Introduction
March is National Colorectal Cancer Awareness Month, and the best way to celebrate is to have a screening examination in order to reduce your risk of developing
colon cancer.
Here are the stats:
- Roughly one in 18 Americans will develop colorectal cancer during their lifetime.
- There are about 150,000 new cases of colorectal cancer and almost 50,000 deaths from colorectal cancer in the U.S. each year.
- Inflammatory bowel disease (IBD) increases your colorectal cancer risk by about two to five times the average risk.
But here is the good news:
If detected early, colorectal cancer is one of the most treatable cancers, and survival rates in people with IBD are the same as survival rates in the
general population. What's even better is that screening can actually help prevent colorectal cancer.
When it comes to colorectal cancer screening,
colonoscopy is the most comprehensive and reliable diagnostic tool. Colonoscopy allows your doctor to examine
the lining of your colon by threading a colonoscope (a thin, flexible tube with a tiny video chip and light on the end)
through the length of your colon. As the colonoscope is withdrawn, your doctor can examine the wall of your colon for
polyps and other abnormalities, as well as remove or "biopsy" any abnormality that is found.
A successful colonoscopy depends on two key things:
- how well you prepare for the procedure, and
- how thoroughly your endoscopist examines the bowel wall during the procedure.
This newsletter will walk you through steps you can take to help ensure that your colonoscopy is as accurate as possible.
Back to Top
Preparation Quality
- The importance of a clean colon
For an accurate colonoscopy, you must use a bowel cleansing product to completely empty your colon before the procedure. Thorough bowel cleansing makes
it possible for your doctor to identify all colon polyps, as well as any other abnormality within your colon. It is important that the entire length
of your colon is clean, so no sections are missed during your exam. A clean colon will decrease the chance of undiagnosed polyps and a need to return for a second
exam. Click here to read "Prep Tips from a Pro" and learn how a gastroenterology nurse prepared for her first colonoscopy.
- How do I know if my colon is completely cleaned out?
You can be confident that the bowel is adequately cleaned out if your rectal output is clear and contains no solid residue.
- Following your doctor's instructions
When it comes to bowel preparation, it is critical to follow your doctor's instructions carefully and to complete the regimen exactly as prescribed. Pay
close attention to the diet you are told to follow and any medication you are told to avoid prior to your procedure. Finally, because bowel preparation
involves significant fluid loss, it is important to keep hydrated. Be sure to contact your doctor if you vomit or are unable to drink the amount
of liquid prescribed.
New American College of Gastroenterology guidelines recommend "split dosing" or "PM/AM dosing." This simply means taking half of your bowel preparation
regimen on the day before your colonoscopy and half on the day of your colonoscopy (i.e., within six hours of the procedure). For instance, if your
colonoscopy is scheduled on Tuesday at 10:00 a.m., you would consume the first half of your bowel preparation regimen on Monday evening and start
the second half on Tuesday at 4:00 a.m. Although there are a number of different bowel preparation products available, OsmoPrep® and
MoviPrep® are the only two with FDA approval for split dosing1.
Split dosing may sound like a challenge, but research clearly indicates that it actually makes bowel preparation more tolerable. What's more, ten independent
studies indicate that split dosing improves bowel preparation quality, especially on the right side of the colon. The right side of colon, or proximal colon, has
traditionally been the most difficult to examine. It is also the area where abnormalities are most easily overlooked, since right–sided
polyps tend to be flat and therefore easily obscured by small amounts of fluid or debris. When asked about bowel preparation in a recent
study, more than 80% of patients said that they were willing to follow a split–dose regimen that involved getting up during the night, once
they understood that doing so would help their doctor perform a more accurate examination.
Back to Top
Procedure Quality
A number of studies have shown that, in addition to bowel preparation quality, the ability to detect abnormal growths in the colon is also related to a
variety of factors involving the colonoscopy procedure itself. These include the ability to reach the end of the colon, the time spent withdrawing
the colonoscope, and the polyp detection rate. You can improve your odds of having a high quality colonoscopy by asking your doctor the following questions
before scheduling your procedure. These questions are also summarized in an
easy–to–use worksheet.
Your physician should be board certified in gastroenterology or colorectal surgery. Studies have shown that when internists and family practice physicians
perform colonoscopies, they are less likely to detect cancer and precancerous growths.
- How many colonoscopies do you do in a day?
Your physician should allow at least 30 minutes for each colonoscopy. Physicians performing more than 12–15 procedures a day may feel rushed and
cut corners in order to stay on schedule.
- How often are you able to insert the colonoscope the full length of the colon?
Your physician should reach the end of the colon (the cecum) during 90% or more of all procedures.
- How long does it typically take you to withdraw the colonoscope?
Your physician should spend at least seven or eight minutes during withdrawal of the colonoscope to maximize the opportunity to inspect the bowel lining
to detect cancer and precancerous growths. This is especially true when it comes to detecting flat polyps, which are often hidden in the colon wall
and easily missed by withdrawing the colonoscope too quickly. In a recent study, doctors who took the most time during colonoscopy found more polyps
than did doctors who took the least time.
- How often do you identify and remove precancerous polyps during elective colonoscopy?
About 25% of men and 15–20% of women will have precancerous polyps during their first screening exam, so your doctor's detection rate should be at
least that high.
