Frequently Asked Questions
What is colonoscopy?
Food passes through the stomach and is digested in the small intestine. Here, nutrients are absorbed, then waste enters the colon, also known as the large intestine. The colon absorbs excess fluid and the final result is a formed bowel movement, which leaves through the anus.
Colonoscopy is an examination of the lining of the colon to look for abnormal growths called polyps, inflammation, bleeding sites or ulcers. It is used to understand why patients have symptoms such as abdominal pain, blood in the stool, weight loss or a change in bowel habits. The procedure is also performed to detect polyps and cancer in patients without symptoms. Most often, colon polyps do not cause symptoms, and this is why screening is recommended.
Colonoscopy is diagnostic and can be therapeutic. That is, if a polyp is found, it can be removed during the exam and sent to the lab to see if it contains cancer cells. Most polyps are benign (do not contain cancer), but virtually all colon cancer begins as a polyp. Therefore, removing polyps at an early stage is an effective way to prevent colon cancer.
When polyps are found at an early stage they are usually removed easily and completely. Polyps can grow and eventually contain cancer. When colon cancer is found at later stages it is often fatal.
What does colonoscopy prep involve?
Prior to the test, the patient undergoes a colon preparation to empty the colon. This can take one or two days, depending on each patient. The typical prep at Jefferson involves staying on clear liquids the day before colonoscopy. At noon on the same day, two laxative pills are taken. At 5 p.m., the patient consumes 1 liter of Gatorade, which includes a laxative powder. At 4 a.m. on test day, a second 1 liter dose of Gatorade mixed with laxative is taken. This liter must be completely finished so that the patient takes nothing by mouth for at least 3 hours before the procedure. This is to avoid the risk of aspiration (or inhaling any stomach contents that might be refluxed) of any fluid into the lungs.
It is also important that the patient consumes several liters of fluid throughout the day before the exam to stay well-hydrated, because the prep leads to frequent stools and even diarrhea.
In addition, talk to your doctor to get explicit instructions regarding any medication you are taking on a regular basis before preparing for colonoscopy. If you are taking a blood thinner such as Coumadin, adjustments have to be made to decrease the risk of bleeding. Other over-the-counter medications that can also thin your blood and should be discussed include aspirin and pain relievers, such as Advil®, Motrin®, Aleve® or any form of ibuprofen.
How is colonoscopy performed & how long does it take?
Colonoscopy is an outpatient procedure. Sedation is administered by a certified nurse anesthetist. This "conscious sedation" makes a patient very sleepy and relaxed, but it does not involve general anesthesia. While lying on the left side on a comfortable stretcher, the thin flexible tube is inserted through the anus and the entire colon is examined. There is a small video camera inside the scope that gives the physician a clear view, and pictures can be taken of any abnormal findings. Most often, the exam takes less than 30 minutes, but sometimes longer if multiple polyps are found.
Is there any pain or discomfort after the procedure?
Following the procedure, the patient remains in the recovery area for about one hour to ensure that the vital signs are stable and that he/she can tolerate juice and crackers without getting sick. The colon is insufflated with air during the exam, so some retained gas is common. The patient may experience cramping or bloating, and may pass gas for several hours. The average patient is fully recovered and back to a normal routine on the following day.
The doctor will talk to the patient and review the findings of the exam. The nurse will again read and review written discharge instructions from the doctor before the patient leaves the Endoscopy Unit. In rare instances a patient may develop side effects and should call the doctor immediately if experiencing any of the following:
- Severe abdominal pain
- Rectal bleeding
Because sedation is administered, each patient must be accompanied by a relative or friend at discharge. The restrictions following sedation include no driving for 24 hours and no drinking of alcohol for 24 hours.
At what age should colonoscopy begin & how often should it be repeated?
Studies suggest that age 50 is the time to begin routine screening to look for early signs of colon cancer. However, there are certain risk factors that lead some patients to begin colonoscopy at a younger age.
