult for me. My system is used to *lots* of fiber (more on that later) and when I stopped eating it, my stomach turned somersaults all day long. That day I had to do a 10km training run and it was thee most pathetic run I have ever done. I drank 16oz of apple juice before for energy and I was fine for about 25 minutes then I bonked big time, lost all energy – thats the trouble with simple carbs. Anyway at 6pm on the day before it was time for the first dose of “Suprep”, a nasty tasting liquid that empties your bowels. Its about the nastiest thing I have ever tasted and I could barely quaff it down. The following 3.5 hours I had to stay very close to the toilet if you get my meaning, no biggie, from international travel I’m used to getting travelers diarrhea all the time. Slept fine. When I woke up I got rehydrated with apple juice because I knew I wouldn’t be able to eat or drink anything the last 4hrs before the procedure. At 4hrs before I got another yummy dose of the “Suprep” which kept me near the toilet another 3 hours but by this time nothing solid was coming out, just dirty water. So the prep wasn’t really that bad at all, up to this point the worst thing was being deprived of solid food for 30 hrs.
At the colonoscopy clinic I got to wear one of those high fashion gowns that was too small for me and they got the IV put in. I have to say, I have a real problem with needles. Not just normal squeamishness but a near phobia of needles. That was definitely the worst part for me. After wheeling me in and getting me hooked up to the monitors they started the light sedative. Over the next 30 seconds, I started to get a feeling of well being and comfort, like laying in the warm sand on a perfect beach day. I wasn’t totally out, I could hear their voices but my brain didn’t do a good job at parsing what they were saying. A few times during the procedure their was slight discomfort but no wincing pain at all. It seemed like the elapsed time was about 5 minutes when it was really more like 30 minutes.
I sobered up quickly and was able to walk to the car fine but it was clear that my balance and reaction time were compromised so its a good thing they require you to have someone drive you home. My first meal (black beans and salsa of course!) was not quite as satisfying as I had dreamt it would be. No pain or anything, just didn’t taste as good as it normally did. WIth the afternoon off from work I was *really* tempted to go up on the roof and continue with the work mounting our solar panels but I wisely decided that should be left for a later date when my judgement, balance, and coordination are at 100%.
So the doctor didn’t find a single polyp, so I’m clear for another 10 years. Honestly, I wasn’t surprised because the odds were really in my favor. I have no family history of colon cancer, I get lots of exercise, I eat no processed meats or red meat, and I have a high fiber pseudo-vegetarian diet. Will I follow the recommendation and get another colonoscopy in 10 years? You bet! Its one of the cheapest life insurance policies available :)
On a more humorous note, there is a positive side of having a colonoscopy. Its one of two or three days in your life when the doctors orders are to eat nothing but sugar and to someone with a sweet tooth like mine, its a dream come true! Pure, refined, glorious sugar. No solid food allowed. There is virtually no healthy food I am allowed to consume in this 24hrs! No vegetables, no fruits, no grains, no brussel sprouts – no nothing. Just sugar water. For 24 hours I get to live like a hummingbird sipping the nectar of the Gods – Coca Cola. As I type I am having my ‘breakfast’ which is 16 ounces of Coca-Cola, 300 calories worth of high fructose corn syrup! I am really excited about my next meal, its mountain dew! As with wine tasting, you start with the subtle flavors and work up. Since Mountain Dew is even sweeter and more caffeinated, I will leave that for last. I know some of you are gasping right now with your jaw in your laps. You are thinking its appalling I’m drinking this junk when I could have apple juice or honey. Sorry, its just sugar with a vitamin pill added. This is a once in a lifetime opportunity, I am drinking Coke and Mountain Dew – you can have apple juice. :)