Screening and Surveillance for Colorectal Cancer Expanded Version

Colorectal cancer is a common malignancy for both men and women.  Screening for colorectal cancer is the process of identifying apparently healthy people who may be at increased risk of developing this disease. This information was prepared to help patients understand the screening options for colorectal cancer; specifically, recommendations for the age to start, interval between tests, and the various modalities that are used. It may also be useful to the friends, families, and caregivers of patients making decisions about colorectal cancer screening.

Properly done, screening for colorectal cancer saves lives. It is an ideal disease for which to provide screening, since there is an identifiable and treatable pre-cancerous condition – the polyp. Removing a pre-cancerous polyp prevents the development of colorectal cancer.  In addition, if found early, colorectal cancer may be cured in up to 90% of cases.

Screening is for people without symptoms. Patients who experience rectal bleeding, changes in their bowel habits, abdominal pain, or unexplained weight loss should seek medical attention, even if they are currently following current screening guidelines.

Patients who are considering screening for colorectal cancer need information about:

WHAT IS THE RISK OF COLORECTAL CANCER?

According to the National Cancer Institute, there were over 140,000 new cases of colorectal cancer and over 51,000 deaths in 2011. It is estimated that the lifetime risk of developing colorectal cancer is about 1 in 20. The risk is similar for men and women. In men as a whole, it is the third most common non-skin cancer, behind prostate and lung cancers. In Hispanic men, colorectal cancer is more common than lung cancer. For all women, it is also the third most common, behind breast and lung cancers, but is second in women of Hispanic or Asian/Pacific Islander descent.

Some people are at a slightly higher risk for colorectal cancer due to their personal or family characteristics. Patients who have had prior pre-cancerous polyps or a cancer are at an increased lifetime risk of developing more polyps or another cancer. Close relatives (parents, siblings, children) of patients with colorectal cancer OR polyps have a two- to three- fold increased risk of developing colorectal cancer or polyps, depending on the number of affected relatives.

Certain people have a significantly higher risk of developing colorectal cancer. Familial Adenomatous Polyposis (FAP) is an uncommon inherited condition which typically causes hundreds of polyps in the colon. Patients with this condition have an almost 100% chance of developing colorectal cancer, usually before age 50.

Hereditary Non-Polyposis Colon Cancer (HNPCC) is another uncommon inherited condition, characterized by colorectal cancers in multiple family members, some of which may occur at an early age. Cancers involving the kidney, uterus, ovary, or bladder may also be seen in families with this condition. It is estimated that the risk of colorectal cancer is about 70% by age 65 in affected individuals.

Other genetic diseases such as MYH (MYH-associated polyposis or MAP) and the attenuated form of FAP also are associated with a much higher lifetime risk of developing colorectal cancer.  Genetic testing and counseling is available for each of these.

Patients with inflammatory conditions of the colon, such as Crohn’s disease or ulcerative colitis, have an increased risk of colorectal cancer as well. This is related to the extent, duration, and severity of the inflammation, with patients who have severe colitis involving the whole colon for more than ten years at the greatest risk. Other more common conditions such as hemorrhoids, diverticulosis and irritable bowel disease do not increase the risk of colorectal cancer.

WHAT IS THE BENEFIT OF COLORECTAL CANCER SCREENING?

Like other serious, common medical problems such as high blood pressure and diabetes, colorectal cancer is considered to be a “silent disease” in its early stages. Large studies done both in the United States and in Europe have shown that routine colonoscopy with the removal of polyps may reduce the incidence of colorectal cancer by about 75%.          

In addition to finding and removing polyps, screening can aid in the detection of early, asymptomatic cancers that are associated with higher rates of cure. Up to 90% of these early cancers can be cured, but once symptoms develop, cure rates fall to less than 50%. According to the Centers for Disease Control, both the incidence and death rate for colorectal cancer has fallen by about 3% in all populations from 1999 to 2008. It is estimated that over 50% of this reduction is due to increased screening efforts.

