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Colon Cancer: Prevention and Prepping for a Colonoscopy

March 23, 2016 9:59 AM with Dr. Laura Bianchi

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Colon cancer is the third most common type of cancer amongst men and women. Fortunately, more and more people are getting screened, allowing their doctors to catch symptoms and treat the disease earlier. If you’re apprehensive about getting a colonoscopy or unsure of how you may be able to prevent cancer, join the discussion with Laura Bianchi, MD, Gastroenterologist at NorthShore. She’ll be providing helpful information and answering questions about screening and ways you can reduce your risk for colon cancer.

Dr. Laura Bianchi (NorthShore) - 9:41 AM:
Welcome! My name is Laura Bianchi and I have been an Attending Gastroenterologist at NorthShore for the last 9 years, primarily based at Evanston Hospital, and now also Skokie Hospital. My areas of interest within the field of gastroenterology include colon cancer prevention and women's health. I look forward to answering your questions about colon cancer risk, prevention, screening, and colonoscopy.

Kathryn (Moderator) - 10:00 AM:
Our chat on colonoscopies and cancer prevention is now open! Feel free to submit questions at any time during the chat.

  Ann (Skokie, Illinois) - 10:00 AM:
My mom died of colon cancer at age 60. I have gone for a conoloscopy since I was 50. Last time going - had polyps. My mom, aunt, uncle all had colon cancer. Just on mom's side. How often should I be going to conoloscopy?
Dr. Laura Bianchi (NorthShore)
Hello, Ann, and thank you for your question. I am so sorry about your mother and the other family members who were affected by colon cancer. Typically when a family has multiple members with a history of colon cancer such as you described, I recommend a discussion with our medical genetics team prior to determining the appropriate interval for your colon cancer screening. The medical genetics team will discuss your family history and possibly recommend genetic testing. When the family history is so strong, I typically wait to decide on the screening interval until after the medical genetics consultation.

  Celeste (Lake Forest) - 10:04 AM:
Is there a low volume effective prep that can be used instead of the suggested prep for colonoscopy?
Dr. Laura Bianchi (NorthShore)
Celeste--This is a very common question and yes there are low volume preparation options that you can discuss with your doctor. Some preparations are 3-4 liters in volume, such as TriLyte and GoLytely. There are lower volume preparations such as Moviprep, SuPrep and Prepopik which can be just as effective in most individuals.

  Bernita - 10:06 AM:
I have Crohn's disease and haven't had a colonoscopy in over ten years. Do I need one since my Crohn's disease hasn't been active?
Dr. Laura Bianchi (NorthShore)
Bernita, Thank you for your question. A history of Crohn's disease may affect your risk of colorectal cancer depending on where in your GI tract the Crohn's disease has been active, as Crohn's can affect the small bowel and/or the large bowel (colon). You should talk with your GI doctor about his or her recommendations for colonoscopy as this is a very important discussion, even if your Crohn's is not active.

  Rhonda (Evanston, IL) - 10:09 AM:
How soon should you have a bowel movement after you eat? Should you have food before you go to bed?
Dr. Laura Bianchi (NorthShore)
Rhonda, It sounds like your question is about general GI health and the timing and frequency of bowel movements varies considerably among people. Some people have bowel movements promptly after eating and others do not. I tell my patients that the range of "normal" would be having a bowel movement three times each day to three times each week. You can see that this is a wide range. As to your second question, eating before bedtime may not be well tolerated in patients who have acid reflux, or GERD.

  Kathy (Chicago,IL) - 10:13 AM:
I have a family member that had a very different prep to do for the colonoscopy. 4 pills, 2 large bottles of gatorade and 2 magnesium citrate..that's it. No nasty liquid prep to drink. Is this something commonly offered?
Dr. Laura Bianchi (NorthShore)
The Gatorade based preparation has not been shown to clean out the colon as well as the other preparations I mentioned, therefore we do not commonly offer this. The goal of the bowel preparation prior to colonoscopy is to clean the colon lining so that small or subtle polyps can be seen and a less effective preparation can significantly compromise our ability to do this.

  Cinti (Niles, IL) - 10:17 AM:
I have bowel movements maybe every 5-6 days. I have discussed a colonoscopy with a doctor and he said it is fairly common (especially for women) to have that type of bowel movement. However, I am still concerned. Do you recommend a colonoscopy.
Dr. Laura Bianchi (NorthShore)
Cinti--The recommendation for colonoscopy would likely depend on your age and your response to conservative measures that can help with constipation such as increasing your water and fiber intake, as well as regular exercise. I think it would be very reasonable to consider a consultation with a gastroenterologist to discuss further evaluation, which may include colonoscopy.

  Jeff - 10:20 AM:
I have a high deductible Blue Cross PPO plan. I am 53 years old and have never had a colonoscopy. Is this procedure covered by insurance without having to meet my deductible first?
Dr. Laura Bianchi (NorthShore)
Insurance plans are very unique and I can't comment on your plan specifically, but I can tell you that many insurance plans will cover a screening colonoscopy as a preventive service. Call your insurance company and tell them you are due for a screening colonoscopy for colon cancer prevention and ask them how this would be covered for you.

  NorthShore Patient (Evanston, IL) - 10:23 AM:
Dr. Bianchi, Is a person at higher risk for colon cancer if she/he has had breast cancer and there is a strong family history for other (non-GI) cancers? Also, does benign thickening of the stomach wall need to be monitored over time if there are no GI symptoms? Thanks.
Dr. Laura Bianchi (NorthShore)
The possibility of a link between breast cancer and colon cancer continues to be investigated. There is evidence that patients who have an genetic mutation called the BRCA mutation, and specifically the BRCA1 mutation, have an increased risk of colon cancer. More recently a study of Swedish patients looking more broadly at all patients with breast cancer (not just those with a genetic mutation) found that they had a significantly increased risk of colon cancer. This needs to be further investigated, but at present a history of breast cancer alone does not change our screening recommendations. To speak to the question regarding other cancers, you should review your family history with your doctor. There are non-GI cancers that can cluster in families and these may be related to an inherited syndrome that raises the risk for other, GI and non-GI, cancers.

