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There are genetic relationships in regards to colon cancer and colon polyps. If a family member, especially a first degree relative, which means a brother, a sibling or parents have a history of colon cancer, or if they have a history of multiple polyps, your screening schedule gets altered according to the age at which they were diagnosed. You would have to do a colonoscopy 10 years before the diagnosis of your first degree relative.
So the preparation for the colonoscopy is the most important part of the procedure. You want to be as clean as possible when the physician goes in with the camera and takes a look because you want to be able to see every small little polyp or lesion behind the corner of the folds of the colon. The preparation includes being on a liquid diet the day before, which means that you could have Jello, juice, broth, water, tea, coffee, any of these things the entire day before the procedure. And then every physician has their own medication that they like to use for a colonoscopy, and that’s usually given the night before the procedure. And that involves drinking a type of liquid that ends up flushing your system out and cleaning everything in order to make sure that everything is nice and safe for the procedure.
If a piece of tissue or a polyp is removed during your colonoscopy and after it’s been analyzed and if it comes back and you’re told that it is cancer, there are different treatments possible depending on the subsequent screening that’s done on the patient, which means a CT scan is done, the pathology of the polyp is reviewed, and a lot of times an oncologist is incorporated into your team in order to help you and guide you in terms of what your treatment will be. Sometimes if it’s a polyp that can be removed, what is true and an endoscope, you may need a subsequent colonoscopy to remove the remaining portions of that polyp, if any was left. If it is a polyp that cannot be removed endoscopically, then the patient may require a surgical resection, which means a surgeon would go in and remove that portion of the colon that has the lesion, and some patients do require chemotherapy and radiation either before surgery or after surgery.
So a colonoscopy is a procedure where we take a camera. The camera is about the width of my finger. We go in through the rectum and we go through the entire colon and into the last portion of the small intestine. And there’s many different reasons why we do a colonoscopy. If someone has symptoms, which means if they have any bleeding, diarrhea, change in bowel habits, weight loss, we do a colonoscopy in order to evaluate the reason and the etiology behind those symptoms and we’ll be able to treat them or put them on medications or take biopsies. But one other very important thing about a colonoscopy is screening colonoscopies, which people do in order to find any polyps or lesions that can then become cancerous in the future. And we’re able to remove them during that procedure in order to reduce the risk of cancer progression.
A colonoscopy is a very simple procedure. You come into a surgery center or in a hospital setting the day of your procedure, a nurse takes your vitals and puts an IV line for you. Then if an anesthesiologist is involved or if the physician is giving the anesthesia themselves, they speak to you, they talk to you about the risks and benefits of the procedure, and then you go into the examination room. At that point, medication is given to you that allows you to go to sleep and be comfortable. And then the camera, which is the width of my finger, goes through the rectum, takes a look at the entire colon, and if there’s anything that needs to be removed or biopsied it’s done at that time. During the procedure. A colonoscopy on average can take anywhere from 20 minutes to 40 minutes. It could be sooner if everything looks fine and the prep is excellent, it could be a little bit longer if your prep is not good and the doctor has to clean things and wash things in order to be able to see properly, or if any manipulation is done such as removal of polyps or biopsies. You’re relatively asleep during the procedure and you shouldn’t feel anything. The procedure should not hurt. Some patients feel a little bit bloated and gassy after the procedure, but they’re able to pass gas and they feel better almost immediately.
During a colonoscopy, if a polyp is found or if there’s any abnormalities a biopsy is conducted. A biopsy is a procedure in which a forcep is used to remove a significantly small amount of tissue so that we can look at it under a microscope and see exactly what’s going on. It is not painful, you do not feel it, and it is a microscopic biopsy, usually.
There are definitely risks involved with a colonoscopy. It is a procedure. During the procedure you are given sedation, so there’s slight risks with sedation, especially if you have any allergies to the medications or if you have any other medical problems that can make sedation dangerous. But overall, when you look at the risk of the procedure compared to the benefits of the procedures, the benefits definitely outweigh the risks. Some of the common risks of colon cancer screening and a colonoscopy include an infection or bleeding, especially if any polyps are removed or any instrumentation is done. There is a very low risk, less than one in 100,000 of a perforation, which means that the colonoscopy, a scope goes through the wall of the colon, and in that case, surgery may be needed, but the risk is significantly low.
