Checkup

Scoping Out a Killer

Jim Driscoll came to Mayo Clinic in the summer of 2004 to see if doctors could help him with a swallowing problem. As it turned out, the valuable results he went home with were also hard to swallow — but they saved his life.The swallowing problem he came in with was diagnosed by a Mayo gastroenterologist as a common and treatable condition. But in the process of his exam, the doctor found out he had never had a screening colonoscopy. Driscoll, a successful South Florida businessman, had been treated in the past for prostate and lung cancer — both caught early and cured — and had regular checkups. At the age of 74, however, he had simply never had the screening test for colon cancer, which is recommended for all people over 50. His doctor urged him to get one.

"I was healthy in that respect, so I didn't know I should have a colonoscopy," says Driscoll. "But I do whatever my doctors tell me I should, so I had one."

The procedure itself was "absolutely nothing to go though," Driscoll says. The worst part was the preparation the night before, but going through it turned out to be a lifesaving experience.

"My doctor told me they found something quite large in there," says Driscoll. "What they found was on the way to becoming cancer, so it was good that they got it when they did. It could have been a big problem for me. It's something I never even felt, but it could have put me down."

What they found and removed was a 1.2-inch polyp with "high grade dysplasia" — a mass on the verge of turning into cancer. Mayo gastroenterologists were able to completely remove the polyp during the colonoscopy and avoid surgery.

Driscoll's experience illustrates an important fact — screening tests help locate polyps that can be removed before they become cancerous. They also help detect colorectal cancer early before it spreads. When diagnosed early, 90 percent of colorectal cancers are completely curable.

"Colorectal cancer is the second leading cancer killer in the country," says Dr. Mark Stark, a Mayo Clinic gastroenterologist. "If everyone 50 or older had regular screening tests, most colon cancers would be prevented, and deaths from this cancer could be avoided."

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Colorectal cancer generally starts from polyps that can develop anywhere along the wall of the large intestine. These growths form on the lining of the colon or rectum and produce few, if any, symptoms. Most are benign but over time, some can develop into cancer. People who have a family history of polyps or colon cancer or a history of polyps themselves are most at risk. People who suffer from inflammatory bowel disease or Crohn's disease also have a higher risk of developing colon cancer.

The colonoscopy is the gold standard screening test, because it provides the best view of the colon and allows the doctor to remove polyps during the procedure.

Other tests include the fecal occult blood test, which checks stool samples for blood; the flexible sigmoidoscopy, which is similar to a colonoscopy but is limited to checking the rectum and lower third of the colon; and the double contrast barium enema, which uses X-rays and special dye to look for abnormalities in the colon. Medicare and many insurance plans cover these screening tests. Virtual colonoscopy, otherwise known as CT colonography, is a new type of CT scan that can detect masses in the colon. But if a mass is found, a colonoscopy is done to investigate. The test is still being studied, but Stark says it shows promise for future use.

Side effects associated with a colonoscopy shouldn't deter patients, Stark says. Mild intestinal discomfort such as bloating and cramping can follow the procedure, but it goes away within several hours. In less than one per 1,000 cases, bleeding or damage to the wall of the bowel occurs after a polyp is removed. The mild discomfort Driscoll experienced is nothing compared to what he would have faced had he not had the procedure at all. In fact, he already has the next colonoscopy penciled in on his calendar.

"It's a colonoscopy every three years for me now," says Driscoll.

Info:
Division of Gastroenterology
(904) 953-0816

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