Screening colonoscopy: prevent cancer!

All over the world colonoscopy is one of the most effective investigations on colorectal cancer prevention and early detection. It is explained by the fact that during the investigation the doctor has got the possibility to remove polyps and adenomas which in some time could cause cancer. But in our country this screening is not very famous and popular. Who has to pass through this investigation? Vadim Korpyak, a surgeon, endoscopist of LISOD Hospital of Israeli Oncology told us about that.

- Why is this system so important? Because colon cancer in Ukraine is on the first place in terms of both morbidity and mortality among all localizations of cancer diseases. Yes, I am not mistaken. None of the cancers in Ukraine takes so many lives as colorectal. Everybody can check it, looking through the data of the national cancer register. And although there is no such section as colorectal cancer, it is worth simply summarizing the data on colon cancer and segmented colon cancer, and in histograms - to calculate the percentage of morbidity or mortality by localization in men and women. And our big trouble is that this problem is not covered and is not raised in any way, and accordingly they do not struggle with it in any way.

In the entire civilized world (and according to WHO data colon cancer is the fourth in terms of morbidity in the world) there are colorectal cancer screening programs. In some countries colonoscopy is used as screening, in others – tests for occult blood and sigmoidoscopy. There are no such programs in Ukraine at all.

As a consequence, according to the same cancer-register, in 2015, colorectal cancer affected more than 16,000 people, and in the same year 2015, more than 9,000 people died from this disease! In just one year! This is despite the fact that some patients with colorectal cancer 

just were not set a diagnosis (or did not want to). Therefore, the real figures are greater.

It is possible to prevent this cancer, but it all depends on you! You just have to resign to doing it and find time for that. The absolute majority of malignant colon tumors appear from benign precursors – adenomas. I will not go into details about what they are, but I will say that adenomas of any size in the gut should be removed - otherwise the way in those 16 thousand is open.

None of the investigation methods allows detecting and removing all adenomas simultaneously (at least, the majority), besides colonoscopy. The only exception is large adenomas, which can also be removed endoscopically, but not immediately, but after histological examination and hospitalization. There is one important “BUT” – colonoscopy must be performed with high quality.

According to the world statistics, in patients undergoing screening colonoscopy, the risk of colon cancer is extremely low, and the risk of dying from such cancer is approaching zero due to early detection and treatment, often endoscopic.

Factors indicating that it is necessary to undergo a screening colonoscopy:

- a family history, burdened with colorectal cancer (if blood relatives had colon cancer) - the first screening at 40 years (or minus 10 years from the age of the relative when he had the disease. And it is necessary to focus on the smaller of the two indicators);

- a family history, burdened with polyposis (if blood relatives had multiple polyps detected). Here it is worth to be specified that polyposis may be different, so the age at which screening begins varies greatly. With a detailed family history it is worth to address a specialist in an obligatory way. On the other hand if you are 30 years old and there are no contraindications to colonoscopy, it is better to do it with such a family history rather than not to do it;

- if blood relatives had endometrium cancer, screening has to be started from 40 (this is a major external intestinal localization, connected with genetic colorectal cancer called Lynch syndrome);

- rare, so-called Lynch-associated localizations – stomach, testicles, pancreas, ureters, kidneys, brain (gioblastoma),  bile ducts, small intestine, adenomas and carcinomas of the sebaceous glands, keratoacanthomas. Again, the beginning of screening should start at 40 or 10 years earlier than one of the above cancers was detected in blood relatives. Individuals with the above listed lesions in personal and not family history also need an obligatory colonoscopy;

- individuals having eight and more years of Krone disease and ulcerative colitis history. As a rule, such patients are under constant follow-up, but I still remind, knowing the attitude of the average patient to colonoscopy.

In the second turn, a colonoscopy should be performed by ALL who turned 50, and even better 45. ALL without exception. I understand what everyone will think: I do not have the risk factors mentioned above, then it will be a lucky break. Are you sure you will not get to 16,000 a year? If I say that in good medical institutions adenomas are found in every third person who came for the colonoscopy, and in the best – in 3 out of 5 (even in 7 out of 10) patients who came for colonoscopy? Still optimistic?

And I will tell you one more thing that the absolute majority of patients have asymptomatic adenomas. Moreover – even cancer at early stages is asymptomatic. And when there already appear symptoms, it remains only to regret colonoscopy not performed on time.

Therefore, the conclusion is obvious: screening colonoscopy is the most effective way to prevent colon cancer.