Digestive Health FAQs

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FOR PATIENTS

What is a gastroenterologist?

A gastroenterologist is a physician who specializes in the diagnosis and treatment of disorders of the gastrointestinal tract, including the esophagus, stomach, small intestine, large intestine, pancreas, liver, gallbladder and billary system. A gastroenterologist must first complete an internship and a two-three-year Internal Medicine residency and is then eligible for additional specialized training in Gastroenterology. This fellowship is generally 2-3 years long so by the time Gastroenterologists have completed training, they have had 5-6 years of additional specialized education following medical school.

How long does a colonoscopy take?

The procedure itself typically lasts between 15 and 30 minutes. When complete, your nurse will take you into a recovery area, where the sedation quickly wears off.

What is a colon polyp?

Anyone can develop colon polyps, a small clump of cells that forms on the colon lining. Colon polyps can be raised or flat. Many middle-aged and older adults have one or more colon polyps, though you’re at a higher risk if you are 50 or older, are overweight or a smoker, eat a high-fat, low-fiber diet, or have a personal or family history of polyps or colon cancer. It’s important to remember that the great majority of colon polyps are harmless, but some can become cancerous over time. Screening is especially important because most polyps don’t cause symptoms. In most cases, the doctor removes colon polyps during flexible sigmoidoscopy or colonoscopy, then tests them for cancer.

What do I need to bring the day of my procedure?

  • Your insurance card(s).
  • Your driver’s license. If you don’t have one, then please provide two alternate forms of identification.
  • A friend or family member to drive you home.
  • Any change of address, phone or email updates.
  • The contact information for your referring physician.
  • A current list of all medications and dosages.
  • A current list of any vitamins, herbs or supplements you’re currently taking.
  • A list of any known allergies.
  • If you’re younger than 18, you must have a parent or guardian accompany you to sign your paperwork.
  • Ask the scheduler if you should bring anything else.

What should I wear the day of my procedure?

We recommend you wear comfortable, loose clothing. Please leave all belts, jewelry and valuables at home.

What is colon/colorectal cancer?

Colon cancer forms in the tissues of the colon, which is the largest part of the intestine. Most colon cancers begin in cells that make and release mucus and other fluids to aid in digestion and the elimination of waste products. Rectal cancer forms in the tissues of the rectum, the last several inches of the large intestine before the anus. Either of these cancers is called colorectal cancer.

What causes colon cancer?

Though scientists are unsure of the exact causes of colon and colorectal cancer, some risk factors have been identified, including being over age 50, presence of polyps, a high-fat diet, family or personal history of colon cancer, ulcerative colitis, Crohn's Disease or other inflammatory bowel diseases, a sedentary lifestyle, diabetes, obesity, smoking and alcohol, growth hormone disorder and radiation therapy for cancer.

What can I do to detect colon cancer?

Screenings, such as flexible sigmoidoscopy and colonoscopy, can help detect cancer or other ailments in the early stages, before symptoms appear. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Why did my doctor order a screening test?

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms in order to prevent cancer or catch it in its earliest stages. Once begun, they are typically repeated on a regular basis which can vary from one year to every 10 years depending on your medical history.

Certain habits, behaviors and environments are considered to be risk factors for cancer, based on scientific research. The presence of any of these risk factors may lead doctors to recommend that a patient be screened for cancer, which screening tests should be used, and how often the tests should be done.

What is my doctor looking for from the screening?

Screenings can help detect cancer or other ailments in the early stages, before symptoms appear when treatment is much more successful. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Are there any complications of the procedures?

There are complications with any medical procedure. However, colonoscopies and flexible sigmoidoscopies are safe and have minimal risks when performed by physicians, called gastroenterologists, who have been specially trained and are experienced in these procedures.

One rare but major possible complication is perforation, in which a tear through the colon wall may allow leakage of intestinal fluids. It may be managed with antibiotics and intravenous fluids, although surgery is usually required. Bleeding may occur from the site of biopsy or polyp removal. It is usually minor and stops on its own. Rarely, transfusions or surgery may be required.

Localized irritation of the vein can occur at the site of medication injection. A tender lump develops which may remain for several weeks to several months but goes away eventually. Other risks include drug reactions and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare but remains a remote possibility.

In short, with these procedures, complications are extremely rare, but they can happen. Your physician can tell you more about these risks.

Why are screenings necessary?

These screenings are a valuable tool for the diagnosis and treatment of many diseases of the large intestine. Abnormalities suspected by X-ray can be confirmed and studied in detail. Even when X-rays are negative, the cause of symptoms such as rectal bleeding or change in bowel habits may be found by these screenings. Furthermore, while colon cancer is the number three cause of death from cancer, it doesn't have to be. It is highly preventable with timely screenings.

How do I prepare for my screening?

For the best possible examination, the colon must be completely empty. Patients will be asked to temporarily discontinue the use of aspirin products, iron tablets and possibly other medications before the examination. The physician will give detailed instructions to follow the day before the procedure, including the use of liquid laxatives and/or pills and fasting that will help ensure your colon is empty of all digested material on the day of the procedure. Patients should inform the physician if they are allergic to any drugs. Someone must accompany the patient to the appointment because they will be sedated and not allowed to drive after the screening.

