by Jeffry Potash

March is Colorectal Cancer Awareness Month, creating an opportunity to educate the community about the dangers, prevention and treatment of colon cancer. Colon cancer is the third most common cancer. In Vermont, there are about 330 new cases per year and 24 of them are from Windham County.

1. Can colon cancer be prevented? What is a polyp?

Yes, to a significant degree. Colon cancer is unique because it begins as a benign tumor called a “polyp”. By removing polyps, we may be preventing cancer and the need for an operation.

2. Should I have testing to look for colon cancer/polyps?

Yes. Starting at age 50, all major health authorities recommend “screening”. Screening is testing people for the disease, even if they have no symptoms. Individuals should not wait for a symptom, such as rectal bleeding, to have their colons checked. People presenting with symptoms typically have advanced cancer. While it is very rare to find colon cancer when screening, it is common to find precancerous polyps. Note: If close relatives have had colon cancer, you may be advised to start screening by age 40.

3. What kinds of tests are there to detect cancer/polyps?

The vast majority of patients have a colonoscopy to look for growths. There are other alternatives such as X-ray tests, sigmoidoscopy, and stool collections which look for blood. Any type of screening is far better than no screening.

4. If there are multiple options, what should I do?

As mentioned, the vast majority of people protect themselves from colon cancer by having a colonoscopy. It is the most complete, most comfortable, and most accurate type of exam. It is also the only test that can deal with abnormalities definitively by removing polyps. Colonoscopy is recommended every 10 years if no abnormalities are found.

5. I’ve heard the preparation for colonoscopy is awful! Is that true?

Some people do have a hard time as they need to drink a gallon of salty water over a period of four hours to cleanse the colon. There are alternative “clean outs” and almost everyone can get through the process.

6. Once I’ve gotten through the prep, what will happen?

You will come to the hospital for about three and a half hours to receive intravenous fluids, go under sedation, have the colonoscopy, and recover for an hour. Someone will have to drive you home afterwards.

7. How dangerous is a colonoscopy?

Generally quite safe. But, there can be serious complications like bowel perforation, bleeding or over-sedation. Even taking into account the chance of something going wrong, the potential benefit of finding a problem is felt to outweigh the risk in almost all patients under age 76. According to guidelines released in 2008, patients age 76-85 should carefully weigh the risk-benefit ratio. Patients over age 85 should not have colonoscopy screening. My last major complication was several years ago.

8. Will the procedure be painful?

Using a sedation technique referred to as “intravenous conscious sedation,” almost all patients will sleep through the procedure. Rarely, standard sedation is ineffective and an anesthetic would be required for subsequent colonoscopy. There was one significant complaint of pain with colonoscopy in 2011 out of over 800 procedures.

9. How much will this cost?

Colonoscopy is often covered by health insurances and, according to Vermont law, preventative tests (like colonoscopy) should be covered. Contact your insurance for their coverage policy.

10. Is the United States making progress getting rid of colon cancer?

Yes, the incidence of new discoveries of colon cancer is decreasing. However, no test is perfect and about four in ten Vermonters have not been tested.

11. I’ve never been advised to have a colonoscopy. What should I do?

There could be many reasons for that. You should be proactive with your health and ask your doctor about getting tested for colon cancer.

12. Are there better places than Brattleboro Memorial Hospital to have colonoscopy?

No. BMH has all the equipment, expertise, and facilities to do excellent colonoscopies. Nationally recommended guidelines of “scope withdrawal time” and “polyp detection rate” are being met. I believe the personalized nursing care at BMH is outstanding.

Jeffry Potash, MD is a board-certified gastroenterologist at Brattleboro Memorial Hospital. He can be reached at 802-254-4947.