Catherine Merton (Moderator) - 12:56 PM:
Welcome! Today’s chat: Colon Cancer Screening Can Be A Lifesaver will begin shortly. Please start submitting your questions and Dr. Monica Borkar will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the
Kellogg Cancer Center to obtain more information about colorectal cancer. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.
Dr. Monica Borkar (NorthShore) - 1:00 PM:
Good afternoon! I am Dr. Monica Borkar, a board-specialized gastroenterologist practicing primarily out of Glenbrook Hospital and our Vernon Hills facility. Today, I'd like to hear your questions about colorectal cancer screening, as this is an extremely important issue in preventative healthcare. Feel free to ask any questions you may have, and let's get started! Thank you for joining us today.
Dawn (Chicago, IL) - 1:01 PM:
Any early detection signs for polyps other than screening?
Dr. Monica Borkar (NorthShore)
Hi Dawn,
Great question. Some physicians rely on a card that detects whether there is blood in the stool. Unfortunately, there is a high false detection rate with this test, meaning that even if the test is negative for blood, polyps may still be present. Other modalities include CT scan and barium enema. However, the detection rate is still quite low and therefore, colonoscopy is the best test not only for the detection of polyps, but for removal.
Arlene (Chicago,IL) - 1:03 PM:
Do you do a colonoscopy after surgery for a very low tumor, that did not affect the lymph nodes or go through the walls of the colon?
Dr. Monica Borkar (NorthShore)
This is a great question, as well, Arlene.
Yes, the follow up for repeat colonoscopy is usually 6-12 months after the surgery is completed.
Mark (Wilmette, IL) - 1:04 PM:
My father died of colon cancer at 62. I am 38 and have never had a colonoscopy. Two questions: Should I get one? Is there a high risk that my children, ages 6 and 8, might be predisposed to colon cancer?
Dr. Monica Borkar (NorthShore)
Mark,
I am sorry for your loss. It is a very good idea to be pro-active in your health. I would recommend having a colonoscopy at age 40 and if no polyps are found, then every five years afterwards. Your children do not have a higher risk of developing cancer.
David (Northbrook) - 1:06 PM:
While I understand the need to cleanse the colon prior to a screening, I don't understand why I have to drink so much of that prep solution. Please explain.
Dr. Monica Borkar (NorthShore)
David,
This is a very common question and very understandable! We ask that you drink the preparation so that the colon is completely cleansed of all fecal material. This will result in the best test for you, since polyps can sometimes be tricky and hide behind folds in the colon or underneath small amounts of feces. The prep that we give is the safest one as there have been reports of kidney damamge with some of the alternatives. As long as the stool looks like urine (yellow, rather than clear) with no brown particles, this degree of cleansing is adequate for colonoscopy. I hope this helps.
Lisa (Lake Forest, IL) - 1:09 PM:
What causes a polyp to form in the colon and does it automatically turn into cancer if not detected or treated?
Dr. Monica Borkar (NorthShore)
Excellent question, Lisa. We think the major cause of polyp formation is genetics. After that, eating high fiber and the smallest amount of red meat can protect the colon from polyp formation. Polyps tend to grow slowly over time and do not always result in cancer. That being said, however, the chance of cancer formation increases as the polyp increases in size. This is why we remove polyps at the time of colonoscopy.
Jim (Glenview, IL) - 1:12 PM:
I have type 2 diabetes. I keep my blood sugar under control with medicine, diet and exercise. I realize that diabetes puts me at higher risk of developing kidney failure, blindness, etc. Does it also increase my risk of developing colon cancer?
Dr. Monica Borkar (NorthShore)
Another excellent question, Jim. I applaud you for the steps you are taking to keep your diabetes under control! We do not think that there is a correlation between diabetes and colon cancer formation, so I would recommend having your first colonoscopy at age 50.
Susan (Chicago, IL) - 1:14 PM:
I'm curious to know if men are more likely than women to get colon cancer or the opposite. It seems to me that colon cancer is looked at as a "man's disease" much like prostate cancer.
Dr. Monica Borkar (NorthShore)
Hi Susan,
That's a great question and very commonly asked. Colon cancer is not gender-specific, so men and women tend to develop it at equal rates- about one in 18 people in this country will be diagnosed with colon cancer, which is why screening is so important.
Edward (Evanston) - 1:16 PM:
How curable is colon cancer?
Dr. Monica Borkar (NorthShore)
Very good question, Edward. If found early, colon cancer has a survival rate of over 90% over a five-year period of time.
