Polyps are common. Studies have shown about 25-30% of people over the age of 50 have a precancerous colon polyp on their exam. Most all polyps are removable during the colonoscopy. We have many tools that we can put through the working channels of the colonoscope during your exam that allow us to safely remove them. For small polyps, I use biopsy forceps that are like small scissors and allow to me to trim the polyp out. For larger polyps I use a snare (like a loop) that goes around the base of the polyp. Then, while cutting through the polyp, an electric current is applied that cauterizes the base to help keep it from bleeding. Since the polyps grow in the superficial lining of the colon (mucosa) there are very few significant blood vessels so any bleeding is usually minimal and stops on its own in a minute or two. Polyps that are too large to be safely removed are biopsied and tattooed (a dye is injected into the lining of the colon at the site of the polyp for easy identification in the future). Then, once the biopsy results come back, we sit down and discuss the significance of the polyp and decide if we can safely just monitor it or have it removed laproscopically (surgery). All polyps that are removed are sent to a gastroenterology trained pathologist who reviews the polyp and sends me a report as to what type of polyp it is. That information, along with my recommendations, are then sent to you through my patient web portal and faxed to your physician as well.
Yes. We will sedate you for the exam so legally you cannot drive for 24 hours. You will need an adult that you know (not a taxi driver) that will be present at the end of your exam to take you home. They do not need to be present during your exam and we can call them to come pick you up when done. This policy is in place for your safety.
The day before your colonoscopy you will be put on a liquid diet around lunch. You can go to work during this. That evening, usually after work, you begin the bowel prep. This will keep you busy for the night so if you work graveyard shift you will want to take that shift off to be at home. The day of the exam we request that you take the whole day off work. Even though you will only be at our endoscopy center for center for about 2-3 hours, you will be sedated so we don’t want you driving or making any major decisions for the rest of the day. You well feel like going home and resting. The next day you can return to full activity.
We are very professional about your privacy at all time. We understand that the thought of a bunch of strangers seeing your naked behind can be embarrassing. We take extra steps to keep you covered up with warm blankets right up to the time of your exam. Once you are asleep I will expose just enough of your behind to safely pass the colonoscope and perform your exam. The nurse and anesthesiology provider are doing their job on the opposite side of your exam table and cannot peak. The endoscopy technician that assists me during your exam will be standing by my side but conducts things in a very professional manner as well. We do everything we can to keep your privacy in mind.
A colonoscopy in the hands of an experienced team should not be painful at all. I have been though one myself. Before the exam starts you will be given some sedating medication through your IV by an anesthesia provider and you will drift off to sleep. You are awake enough that you are breathing on your own but sleepy enough that you are comfortable. During the exam you should not feel anything at all. After the exam you are gassy and bloated for awhile due to the air that is put into your colon during the colonoscopy, but that usually passes rather quickly (and sometimes loudly). During my colonoscopy I remember laying in the colonoscopy suite talking to my partner who was going to do my exam, I remember some Willie Nelson playing in the back ground then I remember waking up in recovery. It feels about that quick.
The U.S. Preventive Services Task Force and American College of Gastroenterology both recommend the colon cancer screening guidelines should start colon cancer screening at age 50. They also recommend continued surveillance until at least age 75 depending on other health factors. If there are other risk factors involved like family history of colon cancer or precancerous polyps (adenoma), personal history of other types of cancer or a hereditary condition that you may have that is associated with increased colon cancer risk, then you would be screened at a younger age. Unexplained rectal bleeding at most any age should be evaluated as well. If you have specific questions as to when you should be screened, please contact me at my San Antonio gastroenterology clinic.
For the correct indication colonoscopy is covered buy most all insurance carriers. For screening at age 50 or older, for screening sooner than age 50 in people with risk factors and for blood in the stool it is covered by most every insurance carrier. The only way to know for sure is to have our business office run your insurance benefits, which they will do for you free of charge, and they can determine if and how well it is covered on your plan. Don’t let your insurance companies decision on coverage or not deter you from getting screened- if a colon cancer is missed, they save the money on the colonoscopy, but you have to deal with the colon cancer. For most all endoscopy centers, mine included, we offer private pay cash prices when your insurance doesn’t cover your exam. Our goal is to make this cost effective for you so we can get you screened.
