ASK THE EXPERT: COLON RECTAL SCREENING

If we experience chronic stomach or digestion issues, our physician is likely the first person we turn to for help. However, the Centers for Disease Control (CDC) recommends that adults over 50 visit their physician to be screened regularly for colorectal cancer---even if they are not experiencing symptoms related to digestive issues.

With colorectal cancer ranking as the second most deadly cancer in the United State for both men and women, screenings can save lives. Colorectal cancer develops in the colon or rectum, which are parts of the digestive tract. The colon is the large intestine or large bowel and the rectum is the passageway that connects the colon to the anus. Precancerous polyps (abnormal growths) can be present in the colon for years before invasive cancer develops. Since many polyps do not produce symptoms, particularly in the early stages, colorectal screenings can assist physicians in locating and removing these growths or abnormalities.

According to the United States Preventative Services Task Force, screening for colorectal cancer reduces mortality by allowing physicians to detect cancer at earlier, more treatable stages, as well as to identify and remove precancerous polyps.  In addition, colorectal screening can assist physicians in the diagnosis of other diseases of the digestive tract.

Paul Savoca, MD, a colorectal specialist who recently joined the program at St. Charles Hospita in Port Jefferson, is board certified in both the surgical and non-surgical treatment of benign and malignant colon and rectal conditions. He completed his surgical residency at Yale University School of Medicine and a fellowship at the University of Minnesota. While in private practice, Dr. Savoca completed approximately 200 major colorectal surgeries annually. He brings his expertise to St. Charles Hospital, where surgeons performs minimally invasive laparoscopic colon and rectal surgery, which reduces patients’ pain and allows them to return to full activity more quickly following surgery.

Dr. Savoca explains the importance of annual colorectal screenings and what to expect during the procedure.

What is a colorectal screening?

Dr. Savoca:
Colon screening refers to testing for the presence of polyps, small growths on the intestinal lining, which may eventually develop into cancer. Removal of these polyps at the time of colonoscopy can halt their progression to cancer. It is important that patients get tested as early and as regularly as possible, as colorectal cancer is a disease in which patients may not experience symptoms in the beginning stages.

Who should be screened?

Dr. Savoca: All individuals over the age of 50 should be screened for colorectal cancer.  If there is a family history then screening should begin at age 40 or 10 years prior to the age of onset of the youngest relative with colorectal cancer.  Screening should begin even earlier if you have inflammatory bowel disease or in the presence of relatively uncommon inherited syndromes, (HNPCC or Lynch syndrome and Familial Polyposis-FAP). In addition, patients with symptoms of bleeding, change in bowel habits, abdominal pain, or sudden and unexplained weight loss, need to have their symptoms investigated regardless of age.

What can a patient expect the experience to be like?

Dr. Savoca: The current screening test of choice is colonoscopy. The colonoscopy procedure itself should not be uncomfortable for patients as they are sedated.  Preparation for the exam requires that patients to cleanse the colon by drinking a laxative the night before.  Adequate preparation of the colon is essential to performing a proper exam so that even the smallest polyps can be seen. 

Once the colon is prepared, the procedure is performed under a sedative--not a general anesthetic.  The physician inserts a flexible tube equipped with a digital camera into the large intestine through the anus. This allows the physician to see the intestinal lining where polyps are likely to occur.  Removal of polyps can be performed at that time for further evaluation to determine if malignant (cancerous) or benign (not cancerous.)

Following a colonoscopy, patients can experience bloating or gaseousness due to the fact that the colon is inflated with air during the exam so as to see it better. Once a patient is aware and had had some food and drink, they are discharged home.

What are doctors looking for in the screening results?

Dr. Savoca: Polyps are the most important finding during colonoscopy.  Most colon cancers begin as small polyps, which if not discovered can develop into cancer over a five to eight year period.  Other common findings include tumors, colitis (inflammation) and diverticular disease.

When surgery might be an option and what does it involve?

Dr. Savoca:  If a patient is diagnosed with colon cancer, surgery is almost always the primary treatment.  Surgery is often employed to relieve symptoms of intestinal blockage, as well.

Colon cancer surgery typically involves re-sectioning of the large bowel, a procedure in which the diseased part is removed and the healthy ends are reconnected. Occasionally, a colostomy (“bag”) may be required following surgery. This technique is used for advanced tumors, especially those that lie close to the anal opening.

At St. Charles physicians use the most advanced, minimally-invasive techniques to minimize recovery time for their patients.

What are some basic lifestyle habits which promote good colon and rectal health?

Dr. Savoca:
A diet rich in fresh fruits and vegetables and low in fat, particularly fat found in red meat, has been linked to a lower risk of colon cancer.