FAQ
Contents
- Why do we recommend colon cancer screening?
- Types of Screening
- Who is at "high risk" for colon cancer?
- What to do before your colonoscopy?
- How long is the colonoscopy visit and what time should I arrive?
- What can I expect during my colonoscopy?
- Will I be asleep during the procedure?
- Is this covered by my insurance and do I need a referral or authorization?
- Billing
- Dave Barry’s colonoscopy
Why do we recommend colon cancer screening? In the United States, 5% of the population will get colon cancer, mostly after the age of 60. Colon cancer is rare before the age of 40, uncommon under age 50, and then increases with age. Nearly 60,000 Americans die from colon cancer yearly. It is a slow growing cancer. If it is found late, after it has grown through the wall of the bowel, it is usually not curable. But if it is found early, surgery can remove it completely. We now believe that colon cancer can be prevented by finding the small benign tumors (polyps) that might grow and develop into cancer, and removing them by colonoscopy. Polyps are solid lumps or growths that can develop in the colon as people get older. About 25% of people in the U.S. grow polyps, usually after age 40 or 50. The tendency to grow polyps seems to run in families. It takes several years for polyps to grow from tiny bumps to growths an inch or more in size. Eventually such polyps can turn into cancer. Probably most polyps never do turn into cancer, but almost all colon cancers start in polyps. So far there is no way to tell which polyps might turn into cancer, so we have to remove them all to prevent cancer. Since colon cancer is both common and preventable, screening for it makes good sense. Screening usually begins at age 50; this is to try to find noncancerous polyps and very early cancers, so that they can be removed.
Types of Screening: Everyone now agrees that screening is a good idea, but how to do it is still somewhat controversial. The most thorough test is colonoscopy, but it takes a fair amount of time, effort and money.
Sigmoidoscopy:The “average risk”-screening test has long been sigmoidoscopy. It is less trouble, but relies on the odds of an incomplete test finding an abnormality. Sigmoidoscopy looks only at the last 1/3 of the colon where about 3/4 of all polyps and 2/3 of all cancers are found. Sigmoidoscopy preparation usually requires only two enemas immediately before the procedure. No sedating medication is given, so it can be uncomfortable, but it only takes 5 or 10 minutes. However, sigmoidoscopy will miss about 20% of all polyps. If a polyp is found, a full colonoscopy will be needed to remove it and to look for more polyps further up inside the colon. If no cancer or polyps are found, a repeat exam is recommended in 3 to 5 years.
Hemoccult: Testing the stool for hidden blood (Hemoccult testing) is another screening test. It is not very accurate, but it is pretty easy to do. If blood is detected, a colonoscopy will be recommended.
Barium enema requires the same cleansing preparation as a full colonoscopy, but does not use sedation. It can miss about 20% of polyps; if polyps are seen, you will need a colonoscopy to remove them. This test is cheaper than colonoscopy, and is sometimes done if there is a low likelihood of abnormal findings, or if colonoscopy is not possible, or not available.
CT Scan: A CT scan of the abdomen is not a useful screening test for colon cancer because it does not see the inside of the colon or its lining.
Virtual colonoscopy, which is a specialized CT scan, is still under development as a colon cancer-screening test, and is not yet reliable enough to be recommended.
The swallowed camera looks only at the small intestine, and is not a screening test for colon cancer.
Colonoscopy:If you have a high risk for colon cancer because of symptoms, or a strong family history of the disease, everyone agrees that colonoscopy is the test to do. However, in the past five or ten years, there has been a growing interest in making full colonoscopy the standard screening test for colon cancer. To prepare for colonoscopy, it is necessary to go on a clear liquid diet for a period of time, and then take laxatives to thoroughly cleanse the colon. When you arrive at the endoscopy facility for the scheduled procedure, you will change into a hospital gown, and an “IV” will be placed. A nurse will review your medical history and medications, and ask you to sign “informed consent” for the procedure. (This means that you understand the benefits and risks.) Looking at the entire colon can take from 15 minutes to an hour, so intravenous medication is given to relax you and make the procedure more comfortable; this is called conscious sedation. During the period of sedation, you will have one-on-one continuous monitoring of your breathing, pulse, and blood pressure; if you should become uncomfortable, more medication can be given through the “IV.” Because of the medication, you must have someone to drive you home afterward, and you should not expect to go to work that day. You may be a little groggy for several hours. You will be in the endoscopy facility for 2 or 3 hours altogether. If no polyps are found, you will not need another procedure for 5 or 10 years.
The risksof a complication from such a negative procedure are about 1 in 5000; the main risk is of some problem with the sedation medication or the IV site. If polyps are found, they are removed by means of a wire loop and electric cautery. This has the important benefit of preventing a potential cancer from developing, but also carries some risk: a hole could be burnt through the bowel wall, or the removal site could bleed. These risks are very low for small polyps, but removal of large polyps (over 1 cm in size) has a 1 in 100 risk of a complication. Of course, the larger a polyp is, the more likely it is to be one that will develop into cancer, so the risk is considered worth taking. Some polyps are so small that they can be simply biopsied off, with very little risk of bleeding. All biopsies are sent to a pathologist for microscopic diagnosis, and you will be notified of the report. It is possible to miss finding a polyp, especially if it is very small. If polyps are found and removed, your gastroenterologist will usually recommend repeating colonoscopy in 3 years to look for new polyps while they are still small and easy to remove.
