# Would like to rule out colon cancer (doc thinks it is IBS), so question about colonoscopy



## ladybug888 (Jul 22, 2013)

Hello! This is my first post here and am hoping to get some feedback as I am tore up with worry and of course it is two weeks before I can get in to see my gastronenterologist! Let me share a bit about my history and then I will ask my questions:

I am a 47 year old female with no significant health issues. About eighteen months ago I had some 'burning stomach' issues which prompted an endoscopic examination and a colonoscopy. I had a polyp removed which was not cancerous, but other than that, everything looked 'normal'. My BIG question is whether or not I can be assured that whatever I am dealing with now is NOT colon cancer after having a colonoscopy only 18 months ago. It is my understanding the polyps are slow-growing, so even if one was missed during that exam, surely it couldn't be something serious enough to cause my current symptoms 18 months later???

Symptoms: over the last 4 months, off and on - though more 'on' than 'off' lately - I have had severe cramping and burning under my ribcage area along with diarrhea which is now unfortunately causing 'quality of life' issues (TWO accidents while in public). The diarrhea will go away for a few days or a week, only to return a few weeks later. I have had this going on for four months now! Primary PCP did bloodwork - no anemia, but high WBC count and high ESO (which MAY be common in parasitic infections, but also in tumors!). I have no bleeding, bloating, gas, etc., just immense pain and diarrhea that is here more days than it is not.

ANy thoughts as I wait TWO LONG WEEKS to see the GI?? This is torture. My mental health is going to be horrible until then. Do I ask for a repeat colonoscopy? Would a CT scan also show something? Please advise, as I understand IBS is a diagnosis of exclusion, and I want to be 100% sure that everything else has indeed been ruled out.

Thanks you in advance . I will also post this on the IBS-D board .


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## Kathleen M. (Nov 16, 1999)

Well the best CT scan for colon cancer is a virtual colonoscopy which requires all the prep of a regular colonoscopy and they would have to put the scope in if they see anything.

Generally colon cancer causes vague, often easy to ignore symptoms. IBS tends to cause obvious, hard to ignore symptoms.

Looks like they usually do a follow up after a polyp removal in the 3 year range. Unless you had several polyps removed, or have a family history of colon cancer.

I don't have the stats off the top of my head let me look some things up....

Fewer than 10% of colon polyps become cancerous. So if they missed 1 additional polyp there is a less then 1 in 10 chance it would ever become a cancer. Assuming the one that was missed was small it usually takes 2-5 years to become a large polyp likely to become a cancer and then another 2-5 years to become a cancer.

So they would have had to miss a lot to have something go to full blown cancer in 18 months.

Have you started having any perimenopausal changes? A lot of time people in your age range do and female hormones going wonky can effect the GI tract so that may be a why now.


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## ladybug888 (Jul 22, 2013)

BLESS YOU, KATHLEEN for responding to this and so quickly, too. I am a nervous wreck! NO, these symptoms CANNOT BE IGNORED, there is nothing whatsoever easy to ignore about them AT ALL. The doc did tell me 18 months ago that he wanted to do a repeat colonoscopy in 5 years......though I was going to ask him at the end of year 3 if I could do it then..........just because I would feel better about it! BUT..........regardless......eighteen months later, I just want to THINK that something couldn't develop THAT QUICKLY even if something was missed. For reasons similar to what you have described above.

I found an article in a professional journal which I CANNOT UNDERSTAND..........if you can understand it, please explain it in layman's terms )

http://jama.jamanetwork.com/article.aspx?articleid=202911

Some of my other 'weird' symptoms lead me to believe that I am in fact in perimenopause, though there aren't really any conclusive 'tests' that they can do for that. I wonder if it IS that and the GI stuff is just another symptoms of it...........OR it could be connected to this awful case of gastroenteritis that I had two years ago and after-effects of that. I saw somewhere else where that is sometimes a trigger for people who have never had digestive issues before.

Just "talking" this through on this board with you I am wondering if I am not totally over-reacting................though I do have a question about CTs in general (REGULAR CT's not the ones they do for virtual colonoscopy)...........would they not be able to see a tumor on there (even though they may have to do something else to assess what that tumor is, wouldn't they at least be able to SEE if there were something??


