Conditions that call for<unk> es include gastrointestinal hemorrhage, unexplained changes in bowel habit and suspicion of malignancy.<unk> es are often used to diagnose colon cancer, but are also frequently used to diagnose inflammatory bowel disease. In older patients (sometimes even younger ones) an unexplained drop in hematocrit (one sign of anemia) is an indication that calls for a<unk> , usually along with an esophagogastroduodenoscopy (EGD), even if no obvious blood has been seen in the stool (feces). Fecal occult blood is a quick test which can be done to test for microscopic traces of blood in the stool. A positive test is almost always an indication to do a<unk> . In most cases the positive result is just due to hemorrhoids; however, it can also be due to diverticulosis, inflammatory bowel disease (Crohn's disease, ulcerative colitis), colon cancer, or polyps. Colonic polypectomy has become a routine part of<unk> , allowing quick and simple removal of polyps during the procedure, without invasive surgery. Colon cancer screening<unk>  is one of the colorectal cancer screening tests available to people in the US who are 45 years of age and older. The other screening tests include flexible sigmoidoscopy, double-contrast barium enema, computed tomographic (CT) colongraphy (virtual<unk> , guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multitarget stool DNA screening test (Cologuard). Subsequent rescreenings are then scheduled based on the initial results found, with a five- or ten-year recall being common for<unk> es that produce normal results. People with a family history of colon cancer are often first screened during their teenage years. Among people who have had an initial<unk>  that found no polyps, the risk of developing colorectal cancer within five years is extremely low. Therefore, there is no need for those people to have another<unk>  sooner than five years after the first screening. Some medical societies in the US recommend a screening<unk>  every 10 years beginning at age 50 for adults without increased risk for colorectal cancer. Research shows that the risk of cancer is low for 10 years if a high-quality<unk>  does not detect cancer, so tests for this purpose are indicated every ten years.<unk>  screening prevents approximately two-thirds of deaths due to colorectal cancers on the left side of the colon, and is not associated with a significant reduction in deaths from right-sided disease.<unk>  reduces cancer rates by detecting some colon polyps and cancers on the left side of the colon early enough that they may be treated, and a smaller number on the right side; many of these left-sided growths would have been detected by a sigmoidoscopy procedure. Since polyps often take 10 to 15 years to transform into cancer in someone at average risk of colorectal cancer, guidelines recommend 10 years after a normal screening<unk>  before the next<unk> . (This interval does not apply to people at high risk of colorectal cancer, or to those who experience symptoms of colorectal cancer.) Although widely touted in the US as the "gold standard" of colon cancer screening,<unk>  has never been studied as a screening tool. Most of the potential benefits of<unk>  have been extrapolated from randomized trials of the sigmoidoscopy. The CONFIRM trial, a randomized trial on<unk>  vs. FIT is currently ongoing. Recommendations The American Cancer Society recommends, beginning at age 45, both men and women follow one of these testing schedules for screening to find colon polyps and/or cancer: # Flexible sigmoidoscopy every 5 years, or #<unk>  every 10 years, or # Double-contrast barium enema every 5 years, or # CT colonography (virtual<unk>  every 5 years # Yearly guaiac-based fecal occult blood test (gFOBT) # Yearly fecal immunochemical test (FIT) # Stool DNA test (sDNA) every 3 years Medicare coverage In the United States, Medicare insurance covers the following colorectal-cancer screening tests: #<unk> : average risk — every 10 years beginning at age 50, high risk — every 2 years with no age restriction # Flexible sigmoidoscopy — every 4 years beginning at age 50 # Double-contrast barium enema: average risk — every 4 years beginning at age 50, high risk — every 2 years # (CT) colongraphy: not covered by Medicare # gFOBT: average risk — every year beginning at age 50 # FIT: average risk — every year beginning at age 50 # Cologuard: average risk — every 3 years beginning at age 50
Colonoscopy
Proctoscopy
Sigmoidoscopy
GI cocktail
Defecography
Capsule endoscopy
Chromoendoscopy
Colonic polypectomy