Having regular colorectal cancer screening can prevent and detect cancer at its early stages when treatment is more effective.
Why get screened?
Colorectal cancer is one of the most common cancers in Alberta and affects about 1 in 14 men and 1 in 17 women in their lifetime. Although colorectal cancer can happen at any age, your risk of getting it increases as you get older. Learn more about risk factors that may increase your risk. If you’re between the ages of 50 and 74, it’s important to get screened regularly.1
What is colorectal cancer screening?
Screening for colorectal cancer (or colon cancer) means looking for early signs of cancer in people who feel well and have no symptoms. Colorectal cancer is easier to treat when found at an early stage. In fact, 90% of cases can be treated successfully if found early.2
The 2 main screening tests for colorectal cancer are:
FIT home stool test: This test looks for blood in your stool (poop) that you can’t see. It’s an easy test that you can do at home. If blood is found in your stool, you will need a colonoscopy to make sure the blood isn’t caused by cancer.
Colonoscopy: This test lets a healthcare provider see the inside lining of your rectum and colon. This is done with a long, flexible tube called a colonoscope. If polyps or tissue growths are found they can be removed during the test.
Both of these tests find problems early and help save lives. Talk to your healthcare provider about which screening test is right for you and how often you need to have it. Learn more about which test may be right for you.
If you’re 50 to 74 years of age, you should be screened regularly. Think of it as part of your regular health routine. If you have a family history of colorectal cancer you may need to start screening at age 40 or younger. Find out which test may be right for you:
You’re 50 to 74 years old and have no personal or family history of polyps or colorectal cancer …
Ask your healthcare provider when you should be screened. Risk factors such as personal or family history may mean you should start screening at age 40 or even younger.
If you have symptoms of colorectal cancer, whatever your age, talk to your healthcare provider right away.
Symptoms may include:
A change in your bowel habits
Pain in your abdomen
Losing weight and you don’t know why
Your symptoms may be caused by something other than cancer but speaking to your healthcare provider can help you know for sure. Learn more about signs and symptoms at MyHealth.Alberta.ca. To learn more about your risk of colorectal cancer try the Risk Calculator
What is a FIT home stool test?
The Fecal Immunochemical Test (FIT) is used to screen for colorectal cancer in people aged 50 to 74 who have an average (or normal) risk for getting the disease. People with an average risk have no personal or family history of the disease. Anyone aged 50 to 74 who is at average risk should screen with FIT every year. Talk to your healthcare provider about your personal risk factors and if FIT is the right test for you.
To do the FIT you’ll need to collect a small sample of stool from 1 bowel movement. Easy to follow instructions come with the FIT kit. FIT Lab Instructions [info sheet]
Is FIT right for you?
Talk to your healthcare provider about colorectal cancer screening and ask if the FIT is the right screening test for you. Not sure if you need to be screened? Use the Risk Calculator to find out.
What to expect with FIT
The FIT checks your stool (poop) for traces of blood that you can’t see. It’s safe, easy to do and can be done in the privacy of your own home.
How do I get a FIT kit?
Talk to your healthcare provider about colorectal cancer screening and which test is right for you. If FIT is screening test you should use, your healthcare provider will give you a lab requisition form. You’ll need to take the form to the lab to pick up your FIT kit.
How to do a FIT
The FIT kit comes with easy to follow instructions. You’ll need to collect a small sample of stool (poop) from 1 bowel movement. After collecting your stool sample, you’ll take your completed FIT kit back to the lab. The lab will then test the sample for any hidden blood.
Your FIT result will be sent to your healthcare provider who will follow-up with you directly. Learn more about getting your FIT results.
Benefits and risks of FIT
As with any test, there are both benefits and risks.
Benefits of doing a FIT
A FIT is easy to do, safe and won’t hurt. It can detect traces of blood in your stool that you can’t see. If any blood is found, the recommended follow-up test is a colonoscopy. A colonoscopy may find any precancerous polyps or cancer at its early stages, when treatment can work better.
Risks of doing a FIT
The FIT does run the risk of missing blood in the stool, because a polyp or cancer may not bleed at the time you take the test. This is why screening with FIT every year gives you the best chance of colorectal cancer being found early, when treatment can work better.
What is a colonoscopy?
A colonoscopy is a specialized test that lets the doctor see the inside lining of the colon and rectum using a colonoscope (scope). The scope is a long, flexible tube about the width of a finger with a light and tiny video camera on the end. The scope is put through the anus into the rectum and colon.
