The Turning 50 Test

By Mi Lee, R.N., Asia World Media

There are many things that come with turning 50, it is a time of celebration of one’s achievements and all of life’s accomplishments. The other joy is that your doctor will start recommending a colonoscopy. You may not have a family history, or a medical diagnosis of colorectal cancer, but 50, is the magic number.

The Importance Of Colorectal Cancer Screening

About one in three adults aged 50 to 75 years have not been tested for colorectal cancer as recommended, according to a report, from the Centers for Disease Control and Prevention (CDC).  Despite research that shows colorectal cancer screening tests saves lives, screening rates remain low.

“There are more than 20 million adults in this country who haven’t had any recommended screening for colorectal cancer and who may therefore get cancer and die from a preventable tragedy,” said CDC Director Tom Frieden, M.D., M.P.H. “Screening for colorectal cancer is effective and can save your life.”

And according to the World Cancer Research, worldwide data (2012), colorectal cancer is the third leading cancer killer among both men and women (at national level, worldwide, for 184 countries in the world), after lung cancer.  Screening tests can prevent cancer or detect it at an early stage, when treatment can be highly effective.

The goal of a colonoscopy then, is to detect precancerous polyps, so they can be removed before the polyps, turn into cancer.

** Colorectal cancer was the third most common cancer with nearly 1.4 million new cases in 2012 

** Source: J. Ferlay, I. Soerjomataram, M. Ervik, R. Dikshit, S. Elser, C. Mathers, M. Rebelo, DM Parkin, D. Forman, F. Bray.  GLOBOCAN 2012 v1.1, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2014

What Is Colonoscopy?

A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon).

During a colonoscopy, the doctor uses a colonoscope, a four foot long, flexible tubular instrument about 1/2 inch in diameter (about the thickness of a finger) with a camera and a source of light at its tip. The tip of the colonoscope is inserted into the anus and then is advanced slowly, under visual control, into the rectum and through the large intestine, usually as far as the cecum.  This procedure allows a doctor to exam the large intestine for any abnormalities.

Patients will lie on their left side as the colonoscope is advanced, slowly. Once the tip of the cecum is reached, the colonoscope is slowly withdrawn, and the lining of the colon is carefully examined.

The Doctor Who Does Your Colonoscopy Matters

Colonoscopy saves lives, and “high quality” colonoscopies save even more.  “High quality” means screening by doctors adept at identifying precancerous growths (polyps).

A gastroenterologist is a physician that specializes in the study of the functions and diseases of the esophagus, stomach, small intestine, large intestine (colon) and rectum.   Studies have shown that gastroenterologists perform higher quality colonoscopy examinations and comprehensive consultative services when compared to other physicians. This translates into more accurate detection of polyps and cancer.

The primary care physician typically would refer the patient to a gastroenterologist.  Depending on the patient’s health insurance (HMO, PPO, HSA, etc), one may not even need a referral.

Once a gastroenterologist has been chosen, make an appointment to meet the physician and establish a relationship as a patient (also known as an “established patient”).  During the initial appointment, your gastroenterologist will review your medical history and answer any questions.  You will then get a prescription for a bowel cleanser along with very detailed instructions for preparation.

Since each patient is different and has varying medical background, your gastroenterologist will prescribe a bowel cleanser, most suitable for you.   The patient basically fast the entire day before the procedure and follow instructions, for the bowel cleanser. 

What Is “Fasting”?

The day before your procedure you can have only clear liquids (nothing red, purple or blue in color).  You may have Jell-O, broth, coffee, tea and soda.  You will probably also be advised against having any dairy products such as milk creamer and such.  For example, if you choose to have coffee, have coffee; just no creamer, no milk or no half-half, etc.  You can add sugar or sugar substitute.

It is extremely important that you avoid solids the day before the procedure.

Why Is It Important to “Fast”?

Patient-To-Self:  “Do you think they’ll know if I cheat a little?  I mean I am taking the cleanser medicine so it should be okay, right?”

Nurse:  The answer is “NO.”   “NOT OKAY” to cheat, even the slightest.

The colon needs to be clean in order for the gastroenterologist to see everything, leaving no part of the patient’s large intestine or any polyp unchecked.  Remember, if the procedure is to be complete and accurate, the colon must be completely cleaned. The cleansing preparation instructions should be followed exactly as prescribed, or the procedure may be unsatisfactory (visualization of the lining of the colon may be obscured by residual stool), and the screening may have to be repeated, at a later date; or a less accurate alternative test may be performed in its place.

The day before the procedure is the hardest for most people.  No one likes to go a day without food, but the patient is truly “not allowed” to eat any real food, with substance.  Typically, patients will feel like they are starving. Also, once the preparation (solutions) has been taken, the patient is advised from leaving the house, so plan your day accordingly.

If the patients “fudged” they will find themselves in the bathroom — all evening — dealing with the aftermath of the prescribed bowel cleanser.

Day Of The Procedure

The patient will be required to bring a driver (family, friend or neighbor) as the procedure does involve anesthesia.  You do not want to have a colonoscopy without anesthesia. After checking into the designated facility and signing the consent forms/documents, the patient is taken back so a nurse can prep the patient for the procedure.

The procedure last approximately 30-60 minutes.  The patient sleeps through the entire procedure and will awaken, after the procedure has been completed. You will need to have someone drive you home, as it is unsafe to drive or operate machinery for about 8 hours after the procedure (due to the sedative medication given).

Keep in mind that each and every physician and facility has their own procedures, processes and protocols.

Summary

Many people put off  having a colonoscopy, believing that no symptoms equals a healthy colon, only to find out they had colorectal cancer.  Remember, colorectal cancer can often be cured if it is found early. It is also one of the few types of cancer that can be prevented, by using colonoscopy.  Many of the deaths occur in patients who were not tested, according to the American Cancer Society.

The good news, a colonoscopy is recommended once every 10 years, for most people, if no polyps are found.

Be proud that you have reached your 50 year milestone.  Congratulations!

Mi Lee Bio

Mi Lee is a Registered Nurse (RN) in the specialty field of gastroenterology and colorectal surgery. When she isn’t working, she loves being at home spending as much time with her family and friends and their two dogs. In addition to being an RN, Mi is also a first-time mother embarking on a new journey of parenthood.