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Fecal Occult Blood Test - FOBT Introduction A fecal occult blood test is used to screen patients for colorectal cancer. The test helps detect the presence of hidden blood in the stool, which is one of the first warning signs that a patient may have colorectal cancer. Your doctor may ask you to have a fecal occult blood test, or FOBT. This reference summary explains why the test may be performed, how it is performed, and how its results are interpreted. Colorectal Cancer The FOBT is most often used to screen patients for colon cancer. This section gives you some information about the disease. Cancer that occurs in the colon or rectum is called colorectal cancer. The colon is the large intestine; the rectum is the end of the digestive tract from where stool is excreted through the anus. Colorectal cancer is the fourth leading cause of cancer-related death in the world. The earlier colorectal cancer is detected, the more successfully it can be treated. Polyps and cancers tend to grow slowly and may bleed from time to time (Polyp is a mass of tissue projecting outside the inner membrane of the digestive tract. It is like a small grape in shape). Sometimes this blood is visible in a patient’s stool; other times it is not. Hidden blood in the patient’s stool can often be detected by a screening test like FOBT, which may give a warning sign regarding potential colorectal cancer. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2015, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 11/08/2015 ge2001030i 1 Fecal means stool, occult means not seen by the naked eye. Therefore, a fecal occult blood test, or FOBT, detects blood in the stool that cannot be seen by the naked eye. If an FOBT detects blood, however, this does not necessarily mean you have colorectal cancer. Many factors can cause blood in the stool. Your doctor will order additional tests to diagnose the cause of the bleeding. How to Prepare Because colon cancers may bleed only from time to time, the FOBT tests three separate bowel movements over a period of several days. This increases the chance of detecting small amounts of blood in your stool. Some foods can cause the results of FOBT to be a “false positive,” which means it appears that there is blood in the patient’s stool even though there is no blood in the stool. You need to avoid these foods 2 to 3 days before the test: turnips, beets, radishes, horseradish, artichokes, mushrooms, broccoli, bean sprouts, cauliflower, apples, oranges, bananas, grapes and melon. The blood in red meat may also cause blood to appear in a patient’s stool. Therefore, you should avoid red meat 2 to 3 days before the test. Iron supplements, aspirin, and Vitamin C can also affect the results. Avoid them before the test. Your doctor may ask you to stop some medications that could affect the FOBT test results. These include colchicine, iodine, antacids or boric acid. If you have your menstrual period or have bleeding hemorrhoids, do not take the FOBT. How it is Done The fecal occult blood test (FOBT) is one type of colorectal screening test. The test can be conducted in a doctor’s office or at the patient’s home. A small sample of stool is placed on a chemically treated card, pad, or wipe; then a chemical developer solution is put on top of the sample. If the card, pad, or cloth turns blue, there is blood in the stool. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2015, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 11/18/2015 ge2001030i 2 The procedure for testing blood in the stool varies depending on which type of home test you have. It is important to follow the manufacturer's instructions provided with its test. Always check the expiration date on the package. Read the instructions that come with your test carefully and follow the directions exactly. For most tests, you will use stool samples from three different bowel movements over three different days. It can be unpleasant to collect a stool sample. However, the test has no risk and is an effective way to screen for cancer. Note: Products that are used to clean or deodorize the toilet may contaminate the FOBT testing kit. Repeat the test if the stool sample card touches the toilet seat or other objects that have such chemicals. Results If the card turns blue, this means there may be blood in you stool. This is called a positive test, or abnormal results. If the card does not turn blue, this means no blood was detected in your stool. This is called a negative test, or normal results. If your FOBT results are abnormal or the test is positive, your doctor will order followup tests to check for the causes of bleeding, if any bleeding is confirmed. Follow-up tests may include colonoscopy, upper GI endoscopy or sigmoidoscopy. • Colonoscopy is the examination of the colon with an endoscope. The endoscope is a long thin tube topped with a camera that allows the doctor to see inside the colon. • Endoscopy is the examination of the upper digestive system with an endoscope. The endoscope is a long thin tube topped with a camera that allows the doctor to see inside the colon. • Sigmoidoscopy is the examination of the last part of the large colon with a scope. The scope allows the doctor to see inside the colon. If the FOBT is positive and additional testing does not find blood in the stool, this means the original test was incorrect, or a “false positive.” Because many foods and medicines affect FOBT results, don’t be anxious yet if you have a positive FOBT. Wait for follow-up testing to confirm it was a “true positive.” The test may have been affected by another condition, or food you ate. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2015, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 11/18/2015 ge2001030i 3 If the FOBT is positive and additional testing confirms blood in the stool, this means the original test was correct, or a “true positive.” This still does not mean the patient has cancer. In fact, the majority of patients who have a “true positive” FOBT have bleeding in the digestive system that is not caused by cancer. If the FOBT is negative but later on other tests find blood in the stool, this means the original test was a “false negative.” Because early colorectal cancer does not bleed all the time and some colon cancers do not bleed, an FOBT may be negative when the patient actually has cancer. That is why your doctor may recommend repeated testing over time. Conclusion A fecal occult blood test is a screening test that helps to detect the presence of hidden blood in the stool. It is mostly used to screen for colorectal cancer. The test can be performed at home. If the card on which the stool sample is placed turns blue, the FOBT is positive, which means traces of blood were found in the stool. If an FOBT detects blood in your stool, contact your healthcare provider; you may need additional tests, such as a colonoscopy, upper GI endoscopy or sigmoidoscopy, to confirm the bleeding and find its cause. In most cases, the bleeding is caused by medical conditions other than cancer. The FOBT screens for colorectal cancer but does not diagnose it. Many foods and medications can affect an FOBT, causing it to be positive. Prepare for the FOBT test by halting the consumption of such foods and medications. The earlier we detect colorectal cancer, the more successfully we can treat it. Regular FOBT screening saves lives. Your doctor can recommend how frequently you should have the test, which depends on your age and your risk factors. This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2015, The Patient Education Institute, Inc. www.X-Plain.com Last reviewed: 11/18/2015 ge2001030i 4