Cancer of the colon is a major health problem in the United States. It ranks as a leading form of cancer, along with lung and breast cancer. Importantly, colon cancer is also one of the most curable forms of cancer. When detected early, more than 90 percent of patients can be cured. Roughly 150,000 people develop colon cancer annually and 60,000 succumb to this disease. Colonoscopy is the procedure of choice for detecting and removing growths from the colon. Colonoscopy utilizes a relatively thin, long tube with a video chip located at the tip. The system provides for high resolution color examination of colon. The instruments are equipped with working channels that allow for the passage of devices that take samples (biopsies) or remove growths (polyps). The tube is passed through the anus into the rectum and is advanced through the entire colon. A complete exam is essential and means the scope was passed into the right colon to an area called the cecum. The colon is like an inverted U in your abdominal cavity. The first area entered is the rectum, then to the left colon comprised of the sigmoid and descending colon. It continues across the upper abdomen through the transverse colon into the right colon, called the ascending colon, and into the cecum. The cecum connects to the small intestine referred to as the terminal ileum. The colon is about 6 to 8 feet long. The preparation for colonoscopy is often dreaded, but with newer formulations has been made easier. Most patients maintain a clear liquid diet the day before the test and consume a cathartic substance that forces several bowel movements until the stool appears clear. The specifics of your colonoscopy preparation will be provided by your gastroenterologist. The alternatives to colonoscopy include barium enema x-ray that must be combined with flexible sigmoidoscopy (a short scope that views the rectum and left colon) to properly view the left colon, or virtual colonoscopy. Barium enema is less senstive than colonoscopy for picking up abnormilties. Virtual colonoscopy utilizes CAT scan 3D imaging to reconstruct images of the colon. It still requires preparation and rectal tube insertion to introduce air to expand the colon. Unfortunately, it can miss small polyps (less than 0.5 centimeters) and is ususally not covered by insurance. Both barium enema and virtual colonoscopy do not allow for sampling of colon tissue. If there is an abnormality with either of these tests, then you will require colonoscopy as a definitive diagnostic test that is able to sample tissue or remove abnormal growths. No exam is perfect. Miss rates do occur with colonoscopy and have been reported to occur anywhere from 6-20 percent of the time. Routine checking of the stool for hidden or occult blood is used in colon cancer screening on an annual basis for anyone of average risk 40 years of age or above. Colonoscopy is recommended for average risk persons beginning at the age of 50. Consult with your doctor about the additional screening guidelines. Remember, any form of screening is better than none at all. If you have any alarm symptoms such as rectal bleeding, a change in your bowel pattern, abdominal pain, or unexplained weight loss, contact your doctor.

This disease begins in the cells that line the colon. There now is strong medical evidence that there is an abnormal gene for colon polyps and cancer that can be passed from parent to child. The genes within each cell are the hereditary structures that tell the cell what it should do. It is becoming increasingly clear that certain of these genes control the growth of the cells on the lining of the colon. When these controlling genes are absent, there is a tendency to grow polyps. The cells in the polyp eventually become uncontrolled and turn into cancer. Colon cancer also can develop from other conditions, such as colitis.

What is Colon Polyp?
A polyp is a growth that occurs in the colon and other organs. These growths, or fleshy tumors, are shaped like a mushroom or a dome-like button, and occur on the inside lining of the colon. They may be as small as a tiny pea or larger than a plum. It is important to note that while colon polyps start out as benign tumors, some polyps, in time, become malignant. In fact, the larger the polyp, the more likely it is to contain cancer cells. In most cases, it is a polyp called an adenoma polyp that develops into colon cancer. The good news is that these growths are often dectected by colonoscopy and can be safely removed at the same time as detection.

What Are The Risk Factors For
Developing Colon Polyps and Cancer?

Family history of polyps, cancer, and especially colon cancer.
Western civilization and diet.
Being over 40 years of age
History of breast cancer
Ulcerative Colitis
Crohn's Disease

In Summary...
Cancer of the colon is a serious but readily detected malignancy. In addition, early detection promises a particularly high chance of survival. Most colon cancers start as polyps, which can usually be removed with an outpatient procedure. Today, much information is available to significantly reduce the risk of this disease. The essential first step involves action by the patient.

Additional Resource Material

More on Colon Polyps

Everyone occasionally has heartburn. This occurs when stomach acid flows backward into the esophagus, the food pipe that carries food to the stomach. People usually experience heartburn after meals as a burning sensation or pain behind the breast bone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or milk temporarily relieves heartburn for most people.

Why Does Heartburn Occur?
To understand heartburn, let us look at the body's anatomy. The esophagus carries food and liquid to the stomach. A sphincter, or muscular valve, is located at the end of the esophagus at the border between the esophagus and stomach. Known as the lower esophageal sphincter (LES) this muscle contracts much the same as the anus does. The sphincter should maintain a certain pressure to keep the end of the esophagus closed so that stomach juices are not admitted. The LES muscle should only open when food is passed into the stomach.

However, the LES muscle does not always work perfectly. It is felt that the problem is with inappropriate, transient relaxations of this sphincter valve that result in reflux. Sphincter function can be easily overcome by a number of factors, the most common being eating a large meal. Along with swallowed air, a large meal causes an upward pressure in the stomach to rise, thereby overpowering the LES muscle. Other factors that reduce the LES pressure and allow reflux are:

• Nicotine (cigarettes)
• Fried or fatty foods
• Chocolate
• Coffee
• Citrus fruits and juices
• Peppermint
• Pregnancy
• Lying flat
• Hiatus hernia
• Certain prescription medications

Swallowing difficulty, medically termed dysphagia, can arise for a variety of reasons.  Firstly, reflux alone can disturb the muscular contraction or motility of the esophagus and interfere with the passage of liquids and solids.  Often, when reflux is controlled, these symptoms will disappear.

The inflammatory response of the esophagus from chronic reflux can lead to the formation of a ring of scar tissue at the end of the esophagus where it meets the stomach, an area know as the gastroesophageal junction (the location of the LES), that can lead to a mechanical obstruction causing difficultywith swallowing solids.  This entity is known as an esophageal ring or a Schatzki Ring.  In some cases the ring needs to be disrupted in order to resolve the blockage.

Of course with chronic reflux comes the risk of esophageal cancer and although the risk is low, it is very real.  Such tumors can cause significant blockage and bleeding.  The cancers are diagnosed most often by way of video upper endoscopy.  A person presenting with new-onset swallowing trouble, a history of reflux, bleeding, and weight loss should seek a medical evaluation immediately.

There are a variety of primary esophageal motility disorders that cause swallowing trouble.  Achalasia is a disorder that can be quite insidious and involves that loss of motility in the body of the esophagus and the lower esophageal sphincter (LES)fails to relax.  The physical presentation can look like reflux because the patient does not clear contents of the esophagus and those materials can backwash into the upper esophagus and mimic GERD. The diagnosis of Achalasia is made by way of esophageal manometry whereby the wave forms  of the esophagus are measured to make the diagnosis.  Achalasia can be treated surgically (laparoscopically) or by balloon dilation of the lower sphincter.

There are other esophageal motility disorders that can be described by esophageal manometry and they include diffuse esophageal spasm that is often associated wit noncardiac chest pain, the Nutcracker esophagus, and Ineffective Esophageal Motility.  Esophageal motility studies ( manometry) will require the passage of a small caliber tube into the esophagus through a nasal passage.  The test takes about 20-30 minutes to complete and is well-tolerated.  It is performed as an out-patient.