Internal Medicine

Colon cancer screening

introduction

The term colon cancer screening means a special screening program for the early detection of malignant changes in the intestine.

Colorectal cancer screening is based on the individual risk of different groups developing colorectal cancer. The exact time and frequency of the preventive medical check-up depend on the classification of a person in one of these specific risk groups.

People with a family history of colon cancer are particularly at risk.

Patients suffering from inflammatory bowel disease are also recommended to join a colon cancer screening program at an early stage.
In principle, if there is an increased risk of developing colon cancer, colon cancer screening should be done at a younger age (25-30 years) can be started. People without a significant risk should be enrolled in a colon cancer screening program by the age of 50 at the latest. This recommendation can be justified by the fact that the risk of colon cancer increases significantly from the age of 50.

The costs for carrying out bowel cancer screening for patients over the age of 50 are partially covered by the statutory health insurance companies. This means that both the preparation of an annual stool test and the performance of a so-called digital rectal examination as part of colon cancer screening are paid for.

Read more on the topic: Cost of a colonoscopy

From the age of 55, a colonoscopy is also carried out.
Various examination methods are available for colon cancer screening. In some patients, performing one of these methods is sufficient to rule out the presence of malignant changes in the bowel area. In many cases, however, it makes sense to combine several examination methods.

What methods are there?

The most common bowel cancer screening procedures used include:

a test for invisible blood residue in stool (Occult blood test)
Palpation of the rectum (Digital rectal exam)
Colonoscopy (Colonoscopy)
Virtual colonoscopy (CT colonoscopy)
special laboratory tests

Read more about: How do you recognize colon cancer?

Various methods of colorectal cancer screening are available in medical diagnostics. They all have different areas of application, accuracies and subsequent therapy options. Colonoscopy is very often used as a preventive measure. It is paid for by the health insurance company from the age of 55 and represents one of the most precise diagnostic procedures. Changes in the mucous membrane and wall of the colon can be detected and even treated at an early stage. Polyps, which are potential precursors of cancer, but also small, localized cancer foci, can be removed immediately in a colonoscopy, also known as "colonoscopy". Testing them for malignant cells in the laboratory is another important precautionary measure.

Furthermore, the hemoccult test can be used as an uncomplicated procedure in colon cancer prevention. Although this does not provide a definitive diagnosis and its informative value is limited, positive results can provide important initial indications of malignant growth inside the intestine. The test detects the smallest, invisible traces of blood that could indicate a tumor.

The digital rectal palpation examination can also be carried out cheaply and quickly, but its meaningfulness is limited. This can only be used to examine gross changes in the rectum and prostate.

Genetic diagnostics is an important precaution, especially for young people who have a family history of colon cancer. Certain genes that increase the likelihood of colon cancer can be identified at a young age. If the results are positive, other precautionary measures must be used, for example more frequent colonoscopies.

In order to diagnose colon cancer at an early stage, CT examinations, blood tests and the determination of so-called "tumor markers", as well as capsular colonoscopy or numerous other modern methods can be used. However, their efficiency has not yet asserted themselves in everyday clinical practice and they still have no place in routine preventive care.

Test for blood in the stool (occult blood test)

Blood deposits on or in the stool are not always visible to the naked eye.
When performing the so-called occult blood test, hidden blood in the stool can also be detected and an initial suspicion of the presence of colon cancer can be raised.
Such blood deposits can originate from intestinal polyps or intestinal tumors, which provoke open areas in the area of the intestinal tube.

As part of colon cancer screening, the occult blood test is carried out regularly once a year. For patients who have reached the age of 50, the costs for carrying out this test are fully covered by both statutory and private health insurances.
With this method of colon cancer screening alone, 25 to 30 percent of polyps and tumors can be identified early.

If the occult blood test is positive, a colonoscopy must be performed immediately. In this way, the finding can be confirmed if necessary.

You might also be interested in: Can you detect colon cancer in the blood? These colorectal cancer tests exist and they are so reliable!

Digital rectal exam (palpation of the rectum)

The so-called "digital rectal examination" is a simple examination method that should be carried out regularly as part of colon cancer screening.
In the course of this examination, the doctor inspects the anal region and feels the rectum with his finger.
In this way, changes in the area of the anus can be detected at an early stage.

