Dr. Orfanidis
Colonoscopies save lives. Still, too many people do not undergo this important procedure to screen for colon and rectal cancers at the recommended age. We asked Jefferson gastroenterologist Nicholas T. Orfanidis, MD, to answer some common questions that patients raise about colonoscopy.
Q: Why is it important to undergo a colonoscopy?
Dr. Orfanidis: Colon cancer is the third leading cause of cancer death in the U.S. for both men and women, according to American Cancer Society data. This disease led to nearly 50,000 deaths in 2013. Colonoscopy is a screening test for colorectal cancer that has been shown to be effective in decreasing the rate of death attributable to colon cancer by removing precancerous polyps (adenomas) at the time of the procedure. Moreover, having a colonoscopy at the appropriate times based on your age and family history (see below) can catch colorectal cancers earlier when treatments can be more effective.
Q: I’ve heard that preparation for the colonoscopy is difficult and unpleasant. Why is it necessary to prep for a colonoscopy and, if so, are there approaches that are easier to undergo than what I’ve heard about?
Dr. Orfanidis: This is often a worry and complaint that patients have when scheduling their colonoscopy. The preparation is often the most important part of the procedure. The goal of colonoscopy is to remove precancerous polyps, which are typically less than a centimeter in size. As you can imagine, it is easier to find these small polyps when the colon is adequately cleaned out. If the colon isn’t adequately cleaned, we can’t be sure that we aren’t missing small polyps that could potentially turn into cancer.
There are several different preps available, and the most important thing is for you to discuss your concerns with regards to the prep with your doctor so that the best prep can be chosen for your procedure. Most recent studies suggest a split-dose prep regimen (meaning the patient takes the prep in two separate doses, often with the second dose the morning of the procedure), which often makes it a little easier for the patient to take and leads to the detection of more polyps.
Additionally, there are some single-day prep strategies that have been developed and are available at Jefferson. It is important to follow the prep instructions, including dietary changes, as best as you can, as this will decrease the need to undergo a repeat procedure at a shorter time interval.
Q: I have an arrhythmia and my cardiologist has me taking a blood thinner. Should I stop taking this or other medications before a colonoscopy?
Dr. Orfanidis: Blood thinners such as warfarin (Coumadin), clopidrogel (Plavix), Effient, Brilinta, Pradaxa and Xaralto should not be taken prior to most colonoscopies. It is important to get permission from your cardiologist, or whoever prescribes these medications, prior to stopping any of these medications before any procedure.
The exact length of time that the medication needs to be stopped before the colonoscopy varies depending on the medication and should be discussed with your cardiologist and gastroenterologist. For most colonoscopies it is OK to continue aspirin. Diabetic medications often need to be adjusted or held the day/night prior to your colonoscopy, and you should discuss this with your gastroenterologist when you schedule your examination.
Q: If polyps are found during the procedure, does that mean I have colon cancer?
Dr. Orfanidis: No. Polyps are precancerous lesions that over time could turn into cancer if they were not removed at the time of the colonoscopy. All polyps that are removed during your colonoscopy are sent to a pathologist for closer examination under the microscope to see if they have any features that make them more worrisome. You should be notified of these results within about two weeks.
Polyps are quite common so don’t fear if you have one. Studies have shown that if we don’t find polyps in about 25 percent of people undergoing routine colonoscopies, we are not doing a good job looking. If you do have polyps, it does mean that you will need to undergo a repeat colonoscopy in a shorter time period than if you didn’t have any polyps.
Q: When should I start having colonoscopies and how often do I need to do so?
Dr. Orfanidis: The current recommendations call for screening to begin at the age of 50 if you have no family history of colorectal cancer. If you have a first-degree relative (parent, sibling, child) with colorectal cancer screening, you should begin at age 40 or 10 years before the youngest relative was diagnosed with colorectal cancer.
For example, if your father was diagnosed with colon cancer at the age of 45 you should undergo your first colonoscopy at the age of 35.
If your colonoscopy is completely normal and you have no family history of colorectal cancer, your next colonoscopy should be in 10 years. If polyps are found during your colonoscopy, the timing of your next colonoscopy will depend on the number, size and microscopic features of your polyps but will typically range from three to five years.
It is important to note that even if you aren’t supposed to have your next colonoscopy for 10 years, you should call you doctor if during that time you develop new symptoms such as bleeding, constipation, change in your bowel habits or if someone in your family is diagnosed with colon cancer, as you may need to undergo the repeat exam at an earlier date than originally planned.
For more information about colonoscopy, or to make an appointment with a Jefferson physician, call 1-800-JEFF-NOW (1-800-533-3669) or use our online appointment request form.
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