​​​​​​​​​​​​​​Colonoscopies are so interesting. No one wants to talk about them, or have one, but they are absolutely necessary to rule out colon cancer.

You'll never forget when you have your first colonoscopy, though. After I had my daughter, my digestive system was all messed up, so my doctor suggested that I get a colonoscopy. I just remember when I told everyone that I had to have a colonoscopy, they couldn't stop talking about the prep and how horrible it was.

The prep was very, shall we say, “freeing," but was necessary to get an accurate result. The colonoscopy itself was over quickly. In honor of March being National Colorectal Cancer Awareness Month, I reached out to Dr. Janice Rafferty at The Christ Hospital, the Chief of Colorectal Surgery and Director of Surgical Oncology, to find more about colon cancer and why the numbers are increasing amongst younger adults.

​Look for signs

When it comes to any kind of cancer, it is always important to know the signs. Dr. Rafferty said, “The top symptom of colon cancer is actually nothing, which is why it's important to get your recommended colonoscopies to increase your chances of early detection or to remove polyps before they develop into cancer."

“However," she continued, “other top symptoms would be bleeding, bloating, unintended weight loss, cramping, pain, pelvic pressure, feeling like you have to have a bowel movement, but nothing-will-come-out kind of thing."

It's also important to know when to get checked out. For me, I knew something was off with my digestive system because I was going to the bathroom very frequently and everything seemed to make me sick.

Dr. Rafferty said, “If the symptoms come and go, it's more likely than not to be something completely benign, nothing to worry about. But if the symptoms start and they don't go away, you need to get evaluated. You could start with your primary care doctor, or if you already have a relationship with a gastroenterologist, go ahead and see them. But bring it to the attention of a doctor and point out that it's something new and different. And if you're really worried about it, you have to push sometimes for more thorough evaluation."

​When should you get a colonoscopy?

Unless you have some sort of digestive system issue or a family history of polyps, Dr. Rafferty says, “The current recommendation from the American Cancer Society and other professional organizations to start screening for colorectal cancer is 45 years of age. However, if you have a family history of polyps or cancer, then you need to start earlier.

“It's either at the age of 40, or 10 years before your youngest first degree relative was diagnosed. So, if your mom was diagnosed with colorectal cancer at the age of 42, you need to have your first exam at the age of 32. Know your family history. So, if for example polyposis syndromes run in your family, you can't escape your genes. You need to be screened much, much earlier than that."

​Which test is best?

The colonoscopy is just one way to test for colorectal cancer, but some doctors are suggesting a test where you can ship your stool in a box. So, which one is better and, what's the difference between colonoscopy and shipping it in the box?

Dr. Rafferty explains, “These are all screening tests for colorectal cancer, and it goes from easiest to do but least accurate to hardest to do but most accurate. Easiest to do but least accurate would be something like a fecal occult blood test, which is something you do in your doctor's office where they put a little smear of stool on a card and then they rehydrate it with a solution that turns blue if there's blood in your stool.

“So, it's easy, but it's the least accurate because if you have been eating radishes, or you had a cheeseburger yesterday, or you've been taking a non-steroidal medicine to relieve joint pain, for example, you might have “heme" or that red coloring in your stool. That's detected, but it has nothing to do with colorectal cancer.

“The most difficult, so to speak, test to do would be colonoscopy, but it's the most accurate. You must do the prep. The lining of your colon has to be completely visible to the person doing the colonoscopy. You're going to have, you know, lots of diarrhea when you take the prep, but when the colonoscopy is done, polyps can be seen and removed. Other things can be seen and diagnosed. The exact location of the abnormality is diagnosed, so it's the most accurate and reproducible exam to get."

The ship-it-in-a-box test is called Cologuard. Dr. Rafferty said, “Cologuard is the one that everyone is very excited about, and it is kind of exciting because you can send in a stool sample, and it detects tumor DNA in stool. It is accurate to a certain extent. It will miss cancers in 8% of patients who actually have cancer, and it can miss polyps in up to 50% of patients who actually have polyps.

“Cologuard is a very valuable test. If you can't get a colonoscopy for some physical reason, Cologuard is better than nothing, but you must be realistic about the results interpreting those results. If you do a Cologuard, you have to do it again in three years. If you get a colonoscopy and it's negative, you have to do it again in 10 years because the average length of time from a polyp forming to a polyp turning into cancer is 10 years."

​Remember—It's not always based on age!

I was watching The Today Show recently, and they did a segment on the uptick in the number of younger adults with colorectal cancer.​ There isn't a definite answer as to why, but Dr. Rafferty suggested, “It's because we're looking for it in younger age groups, because it's become evident over the past probably 5 to 10 years that younger people are more frequently affected by colorectal cancer. The age for onset of screening has dropped from 50 to 45, but that's for screening patients who have no symptoms of a problem.

“If you have a symptom of a problem, you need a diagnostic exam. Some of the saddest stories I hear are, 'Well, I've had bleeding for a couple of years, but I didn't think I could get a colonoscopy until I was 45.' If you have no symptoms, it's 45. But if you have symptoms, bleeding, bloating, cramping, a sense of incomplete evacuation, unintended weight loss, you know, palpable mass that you can feel—those sorts of things—that's a diagnostic exam, and that can occur at any time. You don't have to be 45 for that. You could be 25 for that. It's rare that you know you're going to find something terrible in a 25-year-old, but it's not unheard of."

​Scheduling and next steps

Scheduling a colonoscopy is easy, but you need to have a doctor put in an order that you need one. You most often will get this order from your primary care provider, but it really can come from any doctor. Or if you're having symptoms, a colorectal surgeon like Dr. Rafferty can help you out.

If you do get some not-so-great results, please make sure to reach out to Dr. Janice Rafferty or another expert at The Christ Hospital. Dr. Rafferty said, “You'll need an expert to give you the best advice possible and to render the absolute best treatment, the most cutting-edge best treatment possible. It might mean surgery. It might mean chemotherapy and radiation, followed by surgery. It might mean chemotherapy and radiation, followed by no surgery. So, what you need is a team of experts in this disease process who are familiar with the latest recommendations, who are able to perform and carry out the latest recommendations, who can give you the absolute best advice possible." You need a team from The Christ Hospital!

​To schedule an appointment with The Christ Hospital Physicians - Colon & Rectal Surgery, call 513-585-2888.