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Colon and Rectal Cancer: Prior to Diagnosis

Comparison Of Diagnostic Techniques

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

OUTPATIENT PROCEDURES

Screening Method

Advantages

Disadvantages

Colonoscopy

Examines inside the rectum offsite link and entire colon using a long, lighted tube called a colonoscope offsite link.

Every 10 years if normal

  • The most complete screening method available, identifying and removing polyps offsite link in one session.
  • Sedation offsite link is given to patient to minimize discomfort.
  • Screens full colon.
  • Depending on results may only need to be re-screened every 10 years.
  • Typically requires 1 day of clear liquids & laxative offsite link preparation.
  • Will need to set aside a day for procedure and have a ride home in order to leave the medical facility.
Computed Tomographic Colonography (virtual colonoscopy)

Uses x-rays and computers to take 2- or 3-dimensional images of your colon offsite link and rectum offsite link.

Every 5 years

  • Can identify polyps offsite link that are >5mm before they turn into cancer.
  • Identifies lesions offsite link in the entire colon and lower belly.
  • Less risk of complications than colonoscopy.
  • Polyps offsite link cannot be removed during the screening process -- will need to get a colonoscopy offsite link if test is positive.
  • Requires liquid diet and bowel preparation beforehand.
  • Not yet widely available, but now reimbursed in about 30 states.
Flexible sigmoidoscopy

Examines your rectum offsite link and the lower part of the colon offsite link with a lighted tube called a sigmoidoscope offsite link.

Every 5 years

  • Can identify polyps offsite link before they turn into cancer.
  • Moderate cost; covered by most insurance.
  • Many primary care providers can do the test in their office.
  • Can accurately find polyps offsite link in the lower part of the colon offsite link (where most polyps offsite link occur).
  • Requires enema offsite link preparation.
  • Patients may find test uncomfortable or embarrassing.
  • Does not screen the upper section the colon offsite link.
Double-contrast barium enema

Air and barium are pumped into your rectum. The solution will show any polyps offsite link or tumors on x-rays offsite link.

Every 5-10 years

  • Accurate for finding abnormalities, such as narrowed areas or pockets or sacs in the intestinal wall.
  • Polyps offsite link cannot be removed during the screening process -- will need to get a colonoscopy offsite link if test is positive.
  • Patients may find test uncomfortable or embarrassing.
  • Availability is decreasing; usually only for patients who cannot undergo colonoscopy offsite link.
Digital Rectal Examination

Doctor examines inside of rectum offsite link with a gloved finger, to feel for abnormalities

Once a year

  • No advance preparation or dietary restrictions.
  • The procedure does not cause significant pain.
  • Less costly than other methods.
  • Polyps offsite link usually cannot be identified during the exam -- will need to get a colonoscopy offsite link if abnormality is noted.
  • Only checks the first 2-3 inches of the rectum offsite link and is dependent on examiner's technique.
  • You may experience slight, momentary discomfort during the test.
  • Included in standard physical examination.

 

IN HOME TESTING

Screening Method

Advantages

Disadvantages

Fecal occult blood test (FOBT)

Can detect small amounts of blood in the stool offsite link by submitting a portion of several bowel movements to your doctor for testing.

Once a year

  • Inexpensive; covered by most insurance.
  • Can be simple to complete.
  • Can be completed in the comfort of your home.
  • Cannot identify polyps offsite link, can detect signs of cancer.
  • Patients may find test unpleasant.
  • Requires strict adherence to the test protocol for the test to be accurate (restricted diet and multiple days of stool offsite link collection).
  • High false positive rate -- non-cancerous conditions may also cause blood in the stool offsite link and not specific for human blood.
  • May miss tumors that bleed in small amounts or not at all.
Fecal Immunochemical Test offsite link (FIT)

Submit a small amount of a single bowel movement to your doctor's office for testing.

Once a year

  • Inexpensive; covered by most insurance.
  • Can be completed in the comfort of your home.
  • More specific than FOBT offsite link; identifies human blood only.
  • Not as many stool offsite link samples required as FOBT offsite link and fewer restrictions on diet prior to testing.
  • Simple to complete.
  • Cannot identify precancerous polyps offsite link, only indicates if you already have cancer.
  • Patients may find test unpleasant to do.
  • May miss tumors that bleed in small amounts or not at all.
Stool DNA Test offsite link (sDNA)

Checks for changes to the cells in the colon offsite link by looking at DNA cells in the stool offsite link.

Screening interval uncertain -- discuss this with your healthcare professional

  • No advance preparation or dietary restrictions.
  • Can be completed in the comfort of your home.
  • Non-invasive, painless, and simple.
  • Results to date indicate the test is likely to be highly accurate.
  • Cannot identify precancerous polyps offsite link, only indicates if you already have cancer.
  • Not FDA offsite link approved.
  • More expensive than other stool offsite link tests.

 





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