National Bowel Cancer Screening Program's Information Booklet
If your FOBT result is positive, you will need to discuss the result with your doctor. Your doctor may recommend a further test, usually a colonoscopy, to find the cause of the bleeding. You should discuss with your doctor any risks associated with such testing.
What does a colonoscopy involve?A colonoscopy is a procedure to examine the bowel. The usual procedure for a colonoscopy is described below.
The day before:The day before the colonoscopy you will be asked to drink a special preparation to help empty your bowel. This is very important, because it helps the doctor see the lining of your bowel more clearly and find any changes. You will need to be near a bathroom all day, so you may need to take time off work or plan ahead if you need to travel for your colonoscopy.
The day of the procedure:On the day of the procedure you may be given a sedative that will make you feel drowsy. The doctor will then insert a narrow flexible tube into the rectum. This tube is called a colonoscope. It has a very small camera attached to it, which lets the doctor look for polyps or cancerous growths in the bowel.
The test itself takes about 20 to 30 minutes and is usually carried out in a hospital or day clinic. After the procedure you will remain in the hospital recovery area for about two hours until the effect of the sedation wears off.
You may then go home. You will need to have someone come and pick you up. Because of the sedation, it is very important that you do not drive a car, travel on public transport alone (including in a taxi), operate machinery, sign legal documents or drink alcohol for 24 hours after your test.
If any polyps are seen, the doctor will usually remove them immediately and test them for cancer. You may feel some discomfort after the procedure, but this will settle quickly. You should not feel any pain.
Further details on colonoscopy can be found on the program’s website: Cancer Screening website
Are there any risks from a colonoscopy?Complications from colonoscopy may occur. Serious complications may include perforation (making a hole) of the bowel wall (about 1 in 1,000 examinations) and/or major bleeding from the bowel (about 3 in 1,000 examinations)8.
You could also have a poor reaction to the bowel preparation and/or to the sedatives or anaesthetic. Rare side effects can occur with any procedure. Death is a remote possibility.
It is important that you discuss the risks and benefits with your doctor before consenting to any procedure, including colonoscopy.
Where can I have a colonoscopy?Colonoscopies are generally performed in a hospital or day clinic by a specialist. You will usually need a referral from your doctor and can be referred as a public or private patient. There are waiting lists for colonoscopy in some parts of Australia. If you are concerned you should discuss this with your doctor in the first instance.
How much does a colonoscopy cost?The Government pays a Medicare rebate for colonoscopies performed in the private sector. Depending on whether you have your colonoscopy as a public or private patient, you may have to pay an additional gap fee. You should discuss the possible costs with your doctor and health insurance fund.
What happens if a bowel cancer is detected?You will usually require surgery if a bowel cancer is found. If the cancer is found at an early stage, the chance of a full recovery is high. Most people will be able to return to their current lifestyle.
What if the colonoscopy doesn’t show anything?A clear colonoscopy means that no polyps or cancerous growths were detected. Your specialist will discuss your result with you and the frequency and type of future testing required based on your individual circumstances. This may include a return to two yearly FOBT screening, as recommended by the NHMRC9.
In the meantime, if you develop any of the symptoms described in this book, you should see your doctor immediately.
8 The National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer (2nd edition, December 2005), p 92.
9 ibid, p 38.