Colorectal cancer is not something often discussed in polite company. But it
should be.
Colon and rectal cancers are the second leading causes of cancer-related deaths
in the United States. Only lung cancer claims more lives. This year alone, more than
130,200 Americans will learn they have colorectal cancer.
This month marks the first National Colorectal Cancer Awareness Month, but
public discourse about the deadly disease has been heightened recently because of
``Today'' host Katie Couric's crusade to stop the cancer that claimed her husband,
Jay Monahan, two years ago.
The tragedy of Monahan's death, and the 56,300 people who die annually from the
disease, is that with early detection colorectal cancer loosens its death grip. Early
detection and removal of polyps reduces the chances of developing colon cancer by 90
percent and death almost entirely.
Colonoscopy is considered unparalleled in colon cancer detection because of its
sensitivity. The procedure -- demonstrated by Couric recently on the ``Today'' -- can
detect changes within the colon and rectum and pinpoint the development of polyps.
Here some answers to common questions about colonoscopy.
Q. What is colonoscopy?
A. Colonoscopy involves snaking a narrow flexible tube through the rectum into
the colon to detect bleeding in the lower gastrointestinal area and to confirm
ailments such as colon cancer and ulcerative colitis. The colonoscope comes in 42-
inch or 72-inch lengths. Attached to the end of the tube is a tiny light and video
camera that surveys the interior of the colon.
Q. What are the advantages of colonoscopy?
A. Colonoscopy beats barium enema for precision, says Dr. Philip Styne, a
gastroenterologist with Gastroenterology Associates of Central Florida in Orlando.
Doctors can pass other instruments such as a heated loop through the colonoscope to
remove polyps or extract tissue for biopsy. ``With the colonoscopy, you can remove
the polyp. Since a large number of polyps are a precursor to cancer, by removing the
polyp you are preventing cancer.''
Q. When do I need colonoscopy?
A. You should have the procedure if you experience bleeding or pain in your
rectum, or changes in bowel habits such as chronic diarrhea. The American Cancer
Society also recommends regular colorectal screening beginning at age 50. More
frequent or earlier screenings are suggested for those with a family history of colon
cancer, or who have previously had polyps or colon cancer.
Q. How do I prepare for colonoscopy?
A. Preparation is often the worst part of colonoscopy. You will be restricted
to a clear liquid diet. The most critical step -- and most unpleasant -- involves
cleansing the colon. The better the cleansing, the better the accuracy of the test.
You can use laxatives (such as castor oil), special diets, or enemas. Or you
may have to consume a gallon of cleansing fluid to stimulate the bowels. An enema
three to four hours before your colonoscopy completes the cleansing.
Q. What can I expect during the procedure?
A. You will receive medication through an intravenous line, or IV, to relax you
and make you drowsy. You will remain awake and cooperative but may remember little of
the experience. Once the medication takes hold, the doctor will conduct a digital
rectal examination before inserting the lubricated colonoscope. As it threads into
your colon, you may feel the urge to move your bowels. Because air is expressed to
enlarge the intestinal wall for viewing and to ease the advance of the colonoscope
you may experience raging flatulence. Don't try to suppress it.
Q. Are there possible complications?
A. If the walls of your colon have been weakened by diverticulitis or colitis,
colonoscopy can result in perforation, or a puncture of the colon walls, which may
require surgery, says Dr. Maureen Holasek, a radiation oncologist at M.D. Anderson
Cancer Center Orlando. Polyp removal (polypdectomy) can led to hemorrhage.
Q. How long does it take?
A. Colonoscopy on average lasts 45 to 60 minutes. You will spend additional
time in a recovery area shaking off the effects of the medication.
Q. What will I feel after the colonoscopy?
A. You may feel gassy or bloated, or experience mild cramping. This should pass
within 24 hours.
Q. How much does it cost?
A. A simple colonoscopy costs about $675, says Carmela Adam, billing supervisor
at Gastroenterology Associates of Central Florida. A biopsy or polyp removal
increases the cost to $725 and $900, respectively, more if hospitalization is
required.
Q. Will insurance cover the cost?
A. If a doctor recommends colonoscopy because of symptoms or family history,
you shouldn't have any out-of-pocket costs with most HMOs, Adam says. Rarely you may
be responsible for a deductible. If you are insured with a preferred provider
organization (PPO) or indemnity plan, you can expect some out-of-pocket costs. What
you pay depends on the plan.
If you request the screening without symptoms, you may have to bear the costs.
Colonoscopy every two years is covered for high-risk adults (those with a family
history or other risk factors) 50 or older with Medicare benefits.
Q. Is this test suitable for everyone?
A. Skip the test if you have ischemic bowel disease, or other inflammatory
bowel disorders such as acute diverticulitis, peritonitis or colitis.
Q. How reliable are the test results?
A. No test is perfect, but Styne says ``a good colonoscopy done with a good
prep is very accurate.''
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An ARCHIVE PHOTO of Katie Couric is available on PressLink from KRT Photo Service, 202-383-6099.