Yes. There are many studies that have been done looking at this topic and we have found that colonoscopy and colon cancer screening do saves lives. It is estimated that over 150,000 people will be diagnosed with colon cancer in the United States this year and 50,000 will die from colon cancer. There was a large, long term study from Harvard School of Public Health that concluded that 40% of all colorectal cancers could be prevented if people underwent colonoscopy screening. The National Polyp Study done in the United States in 1993 found anywhere from a 76% to 90% reduction in colon cancer risk among those that were screened with colonoscopy. These are just 2 of many examples of studies we have showing that colonoscopy is effective in helping to prevent colon cancer by finding and removing polyps and that it does save lives.
A colonoscope is a thin (10mm) tube that contains a lighted camera. It also has channels in it so that different instruments (like small forceps to biopsy things or snares to remove polyps) can be passed into your colon during the exam. This makes the colonoscope a tool that helps us both detect polyps and removed polyps during the same exam. It is used by gastroenterologists, like me, to treat bleeding in the colon, remove polyps, detect colon cancer and remove foreign objects (yah you read that right).
A colonoscopy is a procedure where a thin flexible tube with a camera on the end is advance through the colon (large intestine) while you are asleep to look for and remove lesions. It has been available in the United States for about 40 years, and luckily, has advanced a lot over that time. It is done Monday through Friday here at my San Antonio, TX gastroenterology clinic. When you arrive for your colonoscopy you will be checked in by my endoscopy nursing team to obtain your medical history and get you an IV so we can make you comfortable for your exam. You will then be seen by the anesthesiology provider to discuss your sedation. Then you will speak with me to go over things further and answer any last questions you may have. This whole process takes about 30-60 minutes. Once you’re in the endoscopy suite you will be given medication through your IV to make you sleepy and comfortable. You will be awake enough that you are breathing on your own but sleepy enough that you don’t feel any discomfort during your exam. While you are asleep, I will pass the colonoscope (small thin tube) along the inside of your colon until it hooks up with your small intestine on the other side (about 5-6 feet in total). Any polyps along the way will be removed at this time. The exam takes about 15-30 minutes, and then you will go to the recovery room where you will slowly wake up. Once you are awake (about 30-60 minutes) I will go over the results of your exam with you before you go home and you will get a copy of the report for your records.
The majority of the risks of treatment for colon cancer are associated with side effects of the medications. I will say that the risk of NOT treating colon cancer is higher than any of them. The main risks of surgery for colon cancer are bleeding and infection. There will likely be some degree of pain or discomfort afterwards as well. These things we can control with medication. If you require an ostomy bag after the operation there may be skin irritation and pain associated with that as well. If radiation is required for the colon cancer, it can cause radiation damage to the tissues and organs around the colon. This can cause scar tissue to develop which may lead to abdominal pain and it can cause radiation damage to the tissues that can result in bleeding later on. If you require chemotherapy there are many different side effects depending on which chemotherapy you get. Most common problems with chemotherapy are increased risk of infection, nausea and vomiting, diarrhea, hair loss and fatigue. We have medications available to help lessen most of those symptoms but sometimes they get bad enough that the chemotherapy has to be stopped.
In the unfortunate event that colon cancer is found in your colon on exam there are still options. The success of these options all depend on how early the cancer was detected, obviously the earlier the better. Most all cancers, if caught in time, are still curable. Once someone is diagnosed with colon cancer several things will happen. First, the cancer will be staged. What time means is, through a combination of biopsy, lab work and radiology studies I will determine if the cancer is localized (contained within that section of the colon only) or metastatic (has advanced through the wall of the colon into the blood supply, lymphatics or tissues beyond the colon). The majority of the time when a colon cancer is detected early and is still localized it can be cured by surgical resection. During surgical resection, the colorectal surgeon will cut out the diseased section of the colon, many times laproscopically, and then hook the colon back together without the need for an ostomy bag. You are then put on a surveillance program with colonoscopy to watch for recurrence. If the colon cancer has already spread beyond the wall of the colon (metastatic) then treatment is more involved. Treatment for this is usually a combination of surgery to remove the disease section of colon and chemotherapy with radiation. The types of chemotherapy and decisions on which we use are beyond the scope of this blog but I want you to understand that the types of chemotherapy medications we have and the success of those medications has gotten a lot better over time.