Thomas (Chicago, IL) - 1:17 PM:
Since the colon is long and twisted, is it difficult to detect polyps in certain areas of the colon? How accurate is the screening at detecting cancer?
Dr. Monica Borkar (NorthShore)
Yes, Thomas, it is. The sigmoid colon, which is located on the left side of the abdomen, and is attached to the rectum, can be a difficult area in which to detect polyps, particularly small, flat polyps. This part of the colon tends to be thicker and more tortuous than the remainder of the colon. With a good prep and adequate visualization of the colon, cancer is detected almost 100% of the time.
Karen (Mount Prospect, IL) - 1:22 PM:
What is the difference between a colonoscopy and a flexible sigmoidoscopy? Is one a better screening test than the other? I'd like to know so I can consider some options.
Dr. Monica Borkar (NorthShore)
Sure, Karen, this is an excellent question, and one that comes up very frequently. A colonoscopy looks at the entire colon (approximately 5 feet) whereas the flexible sigmoidoscopy (which was used for screening in the past) looks at only the last 25% of the colon. Therefore, polyps in the other parts of the colon may be missed if only a flexible sigmoidoscopy is done. This is why we began to recommend colonoscopy for screening. It truly is a better test.
Theresa (Skokie, IL) - 1:25 PM:
I have an ileostomy from a bowel resection - can a colonoscopy be done with the ileostomy and what prep would be necessary?
Dr. Monica Borkar (NorthShore)
A very good question, Lisa. Yes, colonoscopy can be done with an ileostomy. The prep is typically the same as for colonoscopy. However, once the output into the ileostomy bag is clear, you do not need to drink any additional prep.
Stephanie (Glenbrook, IL) - 1:27 PM:
I know you’re not really supposed to eat anything the day before a colonoscopy, but are there certain foods you should/shouldn’t be eating leading up to the day you fast?
Dr. Monica Borkar (NorthShore)
Stephanie,
This is another good question. You can drink any clear liquids on the day prior to colonoscopy, although we do recommend avoiding any liquids that are red, orange, or purple. In regards to the days prior to colonoscopy, there are no specific foods that you need to avoid. I also recommend that you remain well-hydrated during the days prior to colonoscopy.
Rachel (Evanston, IL) - 1:30 PM:
Are there certain activities that can increase you risk of developing colon cancer?
Dr. Monica Borkar (NorthShore)
Great question, Rachel. Eating a healthy, low-fat, high-fiber diet is the best thing you can do to prevent the development of polyps and colon cancer. Maintaining a healthy, active lifestyle including cardiac activity 30-40 minutes 4-5 times a week, can help too. You can also prevent colon cancer by not smoking and by avoiding red meat in your diet.
Stephanie (Glenbrook, IL) - 1:33 PM:
Are colonoscopies painful?
Dr. Monica Borkar (NorthShore)
This is probably the most common question we are asked, Stephanie! We primarily use conscious sedation, or "twilight," for colonoscopy. Most people tolerate this extremely well and have little to no discomfort during and after the procedure, which usually takes 20-30 minutes.
Richard (Skokie, IL) - 1:35 PM:
Are all colonoscopists equally effective at finding polyps and cancers during colonoscopy?
Dr. Monica Borkar (NorthShore)
Good question, Richard. Gastroenterologists vary in terms of technique and accuracy in detecting polyps and cancer. That being said, detection rates for both polyps as well as cancers are extremely high. These numbers increase as the withdrawal time, meaning the time it takes for a physician to inspect the walls of the colon, increases.
Jeff (Highland Park, IL) - 1:39 PM:
I heard there’s a risk of making a hole in the colon during the colonoscopy. Is there a way to lower that risk?
Dr. Monica Borkar (NorthShore)
Good question, Jeff. Yes, there is a risk of a perforation, or hole in the colon, and this is approximately 1 in 2000. The risk increases slightly if the physician feels that a maneuver (such as biopsy or polyp removal) is needed or if there is existing disease (such as colitis, or inflammation of the colon) present. The way to lower your risk is to make sure that the colon is adequately cleansed of fecal material. Small perforations usually seal themselves off and are followed with close observation in the hospital. Larger perforations may require surgery and removal of the injured bowel.
Stephanie (Glenbrook, IL) - 1:43 PM:
Are there certain medications that shouldn’t be taken prior to a colonoscopy?
