Colon Cancer Screening (cont.)
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
In this Article
- Introduction to colon cancer screening and surveillance
- Screening recommendations for individuals with average risk of colon cancer
- Fecal occult blood tests
- Flexible sigmoidoscopy
- Screening colonoscopy
- Virtual colonoscopy
- Air contrast (double contrast) barium enema
- Surveillance recommendations for individuals with higher then average risk of colon cancer
- Patients with history of colon polyps
- Patients with history of colorectal cancer
- Patients with ulcerative colitis
- Family history of colorectal cancer
- What are hereditary colon cancer syndromes?
- Who should consider genetic counseling and testing and how is it conducted?
- Summary of colon cancer screening
Air contrast (double contrast barium enema)
Even though double contrast barium enema has been included in screening guidelines, it is not as accurate as colonoscopy or, perhaps, virtual colonoscopy in detecting small polyps or cancers. Like virtual colonoscopy, it cannot remove polyps. Also like virtual colonoscopy, it may mistake particles of stool for polyps. In addition, as the numbers of barium enema examinations decreases, radiologists have less experience doing them, and their ability to do a good examination is decreasing. For these reasons, double contrast barium enemas are not widely used for colon cancer or polyp screening. For more information, please see the Barium Enema article.
Many individuals are at higher than average risk for developing colon cancer because of a family history of colon cancer, history of chronic ulcerative colitis, rare hereditary colon cancer syndromes, or a history of colon polyps or cancer. Periodic surveillance colonoscopies are recommended for these individuals to remove precancerous polyps, and /or to detect early cancers.
Patients with history of colon polyps often develop polyps subsequently. Therefore, periodic surveillance colonoscopies are recommended. In individuals with only precancerous polyps that are completely removed, the usual recommendation is to repeat the colonoscopy after 3 years. If the colonoscopy at 3 years shows no recurrence of polyps, then the interval between subsequent colonoscopies is extended to 5 years.
Sometimes, doctors are not confident that all polyps have been completely removed. Examples include individuals with multiple pre-cancerous polyps, polyps that are technically difficulty to completely excise, or less than optimal visualization of the colon due to inadequate cleansing of the colon. Under these circumstances, the decision regarding the interval between surveillance colonoscopies is best arrived at jointly between the patient and the doctor. For more information, please see the Colon Polyps article.
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