Colonoscopy was fine the year before, but colon cancer was detected this year! How often do you need insurance for a colonoscopy?
How long can colonoscopy be safe?
With the improvement of the awareness of early diagnosis and early treatment, colonoscopy has also become a hot spot of everyone’s attention. It is said that a colonoscopy can protect against colon cancer for 10 years. Is this true?
Just after the new year, an old man in the outpatient clinic was admitted to the hospital because of frequent blood in the stool. The family members were puzzled and said that the old man just had a colonoscopy the year before and everything was fine, but he had frequent blood in the stool a few months ago and thought it was hemorrhoids, so he didn’t care. Doesn’t it mean that a colonoscopy can be guaranteed for 10 years? Why was it okay the year before, but bowel cancer was diagnosed this year?
At this time, another patient also echoed, me too, I only had a colonoscopy for 5 years, and found that the polyps had been removed, how could I still have colon cancer? Anything that is guaranteed for 10 years is fooling people!
Isn’t a colonoscopy guaranteed to keep you healthy for 10 years? What happened to these two patients? How often do you need insurance for a colonoscopy?
Why do you say that a colonoscopy can keep you healthy for 10 years?
It is generally believed that 95% of colorectal cancers evolve from colorectal polyps (adenomatous) step by step. The general growth process is as follows:
Polyp→small adenoma→large adenoma→low-grade intraepithelial neoplasia→high-grade intraepithelial neoplasia→early adenocarcinoma→advanced adenocarcinoma
This process is very long, at least 10 years, or even 20 or 30 years, depending on individual differences. That is to say, the predecessor of bowel cancer is intestinal polyps, so cutting out the intestinal polyps is equivalent to dismantling the ticking time bomb and strangling it in the bud.
A recent study in the Annals of Internal Medicine showed that, in non-high-risk groups, a negative colonoscopy result was associated with a reduction in colorectal cancer incidence and mortality for 17.4 years, but only a high Only quality colonoscopy can produce this ” profound and stable” effect.
The results of this study of 165,000 people suggest that the currently recommended 10-year interval for colonoscopy screening is safe.
Professor Li Zhaoshen, an academician of the Chinese Academy of Engineering, once said: “If you are over 45 years old and have not had a colonoscopy, you must have a colonoscopy before the end of the year. After a colonoscopy, you will be fine for five or ten years. Colorectal cancer.”
Do you understand? There are two prerequisites for a colonoscopy to ensure safety for 10 years.
First, high-quality colonoscopy, which includes bowel preparation, the quality, and experience of doctors, equipment, etc., that is to say, this colonoscopy must be guaranteed not to be missed;
Second, it is aimed at non-high-risk groups, that is, non-high-risk groups with no polyps or only benign polyps and no adenomas. Because for newly grown adenomatous polyps that can cause cancer, it generally takes 5-10 years from adenoma to cancer, that is to say, the first colonoscopy is no problem, and there is generally no major problem after 10 years.
Why were these two patients diagnosed with cancer in a short period after a colonoscopy?
patient one
The first patient, a 67-year-old male, underwent his first colonoscopy at the age of 66. No obvious abnormality was found at that time, but less than a year later, the patient was diagnosed with right colon cancer.
A study abroad confirmed that about 6% of patients who received health checks were diagnosed with colorectal cancer within 3 to 5 years of colonoscopy. These cancers may go unnoticed during colonoscopy or develop rapidly after colonoscopy.
The study found that this group of people has the following characteristics:
First, it occurs more in people over the age of 65, with a family history of colorectal cancer, and in patients with previously discovered polyps;
Second, the missed bowel cancer generally occurs in the right side of the colon. This is because cancers on the right side of the colon are often biologically different from cancers elsewhere in the colon, due to the different types of polyps. These types of polyps are flat and grow faster, which may explain why they are often not seen during colonoscopy and why cancer can develop even without polyps.
Therefore, experts recommend starting colonoscopy for the first time in people aged 40 years and older in the general population, followed by colonoscopy every 10 years to screen for colorectal cancer, and colonoscopy every 5 years in high-risk groups. In addition, both patients and physicians need to recognize the limitations of colonoscopy to improve the use of colonoscopy and the ability to detect polyps.
patient two
Patient 2 underwent colonoscopy in the spring of 2015 and found 4 polyps ranging in size from 0.3 to 0.8 cm. Pathology showed that some of them were villous tubular adenomas, which were excised under endoscopy. The doctor warned him that this is a polyp that is easy become cancerous. It is relatively large and easy to recur. It must be reviewed regularly.
However, after the excision, this patient took the doctor’s words to a deaf ear. He did not re-examine for four years until he felt uncomfortable. Who knew that it was already cancerous, but fortunately it was still early cancer, and the pathology showed that it was high-grade intraepithelial Neoplasia (intramucosal cancer) that can be removed by colonoscopy.
Therefore, colonoscopy is not done once and for all. Again, please pay attention to the following points:
First of all, adenomatous polyps are prone to recurrence, or growing new ones;
Second, if the first excision is not complete and residues remain, it may be revived;
Third, the intestinal structure is complex, with many folds, and some small ones may be blocked;
Fourth, because the colonoscopy needs to be inflated after the intestinal lumen is stretched, some small polyps will be flattened and difficult to find;
Fifth, not everyone’s bowel preparation is clean and ideal, and substandard bowel cleanses, and feces may just cover the bad guy.
Therefore, only a high-quality colonoscopy can ensure 10 years of safety. Also, although it takes 5-15 years for an adenoma to become cancerous, this is just big data, but some individuals will develop very quickly, and even become cancerous in three to five years. Therefore, once it is detected that it is an intestinal adenomatous polyp, you must remember to review it as often as the doctor says.
How often should colonoscopy be performed?
Different populations have different intervals for colonoscopy.
Clinically, the review time is usually determined according to the results of colonoscopy pathological examination, completeness of resection, bowel preparation, health status, family history of polyps, and past medical history;
1. If there is no growth or inflammatory polyps, and there is no other abnormality, you can do it again in 5-10 years;
2. For low and medium-risk polyps (non-adenomatous polyps, low-risk adenomas), the review time after resection is recommended to be within 1 to 3 years; single polyps removed and pathologically proven to be benign, only need to be checked once a year at the beginning Colonoscopy can be checked for 2-3 consecutive years without recurrence, and then it can be changed to check every 5-10 years.
3. For the following situations, it is recommended to review a colonoscopy within 3 to 6 months in a short period
(1) Poor bowel preparation, which affects the inspection field of view;
(2) Those who failed to complete the full colon examination last time due to various reasons;
(3) The total number of polyps removed at one time exceeds 10;
(5) Fractional excision of broad-based polyps larger than 1 cm;
(6) Villous polyps larger than 1 cm with severe dysplasia;
(7) The polyp has been locally cancerous and has not reached the submucosal layer or is beyond the mucosal layer and is unwilling to undergo additional surgical resection.
(8) If there is a history of colon polyps or a family history of patients, the frequency of re-examination should also be increased, such as once a year after the age of 45.
(9) For familial adenomatous polyposis, it is necessary to start screening for colorectal cancer around the age of 10 to 12 years, and perform colonoscopy every year to record the number and size of polyps, and remove polyps as soon as possible.
(10) Inflammatory bowel disease: It is recommended to start colonoscopy after 8 years of illness, every 1-3 years.
(11) Patients after colorectal cancer surgery: Colonoscopy must be done 1-2 times within one year after colorectal cancer surgery. Subsequent colonoscopy should be performed every 3-5 years based on the results of the examination, or as directed by a physician.
