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Colorectal Cancer FAQs for Primary Care Physicians
For primary care physicians, being vigilant and proactive with recommended colorectal cancer screenings and maintaining a high index of suspicion is critical, even in younger patients. Rarely are there symptoms in the early stages of colorectal cancer, which is why colonoscopy is so critical.
What Strategies Would Be Most Helpful to Initiate a Conversation With My Patient About Getting a Colorectal Cancer Screening?
Encouraging patients to get a colorectal cancer screening isn’t always easy as they may be reluctant or embarrassed. Try to put them at ease, and ask about their family history so that you know at what age they should be screened. Family history should be updated periodically as siblings may get diagnosed during the course of a primary care doctor-patient relationship. It’s also important to ask if the patient has had rectal bleeding, a change in bowel habits, unanticipated weight loss, or is a smoker. If there are concerns, a referral may be warranted to evaluate the need for colonoscopy or other testing.
What Are the Most Common Questions My Patients May Have About Getting a Colonoscopy Screening?
- When should I get a colorectal cancer screening? A colonoscopy is the most reliable and accurate test for colorectal cancer screening. The American Cancer Society currently recommends a colonoscopy at age 50 for low-risk patients and every 10 years thereafter if no polyps are detected. Patients under age 50 with other risk factors such as a strong family history should have a colonoscopy screening 10 years prior to the diagnosis of a first-degree relative and every five years thereafter.
- Is a colonoscopy covered by insurance? Generally, yes, it is covered by most health plans, typically every 10 years for Medicare and low-risk patients and every two years for high-risk patients. Patients may have some financial responsibility if polyps are removed during the colonoscopy. Check with your health plan for complete coverage details.
- What is the risk of perforation? The risk is about one in 5,000 cases and is vanishingly rare in healthy people undergoing screening. Available data suggests that serious colonoscopy-related complications (e.g., deaths or adverse events requiring hospitalization) occur in about one out of every 400 colonoscopies in the overall population, and in about one out of every 75-150 colonoscopies in elderly patients.*
*Essence Healthcare, Clinical Informatics, February 2012
- Will it be painful? Most people don't even remember the colonoscopy procedure, and the vast majority of patients feel very little. Rarely, there may be some bloating or gas pain.
- Do I have to drink the prep solution? It is critical for patients to drink the bowel prep solution so that polyps can be seen during the colonoscopy. The solution does not taste great and it does cause diarrhea, but it is a necessary part of the screening. Some solutions are expensive and aren’t covered by insurance, so a good option to purchase is a generic Polyethylene Glycol (PEG) electrolytes solution, which costs about $10. Video: Swedish Colorectal Surgeon Rod Kratz, MD, shares his experience preparing for his first colonoscopy.
- Can I just take a taxi home after a colonoscopy? No. For medical and legal reasons, a patient must leave with a responsible adult. If necessary, arrangements can be made for a short-stay, non-sedated colonoscopy if a patient doesn’t have an adult to provide transportation home.
- Who performs the colonoscopy? A colonoscopy is performed by a physician who is formally trained in endoscopy and is board certified in either gastroenterology or colorectal surgery. Ideally, this should be someone who follows best practices, participates in quality metrics and has a polyp detection rate of more than 25 percent. At Swedish, colonoscopies are performed thousands of times a year by experienced colorectal surgeons and gastroenterologists—making Swedish's colorectal cancer screening program the largest in the Northwest.
- Can I just get a "virtual colonoscopy"? A virtual colonoscopy has several disadvantages: it is not paid for by most insurance companies, it exposes patients to radiation, and it still requires the bowel prep. And, if something questionable is discovered, the patient has to do the prep all over again for a standard optical colonoscopy to take biopsies or remove polyps.
- What can I eat to reduce my risk of colon cancer? Diets high in animal fat and low in fiber are associated with higher rates of colon cancer. However, colon cancer can occur even among vegans. The best way to avoid colon cancer is to get a screening colonoscopy at the recommended intervals.
- View more commonly asked questions from the American Cancer Society.
What Educational Resources Can I Provide for My Patients?
Swedish has a great one-stop resource for colorectal cancer patients with a wealth of information. Learn more.
What Are the Most Common Risk Factors?
The primary risk factors are family history and age. Diet, lifestyle and smoking can also play a role. Most patients with colorectal cancer are diagnosed after age 50, although over the last five years, colorectal surgeons at Swedish have seen a higher percentage of colon cancer patients under age 50. Younger patients can get colorectal cancer due to family history or genetic syndromes such as Familial Adenomatous Polyposis, a rare condition, or Hereditary Nonpolyposis Colorectal Cancer, the most common form of genetic colorectal cancer. Women with a personal history of breast or female genital cancer are also at higher risk.
What Circumstances Indicate That Someone Younger Than the Recommended Age of 50 Should Get a Colonoscopy Screening?
If a patient has new, unexplained symptoms such as rectal bleeding, unintentional weight loss or a major change in bowel habits, a colonoscopy screening may be advised, especially if the patient has a family history of colon cancer. Regardless of age, any patient with these symptoms and/or strong family history should be referred to a colorectal surgeon for consultation.