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## Kathleen M. (Nov 16, 1999)

IBS commonly develops after a bout of gastroenteritis, so that could very much be playing a role.

Usually colon tumors are more inside the colon as they develop from the lining than they are on the outside. Unless it is really large and by then there would be signs of cancer in the tests they have done.

Off to read the article and see if I can translate.


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## Kathleen M. (Nov 16, 1999)

So basically they are trying to figure out if you have a clear colonoscopy what does that mean for cancer rates down the road, and when to set your next look-see.

So having a clean colonoscopy at 50 means that you are less likely to have colon cancer at 60 than people in the general population.

They did find more right sided cancer than the population as a whole, with the concern being maybe doctors aren't seeing stuff on that side as well, so you may miss a few and that you removed all the ones with easy to find polyps on the left so the remainder tends to be skewed compared to all the people that never had a screening colonoscopy.

The initial 10 year interval was based on estimated growth times. So at some point you expect the rates of the clean colonoscopy group to be the same as the population, but the question is when.

At 10 years you are still less likely so the "they catch up" rate is something over 10 years.

We know that if you remove the polyps you reduce the risk, the question here was if you don't find anything, how long can you assume that there isn't likely to be anything in there to worry about.

Now they usually do one before 10 years if they find a polyp because if you made one you might be at higher risk of making another one that someone that never made one. Usually I hear more 3-5 years as it does take awhile for them to grow.


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## ladybug888 (Jul 22, 2013)

Thank you, this is all making sense and I am trying to process it all. I went back and read more on this forum and saw the part about how some cases of IBS can result from a bout of gastroeneteritis, and I am truly thinking that might be my situation. My husband and I both had a really, really bad bout of something two years ago which is what triggered the burning pain for me which resolved after a few months on Prilosec (and was the reason why I had that initial colonoscopy and endoscopic exam)..............fast forward to now, the diarrhea has come into play, which was NOT the case two years ago. I think that's why I am so freaked out -the cramping and diarrhea in addition to the burning pain. But I do think it is ALL related to that bug I had two years ago OR to perimenopause. The more I think about it, the more I truly think it is that and not colon cancer.

Out of curiosity, can you explain this that was cited in the article:

A negative colonoscopy was associated with SIRs of 0.69 (95% confidence interval [CI], 0.59-0.81) at 6 months, 0.66 (95% CI, 0.56-0.78) at 1 year, 0.59 (95% CI, 0.48-0.72) at 2 years, 0.55 (95% CI, 0.41-0.73) at 5 years, and 0.28 (95% CI, 0.09-0.65) at 10 years. The proportion of colorectal cancer located in the right side of the colon was significantly higher in the colonoscopy cohort than the rate in the Manitoba population (47% vs 28%; P<.001).

Does that mean that .69 people were diagnosed with colon cancer at 6 months post-colonoscopy, .66 at 1 year, .69 at 2 years, and .28 at 10 years? Is that like .69 out of 1,000 people? I would like to understand the numbers and think I am reading that right...but maybe not??

And YES, my doctor recommended 5 years for me, which makes me think that 18 months is wayyyyy too soon for something to happen. Even if there was an unnoticed polyp 18 months ago, it would NOT have time to develop into anything threatening in 18 months NOR by another 18 months when it is time to repeat the colonoscopy.

I truly think I am not dealing with colon cancer after talking this through. I am still going to ask about the CT just to relieve my mind that there isn't something major that has gone outside of my stomach or colon to other parts, but other than that, I think I will wait it out for the 18 months to get the repeat colonoscopy (remember, I am going to ask for it at THREE YEARS and not five, if the doc will agree to it), and try to learn how to deal with IBS since it probably is what I have.

KATHLEEN, thank you for your insight and time put into this post. I am going to read, read, and read some more ))


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## Kathleen M. (Nov 16, 1999)

I'm not clear on what statistic that is, but I'll see if I can suss it out.


