9 Questions You’re Too Shy To Ask: Colon Health

There’s no easy way to say it: If you are age 45 or older and haven’t talked to your doctor about colon screening, you are already behind. 

We get it. Colonoscopies get a bad rap and people are uncomfortable talking about their bowels and bathroom habits. But when it comes to your health, ignorance isn’t bliss. Colorectal cancer is the third most common cancer diagnosed in both men and women. And according to the American Cancer Society, those born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer of those born before 1950. When patients delay or avoid their colonoscopy, Ellen Davis, MD, at UVM Health Network – Porter Medical Center says, “If you think a colonoscopy is a pain in the butt… how about colon cancer?”

She has a really good point. Colorectal cancer is treatable when caught early. “That’s why screening is so important,” says Sarah Gillett, PhD, MD, a hematologist and oncologist at the University of Vermont Medical Center, Assistant Professor at UVM’s Larner College of Medicine and member of the UVM Cancer Center. In fact, the American Cancer Society updated its age recommendation in 2018 to start regular colorectal screenings at age 45. 

Curious about colonoscopies? Drs. Gillett and Davis take your top questions. 

Why do I need to get my colon checked? I feel fine.

Someone in the early stages of colorectal cancer might have no symptoms at all. And by the time they do start to feel the effects, the cancer could be advanced and much harder to treat. “A colonoscopy is the single best tool for detecting and even removing any potential problems early on, before they become a threat,” says Dr. Davis.

Both Drs. Davis and Gillett point out that a screening starting at age 45 can head off any issues that could be life threatening if left undetected. When it comes to screenings, you have options. Some can even be done at home, like a stool test that look for blood or other signs of a potential problem. A colonoscopy procedure, performed at a medical facility, only needs to be performed once every 10 years and is much more thorough.

What is a colonoscopy?

A colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine, also known as your colon and rectum. The doctor uses a thin, flexible tube called a colonoscope with a tiny camera and moves it slowly through the rectum and into your colon. Carbon dioxide gas is used - the same that you'd find in soda, which helps bloating afterwards - to inflate your colon so the doctor can see the lining of the colon on a monitor. During the test, the doctor will be looking for polyps, ulcers, tumors, inflammation or bleeding. They can remove any concerning tissue right then and there and review under a microscope to see if it is cancerous. The colonoscopy takes about 30 to 45 minutes. If it is normal, you only need to have this procedure done once every 10 years. 

Does a colonoscopy hurt? 

Most colonoscopies don’t hurt, but some people do experience burning or cramping or a feeling of bloating afterwards. During the test you may feel sleepy or relaxed, due to the sedation and pain medicines.

I’m afraid of being put to sleep, can I do it without sedation? 

Colonoscopies don’t require general anesthetic, what most people think of as being ‘put to sleep.’ For most patients, colonoscopies only require light sedation, which doesn’t put you to sleep but instead allows you to relax or even nod off briefly which helps the procedure go smoothly. In some cases, a deeper level of sedation may be required depending on a patient’s medical history.

What are the signs of colorectal cancer?

Dr. Gillett says that most early-stage colorectal cancers often present no symptoms at all, which is why screenings with colonoscopies, or at least yearly stool-based tests, are so important. If you notice blood in your stool, experience fairly sudden weight loss, fatigue or gradual changes in your bowel movements, you should contact your provider as soon as possible.  

I have a history of colon cancer in my family, am I at increased risk?

Colon cancer genetic testing is a blood test that can tell you whether you carry the rare mutated genes that can cause colon cancer. Although most people who get colon cancer do not have one of these mutated genes, having them greatly increases your chance of getting colon cancer. If possible, Dr. Gillett says testing a family member who has colon cancer is the best way to determine risk among their family or relatives. If that’s not possible, ask your doctor for a referral to a genetic counselor who can help determine whether your family history puts you at high risk for cancer, and if screening for inherited cancer risks such as Lynch Syndrome is warranted. 

Are certain people (age, race, ethnicity, etc.) more at risk?

Yes. The older you are, the greater the risk. Men are slightly more at risk compared to women. African Americans, people with obesity or people with Ulcerative Colitis, Crohn’s Disease or other gastrointestinal diseases are all at higher risk. 

How can I keep my colon healthy?

There are several things you can do, says Dr. Davis. For starters, if you smoke, then quit. This will reduce your risk of heart attack, stroke and other types of cancers. A diet high in vegetables and low in red meat will also improve your colon health. Exercise, staying active and managing a healthy weight are also great ways to improve your colon health and have huge benefits to your overall health. 

If I have colorectal cancer, then what? Is it treatable?

Yes. Especially if it is detected early. Dr. Gillett says that 90% of the time many early-stage cancers can be cured with surgery alone. There are more options available for more advanced cases, even immunotherapies.

The University of Vermont Health Network also has another powerful tool to combat cancer. Knowledge. “We have five gastrointestinal oncologists here – that’s a lot,” says Randall Holcombe, MD, Director of the UVM Cancer Center at the Larner College of Medicine and Division Chief of Hemotology and Oncology at the UVM Medical Center.

Because the UVM Medical Center is an academic medical center, Dr. Holcombe says UVM Health Network patients can access sub-specialty cancer treatment care that just doesn’t exist in other communities our size. There are clinical trials for patients with metastatic cancer, including colon, that offer genetic testing of cancer tissue so that oncologists can employ targeted therapies that can and do offer better outcomes in many cases.

“Patients shouldn’t have to travel to New Hampshire or Boston for the best care, they should be able to get it close to home,” Dr. Holcombe says. 

Despite all these resources to fight cancer, Dr. Holcombe also promotes what he and Drs. Davis and Gillett all know is the best treatment of all: prevention.

“The best way to treat cancer is to not let it happen in the first place,” he says.  

If you are at least 45 years old, talk to your provider about a colon screening or colonoscopy.