Here are the American Cancer Society colorectal cancer screening recommendations for average, moderate and high risk patients:
Average Risk Patient
Patients at average risk do not have the risk factors listed in the moderate or high risk groups. The risk of developing cancer in this group is about one in 20 if no screening is done. An average risk patient should have a colonoscopy starting at age 50. If no polyps are found, a colonoscopy only needs to be done about once every 10 years. A colonoscopy is performed under sedation and requires clearing the bowels with a laxative medication. It has the advantage of viewing the complete lining of the colon, allowing polyps or other lesions to be removed or biopsied for an accurate diagnosis.
Moderate Risk Patient
Patients are at moderate risk for colorectal cancer if they have one or more of the following:
- a personal history of polyps or colorectal cancer
- a family history (sister, brother, parents, or children) of colorectal cancer or polyps
- for women, a personal history of breast, ovarian, or endometrial cancer
- a personal history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
The risk of developing cancer in this group is about one in six if no screening is done. Patients in the moderate risk group should have colonoscopy beginning at age 40 and every three to five years thereafter.
High Risk Patient
Patients at high risk for colorectal cancer include those who have either:
- a family history of Familial Adenomatous Polyposis (a genetic disorder causing cancer to develop at an early age in 100 percent of those affected, if no treatment is given)
- a family history of Hereditary Nonpolyposis Colorectal Cancer (a genetic disorder causing colorectal cancer at an early age in 50 percent of those affected)
Patients in the high risk group for colorectal cancer should have a colonoscopy starting at age 21, or as soon as an individual finds he or she is in this high-risk group. This exam should be repeated every two years until age 40 and then every year thereafter. Genetic testing is available, but is not sufficiently accurate by itself to be useful as a screening test at this time.
If My Patient Has Colorectal Cancer, How Can I Monitor His or Her Care During Cancer Treatment? What Sort of Follow-Up Care Is Important?
After a patient is diagnosed, treatment is typically handled efficiently by a team of specialists at a cancer center such as the Swedish Cancer Institute. However, you may want to check in with your patient during their treatment and offer your encouragement and support. As a Swedish primary care physician, you can monitor your patient’s cancer treatment by looking at his or her EPIC electronic medical record. (Physicians not on the EPIC system can also sign-up for viewing access) It’s helpful for you to be familiar with your patient’s treatment, in the event he or she comes in for an appointment for a non-cancer related issue. Also, it’s critical to make sure your patient is screened at the appropriate intervals, since the screening frequency changes after a colorectal cancer diagnosis.
If a Positive Diagnosis Indicates That My Patient Needs Surgery, Should He or She See a Surgeon Specialist or a General Surgeon?
This is up to the patient and the referring physician. While most general surgeons can do an early, segmental colectomy, a colorectal surgeon or oncologic surgeon may have more experience and success with rectal cancers, deeply invasive cancers, localized metastatic disease to the liver, etc. Further, many early cancers can be removed using minimally invasive techniques such as laporoscopic or robotic colon surgery with similar outcomes. Before deciding on surgery for large benign polyps, consideration should be given to an attempt at endoscopic resection by an experienced endoscopist who has training, interest and expertise in these techniques. Many "surgical" polyps can in fact be removed safely without surgery.
Should I Encourage My Patient to Get a Second Opinion for Colorectal Cancer Treatment?
It’s important for patients to feel confident that they’ve explored all their treatment options, thoroughly understand their condition and have found the right fit with a cancer treatment team. Patients should not feel bad or feel as if they're hurting the physician’s feelings when asking for another opinion. A second opinion is a good idea if a patient has an unusual cancer that could be better treated by a larger group with more experience specific to that particular type of cancer. Sometimes a second opinion is even requested by the treating physician, especially for a significantly life-changing treatment such as a colostomy.
At Swedish, we believe that if a patient has a clear cancer diagnosis that calls for a very standardized treatment plan (which is often the case for colorectal cancer) and the patient is comfortable with the treatment team, there’s typically no need for a second opinion.
What Are the Advantages of Sending My Patients to the Swedish Cancer Institute?
At Swedish, colorectal cancer is never treated by just one physician; it involves an entire team of board-certified surgeons and specialists collaborating on the best possible care for the patient. This collective experience is far greater than the knowledge and experience of any one or two providers and is leveraged against the cancer in favor of the patient. Swedish Cancer Institute patients benefit from this integrated, multi-disciplinary system that gives them every advantage in cancer treatment, including:
- the latest cancer services, state-of-the-art imaging, technology and equipment under one roof.
- board-certified colorectal surgeons who specialize exclusively in colon and rectal cancer.
- more colorectal surgeries performed at the Swedish Cancer Institute than any other cancer center in the region.
- experienced, dedicated physicians in an extensive range of specialties, including gastroenterology, general and colorectal surgery, oncology, radiation oncology and hepatology.
- specialists closely collaborating with the same electronic medical record; using evidence-based medicine and best medical practices including regular tumor boards and personalized follow-up.
- facilitation of care that can be done close to home, reserving patient travel for advanced procedures and periodic follow-up.
Are Patients Provided With Options for Care That Can Be Integrated With Cancer Treatment, Such as Massage Therapy or Meditation?
Swedish offers many complementary therapies that can be part of a patient’s cancer treatment plan, including meditation, massage, art and music therapy, nutrition, and naturopathic care. Learn more about integrated care options at the Swedish Cancer Institute.
What if My Patient Is Having Surgery at Swedish but Lives Far Away? Are There Affordable Accommodations for Family Members?
Family members will find the Inn at Cherry Hill a reasonably priced option for staying near our First Hill Campus. Learn more about the Inn at Cherry Hill and other neighborhood accommodations.