Colorectal (Bowel) cancer in New Zealand New Zealand has a relatively high rate of cancer deaths from bowel cancer.  The risk of this disease increases with age and other factors, however lifestyle also affects the risk. Knowledge and management of risk factors that are able to be modified and also surveillence by  having colonoscopy examinations when appropriate are measures that may reduce the risk of disease.  New Zealand is moving towards a national screening programme for bowel cancer in line with Australia and England. Colonoscopy is a procedure to examine the large bowel, an examination which is appropriate as a survellence procedure for people with a higher risk of bowel cancer. Mr Doug Knight is an experienced General Surgeon operating in Napier, New Zealand,  and is an experienced colonoscopist, performing over 300 colonoscopies annually. Consultation with a medical specialist experienced in performing colonoscopy examinations is a useful preventative measure for a large group of New Zealanders. For more information and further links CLICK HERE....................................... Risk Factors for Bowel Cancer Age The risk of getting this disease increases, as you get older. Family history of bowel cancer If you have close relatives who have been diagnosed with bowel cancer before the age of 45 or close relatives who have been diagnosed at any age, you are at increased risk.  Other bowel disease  People with a history of Crohn’s disease and ulcerative colitis have increased risk.  Diet  It may help to prevent bowel cancer if you eat ·          Less cured and processed meat such as bacon, sausages and ham    ·          Less red meat and more fish    ·          More fibre from cereals, beans, fruit and vegetables    ·          More vegetables such as carrots, cabbage, broccoli    ·          Less refined carbohydrate, including sugary foods such as cakes, biscuits and chocolate    ·          Less alcohol   Exercise   Physical exercise is linked to a lower risk of bowel cancer.   Aspirin and anti-inflammatory drugs (e.g. Nurofen)   These drugs may help prevent bowel cancers and other digestive system cancers. What is a Colonoscopy?   Colonoscopy is the examination of the colon (large bowel) using a video camera on a thin flexible tube, which is passed through the anus.  This procedure enables the doctor to look for any abnormality and take tissue samples for analysis. Indications for colonoscopy are: Rectal bleeding Iron deficiency anaemia. Abdominal pain and alteration in bowel habit The presence of colorectal cancer risk factors Clarification of barium enema findings Positive Faecal occult test. Indications for repeat colonoscopy Patients with previous bowel polyps or cancer Surveillance of inflammatory bowel disease. Patients with a family history of bowel cancer or polyps in first degree relatives. Why have this test? You might need a colonoscopy if you have symptoms such as blood in the stool (bowel motion), a change in bowel habit or have a family history of bowel cancer. It is a safe and effective way to check for check for inflammation, or abnormal growths.  Colonoscopy is often used to remove polyps (polypectomy), which can vary in size and shape, and while most are not cancerous, they need to be removed and examined. What are the risks? Any procedure carries a small element of risk.  Colonoscopy is normally a safe procedure and complications are unusual.  Slight bleeding may occur after tissue removal.  Greater loss of blood and perforation of the bowel are possible and can depend on the skill and experience of the operator.  An estimated risk for bowel perforation during colonoscopy has been found in one study to be 1 for every 1,000 operations (Luning et al., 2007). Can polyps or cancers be missed? This is possible to miss small polyps and this is often due to poor bowel preparation. How do you prepare for this examination? The colon (large bowel) must be cleared of solid matter to allow a view of the colon lining.  How well you clear the bowel affects how much the doctor can see.  Different doctors advise slightly different methods of clearing the bowel but you will be given clear instructions about what you are able to eat and what foods to avoid.  You will most likely be given a special fluid to assist in the clearance and may be asked to stop taking iron tablets one week before the appointment.  It is normal to take only clear fluids in preparation for the examination.  If you are diabetic, special instructions will apply.  Follow the directions carefully. Procedure You will be asked to lie on your left side of the table and given some pain medication and a sedative. The flexible tube will be inserted into your rectum and guided into the colon.  A video screen will show the inside of the colon and the lining of the colon can be examined.  Air is blown into the bowel to help get a better view. Most patients do not remember the procedure afterwards. Polyps will be removed or biopsied. A colonoscopy normally takes 30 – 60 minutes.  After the procedure You will need to rest for several hours before being taken home. Full recovery by the next day is normal.   Reference Luning, T. H., Keemers-Gels, M. E., Barendregt, W. B., Tan, A. C. & Rosman, C. (2007) Colonoscopic perforations: a review of 30,366 patients. Surg Endosc, 21, 6,  994-7.   Links to further information   National Digestive Diseases Information Clearinghouse MedlinePlus PatientUK Colonoscopy video (Mayo Clinic) WebMD colonoscopy EMedicine colonoscopy Cancer Research UK