Judy Rupp

Commentary



As a colon cancer survivor, Martin tells nearly everyone he knows about the importance of screening. He fears most of them do not really listen.

Colorectal cancer is deadly. It kills more Americans than any other cancer except lung cancer; but when detected early, as it was in Martin’s case, 90 percent of patients are cured.

Cancer nearly always begins with the growth of polyps in the lining of the colon or rectum. Not all of these polyps are malignant, and those that are may take many years to become cancerous. Effective screening involves detecting premalignant polyps and removing them. There are several methods for doing this, all of which have elements that many patients consider disagreeable.

FECAL OCCULT BLOOD TESTING (FOBT) takes an indirect approach by looking for bleeding related to polyps. FOBT, a simple test to be performed at home, requires collecting six stool samples on three consecutive days and mailing them to a laboratory for testing. Although the test is easy to perform and not invasive, some consider the collection of stool samples disagreeable.

COLONOSCOPY offers the most thorough examination of the colon. Also the most invasive screening method, it involves threading a scope or thin lighted tube through the colon to examine the lining. If polyps are found, they may be removed during the same procedure.

DOUBLE CONTRAST BARIUM ENEMA involves the use of a contrast material, barium, delivered via an enema to allow x-rays of the rectum and colon. This test gives a doctor the ability to examine the entire colon almost as effectively as with colonoscopy. However, if polyps are found, they cannot be removed immediately as they can with colonoscopy.

The biggest problem is not the effectiveness of the screening test, but the reluctance patients have to use them. “Sometimes patients agree to have sigmoidoscopy, then call in to cancel the appointment,” one doctor said. Often, the patient takes the FOBT kit but does not send back stool samples.

Virtual colonoscopy uses computerized CT technology for a non-invasive scan of the intestines. This test can be performed in 10 to 15 minutes without general anesthesia, and it eliminates the risks of bleeding and perforation. It requires an even more thorough preparation of the bowels and pumping of air into the bowels through a rectal tube that many find uncomfortable. According to early reports, virtual colonoscopy can be a relatively effective screening tool.

The other method under investigation is fecal DNA testing-sampling for mutations of specific genes known to play a role in the development of colorectal cancer. This test requires only one stool sample using a simple collection method and it requires no food or medication restrictions or preparation of the bowels. Results from early studies have been promising.

If some or all of the available screening tests seem disagreeable to you, then you may want to talk to a cancer survivor. “Having a colostomy is disagreeable, too,” Martin said. “If I could go back 10 years in time and start complying with screening tests, I’d do it with no complaints.”



Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.