Colorectal Cancer ScreeningAt a Glance Screening & Results Your Risk Factors Myths & Facts Resources
Get the FIT – the colorectal cancer screening test which is easy to use, non-invasive and can be done at home.
Colorectal cancer screening
If you’re 50 years or older, it’s a good idea to consider colorectal cancer screening as part of your regular physical check-up. It’s one of the most commonly diagnosed forms of cancer in Alberta and affects about 1 in 13 men and 1 in 16 women in their lifetime.
Colon cancer screening is used to detect polyps or cancers in people who don’t have any symptoms of colorectal cancer. Polyps are small growths that can develop in the inner wall of the colon or rectum, and may or may not be related to cancer. Screening is really the only way to find the disease early. In fact, most cases can be treated successfully if they’re found early.
Types of colorectal cancer screening tests
There are a few ways to screen for colorectal cancer:
- The FIT home stool test is the preferred method of testing for people at average risk who are aged 50 and over. It’s not invasive, involves less risk, and can be done at home.
- A colonoscopy is performed in a healthcare facility and is the screening test used for people at increased risk of colorectal cancer, or if you require any follow-up after having an abnormal FIT result.
- Other tests may be discussed by your doctor, including a CT colonography or flexible sigmoidoscopy.
Abnormal results and next steps
If your tests come back abnormal, don’t panic. In many cases, the results mean something other than cancer, and pre-cancerous symptoms can often be treated before they develop into cancer.
What to do next if you have abnormal stool test results
Even if you’re told your stool test results are abnormal, it doesn’t necessarily mean you have cancer. It means you’ll likely need to have more tests done to know for sure, because sometimes blood in the stool can be caused by something else, like hemorrhoids.
Your doctor will follow up with you if your test comes back abnormal, and will schedule a colonoscopy as part of follow up assessment.
What to do next if you have abnormal colonoscopy results
If the results of your colonoscopy indicate colorectal cancer, your doctor will discuss treatment options with you.
What is a FIT?
The Fecal Immunochemical Test (FIT) is the recommended screening test for colorectal cancer for people at average risk aged 50 or over. It’s the least invasive, it’s safe, it’s easy to do and can be done in the privacy of your own home.
This colorectal cancer stool sample test is used to screen both men and women at average risk (those who are 50 years or older with no family or personal history of the disease). This includes the majority of Albertans, and we recommend you take the FIT home stool test every year.
This test checks your stool for traces of blood that you can’t see. To complete the test, you’ll collect a small stool sample from 1 bowel movement.
Traces of blood can be present in the stools for a variety of reasons. But if you’re 50 years or older, and your stool sample shows any traces of blood, you’ll need to have a colonoscopy in order to look for polyps and or colorectal cancer.
Should you have a FIT?
Preparing for a FIT
Taking a stool test for colorectal cancer is simple. But make sure to take a few minutes to read all of the instructions included in the FIT kit carefully before you take the test.
Here’s what you can expect:
- Your doctor will arrange for you to pick up a FIT kit from the lab to take home.
- You’ll be asked to collect a stool sample. However, you should avoid collecting a sample if blood is visible in your stool or urine. For instance, if you have your period, bleeding hemorrhoids, or a urinary tract infection, it’s not a good time to do a FIT.
- There are no foods or medications you need to avoid to take the test.
- Labs will ask that the test be completed and returned to the lab within a specific number of days after the stool sample is collected. It is best to return the stool sample as soon as you can after you complete the test.
Taking the FIT
The FIT kit you’re provided with will give you detailed instructions on how to collect the stool sample. The instructions here will give you an idea of what’s involved:
- Place plastic wrap or newspaper loosely underneath the toilet seat in the toilet bowl to catch the stool, or use a clean, dry disposable container such as a paper plate or plastic bucket.
- Be sure the stool sample does not mix with urine or touch the water.
- Open the bottle.
- Collect a small sample of stool on the stick attached to the cap.
- Put the stick with the stool sample into the bottle and tighten the lid.
- You can then flush the remaining stool down the toilet.