  Sharon (Libertyville) - 10:29 AM:
Do all patients with GERD always end up with cancer? I think this is a big scare among all of us who have acid reflux.
Dr. Laura Bianchi (NorthShore)
Sharon, As you know, GERD, or acid reflux, is a very common condition and esophageal cancer is an uncommon cancer. Risk factors for esophageal cancer include obesity, alcohol and tobacco in addition to long standing GERD. The best way to prevent this and other GI cancers is to lead a healthy lifestyle and be sure to talk with your doctor if you have new symptoms. In addition, the risk of colon cancer in patients with and without GERD is much higher than the risk of esophageal cancer in either of these two groups.

  Jeff (Skokie, IL) - 10:34 AM:
If my stool often has a flat side to it, can that be normal or is it possibly a warning sign of a problem?
Dr. Laura Bianchi (NorthShore)
Jeff, Variation in the stool shape, color, and caliber is common. We are typically concerned if patients describe narrow, or "pencil thin" stool that never returns to a more normal caliber. If your stool changes persist, talk with your doctor about your concerns.

  Anonymous - 10:39 AM:
Are you more at risk for colon cancer if you frequently experience constipation and/or hard, strained BMs?
Dr. Laura Bianchi (NorthShore)
There has been quite a bit of research into this question regarding a possible link between constipation and colon cancer risk. Some studies suggest there may be a link and other studies have shown no association. The best advice that I can give patients is to eat a healthy diet, high in fiber, with the goal of regular, soft bowel movements, and get your screening colonoscopy at the intervals recommended by your GI doctor.

  Valerie (Buffalo Grove, IL) - 10:43 AM:
Can colonoscopies find other problems that aren’t cancer?
Dr. Laura Bianchi (NorthShore)
Valerie, In addition to colorectal cancer, colonoscopy detects pre-cancerous colon polyps which can be removed at the time of the colonoscopy. This is why colonoscopy is such a powerful colon cancer prevention test--it is designed to remove polyps before they can progress to cancer. Colonoscopy can also detect common conditions such as diverticulosis and hemorrhoids. And, in some patients we find inflammation in the colon, called colitis.

  Janice (Oak Park, IL) - 10:46 AM:
Is there anything I can do in my diet to help keep my colon healthy?
Dr. Laura Bianchi (NorthShore)
Janice, This is a wonderful question. While the risk of colon polyps and colon cancer increases as we age there are many things we can do to reduce the risk of colon cancer. With regard to diet, we recommend a diet high in fruits and vegetables and whole grains, with limited red and processed meats. I also recommend limiting alcohol intake.

  Anna (Evanston, IL) - 10:49 AM:
Is colon cancer in women different than in men?
Dr. Laura Bianchi (NorthShore)
Anna, This is another excellent question. In fact, colon cancer does behave differently in women than in men. While men and women both have an equal lifetime risk of developing colon cancer (about 5-6%), women are diagnosed at a slightly older age than men are. Another major difference is that women have more "right-sided" colon polyps/cancer than men. This means that the polyps and cancer develop in the first portion of the colon (located on the right side of your body). This area is where polyps can be subtle and this is why an excellent bowel preparation is so important to help with polyp detection and removal. There are other biologic differences, but these are two of the most important differences.

  Sean (Waukegan, IL) - 10:54 AM:
Are patients awake during colonoscopies? Are there ways to make patients with anxiety more comfortable?
Dr. Laura Bianchi (NorthShore)
Sean, We use conscious sedation during colonoscopy. Patients are typically relaxed and may experience some discomfort which can feel like mild or more uncomfortable gas pains related to the air we are putting in your colon. I use soothing music and aromatherapy (lavender) to help with anxiety prior to the procedure, but if you are highly anxious talk with your doctor about using monitored anesthesia care, or MAC. With this type of sedation, you will be less aware during the procedure and experience less discomfort; this can be helpful for very anxious patients.

  Michael (Chicago, IL) - 10:58 AM:
What types of problems can happen if I don't get my colon checked?
Dr. Laura Bianchi (NorthShore)
Michael, Colon cancer is a highly preventable cancer. Unfortunately, 1 in 3 Americans ages 50-75 do not undergo any form of colon cancer screening. Without screening, you are at risk for colon polyps to develop and grow into colon cancer. Colon cancer is typically asymptomatic in its early stages, so when symptoms develop it is usually related to a later stage colon cancer which has a much worse prognosis. After the age of 50, waiting for symptoms to develop prior to going for a colonoscopy is not a good plan.

Kathryn (Moderator) - 11:02 AM:
This will be the end of our chat. Thank you for your questions.

Dr. Laura Bianchi (NorthShore) - 11:06 AM:
Thank you for your thoughtful questions and your interest in colon cancer prevention. March is Colon Cancer Awareness month and as a final reminder we recommend starting screening colonoscopy at the age of 50. If you have a family history of colon polyps or colon cancer, or a personal history of inflammatory bowel disease, talk with your doctor about whether you should start screening sooner. Thanks!

Kathryn (Moderator) - 11:13 AM:
To find out how to schedule a colonoscopy or talk to a GI specialist like Dr. Bianchi, contact the department of Gastroenterology
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