Dr. Monica Borkar (NorthShore)
Another excellent question, Stephanie. For seven days prior to colonoscopy, we ask that you avoid taking supplements that contain iron, as this may discolor the colon, making visualization and detection of polyps more difficult. In addition, anti-inflammatories, such as motrin, ibuprofen, aleve, and naproxen as well as aspirin should be avoided, as these medications increase the risk of bleeding, especially if polyps are found and removed.
Perry (Willmette, IL) - 1:45 PM:
How will I feel after my colonoscopy?
Dr. Monica Borkar (NorthShore)
Good question, Perry. Following the colonoscopy, you may feel a bit groggy from the medications (but will feel little to no abdominal discomfort). This is why we ask that you bring a responsible friend or family member to drive you home.
Tricia (Chicago, IL) - 1:47 PM:
I read recently that women typically develop polyps in different areas of the colon then men. What's the reasoning behind this? Is the biological makeup of a colon different in men and women?
Dr. Monica Borkar (NorthShore)
Hi Tricia,
Excellent question and this alludes to a similar question from earlier in this session. Since women tend to have more surgeries and are more anatomically complex in the abdominal cavity, polyps may be more difficult to detect in the more tortuous, thicker parts of the colon, located in the lower left part of the abdomen. Polyps in men are usually easier to detect in this area, which may account for why more polyps are found here in men than in women, in whom we tend to detect polyps further up in the colon.
Meghan (Wilmette, IL) - 1:53 PM:
Are women who've been diagnosed with breast cancer more likely to develop colon cancer?
Dr. Monica Borkar (NorthShore)
Meghan,
Excellent question and one that we do not fully know the answer to. Some studies suggest a correlation, and some do not. However, if the BRCA gene mutation is found as a cause for a person's development of breast cancer, then more rigid colon screening should be done, as this gene predisposes a person to the development of colon cancer.
Jason (Chicago, IL) - 1:55 PM:
What are the next steps following my first colonoscopy?
Dr. Monica Borkar (NorthShore)
Hi Jason,
Good question. If polyps are found and removed during the colonoscopy, your physician may have you follow up in 3-5 years for surveillance as the presence of polyps predisposes to the formation of new polyps. Biopsies take about one week to come back. If no polyps are found and you do not have a family history of colon cancer, your next colonoscopy should be 7-10 years after your first one.
Catherine Merton (Moderator) - 1:56 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.
Jim (Mt. Prospect, IL) - 1:57 PM:
I know that a colonoscopy is considered the gold standard of care. But what are your thoughts on other types of tests like a virtual scan or simple blood test? Are they viable alternatives to the colonoscopy?
Dr. Monica Borkar (NorthShore)
Very good question, Jim. The problem with other types of tests, such as the virtual colonoscopy, is that the preparation is the same for these procedures as for colonoscopy, and if polyps are found, then colonoscopy still needs to be done for removal. In addition, the detection rate remains less than optimal with these tests. Blood tests can certainly detect anemia, or a low blood count, which is an indication for colonoscopy. However, no specific blood test has been shown to be sensitive enough to detect colon polyps or cancer.
Richard (Skokie, IL) - 2:00 PM:
Can a colonoscopy detect prostate cancer?
Dr. Monica Borkar (NorthShore)
Good question, Richard. Just prior to the colonoscopy, after you have been sedated, the gastroenterologist performs a rectal examination, just like the one your regular doctor does in the office. Sometimes, we are able to feel any irregularity in the prostate, but the colonoscopy itself cannot detect prostate cancer Your primary doctor will obtain blood tests for prostate cancer screening.
Lisa (Glenbrook, IL) - 2:02 PM:
How soon after a colonoscopy can you eat?
Dr. Monica Borkar (NorthShore)
Good question, Lisa! You can eat in the recovery room after colonoscopy as long as your abdomen feels comfortable and you have passed air. Upon discharge from the GI lab, you can eat whatever you want!
Catherine Merton (Moderator) - 2:06 PM:
Thank you again for participating in our chat today. For more information please visit our
Kellogg Cancer Center pages.
Also, a transcript of this chat will be available shortly.
Dr. Monica Borkar (NorthShore) - 2:11 PM:
Thank you all for taking part in this chat. I am very impressed by your questions and the role you are taking in your health. All of your questions were excellent and I am certain that this online transcript will help others in the future. If you have any other questions, please do not hesitate to call my office at (847)-657-1900. Thank you again for your time and for your participation.