After the FIT
- Store the kit with your sample at room temperature until you return it to the lab.
- Bring the sample with the requisition form to the nearest lab as soon as possible and no later than 7 days after completeing the sample.
- The stool sample will be checked for blood.
- The result of your test will be sent to your doctor who will then follow up with you directly.
Getting your results
Once the lab has processed your sample, there are several different ways you may get your results:
- You may hear directly from your doctor.
- You can always contact your doctor directly.
- If you have an abnormal result, you’ll receive a result letter from the Alberta Colorectal Cancer Screening Program (ACRCSP). Your doctor will follow up with you and will likely recommend further testing. If your result is normal you won’t need any further testing at this time, but you should continue to be screened every year or see you doctor early if you have any symptoms or concerns.
When do you need to get screened again?
If your result comes back normal, it’s recommended to take the FIT every year as part of your health routine.
If the test does show abnormalities, you should discuss your result with your doctor and follow-up with a colonoscopy, an outpatient procedure that takes place in a healthcare facility.
Benefits and risks of the FIT
First and foremost, taking the FIT can help put your mind at ease. It doesn’t take long and can truly save your life — because colorectal cancer can grow and exist for some time without any symptoms.
Stool tests for colon cancer can detect traces of blood in your stool that you can’t see. If any abnormality is found, you’ll be able to take the important next step of having a colonoscopy — and treat any cancer found early.
Colorectal cancer screening tests are generally very safe; however any medical test has its own set of risks. The FIT does run the risk of missing blood in the stool, because a polyp or cancer may not be bleeding at the time you take the test.
What is a Colonoscopy?
A colonoscopy is a procedure that uses a camera inserted into the anus and the colon to examine the entire lining of the rectum and colon. It’s the follow-up test for people who have an abnormal result from the FIT home stool test. It is also the screening test used for people who have been identified as being at higher risk for developing colorectal cancer. Colonoscopy is also a test that is commonly used for the diagnosis and management of various diseases affecting the bowel.
The good news is, if polyps are found they can usually be removed during the procedure. Growths that are too large to be removed and/or appear to be cancer are removed surgically at a later date and a biopsy is taken to get a sample of cells for testing.
Should you have a colonoscopy?
A colonoscopy is usually recommended as a screening test for people at increased risk for colorectal cancer (those with a personal or family history of the disease) or as a follow-up test if you’ve had an abnormal result from a FIT home stool test.
Preparing for your colonoscopy
The most important thing you can do to ensure a successful colonoscopy procedure is to properly prepare for the test. Be sure to read all of the colonoscopy preparation instructions provided by your doctor carefully to ensure a safe and successful procedure.
- Before a colonoscopy, you’ll be asked to make sure your colon is completely empty. This means following a special diet for a few days before the test, like drinking clear liquids such as broth or clear juice only, then taking a laxative the day before the test.
- Make a list of medications you’re taking, and make sure you have your health card to bring to the appointment.
- Find someone who can go with you to the appointment. You may be given sedatives before the colonoscopy to help you relax, so you won’t be able to drive yourself home. It’s also a good idea to plan to have someone at home with you during the 24 hours following the colonoscopy, since the sedative may remain in your system for that time.
- You’ll also want to leave your valuables at home on the day of your appointment.
Having a colonoscopy
Here’s how the colonoscopy procedure works:
- The procedure will be performed by a trained physician, called an endoscopist, and one or two nurses will also be present in the room.
- You can choose to have a sedative before the procedure begins. The medication may make you sleepy and may make you forget the event, but most people remain somewhat aware but comfortable and relaxed during the test.
- You will be lying on a stretcher, on your left side, and may be asked to turn on to your back or right side during the procedure.
- A long, flexible videoscope is inserted into the rectum through the anus then passed to the beginning of the colon.
- The endoscopist may inflate the colon with air, in order to see better.
- The endoscopist will use the video camera to examine the large bowel.
- You may feel some cramping and discomfort, but should not feel any pain.
