March is Colorectal Cancer Awareness Month!
In this post:
Folks, this post is about colorectal cancer screening. Most articles, blog posts, and websites, especially from doctors and health organizations, will use a lot of confusing scientific language to talk about this topic, mostly because it’s considered more polite and helps us sound very serious when talking about a very serious topic.
Well, we certainly don’t intend any disrespect, but we believe this topic is too important to leave any room for confusion. So, we’re going to be very frank and use words everyone knows even if they sound sort of silly or rude—like poop. You can’t talk about colorectal cancer without talking about poop. We’re going to be saying “poop” a lot in this post, and probably some other words that we’d all rather avoid.
Don’t worry, though. If your inner five-year-old starts giggling uncontrollably, no one will know but you, and we’ll still learn all about colorectal cancer.
What is colorectal cancer?
Colorectal cancer, also known as colon cancer, is a disease where cancer cells develop in the colon or the rectum.
Okay, but what does that mean? Here’s a quick, plain-language breakdown of those medical terms, to make sure everyone understands what we’re talking about. We’ll use these words a lot in the rest of this post, too.
- The colon is also called the large intestine. It’s where your gut puts the food when it’s done digesting it. The colon re-absorbs water and some minerals, and turns what’s left into stool (that’s poop).
- The rectum is at the end of the colon, connecting it to the anus—where the poop comes out of you. The rectum stores the poop until it is ready to leave your body when you use the bathroom.
- Putting the two together, “colorectal” means “of the colon and rectum,” or “where your poop is made and stored.”
- Cancer is when your body makes uncontrolled, abnormal cells or growths that can cause damage to other, normal cells around them. The growths can block pathways, use up energy, and spread to other parts of the body.
For those of us who like pictures (and who doesn't?), here is a handy diagram of the colon. No pictures of poop, as promised.
Now that we know what those words mean and have a nice picture to help us out, we can translate that first sentence a little better:
Colorectal cancer, or colon cancer, is a disease where bad cells grow in the part of your body that makes and stores poop.
If untreated, those bad cells can cause a lot of damage. This means your poop systems won’t work the way they’re supposed to—like bad plumbing in the sewage system of your home. The cancer cells can also spread to other parts of your body, causing all kinds of damage there, too.
Colorectal cancer often starts as little growths called polyps. Polyps are not cancer, but they can turn into cancer. Polyps can cause unpleasant symptoms in your bowels (that’s another word for the poop system), but can also be removed before they cause too much damage or turn into cancer.
What are the symptoms of colorectal cancer?
Sometimes, people can have colorectal cancer or colorectal polyps for a long time without having any symptoms at all. That’s why it’s important to get screened regularly—so you can be treated before the growths cause problems or start spreading. If you do have symptoms, they can include:
- Diarrhea or constipation
- Feeling like you don’t empty your bowels all the way when you poop
- Changes in your bowels or pooping habits
- Blood in or on your poop
- Pain, aches, or cramps in your bowels or abdomen that don’t go away
- Losing weight and not knowing why
It’s important to not be shy about talking to your doctor about these symptoms, or about getting screened for cancer. If you develop colorectal cancer and leave it untreated for a long time, it can lead to long-term problems. Complications of colon cancer can include:
- Chronic diarrhea
- Frequent need to use the bathroom
- Not being able to hold your poop and depending on adult diapers
- Permanent or temporary dependence on a colostomy bag (a bag that is attached to your colon through a surgical hole in your abdomen to collect your poop outside your body because your colon can no longer process your poop properly)
- Cancer spreading to other parts of your body (called metastasizing)
Sounds unpleasant. How do I get screened so I can avoid it?
Most people need to be screened for colon cancer starting at age 45. Screening should then be done at regular intervals, depending on the type of screening and what was found. You may need to start being screened earlier than age 45 if:
- Someone in your immediate, biological (birth) family has had colorectal cancer or colorectal polyps – like your parent, grandparent, aunt, or uncle
- You have already had colorectal cancer or colorectal polyps
- You have inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
- You have a genetic syndrome such as familial adenomatous polyposis or Lynch Syndrome (hereditary non-polyposis colorectal cancer)
There are many types of screening tests for colorectal cancer. Some tests (called stool tests) require you to collect a sample of your poop and send it in to a lab to check for blood or altered DNA. Others (sigmoidoscopy and colonoscopy) use flexible camera tubes to check your insides for abnormalities. A CT colonography uses X-rays and computers to create images of the colon.
In this post, we’re going to focus on the two most common and most recommended types of colorectal cancer screening. We’ll explain why.
FIT Stool Test
The fecal immunochemical test (FIT) is a very common stool test preferred by patients because it is inexpensive, can be completed at home and does not require you to make any special preparations—unlike colonoscopies or other types of stool tests. It checks for blood in your poop, which can indicate bigger problems. It is less accurate than a colonoscopy and must be repeated far more often, and should not be chosen if you have a known history of colorectal cancer or polyps.
- can be done at home
- covered by most insurances
- very inexpensive
- must be repeated once a year
- can have false negatives or false positives
- positive tests may mean you have to get a colonoscopy anyway
Your doctor or healthcare provider will most often recommend a colonoscopy as the first choice for colorectal cancer screening. A colonoscopy is where a doctor uses a long, thin, flexible, lighted tube with a camera to check the entire inside of your rectum and colon for polyps or cancer. It is more thorough and accurate than a sigmoidoscopy, which only checks the rectum and the lowest part of the colon (the sigmoid—see our diagram). Colonoscopies are also covered by most major insurances (unlike the CT colonography).