Unfortunately, not everyone receives proper screening. Although most screening modalities are now covered by insurance or Medicare, up to half of the population is not current on the appropriate tests. The rate of screening varies widely by location, race, or socioeconomic factors.

WHAT SCREENING TESTS ARE AVAILABLE?

Fecal occult blood testing (FOBT) uses either a chemical reaction or antibodies to detect very small amounts of blood in stool that may have been shed from a cancer or polyp. Usually two samples are taken from three consecutive stools at home and are placed on collection cards. These are then returned to the ordering physician or lab for analysis. Short-term changes in diet may be needed around the time the samples are collected to prevent falsely positive results. Well-done large studies have shown that when properly administered to patients between 50 and 80 years of age, FOBT will reduce the risk of death from colorectal cancer by 15-33%.

The advantages of FOBT are that it is inexpensive and non-invasive; bowel cleansing and sedation are not required. Disadvantages include its low specificity (low likelihood a positive test indicates the presence of cancer) – only about 2-5% of patients with a positive FOBT actually have cancer. Additionally, it is not very sensitive (the test identifies a cancer if it is present); about half of all colorectal cancers can be detected by this method, but only 10% of patients with pre-cancerous polyps will have a positive test. Positive tests require another procedure, typically a colonoscopy.

Flexible sigmoidoscopy uses a thin, flexible tubular instrument to give magnified views of a patient’s large intestine (colon and rectum).  It allows the doctor to examine the lower third of the colon and the rectum directly and to take samples of abnormal areas for testing in the lab. The colon and rectum are cleansed with a liquid diet and enemas given shortly before the procedure, which is commonly done in an office without sedation. The procedure itself is short and causes minimal discomfort.

Flexible sigmoidoscopy has been shown to be highly effective in detecting polyps in the area viewed and is an effective method, especially when paired with FOBT, to reduce colorectal cancer mortality. The main advantages are its short duration, the ability to take samples, and the lack of significant discomfort. A rigorous bowel cleansing and sedation are also not required, allowing patients to resume normal activities immediately afterwards. Disadvantages include the inability to see the whole colon, making a follow-up colonoscopy necessary for patients who have a polyp found on flexible sigmoidoscopy. There is also a small (2 per 10000 patients) risk of causing a tear in the colon wall or significant bleeding.
image1_1.gif

Colonoscopy is similar to flexible sigmoidoscopy, but the entire colon is examined. A colonoscope is a long, thin, flexible tubular instrument that provides magnified views of a patient’s large intestine (colon and rectum). Abnormal areas can be sampled or removed completely, depending on their size. As this is a more extensive test, a thorough cleansing of the bowel is required. Patients undergoing colonoscopy are typically sedated, so they need someone to drive them home upon completion; normal activities can be safely resumed the next day. Colonoscopy is often considered the “gold-standard” screening test, as it allows for both detection and removal (or sampling) of polyps and cancers.

The advantages of colonoscopy are the ability to examine the whole colon and to sample or remove abnormal tissue. Disadvantages include the need for a more thorough bowel cleansing and sedation and the need to stop certain medications, especially blood thinners such as aspirin, warfarin or clopidogrel. Complications of colonoscopy are rare (1 per 1,000 procedures), but are potentially life-threatening. The rate of colonic rupture ranges from 0.6 per 1,000 for colonoscopy alone, to 7.0 per 1,000 if samples are taken or a polyp is removed. Significant bleeding can occur in up to 8.7 per 1,000.

Barium enema is an x-ray test that allows examination of the lining of the colon. In screening for colorectal cancer, a double contrast barium enema (DCBE) is used. After a thorough bowel cleansing similar to that used for colonoscopy, barium (a substance that x-rays do not pass through) and air are introduced into the colon via a small catheter that is placed in the rectum to help display the outline of the colon and show polyps or cancers. Multiple pictures are taken with the patient in various positions; sedation is not required. Some cramping during the procedure is normal and patients may resume normal activities immediately upon completion. DCBE is not as good as colonoscopy at finding polyps or cancer. The main advantage of DCBE is that sedation is not required. Disadvantages include a small risk of perforation (<1%), x-ray exposure, less sensitivity, and the need for a thorough colon cleansing. Additionally, if abnormalities are seen, a colonoscopy is then required.