The recovery process for a colonoscopy is almost immediate. Once you’re done with the procedure and once the sedation wears off, which takes anywhere from 20 minutes to an hour, you’re able to go and do your regular activities of daily living. The only thing that we tell patients after a colonoscopy is that they can’t drive a vehicle or operate any heavy machinery because of the effects of any sedation that has been given. And usually that wears off at the most 24 hours.
You shouldn’t have any significant pain after a colonoscopy. Sometimes because of the air that is used to insufflate and dilate the colon during the procedure, patients could have some mild cramping. If procedures are conducted during the colonoscopy, such as a polypectomy or a biopsy, then you may have some very minimal bleeding after the procedure. If you are on any blood thinners and any instrumentation is done, your risk of bleeding is slightly higher. But if you do have any significant bleeding, more than a few drops after a colonoscopy, you should definitely contact your doctor.
The results of the colonoscopy can be given to as quickly as immediately after the procedure, if everything looks perfect and no polyps were removed. On the other hand, if polyps were removed, or if anything was biopsied, it could take one to two weeks to get back the biopsy results in order for the doctor to make an analysis.
Insurance does cover colonoscopies, especially screening colonoscopies because of the fact that it is such an effective screening tool and it really reduces the risk of cancer in patients. Insurance covers almost all patients above the age of 54, their screening procedures. Now we do do colonoscopies for non-screening procedures with what we call diagnostic procedures and insurance does cover most of those as well. But you should definitely speak to your insurance company and find out exactly what your plan covers before speaking to your physician.
So I’ve always wanted to be a doctor. Since I was young. There was only one doctor in our family, and it was my uncle. And I always looked up to him. After going to Undergrad, I subsequently went to med school at UCLA. And after being there, I did my residency at Cedars-Sinai Medical Center. While at Cedars-Sinai Medical Center, I realized that I really enjoyed gastroenterology because it encompassed both surgical procedures as well as dealing with internal medicine and treating patients as a whole. So I did a fellowship at UCLA once again in gastroenterology, and then I went into a private practice with my partner. And we are also academic appointees at Cedar-Sinai Medical Center in the department of hepatology as well.
So we’re a a gastroenterology group with three gastroenterologists. It’s me myself, Dr. Shay and Dr. Afghani. We encompass pretty much all fields of gastroenterology and internal medicine. We specialize in liver disease and hepatology, colorectal cancer screening, inflammatory bowel disease, and pancreatic disorders. We are also endoscopists and we do colonoscopies on our patients and we do those at our surgery center that’s attached to our office. And we’ll be able to do pretty much all endoscopic procedures for any specific field in gastroenterology.
So a gastroenterologist is a physician that deals with pretty much all of the organs from the mouth to the anus. So we deal with the Esophagus, the stomach, the liver, the pancreas, the gallbladder, the small intestine, the large intestine and the rectum. So anything that has to do with that, including, you know, diseases with diarrhea, constipation, internal bleeding, any type of internal malignancies, which involve the GI tract, that’s pretty much what we deal with on an everyday basis.
A polyp is a abnormal growth within the colon. It is a reason to why we do colonoscopies in order to remove these polyps so that they don’t grow and become cancerous in the future. Approximately, I would say 60 to 70% of people that have a colonoscopy will end up having some amount of polyps in their colon and those are all removed. The type of polyps,, the growth and size of the polyp and the amount of polyps that a patient can have vary. That’s dependent on diet, that’s dependent on genetics. And every patient is different and they’re usually asymptomatic, which means patients usually don’t have symptoms when they have polyps and that’s why we have to do the screening procedures.
