As a digestive specialist with more than a decade of experience, I have witnessed the rapid development of medical technology, especially in the diagnosis of gut health. Bowel cancer, as a common malignancy, is crucial for its early detection and treatment. However, many patients have misconceptions and fears about colonoscopy, fearing pain and embarrassment, and therefore often delay treatment. Today, I would like to share some other examination methods in addition to traditional colonoscopy, which are not only effective, but also more user-friendly, which can help us complete the examination in a comfortable state and detect problems early.
Last spring, Mr. Li (not his real name) came to my clinic with a pale face and looking very anxious. Mr. Lee, a 50-year-old restaurateur, has not had time for regular health check-ups due to his busy schedule. Recently, he noticed that he had lost quite a bit of weight for no apparent reason, accompanied by irregular abdominal pain and constipation. Mr. Li was worried that it might be a symptom of bowel cancer, but he was extremely afraid of having a colonoscopy. After talking to him in detail, I learned that his main concern was about the pain and invasiveness of colonoscopy.
In order to reduce his psychological burden, I recommended to him CT colography, which is a non-invasive intestinal examination method that allows a quick and comprehensive scan of the intestine through high-tech CT scanning technology. I explained to Mr. Li that this method does not require the insertion of an endoscope, is almost painless, and provides accurate diagnostic results. Mr. Li was visibly relieved and decided to try this new method of examination.
During the procedure, Mr. Li simply took a special contrast medium and lay down on the CT scanner for a few minutes. The whole process was quick and smooth, and Mr. Li did not feel any discomfort. Eventually, the results of the examination revealed that Mr. Li had several polyps in the early stages of his large intestine, and although these polyps were benign, they could turn malignant in the future if not treated. We performed polypectomy surgery in a timely manner and Mr. Lee's health has improved dramatically.
Overview of colonoscopy
Definition and Importance
Colonoscopy, medically known as colonoscopy, is an endoscopic technique that is primarily used to look inside the large intestine, including the complete colon from the rectum to the cecum. This technology is crucial in diagnosing intestinal diseases such as chronic inflammation, polyps, intestinal infections, and the early detection of bowel cancer. Through colonoscopy, doctors are able to look directly at the intestinal lining to detect possible abnormalities, such as polyps or tumors, and can remove these samples for biological examination in the same procedure, greatly improving the timeliness and effectiveness of treatment.
Check the process
When a colonoscopy is performed, the patient needs to prepare the bowel first, usually starting the day before on an empty stomach and taking laxatives to empty the intestinal contents. On the day of the examination, the doctor will use a flexible endoscope tube about 1.5 meters long, which is equipped with a camera and light at the end, and slowly advances it through the anus to the entire large intestine.
Throughout the procedure, your doctor may blow in a small amount of air or carbon dioxide through an endoscope to better unfold your intestine and get a clear view of the intestinal wall. For polyps or suspicious areas found, biopsy or removal of polyps can be performed using the tool passage of the endoscope.
Pain level
Many people worry about the pain of colonoscopy, but in fact, this worry stems from unfamiliarity with the procedure. Modern colonoscopy is usually performed with the aid of analgesia and light anesthesia, and most patients may experience mild discomfort or a feeling of pressure in the abdomen, but not severe pain. The analgesics and anesthetics used can make the patient comfortable throughout the procedure, and many patients will not even remember the specifics of the examination.
Follow-up and potential risks
Although colonoscopy is the gold standard method for diagnosing and treating intestinal diseases, it also comes with certain risks and discomforts, such as intestinal perforation, bleeding, etc., which are extremely rare. After the test, the patient may experience bloating or brief intestinal cramps, which usually resolve on their own within a few hours.
Depending on the nature and amount of tissue, your doctor will recommend further monitoring strategies or treatment options, if polyps or other abnormal tissue are found. If the test results are normal, the doctor will recommend the next screening time, usually 5-10 years later, depending on the patient's risk factors.
Alternative to colonoscopy
1. CT colonography (virtual colonoscopy)
Virtual colonoscopy uses CT scanning technology to produce detailed three-dimensional images of the intestine, which is very effective for detecting colorectal polyps and bowel cancer.
How it works: Patients need to empty their bowels before the test, which usually requires taking oral laxatives. During the test, the patient lies on a CT scanner and a small amount of air or carbon dioxide is introduced into the intestine in order to dilate the intestine and obtain a clearer image.