The digital rectal examination is also carried out as part of prostate cancer screening.

Using this method of colon cancer screening, around half of the tumors located in the area of the rectum can be detected.
However, digital rectal examinations are unsuitable for preventing colon cancer in higher-lying tumors.

Read more on the subject at: prostate check

Colonoscopy (colonoscopy)

This form of colon cancer screening is usually carried out on an outpatient basis in special specialist practices (gastroenterology, doctor for gastrointestinal diseases) or in the hospital.

Before the actual colonoscopy, the intestinal tube must be completely emptied and cleaned by the patient. Only in this way can the attending physician accurately assess the intestinal mucosa during colon cancer screening.
For the purpose of emptying and cleaning the bowels, a laxative must be taken the day before the mirroring. Afterwards it is advisable to have sufficient amounts of liquidWater or apple juice) to take in.
The gastrointestinal tract can then excrete the clearest possible liquid until the colonoscopy begins and thereby rid itself of any remaining fecal deposits.

The preparation for colon cancer screening should be taken very seriously by the patient to be examined. A successful, meaningful colonoscopy can only be carried out if the colon is well cleaned.

Immediately before this form of colon cancer screening, the attending physician conducts a digital rectal examination. If desired, the patient can then receive a slight sedation.

During the actual colonoscopy, a flexible endoscope (a hose with an integrated camera) introduced through the anus into the intestine. This device is advanced piece by piece, along the large intestine to the small intestine.
Air is also carefully introduced into the intestinal tube while it is being pushed forward. The consequence of the influx of air is the unfolding of the intestinal walls and an associated improvement in visibility.

As soon as the endoscope has been advanced to the small intestine, the actual colon cancer screening begins. While slowly withdrawing the endoscope, the intestinal mucosa can be viewed section by section.
The camera head of the endoscope can be flexibly moved back and forth during the examination and in this way enables an ideal overview of the mucous membrane conditions.

The duration of this form of colon cancer screening is around 20 minutes in most cases.

In general, the entire procedure is largely painless.
Some patients only find it uncomfortable to push the endoscope forward.

Another advantage of this type of colon cancer screening is the fact that possible changes in the mucous membrane (for example polyps) can be removed during the colonoscopy.
It is therefore an early detection examination in which the precursors of the colon cancer can be removed immediately.

Following the examination, it is advisable to take a rest phase. Patients who received sedatives during the colonoscopy remain in the practice for about one to two hours.
As soon as the patient's circulatory system has stabilized and consciousness has been fully regained, he can be discharged with a family member.

As with most medical procedures, having a colonoscopy to screen for colon cancer have certain risks.
In general, however, one can assume that a colonoscopy performed by an experienced specialist is one of the safest and gentlest examination methods.

In rare cases, the intestinal mucosa can be impaired. Bleeding can only be observed in a few patients.
Piercing the intestinal wall (so-called perforation) cannot be completely ruled out when taking tissue samples, but it is one of the rare occurrences during colon cancer screening.
The risk of perforation is only increased for patients suffering from inflammatory bowel disease. However, this is related to the already severe impairment of the intestinal walls.

Patients who have intestinal cancer screening carried out in twilight sleep may develop allergic reactions to the medication administered.

Virtual colonoscopy

The virtual colonoscopy is one of the newer examination methods that are carried out in the course of colon cancer screening.

This procedure enables a virtual colonoscopy without having to penetrate the body with medical equipment.

While the virtual colonoscopy is being carried out, computer tomographic or magnetic resonance tomographic tomographic images of the abdomen are made. With the help of a special 3D computer program, the slice images determined can be converted into a three-dimensional image of the intestinal tube. The entire gastrointestinal tract can then be examined by a specialist on the screen for abnormalities.

The disadvantage of this examination method for colorectal cancer screening is the fact that especially small and / or flat colon polyps can possibly be overlooked. In addition, even if a polyp is discovered, immediate removal is not possible. If the specialist sees an intestinal polyp on the screen, an ordinary colonoscopy must be arranged to remove the abnormality.

Capsule colonoscopy

Patients who do not want to undergo a conventional colonoscopy can alternatively consider colon cancer screening using capsule colonoscopy.
This form of colon cancer screening is considered to have fewer complications than conventional examination methods.

