Colonoscopy for Colon Cancer Prevention Video Script – 2010

M. D. Anderson Cancer Center
Date: February 2008

Video #1: About MD Anderson

MD Anderson Cancer Center in Houston is one of the top cancer centers in the world.  Located in the Texas Medical Center, it is dedicated to cancer care, research, education and prevention. Patients come here from all over the world to receive the latest treatments.

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 Cancer Prevention Center can help you understand your risk of developing cancer through risk assessment and, when appropriate, genetic testing.  The Center provides personalized risk reduction strategies…such as healthy lifestyle recommendations…and performs cancer screening examinations based on age, gender and cancer risk.

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 Gastrointestinal Center diagnoses, treats and manages cancers of the digestive system.  Specialized services include screening exams that help find cancer early.  One of these exams is called colonoscopy...for the early detection of colon and rectal cancers. 

 

Video #2: About Colon Cancer

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:

  • rectal bleeding,
  • blood in the stool or toilet after a bowel movement,
  • prolonged diarrhea,
  • a change in size or shape of your stool,
  • abdominal pain or a cramping pain in your lower stomach, or
  • a feeling of discomfort or urge to have a bowel movement when there is no need.

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 Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd, Houston, TX 77030
1-800-392-1611 (USA) / 1-713-792-6161