Pictures are taken of the lining of the colon and can be seen on a computer screen. This helps the doctor to have a clear view and to check if there are any polyps or abnormal growths. If a small polyp is found it can usually be removed during the test using special tools that can be passed through the scope. The removed polyp is then sent to the lab to check if it has any areas that have changed into cancer. This is because some small polyps can become cancerous over time.
A polyp or abnormal growth that is too large to be removed and/or appears to be cancer may need to be removed at a later date. A small piece of it will be removed (biopsied) through the scope. The sample will be sent to the lab to see if it’s cancerous, a non-cancerous growth or something else.
What to expect with a colonoscopy
Before the test
Let your healthcare provider know about any drug allergies or health issues you have.
Write down all of the medications you take and make sure your healthcare provider sees this list. Your list should include prescriptions and over the counter medicine, such as Advil®, Aspirin®, iron supplements and herbal supplements. Be sure to include marijuana, strong painkillers (opioids) and tranquillizers such as Valium® and Xanax®.
Let your healthcare provider know if you use any medical devices such as hearing aids, insulin pumps, pacemakers, defibrillators, home oxygen, and sleep apnea machines.
Most medications can be taken up to and on the day of your test. Don’t take any medication within the 2 hours before or after drinking the bowel prep solution. (See how to prepare below)
Diabetic pills and/or insulin, blood thinners and antithrombotics (for example, Coumadin®, Plavix®, Pradaxa® and Xarelto®) are examples of medications that might need to be adjusted or stopped.
If you take these medications, talk to the healthcare provider before your test. They will tell you if you need to stop or change any medicine before your test.
If you start a new medicine between your pre-colonoscopy visit and the date of your colonoscopy, it may make it unsafe for the test to be done. Ask your healthcare provider before the day of your test to make sure it is okay to take.
Make plans for getting home after the test
You may choose whether or not you want to have sedation. Although some people may get cramps, colonoscopies can be comfortable without sedation to help you relax. Many people choose to have sedation for the test.
If you don’t want sedation, talk to your healthcare provider on the day of the test. Make plans to have someone drive you home after the test in case you end up asking for sedation so you can be more comfortable.
If you have sedation, do not drive for at least 8 hours (or longer in some cases depending on what your healthcare provider has told you) after you were given sedation. A responsible adult is required to take you home after the test. The driver will need to come into the department where you’re having your colonoscopy done to pick you up. Don’t drive, take a taxi or bus by yourself to get home.
The sedation medication can stay in your body for 24 hours after your colonoscopy. So it’s also a good idea to plan to have someone at home with you during that time.
How to prepare for a colonoscopy
A clean colon and rectum helps the healthcare provider to see the entire inside lining. Your colon and rectum will need to be empty and cleaned out before your colonoscopy. To clean out your colon and rectum, you’ll need to follow a special diet and drink large amounts of a bowel preparation (laxative) solution. Drinking this solution will cause you to have loose and watery stool (diarrhea) so that your colon will be empty for the test.
You’ll be given specific instructions before your colonoscopy to let you know how to get ready for your test. Read through all of the instructions several days before the test, since you’ll need to make changes to your diet in the days before your test as well as buy your bowel prep solution and supplies.
Call the telephone number you were given by your healthcare provider if you have any questions about the instructions.
Why is getting ready for a colonoscopy so important?
If the colon and rectum aren’t completely cleaned out:
A polyp or a cancer may not be seen.
The test may take longer to complete.
The test may be cancelled. It wouldn’t be safe for the doctor to continue without being able to see properly.
The colonoscopy and the bowel preparation will need to be done again on a different day.
Before you go to the facility
Bring your Alberta Health Care card, picture ID (for example, a driver’s license or government issued photo ID) and any medications you were told to bring with you (for example, inhaler or insulin).
Leave all valuables at home (for example, credit cards, money, jewelry).
When you arrive for your colonoscopy
Check-in at the reception desk at the time written on your colonoscopy information sheet. You’ll need to provide the name and phone number of the person coming to pick you up after the test.
Expect to be at the facility for about 2 to 3 hours. Don’t make plans for the rest of the day in case your test is delayed unexpectedly.
A nurse will take you to an area where you will change into a hospital gown. The nurse will review any medication you take, any allergies you have and check your blood pressure and pulse.
If you have questions about your colonoscopy ask the nurse or doctor before your procedure.
