Colorectal Cancer

January 18, 2012

This high-tech outpatient procedure plays an important role in the prevention and earlier detection of colorectal cancer, which can be treated more successfully, and with less patient trauma, the earlier it’s detected.

Do I really need a colonoscopy?

This high-tech outpatient procedure plays an important role in the prevention and earlier detection of colorectal cancer, which can be treated more successfully, and with less patient trauma, the earlier it’s detected.
Colorectal cancer is a serious, potentially-fatal disease. It’s also preventable, treatable and curable the earlier it’s detected. Better Health sat down with Dr. Poungpen Sirisuwannatash, a specialist in gastro-enterology and hepatology at Bumrungrad, to find out more about the colonoscopy procedure and its use in screening for colorectal cancer, and who should have one.


Better Health:  Is colorectal cancer a significant health threat in Thailand?


Dr. Poungpen:  Colorectal cancer is now the fourth most common cancer among Thais. Among men, it ranks third among all cancers, and for Thai women it ranks fifth. And the number of cases continues to trend up.

Better Health:  How can a person know if he or she has a high risk of, or may already have, colorectal cancer?
Dr. Poungpen:  Most patients don’t know that they already have the disease. It’s usually detected in one of three ways: In a small percentage of cases, it’s detected when a health-conscious patient has a periodic check-up including colorectal cancer screening.

The second way involves patients who consult their doctor only after noticing something suspicious that gives them cause for concern. Some patients in this group turn out to have only polyps or non-cancerous tumors, both of which can be treated successfully.
The third way involves patients seeing a doctor only after they notice serious symptoms such as bloody stool. Quite a few of these patients will be diagnosed with colorectal cancer that has already progressed beyond the early stage.


Better Health:  What should people look for in terms of warning signs?
Dr. Poungpen:  Colorectal cancer can be prevented, largely because the pre-cancerous stage tends to last quite a while, and tests are capable of detecting it during this pre-cancer stage. But symptoms can prove difficult to recognize, and some patients remain symptom-free during the earlier stages.
Commonplace symptoms such as diarrhea, constipation and flatulence are easy to mistake for minor gastro-intestinal disorders. Some people assume bloody defecation indicates hemorrhoids. Many patients figure it’s not something worth the inconvenience of a doctor visit.

I encourage people to broaden their thinking about when to talk to their doctors. Beyond seeing your doctor when you need treatment for a disease or condition, doctors can be of great help in disease prevention.
Periodic check-ups are critical for detecting small problems well before they grow into much more serious threats. People in good overall health and with no family history of cancer should generally undergo colonoscopy cancer screening by age 50.

Better Health:  What procedures other than a colonoscopy can be used to detect colorectal cancer?
Dr. Poungpen:  There are other tests available – primarily laboratory stool examination and barium enema testing – but these tend to be less accurate than a colonoscopy. Patients who want a less-invasive procedure may prefer a virtual colonoscopy for its more detailed results compared to a traditional barium enema X-ray. The virtual colonoscopy procedure is capable of detecting between 60 and 90 percent of polyps larger than 0.6 cm. If polyps are detected during a virtual colonoscopy, a total colonoscopy is usually necessary so that a biopsy can be performed.

When screening reveals significant symptoms pointing to cancer, doctors will usually schedule a total colonoscopy prior to deciding on a precise treatment strategy. It’s worth noting that colonoscopy screening for colorectal cancer is widely accepted by the global medical community as being an effective tool for cancer prevention – and a total colonoscopy is the gold standard.
Colonoscopies can spot abnormal tissue growths that may lead to future problems such as inflammation or polyps. Sometimes it takes finding a polyp to get a patient to fully recognize the importance of screening tests.

Better Health:  What happens if the colonoscopy detects a problem?
Dr. Poungpen:  If polyps or pre-cancerous tumors are present in the colon, they can usually be removed right away. The patient would be re-classified as being in the higher-risk group to be monitored periodically.


If no problems are found, it’s safe to say the patient will remain free of colorectal cancer well into the future for at least five to ten years. Studies show that screening reduces colorectal cancer incidence and death rates by 23 to 31 percent, a significant reduction.

Better Health:  What limitations or other concerns should patients know about?
Dr. Poungpen:  One thing to note is that a colonoscopy isn’t exactly cheap, and it costs more than stool testing or X-rays. But the cost pales in comparison to the cost of cancer treatment, which may involve surgery, chemotherapy and radiation therapy. Treatment costs are exponentially higher than having a colonoscopy – and much more disruptive to a patient's quality of life. Prevention and risk reduction are investments that pay huge dividends that can be enjoyed for many years. 
  “It’s worth noting
that colonoscopy
screening for
colorectal cancer
is an effective toolfor cancer prevention.”

Dr. Poungpen Sirisuwannatash
A colonoscopy is not a routine procedure that any doctor can perform. Physicians must undergo extensive training and skills development before conducting their first colonoscopy.
As with all medical treatments and procedures, there are risks and possible side effects that patients should know about: anesthesia-related effects, obstructive sleep apnea, bleeding in the bowel or perforation of the bowel have occurred in only a very small number of cases in experienced hands.

Better Health:  Overall, should patients be concerned about the safety of a colonoscopy?
Dr. Poungpen:  Thousands of colonoscopies are performed every day without incident.
Side effects and complications are rare. For example, bowel perforation occurs only once in every 3,000 to 5,000 colonoscopies. 

Doctors will explain the risks, possible complications and potential side effects with patients beforehand. People taking thrombolytic medications will usually be instructed to stop taking them for about a week. An anesthetist may be present to monitor overweight patients, people with obstructive sleep apnea and short-necked or cardiovascular-compromised patients.

No one should have to go through the trauma of battling colorectal cancer. The disease is largely preventable and usually responds well to treatment when detected earlier. I urge people not to skip their colonoscopy screening; it’s a procedure that offers tremendous protection against a serious health threat.
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