Back to Top
Conclusion
Scheduling a colonoscopy probably isn't on your list of favorite things to do, but it can save your life. So if you're due (or overdue) for routine screening,
take care of it this month. By using the tips presented in this newsletter, you can take steps toward getting the maximum benefit from the
procedure. Remember that, although no diagnostic test is perfect, colonoscopy is considered to be the best method for detecting colorectal cancer while it can
still be successfully treated.
Back to Top
They say nurses are the worse patients. As a nurse who has worked in GI Endoscopy for over 26 years I know the importance of a colonoscopy for colon cancer
screening. There is nothing more devastating than seeing a patient diagnosed with colon cancer that did not have a screening colonoscopy as recommended.
I have assisted with thousands of colonoscopies over the years, and hear the patients rejoice when it is over. But they all seem to say
the same thing, "This was a piece of cake, the prep was the worst part!"
As I turned 50 almost 2 years ago, so many things went through my mind. It is a time to reflect on what I have accomplished in my life, and what lies ahead.
As I was blowing out the black candles on my ‘over–the–hill' birthday cake, the reality hit me that it was now my turn to have a colonoscopy.
I used every excuse in the book to postpone it, and taking the time out of my busy schedule for the procedure was next to impossible. I lectured my co–worker
Teresa on her birthday for not having a colonoscopy, and admitted that I was just as guilty. That day we scheduled our colonoscopies together. My own health was not
reason enough to be screened– it wasn't until I felt I needed to do it to motivate someone else. How typical for a nurse!
Knowing the variety of different preps available, I suggested that we take a ‘pill' prep1. I liked the idea of drinking different juices and beverages
of my choosing, instead of a huge jug of liquid prep solution. I also knew that we needed to drink additional liquids prior to, during, and after the prep to keep
from getting dehydrated. I went to the grocery store and bought about six different kinds of drinks, everything from apple juice, lemonade,
pear– flavored water, and Gatorade. At work the day before our procedure, we shared broth, jello, and juices galore. We left work early
to go home and start the colon prep. We were well prepared. We had hemorrhoid wipes, air freshener, and Teresa even had a TV tray set up with her laptop in the bathroom.
We started communicating through our BlackBerry devices, and started our preps at exactly the same time. It was a unique
experience having a ‘prep–pal'. We both experienced the same things at the same time, and we took every opportunity to make it a humorous experience.
There were comments back and forth for the next five hours, until Teresa finally wrote, "I'm going to bed now, I'm pooped!"
The prep experience was much better than I expected. I think it helped being prepared and stocking up on a wide variety of liquids. I was never hungry
and the prep started to work gradually so I never had any cramping. After a couple hours we both experienced chills from all the cold fluids. I just bundled up and
got in bed to watch TV. I came up with a new invention, a Prep–Snuggy, they are open in the back aren't they?
As my patients have told me, the rest was a breeze. I was well sedated during the procedure and woke to find that I had three polyps removed, polyps that
someday could have grown into cancer. A colonoscopy not only detects cancer, it prevents it. Why would anyone put this off?
Because I work with outpatient endoscopy centers, I have incorporated my colonoscopy experience at work. I am even more passionate about colon cancer screening
and Teresa and I both signed up for the local Undy 5000, a national event where walkers wear their underwear to raise awareness for colon cancer
screening. I am fortunate to use this experience to educate and encourage others to get screened. Maybe I'm not such a bad patient after all.
References
Back to Top
Important Safety Information about OSMOPREP
There have been rare, but serious reports of acute phosphate nephropathy in patients who received oral sodium phosphate products for colon cleansing prior
to colonoscopy. Some cases have resulted in permanent impairment of renal function and some patients required long–term dialysis. While some
cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with
increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using
medicines that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers
[ARBs], and possibly nonsteroidal anti–inflammatory drugs [NSAIDs]).
It is important to use the dose and dosing regimen as recommended (PM/AM split dose).
OSMOPREP® (sodium phosphate monobasic monohydrate, USP, and sodium phosphate dibasic anhydrous, USP) Tablets are indicated for cleansing
of the colon as a preparation for colonoscopy in adults 18 years of age or older. Considerable caution should be advised before OSMOPREP is used in
patients with severe renal insufficiency, congestive heart failure, ascites, unstable angina, gastric retention, ileus, severe chronic constipation,
bowel perforation, toxic megacolon, gastric bypass or stapling surgery, or hypomotility syndrome. Use with caution in patients with impaired renal
function, patients with a history of seizures or at higher risk of seizure, patients with higher risk of cardiac arrhythmias, known or suspected electrolyte
disturbances (such as dehydration), or people taking drugs that affect electrolyte levels. Patients with electrolyte abnormalities such as
hypernatremia, hyperphosphatemia, hypokalemia, or hypocalcemia should have their electrolytes corrected before treatment with OSMOPREP.
OSMOPREP is contraindicated in patients with a known allergy or hypersensitivity to sodium phosphate salts or any of its ingredients, and in patients with
biopsy–proven acute phosphate nephropathy. In clinical trials, the most commonly reported adverse reactions (reporting frequency >3%) were
abdominal bloating, nausea, abdominal pain, and vomiting. It is recommended that patients receiving OSMOPREP be advised to adequately hydrate before,
during, and after the use of OsmoPrep.
For complete Prescribing Information for OSMOPREP including BOXED WARNING, please click here.