Computed tomographic colonography (CTC, previously called ‘virtual colonoscopy’) uses a CT scan to make images of the lining of the colon that appear similar to views seen during standard colonoscopy. This test usually requires the same type of thorough bowel cleansing needed for colonoscopy. Sedation is not given, but an IV may need to be placed for drug or contrast administration and air or carbon dioxide is introduced into the rectum, which can cause cramping. Normal activities can be resumed immediately after the scan. Several studies in multiple institutions show that CTC detects 85-90% of polyps, which compares to standard colonoscopy. CTC has not been specifically studied as a colorectal cancer screening tool for average risk patients.

The primary advantage of CTC is its ability to accurately visualize the entire lining of the colon in a non-invasive manner, reducing the risk of bleeding, perforation, or sedation side-effects. The main disadvantage is the need for a follow-up colonoscopy if abnormalities are detected.

Another confusing issue in CTC is finding unexpected abnormalities outside of the colon, such as other cancers or blood vessel problems. While this may appear to be an advantage, studies have shown that CTC generates the need for further testing 6-24% of the time. These additional tests lead to extra worry and expense, but yielded few significant findings. For example, 118 of 2,869 women undergoing CTC were found to have a potential mass of the ovary; 80 had further testing, but no ovarian cancers were found.

DNA is the hereditary material in human cells. Colorectal cancers, and to a lesser extent polyps, shed DNA into the stool, where it can be analyzed for changes that occur as cancer develops. A whole bowel movement must be collected and shipped on ice to the lab. Studies have shown that this test can detect cancers (53%) and advanced polyps (18%), but at a rate far below colonoscopy. Given its cost and sensitivity, it is not currently recommended for routine screening. Several blood tests have recently been investigated as well, but none yet rise to the accuracy level needed for use as a screening tool.

WHAT ARE THE RECOMMENDED STARTING AGES AND FREQUENCY FOR SCREENING TESTS?

For average risk individuals, screening should start at age 45.* This is based on the rate of colorectal cancer in varying age groups, which begins to rise significantly after age 50. Studies have shown that this rise in cancer starts at an earlier age in African-Americans.

Of the screening methods discussed above, FOBT should be done yearly, along with a flexible sigmoidoscopy every 5 years. If colonoscopy is chosen, then it should be done every 10 years if the initial examination was normal and no new symptoms develop. DCBE or CTC is recommended every 5 years and may be useful in patients who cannot tolerate colonoscopy or have an incomplete study.

Several large studies have concluded that the risk of developing a colorectal cancer after an initial normal colonoscopy is very low, at ranges of 11 -14 years. This supports the recommendation for every 10 year screening without the need for additional testing in between screening colonoscopies. Screening remains important for average risk patients; only about a quarter of all colorectal cancers occur in patients with identifiable factors that increase their risk.

Screening should begin earlier in people with a family history of colorectal cancer or polyps. It is important for patients and health care providers to recognize that the presence of pre-cancerous polyps in the family history is just as significant as a history of an invasive cancer. These individuals should begin at 40, or at an age 10 years before the youngest relative was diagnosed with either cancer or polyps. The guidelines above should be followed for intervals between tests.

People with multiple family members with colorectal, urinary tract (kidney or bladder), or gynecologic (uterus or ovary) cancers, especially if these cancers occurred at an early age, may have a condition called hereditary non-polyposis colorectal cancer. They should undergo genetic testing and counseling; colonoscopy every 1-2 years beginning at age 20-25 is recommended.

