Colonoscopy
for
Date: February
2008
Video #1: About MD
Among many honors, U.S. News & World Report has ranked MD Anderson
as one of the nation’s top two cancer centers for the past 15 years.
MD Anderson’s mission is to eliminate cancer. It is committed to ‘making cancer history.’
Hello. I’m Don Armstrong.
Part of MD Anderson’s mission is to eliminate cancer by offering prevention
and early detection programs.
Experts think about two-thirds of all cancer may be linked to things we
can control, especially avoiding the use
of tobacco, limiting alcohol use, eating
a healthy, well-balanced diet and controlling our weight. It is important to have regular cancer
screenings. These medical tests can help
find cancer early when treatments are most successful.
MD Anderson’s
When there is a suspicion of cancer, patients are usually seen in one of
our outpatient Care Centers. Specialists
in these centers diagnose and treat patients according to their type of
cancer. Each center uses an interdisciplinary, or team approach, where
surgeons, medical oncologists, radiation therapists and other cancer
specialists work together to provide the best possible care.
MD Anderson’s
Video #2: About
According to the American Cancer
Society, colorectal cancer is the third most common cancer in both men
and women. The colon, rectum and cecum make up the
large intestine, the lower part of your digestive system.
Cancer occurs when cells grow
and multiply out of control, damaging surrounding tissue and interfering with
the normal function of the colon or rectum.
The majority of colon and rectal cancer
cases are sporadic, meaning that their cause is unknown.
The remaining cases are hereditary.
Hereditary cancer can be passed to an individual through one of their parents.
These cancers are rare, generally occurring when a person is in their 30s to
40s.
When colon and rectal cancers are
detected early, there is nearly a 90% chance for a cure.
Most colon cancers begin as a polyp, a small non-cancerous growth on the
colon wall that can grow larger and become cancerous. As polyps grow, they can
bleed or obstruct the colon.
Often, there are no symptoms of colon cancer in its early stages,
but when symptoms do occur, they include:
If you notice one or more of these symptoms for more than two weeks, see
your doctor. Remember, it is
important to detect cancer in the earliest stages, when treatment can be most
successful. There are several methods
for screening and diagnosis of colon cancer. They include:
·
the fecal occult blood test which examines a stool
sample for traces of blood;
·
sigmoidoscopy in which
a flexible tube with a tiny camera is inserted into the rectum, allowing the
doctor to view the rectum and lower colon, and
·
colonoscopy which
also uses a flexible tube with a tiny camera but allows the doctor to view the entire
colon.
“When it comes to screening, it’s not just going for the procedure. You
want to have a complete examination of the colon, careful withdrawal and taking
time to screen the colon, removal of all the polyps, and a plan made based on
the number of the polyps and the type of the polyps. Covering all these bases is critical for
colon cancer prevention. Falling short
on any one of these could miss the opportunity to prevent that cancer.”
“In terms of the
colon cancer screening, you start...if you do not have anybody in your family
with a history of colon polyps or cancer...one should start at the age of 50.”
Video #3: About the Colonoscopy Procedure
It’s important to remember that, of the
several screening methods, only colonoscopy allows your doctor to view the
lining of your entire lower gastrointestinal tract.
Colonoscopy is capable of detecting
inflammation, infections, ulcers, diverticulosis,
intestinal narrowing, colorectal polyps, cancer or other problems that may be
present.
The procedure is performed using an
endoscope which is a long thin flexible tube with a light and a tiny video
camera attached to the end. The camera
transmits images to a monitor allowing the doctor to see the inside of the
colon.
In a sigmoidoscopy,
the endoscope reaches only to the top of the descending colon.
In a colonoscopy, the endoscope reaches
through the entire length of the colon where it connects to the small
intestine.
Most colon
cancers...about 70%...are found in the first six feet of the large intestine.
The other 30% occur in the last 10 inches of the large intestine, or
rectum. These cancers are referred to
as colorectal cancers.
Video #4: Preparing for and Having a Colonoscopy
The colon must be completely clean for the
colonoscopy procedure to be accurate.
“When you’re going through a test like
colonoscopy, it is absolutely essential to come up with a clean prep. If the prep is clean, the doctor will be able
to do the procedure well, able to see not only big polyps but the so-called
flat polyps or flat lesions which tend to have a different nature compared to
the bigger polyps, different in the sense they could actually grow to cancer
faster. So you want to pick the bigger
polyps but also the flatter ones. And in
order to see the flatter ones, you don’t want any stool lining the colon.”