Actual cancer is not found very often, but if it is found, referral to a surgeon is the next step. Cancers cannot be completely removed by the colonoscopy unless they are in the very early stage. Cancers found before there are any symptoms are usually curable, and almost never require a colostomy.Who is at “high risk” for colon cancer?Those with a strong family history (2 or more close relatives with colon cancer, especially if they were younger than 55 when cancer was found) are thought to have a 10% risk of developing colon cancer. Moderately increased risk for colon cancer includes one close relative with colon cancer at any age, a personal history of breast cancer, a history of radiation damage to the colon, or longstanding inflammatory bowel disease (Crohns or ulcerative colitis). Rectal bleeding, hidden blood in the stool, iron deficiency anemia, a recent change in usual bowel habits, or new abdominal pain and weight loss are all considered possible signs of colon cancer, especially in a person over age 50. These signs usually warrant a consultation with your gastroenterologist before the procedure, which would then be a diagnostic (rather than a screening) colonoscopy.
What to do before your colonoscopy?For the procedure to be accurate and complete, the large intestine must be completely clean. Particles of stool that are not removed can interfere and impede the physician’s view. The process to prepare for a colonoscopy may begin several days before the procedure; refer to the enclosed colonoscopy prep instructions.
How long is the colonoscopy visit and what time should I arrive? The total time in the endoscopy suite from arrival to discharge is approximately 2-4 hours. Patients are to arrive at the endoscopy suite one hour prior to the procedure. The procedure takes 30-60 minutes. The patient is in recovery for 30 minutes after the procedure.
What can I expect during my colonoscopy? The patient is registered and a medical history is documented. The patient is asked to change into a patient gown. An IV will be started, blood pressure will be monitored and a small oximeter will be placed on a fingertip to monitor your pulse rate and breathing functions during the exam. Your gastroenterologist will perform an exam, answer questions, administer the sedation and perform the colonoscopy. On completion the patient is moved to a recovery area. The patient remains in the recovery area until awake and their vitals signs are stable. The physician will review the results of the colonoscopy with you and provide additional information as needed. You are discharged to a responsible adult to be escorted from the endoscopy suite and transported home. Because of the effects of the medication, you may be forgetful and will probably feel drowsy after the exam. Whether traveling by car, bus or taxi make prior arrangements for a responsible adult to pick you up from the recovery area and accompany you home. You are not permitted to drive or operate dangerous machinery until the day after the examination
Will I be asleep during the procedure? Medications will be given before and sometimes during the procedure to help you feel drowsy and relaxed, but most patients remain awake enough to be able to follow commands. It is not uncommon, however, to fall asleep during the procedure and it is unlikely that you will remember the procedure.
Is this covered by my insurance and do I need a referral or authorization? Most insurance companies will not pay for screening colonoscopy even with a referral from your primary care provider. However, if your physician has referred you for other reasons (i.e. unexplained changes in bowel habits, blood found in the stool, unexplained anemia) or your gastroenterologist finds a polyp during the procedure, then the procedure is likely to be covered by your insurance. You will need to call your insurance company and ask if your policy covers screening and/or diagnostic colonoscopy.
If your managed care or insurance plan requires a referral or authorization, it is your responsibility to know your insurance plan requirements and provide authorization from your primary care provider when necessary. If your insurance does not cover the costs of the visit you will be responsible for the charges. If we have not received a required referral from your primary care provider you will be asked to sign a waiver form promising personal payment. We will discard this waiver once the proper referral form is received. If we have not received the required referral form and you refuse to sign the waiver, regretfully we will have to reschedule your appointment to a later date.Billing:We recognize the need for a definite understanding between you and your physician concerning health care and the financial arrangements for this medical care. Our commitment is to provide the very best health care to our patients while recognizing the need to limit services to only those that are necessary. Responsibility for payment of fees for these services is the direct obligation of the patient. Any financial payment you may receive from private insurance or government agencies is a matter strictly between you and the insurance carriers or government agencies. Our physicians are participating Medicare physicians and do accept assignment on Medicare claims; however, any deductible, co-payment or percentage not paid by Medicare or other carrier is your responsibility. It is also your responsibility to know if your insurance carrier has specific rules or regulations which require referral from primary care physicians, pre-certification, limits on outpatient charges or limit you to specific physicians and/or hospitals. You should know about any deductible, co-pay and/or percentage for which you are responsible. The same responsibility exists for HMO’s or PPO’s in which our physicians participate. We are participating physicians with many health insurance companies in this area. Our office will file insurance claims for you.
If you have an endoscopic procedure you will, of course, receive a bill from us for physician services. In addition, you will receive a bill from the facility (NGC endoscopy services or an affiliated hospital). If tissue samples were obtained you will receive another bill for the pathology services.
Most outpatient endoscopic procedures are performed at NGC Endoscopy Services LLC, a fully licensed ambulatory surgical center. Our physicians also have hospital affiliation with Legacy Good Samarian Hospital, Legacy Emanuel Hospital, and Providence Portland Hospital.
We look forward in seeing you for your procedure. Our goal is to provide you with the highest quality care in a comfortable, caring, convenient, friendly, and non-intimidating environment. You can contact our offices if you have any questions.Dave Barry's colonoscopy: OK, You turned 50. You know you're supposed to get a colonoscopy. But you haven't. Click here for more.