People with an inherited condition called familial adenomatous polyposis have an extremely high risk of colon cancer; their close relatives should undergo genetic testing and counseling. If genetic testing conclusively shows that they do not have the affected gene, then they can begin screening like average risk people. If the gene test is positive, inconclusive, or not done, then flexible sigmoidoscopy should be done yearly starting at puberty.

There is no clear recommendation on the upper age at which screening for colorectal cancer should stop. Current guidelines suggest regular screening from ages 45-75, and then base further screening on multiple factors including current health status and how long other family members have lived. In general, most doctors would feel screening is not needed after the age of 80-85.

*In 2018, secondary to new data on the increased risks of colon cancer in those under 50, the American Society of Colon and Rectal Surgery changed recommendations to consider starting screening at age 45. 

SURVEILLANCE

Surveillance refers to the process of evaluating patients with a personal history of polyps or cancer.  People who have precancerous polyps completely removed should have a colonoscopy every 3-5 years, depending on the size and number of polyps found. If there are 1-2 polyps <1 cm in size (~1/2 inch), then another colonoscopy in 5 years is appropriate. Colonoscopy at 3 years is recommended for patients with 3-4 polyps <1 cm in size or one polyp >1 cm. If there are 5 or more small or 3 or more larger polyps, then follow-up in one year is recommended. Findings on subsequent colonoscopies will determine the next follow-up interval; in general, the time between colonoscopies may be increased if fewer or no polyps are found.

If a polyp is not completely removed by colonoscopy or surgery, and the biopsy results are completely benign, another colonoscopy should be done in 3-6 months. Every effort should be made to remove polyps, as there is a significant risk that over time they can progress to an invasive cancer. If a polyp cannot be removed with colonoscopy, surgery to remove that portion of the colon is often needed.

Most patients who have a colorectal cancer removed surgically should have a colonoscopy within one year. If the whole colon could not be examined prior to surgery, then colonoscopy should be done within 3-6 months after surgery. If this first surveillance is normal, then follow-up colonoscopy should be done every 3-5 years. The risk of developing another colorectal cancer is estimated to be about 0.3% per year.

Patients with ulcerative or Crohn’s colitis for eight or more years should have a colonoscopy with multiple biopsies every 1-2 years. Pre-cancerous changes may be hard to evaluate in the presence of long-standing inflammation. Once these pre-cancerous changes (called dysplasia) are found, complete removal of the colon and rectum is usually recommended; the rate of finding an invasive cancer in these patients is 6-10%.

QUESTIONS FOR YOUR PHYSICIAN:

  • Given my personal and family history, what is my risk of colorectal cancer?
  • At what age should I start screening?
  • Can screening be safely stopped at some point?
  • What are my options for effective colorectal cancer screening?
  • What are the benefits of colorectal cancer screening?
  • What are the risks involved with the various screening methods?
  • A polyp was removed at my recent colonoscopy. What should I tell my close family members regarding their screening?

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances
presented by the individual patient. 

CITATIONS

Hall, J. F. and Read, T. E. Chapter 39, “Colorectal Cancer: Screening”.   Chapter in Beck, D. E., Roberts, P. L., Saclarides, T. J., Senagore, A. J., Stamos, M. J., Wexner, S. D., Eds. ASCRS Textbook of Colon and Rectal Surgery, 2nd  Edition.  Springer, New York, NY; 2011.

Ko, C., Hyman, N. H. on behalf of the Standards Committee of The American Society of Colon and Rectal Surgeons. Practice Parameter for the Detection of Colorectal Neoplasms: An Interim Report (Revised). Dis Colon Rectum. 2006; 49:299-301.

