A diagnosis of colon or rectal cancer is generally a multi-step process that begins with a visit to your primary care physician or internist who is responsible for your overall health care. He or she will take a medical history and perform a physical examination. If there is any concern that colon or rectal caner may be present, you willl generally be referred to a medical doctor known as a gastroenterologist (a doctor who specializes in the diagnosis and treatment of disorders of the gastrointestinal tract. the gastrointestinal tract includes the colon and rectum.) 

Concern about colorectal cancer generally starts one of two ways:

• Through a test known as a colonoscopy or a virtual colonoscopy which is recommended for adults age 50 or over and for younger people who may have a gene which makes them more likely to get colorectal cancer than the average person. For a list of the diagnostic techniques currently in use to detect colorectal cancer, click here For a comparison of the diagnositic techniques, click here.
• Occasionally through symptoms which are described in another section of this document. 

A colonscopy looks for polyps and other changes in the colon. Colon and rectal polyps are important because some may turn into colorectal cancer over time. It is important to recognize that while not every polyp turns to cancer, experts believe that colorectal cancer typically begins as a small non-cancerous polyp. Fortunately, during a colonoscopy, these polyps can be identified and removed or destroyed which prevents the development of colorectal cancer. If a polyp is large enough, tissue can be retrieved and sent for biopsy to determine the exact type of polyp.

A colonoscopy is performed by doctors known as gastroenterologists (a doctor who specializes in the diagnosis and treatment of disorders of the gastrointestinal tract which includes the colon and rectum).

Unlike most tests, you will know immediately after a colonoscopy if there is the possibility of cancer in your colon or rectum. If there are no polyps or other unusual condition, there is no cancer. If there is a polyp or unusual condition, there will not be a definitive answer until the sample is vetted in a lab by a doctor known as a pathologist. Those test results will be given to your doctor to share with you.

Other diagnostic tools used with respect to colorectal cancer are described in the section: Diagnostic Techniques: Colorectal Cancer. As you consider different tests, it helps to have at least a beginner's understanding of the colon.

As you go through testing to find out whether you do indeed have colorectal cancer, keep in mind the following:

• The vast majority of test results do not turn out to be colorectal cancer.
• Colorectal cancer is one of the most treatable of all cancers. 
• Thanks to continuing medical advances, there is less and less likelihood that treatment will include an ostomy (an opening in the body for the discharge of body wastes).
• Whether due to research or people sharing their stories with you, it is easy to focus on "bad news" colorectal cancer stories. Keep in mind:
  • Medical information and techniques are constantly being added to.
  • We are all unique individuals and each medical situation is different. 
• With respect to financing diagnostic tests:
  • If you have health insurance:
    • Diagnostic techniques are generally covered by health insurance.
    • Now is a good time to learn how to maximize use of your health insurance, and to think about how to pay your share of the costs. Since the techniques for dealing with financial issues ranging from a short term financial difficulty to teetering on bankruptcy are basically the same, we call the subject "dealing with a financial crunch."
    • For information about maximizing health insurance and financial issues, see the documents in "To Learn More."
  • If you do not have health insurance:
    • When a diagnostic test is recommended:
      • Request a list from your doctor of qualified, experienced doctors who perform the desired test in an area you live in or that you can get to. (Many hospitals have an unbiased referral line you can call. The lines are offered as a service to the community.)
      • Contact each and ask about price. Keep in mind that you can negotiate price. (To learn how to negotiate a medical bill, click here.)
    • Think about how to pay for the costs. Since the techniques for dealing with financial issues ranging from a short term financial difficulty to teetering on bankruptcy are basically the same, we call the subject "dealing with a financial crunch."
    • Keep in mind that going forward, despite your health condition, you can still get health insurance.
    • For information about these subjects, see the documents in "To Learn More."
• It is advisable to take a trusted family member or friend with you to all important doctor visits for moral support, help asking questions, and to recap what was said once you get home. If the doctor permits, record the conversation. Recorders are inexpensive. You may even be able to record on your mobile phone. 
• Waiting for a test result is likely to be an emotionally difficult time.
  • The period of time from having symptoms which are serious enough to suggest a visit to a doctor until you undergo a diagnostic test is likely to provoke a variety of emotions, including fear, anxiety and possibly depression. Don't let the emotions keep you from taking the test. The earlier a disease is diagnosed the more likely it can be treated and even cured. There are techniques to help you through the emotional rollercoaster. For more information about dealing with emotions that may arise, click here.
  • After the test, there is a period of time before you get the results. During this period the emotions which are likely to surface include fear, anger or anxiety. As you will see in the documents in "To Learn More", the key is to try to manage them -- not control them. For tips about coping with waiting for tests and test results, click here.
• Screening for colorectal cancer is routine for people age 50 or over. If you are having symptoms and are concerned about telling friends and family, think about what you want to tell them and how you want to say it. It may too early to tell some people, particularly people at work, but the decision is yours. For information about telling people, see the documents in "To Learn More."
• While there are no definitive studies on the subject, common sense indicates that it is advisable to start eating a cancer risk reducing diet such as the one recommended by the American Cancer Society , to exercise and get appropriate rest and sleep. If you smoke, quit. Changing to "light" cigarettes doesn't help. Light cigarettes are just as harmful as regular ones.