The capsule colonoscopy impresses above all with its absolute freedom from pain and the non-invasive implementation. Since a large number of patients feel uncomfortable or even embarrassed during the usual colonoscopy, capsule colonoscopy offers completely new possibilities.
In addition, no sedation and / or calming is required during this examination method.

At the beginning of the colonoscopy, the patient must swallow a capsule the size of a large, elongated tablet. Thanks to its particularly smooth surface, the capsule is particularly easy to swallow.
The capsule then passes through the gastrointestinal tract on its own over a period of several hours and is then excreted in the stool.

The capsule itself is equipped with an optical technology that depicts the inside of the intestinal tube at around 35 images per second. The recorded images are also particularly high-resolution and are sent outside during the intestinal passage.
A special receiver device that the patient must wear on the belt during the entire examination time is used to record these images.

After the intestinal transit, the excreted capsule can simply be disposed of in the toilet. However, patients who decide against colonoscopy screening for colon cancer and in favor of capsule colonoscopy must be aware that the reliability of this method is comparatively lower.
In addition, colon polyps cannot be removed during capsule colonoscopy. This means that if such polyps are found, an ordinary colonoscopy must still be carried out.

Capsule colonoscopy as part of colorectal cancer screening is not performed in every gastroenterological practice. In most cases, patients need to see specialist doctors.

The cost of performing a capsule colonoscopy is currently around 1000 euros. Both statutory and private health insurances only cover these costs in rare cases. There is no entitlement to reimbursement of costs.
Patients who decide to have a capsule colonoscopy should contact their health insurance company directly about possible reimbursement of costs.

Further precautionary measures or preventive measures

The most important form of colon cancer screening is a targeted adjustment of the individual lifestyle.
Too little exercise, being very overweight, high-fat food and the consumption of alcohol and / or nicotine are among the most important risk factors for the development of cancer of the bowel.

Because of this, a Change of diet already play a large part in preventing colon cancer.
Patients who are already exposed, for example for family reasons, should avoid frequent consumption of high-fat foods.
A balanced diet with lots of fiber and sufficient fruit and vegetables can significantly reduce the risk of colon cancer.

In addition, short sports units should be completed on at least 3 days a week. Often, even short walks in the evening help effectively prevent colon cancer.

The consumption of nicotine and alcohol should also be restricted or stopped entirely.

How useful is colon cancer screening?

Colon cancer screening, like most screening exams, may seem superfluous. The likelihood of developing colon cancer is low, but early detection is extremely important. In cancer treatment, early detection of cancer is the most important prognostic factor. With the help of colonoscopy, polyps and precursors of colon cancer can be detected and removed early, which may soon cause the malignant disease.

At this stage, the cells have not yet distributed in the body and the changes have not yet caused any damage in the intestines. Colon cancer screening is a very important diagnostic criterion and increases the chances of a cure and timely treatment of the cancer in the event of illness. The screening of colon cancer is particularly intensive and well studied, as it is one of the most common cancers in adults.

How safe is a rapid test?

Nowadays, many rapid tests and simple colorectal cancer screening methods are being researched. In everyday medical practice, however, the haemoccult test, the stool test, still exists as a simple test method to detect bleeding that can occur due to colon cancer at an early stage. However, the security of the test is limited. Bleeding rarely occurs in the early stages, and the test cannot provide a reliable diagnosis even with existing tumors. On the other hand, the test can also show false positive results in many cases even though no tumor or bleeding has occurred in the intestine. The safety of the rapid test is therefore severely limited, but it can nevertheless serve to confirm an important suspected diagnosis using a simple procedure.

At what age should I go to preventive care?

The preventive age varies with the individual risk or based on previous indications and changes. For an unaffected adult, however, there are certain age limits from which the preventive examination makes sense from a medical point of view. Since studies show that the risk of the disease increases more strongly after the age of 50, the first preventive examinations are also recommended at this age.

The hemoccult stool examination and the digital rectal palpation examination are recommended annually from the age of 50. From the age of 55, colonoscopy is also medically advisable as a preventive measure. Since this is a more complex procedure and changes such as polyps only grow slowly, it is carried out prophylactically about every 10 years. In the case of abnormal stool examinations or previously diagnosed abnormalities of the bowel, the colonoscopy should be done more often, for example every 2 years.

