Colon Cancer Screening

Colon cancer does not pop up out of nowhere, rather it goes through an evolution, from a polyp to high grade dysplasia (precancerous changes) to full cancer. From there, cancer can spread to the lymph nodes and finally to other organs. Not all polyps go through this progression but about a third do and removal of the polyps, typically via colonoscopy, prevents the advancement to cancer.

All patients are recommended to have routine screening at 50 years of age. Unfortunately, less than half do so. Both gastroenterologists (GI) doctors and colorectal surgeons perform this procedure.

Some patients may be recommended to have colonoscopy done even earlier than 50, such as those with a strong family history. This can include families with colon, endometrial, ovarian, small bowel or bilary tract cancers. Especially at high risk are those who have three or more family members affected, two successive generations with cancers, a family member with any of these cancers under 50 years of age or a family history of familiar adenomatous polyposis (FAP). These patients will often be recommended to have screening started younger than 50, and should have a conversation with their physician as to the timing.

Colonoscopy is a one and a half day test. The day before the procedure involves a bowel prep to cleanse the colon of stool. This usually starts in the afternoon and involves drinking a mix of laxatives and hydration. The next day is the actual test, which is typically done with sedation for patient comfort and ease of the procedure. Sedation does require patients take the day off work and have a ride home with a responsible adult.

The scope is then moved through the colon under the guidance of the physician to the cecum, which is the end of the colon where the small and large bowel connect. The scope is then slowly withdrawn to evaluate the colon tissue and check for polyps or masses. If found, the polyps are typically removed either with a forceps or a snare to lasso the polyp. These are then sent for biopsy to evaluate for cancer and assess risk for future polyps. This is what dictates timing of repeating your colonoscopy

While colonoscopy is a very safe test, it does carry a small risk of bleeding and perforation of the colon. It also has a 10% missed lesion rate, but it is the gold standard for screening and no other test is as good for both finding and treating pre-cancerous polyps.

People often ask about other options. Historically doctors have used stool tests such as fecal occult blood testing (FOBT) which checks for blood. These tests have a high false negative rate, which means they miss many cancers. Currently there are primarily two other viable options: CT colonography and Fecal Immunohistochemical Test (FIT for screening).

CT colonography involves a prep similar to a colonoscopy. The colon is filled with contrast and a 3-D image is constructed to evaluate the colon. This is typically done without sedation and if any abnormalities are found, a colonoscopy is required for further evaluation and removal. This testing is generally reserved for patients who are poor candidates for sedation (high risk for anesthesia) or patients who have had a failed colonoscopy due to issues like a tortuous colon or severe diverticulosis.

FIT test simply involves sending a stool sample to look for cancerous DNA. It is almost as good as colonoscopy for detecting a cancer, but it is only about half as good for detecting polyps. Removing polyps is the great benefit of colonoscopy, which can avert cancer.

Colon cancer is often preventable . While we understand no one looks forward to a bowel prep and colonoscopy, the consequences of missing this opportunity can be significant. Taking out polyps with a scope is a quick outpatient procedure. Taking out a piece of colon for a cancer is a very different process.

We encourage all our patients to have their routine screening. While we are not gastroenterologists, we do perform routine screening colonoscopies. At Fairfax Colon and Rectal Surgery, we are surgeons, dedicated to not only treating colon cancer in the operating room, we also work towards preventing colon cancer in the first place.

Katherine Khalifeh, MD, FACS, FASCRS
Dr. Khalifeh is a Johns Hopkins trained, board certified Colon and Rectal Surgeon, with specialized training in the treatment of disorders of the colon, rectum and anus, including cancer, inflammatory bowel disease, fecal incontinence, hemorrhoids, pilonidal disease and pelvic floor disorders. Born and raised in Minnesota, she earned her BS from Boston College and her MD from Johns Hopkins University. She remained at Johns Hopkins for her general surgery training and completed her Fellowship in Colon and Rectal Surgery at Washington Center Hospital in 2012. She joined Fairfax Colon and Rectal Surgery in the Fall of 2012 and became a partner in the practice in 2016. She has a unique perspective on patient care and treatment, having first been a critical care nurse for 10 years, before taking on the challenge of graduating from one of the most demanding surgical training programs in the nation. She also comes from a family of physicians, and follows in the foot-steps of both her father and grandfather pursuing a career in surgery. Dr. Khalifeh has been published in professional journals including Current Problems In Surgery, Archives of Surgery, and Journal of Critical Care. She has presented papers at conferences including the American Society of Colon and Rectal Surgeons, the Chesapeake Colorectal Society, and the American Medical Association. She is an active member both of the American Society of Colon & Rectal Surgeons and the American College of Surgeons. Her husband Marwan is a plastic and reconstructive surgeon, and together they spend their leisure time skiing, biking and traveling with their two young daughters and dog Bisou.