On October 29, 2013 during a live 30-minute colonoscopy procedure, Dr. Shekar Narayanan, colorectal surgeon at Community Health Network, answered questions about colon and rectal cancer and why it’s important to have a colonoscopy if you are 50 years and older - or earlier if you have a family history of colorectal cancer.
Replay now available! Watch the broadcast below or at eCommunity.com/coloncancer.
Patient Tami Schwenk of Columbus, IN, whose father is recovering from colon cancer, felt having a colonoscopy is a common sense thing to do and encourages others to take time to prevent the third most common cancer for men and women and the second leading cause of cancer deaths. One in 20 adults are at risk for developing colorectal cancer. Watch videos: More about Tami and her history >>
Tami prepped the day before, drinking a solution throughout the day to clean out her large intestine. Dr. Narayanan said as he observed her colon during the colonoscopy, her overall prep condition was fair, but not excellent. There were sections of Tami’s colon that could not be observed with the digital camera/scope that traveled from her rectum through the large intestine/colon to the start of the small intestine. The folds in the lining of her colon are normal, said Dr. Narayanan. In the rectum, a hemorrhoid was observed. With her family history and this being her first colonoscopy, he would recommend a repeat colonoscopy in five years instead of 10 years as part of her best practices.
Q/A with Dr. Narayanan
Q. What is the first step of the colonoscopy procedure?
A. The patient is sedated. She doesn’t feel the digital rectal exam or scope being inserted through her rectum. Initially, I look at the rectum for any masses or strictures that may impede the scope. The flexible scope moves through the colon (or large intestine) to the start of the small intestine. Then the scope is backed out slowly to observe as much of the colon that can be seen through the scope's small camera. A 360-degree camera head has not been developed yet, but that technology is coming. I have about 270 degrees of visibility so that is why we look carefully going up and out of the colon and rectum.
Q. What are the symptoms of colon cancer?
A. Some people diagnosed with colon cancer do not have symptoms, but if you do have blood in the stool or rectal bleeding, changes in your bowel, unresolved diarrhea, cramping and nausea, and rectal pressure then see your primary care physician or gastroenterologist. Do not delay! These symptoms may or may not be colon cancer but could be other types of intestinal disease that need to be checked out sooner than later.
Q. Are all polyps cancer?
A. Polyps are growths attached to the lining of the colon. Some polyps are called serrated polyps or flat cancer. All polyps have the potential to be malignant (cancerous). With a colonoscopy, we can remove the polyp as a biopsy and look at the pathology to see if there are cancer cells. The sooner we remove the polyp the better. Polyps can grow into the lining of the colon wall and from there spread to other parts of the body like the lymph nodes.
Q. What was your training at MD Anderson Cancer Network™?
A. My practice has been in Indianapolis since 1979. I have been very fortunate to learn from a leading cancer center in America. Their expertise, protocols, guidelines and treatment plans are available to us at Community Regional Cancer Care. We can discuss best practices for a patient’s cancer treatment and how to incorporate radiation and medications for the best outcomes. I feel very lucky to have participated in the certification and to have this support and interaction with MD Anderson cancer specialists. Learn more >>
Q. What’s the difference between colonoscopy and the over-the-counter colorectal screening tests?
A. The tests like Hemoccult® and FIT® are fairly sensitive tests (average 79%) for blood, but not very specific for cancer. So if you get a positive finding for blood from a Hemoccult test, the next course of action is a colonoscopy to identify polyps. The FIT test looks for DNA associated with cancer cells so it is more specific, but a positive result still means a colonoscopy is needed to observe the rectum and colon. Another type of screening is the Virtual Colonoscopy, which uses a CT scanner to look at the colon. You still need to do the prep and this is often used for people who have scar tissue or obstructions in the bowel or who cannot be sedated for medical reasons. We have that technology here and if I see a polyp, the growth still needs to be biopsied and removed with another outpatient procedure.
Q. Are men or women more likely to get colon cancer?
A. The rates of colorectal cancer are fairly even between men and women. Current medical opinion suggests that African Americans need to be screened before age 50 because their risk is so much greater for getting colon cancer.
Q. Are there different arteries that supply blood to the colon versus the rectum?
A. Yes, the colon or large intestine is supplied by several arteries and the rectum is a separate artery. On the colonoscopy you see the blood vessels in the lining of the colon and rectum and that is normal.
Q. Is smoking a cause of colon cancer?
A. I would not say cause, but nicotine is definitely a risk factor for colon cancer and all cancers. The longer and more packs you smoke, the higher the risk. The combination of environmental and diet are risk factors for colon cancer. If you are a smoker, consider having a colonoscopy at age 50. Some doctors will say it’s your birthday present to yourself.
Q. Is colonoscopy covered by insurance?
A. Yes, based on age and family history, colonoscopy is covered by every insurance plan including Medicare. How often you get a repeat colonoscopy depends on your original report and family history. Typically, plans approve men or women at age 50 with no history. With a family history, subtract 10 years from the age of that person who was diagnosed with colorectal cancer or age 50. It’s important to catch this cancer early because it is very treatable.
Q. Can there be polyps in the rectum?
A. Yes, polyps or growths can be in the rectum and easily removed through the colonoscopy procedure, or by other means. How we treat rectal cancer is different than colon cancer. Treating colon cancer may involve a laparoscopic surgery to remove a section of your colon. Rectal cancers often involve radiation therapy. The techniques are so much more advanced than they were 10 years ago and we can often successfully avoid colostomies.
Q. What are the ways to have good digestive health?
A. Decreasing fat in your diet and having good protein is a start. Overall, eat smartly, three smaller meals and not eating before bedtime. I am also a believer in probiotics.
Q. Is Crohn's disease or colitis a risk for colon cancer?
A. Inflammatory bowel diseases including Crohn's and colitis do increase your risk for colon cancer. Often these patients are vigilant in their digestive health and having a colonoscopy is part of those good health practices. The cancer risk associated with these diseases goes up the longer you have them.
Learn more: Watch the colonoscopy and send us your questions
Replay the Community Health Network LIVE colonoscopy webcast at www.eCommunity.com/coloncancer. Tweet us your follow-up comments and questions (@CHNW, #CHNcancer). To be referred to a Community gastroenterologist to schedule your colonoscopy, please call 800-777-7775.