In the procedure room
If you chose to have sedation, it’ll be given through an intravenous (IV) in a vein in your hand or arm. This medication may make you feel sleepy or light-headed. Most people stay aware of what is happening but are comfortable and relaxed during the test.
The colonoscopy takes about 20 to 45 minutes to complete and will be done by a doctor and 1 or 2 nurses will also be in the room. You’ll lie on your left side on a stretcher and may be asked to turn onto your back or right side during the procedure.
The doctor will insert a colonoscopy (scope) into the rectum, through the anus, then pass it through the colon. The scope has a camera and light attached to the end of it. Air is pumped into your colon to keep it inflated so the doctor can see the entire colon. This might cause you to feel some sudden sharp abdominal pains or cramps.
If polyps are found the doctor will remove them or do a biopsy on any abnormal areas.
See what happens during a colonoscopy with this 3D animation from the Canadian Partnership Against Cancer.
What happens if polyps are found?
Polyps are tissue growths on the inside of your colon. They are usually benign (non-cancerous), but can develop into cancer if they’re not removed and continue to grow. Any polyps found during the procedure will be removed with a tool (snare) that can go through the colonoscope. This is called a polypectomy. It doesn’t usually hurt when a polyp is removed. A polyp or abnormal growth that is too large to be removed and/or appears to be cancerous may need to be removed at a later date. A small piece of it will be removed through the scope and then sent to the lab to be examined under a microscope (biopsied) to see if it’s cancerous, a non-cancerous growth or something else.
Is a colonoscopy painful?
A colonoscopy is generally easy to tolerate. It’s common to have minor discomfort and pressure as the doctor moves the colonoscope around the corners of your colon. Most patients choose to have sedation and a pain medication to help them relax. The sedative may make you feel sleepy and possibly forget some details about the test. While under sedation, you’ll still be able to breathe on your own – you’re not ‘put under’ or unconscious. The test may need to be stopped and done at a later date if you’re having too much discomfort and don’t want any sedation or pain medication to help you feel more comfortable.
After your colonoscopy
After the test you will be taken to a recovery area to rest. It can take 30 to 60 minutes for the first effects of the sedation to wear off. Your blood pressure, heart rate and oxygen levels will be recorded and monitored during this time.
You may have some cramping or pressure in your abdomen (belly) because of the air pumped into your colon during the test. This feeling should go away as you pass gas.
It’s also common to see a small amount of fresh blood on the toilet tissue if a polyp was removed.
Getting your discharge instructions
Before you leave the clinic you’ll be given a discharge instruction handout. It’s a good idea to have a member of your family or friend with you, if possible, when you’re given these instructions, since many people don’t remember very much about the test because of the sedation.
Some questions you may want to ask:
Was my colon cleaned out well enough for the doctor to see clearly?
Was my whole colon examined?
Were all polyps seen on the scope removed, collected and sent to the lab for testing?
Before you leave the clinic, the healthcare provider will discuss the results of your colonoscopy. If no polyps were found, you’ll be told when to have your next screening test. If polyps were found, it’s important that you make an appointment with your healthcare provider to review the results and find out what follow-up is needed. Your healthcare provider will get a copy of your colonoscopy report and the results of any polyps that were removed for testing.
Effects of the sedation
Sedation is a medication that can affect your concentration and coordination for several hours. You may feel sleepy or light-headed. Don’t do the following for at least 8 hours after getting sedation (or longer in some cases depending on what your doctor has told you):
Make sure you have a responsible adult to stay with you and care for any small children in your care.
If you usually use a CPAP or BiPAP machine, start wearing it again in any setting where you may fall asleep for the first 24 hours after being discharged – even to take naps.
It’s important to rest after your colonoscopy. Avoid any activity that takes a lot of energy (for example, hard exercise or heavy lifting)
Drink lots of fluids when you get home and start to eat your normal diet.
Take your regular medications, unless your doctor or nurse has told you something different. If you usually take a blood thinner (anti-thrombotic) medication and have stopped taking it because of your colonoscopy, start taking it again at the time you were told by the healthcare provider at the facility where you had your colonoscopy done.
Most of the time you can go back to work the day after your colonoscopy, depending on your job.
It’s important to note that you may not be covered by your travel insurance if you have a complication (problem) from your colonoscopy and are out of the province or country. If this is a concern, avoid travelling for 2 weeks after your colonoscopy.
Complications are rare but can happen. Complications don’t always happen right away. Bleeding from the site where a polyp was removed can happen up to 4 weeks after a colonoscopy. Don’t ignore any symptoms that you’re worried about or that you didn’t expect.
