President George W. Bush has polyps. He has had at least two colonoscopies and had polyps removed from his bowel. Just like many other people worldwide, he is at risk for colorectal cancer. Unlike many, he is screened regularly to detect and treat this type of cancer as early as possible to increase his chances of survival.

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Colorectal cancer is common. Early detection can improve the chances of survival drastically. However, it can only be detected early by means of screening tests such as a colonoscopy. When symptoms appear, the disease has already progressed.

A colonoscopy is an internal investigation of the colon with a flexible instrument. It is done after proper bowel preparation, and (fortunately) after intravenous sedation. So it might sound awkward and embarrassing to have a tube-like instrument inserted from behind, but this is all in a day’s work for the physician, and you’ll be blissfully unaware. More importantly, this procedure may save your life.

What are the warning signs and symptoms that just might point towards colorectal cancer and would make a doctor recommend a colonoscopy? Dr Peet van Eeden, gastroenterologist, listed the latest guidelines.

You may need a colonoscopy if:

• Your bowel habits have changed – if you are either constipated or suffering from diarrhoea, or constantly switching between these extremes;
• There is fresh blood in your stools – this can be confirmed by testing the stools;
• Your doctor suspects infection of the colon such as acute bacterial infection or diarrhoea after the use of antibiotics;
• Your doctor suspects inflammation of the colon such as ulcerative colitis or Crohn’s disease;
• You are older than 50 years. A routine colonoscopy should be part of your regular check-ups;
• You have a strong family history of colorectal cancer, typically if your mother, father, brother or sister has been diagnosed with colorectal cancer;
• You have had previous colonic polyps or have a family history of polyps;
• You had a barium meal and the radiologist detects an abnormality that needs further investigation.

The screening tests and how often a patient should be screened
It is not a matter of who should be screened, but from what age, how often and which screening tests to have done.

With as many as one out of four cases of colorectal cancer linked to a hereditary factor, it makes sense that people with a family history of colorectal cancer should be screened more often than others. In the case of colorectal cancer, screening tests include:

• 1. The testing for blood in the stool. This involves a faecal occult blood analysis;
• 2. A sigmoidoscopy, an inside look at the last third of the colon;
• 3. A colonoscopy, an inside look at the full length of the colon, can detect disease with greater accuracy than occult blood tests and a sigmoidoscopy combined. A colonoscopy can also detect diseases of the colon and rectum more accurately than a barium enema, and has two added benefits: firstly polyps can be removed during a colonoscopic examination and can either be cauterised or snared, and secondly a biopsy can be performed during a colonoscopy but not with a barium enema.
• 4. A barium meal or enema. Barium, a compact substance, is either taken orally or as an enema, and shows up as solid white matter on an X-ray, highlighting abnormalities in the bowel. This test is not really used as a routine screening test, and thanks to new technology (such as colonoscopies), used to lesser degree.
• 5. A DNA test to determine whether the individual carries the genes for a form of colorectal cancer, giving the individual a 100 % chance to develop colorectal cancer in future. DNA-tests are based on new technology and breakthroughs and are now available to detect Crohn’s disease, as well as hereditary non-polyposis colorectal cancer (HNPCC), and familial adenomatous polyps (FAP). DNA researchers recommend DNA testing at 18 years, before any symptoms or signs appear, for the best preventative procedures.

The individual’s risk will determine the screening test or combination of screening tests to be selected.

Dr Van Eeden provided guidelines as to how often a person with a specific risk should be screened.

Determine your risk by selecting one of the following eight options that best fit your profile:

1. You have no family history of colorectal cancer.
Your risk of colorectal cancer is the same as that of the general population, namely 6 %. You should undergo “average risk screening”, which consists of either an annual faecal occult blood testing plus a sigmoidoscopy every five years from age 50, or alternatively a colonoscopy every five years from age 50.

2. Your grandparent/aunt/uncle has been diagnosed with colorectal cancer.
You have a 9 % risk or 1,5-times higher risk than the general population. You should undergo “average risk screening”, which consists of either an annual faecal occult blood testing plus a sigmoidoscopy every five years from age 40, or alternatively a colonoscopy every five years from age 40.

3. Your mother, father, brother or sister (a first-degree relative) has been diagnosed with colorectal cancer when they were older than 50.
Your risk for colorectal cancer is 12 – 18 %, or to three-fold higher than the risk of the general population. You should undergo “average risk screening” (an annual faecal occult blood testing plus a sigmoidoscopy, or alternatively a colonoscopy every five years) starting at age 40. DNA screening is recommended after age 18.

4. You have two first-degree relatives (a mother and sister, sister and brother, father and sister, etc.), who have been diagnosed with colorectal cancer.
Your risk is 18 – 24 %, or three- to four-fold higher than the population risk. You should undergo a colonoscopy every five years starting at age 40 years. A DNA screening test is recommended, possible after age 18.

5. Your mother, father, brother or sister had been diagnosed with colorectal cancer when they were younger than 50.
Your risk for colorectal cancer is 18 – 24 %, or three- to four-fold higher than the general population. You should undergo a DNA screening test as soon as possible after age 18 and a colonoscopy every five years starting at age 40 years.

6. Your mother, father, brother or sister has been diagnosed with adenomatous polyposis.
You are at an increased risk (between 24 and 80 %) for this specific form of colorectal cancer. You should undergo DNA screening at 18 years and “average risk screening” from age 40 years.

7. Your mother, father, brother or sister has been diagnosed with Hereditary non-polyposis colorectal cancer (HNPCC).
Your risk to develop this form of colorectal cancer is 80 %. You should undergo DNA screening at 18 and a colonoscopy every two to three years starting at age 25 years.

8. Your mother, father, brother or sister has been diagnosed with Familial adenomatous polyposis (FAP).
Your risk to develop FAP is 100 %. You should undergo a sigmoidoscopy every six months, starting at age 10 -12 years and DNA screening at age 10 in order to remove polyps as soon as they form.

Remember: Timeous removal of polyps can prevent the polyps degenerating into cancerous growths. These actions – early detection and treatment – may save your life.
 

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