- A patient is at increased risk if a first-degree (parent, sibling, child) relative has had colon polyps or colon cancer. The formula determining the first screening exam considers the age when the affected relative was diagnosed. For example, if a parent is diagnosed at age 50, then screening should begin when the patient is 10 years younger. Here, the new patient would begin routine screening at age 40.
- A personal history of colon polyps or colon cancer
- A personal history of inflammatory bowel disease including Crohn's disease or ulcerative colitis
- A personal history of uterine or ovarian cancer before the age of 50
When the colonoscopy is repeated will be determined by the findings at the initial examination. If a patient has no polyps and no family history or other risk factors listed above, they are often instructed to return in 10 years. The important point to remember is that a patient should call his/her doctor and return immediately if he/she develops new symptoms or signs such as rectal bleeding, change in bowel habits or abdominal pain. A patient might also need repeat colonoscopy sooner if a new diagnosis of colon polyps or colon cancer is made in a family member.
If a patient has no polyps or cancer, but they have a family history of colon polyps or cancer, they will likely be asked to return for colonoscopy every five years.
For patients who do have colon polyps found during the exam, they will be asked to return at a time interval depending on how many polyps are found, how large they are and the pathology report. Each case will be discussed in great detail with the doctor who performed the colonoscopy exam. If multiple polyps are found, the exam may have to be repeated in three years. If a very large polyp is found, colonoscopy may even be repeated within one year to ensure that all the polyp tissue was removed.
Is surgery the only treatment needed?
When a polyp is removed by colonoscopy, it is usually the only treatment needed.
For colorectal cancer, surgery is the normal treatment and is often the only treatment needed when the cancer is detected early. In some cases, your specialist can remove the cancer using colonoscopy. Often, an open surgical procedure will be required. Treatment may also include radiation therapy before, during or after surgery; chemotherapy after surgery; or immunotherapy to strengthen the body’s immune system so it can attack and destroy cancer cells. These cancer treatments may be given separately or in combination. Your doctor will recommend the treatment methods best for you, depending on the size of the tumor, the stage of malignancy and whether it has metastasized, or spread, as well as other factors.
If I have colorectal cancer, will I have to have a colostomy?
Usually not. Surgeons can almost always treat colon cancer by removing the cancerous part of the colon and joining the remaining two ends together. Other times, a procedure called a colostomy may be needed. In this surgery, the cancerous part of the bowel is removed, after which the surgeon creates an artificial opening in the abdomen, bypassing the lower colon and rectum for the elimination of body waste. The waste is collected in a special bag attached to the opening.
Usually, a colostomy is only temporary, to give your bowel time to heal. In fact, thanks to new medical and surgical developments in recent years, the need for permanent colostomies has been significantly reduced. Today, even patients with rectal cancer, whose only choice in the past was usually a permanent colostomy, have other options. Preoperative radiation therapy and innovative surgical techniques can treat cancer in the lower rectum without jeopardizing the natural function of the muscles that control bowel habits, thereby dramatically reducing the likelihood of needing a colostomy.
Will I have to come back after treatment?
Once you have been treated for polyps or, especially, colorectal cancer or its precursors, you must remain vigilant. Your doctor will want to use blood tests, as well as other screening tests described above, to watch for any reoccurrence, suspicious areas or warning signs of any additional cancer.
What are polyps?
Colon cancer is believed to begin as a small growth called a polyp. The colon, also known as the large intestine, has several continuous areas, and the lowest portion is called the rectum. Colorectal polyps are bumps or growths on the inside lining of the colon or rectum. Most colorectal cancer develops in or at the site of polyps. Since 90 to 95 percent of all colon cancers stem from polyps, removing them helps to prevent cancer.
What does it mean if polyps are found in your colon?
There are two types of benign polyps that are related to colon cancer.
- Hyperplastic polyps are usually very small and were formerly thought to not increase the risk of cancer. Now there is evidence to show that there is an increased risk of cancer if a patient has more than 30 hyperplastic polyps at the initial exam.
