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Colon cancer screening

Colon cancer is one of the leading causes of cancer-related deaths in the United States. The good news is that earlier diagnosis due to screening tests often leads to a complete cure. Colorectal cancer starts in the large intestine, also known as the colon. Nearly all colon cancers begin as noncancerous, or benign, polyps, some of which may slowly develop into cancer.

Screening can detect these polyps and early cancers. Polyps can be removed years before cancer even has a chance to develop.

Your doctor can use two types of tools to screen for cancer. The first type is a stool test. Polyps in the colon and small cancers can bleed tiny amounts of blood that you can't see with the naked eye. The most common method to test for the presence of blood is the fecal occult blood test or FOBT. This test checks your stool for small amounts of blood that you may not be able to see. Two other stool tests are the fecal immunochemical test and the stool DNA test.

The second type of screening tests involve looking at the lining of the colon. One of these tests is a sigmoidoscopy exam. This test uses a flexible scope to look at the lower portion of your colon. But, because it looks only at the last one-third of the large intestine, it may miss some cancers. So this test is done along with a stool test. A colonoscopy is similar to sigmoidoscopy, but it can see the entire colon. For this test, your doctor will give you instructions for cleansing your bowel. This is called bowel preparation. During the colonoscopy, you’ll receive medicine to make you relaxed and sleepy.

Another test your doctor may recommend is a virtual colonoscopy, also called a CT colonography. This test uses a CAT scan and computer software to create a 3-D image of your large intestine.

Beginning at age 45, all men and women should have a screening test for colon cancer. Screening options for people with average risk for colon cancer include visual based exams.

These could be a colonoscopy every 10 years starting at age 45 or a virtual colonoscopy every 5 years. A Flexible sigmoidoscopy every 5 years or a Flexible sigmoidoscopy every 10 years plus stool testing with FIT done every year.

Screening options also include stool based tests. People with average risk should have an FOBT or FIT every year. A colonoscopy is needed if the results are positive, or a Stool DNA test every 1 to 3 years. A colonoscopy is needed if the results are positive.

People with certain risk factors for colon cancer may need screening at a younger age, or they may need screening more often. Such people include those with a family history of colon cancer, those with a history of previous colon cancer or polyps, or people with a history of ulcerative colitis or Crohn disease.

The death rate for colon cancer has dropped in the past 15 years and this may be due to increased awareness and colon screening. In general, early diagnosis is much more likely to lead to a complete cure.

Colon cancer screening

Review Date: 8/1/2023

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 04/18/2023. Internal review and update on 08/01/23 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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