SELECTED READINGS

National Cancer Institute: http://www.cancer.gov/cancertopics/factsheet/detection/colorectal-screening

Centers for Disease Control and Prevention: http://www.cdc.gov/cancer/colorectal/basic_info/screening/

American Cancer Society: http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/index



Filter by Language:

ANAL ABSCESS AND FISTULA An anal abscess is an infected cavity filled with pus near the anus or rectum.  An anal fistula (also called fistula-in-ano) is a small tunnel that tracks from an opening inside the anal canal to an outside opening in the skin near the anus. ...
WHAT IS AN ANAL ABSCESS OR FISTULA? An anal abscess is an infected cavity filled with pus found near the anus or rectum.  Ninety percent of abscesses are the result of an acute infection in the internal glands of the anus. Occasionally, bacteria, fecal material or foreig...
The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). When you have a bowel movement, stool leaves your body from the rectum through the anal canal. Cancer begins when some of the b...
  Anal cancer is an abnormal growth of cells in or around the anus or anal canal, the short passage through which bowel movements pass. The most common type of cancer found in this location is believed to be related to a type of viral infection linked to causing other ty...
The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but a...
  WHAT IS AN ANAL FISSURE? An anal fissure (fissure-in-ano) is a small, oval shaped tear in skin that lines the opening of the anus.  Fissures typically cause severe pain and bleeding with bowel movements.  Fissures are quite common in the general population, but are of...
Anal pain can occur before, during, or after a bowel movement. It can range from a mild ache that can get worse over time to pain that is bad enough to restrict daily activities. Anal pain has many causes, most of which are common and treatable. However, if anal pain does not...
Anal warts (condyloma acuminata) are caused by the human papilloma virus (HPV), the most common sexually transmitted disease (STD). The warts affect the area around and inside the anus, but may also develop on the skin of the genital area. They first appear as tiny spots ...
WHAT ARE ANAL WARTS? Anal warts (also called "condyloma acuminata") are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may...
Colorectal Cancer Risk Colorectal cancer—cancer of the colon and rectum—is the second leading cancer killer in the United States affecting both men and women.  Your risk increases as you age.  Some people are at even higher risk depending on their personal or family history....
WHY IS IT SO IMPORTANT? Colorectal cancer — cancer of the colon and rectum — is the second leading cause of cancer-related deaths in the United States for both men and women combined. The general population faces a lifetime risk for developing the disease of about 5 percent,...
WHY SHOULD THERE BE A POSTOPERATIVE FOLLOW-UP PROGRAM? Surgery is the most effective treatment for colorectal cancer. Even when all visible cancer has been removed, it is possible for cancer cells to be present in other areas of the body. These cancer deposits, when very...
Following treatment for either colon or rectal cancer, ongoing follow-up to detect recurrent disease is considered an important part of patient care for colorectal cancer. Colorectal cancer follow-up refers to a systematic approach to monitoring patients for new or recurr...
Colon cancer (commonly referred to as colorectal cancer) is preventable and highly curable if detected in early stages. The colon is the first 4 to 5 feet of the large intestine. Colorectal cancer tumors grow in the colon’s inner lining.  FACTS AND STATS In 2017, nearly...
Colon cancer is a common malignancy in the United States. The treatment of patients with colon cancer can be complicated and may require a team of surgical and medical specialists. This review provides general information for patients and their families, covering colon ca...
There are many myths and legends surrounding colon cancer, which can be entirely preventable. The following helps to set the record straight. If you are concerned about colon cancer, or if you have a strong family history of colorectal cancer, ask your doctor if you need ...
  WHAT IS COLONOSCOPY? Colonoscopy is an effective procedure to diagnose abnormalities of the large intestine and to screen for colorectal cancer and colorectal polyps. A colonoscope is a long, thin flexible instrument that provides magnified views of the colon and rectum...
WHAT IS CONSTIPATION Constipation, a common complaint, is usually simple to prevent and easy to treat when it occurs. However, constipation may reflect a more serious problem that will require the help of your medical provider to suggest tests, medical intervention and, ...
