Your first colonoscopy: What to expect
Men and women at average risk colorectal cancer should get a screening colonoscopy every 10 years beginning at age 50. African American men and women should begin regular screening colonoscopies at age 45.
Along with regular exams, practice awareness. This means you should be familiar with your body. That way you’ll notice changes, like bleeding or unusual bowel movements. Then, report them to your doctor without delay.
Your doctor can help you decide if you should continue screening after age 75. MD Anderson doesn’t recommend screening for adults after age 85.
What is a colonoscopy?
During a colonoscopy, you will be sedated. Your doctor will insert a flexible tube with a video chip into your rectum and through the length of your large intestine (colon). Your doctor will examine the surface of your colon as they withdraw the tube.
Your colon must be completely clean in order for your doctor to see any abnormalities. The day before the test, you will prepare by avoiding solid foods and drinking only clear liquids. You also have to drink a solution that will cause you to go to the bathroom - probably several times – so there is absolutely no waste in your colon.
One of the benefits of colonoscopy is that your doctor can remove precancerous polyps during the exam without scheduling another procedure.
Alternative tests to colonoscopy
Virtual colonoscopy - If you choose virtual colonoscopy over regular colonoscopy, MD Anderson recommends you get the test every five years starting at age 50. African Americans men and women should begin screening at 45. A colonoscopy will be performed if polyps are found.
During a virtual colonoscopy, your doctor performs a low-dose CT scan of your abdomen and pelvis to create 3D images. These images show polyps and other abnormalities inside your colon and rectum.
A virtual colonoscopy requires the same preparation as a colonoscopy. Your colon must be completely free of waste in order for your doctor to get a clear image. Virtual colonoscopies can miss small or hard-to-see polyps.
If your doctor does find polyps or anything suspicious, you will need to get a regular colonoscopy. This test will not be considered a screening test, but a diagnostic test to diagnose the problem. Your insurance may bill this second colonoscopy differently.
If you choose a virtual colonoscopy, check with your insurance provider before scheduling an exam. Not all insurance providers cover the cost of this exam.
Stool-based tests - If you choose stool-based tests over colonoscopy or virtual colonoscopy, MD Anderson recommends you get tested every year beginning at age 50. African American men and women should begin screening at age 45. Your doctor will recommend a colonoscopy if signs of cancer are found. Stool-based DNA tests can be performed every three years.
There is no preparation for this type of test. You may be told to restrict certain foods or medications before the test. Stool-based tests look for signs or "markers" for cancer in your stool. There are three main types of stool-based tests:
- Stool DNA tests can detect changes in DNA that happen as colon cancer develops. These combine testing for changes in stool DNA with a fecal immunochemical test (FIT). These are the most accurate of the stool-based tests.
- Fecal immunochemical tests (FIT) look for proteins found in blood. This can let your doctor know that there may be blood in your stool, which can be a sign of colon cancer.
- Fecal occult blood tests (FOBT) look for traces of blood in your stool that cannot be seen with the naked eye.
Colorectal cancer symptoms and risk factors
Adults at increased or high risk are more likely to get colorectal cancer. This doesn’t mean you’ll definitely get cancer. But, you may need to start screening at an earlier age, get additional tests or be tested more often. Learn more about colorectal cancer risk factors.
Colorectal cancer often does not have symptoms in the early stages. Most colon cancers begin as polyps, small non-cancerous growths on the colon wall that can grow larger and become cancerous. As polyps or cancers grow, they can bleed or block the intestines. If you have symptoms of the colorectal cancer, talk to your doctor. You may need to start screening at an earlier age, get additional tests or be tested more often.
Colorectal cancer recurrence
If you’ve had colorectal cancer, you need a different plan to check for recurrence. This includes periodic colonoscopy. Print the survivorship screening chart below that best describes your cancer type and share it with your doctor. Your doctor can use this chart to create a more tailored plan for you.
Reduce your colorectal cancer risk
Nothing you do can guarantee that you won't get colorectal cancer. But making the following healthy lifestyle choices will reduce the chances that you will get the disease.
- Get screened. Screening exams for colorectal cancer can find the disease early, when it’s most treatable.
- Maintain a healthy weight. Excess body fat is linked to an increased risk of colorectal cancer.
- Exercise regularly. Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week.
- Eat a plant-based diet. Make 2/3 of your plate vegetables, whole grains and fruit. The other 1/3 should be lean animal protein or plant-based protein.
- Limit red meat. The more you eat, the more you increase your risk. Aim to eat no more than 18 ounces of cooked red meat each week. Red meat includes beef, pork and lamb.
- Avoid processed meat. This includes bacon, deli meats and hot dogs.
- Limit alcohol. For cancer prevention, it’s best not to drink alcohol.
- If you smoke, stop. If you don’t smoke, don’t start
The screening plans on this page apply to adults expected to live for at least 10 years. They’re not for adults who have a health condition that may make it hard to diagnose or treat colorectal cancer.
I was hired as an infectious disease specialist by MD Anderson in 1983. And until I retired in January 2019, I routinely helped patients with one of the most common side effects of cancer treatment: infections.
But despite working at MD Anderson for more than 35 years and watching several of my colleagues struggle with cancer diagnoses, I put off getting a colonoscopy until I was 66. That’s 16 years later than recommended. The results showed I had stage I colorectal cancer.
My colorectal cancer diagnosis
It was my wife who saved my life.
Most people get a bit heavier over the holidays, but I’d been losing weight steadily for about four months by early 2017. And I was not trying to. I was also experiencing fatigue. One night, my wife finally looked across the dinner table at me and said, “You are literally melting away before my eyes. What’s it going to take to get you to go to the doctor?”
That was the wake-up call I needed. I reached out to a colleague, who ordered a CT scan. It showed a 1.5-inch tumor in my sigmoid colon. A few days later, I had a colonoscopy. A biopsy of tissue taken during the colonoscopy revealed the tumor was adenocarcinoma. I had surgery to remove the tumor and part of my colon a few weeks later.
Don’t put off screenings and preventive tests
Fortunately, the cancer hadn’t spread to any nearby lymph nodes, so I didn’t need chemotherapy or radiation therapy. My recovery was relatively quick and pretty unremarkable. And my scans have been clear ever since the surgery.
But I was lucky. I made all sorts of excuses for not getting a colonoscopy. I told myself that I had no family history of colorectal cancer. And I already had heart problems, so I had enough to worry about.
But as a doctor, I should’ve known better. Whatever preventive tests or screenings are recommended for someone your age, don’t put them off. Get tested. And if your friends or loved ones are procrastinating, go and talk to them. Follow through.
Because if it can happen to me, it can happen to you.
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