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Bulletin: Colon Cancer Update (includes Rectal Cancer) Part II

Do you have questions about whether the proper tests were done for colon or rectal cancer?  This time we outline some of the pros and cons of widely available tests.

1.  Fecal Occult Blood Test. (FOBT)

Possible advantages: No cleansing of the colon is necessary.  Samples can be collected at home. Cost is low compared with other cancer screening tests.

Possible disadvantages:  Fails to detect most polyps and some cancers.  Additional procedures, such as colonoscopy, are needed if FOBT indicates an abnormality.

2.  Sigmoidoscopy

Possible advantages:  Usually quick, with few complications.  For most patients, discomfort is minimal.  In some cases, the doctor may be able to perform a biopsy and remove polyps during the test.  Less extensive cleansing of the colon is necessary for this test than for a colonoscopy.

Possible disadvantages: Polyps in the upper part of the colon will be missed because the test allows the doctor to view only the rectum and the lower part of the colon. Additional procedures, such as colonoscopy, may be needed if the test indicates an abnormality.

3.  Colonoscopy

Possible advantages:  Allows the doctor to view the rectum and the entire colon.  Doctor can perform a biopsy and remove polyps or other abnormal tissue during the test.

Possible disadvantages:  May not detect all small polyps, nonpolypoid lesions, and cancers. Thorough cleansing of the colon is necessary before this test.  Some form of sedation is used in most cases.

4.  Virtual Colonoscopy

Possible advantages:  Allows the doctor to view the rectum and the entire colon.  No risk of bleeding or tearing/perforation of the lining of the colon.

Possible disadvantages:  May not detect all small polyps, nonpolypoid lesions, and cancers.  Thorough cleansing of the colon is necessary before the test.  If a polyp or nonpolypoid lesion above a threshold size is detected, standard colonoscopy, usually immediately after the virtual procedure, will be recommended to remove the polyp or lesion or perform a biopsy.

5.  Double-Contrast Barium Enema (DCBE)

Possible advantages:  Can allow the doctor to view the rectum and the entire colon.  Complications are rare. No sedation is needed.

Possible disadvantages: May not detect some small polyps and cancers.  Thorough cleansing of the colon is necessary before the test. Doctor cannot perform a biopsy or remove polyps during the test.  Additional procedures are necessary if the test indicates an abnormality.