  Constipation is a very common complaint affecting upwards of 15% of all Americans.  Fortunately, constipation usually is simple to avoid and easy to treat when it occurs.  However, symptoms of constipation may be a sign of a more serious problem requiring medical atten...
Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. The gastrointestinal tract is a system of body organs responsible for carrying and digesting food, absorbing nutrients, and getting rid of waste. Inflammation (re...
OVERVIEW Crohn's disease is a chronic inflammatory disease of unknown origin potentially affecting all parts of the gastrointestinal tract.   While medical management of the disease is the first choice, surgery may be indicated for specific reasons.  This information was...
Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon). Although these sacs can form anywhere in the colon, they are most common in the sigmoid colon (part of the l...
OVERVIEW The purpose of this patient education piece is to provide patients with information on the background, causes, and treatments of diverticular disease and its complications.  It may also be useful to the friends, families, and caregivers of patients dealing with ...
  Enhanced recovery after surgery, known as ERAS is a multimodal approach to surgical care that has been shown to improve recovery after surgery, especially in patients undergoing colorectal surgical bowel resections. Patients typically experience less pain, faster reco...
WHAT IS FECAL INCONTINENCE? Fecal incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. Failure to seek treatment can result in social ...
OVERVIEW The purpose of this patient education piece is to provide patients and their families with information on the background, causes, and treatments of fecal incontinence.  This is intended for a general audience. WHAT IS FECAL INCONTINENCE? Fecal incontinence is ...
What is colorectal cancer? Colorectal cancer is cancer of the colon and rectum that begins with the development of pre-cancerous polyps from the lining of the colon and rectum. What is a polyp? Polyps are mushroom-like growths that form when cells lining the colon grow, di...
Often described as "varicose veins of the anus and rectum,” hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. The rectum is the bottom section of your colon (large intestine). The tissues supporting the vessels stretch. As a result, ...
WHAT ARE HEMORRHOIDS? It is important to note that all people have hemorrhoidal tissue as part of their normal anatomy. Only in a minority of people do hemorrhoids become enlarged or otherwise symptomatic. Hemorrhoidal tissue lies within the anal canal and perianal area ...
THE ROLE OF GENETICS Genes are inherited from each parent. They determine various physical features and may predispose people to certain diseases. All cancers, but especially colon and rectal cancers, commonly referred to as colorectal cancer (CRC), have hereditary facto...
THE ROLE OF GENETICS Genes are made up of DNA. They are the basic units inside a cell by which we inherit traits from our ancestors and pass down traits to our children. Our genetic information, found in our DNA, determines much about us: for example, our eye and hair co...
Irritable bowel syndrome (IBS) is a common disorder, affecting an estimated 15% of the population. It is one of the several conditions known as functional gastrointestinal disorders. This means the bowel may function abnormally, but tests are normal and there are no detec...
Irritable bowel syndrome (IBS) is a common disorder affecting over 15 percent of the population. The following information has been prepared to help patients and their families understand IBS, including the symptoms, causes, evaluation, and treatment options. IBS is one ...
Laparoscopic or “minimally invasive” surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal s...
  Many diseases and conditions of the colon and rectum are treated surgically. A surgeon may use traditional (open) or minimally invasive techniques depending on the individual case.   TRADITIONAL COLON AND RECTAL SURGERY In open abdominal surgeries, surgeons typicall...
OVERVIEW There are a variety of diseases and conditions of the colon and rectum for which surgery is recommended.  In addition to the decision to undergo surgery, patients are often faced with a choice of traditional or minimally invasive surgical techniques.  In order t...
Obstructed Defecation Syndrome (ODS)
OVERVIEW An ostomy is a surgically created opening between an internal organ and the body surface. Ostomies are often created as a part of intestinal surgery when there must be a new way for intestinal waste to leave the body.  This information was prepared to help patie...
  Pelvic floor dysfunction is a group of disorders that change the way people have bowel movements and sometimes cause pelvic pain. These disorders can be embarrassing to discuss, may be hard to diagnosis and often have a negative effect on quality of life. Symptoms vary...
