Caring for your colon – what to look out for and what tests you might need

Have you noticed a change in your bowel habit or blood in your stools? 

It is important to be aware of the symptoms that should prompt further testing to check the colon. Tests will tell you why your symptoms have occurred and look for colon polyps or other growths, as well as a condition known as diverticular disease. This condition can cause lower abdominal pain and blood in the stools. Several countries have started screening programmes for colon cancer, however many people still get diagnosed with cancer outside of these programmes so awareness of the symptoms is important.

Some of the symptoms to look out for include:

  • a change in your usual bowel habit (going more or less often)
  • blood in the stools or on the toilet paper
  • mucus or slime mixed with the stools

Another reason to have a test is if your blood count is low because of a lack of iron (iron deficiency anaemia). In this case it is important to check if there is a polyp or growth in the colon bleeding slowly and causing the anaemia.

Figure 1
A 3D map of the colon generated during a CTC test – this is possible because of the air that is put in.

The two main types of test are:

1.  A camera test, optical colonoscopy (OC)

2.  A scan, CT colonogram (CTC)

Recent research has shown that a CTC is as good as an OC for diagnosing important growths in the colon, and also offers some advantages over OC. In a CTC scan, air is gently put into the bowel and a scan of the whole of the abdomen and pelvis is taken. The colon is then examined by the radiologist on the CT scan images.

Here are 5 important facts to know about CTC:

#1 Scan Preparation

The preparation for CTC is lighter and better tolerated by patients than the preparation for an OC. Many centres are now moving to a “minimal” or “light” preparation protocol, and some only use a type of medication called Gastrografin. This is an x-ray dye agent which mixes with the stool and “paints” it so it appears bright on the CT scan. Small pieces of stool can then be distinguished much more readily from polyps. Using this process means that your life isn’t disrupted as much, either on the day before or the day of the scan. An OC requires the bowel to be completely empty, so the preparation causes diarrhoea. This occurs far less with the Gastrografin preparation for a CTC.

#2 Comprehensive Scan

Figure 2
The arrows point to a polyp in the colon, seen outlined by some white fluid – this is Gastrografin which many centres are using as the only preparation for CTC.

As well as the bowel, a CTC can examine all of the other structures inside the abdomen – the organs such as the liver, kidneys and pancreas, the blood vessels, and the lymph nodes. This is important if you have pain as it could be coming from an abnormality in one of these other structures rather than the bowel – this can’t be assessed with an OC.

#3 Greater Patient Safety

It is a safe test to have – the rate of perforation or puncture of the bowel as a result of a CTC is 1 in 2500-5000 procedures, with only 1 in 12500 patients requiring surgery as a result.

#4 A Complete Picture

The whole of the colon can be assessed with a CTC, whereas with an OC sometimes the endoscope cannot be passed through narrowed areas in the colon, or the endoscope cannot reach the end of the colon because it is tortuous. In these cases, a CTC is requested as a second test.

#5 OC for Biopsy

Figure 3
A 3D image of a polyp generated from a CTC scan – the data from the scan can be processed by special software to generate a “virtual” colonoscopy picture that looks like an OC picture.

If a colon polyp or other growth is seen, then an OC would be necessary to take a biopsy as this is not possible with a CTC. However, the vast majority of patients do not need to go on to have an OC as a diagnosis can be provided with the CTC.

If you have any of these symptoms or are concerned about getting your colon checked, it is important to go and have a chat with your doctor first – a detailed history and examination will help you and your doctor to decide which tests you may need.

 

However, if you’re not completely happy with your initial diagnosis be aware that you can seek a second medical opinion? Diagnose.me is a specialist online health platform, which connects patients seeking a second opinion with some of the world’s leading specialists. They will find, confirm or correct a patient’s diagnosis from their X-Ray, CT, PET-CT, ultrasound or MRI scans.


References:

[1] http://www.ncbi.nlm.nih.gov/pubmed/23414650

[2] http://www.ncbi.nlm.nih.gov/pubmed/19626326

[3] http://www.ncbi.nlm.nih.gov/pubmed/20959977

[4] http://www.ncbi.nlm.nih.gov/pubmed/24816935

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