Colonoscopy Alternatives: Exploring Other Procedures To Detect Colon Cancer

Getting screened for colon cancer is one of those things in life that most people know are important, but they don't want to do it.

Regular colon screenings are important because they can help find precancerous polyps, which can be removed before they turn into cancer.

Colon cancer is also easier to treat and has a much better success rate when caught early.

Colonoscopies are one of the most popular procedure methods among colorectal surgeons when trying to detect colon cancer.

The procedure involves inserting a long thin tube with a camera and light (called a colonoscope) into the rectum. Once the camera is inserted into the colon, the doctor can get a clear picture of any abnormalities.

Colonoscopies are the preferred colon cancer screening method. However, many patients would rather try a less invasive procedure.

Why do some people dislike colonoscopies?

A colonoscopy is an invasive procedure, but the patient is fully or partially sedated most of the time. Even so, many people are apprehensive about getting this procedure done for several reasons, including:

• The procedure can be expensive

• You have to take time off of work

• The procedure itself can seem uncomfortable and a little embarrassing

• You need to find someone to give you a ride home after the procedure

• The day before a colonoscopy, you have to drink a bitter-tasting liquid to clean out your colon, which often means frequent toilet visits afterward. You will need to have a liquid diet and fast to try and ensure the colon is as empty as possible before your colonoscopy. 

• As biopsies or polyps are potentially removed, there is a risk of bleeding or, rarely, a perforated bowel. 

What are some alternatives to a colonoscopy?

If you are unsure about getting screened for colon cancer just because you are worried about getting a colonoscopy, there are a few alternative solutions that may be right for you.

1. Double-contrast barium enema

For this procedure, a tube is gently placed into the rectum to insert a silver-white metallic liquid (barium) into the colon. Once the metallic compound is in place, the doctor will then use an x-ray to get a better look at the inside of your colon and check for any abnormalities. As x-rays pick up metal, if the liquid is pushed aside by anything, it will indicate a potential mass.

Pros:

• Less expensive than a colonoscopy

• Can easily find lesions and other abnormalities in the narrowest parts of the colon

• You do not have to be sedated for the procedure.

Cons:

• Requires a similar pre-procedure diet and laxative regimen as a colonoscopy

• Exposes you to a small level of radiation from the x-ray

• If polyps are found during the procedure, you will still need to get a colonoscopy for their removal

• The procedure can be uncomfortable or embarrassing for some people

• May not detect cancers further up in the colon

2. Sigmoidoscopy

A sigmoidoscopy is often done to investigate when someone has bright red bleeding thought to be from the lower part of the colon or rectum. This procedure is similar to a colonoscopy. A thin, flexible tube with a camera and light at the end of it is inserted into the rectum and travels to a small portion of the colon.

Pros:

• Usually does not require sedation

• It only takes around 15 minutes to complete

• Has fewer risks than a colonoscopy

Cons:

• It can be uncomfortable. Some people experience lower belly pain and cramping during the procedure.

• Cannot check the entire colon; only checks a small portion of the large intestine.

3. Fecal immunochemical testing (FIT)

The FIT test can detect any blood in your stool, which can be a sign of colon cancer. You can usually perform this test at home. You simply collect a stool sample and then send it to your doctor. Your doctor will then examine the sample to check for any blood or other abnormalities.

Pros:

• Not invasive. The sample can be collected in the privacy of your home.

• No bowel prep is necessary.

• It may be able to detect colon cancer in its early stages.

Cons:

• It cannot diagnose cancer

• It can detect blood from benign causes such as hemorrhoids, and if found, you may need to have a colonoscopy to investigate further.

• Does not check the entire colon

4. Fecal occult blood test (FOBT)

The FOBT is very similar to the FIT. The main difference is that the FOBT can check for blood in a larger portion of the intestines. It may require more than one fecal sample to get an accurate result.

Pros:

• Noninvasive; you can do the test at home

• Can detect blood from various parts of the GI tract

Cons:

• Multiple stool samples are required for this test

• You may have to stop eating certain foods and taking certain medications a few days before the samples are collected

• The test is not 100% accurate in detecting blood

5. CT colonography

A CT colonography is also known as a virtual colonoscopy¹. Instead of having a scope with a camera inserted into your colon, a doctor will use a CT scan to capture several images of your colon. The multiple images taken are combined to create one detailed image of your colon. To get a clear picture of the colon, a tube is inserted in the rectum, and the air is used to inflate the colon.

Pros:

• This is an outpatient procedure that usually takes ten or 15 minutes to complete

• There is no need for sedation.

• It doesn't use a colonoscope, so the procedure may be more comfortable than a traditional colonoscopy.

Cons:

• You will still need to do the same pre-procedure colon prep that you have to do with a traditional colonoscopy.

• It can be difficult to find small polyps.

• If polyps are found, you will need a traditional colonoscopy for the removal. 

Determining if a colonoscopy is really necessary

According to the American Cancer Society², a person should start screening for cancer at 45. However, that does not necessarily mean that you need a colonoscopy at that age. You should talk with your doctor to decide which screening method would be right for you.

When determining whether or not a colonoscopy is necessary, your doctor will look at the following factors:

• Gastrointestinal problems. If you are exhibiting chronic gastrointestinal symptoms, such as rectal bleeding. Severe diarrhea, severe constipation, or bloating.

• Medical conditions. Certain medical conditions, like Crohn's Disease, can put you at a higher risk of getting colon cancer.

• Family history. According to the CDC³, you are at a greater risk of developing colon cancer if a close member of your family (i.e., parent, grandparent, or sibling) had colon cancer before 50.

• Positive results on a previous test. If you have tried another cancer screening method and polyps or other abnormalities were found, your doctor will want to investigate the situation further with a colonoscopy.

The lowdown

If you are at an elevated risk of developing colon cancer, it is important that you get screened as soon as possible. Early detection and treatment greatly increase the success rate of colon cancer, so please don’t let the thought of an uncomfortable screening procedure make you put it off.

Colonoscopies are not the right choice for everyone and are sometimes not a doctor's first choice for their patients. It is important that you talk with your doctor about the advantages and disadvantages of getting a colonoscopy.

Make sure to tell your doctor why you are apprehensive about the procedure. Then, you and your doctor can come up with a comprehensive plan - and possibly a less invasive way - to screen you for colon cancer.