But the prep makes me feel ill!

Preparation for a colonoscopy is certainly inconvenient, and the laxative materials you are asked to swallow or drink can make someone slightly queasy for a few minutes. This usually does not last long and is a small price to pay to save your life from colon cancer. Also, if prep does make you feel nauseated, tell your physician. There are other choices that can be made for you next time that might help alleviate that inconvenience.

What happens after a procedure?

Patients will be monitored until most of the effects of any medication have worn off. Patients may feel bloated and gassy right after the procedure if any air was introduced into the colon. As soon as the procedure has been completed, patients may resume their usual diet unless other instructions are given. If polyps have been removed, the doctor may suggest a modified diet and probably will advise you to avoid heavy lifting and exercise for several days.

Why can't I opt for a virtual colonoscopy?

Virtual colonoscopy is slowly becoming available, but it is still in its very early stages, so availability is very limited. Also, virtual colonoscopy has its limitations. It doesn't eliminate the colon-emptying preparation steps; you must still do that prep. But its primary limitation is that it can't remove any polyps found and it is not preventive. If polyps and other abnormalities are seen during a virtual colonoscopy, a traditional colonoscopy must be scheduled to remove them, requiring a second prep and procedure appointment. Last, there are concerns being expressed about the amount of radiation received during a virtual colonoscopy.

Since colon cancer is the second leading cause of cancer death in the U.S., the recommendation is not to wait to get your colonoscopy if you presently meet screening guidelines. If no polyps are found and if this technology progresses as hoped for, your next colonoscopy could perhaps be a virtual colonoscopy.

What are the symptoms of colon cancer?

A common symptom of colorectal cancer is a change in bowel habits. Symptoms include:

  • Frequent diarrhea or constipation
  • Feeling that your bowel does not empty completely
  • Blood (either bright red or very dark) in your stool
  • Stools that are narrower than usual
  • Frequent gas pains or cramps, or feeling full or bloated
  • Losing weight with no known reason
  • Feeling very tired all the time
  • Having nausea or vomiting

Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. Anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.

Usually, colon cancer does not cause pain in its early stages when it is almost 100 percent treatable. It is important not to wait to feel pain before seeing a doctor.

What are the risk factors?

No one knows the exact causes of colon cancer. Doctors often cannot explain why one person develops this disease and another does not. However, it is clear that colon cancer is not contagious. No one can catch this disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop colon cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for colorectal cancer:

  • Over age 50
  • Colon polyps
  • Family history of colon cancer
  • Personal cancer history
  • Ulcerative colitis or Crohn's Disease
  • A diet high in animal fat and low in calcium folate and fiber
  • Cigarette smoking

Because people who have colon cancer once may develop it a second time, it is important to have checkups. Also, if a patient is diagnosed they may be concerned that family members may develop the disease. People who think they may be at risk should talk to their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

But keep in mind that while risk factors can increase an individual's possibility of getting colon cancer, about 75 percent of those who are diagnosed with it have no family history and no apparent symptoms.

How common is colon cancer?

In the United States, colorectal cancer is the fourth most common cancer in men, after skin, prostate and lung cancer. It is also the fourth most common cancer in women, after skin, breast and lung cancer.

How can I prevent colon cancer?

Getting screened is the first step in preventing colon cancer. Screening should begin at age 50 for people without any risk factors for developing colon cancer. Recent studies suggest that African-Americans may want to start screening at age 45. Consult your physician if you are African-American.

Several screening options are available, including colonoscopy and flexible sigmoidoscopy. More frequent and earlier screening is recommended if you are at a high risk for colon cancer. Remember that these procedures not only detect cancer, but can prevent it, by removing any tissue that could potentially become cancer, in the same procedure.

What are the treatments for colon cancer?

Treatment options for colon cancer depend on the following:

  • The stage of the cancer
  • Whether the cancer has recurred
  • The patient's general health

The three primary treatment options available for colon cancer are surgery, chemotherapy and radiation. The surgical option, a partial colectomy, is the main treatment and includes removing the affected portion of the colon. How much of the colon is removed and whether it is done in conjunction with other treatments will depend on the location of the cancer, how deep it has penetrated the wall of the bowel and if it has spread to the lymph nodes or other parts of the body.

In surgical treatment, the part of the colon that contains the cancer, as well as portions of healthy colon on either side, will be removed to ensure no cancer is left behind. Nearby lymph nodes will be removed and tested at the same time. Usually the doctor is able to reconnect the healthy portions of the colon, but if that is not possible the patient will have a temporary or permanent colostomy bag. A colostomy bag is a device that is worn on the skin discreetly under the clothing and is attached to the remaining bowel end. Solid waste material travels into this bag which is then disposed of and replaced as needed. Sometimes, a colostomy is done temporarily to give the bowel time to heal; sometimes it becomes permanent if too much of the colon has to be removed.

