About the only thing less appealing to a man than a test for colon cancer is a positive result.
After lung cancer, colon cancer kills more American men than any other form — about 28,000 last year, according to the National Cancer Institute. Probably a third of those deaths could have been prevented if the victim had earlier undergone a diagnostic process known as colonoscopy. But the process, as my physician puts it, can be “hell on wheels.”
Six feet of flexible tubing the diameter of an index finger is inserted into the colon. Equipped with a light and an “eye” in a right-angled, maneuverable head, the colonoscope is attached to a monitor and enables the doctor — and the patient, too, if he so desires — to examine the rosy wall of the gut. The doctor can locate and snip off with a wire attachment any polyp he encounters on the colon wall, and a biopsy will later determine if the polyp is malignant.
For some men the worst part of a colonoscopy is the preparation. The day before, the patient must drink a gallon of liquid during the course of four hours to induce diarrhea and completely empty the bowels. On the big day he is sedated, and following the procedure someone must drive him home to recuperate. Even if the examination turns up no benign or bleeding polyps, there is a small chance that the colonoscope will itself damage the intestine and cause infection.
There are other problems as well. A colonoscopy costs between $800 and $1,000, and many insurance companies won’t pay for any part of it. And if you’re over 50, you definitely need either a colonoscopy or something similar every five years.
Now imagine an alternative scenario: the virtual colonoscopy. The patient waltzes into the doctor’s office, strips and lies down on the console of a computerized tomographic (CT) scanner. He suffers a minute of discomfort as air is pumped into his empty colon, and then his entire abdomen is recorded using magnetic resonance imaging. The process takes less than 20 minutes, and he can drive himself home.
Using the same techniques the entertainment industry employs to create virtual reality, clinicians can reproduce the inside of a patient’s colon in three dimensions and turn it this way and that to locate any problems. If polyps are detected that need removing, then the more invasive procedure can be done with specific objectives.
If this sounds too good to be true, in some ways it is. For one thing, the virtual colonoscopy is new and not available to men who aren’t participants in ongoing studies. And most of the experimental work is being done in Switzerland, not the United States. And it is very expensive, but that could all change in the future.
Meanwhile, men still have to deal with the threat of colon cancer, and there are alternatives to the colonoscopy. Men undergoing annual physical examinations participate in the simple fecal occult test for detecting blood in the bowels, and every five years this should be augmented by what is called the flexible sigmoidoscopy.
This procedure is similar to the colonoscopy in that it employs a slender and more flexible tube with a light and a video camera attached to a monitor, but only the rectum and lower third of the intestine are examined. These are the areas where most polyps — and most cancers — occur. Sigmoidoscopy costs about $200 and, in conjunction with the fecal occult blood test, has proven to be effective in detecting and preventing colon cancer.
A third technique — in addition to colonoscopy and fecal occult test/sigmoidoscopy — is the double-contrast barium enema. In this procedure the colon is first filled with a benign chemical solution and then X-rays are bounced off it to determine the condition of the colon wall.
Doctors don’t necessarily agree on which of the above procedures is best, but they do agree that regular screening is necessary and that not enough men are taking advantage of this technology. Less than half of adult American males have been checked for colon cancer. The percentages are improving, however, as physicians increasingly urge patients to regularly undergo one of the detection procedures.
The risk factors in colon cancer do include the usual suspects in problems of health: smoking, lack of exercise and heavy consumption of red meat and alcohol. (Women also die of colon cancer but later in life.) A high-fiber diet has lately been questioned as effective prevention against colon cancer, but in that arena, too, there is still much debate.
The bottom line is that any man over the age of 50, regardless of how he leads his life, needs to get a “scopy” every five years or so.
The information contained in or made available through This Site cannot replace or substitute for the services of trained professionals in the medical field. We do not recommend any treatment, drug, food or supplement. You should regularly consult a doctor in all matters relating to physical or mental health, particularly concerning any symptoms that may require diagnosis or medical attention.