I will start by saying most colon cancer and most all polyps are asymptomatic. Don’t wait until you develop symptoms to get checked. Having said that, if you develop colon cancer the symptoms can include blood in your stool, change in the frequency, consistency of size of your stool (pencil thin stool), abdominal or back pain, unexplained weight loss, weakness, fatigue and shortness of breath.
There are several options available to help detect and prevent colorectal cancer in San Antonio TX.
- Colonoscopy. In this exam I pass a small flexible tube with a camera on the tip into and across the entire length of your colon while you are asleep. With this exam polyps can be both found and removed. Bowel prep before exam is required. Click here for more information on the colonoscopy procedure.
- Barium Enema. A small tube is put into your rectum and the radiologist will instill barium (liquid) and air into your colon to dilate it while you are awake. Then x-rays are taken to look for polyps or cancer. Bowel prep before exam is required. If polyps are found you are sent to colonoscopy to have them removed.
- Virtual CT Colonography. A newer study, where you are given contrast to drink and a tube is put in your rectum to instill air into your colon while you are awake. Then you are sent through a CT scanner to take images of your colon. If polyps are found you are sent to colonoscopy to have them removed. Bowel prep before exam is required.
- Fecal Occult Blood Test. This is a test for blood in your stool. Most cancers and most polyps leak small amounts of blood. Your doctor will test your stool for evidence of trace amounts of blood and, if detected, you will be recommended to have a colonoscopy to find the source. Main limit of this test is not all polyps leak blood and if it is a colon cancer that is leaking the blood, many times it is too late.
- Fecal Immunochemical Test (FIT). This is similar to the fecal occult blood test. Your stool is tested for trace amounts of blood. Again the limitation is not all tumors leak blood and most only leak blood intermittently. If blood is detected you will be referred for colonoscopy to find the source.
- Stool DNA Test. This tests your stool for abnormal cell DNA that is typically found in polyps and colon cancer. If found you will be sent for a colonoscopy to find the source. This test is not readily available in the United States.
Colon cancer affects people of all color, sex and ethnic background. Some people with no known risk factors develop colon cancer. Some people with several risk factors never develop colon cancer. But, research has shown that there are certain identifiable risk factors that, if present, make it more important that you get colorectal cancer screening in San Antonio TX.
- Age. Although young people can develop colon cancer 9 out of 10 people that do develop colon cancer are over the age of 50. This is why it is recommended that everyone over age 50 have a colonoscopy.
- Family History. If you have a first degree relative (parent, sibling or child) with colon cancer your risk for colon cancer is higher as well. Having family members with precancerous (adenoma) polyps may increase your risk as well. If colorectal cancer or adenoma polyps are in your family talk to your doctor or contact me, you may need a colonoscopy sooner than age 50.
- Personal History of Polyps or Cancer. If you have had colon polyps on previous colonoscopy or if you have a prior history of a cancer of any type, you are at increased risk for colorectal cancer. The number and type of previous polyps, or type of cancer and age at which it developed, helps us determine your risk and when you should be evaluated.
- Inflammatory Bowel Disease. If you have been diagnosed with Crohn’s or Ulcerative Colitis you are at increased risk for colon cancer. Both of these conditions cause chronic inflammation of your colon that can lead to growth of abnormal cells (dysplastic cells) that are at high risk of progressing to cancer. This is a different growth process than a “typical” colon polyp and has different risks for cancer. Evidence shows that it you have had inflammatory bowel disease for longer than 7 years your risk for colon cancer starts to go up. More diligent screening at that point is the right thing to do because, just like with colon polyps, if dysplasia is found in time it can be removed along with the risk of it becoming cancer.