This is where you play an important
role. The preparation starts the day
before your procedure. It involves limiting
your diet to clear liquids, drinking a special cleansing solution and taking
oral laxatives.
You will be asked to drink four liters of
the cleansing solution…the first two the evening before the procedure and the
second two liters on the day of the procedure. Drinking the second dose about 4
to 6 hours before the procedure is critical for an excellent clean out.
“It’s like a wash and a rinse cycle. The
first two liters the evening before works like a wash, removes all the major
amount of stool and the debris in the colon, and despite that, some of the
material that is in the small intestine tends to come down and coat the right
colon, and that we want it to rinse it by the morning dose.”
You will receive detailed written
instructions on how to prepare for the procedure. Follow these instructions
carefully. You should be able to see the bottom of the toilet clearly after the
second dose. In other words, it should be coming out clear like clear liquid.
“Your part of it has to get your colon so
clean that it is as clean as the palm of your hand.” Why?
Because if it isn’t seen, it’s all for naught, because it’s there and it
will continue to do whatever it’s doing.
So the preparation is vitally important to do exactly as instructions
are given.”
“I think the worst thing you could do is to
go through the procedure and not have prepped properly...that the doctors were
able to see what they needed to see.”
‘...that’s why I took it very seriously to
follow all the instructions closely and it wasn’t that difficult. The
instructions were really simple to follow.”
If you have problems with constipation, discuss this with
your doctor. Your doctor may suggest taking laxatives, so that you are not
constipated on the day you begin taking the preparation solution. Do not take
Metamucil® and do not eat foods with small seeds such as bread with
sesame seeds, kiwi and cucumbers.
Remember to tell your doctor about
any medicines you’re taking, particularly aspirin products,
non-steroidal
anti-inflammatory medicines, arthritis medicines, blood thinners, insulin or iron products. Most medicines can be continued as usual, but
some can interfere with the preparation or the exam.
Before the day of the procedure, you must
arrange for a responsible adult to come with you to the hospital and take you
home after the procedure is over. You may receive medicine that will make you
sleepy and unable to drive.
Dress in loose-fitting, comfortable
clothing and shoes, such as sneakers. Bring a jacket along to keep yourself
warm. Leave all jewelry and valuables at
home.
In the Endoscopy Department, the medical
team will check your blood pressure, pulse and breathing rate.
They also will ask you to sign a consent
form before the procedure begins and answer any questions you may have.
The entire colonoscopy experience will last
two to three hours including waiting times, preparation and recovery times, but
plan on staying up to half a day, since waiting times are unpredictable. Bring a book or music to keep yourself occupied.
Most patients do well during and
after their colonoscopy and rarely have much pain.
During the procedure, your blood pressure,
pulse and the oxygen level in your blood will be monitored. An intravenous line will be started, and you
will be offered pain medicine and a sedative to help you relax. You will feel
sleepy, but you will wake up easily after the procedure.
You will lie on your side or back while the
doctor slowly advances an endoscope into your colon. As your doctor slowly withdraws the
endoscope, he or she will carefully examine the lining. Your doctor may ask you
to change your position slightly to help maneuver the endoscope more easily
through the curves of your lower colon. The camera on the scope transmits
images to a monitor, where the doctor can see the inside of your colon. The scope blows air into the colon which
inflates it to help the doctor see better.
The endoscope and the air may cause you to
feel cramping or pressure and the need to pass gas. This is a normal part of the process.
“Over the last two to three decades the
endoscopic technology has evolved. The
tubes have become much more floppy; they’re almost as soft as noodles. These tubes are associated with much less
pain compared to the scopes that were used earlier.”
“The scope takes the shape of the colon
very easy without causing any stretching or pain. So when a patient is
undergoing a procedure, for example, a full colonoscopy, there should not be
any pain.”
“A typical exam takes anywhere between 20
to 30 minutes, and during that examination, the first step involves passing the
scope gently all the way to the beginning of the colon, identify the opening of
the appendix and the opening of the small intestine. And once you reach there, then as you’re
coming out gently, you scan the entire surface area, looking for polyps or flat
lesions. Once you find them, you stop
and you try to remove those lesions.”
“The actual screening of the entire surface
of the colon wall is undertaken as you’re coming out, and during that process,
you look for not only the big polyps that you may see on the way in but also
the flat lesions. Flat lesions are like
pancakes on the surface which are not easy to detect unless you open up the
colon fully and you take time to slowly withdraw the scope and examine for
those flat lesions.”
