Why are physicians not ordering annual Stool Tests?

[RyanT]

They gave me the anesthesia, I decided to count to 10 but only made it to 8, and...

Wow, I'm pretty sure I only made it to 3!

 

[drrich2]

Wow, I'm pretty sure I only made it to 3!

It was over 2 years ago; I can't remember whether I was counting to 10, or backwards from 10. It was definitely 'lights out.' And I'm glad. I didn't want to be awake and aware.

Colonoscopy and pap smears are 2 very worthwhile screenings. That's another thing I recall from all those years ago; terrible cases of advanced cervical cancer that likely could've been prevented. I came out of the general health care portion of my training with that big takeaway.

Richard.

 

[Miyaru]

What is the convention in Europe for colon cancer screening? Is it consistent across the EU?

Differs per country. Here, everybody between 55 and 75 is invited for research.

 

[Akimbo]

If you have some papers showing that the cancer develops first and then the polyp develops around it, I'd love to get the reference from you.

As I understand it, cancer cells have been found in colon walls absent of polyps, They were found after autopsies and in the relatively rare cases when portions of colon are surgically removed and carefully biopsied after non-cancer procedures. No doubt that most cancers are found in polyps because that is what gets biopsied on a regular basis. It is very hard to find what you aren't looking for.

It is a bit of chicken and egg problem. Colon cancer is relatively common but only 37.8 per 100,000. The amount of work to find the answer would require an enormous amount of time for pathologists to examine 5'/1500mm of colon of many thousands of autopsied corpses.

One of the conundrums with DNA-based early detection technology is finding cancer that isn't in a visible polyp. The problem is then what? Watch and wait? Blast some poor soul with chemo? You can't just chop out random bits of colon to send to a pathologist in the hope of finding "the" spot shedding cancer cells. One of the potential answers to this problem is Immunotherapy for colorectal cancer, which is in the early stages of research.

Diagnostic tests development has to worry about false-negatives and how to tell the difference between false-positives and true-positives that can't be easily found. My greatest respect goes to the incredibly patient scientists and bioengineers working in this field.

Here is an interesting chart of cancers in the US sorted by new cases

Cancer Type	Estimated New Cases​	Estimated Deaths​
Breast (Female – Male)	281,550 – 2,650​	43,600 – 530​
Prostate	248,530​	34,130​
Lung (Including Bronchus)	235,760​	131,880​
Colon and Rectal (Combined)	149,500​	52,980​
Melanoma	106,110​	7,180​
Bladder	83,730​	17,200​
Non-Hodgkin Lymphoma	81,560​	20,720​
Kidney (Renal Cell and Renal Pelvis)	76,080​	13,780​
Endometrial	66,570​	12,940​
Leukemia (All Types)	61,090​	23,660​
Pancreatic	60,430​	48,220​
Thyroid	44,280​	2,200​
Liver and Intrahepatic Bile Duct	42,230​	30,230​

 

[tridacna]

Differs per country. Here, everybody between 55 and 75 is invited for research.

Where is “here”?

 

[Miyaru]

Where is “here”?

Netherlands

 

[Ghost95]

Thankfully no, and this is worth highlighting. Many years ago, one of my parents was to get a colonoscopy, and had what looked to me like a roughly 1-gallon jug of 'GoLytely' - it was my understanding having to drink that was something of a miserable ordeal. After I turned 50, it was my turn and I dreaded it (but with a background in health care, I've encountered colon cancer patients and do not want to be one). I'd also in health care training witnessed colonoscopies, and picturing the physician taking that scope for a scenic 'road tour' of my colon while I felt badly constipated or some such sounded quite unpleasant and embarrassing.

Here's what I recall from the actual experience:

1.) No GoLytely.

2.) Go to Wal-mart, buy some Dulcolax and MgCitrate (flavored; I got cherry). The latter was initially okay but the taste got unpleasant with time, but not terrible, and not nearly the volume I feared with GoLytely. At some point got a home enema (wife's a nurse by training; comes in handy).

3.) I could have clear liquids and some other things that day, including these banana flavored popsicles I liked.

4.) Yes, I hit the bathroom off and on, but I wasn't parked on the throne for hours, making mad dashes to get to it, etc... I don't recall major abdominal cramping.

5.) The next morning at the hospital, at least 2 people explained that propofol was involved in Michael Jackson's fatality but I'd get much lower doses and was not expected to die. They gave me the anesthesia, I decided to count to 10 but only made it to 8, and...

6.) Next thing I knew my wife was shaking me awake in the recovery room after the procedure. After effects were apparently mild; I don't recall any major problems.

My case is one anecdote, your mileage may vary. It wasn't my idea of a fun day (I love to eat), but it wasn't some ordeal to dread, either.

Your experience sounds just like my second one and my wife's first. My first was the GoLytley. Even it wasn't that bad other than I froze. I was told to get the solution cold. I did and then started the process.

You drink this cold liquid, your body warms it up, and then you dump the heat and repeat. I dropped into mild hypothermia and started taking warm showers between "sittings" to try and say comfortable.

For a few years there was a 1 or 2 pill prep. My mom did that and ended up in the E-room. Apparently it dropped her potassium level (maybe calcium in not sure) but it got her heart rhythms messed up. I don't think they use that anymore. And they recommend Gatorade to keep electrolytes balanced.

As far as anesthetic, I love the propofol. I feel the light burn at the injection site, feel it hit my heart and start to move through my system, get a smile on my face, tell the nurses that I'm on my way out, and then wake up done. No problem

 

[NW Dive Dawg]

I did not even take the time to read this entire thread. Bottom lime..... Get a Colonoscopy. It's not a big deal and is a far better option to save your life.

 

[SandyRobinson]

What - you don’t have to use GoLytely (aka Poop Muchly) anymore? Had to use that godawful stuff for surgery in the early 2000s.

I had my last one in January. Other than a light diet two days before and a clear liquid diet one day before, the main prep was 12 large white pills around 6pm with a lot of water followed by another 12 pills at 10PM with a lot of water. Was the easiest prep I have had.

 

[Marie13]

Colonoscopy and pap smears are 2 very worthwhile screenings. That's another thing I recall from all those years ago; terrible cases of advanced cervical cancer that likely could've been prevented. I came out of the general health care portion of my training with that big takeaway.

And mammograms aka getting your boobs squished. I don’t lack in that department, but the stories of my less-well endowed friends involve lots of pain. Ugh. Lots of painful stretching.