Pelvic floor dysfunction includes a group of disorders causing abnormalities of bowel storage and bowel emptying, as well as pelvic pain.   This information is intended to help patients gain a better understanding of the disorders making up pelvic floor dysfunction, as we...
Pilonidal disease is a chronic skin infection in the crease of the buttocks near the coccyx (tailbone). It is more common in men than women and most often occurs between puberty and age 40. Obesity and thick, stiff body hair make people more prone to pilonidal disease. ...
Colorectal polyps are commonly found during standard screening exams of the colon (large intestine) and rectum (the bottom section of your colon). They affect about 20% to 30% of American adults. Polyps are abnormal growths that start in the inner lining of the colon or rec...
Pruritis ani is a common medical problem affecting both men and women. This information was composed to help patients understand pruritis ani, its symptoms, evaluation, and treatment options.  This information may also be helpful to individuals or caregivers of patients w...
Pruritis ani means “itchy anus” in Latin. This condition causes irritation of the skin near the anus, resulting in a strong urge to scratch the area. In many cases, no specific problem is found to explain the itching. These cases are called “idiopathic” (from unknown caus...
The rectum is the last 6 inches of the large intestine (colon). Rectal cancer arises from the lining of the rectum. In 2012, more than 40,000 people in the United States will be diagnosed with colorectal cancer, making it the third most common cancer in both men and women. ...
Rectal prolapse is a condition in which the rectum (the last part of the large intestine) loses the normal attachments that keep it fixed inside the body, allowing it to slide out through the anal opening, turning it “inside out.” Rectal prolapse affects mostly adults, but wo...
This patient education piece is designed to help improve patients’ understanding regarding rectal prolapse, specifically its presentation, evaluation and treatment. This information may also be useful to the friends, families, and caregivers of patients dealing with rectal pr...
A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina. The rectum is the bottom section of your colon (large intestine). This is a very common problem that often does not produce symptoms. Other pelvic organs can bulge into the vagina, incl...
WHAT IS A RECTOCELE? A rectocele is a herniation (bulge) of the front wall of the rectum into the back wall of the vagina. The tissue between the rectum and the vagina is known as the rectovaginal septum and this structure can become thin and weak over time, resulting in a r...
WHAT IS THE RISK OF COLORECTAL CANCER? Colorectal cancer is the fourth most common non-skin cancer, affecting all ethnic groups. 140,000 people will be diagnosed with colorectal cancer each year and more than 50,000 will die; the lifetime risk is 1 in 20 (5%).  An increa...
Colorectal cancer is a common malignancy for both men and women.  Screening for colorectal cancer is the process of identifying apparently healthy people who may be at increased risk of developing this disease. This information was prepared to help patients understand the...
Colorectal cancer — cancer of the colon and rectum — is the second leading cancer killer in the United States and all women and men aged 50 and older are at risk. The good news is that colorectal cancer is preventable and, if detected early, curable. Depending upon your ag...
Get regular colorectal cancer screenings beginning at age 45.* If you have a personal or family history of colorectal cancer or colorectal polyps, or a personal history of another cancer or inflammatory bowel disease, talk to your doctor about earlier screening. Eat plen...
Screening tests for colorectal cancer can save 30,000 lives each year. These tests not only detect colorectal cancer early, but can prevent colorectal cancer. In one test, non-cancerous polyps are removed before they become cancer. When you turn 45* years old, or if you are y...
WHAT IS THE COLON? The colon is also known as the large bowel or large intestine. It is an organ that is part of the digestive system (also called the digestive tract) in the human body. The digestive system is the group of organs that allow us to eat and to use the food we ...
WHAT IS ULCERATIVE COLITIS? Ulcerative colitis (UC) is an inflammatory disease potentially affecting the entire large bowel (colon and rectum). The inflammation is confined to the innermost layer of the intestinal wall (mucosa). UC can go into remission and recur. Medica...
WHAT IS HPV? HPV stands for human papillomavirus. HPV is a collection of 150 related viruses that can cause a variety of different problems of the genital and anal skin. It is the most common sexually transmitted infection (STI) and can cause genital and anal warts, a pr...