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Determining a Diagnosis Colonoscopy Charlene M. Prather, M.D., M.P.H. Associate Professor of Internal Medicine Saint Louis University St. Louis, Missouri Topics List • What is colonoscopy? • What is it used for? • How is it done? • Are there any alternatives? • Interesting findings Colonoscopy • Sedated examination of the colon • Views the internal lining of the colon • Biopsies can be obtained • Polyps can be removed What is Colonoscopy Used For? • Colon cancer screening • Determining the cause of: – Gastrointestinal tract bleeding • Bright red blood from the rectum • Maroon stool • Occult (hidden) bleeding – Unexplained diarrhea – Iron deficiency anemia How is Colonoscopy Performed? • The colon must be clean to be examined – Liquid diet – Laxatives • Stop iron supplements • You may be asked to stop aspirin • Blood thinners are usually stopped How is Colonoscopy Performed? • An I.V. will be placed for sedatives and pain medications • The examination is performed on the left side • Oxygen will be given • Vital signs will be monitored throughout the procedure • The procedure takes 30 to 60 minutes to perform Normal Colon and TI March Colon Cancer Awareness Month • Katie Couric underwent colonoscopy on national television in March 2000 • She continues to actively campaign for colon cancer screening March Colon Cancer Awareness Month • Katie Couric underwent colonoscopy on national television in March 2000 • She continues to actively campaign for colon cancer screening • Other celebrities have joined the campaign Colon Cancer • Second leading cause of cancer deaths • More the 90% of colon cancer is preventable • Affects men and women • Any one can get colon cancer – Usually strikes after age 50 • Risk is increased if a first degree relative has had colon cancer Colon Cancer Prevention • Begin screening at age 50 (average risk) – No family history of colon cancer – No personal history of colon polyps or colon cancer • African Americans should begin screening at age 45 • Higher risk may need to begin at a younger age: – Age 40 or 10 years younger than the relative developed colon cancer • The risk of colon cancer continues to increase with age But Doc, I feel fine! • Early colon cancer has no symptoms • Symptoms of colon cancer – Rectal bleeding • Don’t assume it’s just hemorrhoids – Iron deficiency anemia – Change in bowel habit – Unexplained weight loss The importance of early detection • Colon cancer confined to the colon is curable! – 90% alive at 5 years • If colon cancer has spread outside the colon – 8% alive at 5 years Early cancer What About Prevention? • Early detection – Detecting cancer before it has spread and when it is still curable • Prevention – Removing polyps before they can become cancer Polyps • Small growths in the colon • Two main types of polyps: – Hyperplastic: do not to lead to cancer – Adenomas: precancerous, may develop into cancer over several years if left untreated How Common are Polyps? • Adenomatous polyps are found in 15 – 30% of screened individuals • Removing polyps reduces the risk of cancer by 90% • A single colonoscopy reduced colon cancer death by 31% Who is Getting Screened? • Mammograms – 80% • Sigmoidoscopy/colonoscopy – 20 – 30% Tests for Colon Cancer • Colonoscopy every 10 years – The best screening test • Flexible sigmoidoscopy every 5 years – Reduces deaths from colon cancer – Screens less than ½ the colon • Fecal occult blood testing every year – Reduces deaths from colon cancer – Risk of falsely positively test – Risk of false negatives (polyps rarely bleed) • Barium enema every 5 years – Radiation exposure – Rarely done for screening any more Who Pays for the Test? • Most insurances cover colon cancer screening • CDC funded low cost screening available in St. Louis! – 314-879-6392 New Approaches • Virtual colonoscopy – Prep still required – Rectal tube – Not as reliable as colonoscopy • Stool tests – Genetic markers of cancer • Capsule endoscopy Capsule Endoscopy Technology PillCam™ ESO PillCam™ SB 26 mm 26 mm 11 mm 7 frames per second 7 frames per second Total = 14 frames per second 2 frames per second Capsule Endoscopy • Best for evaluating the small bowel – Bleeding – Crohn’s disease • Not yet good enough for evaluating the colon – Not clear that it will be Interesting Findings 70 year old male with heart disease developed sudden onset bloody diarrhea 60 year old female with sudden onset of bloody stools 40 year old female developed severe diarrhea after taking antibiotics Clostridium difficile 48 year old liver transplant patient with diarrhea Cytomegalovirus colitis 27 year old male with abdominal pain, weight loss and diarrhea Crohn’s colitis ulcer Summary • Colonoscopy is the best colon cancer screening test available • Colon cancer is silent until it is too late! • Get screened and encourage your loved ones to get screened