If the cancer is small, early stage and localized in a polyp, it is possible it may all be removed during a colonoscopy.

If the cancer is very advanced or the patient's health is extremely poor, surgery may be done simply to enhance comfort. This is an operation that will relieve a blockage of the colon to improve symptoms. This will not cure cancer but will relieve pain and bleeding.

Chemotherapy can be used after surgery to destroy any remaining cancer cells, and may be recommended by the doctor if the cancer has spread beyond the colon. Chemotherapy can be used in conjunction with radiation.

Radiation therapy uses powerful energy sources to kill any cancer cells that may remain after surgery or to shrink large tumors before an operation. This option is rarely used in early stages of colon cancer.

How do I find out more?

Check out our Digestive Health Additional Resources section.



FOR PHYSICIANS

When should I recommend my patients get a colonoscopy?

Guidelines generally recommend colon cancer screenings begin at age 50, but you should evaluate each patient based on their ethnicity and other risk factors, such as family history of the disease. Experts now recommend that African-Americans begin screening at age 45 across the board.

Why should I refer my patient to an ASC instead of a hospital?

We appreciate your referral and know how important follow-up is to you and your patients. That’s why we send you all necessary reports and immediately let you know if pathology is found. You should also keep in mind the benefits for your patients: shorter waits, less congestion, easy parking. An ambulatory surgery center is a more pleasant, relaxed environment than a hospital at a much lower cost to your patients. By choosing an ASC, you’re choosing the same high-quality care in a relaxed environment devoted to individualized patient attention.

What tips should I give my patients about good digestive health?

Having good digestive health means the body is working properly to break down food and turn it into energy — so nutrition is critical. Tell your patients to try these tips:

  • Eat small, frequent meals.
  • Take your time when eating. This will help you feel full faster so you don’t overload your system.
  • Include foods rich in fiber, like raw vegetables, fruit, whole grains, nuts and beans.
  • Cut down on fried, fattening foods.
  • Choose lean meats over more fatty ones.
  • Drink plenty of fluids. But watch out for sodas and juices loaded with sugar, which will increase your calorie intake.
  • Maintain a healthy body weight by exercising regularly and eating the right foods.

Is colonoscopy the only option for colon cancer screening?

Colonoscopy isn’t the only option for colon cancer screening, but it’s considered the best. Other screening options for colorectal cancer include flexible sigmoidoscopy, virtual colonoscopy, fecal occult blood test and double-contrast barium enema.

A colonoscopy is considered the most accurate. It detects more cancers, examines the entire colon, and can be used for screening, diagnosis and removing polyps in the same procedure. If polyps are detected outside of a colonoscopy, it’s likely that your patient will have to go through the prep again and have a colonoscopy anyway — so a colonoscopy usually makes the most sense.

How do I find out more?

Check out our Digestive Health Additional Resources section.



FOR FAMILY AND FRIENDS

Why does my loved one need a driver?

A responsible driver with a valid driver’s license must be available to drive our patients home if they have received sedation medication that will impair their ability to drive for 24 hours. The driver should stay at our facility during the procedure. If they don’t have a driver, we will have to reschedule the procedure for a time when they can have an available driver.

What will the recovery be like?

The procedure itself takes 15-30 minutes. Even though the patient will feel fine, the lingering, subtle effects of the sedation will make it dangerous for them to drive, so a responsible adult must be there to take them home. They should be able to resume normal activities the next day. Patients may feel some cramping or the sensation of having gas after the exam is completed because of the air used to inflate the colon. But, this bloated feeling usually stops within an hour.

My loved one refuses to get screened. How can I persuade them?

How do you convince a less-than-enthused spouse, parent or friend that they absolutely must get a colonoscopy? (After all, we’re talking life-saving here!) A little education often goes a long way:

  • It’s not going to hurt because most people don’t feel anything, and you wouldn’t remember it if you did.
  • You don’t have to go to hospital — there are tons of outpatient facility options.
  • Colon cancer is the second deadliest form of cancer in the United States. Each year about 150,000 people will be diagnosed with colorectal cancer, and about 50,000 people will die from the disease, but if caught early, it’s nearly 90 percent curable.
  • Nearly 75 percent of cases have no family history and the disease tends to have no warning signs until the late, often fatal, stages. So none of us are safe. Think of it this way: if you eat and drink, you can get colon cancer.
They found several polyps during my loved one’s colonoscopy. Does that mean they have cancer?

Some colon polyps are benign, which means they are not cancer. But some types of polyps may already be or can become cancer. It’s important not to panic. They are fairly common in adults, which is why screening is so important. Doctors usually remove colon polyps because some of them can turn into colon cancer. Whether or not the polyp is cancerous, it’s important that your loved one have follow-up testing to look for more polyps.

How do I find out more?

Check out our Digestive Health Additional Resources section.

Parkway Endoscopy Center + 488 E. Valley Parkway, Suite 110, Escondido, CA 92025 + P: (877) 217-8505