Dr. Jon J. Ernstoff, a gastroenterologist for more than 35 years, is a well-known and respected specialist in the Wallingford/Meriden area. Board certified in Gastroenterology and Internal Medicine, Dr. Ernstoff is with Connecticut GI in Meriden. He also performs colonoscopies and other outpatient GI procedures in the Specialty Clinics conveniently located at Masonicare Health Center in Wallingford. Throughout his many years in the field, Dr. Ernstoff has seen hundreds of cases that prove how screening for colorectal cancer saves lives. During a recent interview, he shared the following important information with readers.
Is colorectal cancer the same as colon cancer?
Coloncancer and colorectal cancer are both terms used to describe cancer of the large intestine. The term “colorectal” refers to the colon and rectum, which make up the large intestine. Most colorectal cancers start as abnormal growths called polyps, which can be present in the colon or rectum for years before invasive cancer develops. According to the Centers for Disease Control and Prevention (CDC), of all cancers that affect both men and women in theUnited States, colorectal cancer is the second leading cause of cancer-related deaths and the third most common cancer in both men and women. But with regular screening tests, as many as 60% of colorectal cancer deaths can be prevented.
How can I tell if I’m at risk for developing this cancer?
Unfortunately, the exact cause of most colorectal cancers is unknown, but about 75% occur in people who have no known risk factors. We do know that the risk of developing the disease is much higher in people 50 and older, and that a person’s lifestyle can also be a contributing factor. Lack of regular physical activity, a low-fiber and high-fat diet with low fruit and vegetable intake, being overweight or obese, smoking or drinking excess quantities of alcohol can all increase an individual’s risk.
There are other risk factors to be aware of, including a history of inflammatory bowel disease (ulcerative colitis, Crohn’s disease), a personal or family history of colorectal cancer or colorectal polyps, and a genetic syndrome known as familial adenomatous polyposis (a rare, inherited condition causing excess polyps to form in the colon and small intestine).
Be sure to see your primary care physician for annual checkups, and during your visit, ask about screening tests – especially if you have any unusual symptoms or you are over age 50. Screening tests are a recommended starting point and can benchmark any irregularities in the future.
What are some of the symptoms I should be aware of?
At first, colorectal polyps and colorectal cancer may not cause any symptoms, which is why getting screened regularly is so important. If there are symptoms, they might include blood in or on your stool, stomach pain or cramps that don’t go away, and losing weight without really trying. We should recognize changes in bowel habits, such as diarrhea, constipation or a feeling that the bowel doesn’t empty completely. Any suspicious bleeding should be reported to your doctor immediately. Be aware of other symptoms such as fatigue, bloating, and vomiting. Be sure to talk with your doctor as soon as possible if you have any of these symptoms.
What are some things I can do to reduce my risk?
Fortunately, having regular screening tests beginning at age 50 can greatly reduce the risk of dying from colorectal cancer. Finding precancerous polyps and having them removed before they turn cancerous saves thousands of lives each year. Increasing your physical activity and keeping weight under control appears to decrease the risk. As a physician, I recommend that my patients follow a diet that’s low in animal fat and high in fruits, vegetables, and whole grain products. In addition, researchers are closely examining the role of certain medications and supplements such as aspirin, calcium, vitamin D and selenium to see if they may help prevent colorectal cancer.
What are some of the screening tests used to detect colorectal cancer?
There are several tests available, which can be used alone or in combination with each other. Colorectal screening is recommended for men and women aged 50 – 75 using high-sensitivity fecal occult blood testing (FOBT), colonoscopy, or virtual colonoscopy.
High-sensitivity FOBT stool test is a simple procedure you can do at home to detect blood in your stool. Your doctor will give you a test kit, which is returned to the doctor or a lab to be checked for anything unusual. This should be done once a year.
A conventional colonoscopy is usually done every ten years, unless you have known risk factors. During this procedure, which is the most thorough, a thin, lighted tube is inserted through the rectum into the colon to look for polyps, abnormal areas, or cancer. Polyps and tissue samples may be removed for biopsy.
Another procedure that can be used is a virtual colonoscopy. The main difference between a virtual and conventional colonoscopy is how your doctor sees inside the colon. In this procedure, images of the large intestine are taken using computerized tomography (CT) or, less often, magnetic resonance imaging (MRI). A computer puts the images together to create an animated, three-dimensional view of the inside of the large intestine. With this procedure, however, your doctor cannot remove polyps or tissue.
How do I prepare for a colonoscopy? What can I expect during the procedure?
You’ve probably heard some horror stories about colonoscopies, but I can assure you, most are greatly exaggerated. Preparing for the exam can be a little uncomfortable, I’ll admit, but once the prep is completed, the rest is usually a breeze.
Your doctor will give you a special diet to follow the day before the exam, which basically limits you to clear liquids, such as broth, tea and carbonated beverages. You will also be instructed to take a laxative, in either pill or liquid form, as the colon must be completely empty.
In a conventional colonoscopy, a mild sedative will be given with an intravenous pain medication to be sure there’s no discomfort. Your physician will insert a colonoscope – a long, lighted tube with a tiny video camera at its tip – that will pump air into your colon to inflate it and provide a better view of the lining of the colon. The camera sends images to an external monitor so your doctor can study the inside of your colon and remove any polyps or other abnormal tissue he might find during the procedure. The colonoscopy itself can take anywhere from 15 to 30 minutes.
How will I know which test is right for me?
According to the CDC, current data doesn’t suggest that there’s a single “best test” for any one person. You should discuss the available options with your doctor to weigh the pros and cons of each test and determine which one you would prefer. The choice will depend on your preferences, your current medical condition, and the likelihood that you’ll follow through and have the testing done.
Will insurance cover colorectal cancer screening?
You should check with your provider to learn what they’ll cover, but most insurance plans will help pay for screening tests for those 50 and older and many will help with the cost for younger people who are at increased risk. People with Medicare who are over age 50 are eligible for colorectal cancer screening.
Gastroenterology testing and procedures are available at the outpatient specialty clinics at MasonicareHealthCenterin Wallingford. Outstanding, board-certified physicians, who specialize in these procedures, have offices in surrounding communities and also see patients in the Center’s clinics. Free, convenient and handicap accessible parking is available for all clinic services. To schedule an appointment, consultation or procedure through our Outpatient Specialty Clinics, call 203-679-5902, or if your doctor suggests you see a specialist, ask for a referral.
If you’ve been putting off the inevitable, now’s the time to make that appointment. With the start of a New Year, make having a colonoscopy a top priority on your “resolution list!”