Go to an Emergency Department or call 9-1-1 if you:
Are passing a lot of blood from your rectum (bum)
Feel like fainting
Have a temperature over 39°C (100.4°F)
Have pain in your abdomen (belly) that doesn’t get better, even after passing gas
If you aren’t sure about your symptoms, you can call Health Link at 8-1-1 for 24/7 nurse advice or general health information.
If you had to go to an Emergency Department or are admitted to the hospital within 30 days following your colonoscopy due to problems related to your test, contact the clinic where you had your colonoscopy to let them know.
Don’t ignore new bowel symptoms
Although colonoscopies are very accurate, it’s possible for polyps and even cancer to be missed. That’s why it’s important to never ignore new bowel symptoms like:
Bleeding from your rectum (bum)
A change in your bowel habits, such as narrow ribbon-like stool, or frequent diarrhea or constipation
Pain in your abdomen (belly)
Losing weight and you don’t know why
See your healthcare provider if you develop these or any other symptoms you’re worried about.
Benefits and risks of a colonoscopy
It’s important to know the benefits and risks when you’re considering any medical procedure or test.
Benefits of getting a colonoscopy
When it comes to cancer screening, the biggest benefit is finding cancer early as it can save your life. Colonoscopies are important in finding cancer. They can:
Prevent colorectal cancer from developing: If you have any polyps, they can be removed before they become cancerous.
Decrease colorectal cancer deaths: When found early, cancer can be treated successfully and lead to better outcomes.
Risks of getting a colonoscopy
The risks involved in having a colonoscopy are very low. However, like any medical procedure, problems can potentially occur, particularly if a polyp is removed. These include:
A hole in the bowel which may need 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 problems can generally be treated successfully, but in rare instances could result in death – especially in people with serious medical problems. The chance of death is 1/13,000. The most important thing to remember is that the number of people who have been saved through these tests are much greater than those who have had serious medical complications (problems) following the test.
Where to get screened
In Alberta, getting screened can be done easily right at home. If you’re 50 to 74 years old, ask your healthcare provider about the FIT home stool test. If FIT is the right test for you, your healthcare provider will give you a lab requisition form to go and pick up your FIT kit at a community lab.
If you or a first degree relative (parent, sibling, child) have had colorectal cancer and/or high risk adenomas, especially if they were younger than 60, ask your healthcare provider if a colonoscopy is the right test for you. Certain risk factors such as personal or family history may mean you should start screening at age 40 or younger.
Here are some questions you may want to ask your healthcare provider about colorectal cancer screening:
Remember, getting screened is the single most important thing you can do to protect yourself against colorectal cancer.
Other colorectal cancer screening tests
While the FIT home stool test and colonoscopy are the 2 most common screening tests, there are also other colorectal cancer screening methods. Any abnormal results should still be followed by a colonoscopy for the tests described below. Talk with your healthcare provider about which screening test is right for you.
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 the Alberta Health Care Insurance Plan. If a polyp is found, it’s recommended that you have a colonoscopy to remove the polyp, as the CT only looks at your colon.
Flexible sigmoidoscopy: This test uses a colonoscope to examine only the lower left side of the large bowel. If a polyp is found, it’s recommended that you have a colonoscopy to examine the other side of the colon. A flexible sigmoidoscopy is usually done every 5 years.
Research into new colorectal cancer screening tests in Alberta
PolypDX™: Alberta is starting to test a new approach to colorectal cancer screening using a urine test called PolypDX™. This test detects pre-cancerous polyps in the colon. If polyps are found, the follow-up test is a colonoscopy. PolypDX™ isn’t available to Albertans.
LGBTQ2S+ and colorectal cancer screening
Anyone aged 50 to 74, no matter their sexual orientation or gender identity, needs to be screened for colorectal cancer. Sexual orientation or gender identity doesn’t affect your risk of colorectal cancer and won’t change how you’re screened.
Receptive anal sex (bottoming) and colorectal cancer screening
You can keep having anal sex before and after you’ve collected your stool sample for a FIT test and before and after your colonoscopy.
Gender-affirming hormone therapy and colorectal cancer
We don’t know if testosterone, estrogen or progesterone are risk factors for colorectal cancer. There’s no evidence either way. What we do know is that healthcare providers don’t need to know a person’s hormone levels when screening for colorectal cancer. For example, a healthcare provider won’t ask a non-trans woman if they’re on birth control.