- If the polyps found are adenomas, there is an associated risk of colon cancer, and these patients need to be screened at least every five years because they are definitely at risk for forming new polyps, and it is imperative that repeat colonoscopy be done on a regular basis.
According to the statistics about 75 percent of cases occur in patients who have no predisposing risk factors.
If your doctor finds a small polyp, he or she will usually remove it, often in the same endoscopic exam. Even if the polyp does not appear cancerous, it may become cancerous; therefore, it is normally taken out. The Hospital’s lab will examine the polyp to see if it has any areas indicating cancer.
If your doctor sees a large polyp, tumor or other abnormality, the first step may be a biopsy. The specialist takes out a small piece of tissue through the colonoscope. Examining the tissue helps determine if the area is cancerous or benign, or the result of inflammation.
Your medical team may use a follow-up colonoscopy procedure to remove small, limited areas of precancerous or early- cancerous tissue or discrete tumor. For more significant or established cancer (higher-stage cancer), abdominal surgery may be necessary.
Do I need a second opinion?
Polyp removal is a widely accepted preventive step; however, treatment decisions for actual colorectal cancer can be more complex. Before starting such treatment, patients might want another doctor to review the diagnosis and the treatment plan. Here are ways to find another doctor for a second opinion:
- Patients can call the Jefferson Cancer Network at 1-800-JEFF-NOW.
- Ask your doctor to suggest a specialist.
- Contact a local medical society, nearby hospital or medical school.
Are polyps common?
Colon polyps are common. Studies suggest that at least 30 percent of middle-aged people in the U.S. have colon polyps and others quote findings up to 50 percent of people over 60 years of age.
The risk of developing colon cancer is increased by the size and number of polyps found at the initial exam and following exams. If a polyp is larger than 1 centimeter, there is a greater risk that it contains cancer cells.
What is hereditary cancer?
All cancers are due to changes in genes. The majority of cancer is due to gene changes acquired during a person's lifetime and is not considered to be inherited or hereditary. But in some cases, a change in a specific gene may have been inherited (hereditary) and can predispose a person to a particular type of cancer. In these cases, cancer is linked to an inherited trait which can be passed on to a person's children, grandchildren and other extended family members.
Cancer due to an inherited trait results from a change in at least one gene that occurred before conception, and at least one additional change in a gene occurring after conception. A change that occurs before conception can be passed from one generation to the next. Cancers that are not due to an inherited trait are brought about by changes in the genes that occur after conception.
How many cancers are due to inherited traits?
One in every three people will develop cancer in their lifetime. While the majority of cancer is not due to a specific inherited trait, hereditary cancers account for approximately 5 to 10 percent of all cancer cases.
If an individual inherits a specific, altered cancer susceptibility gene, his or her lifetime risk for a particular type or types of cancer is significantly increased. Some cancer types, which are known to cluster in families and may be due to an inherited trait, include breast, ovarian, colon and other cancers.
Who may be at risk for a hereditary cancer?
Analyzing a family history can help to determine if a person may be at increased risk for a hereditary cancer. Family histories that may indicate hereditary cancer tend to have certain features in common. These include:
- Cancer in two or more close relatives, on the same side of the family.
- Individuals diagnosed with cancer before the age of 50.
- The presence of the same or associated cancers that comprise a syndrome. For example, breast and ovarian cancers in the same family is suggestive of hereditary breast-ovarian cancer syndrome.
- Bilateral cancer in paired organs, which is cancer in both organs where the body has more than one of a particular organ. For example, cancer in both breasts or ovarian cancer in both ovaries.
- Two or more separate tumors in the same individual.
- Two or more generations affected on the same side of the family.
- Presence of a rare cancer (for example, male breast cancer).
If any one of these circumstances describes your family, you may be at increased risk for cancer due to an inherited trait.
How is an individual's risk for hereditary cancer determined?
