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-than-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
Patients with history of colorectal cancer
Individuals who have undergone colon cancer surgery are at higher risk of developing another colon cancer in the future. It usually is recommended that they undergo a repeat colonoscopy after 6 to 12 months and every 3 years thereafter. Early detection and treatment of future polyps and early cancers can significantly improve chances of survival. The annual testing of stool for occult blood continues.
Patients with ulcerative colitis
Patients with long standing ulcerative colitis also have a higher risk of developing colorectal cancer. The risk of developing colon cancer is proportional to the duration of disease and to the extent of colon involved by colitis. Thus, patients with chronic ulcerative colitis involving the entire colon should have a colonoscopy every 1 to 2 years after having the colitis for 10 years or more. During the procedure, biopsies are taken from the colon to look for early, microscopic precancerous changes in the cells. If precancerous cells are detected, colonoscopy is repeated 3 months later. If still present, doctors may discuss with the patient the benefits of surgically removing the colon to prevent colon cancer. If the colitis is limited to only the left colon, the same surveillance program is started 15 years after the onset of colitis. For more information, please see the Ulcerative Colitis article.
Family history of colorectal cancer
Colorectal cancer may run in families. Colon cancer risk to an individual is even higher if more than one immediate family member (parents, siblings or children) has had colorectal cancer, and/or the family member developed the cancer at a young age (less than 55). Under these circumstances, it is recommended that individuals undergo a colonoscopy every three years starting at an age that is 7-10 years younger than the age at which the family member who developed colorectal cancer at the youngest age developed his or her cancer.
If only one immediate family member developed colorectal cancer at an advanced age, the colon cancer risk to the individual is still higher than average but not as high as if two immediate family members developed colorectal cancer or if a family member developed colorectal cancer at an early age. Whether and when to perform screening colonoscopies in these individuals are best decided jointly by the individuals and their doctors.
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