For more information, see:

• Signs and Symptoms of Colorectal Cancer
• Diagnostic Techniques Used To Detect Colorectal Cancer
• Comparison of Diagnostic Techniques 

The following are the most common signs and symptoms of colorectal cancer. If you have any of these symptoms, talk to your doctor without delay about getting screened. The sooner colorectal cancer is found, the more likely it can be totally eliminated.

• Bleeding from the rectum.
• Blood in your stool. The blood can appear as red (from bright red to brick red) or it can turn the stool black and tarry.
• A change in your bowel habits that lasts for more than a few days. For example:
  • Constipation 
  • Diarrhea 
  • A combination of both constipation and diarrhea
  • A narrowing of your stool (called pencil stools).
• Continuous abdominal cramping.
• An abdominal pain that continues for more than a few days.
• Feeling that your bowels are full after having a bowel movement (also referred to as incomplete evacuation).
• Weakness or fatigue.

Diagnosis of colorectal cancer is a multistep process.

A diagnosis usually starts with a visit to your primary care doctor who is responsible for your overall health care or an internist. Your primary care doctor will:

• Take a medical history.
• Perform a physical examination.
• Make recommendations for procedures including lab tests that may be warranted by your symptoms.

If there is any concern that colorectal cancer could be present or you are 50 years of age or older and have not had a diagnostic procedure known as a colonoscopy, you will generally be referred to a medical specialist known as a gastroenterologist.

A gastroenterologist will generally:

• Review your medical history.
  • A medical history is a listing of your current and past symptoms, as well as your personal and family medical history.
  • Your family history of colorectal cancer is very important if you are under the age of 50 and having any symptoms. (Survivorship A to Z provides a Symptoms Diary to help you keep track).
• Give you a physical exam: During a physical exam, your doctor is likely to check for general signs of health. He or she is also likely to give you a digital rectal exam (DRE).

The gastroenterologist may use one or more of the following techniques to determine if you have colorectal cancer. Which test(s) will be used depends on your individual situation. 

• Colonoscopy (Colonoscopy is considered the "Gold Standard" of colorectal cancer diagnostic tests. A colonoscopy can detect lesions that could become cancer or are cancerous. It can also remove them during the same procedure.)
• Fecal or stool tests. There are 3 fecal or stool tests in use today:
  • Fecal occult blood test (FOBT)
  • Fecal immunochemical test (FIT)
  • Stool DNA test (sDNA)
• Sigmoidoscopy

If one of the above tests indicates that cancer is present, one of more of the following tests can show whether the cancer has spread to other parts of the body:

• A biopsy
• Blood tests
• Chest X-Ray
• CT scan
• Double Contrast Barium Enema (DCBE)
• Endoscopic ultrasound (EUS)
• Liver function tests which indicates the overall health of the liver for receiving treatment and if the cancer has spread to the liver how compromised the liver may be.
• MRI scan
• PET Scan

If type II colon cancer is present, an Oncotype DX test may be recommended.

The following description of diagnostic techniques, advantages and disadvantages was prepared by the Colon Cancer Alliance:

OUTPATIENT PROCEDURES

IN HOME TESTING