A person's cancer risk may be derived in a number of different ways. Typically, however, it begins with obtaining a pedigree, or a three-generation family history. This involves collecting information about first, second and third-degree relatives on both the mother's and father's side of the family. First-degree relatives include the mother/father, brothers/sisters and children. Second-degree relatives include grandparents, aunts/uncles, nieces/nephews and grandchildren.
Cousins, who are third-degree relatives, help complete the full picture. Ethnicity and race are also important because of the higher prevalence of certain gene changes in specific populations. A family history questionnaire is usually distributed and completed prior to an individual's office visit. Completing a family history questionnaire gives a person the opportunity to contact relatives and gather more detailed information before speaking with a genetic counselor who will analyze the family history.
Can several family members have cancer without it being hereditary?
Non-hereditary or non-genetic factors may also increase a person's risk to develop cancer. For example, cancer may occur in a family at a higher than expected rate due to hormonal or reproductive factors, lifestyle or environmental exposures, such as smoking cigarettes.
What is genetic counseling?
During genetic counseling, a genetic specialist educates families about their risk of having an inherited disorder, as well as the testing, management and screening options available for at-risk individuals. The process includes:
- Careful review of a patient’s medical history, family history and other risk factors
- Estimating the likelihood that cancers in the family are hereditary, and the patient’s individual risk of developing specific cancers
- Discussion of the benefits, limitations and implications of genetic testing
- When appropriate, facilitating genetic testing for at risk individuals and providing a detailed explanation of the results and their meaning
- Review of cancer screening and risk reduction recommendations tailored to the patient’s level of risk
- Opportunity for enrolling in unique clinical trials, genetic testing studies and cancer registries to further understand the genetics of cancer
Is gene testing available for certain types of cancer? Who are candidates for gene testing?
Over the past decade, research advances have led to the identification of many genes responsible for hereditary cancer syndromes. Currently, testing is available for breast, ovarian, colon and medullary cancers, retinoblastoma and other, more rare cancer types. In many cases, gene testing involves a simple blood test after a person receives genetic counseling. Although genetic testing is available for a number of hereditary cancers, it is not practical or appropriate to screen everyone, since only 5 to 10 percent of all cancers is due to an inherited risk.
Who should have genetic testing for hereditary cancer?
Analysis of a person's medical and family history is used to determine whether genetic counseling and genetic testing are necessary. Genetic testing may be considered in the following situation(s):
- When an individual has a reasonable likelihood of carrying a cancer predisposing gene change.
- When a genetic test is available that can be adequately interpreted.
- When results of testing will influence medical management.
- When the information revealed from testing will be meaningful and empowering to the person.
Genetic testing is always voluntary and is a decision to be made only after the risks, benefits and limitations have been presented by a trained genetic counselor.
What are the benefits of genetic testing for hereditary cancers?
For people in higher risk families with a known change in a cancer susceptibility gene, a negative test can provide a sense of relief. Additionally, unaffected family members of patients with identified gene changes who test negative can be spared the need for intensive cancer screening and intervention.
A positive test can help individuals make decisions about follow-up care. Some individuals may choose to have surgeries such as a prophylactic mastectomy or oophorectomy. These surgeries can reduce the risk of developing cancer in a particular organ. Additionally, patients may feel empowered by detecting cancer early through intensified screening or reducing their risk for cancer by altering their lifestyle. Results of gene testing in some families may also guide family planning.
Genetic testing involves complex issues that should be discussed with the individual considering testing. For this reason and others, genetic counseling is an important component of the process – both before testing is considered and after a test is ordered.
Is genetic testing covered by insurance?
Some genetics tests for well-defined hereditary cancers where a positive or negative result will change medical care are considered part of standard management. Other genetic tests for hereditary syndromes where the medical benefit of identifying a mutation carrier is not yet established are not considered standard medical practice. Recently, there has been a trend among the larger insurance companies to recognize the importance of testing and provide coverage for genetic counseling and testing.