There are definitely different types of polyps that we are able to see during a colonoscopy. There’s completely benign polyps, which are tubular Adenomas and hyperplastic polyps. These are slower growing polyps and they take about five to 10 years to then change and become cancerous if they do change. There are other types of polyps such as tubulovillous, Adenomas, which are slight, usually larger, and those are usually more progressive, which means that they can change and become cancerous in a faster period of time. And that’s why, depending on the type of polyp you have, it depends. That changes your, what we call surveillance or the time that you get your next colonoscopy. Tubulovillous Adenomas, for example, you would have to have a colonoscopy within three years of a diagnosis of that. And that’s why every polyp that we take out, we sent to a pathologist to review under a microscope because they’re able to tell us exactly the morphology and the pathology of that polyp.
The cause of polyps is not 100% known. We know that there’s definitely a genetic component to it because people that have a family history of polyps or a family history of colon cancer have a much higher risk of forming polyps. Many studies have been done to see if there’s a dietary component to polyps. We know that red meat and patients that have a sedentary lifestyle with a lot of constipation, they have a higher risk of forming polyps and subsequently forming colon cancer. On the other hand, patients that have regular bowel movements that are on a high fiber diet, they have a slightly decreased risk of forming polyps. So it’s a component of environmental and a component of genetic that then leads to the formation of the polyps.
So we can see pretty much anything in the internal colon and small bowel during a colonoscopy. So we’re able to see the tissue. We’re able to see if there’s any abnormalities. We’re able to see if there’s any inflammation. We’re able to look for hemorrhoids or any fissures, which are cuts within the anus. We’re able to see if there’s any masses or any malignancy or cancer in the colon. We’re able to see if there’s any narrowings or strictures or anything that could be abnormal during the procedure.
There are many symptoms involved with colon cancer, but unfortunately, once you get the symptoms and maybe that the cancer has progressed. That’s why screening procedures are so important, but some of the symptoms that you should worry about are if you have bleeding, if you have any type of obstruction, which means you feel like you’re more constipated and unable to pass your stool, weight loss, sometimes nausea. Any of these symptoms can be signs of colon cancer.
So a colonoscopy is required in any one above the age of 50 in order to reduce the risk of colon cancer. Colon cancer screening is actually the only screening that prevents cancer. Other screenings catch cancer early, but we don’t want to catch cancer. We actually want to prevent it altogether. So if you do your screening procedures at the right time, your risk of subsequently getting colon cancer go down to almost zero. Colonoscopies are a life-saving tool. They are the only screening tool that we can do to prevent cancer. We are able to remove polyps before they ever grow and become cancerous and caused major complications in patients. It is something that you should tell your parents to do if they’re above the age of 50 or you should do yourself if you’re above the age of 50. Speak to your physician, get a consultation with a gastroenterologist. It is an extremely safe procedure. It is a painless procedure and you won’t regret it after you do it.
If you’re an average patient that has no family history of colon cancer, has never had a significant history of polyps, you should start having your colonoscopies at the age of 50. If someone does not know their family history, for example, if they had been adopted or if they’ve been separated from their family for a prolonged period of time, then they would fall into the regular screening pattern for colonoscopies, which is starting at the age of 50. And once you have your colonoscopy, if you don’t have any polyps at that time, then you would get your next colonoscopy 10 years later. Now, if you have a significant family history of colon cancer, if you have a first degree relative such as a parent, an aunt, a brother, a sister, or any sibling, you would need to get your colonoscopy 10 years before the time that your sibling, the age at which your siblings were diagnosed. So it varies from patient to patient, but on an average basis, everyone should at at the latest get their first colonoscopy at the age of 50.
Studies have shown that if you start at the age of 50, you’ll be able to catch a majority of precancerous polyps before they become cancerous. If you wait until a later age, you may miss a significant portion of patients that may have polyps that may have already grown to a cancerous state at that point. So the studies that had been done up until now have shown that if you start at the the age of 50 it’s not that you’re going to get 100% of the patients that have a risk of getting polyps or colon cancer, but you will get a significant amount of them that will then prevent them from getting cancer.
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