In special risk cases, the colonoscopy can be performed up to every 2 months according to an individual decision. People who are affected by a first-degree colon cancer case are also recommended to have their first colonoscopy at the latest from the age of 45.

You might also be interested in: Is Colon Cancer Hereditary?

How often should I go to check-ups?

The precautionary guidelines are based on statistical values and the frequency of illnesses. It has been shown that in people of all risk groups and even without previous illnesses, the incidence of colon cancer increases by the age of 50. For this reason, it is advisable to keep to the appointments recommended by the health insurance company and to have a colonoscopy every 10 years from the age of 55. In particular, if polyps or other changes in the intestinal walls have already been detected, the preventive examinations suggested by the doctor should be observed for your own safety.

Does the health insurance pay?

The health insurance company pays this form of medical diagnosis if there is a medical indication or a suspected diagnosis and if the examination is recommended as part of the usual preventive examinations. According to the recommendations, the stool examination is paid annually from the age of 50 and the colonoscopy every 10 years from the age of 55. In the case of high-risk patients, an individual risk is assessed by a doctor, after which the preventive examinations should be carried out and paid for. If abnormalities are discovered during a colonoscopy, further preventive examinations can be paid for at closer intervals. In the case of small polyps, for example, the mirror should be done every 5 years, and more frequently in the case of more advanced changes.

How high are the costs?

The cost of colon cancer screening is relatively high, which is why it is rarely done before the recommended minimum age. It goes without saying that preventive examinations can be carried out earlier at your own expense. However, a colonoscopy often costs over € 300, excluding anesthesia and sedation.

For more information, see: Cost of a colonoscopy

The tests for stool examination (haemoccult) can, however, be acquired and carried out independently. They are available cheaply in pharmacies.

Which doctor does colon cancer screening?

Any doctor can prescribe and perform tests, such as stool blood tests. The family doctor in particular is a suitable point of contact for the first preventive medical check-ups. However, a short stay in hospital is necessary to perform a colonoscopy. This can usually be done on an outpatient basis, so that the clinic can be left a few hours after the examination. The examinations are carried out by gastrointestinal specialists, the gastroenterologists. Most hospitals have endoscopic centers that can do this type of mirroring.

What actually is colon cancer?

Colon cancer can in principle occur in any section of the intestine. Both the small and large intestines and the anal area can be affected.

In most cases, the term colon cancer (Synonyms: colorectal carcinoma, colon carcinoma, rectal carcinoma) but a form of cancer that manifests itself in the end sections of the colon.

The malignant cells of colon cancer develop mainly from the mucous membrane lining the intestinal tube. The most common forms of colon cancer are rectal and colon cancer.
In the case of rectal cancer, degenerate cells are found in the last section of the intestine, the rectum (rectum). Colon cancer, on the other hand, manifests itself in more orally located sections of the large intestine.

Causes of Colon Cancer

The exact causes for the development of colon cancer are largely unexplained. What is certain, however, is that there are certain precursor structures (intestinal polyp) that can be detected and removed early in the course of colon cancer screening.
In addition, the occurrence of various forms of colon cancer can be observed in certain patient groups.
For this reason, factors have been described that are said to increase the risk of developing colon cancer. These risk factors include:

very overweight
longstanding nicotine consumption
Sedentary lifestyle
Low fiber diet
Alcohol consumption
Chronic inflammatory bowel disease (Crohn's disease, ulcerative colitis)
Family background

Read more on the subject at: What are the causes of colon cancer? and Lynch Syndrome

Colon Cancer Symptoms

The symptoms of colon cancer can vary greatly depending on the exact location. However, since early detection of degenerate cells can greatly improve the patient's prognosis, special warning signs should be observed.
Often, however, a tumor in the intestinal area develops over a long period of time without causing symptoms. For this reason, most forms of colon cancer are diagnosed in the late stages without proper colon cancer screening.

Nevertheless, patients should consult a specialist promptly if the following symptoms occur.

Blood on or in the stool
Intestinal cramps that occur more frequently over a period of at least a week
Foul smelling stool
Changes in bowel habits (e.g. switching between diarrhea and constipation, frequent bowel movements, pencil-thin bowel movements)
stomach pain
Unintentional discharge of stool or mucus with flatulence
unclear weight loss
Loss of appetite, listlessness, fatigue
Night sweats
persistent fever
palpable indurations in the abdomen