Here’s some detailed information about the importance of colonoscopy in the early detection of colon cancer in persons with SCI.
By Ravi R. Vinnakota MD, Robert Williams MS, Dr. Mark Korsten, MD, Marinella Galea, MD, and Ann M. Spungen, EdD
Colonoscopy
A colonoscopy is an instrument used by a gastroenterologist to look into a patient’s large bowel (colon). A gastroenterologist is a stomach and intestinal (bowel) doctor. Colonoscopy provides the physician with a complete picture of the inside layer of the colon and rectum. It is quick, and associated with only minimal discomfort. The results are extremely helpful to the physician because it allows him/her to see growths such as polyps and/ or cancer.
Why is the colon important?
As we eat food, it moves down the esophagus into the stomach. As the breakdown of the food proceeds, it first travels down into the small bowel where most of the nutrients are absorbed. The left-over material moves down to the colon (large bowel), entering first the right side of this structure.
As stool moves from the right to the left side of the colon, most of the water and some minerals are absorbed. Uptake of water results in solid stool that is stored in the rectum until evacuation.
How is the colon different in persons with spinal cord injury?
In persons with spinal cord injury (SCI), the nerve connections between the bowel and the brain are disrupted. As a result, the normal movements of the bowel, called peristalsis, may be diminished. In addition, when the rectum is filled, persons with SCI may not be able to know when the rectum is ready to be emptied.
Given these abnormalities, persons with SCI may need help in ridding the body of solid waste. Typically, a person with SCI who experiences problems with bowel movements is placed on a regular schedule of “bowel care”. Bowel care is important because it prevents obstruction of the colon by stool (impaction) and “accidents” (incontinence). Bowel care is not only time consuming, it can cause depression and anxiety in some persons.
Since someone with SCI may not know when serious alterations in bowel function have occurred, colonoscopy should be carried out more frequently than in persons who are not paralyzed. The problem in doing colonoscopy, however, is that it requires a “clean” colon to be effective. This is very difficult to achieve in persons with SCI.
Therefore, although colonoscopy is generally recommended to be carried out every 10 years in able-bodied individuals after the age of 50, the frequency may need to be modified in people with SCI, particularly for those in whom the colon clean-out was inadequate.
Why is colon cancer so dangerous?
Colon cancer is the second most diagnosed cancer in the United States of America. We currently believe that spinal cord injury (SCI) patients have the same risk or worse as able bodied persons for colon cancer because of the disruption of normal bowel routines due to their SCI. This is a serious cancer. In the US, colon cancer is diagnosed in 150,000 people every year and 55,000 people per year die from it. Moreover, colon cancer rates seem to be steadily rising, possibly because of poor diet and other risk factors.
Colonoscopy is the best way to diagnose and remove polyps (pre-cancerous growths that may grow and become colon cancer). However, people do not seek assistance from their physician because they do not or cannot (in the case of persons with SCI) recognize the signs and symptoms of the disease.
What can be done to reduce the risk of colon cancer?
If you are 50 years or older, you should ask your doctor to refer you to have a colonoscopy. This is especially important if there is a change in your bowel habits or you notice blood in your stool or have persistent abdominal pain. These symptoms should never be ignored. If these symptoms are ignored, an early cancer which is curable may become an advanced cancer which is incurable.
As noted above, persons with SCI may not have any symptoms and screening for colon cancer on a regular basis is even more essential. A colonoscopy will give you a better chance at removing polyps at an early stage and prevent further complications. Colon cancer can affect either the right or left side of the colon. There are often fewer symptoms when the cancer involves the right side of the colon. However, the colonoscopy can reach all parts of the colon.
The guidelines of the American College of Gastroenterology for Colorectal Cancer Screening are as follows: everybody should have colorectal cancer (CRC) prevention screening every 10 years beginning at age 50. Screening in African American (black) persons should begin earlier, probably as early as age 45 because of the higher incidence of CRC in this population. These guidelines may be modified if a 1st degree relative (parent or sibling) developed colon cancer. In summary, colonoscopy is crucial in preventing colon cancer in everyone, especially in persons with SCI. While the preparation to “clean out” one’s colon may not be pleasant; the potential for prevention of colon cancer far out weighs the disagreeable nature of the preparation.
If you have not had your colonoscopy screening yet, please contact your local SCI physician for a colonoscopy.
At the James J. Peters VAMC call Robert Williams at (718)-584-9000, ext.3130 or 3126 and e-mail: Robert.williams206485@va.gov.
The authors are physicians and research staff at the James J. Peters Department of Veterans Affairs Medical Center in the Bronx, New York.