Lesions and polyps may vary in size from a
tiny dot to several inches. Your doctor may remove the lesion or take a small
amount of tissue...called a biopsy...to be examined under a microscope.
The biopsy helps distinguish between
non-cancerous and cancerous tissue and can help determine the cause of
bleeding, inflammation or diarrhea.
If one or more polyps are found, your
doctor will remove them.
Because cancer begins in polyps, removing
them is an important way of preventing colorectal cancer.
Video #5: After the Procedure
“People have these terrible misconceptions
about what a colonoscopy is and that it’s going to be painful, but it’s really
not. You are put under sedation, you fall asleep, and the next thing you know
you are awake again in the recovery room, and you have no idea that it even
happened.”
You will be monitored in the recovery area
for about half an hour until the effects of any medicine wears off. You might have some cramping or bloating
because of the air introduced into the colon. This should disappear quickly
when you pass gas. Your doctor will explain the results of the examination to
you, although biopsy results will not be available until approximately two
business days after the procedure.
Remember, you must arrange for a ride home
after the colonoscopy procedure. You
will not be allowed to drive because of the sedation.
Colonoscopy is
generally safe when performed by doctors who have been specially trained and
are experienced in these procedures.
One possible risk
is bleeding which might occur at the site of a biopsy, but it’s usually minor.
Another possible risk is a perforation, or tear, through the colon wall that
could require surgery.
Polyps hiding behind a fold may be
difficult to see, and might not be detected.
“If bleeding happens, it’s very easy to
control. Nowadays there are clips we can apply, and you can control the
bleeding immediately. Perforation—that’s making a hole in the bowel—is another
complication, and if small perforations occur, nowadays we could close them
with clips. If in case we cannot close
them, there may be a need for surgery, and that’s about 1 in 1,000 to 2,000.”
Remember, when
colon and rectal cancers are detected early, there is nearly a 90% chance for
cure. Even though there often are no
symptoms of colon cancer in its early stages, colonoscopy is a reliable and
easy way to detect it, before it spreads.
“Even though standard guidelines say that
people age 50 and over are really the ones who should be getting colonoscopies,
I think that if people are experiencing symptoms anywhere near what colon
cancer symptoms are like, they should be a little more vigilant and aggressive
about asking their doctors, and even if they have to demand that their doctors
perform a colonoscopy.”
“It’s so worth it. The preparation and the
procedure are really not painful at all, and I’m proof that even people under
50 get colon cancer. It’s important to be vigilant about your health.”
“Don’t take a chance with your life.” The profession recommends
that at age 50, one should go and get a baseline colonoscopy; get a look
at your colon. Polyps could be in the
colon; they don’t give symptoms; we are walking around thinking we are well
people and we go through the experience of a colonoscopy only to find that
polyps are there. And we know that
polyps are—can be precancerous—that’s usually how the disease is prevented,
because the polyps can be removed.
“Give yourself some peace of mind. Either you don’t have a problem in your
colon, or if you do have a problem, the sooner you know about it the better and
to take care of it as early as possible.”
We hope the information about colonoscopy
has been helpful to you. Remember…get screened.
Make cancer history!
Video #6: Questions to Ask Your Doctor
You should feel comfortable in talking
openly with your doctor.
The following questions are important to
ask, before you have the colonoscopy procedure:
·
Have you gone through a 3-year gastroenterology
training program and are you board-certified?
·
Is it your intention to reach all the way to the
beginning of the colon?
·
Will you remove polyps completely and document what
type of polyp was removed?
·
Based on the number of polyps and the pathology of
the polyps, will you recommend a time frame when I should have a repeat
procedure?
·
Have you gone through a gastroenterology training
program and are you board-certified? Is it your intention to reach all the way
to the beginning of the colon
·
Will you remove polyps completely and document what
type of polyp was removed?
·
Based on the number of polyps and the pathology of
the polyps, will you recommend a time frame when I should have a repeat
procedure?
Credits
Funding provided by:
The Office of the Executive Vice President
Thomas Burke, M.D.
Physician-In-Chief
Thanks to: Grace Butler, Marisa Mir and Greg
Simmons
Medical Animation Copyright © 2010 Nucleus Medical Media,
All Rights Reserved.
Produced for the Patient Education Office by
UT Television
© 2010 The University of
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