Save the life of someone you love.

• Are you age 50 or older?
• Have you had pre-cancerous polyps or colorectal cancer previously?
• Has either of your parents, brothers, sisters or children had polyps or colorectal cancer?
• Is there a strong extended family history of colorectal cancer (multiple aunts, uncles, first cousins, parents or grandparents)?
• Do you have a history of ulcerative colitis or Crohn's disease of the colon?
• Have you had any rectal bleeding (blood in your bowel movement)?

If you have any of the risk factors listed above or any symptoms of colorectal cancer, you should talk to your primary care physician about screening. If you do not have a primary care physician, please contact  Pen Bay Healthcare's Resource Coordinator at 1-877-596-8200 or (207) 596-8200.

You may be referred to one of the following PBMC Endoscopists for screening:

• Dr. Doug Cole, General Surgeon
• Dr. Robert Davies, General & Vascular Surgeon
• Dr. Joel Lafleur, General Surgeon
• Dr. Gordon Paine, General Surgeon
• Dr. Neil Smith, Gastroenterologist

Colorectal cancer is the second leading cause of cancer death in the United States after lung cancer. The rate of new cases and deaths resulting from this disease is decreasing because of colorectal cancer screening.

Scientific data indicates that screening is the most important thing you can do to fight colorectal cancer.

Following is a list of tests and their advantages and disadvantages.

Fecal Occult Blood Test (FOBT)

Advantages

• No preparation of the colon is necessary. Samples can be collected at home.
• Cost is low compared to other colorectal cancer screening tests.
• FOBT does not cause bleeding or tears of the lining of the colon.

• This test fails to detect most polyps and some cancers.
• False positive results are possible ("false positive" means the test suggests an abnormality when none is present).
• Dietary and other limitations, such as increasing fiber intake and avoiding meat, certain vegetables, vitamin C, iron and aspirin are often recommended for several days before the test.
• Additional procedures, such as colonoscopy, may be necessary if the test indicates an abnormality.

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Sigmoidoscopy

 Advantages

• This test is usually quick, with few complications. Discomfort is minimal.
• In some cases, the doctor may be able to perform a biopsy (the removal of tissue for examination under a microscope by a pathologist) and remove polyps during the test, if necessary.
• Less extensive preparation of the colon is necessary with this test than for a colonoscopy.

Disadvantages

• This test allows the doctor to view only the rectum and the lower part of the colon. Any polyps in the upper part will be missed.
• There is a very small risk of bleeding or tears in the lining of the colon. Additional procedures, such as colonoscopy, may be necessary if the test indicates an abnormality.

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Colonoscopy

Advantages

• This test allows the doctor to view the rectum and the entire colon.
• The doctor can perform a biopsy and remove polyps during the test, if necessary.
• This is the most sensitive test currently available.

• Thorough preparation of the colon is necessary before the test.
• Sedation is usually needed.
• There is a very small risk of bleeding or tears in the lining of the colon. 

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Double Contrast Barium Enema (DCBE)

Advantages

• This test usually allows the doctor to view the rectum and the entire colon.
• Complications are rare.
• No sedation is necessary.
• The test may not detect some small polyps and cancers.

Disadvantages

• Thorough preparation of the colon is necessary before the test.
• False positive results are possible.
• The doctor cannot perform a biopsy or remove polyps during the test.
• Additional procedures such as colonoscopy are necessary if the test indicates an abnormality.

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Virtual Colonoscopy

• Uses special x-ray equipment to produce pictures of the colon.
• Provides detailed images that can show polyps and other abnormalities.
• Is less invasive and does not require sedation.

• Thorough preparation of the colon is necessary.
• It is not possible to remove polyps or perform a biopsy during virtual colonoscopy.
• An additional procedure such as colonoscopy is needed if the virtual colonoscopy finds a potential problem.

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Genetic Testing of Stool Samples

• Testing stool samples for genetic alterations that occur in colorectal cancer cells may help doctors find evidence of cancer or pre-cancerous polyps.

• More studies are needed to determine whether this test can detect colorectal cancer or pre-cancerous polyps in people who do not have symptoms.
• An additional procedure such as colonoscopy is needed if genetic testing finds a potential problem.

Recommended Screening Guidelines

• Begin screening at age 50 with a preferred strategy of colonoscopy every 10 years.
• Flexible sigmoidoscopy followed by double contrast barium enema is an alternative if colonoscopy is unavailable or there is a long wait for the test.
• Positive fecal occult blood test should be followed by colonoscopy.

Moderate Risk:

• If there are multiple first-degree relatives with colorectal cancer, begin screening at age 40 or at 10 years younger than the youngest affected relative, and repeat every 3-5 years.
• If there is a single first degree relative with colorectal cancer diagnosed before age 60, begin screening at age 40 and repeat every 3-5 years.
• If a single first degree relative has colorectal cancer after age 60, begin screening as with average risk at age 50.

High Risk:

• Patients with inflammatory bowel disease should have a colonoscopy with biopsy every 1-3 years beginning 8 years after diagnosis.
• Patients with familial adenomatous polyposis should have flexible sigmoidoscopy beginning at age 10-12. If no polyps are found, flexible sigmoidoscopy should be done annually up to age 40 and every 3-6 years after age 40.
• In patients with hereditary non-polyposis colon cancer syndrome, colonoscopy should be done every 2 years starting at age 25, or 5 years younger than the earliest diagnosis of colorectal cancer in the family.
• Annual colonoscopy should be done after age 40.
  
  

  COLONOSCOPY IS THE GOLD STANDARD FOR COLORECTAL CANCER SCREENING
  

  WHAT IS A COLONOSCOPY?
  A colonoscopy is a visual examination of the large bowel performed by a physician specialist and a nurse. A colonoscopy is a safe and accurate way to remove colon polyps and abnormal tissue for biopsy.
  During the colonoscopy , a long, thin tube is carefully inserted into the rectum and moved through to the end of the large bowel. The tube, called a colonoscope, is flexible and lights up the inner surface of the colon to produce a visual image of the intestinal walls.

  The colonoscopy will last approximately 20-40 minutes. You will receive professional care in a hospital or an outpatient colonoscopy suite. During the colonoscopy you will be given medication to help you relax.

  If the doctor sees a polyp in the colon, he may remove it and send it to the laboratory for thorough examination.

  Afterwards you may be drowsy from the drugs. You will be instructed not to drive. It is necessary to arrange for transportation.

  A colonoscopy is used to diagnose conditions of the bowel, including:
• Ulcerative colitis
• Crohn's disease
• Diverticular disease such as diverticulosis
• Polyps
• Colorectal cancer

• Do not eat on the day of the test.
•  Drink only clear liquids on the day before the test.
• A special laxative is given the day before the test in order to cleanse the intestines.