Pain: Compared to traditional colonoscopy, virtual colonoscopy is much less uncomfortable because it avoids the insertion of a physical endoscope and the patient feels little pain during the whole process.
Cost: The cost of a virtual colonoscopy is typically higher than that of a traditional colonoscopy, but it also varies by region and medical facility. Despite the higher initial investment, it is a more comfortable option for patients who are very concerned about the discomfort of traditional colonoscopy.
Accuracy: A virtual colonoscopy is comparable to a traditional colonoscopy at detecting larger polyps and bowel cancer, but it may not be able to detect very small polyps.
2. Fecal occult blood test (FOBT)
A fecal occult blood test is a method to detect whether blood is present in the stool. The presence of blood may be caused by the presence of polyps in the intestine or intestinal cancer.
How it works: Patients need to collect a stool sample for one to three days and use a specific kit to test for occult blood.
Pain level: This test is completely painless.
Cost: FOBT is a very economical screening tool and is particularly suitable for initial screening for bowel cancer as part of a routine health check-up.
Accuracy: Although FOBT has a low sensitivity for colorectal polyps, it has a high specificity for the detection of colorectal cancer. If the test result is positive, further confirmation with colonoscopy is usually required.
3. Stool DNA test
In recent years, with the development of biotechnology, fecal DNA testing has become an important tool for bowel cancer screening. This method can detect DNA abnormalities in stool samples that may be indicative of bowel cancer.
Procedure: The patient collects a stool sample and sends it to a laboratory for analysis to look for DNA markers for bowel cancer.
Pain level: This method is also completely painless.
Cost: Stool DNA testing is more expensive, but due to its non-invasiveness and avoidance of colonoscopy, many patients and doctors agree that it is a worthwhile option.
Accuracy: Fecal DNA detection has high sensitivity and specificity for bowel cancer, especially in the detection of high-grade intestinal lesions.
Which test method to choose?
1. CT colonography (virtual colonoscopy)
overview
CT colonography, also known as virtual colonoscopy, uses CT scanning technology to obtain detailed three-dimensional images of the intestines. This method does not require the use of an endoscopic tube, so it is a comfortable option for patients who are afraid of pain or have a phobia of endoscopy.
Availability
Patients who have a phobia of traditional colonoscopy.
Patients with medical conditions (e.g., respiratory or cardiovascular disease) that are not suitable for traditional colonoscopy.
merit
Reduces pain and discomfort.
No sedation is required and recovery time is fast.
shortcoming
If abnormalities are found, traditional colonoscopy is still needed to take samples or treat them.
Very small polyps may not be found.
2. Fecal occult blood test (FOBT)
overview
A fecal occult blood test is used to screen for intestinal bleeding by detecting occult blood in a stool sample, which can be an early sign of a tumour or other problem in the intestine.
Availability
It is suitable as a routine colorectal cancer screening tool, especially in low-risk groups.
Annual check-ups, especially for adults over 50 years of age.
merit
Non-invasive and completely painless.
Low cost and simple operation.
shortcoming
Sensitivity and specificity are relatively low and may need to be combined with other tests.
3. Stool DNA test
overview
Stool DNA testing is a newer technique that detects bowel cancer by analyzing DNA variants in the stool. These variants may come from intestinal tumor cells.
Availability
Suitable for patients who are unable to undergo colonoscopy.
Those looking for a non-invasive and more precise way to test.
merit
Non-invasive and painless.
It has higher sensitivity and specificity than FOBT.
shortcoming
The cost is relatively high.
If the result is positive, colonoscopy confirmation is still required.
Personal choice recommendations
The choice of which test method should be based on the following factors:
Personal health conditions: Previous bowel surgery or chronic medical conditions that may affect the suitability of certain tests.
Family history and genetic risk: Individuals with a family history of bowel cancer may need to start screening more frequently or earlier.
Economic factors: Consider the cost of various inspection methods and the financial means of the individual.
Personal preference: Consider the invasiveness of the examination, the level of pain, and the individual's tolerance for a particular medical procedure.
By discussing these factors in detail with your doctor, you can choose the most suitable bowel examination method for you, which will not only effectively detect your gut health, but also ensure comfort and safety during the procedure. Don't ignore these tests, they are a crucial step in the prevention and early diagnosis of bowel cancer.