- Inherited Syndromes. There are certain genetic inherited syndromes that we know increase your risk for colon cancer. Familial Adenomatous Polyposis (FAP) and Hereditary Non-polyposis Colon Cancer (HNPCC) are two examples of this. If you have any genetic syndromes that run in your family speak with your doctor about the risks you have of developing different conditions, like colon cancer, and develop a plan for your screening.
- Racial and Ethnic Background. African Americans and Ashkenazi Jews have the highest incidence of colorectal cancer. The reasons for this are not completely understood.
- Lifestyle Related Factors. We also know that poor diet and lifestyle choices can increase your risk of developing colorectal cancer. Having a diet high in fat, red meat and processed meat, being over weight and not doing much physical activity, smoking and excessive alcohol use all increase your risk of developing colon cancer.
Colon cancer is the second leading cause of cancer death in the United States, behind lung cancer. It is also preventable. Since most all colon cancer develops from colon polyps (small growths of tissue in the colon) that are allowed to continue to grow until they become cancer, the goal for prevention is to find and remove those polyps. The best way to do this is with colonoscopy. Current recommendation is to have your first colonoscopy at age 50 years old (40 year’s old if family history of colon cancer). During your colonoscopy your gastroenterologist will evaluate the inside lining of your colon with a long tube that has a camera on the tip. Any polyps that are found in your colon will be removed at that time. Then, depending on the number and type of polyps you have, you will be put on a surveillance program to catch new ones as they grow.
Colon cancer develops when a colon polyp is allowed to grow too long and change into cancer. The cells that line our colon (large intestine) are constantly being produced, utilized and then shed off and new ones grow back in their place. As this process happens there is a chance one of the cells may develop a defect that allows for uncontrolled cell growth. This uncontrolled growth can develop into a polyp and some of those polyps may continue to grow into a malignant cancer if not removed in time. The malignant cancer will then invade other healthy tissue in and around the colon and can lead to death.
There are two ways to schedule an appointment. One is to contact our office directly at 210-615-8308 and whoever answers the phone will be able to assist you. The second is by clicking this schedule an appointment link and filling in the appropriate information. My office will contact you to make the arrangements. We will also help you deal with and answer all questions regarding your insurance coverage.
If you have a medication that is due for refill typically it is sent through the computer to us from the pharmacy. These are then reviewed and sent back to the pharmacy typically within one to 2 days. If you need them sooner or this process did not happen please contact our office and speak with the medical assistant – (210) 615-8308. We do not refill medications after office hours or on weekends. That time is reserved for emergencies only.
Any time you are scheduled to undergo a sedated procedure (upper endoscopy or colonoscopy) it is recommended that you take that day off of work. Once you have been sedated, legally you should not drive or operating machinery for 24 hours. Because of this, it is important that you bring somebody with you to your scheduled exams that can safely get you home afterwards. The day after your exam you can return to full activity.
We used to use the tablet based prep for procedures. However, due to safety concerns by the FDA regarding renal failure in some patients, it was pulled from the shelves for some time. Due to continued safety concerns with this issue that we still have, we have chosen not to offer this to our patients. Your safety is still our primary concern.
There are a few different bowel preps that we use in our practice to help clean out the small bowel and the colon for your exams. The basic premise of all the preps are the same. The goal is to avoid solid foods the day before your exam and drink as much fluids as you can. The cleaner you can get your small bowel (for small bowel capsule endoscopy) or your colon (for colonoscopy) the more thorough and accurate of an exam we can do for you. We understand this is usually the most unplesant part of having a procedure done, but we have all been through it before as well and there are some things you can do to make it easier. Depending upon the time your exam is scheduled for, sometimes your bowel prep can be split so that half of it is taken the night before the exam and half the morning of your exam. This helps decrease the fullness and bloating feeling and gives you a much better washout. It also helps if you refrigerate your bowel prep as it does taste better when it is cold. If you start feeling to full, bloated or nauseated, take a break from the prep for a while until those symptoms resolved and then resume. It also helps to use baby wipes instead of regular toilet paper as once you start going your bottom side will tend to get a little tender. Click on the link below to find specific directions for the prep you are going to use. If there are other questions regarding this please contact my office.