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## Kathleen M. (Nov 16, 1999)

*Standardized incidence ratio (SIR) and standardized mortality ratio (SMR)*-The aim of the calculation of the SIR or the SMR is to compare the incidence or mortality in the cohort with the general population. It is investigated whether the incidence or mortality in the cohort differ from the values for the general population. It is calculated how many cases or deaths would be expected in the cohort if the incidence or mortality were the same as in the general population (Table 1a/b). The SIR or SMR are calculated by dividing the observed number of cases (or number of deaths) in the cohort by the expected number of cases (or number of deaths) (figure).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853157/

A negative colonoscopy was associated with SIRs of 0.69 (95% confidence interval [CI], 0.59-0.81) at 6 months, 0.66 (95% CI, 0.56-0.78) at 1 year, 0.59 (95% CI, 0.48-0.72) at 2 years, 0.55 (95% CI, 0.41-0.73) at 5 years, and 0.28 (95% CI, 0.09-0.65) at 10 years.

So since the number is less than one they got fewer cases diagnosed than they would expect when you compare them to the population as a whole. So it isn't how many per 100,000 or anything like that, it is if we expected 100 we got 69, doesn't matter if you expect 100 of 1000 people or 100 of 1,000,000 people. They have it in one of the tables what the exact numbers were.


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## ladybug888 (Jul 22, 2013)

Wow.............thank you for that truly layman's explanation, Kathleen. I guess the statistic is something totally different than what I thought. I was hoping it would tell how many developed colon cancer after a colonoscopy that was normal. I still think my earlier statement holds true, that I am looking at IBS as a result of either perimenopause or prolonged after that bout with gastroeneteritis. I have about written off cancer, so now that I can FUNCTION again, need to just educate myself on how to live with IBS. Still gonna get the CT and checks with the OB/GYN as a precaution, but I truly think I am dealing with IBS. I cannot thank you enough for your comments and insight!! Truly!! ))))))))))))))))))))))))


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## Cherie Marcus (Jul 25, 2013)

Ladybug888,
I am in a similar situation to yours... I had a colonoscopy 26 months ago and was told that it was all clear, no polyps, no colitis, nothing suspicious.. I am 47 years old also and have had IBS-type symptoms for the past twenty years. I can usually manage my symptoms with healthy eating, enough fiber & water, and exercise, but for the past four months I have had pain in my right side. Two months ago my stools changed...became more frequent, with either flat stools or diarrhea. 6 weeks ago I developed a lump in my upper right abdomen...it has pain and tenderness. I also have nausea daily.

I see the gasterenterologist in a week and am going to ask for a repeat colonoscopy. I suggest that you do too! A good doctor will take your symptoms into consideration. Better to get checked and have it be nothing than to not get checked and find out later that it is cancer. Your colonoscopy 18 months ago could have missed something.

See this article at:
http://www.nytimes.com/2008/03/05/health/research/05cancer.html?fta=y&_r=0

It is about an easily overlooked type of abnormality in the colon, the most likely type to turn cancerous. 
The findings come from a study of colonoscopy; generally, doctors search for polyps, abnormal growths that stick out from the lining and can turn into cancer. But another type of growth is much more dangerous, and harder to see because it is flat or depressed and similar in color to healthy tissue.

See also 
http://www.nytimes.com/2008/12/16/health/16cancer.html?pagewanted=all&_r=0
An article about how colonoscopy may miss a type of polyp, a flat lesion or an indented one that nestles against the colon wall. A Canadian study in the journal Annals of Internal Medicine, found the colonoscopies are much less accurate than anyone expected.

Good luck and let us know how you're doing.

Cherela


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## Cherie Marcus (Jul 25, 2013)

Update: the GI doctor would not refer me for a colonoscopy as it has been only two years since the last one. He thinks my symptoms are from IBS. The abdominal lump is probably a lipoma, a benign fatty area... That I agree with, but without testing I am not reassured that these symptoms are from IBS. I felt the doctor was patronizing and didn't really listen to me.

The flat stools seem strange to me...neve had any like them in my life, now nothing but flat stools (or diarrhea) for the past 2 1/2 months. 
Less diarrhea and nausea the past weeks, but still have the pain in my right side.

Oh well, I'll keep up with probiotics and fiber and see how I feel... Better, I hope.


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