If your colonoscopy is normal and you don’t have increased risk of colorectal cancer, you only have to have one once every ten years. If it’s abnormal, you may need to repeat it more often. The good news is, if your colonoscopy is abnormal, your doctor can often find and remove most polyps and some early forms of cancer cells, as well as take a sample for testing (called a biopsy) if needed, all at the same time as the colonoscopy. This is one of the main reasons they recommend getting a colonoscopy versus doing a stool test—it’s more thorough, and you get needed treatment right away.
- more thorough and accurate
- get treatment right away if abnormal
- covered by most insurances
- can go up to 10 years between tests
- requires colon preparation before your procedure, avoiding certain foods and drinking a special liquid to flush out your colon
- requires anesthesia
What happens if my test is abnormal / positive?
If your stool test is abnormal, you’ll likely need a colonoscopy to follow up. If your colonoscopy is abnormal, your doctor can remove polyps and certain forms of cancerous cells, as well as take a sample for testing, during the colonoscopy. If your polyps are small and there aren’t very many, you may not need a follow up colonoscopy for another 5 years. If they are large or precancerous (meaning they aren’t quite invasive but could grow into invasive cancer cells), or there are a lot of them, you may need to have another colonoscopy much sooner to be sure your doctor can remove any dangerous growths and prevent you from developing malignant or invasive cancer.
If your doctor finds cancer after taking a sample and testing it, you may need additional tests to determine the stage of the cancer, and you may need to begin cancer treatment. Treatment includes surgery to remove pieces of your colon, or chemotherapy to reduce the spread of cancer cells to other places in your body.
Say I agree to have a colonoscopy. Do I really have to do all this prep?
Yes, you do have to prepare your colon, or the camera won’t be able to see anything useful. The colon prep makes sure your bowels have been emptied of all the poop that is stored there, so your doctor can get a good view of any abnormalities and polyps. Your doctor will give you specific instructions on how to prepare for your colonoscopy, but most of them involve the same few steps.
- A few days before your colonoscopy, change your diet to eat low-fiber foods that leave your system quickly.
- The day before your colonoscopy, stop eating anything solid, and drink only clear liquids.
- The evening before your colonoscopy, take a laxative (a medicine that makes you poop a lot). Your doctor will tell you which one, and may provide you a kit with detailed instructions.
- Two to four hours before your colonoscopy, stop any food or liquid.
It’s also important to make sure you have a ride to and from the hospital or surgery center. For safety’s sake, most places won’t let you leave without an escort. If you need help arranging an escort, talk to your primary care provider—they can help connect you with resources in the community.
Do colonoscopies hurt?
Nope—that’s what the anesthesia is for! You’ll be sedated or unconscious during the entire procedure. You won’t feel it and you most likely won’t remember it.
Listen, Doc. I just really don’t want anyone to do anything with my butt, or go anywhere near my poop.
Alright, we get that. But if we may offer a brief reBUTTal*…
(*It’s okay to laugh—colorectal cancer is no joke, but laughter is good medicine!)
First, it’s important to remember that your doctors and their medical team are professionals who handle colonoscopies and stool samples for a living. Odds are good that you don’t have anything down there that they haven’t seen, and they just want to make sure you’re healthy. Plus, you’ll be sedated for a colonoscopy, so you won’t remember it.
Second, if you skip the screening and later wind up with untreated colorectal cancer, you’ll probably have way more people dealing with your poop (and your butt, and your entire poop system) than you ever wanted. In case you missed it when we talked about the potential complications of colorectal cancer, one of them is dependence on adult diapers or colostomy bags—that’s a bag that is attached to your colon through a surgical hole in your abdomen to collect your poop outside your body because your colon can no longer process your poop properly. In other words, you might have to have a bag of your own poop taped to the outside of your body, filling up whenever it feels like it because you can’t control your poop anymore. You, and maybe your family caretakers, have to empty that poop bag. Having to manage your own poop that way for weeks or months, or even permanently, sounds much less fun than having some professionals poke around at you while you’re unconscious once every ten years, right?
Now of course, many people who live with colostomy bags, either temporarily or permanently, are able to do so discretely and with dignity, and it just becomes a part of their life—no disrespect intended! But if you’re squeamish about poop, your own especially, we recommend that you take the safer gamble and get screened as early and as often as your doctor recommends it.
Okay, fine. Where can I go for colorectal cancer screening?
Your primary care provider (that’s us at ICHC!) can order stool tests or a colonoscopy. Stool tests are completed at home using special testing kits, which your doctor or primary care provider will give you when they order it. For a colonoscopy, they will place a referral to a doctor specializing in colonoscopies, such as a gastroenterologist or an Internal Medicine doctor.
In Fairbanks, colonoscopies are most commonly completed at Fairbanks Memorial Hospital or the Surgery Center of Fairbanks. Some doctors can also do them in their own offices. At ICHC, we will help you choose a doctor who accepts your insurance, and we will help you coordinate any follow-up care such as repeat colonoscopies.
How much does colorectal cancer screening cost?
Stool tests are generally cheaper than colonoscopies. A FIT stool test ranges in cost between $20.00 and $70.00, depending on the type, the lab, and your insurance coverage. Other types of stool tests can cost as much as $500-$600, but we don’t typically order those at ICHC.
Colonoscopies are generally around $1800 to $2500, depending on where you go and your insurance. Remember, your insurance will likely cover most if not all of that cost. If you’re concerned about costs, it’s very important to discuss it with your primary care provider so they can help you choose a doctor that accepts your insurance. You should also call your insurance to discuss coverage and benefits. Financial aid is also sometimes available, depending on where you go and based on your income eligibility and insurance (or lack of insurance!).
Do I need to know anything else?
If you’re interested in colorectal cancer screening, give your primary care provider a call. If you’re a current patient of ICHC, you can leave a message for your provider’s assistant to ask about screening, or send a message through the patient portal. If you don’t have a primary care provider yet, give us a call at 907-455-4567 to schedule an appointment!