5 Risk Factors for Missed Colon Cancer or Polyps During Your Colonoscopy

The first and possibly the most important is an adequate bowel preparation

The ability to see pre-cancer polyps and colon tumors is dependent on you having colon clear of residual stool. This is dependent on you completing the bowel preparation as prescribed as well as drinking lots of supplemental fluid during the prep. All preps require you to fast from solids for a full day before your exam and only drink clear fluids. If you have had a prior poor prep or have tendency to be constipated, take medications or have conditions that slow the movement of your bowels then you may be asked to stop eating solids two days before your exam.

You will be asked to take one of several bowel preparations as directed by your provider. It has been proven that split dosing (dividing the preparation medications into two separate timed doses, typically the evening before very early on the day of the exam) achieves the highest success rate in adequate clearing of the colon. It cannot be over emphasized that no matter what prep you use; all of them are work the best when you drink lots of clear liquids.

Despite being given very detailed bowel preparation instructions some individuals fail to follow these instructions especially drinking plenty of fluids. Some just fail to drink adequate fluids during the prep or fail to avoid eating the day before or start too late to have adequate time to clear out all the stool and fluid. The patients in whom inadequate bowel prep is noted must be rescheduled for a repeat exam. You don’t want to go through the bowel preparation half-heartedly only to have to have to be canceled or have an incomplete or inadequate colonoscopy that requires a repeat exam.

Non-gastroenterologist preforming exam increases risk of missed lesion

Multiple studies have confirmed that the risk of missed polyps and colon cancers is much higher when a physician other than a gastroenterologist performs the colonoscopy exam. The risk of missed polyps has been reported as high as 50% when colonoscopy is performed by a non-gastroenterologist. If possible you should insist that either a gastroenterologist performs your colonoscopy or a colorectal surgeon who routinely performs many exams a year. Most gastroenterologists perform over a 1000 colonoscopies a year.

Incomplete exam during your first colonoscopy risks missed lesions

Failure to reach the end of the colon is known risk for missed colon polyps and colon cancer. Inexperienced endoscopists and non-gastroenterologists may fail to reach the cecum but not be aware. Photo documentation of the anatomical landmarks of the cecum are increasingly used by endoscopists to document the extent of the exam was complete. If it is not clear from your report that exam was complete you should as

Women and older age

Several studies have shown that the female gender and older age are independent risk factors for missed polyps and interval colon cancers. If you are a woman or an older individual you should be aware of these risks and not be dissuaded from insisting that you had adequate bowel prep, complete and careful withdrawal examination. Some women have more difficult examinations technically than men and older patients may also have significant diverticular disease making the examination more difficult so an experienced endoscopist is important. Also older patients commonly have multiple other medical problems that may influence the endoscopist to try to complete the exam quickly to avoid intra-procedure complications including sedation issues.

Inexperienced endoscopists or those with poor technique or too rapid exam

More experienced endoscopists miss less lesions than trainees and less experienced endoscopists even when time of withdrawal is equal. The accepted standard for withdrawal time is now six minutes or more. Almost all exams report withdrawal time and many endoscopists have known withdrawal time averages correlated with their polyp detection rate. Subpar withdrawal times and polyp detection rates would be an indicator that an endoscopist’s technique is below that generally accepted within peers. Poor endoscopy technique is related to training of the endoscopist as well as number of procedures performed in the past. As the number of procedures increase the skill of the endoscopist almost always improves

What Is a Colonoscopy and Why Do I Need It?

Screening for colorectal cancer is important for your health. There’s a recommendation that people over 50, particularly those with colon disease in their family history get screened however some people just don’t bother whilst others seem to test way too often. It is important to know when and why to test.

Colorectal cancer is becoming an increasingly greater threat of death from cancer but if caught early the survival rate increases about 90% so screening is very important as a diagnostic tool.

Colonoscopies are invasive procedures even though the risks are small. There can be bleeding, bowel perforations or other complications especially if you are older however the advantage is that during a colonoscopy the doctor can take a biopsy (a piece of tissue to look at in the lab), remove precancerous polyps if they are there before they grow and spread.

A Colonoscopy is therefore a procedure that diagnoses problems in the colon which is the large bowel or large intestine. A tube is used about the thickness of a finger and this tube is flexible. Through this tube the doctor can examine the lining of the bowel much better than from an x-ray.

Polyps are small growths on the lining of the bowel. They don’t need to be cancerous. Removal of them is called a polypectomy and is done by putting a wire through the instrument and severing the polyp at the base with a small, painless electric current. If these are removed early enough they don’t become cancerous so this procedure is a way of protecting against colon cancer. Usually after a couple of days patients can begin to follow a normal routine.

Some doctors recommend that it is wise to repeat colonoscopies every five years in patients with previous exposure to cancer whilst others feel the test is needed more frequently. Knowing when to test becomes a difficult decision which needs to be made by a specialist.

The tests need to be performed if a patient has problems such as stomach pain or blood in the stools or if there is a history of colorectal cancer in the family or if the person has personally experienced pre-cancerous growths. If patients are younger, then this invasive procedure can be performed more easily and more frequently and it is a matter of safety that they are carried out if a direct relative has had cancer.

Apart from this elderly people are often best not put through the strain of having a colonoscopy. In the USA tests are performed up to the age of 85 only because after that age there is a risk that older people will be at greater risk from the complications that can occur from the screens themselves. What is astounding though is that the average age for colon cancer diagnosis is usually somewhere around the age of 70.

However the matter of how often to test and when is dependent on the doctor and how he chooses to practice. Often a colonoscopy is done because the doctor concerned has difficulty in performing visual examinations of the colon or worries he may overlook polyps so it becomes a decision of safety for the patient. Patients need to ensure that the procedure is necessary and is not simply being performed as a standard practice by the doctor concerned.

If you are having problems with your digestion and have unexplained weight loss, feel that your bowel does not empty completely, have diarrhoea or constipation and/or blood in your stool then you need to consult your doctor and follow his instructions as to what tests you need. Whilst we can sit here and debate whether these tests are a necessity or not, even if you do follow a policy of herbs and natural therapies, it is imperative that you know for sure what is happening with your health and the doctors screenings for bowel problems with the kit and colonoscopies can often assist you in making decisions which will deter future illness.