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It May Be High Time for Colonic Impressions
Colon Cancer Check:
Fecal Occult Blood Test (FOBT)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 17 in the March 2, 2011 issue of
The Mississauga News under the feature: Health & Beauty, Medical Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

If you are over 50 years of age, you probably have done the dirty deed. After weeks of staring at that white envelope we gave you, you decided to lock yourself in the washroom, and sheepishly open it, wondering what wisdom will result?

Aftershocks of repeatedly looking at the instructions settle down and you decide it is in the best interest of mankind that you contribute a stool sample to the government cause. You carefully transfer and smear, gritting your teeth all the way, hopefully wash your hands, lick the envelope and send it off, postage paid. One less thing to get nagged about, right? Not so. The call comes a few weeks later informing you have failed your stool test. How low can your self-esteem go? Your physician sits down and reviews all the things a false-positive entails and reminds you that a false-negative is even worse, and presto, you now find yourself the proud recipient of a jack-pot ticket in the colonoscopy line.

You managed to do the smear test, so how bad can the prep that the hockey guys talk about be? After all it’s only quality time on the throne with a chance to catch up on the amassing reading material. The colonoscopy comes and goes, piece of cake, and the gastroenterologist tells you that it’s only a small polyp and thank goodness for that. His skillful flare and charming wit took care of the problem and now it’s gone, so now what?

Well, as more of these cases accumulate, a growing knowledge base of what to do next is slowing amassing. The first thing to remember is that not all polyps are the same. There are three different sub-types of polyps. Most, or about 90% are called “Hyperplastic Polyps”. These are non-cancerous and are simply normal looking tissue in large clumps, but they do have a chance to progress given a large expanse of time. Less than 1% of polyps are hamartomatous inflammatory polyps which look bad, but are non-cancerous. The other 10% are pre-cancerous Adenomas. These are divided in one of: tubular, villous or tubulo-villous. Patients with adenomatous polyps were watched a lot more carefully for progression to cancer.

What is rather new on the front-lines is taking a closer look at those supposedly normal looking Hyperplastic polyps. Many of them turned out to be “serrated”. This means, they seemed flat but had numerous little branches. It was noticed that this type of polyp tends to occur in genetic bowel cancer type and now there is more attention paid to finding, diagnosing and removing these types. Colonoscopy is an art that involves skillful operators teamed up with attentive pathologists.

At the end of the day, you may be advised to have another colonoscopy sooner than the 5 to 10 year interval currently in use. This interval is the result of research that shows the slow transition time for polyps to transform and takes into account a slow progression of polyps into colon cancer. So, if you are over 50, or have a younger relative with colon cancer, it is high time to get the dirty deed done.

Related resources:

Dr. Linda Rabeneck speaks on Colorectal Cancer. Watch a video (4:11 min.) by Dr. Linda Rabeneck as she explains what colorectal cancer is, who should be screened for it and why.

This Smudge Is for Health (Fecal Occult Blood Test - FOBT) by Dr. Peter W. Kujtan.

Fecal Occult Blood Test (FOBT) from WebMD. "A fecal occult blood (FOBT) test finds blood in the stool by placing a small sample of stool on a chemically treated card, pad, or cloth wipe. Then a special chemical solution is put on top of the sample. If the card, pad, or cloth turns blue, there is blood in the stool sample."

Fecal Occult Blood Test (FOBT) from MedlinePlus. FOBT Instructions Sheet available in these languages: English, French, Arabic, Chinese (Simplified), Chinese (Traditional), Croatian, Farsi, German, Greek, Gujarati, Hindi, Hungarian, Inuktitut, Italian, Korean, Ojibwe, Polish, Portuguese, Punjabi, Russian, Serbian, Somali, Spanish, Tagalog, Tamil, Ukrainian, Urdu, and Vietnamese.

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