- If polyps are found, the endoscopist will remove them or do a biopsy on any abnormal areas.
- Following the procedure, you’ll rest in recovery for anywhere from 30-45 minutes.
- Before you leave, you’ll be informed about the results of your test and you can ask to have a written report for your records. You will also be provided with contact information in case you have questions, as well as instructions about what to do or to look for in the next day or so.
The colonoscopy procedure itself usually takes between 20-30 minutes to complete. See what happens during a colonoscopy with this 3D animation. From Cancer View Canada and the Canadian Partnership Against Cancer.
After a colonoscopy
If you chose to have a sedative before the procedure, you may forget the things you wanted to ask or what you were told before the procedure. Because of this, you’ll want to ask:
- If you can have a copy of your procedure report (or a patient-friendly version of it) and any instructions regarding what to do in the next 24 hours, as well as what to look for in case of a complication.
- If the procedure was successful: Was the entire colon examined? Was the bowel preparation adequate? Were all polyps seen removed, retrieved and sent to the lab?
- In the case where polyps were removed, who will give you the results and when and how will you be instructed about how soon another colonoscopy, if any, should be performed?
After the test you may have some mild cramping or gas pains, but they should subside soon after.
- Drink lots of fluids when you get home and eat your normal diet.
- Make sure you have someone to drive you places if you need to be somewhere. You’ll be a little woozy from the sedatives for 24 hours following the procedure and should not drive.
- Avoid alcohol.
- Avoid making important decisions until the sedative wears off.
- Gradually increase your activity level — go for a walk to help you pass the gas.
- You may have small amounts of blood in your stool, especially if you had a biopsy or if a polyp was removed during the procedure.
Getting your results
Your doctor will follow up with you to discuss your results.
If your results are fine, further screening tests are not required for 10 years. If the results of your colonoscopy indicate you have colorectal cancer, your doctor will discuss treatment options with you. If the results of your colonoscopy indicate you have polyps, which is very common, talk to your healthcare provider about next steps as well as when you need to be screened again.
When do you need to be screened again?
If your colonoscopy results are normal, you will not need to do another screening test for another 10 years. After 10 years have passed, if you’re of average risk, you will usually go back to having a FIT home stool test every year.
If the results of your colonoscopy show polyps, talk to your healthcare provider about next steps as well as when you need to be screened again.
Benefits and risks of a colonoscopy
It’s always important to know the benefits and the risks when you’re considering any medical procedure or test. Of course, when it comes to cancer screening, the biggest benefit is finding cancer to save your life.
Colonoscopies serve a vital role in detecting cancer. They can:
- Prevent colon cancer from developing — if you have any polyps, they can be removed before they become cancerous.
- Decrease colon cancer deaths — detected early, it can be treated successfully and result in a more promising prognosis.
The risks involved in having a colonoscopy are very low. However, like any medical procedure, complications can potentially occur, particularly if a polyp is removed. These include:
- Hole in the bowel which may require surgery to fix.
- Bleeding, which usually only occurs if a polyp is removed and may require blood transfusions and repeat colonoscopy or surgery to stop.
- Heart or lung complications from sedation.
- Severe dehydration, falls, kidney troubles or chemical imbalance from bowel preparation.
These complications can generally be treated successfully, but in rare instances could result in death — especially in people with significant medical problems. The likelihood of death occurring is 1/13,000.
The most important thing to remember is that the number of people who have been saved through these tests dramatically outnumber those who have experienced any negative consequence.
Other colorectal cancer screening methods
While the FIT home stool test and colonoscopy are the two most common screening tests, there are also other colorectal cancer screening methods. If you do have either of the tests below, any abnormal result should still be followed by a colonoscopy.
- Flexible Sigmoidoscopy – This is a colon cancer screening test that uses a flexible videoscope to examine the lower third of the large bowel. This test is usually done every 5 years.
- CT Colonography – This is a CT scan taken of the colon after bowel cleansing to get an accurate picture of the lining of the rectum and colon. This test is usually done at private radiology clinics and is not covered by Alberta Health Care Insurance.