Genetic testing raises ethical, legal and social questions; therefore, some individuals do not want their health insurance company to know if they carry a cancer predisposing gene change. Some fear that the company may use this information to raise premiums or cancel coverage. The extent to which this type of discrimination may occur is unknown. Applicable federal and state laws are explained to individuals considering genetic testing by a genetic counselor.
Can you tell me a little about the Infusion Center?
The Center features spacious, light-filled treatment bays, individual flat-screen TVs and relaxing décor. There are 20 reclining chairs in the unit along with chairs for anyone who may have accompanied you. There are curtains around each unit that can be used for privacy.
The Infusion Center tends to be cold. We can provide blankets if you are feeling chilly or feel free to bring a blanket from home if it will make you feel more comfortable.
Laptops and cell phones are permitted and can provide instructions on how to connect to the Internet through our Hospital Wi-Fi system, Jeff Guest.
Can I bring a family member with me?
On the day of treatment, we encourage you to bring one family member or friend with you. Depending on the length of treatment and medication administered, you may be too tired to drive home. Please understand that many of our patients are at an increased risk for infection from viruses due to compromised immune systems. It is for this reason that a strict policy has been implemented that no children under the age of 16 may be permitted in the Infusion Center unless they are receiving treatment themselves.
Am I allowed to eat before treatment?
There are no restrictions on what you can eat on the day of treatment and you can eat anything during the treatment process. You can bring in your own food or eat what is provided by the Infusion Center. We have snacks, juices, coffee, tea and sodas available at all times and sandwiches are available at lunchtime.
There are also many places outside of the Infusion Center where you may purchase food.
Am I allowed to take my medications on the day of treatment?
If you are taking any prescription medications for any conditions, you are permitted to take those on the day of treatment unless your oncologist has instructed otherwise. If you are unsure, contact your doctor.
Where can I park?
Valet parking is available on 10th street between Market and Chestnut Streets in the Rothman Building. The cost of parking is dependent upon the length of stay. Your parking ticket will be validated at the end of your stay and costs can range anywhere from $2.00 to $4.00. You may also self-park in the Laz Parking Garage on 10th and Chestnut Streets.
What is the check-in process at the Infusion Center?
Upon arrival you will check in on the 2nd floor. At the reception desk, you will see a computer monitor and you need to enter your name in the computer and take a seat in the waiting room. If you have any questions on how to do this, one of the receptionists can help you.
Within a short time, someone will call your name and you will be asked to verify your identity and contact information some questions and asked to provide copies of insurance cards, referrals if needed and any co-pays to complete your registration. Once you have completed the registration process, you take a seat in the waiting room until your name is called to have your lab work done. If you do not have a port, you will be brought back to have a phlebotomist or nurse draw your blood.
If you do have a port, you will be taken into the Infusion Center to have your labs done via your port by an assigned registered nurse.
If you are seeing your physician on the same day of your treatment, you will do that after your labs have been drawn. The physician offices are located on the 3rd or 4th floors.
Once you have completed your physician visit, you will come back to the Infusion Center where you will be seated and treatment will begin.
What lab work will I need done?
Your physician will order blood work to be drawn prior to each treatment to ensure that your lab values are within range to proceed with treatment. Labs will either be drawn from our highly skilled phlebotomists or by a registered nurse if you have an infusaport.
Once the labs are drawn and sent to the lab, it will take approximately 60 to 90 minutes for your physician to get the results. We encourage: You can ask your doctor to have your lab work done several days prior to treatment to avoid the wait time and to speed up your treatment process.
How long can I expect my treatment to take?
The length of your treatment is dependent on the type of chemotherapy your physician has ordered based on your type of cancer.
On your first visit, your chemotherapy is mixed specifically for you and your type of cancer at our onsite pharmacy. The pharmacist does not start mixing the chemotherapy until they receive a checklist from your assigned nurse.
This checklist contains your lab results and weight, which needs to be a certain range for you to receive treatment. If the lab values and weight are acceptable, the pharmacist will mix the therapy. This process can take approximately 30-60 minutes depending upon the type of chemotherapy you are receiving.
Overall you can expect to be there anywhere from an hour to several hours.
