Colon Cancer Screening: Is it too late?

Submitted by Barb Sapa, RN | CliniCare, Cavalier, ND

Has colon cancer screening been something you’ve been meaning to talk to your patients about? Many people have put off necessary and recommended health screenings over the past couple years, especially due to the COVID pandemic. Another reason for putting off colon cancer screening is expense related to screenings. Now more than ever, insurance plans are starting to cover basic colon cancer screenings, which is great news! Another great option for those who are underinsured or not insured is having them apply for screening coverage through the North Dakota Colorectal Cancer Screening Initiative (NDCRCSI). If the patient meets the age and income criteria, they could have their colorectal cancer screening completely covered. There’s no time like the present to talk about cancer screenings and criteria for screening. There are several options for screening for colon cancer such as FIT/iFOBT, Cologuard, or colonoscopy.

The American Cancer Society released new guidelines in May of 2021 to start screening for colon cancer at age 45. Previous guidelines suggested screening start at age 50. One of our clinic patients is especially thankful for the various screening options.

This patient made an appointment with her primary care provider for an annual physical. When she saw the provider, the provider reviewed the patient’s health maintenance items with her and discovered the patient hadn’t had any prior colon checks and met the age criteria for colorectal cancer screening. The patient’s past medical history included hyperlipidemia, type 2 diabetes, hyperthyroidism and nicotine dependence. She was determined to be of average risk for colon cancer because she had no personal or family history of colon cancer or polyps. Education was provided on the different colon cancer screening test options, and the patient chose to do a Cologuard test.

The patient completed the Cologuard test and unfortunately received a positive test result. The patient made a follow up appointment with the ordering provider. A referral was placed for the patient to undergo a follow-on colonoscopy. During the colonoscopy, the surgeon discovered colon polyps measuring 20-25 mm. The polyps were removed and sent to pathology. The pathology report revealed a diagnosis of focally invasive well-differentiated adenocarcinoma arising in a tubular adenoma with low-grade and high-grade dysplasia. The patient also had additional tubular adenomas as well. This diagnosis indicates high risk for the patient as far as how fast it grows and if the cancer would spread.

The patient was referred to a surgeon to discuss treatment options. The patient and the surgeon planned for a laparoscopic assisted low anterior colon resection with stapled circular end-to-end anastomosis. The procedure went well, but the surgeon remarked the patient is now considered a high risk for cancer return, and therefore, will need annual colonoscopy tests to monitor.

Since having a colon resection, the patient had a repeat colonoscopy. The surgeon removed two polyps in the transverse colon measuring 4-5 mm in size and were sessile in nature, and two similar polyps from the descending colon. There were a few polyps removed in the patient’s rectum as well. All the polyps were sent off to pathology for review and analysis. The pathology report indicated no further residual malignancy.

The patient will continue to have yearly colonoscopies, and stated, “I am so thankful there are tests such as Cologuard out there for colon cancer.” The outcome could have been a lot worse had she not tested when she did. She said, “I was not wild about the idea of getting a colonoscopy, but considering what the possible outcome would have been, it’s a small price to pay to have peace of mind.”

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