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Colorectal Cancer

Colorectal Cancer Q&A

September 16, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • David Maron, MD – Colorectal Surgeon

Colorectal cancer is the third most commonly diagnosed cancer and third leading cause of cancer death in both men and women in the US. Our department of colorectal surgery offers world renowned care and has achieved excellent outcomes for colorectal conditions.

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Colonoscopy" with David Maron, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Susanthomas: What to do if you cannot handle the preparation for the colonoscopy. The quantity of water that is required for consumption makes me sick and I can't get out for the test.

David_Maron_MD: The traditional preparation for colonoscopy has required up to 4 liters of fluid. We're using a modified preparation now at the Cleveland Clinic which requires the patient to drink only 64 ounces of Gatorade over several hours.There are also several preps which require tablets only; however these also require drinking a significant amount of fluid to take the tablets. Whichever preparation you decide to take, it is important to try to take the entire prep so that the colon can be cleaned and the colonoscopy is effective.

KerrBear: I have heard about many physicians not using an anesthetic or sedation for this procedure. Why is this? I have not heard good remarks from patients who had the procedure done without either.

David_Maron_MD: Patients may elect to have a colonoscopy without sedation if they choose. Unfortunately, the procedure can be somewhat uncomfortable. We therefore typically recommend sedation.

Peaches217: Is it dangerous for me to have a colonoscopy having a shunt? My surgeon is afraid of infection risk in my shunt but I really need a colonoscopy.

David_Maron_MD: There are many different types of shunts, so without more information, it is difficult for me to answer your question.

BillDaws47: Are there symptoms of colon cancer? Is it curable without surgery? I have heard it is also not preventable no matter how healthy you are... How true is that?

David_Maron_MD: In many situations, colon cancer can't be completely asymptomatic. Symptoms of colon cancer however may be blood in the stool, change in her bowel habits, abdominal pain, or unexplained weight loss. Colon cancer is preventable by undergoing routine screening colonoscopies.

Meanjean: What is colorectal cancer? How does it form?

David_Maron_MD: Cancer in general, is an abnormal growth that starts from normal tissue. Colon cancer develops from the cells that lie in the colon and rectum.

Carmicat17: What is the difference between a polyp in your colon and being diagnosed with colon cancer?

David_Maron_MD: Colon polyps are benign growths from the lining of the colon. The way we understand that many colon cancers start are in polyps that have grown to a larger size. This is why it is important to have regular colonoscopies.

Sam459: My great grandfather had colorectal cancer. Is it true that having a family history of colorectal cancer can increase the risk by two or three times? Does insurance typically cover a colorectal cancer screening at an early age if you have a family history?

David_Maron_MD: A history of colon cancer in your family does increase your risk. Typical guidelines for screening recommend an initial colonoscopy at age 50. In patients with a family history of colon cancer, screenings are recommended earlier.

Pepper19: Are there other ways of diagnosing problems within the intestines other than using a colonoscopy?

David_Maron_MD: There has been a lot of interest in developing tests for diagnosing colon cancer other than colonoscopy. A "virtual colonoscopy" uses CAT scan technology to evaluate the colon. The downside to this test is that if a polyp is in fact found, the patient will need to undergo a colonoscopy later to have this removed.

Lmga: Is a colonoscopy better than an endoscopy to better diagnose an intestinal disease (Crohns)?

David_Maron_MD: This really depends on the symptoms of the patient. Often times both an upper endoscopy and colonoscopy as well as radiographic examinations will be used to help diagnose Crohn's.

Jackspr: Can you comment on minimum withdraw time?

David_Maron_MD: There have been several studies in the medical literature looking at the accuracy of polyp detection. Some of these studies had suggested that the rate of polyp detection is higher when the withdrawal time of the colonoscopy is greater then 6 minutes.

Nthomas: Why are African Americans at higher risk for colon cancer?

David_Maron_MD: It is not entirely clear.

Stayhealthy: Is there a blood protein test available, or soon to be available, to detect colon cancer?

David_Maron_MD: There is a lot of interest in this, looking at gene markers in the blood and specific proteins found in the stool, however none have been proven. Currently, regular screenings remains the standard.

Scg269: Are there any medicines or vitamins that I should stop taking before getting a colonoscopy done? I generally take daily multi vitamins and alive or advil for an old knee injury, as well as wellbutrin. I am getting ready to go in for my first procedure and want to make sure I lesson any chance of any complications. How long should I be off any vitamins? I forgot to ask my doctor in my initial consult.

David_Maron_MD: You should ask your physician specifically, however it typically is recommended that you refrain from any aspirin or ibuprofen-containing medications for 5 days prior to the procedure. Patients taking aspirin or other blood thinners for heart conditions should check with their physician prior to discontinuing these.

Carmicat17: How long does it typically take to get results after your colonoscopy?

David_Maron_MD: Your doctor will provide you with a written report (often with pictures) on the day of the exam. If any biopsies or polyps are removed, it typically takes one to 2 weeks to obtain these results.

Nthomas: You mentioned that Cleveland Clinic is trying 64 oz. of Gatorade to cleanse the colon. Is that enough to do the job? It's a lot better than the stuff you take now.

David_Maron_MD: We have found that it is equally effective and significantly easier for the patient to tolerate.

Jellybean: A close friend of mine had his colon perforated during a colonoscopy. Why did this happen? How common is it?

David_Maron_MD: Every procedure unfortunately has risks, and perforation is one of the risks of colonoscopy. It is very rare, occurring only about once in every 20,000 colonoscopies.

Stayhealthy: Should the amount of sugar in 64 oz of Gatorade be a concern?

David_Maron_MD: The laxatives can be mixed in 64 oz of any clear liquid. We use Gatorade because the electrolytes help to prevent the dehydration associated with the diarrhea. G2 or any sugar-free clear liquid can be used.

Pepper19: What about the camera in pill form? How far have they gotten in perfecting it?

David_Maron_MD: Capsule endoscopy, or the "pill cam", is useful in evaluating the small intestine, but not in the colon.

BillDaws: What are some of the possible complications that may occur during a colonoscopy?

David_Maron_MD: If a biopsy is performed or a polyp removed, bleeding may occur at the site where this was done. In addition, a perforation can occur, however this is very rare (1 in 20,000 colonoscopies).

Scg369: I have heard quite a few horror stories about people becoming very ill with nausea and diarrhea after taking the liquid prep before having a colonoscopy done. Is there anything I can do prevent this from happening to me?

David_Maron_MD: If patients become nauseous during the prep, we typically recommend taking a break for a while and then restarting later.

Scg369: Why do I have to drink so much liquid laxative? I’ve heard that there are alternatives such as pills that can help me prepare for my colonoscopy instead.

David_Maron_MD: There are pill laxative preps for colonoscopy. Many of these require taking more than 40 large tablets. Sometimes, this requires drinking just as much fluid to take the tablets.

Jellybean: How can I be sure that getting a colonoscopy is safe procedure?

David_Maron_MD: The risks involved with colonoscopy are very small, and overall it is a safe procedure.

Parrot822: I do not mind drinking fluid; in fact I would prefer to drink water if possible. And, since I am a diabetic, I have to be careful of drinks that have lots of carbs. Is it up to me which method I choose? Or do I have to do what the doctor says?

David_Maron_MD: Yes, you should consult the physician who will be performing the exam to ask which prep is right for you.

Cleveland_Clinic_Host: I am sorry to say that our time with David Maron, MD is now over. Thank you again, Doctor, for taking the time to answer our questions today about Colonoscopy. To make an appointment with any of the specialists in our Digestive Disease Center, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

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