Will I need an IV to receive treatment?
When you come in for your treatment a registered nurse will be assigned to you. They will determine whether you require an IV or if you have a port that needs to be accessed.
What happens if I miss my appointment?
If you miss your appointment, please be sure to notify your physician so you can be rescheduled for another time. Please contact your physician’s office directly to reschedule.
What if I am running late for my appointment?
If you are running late, please notify the front desk. The telephone number is 215-955-8874. You will not be cancelled but you may be delayed in being seated.
How many times will I need to receive chemotherapy treatments?
Your physician will discuss your treatment and determine how often you will need to receive treatment. Depending upon your type of cancer, a chemo cycle could be every week, every two weeks or every three weeks.
What is a Complete Blood Count (CBC)?
This is a lab value that helps your physician determine if you are able to receive treatment. It looks at your white blood count, hemoglobin (the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.) and platelets (important for blood clotting). If any of these values are extremely low, treatment may be delayed and you will be rescheduled in a week or so to give your counts time to recover.
If your white blood count is too low, you may receive an injection that will boost your count to prevent you from developing an infection or your physician may put you on antibiotics. If your hemoglobin level or platelet count are too low, you may require a blood transfusion.
Where do I go for blood transfusions if I need one?
If you need a blood transfusion because of a low hemoglobin level or platelet count, a blood specimen is drawn and sent to the Blood Bank so that they can match your blood type.
Once your blood type is matched, a bag is prepared and we are notified that it’s ready. Your physician may order pre-medication (Tylenol or Benadryl) prior to the infusion to avoid a possible blood transfusion reaction. Typically the doctor will order 2 units.
This entire process can take up to 4 hours.
What if I have a problem after I get home?
If you have any issues after you receive your treatment please call 215-955-8874 and you will be directed on what to do.
If it is an emergency, please call 911 immediately or go to the nearest hospital.
What are the side effects of chemotherapy?
You may experience some side effects after receiving your treatment. The most commonly reported symptoms are nausea, vomiting, diarrhea, hair loss, peripheral neuropathies, and fatigue. Before your treatment begins, you will be given anti-nausea medications, which will help you during your stay.
It’s important to remember that everyone is different and you may experience none of these effects, some or all. It’s important to share the side effects with your physician who may be able to help you manage the side effects with medications. If your symptoms are severe, please contact your physician immediately.
Also, the Jefferson-Myrna Brind Center of Integrative Medicine offers an Integrative Cancer Care Program that provides complementary therapies such as vitamins, special diets, herbs and acupuncture that may help with some of your symptoms.
You also have access to oncology social workers who are trained in individual and family therapy and are available to meet with you to assist with the psychosocial impact of cancer treatment, and can provide a valuable link to available community resources.
I understand I may lose my hair after treatment. Where can I purchase a wig?
Jefferson's Wig Program for Cancer Patients was created to help ease the stress and/or embarrassment of sudden hair loss experienced by our patients. If you are being treated for cancer, either as an inpatient or an outpatient at Jefferson, and you have hair loss, we are happy to provide you with a free synthetic wig, turban or hat.
To make an appointment, place call Patient Services at 215-955-7777 or 5-7777 (from inside the Hospital).
Here at Jefferson, we want our patients to be as educated and informed as possible when it comes to their cancer care. We suggest you bring a list of questions and a notepad to ensure you get the most information possible during your visit with us. Some frequent questions asked of our radiation oncologists about cancer include:
- What type and stage of cancer do I have?
- How will radiation therapy help me?
- How does radiation therapy work? Is it internal or external?
- How many and how long will I receive radiation treatments?
- What are the chances that radiation therapy will work?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments?
- How can I expect to feel during treatment and in the weeks following radiation therapy?
- Can I drive myself to and from the treatment facility?
- Will I be able to continue my normal activities?
- What side effects may occur from the radiation?
- Will radiation therapy affect my ability to have children?
- What are some of the support groups I can turn to during treatment?