Colon cancer screening
and Martina Feichter, medical editor and biologistDr. med. Mira Seidel is a freelance writer for the medical team.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
In Germany, colon cancer screening is recommended from the age of 50. A test for hidden blood in the stool is available for this purpose. In addition, men from the age of 50 and women from the age of 55 are entitled to two colonoscopies every ten years. You can find out more about colon cancer screening here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C17C21C19C18C26C20
What is colon cancer screening?
Colon cancer screening is part of the statutory early detection programs. Its purpose is to detect colon cancer (or its precursors) as early as possible. Because the smaller the tumor is and the less it has spread, the better the chances of recovery. This is very important because colon cancer is very common: In Germany it is the second most common cancer among women and the third most common cancer among men.
Depending on the age, the statutory and private health insurance companies pay for certain examinations for general colon cancer screening - also known as "screening". There is also a more closely-knit early detection program for high-risk patients. These are people who are known to be at increased risk of colon cancer. This is the case when a first-degree relative (parents, children) already has colon cancer. Even if a second-degree relative (grandparents, grandchildren, siblings) has or has had a malignant tumor in the intestine, there is a slightly increased risk.
General colon cancer screening
The general colon cancer screening program is for people who are not at special risk for colon cancer.
Immunological stool test (iFOBT)
Colon tumors can temporarily secrete blood. The immunological test for occult blood in the stool (immunological fecal occult blood test, iFOBT, English: FIT) is used to detect such blood in the stool. It is based on antibodies that specifically couple to the human blood pigment hemoglobin. Compared to previous biochemical tests (guaiac test, haemoccult test), this is a great advantage: These also responded to blood that entered the intestine from food such as meat. In addition, immunological tests provide more reliable evidence of blood in the stool.
However, it can also happen here that the test is carried out at a time when an intestinal polyp or tumor is not bleeding. A negative result does not offer 100 percent certainty that there is no colon cancer.
Conversely, a positive immunological test does not mean that the patient has colorectal cancer with certainty. Because blood in the stool can also have other causes: For example, hemorrhoids or bleeding gums can be the reason if the immunological test is positive.
If the test gives a positive result, the exact cause must be clarified. Colon cancer can be clearly detected with a colonoscopy.
Colonoscopy
The safest method of colon cancer screening is a colonoscopy. A flexible tube (endoscope) is inserted through the anus and into the intestine of the patient under light anesthesia. At the front end of the endoscope there is a light source and a small camera. The doctor carefully pushes the endoscope through the entire colon. In this way, he can continuously examine the images on a monitor that the camera takes of the inside of the intestine.
If necessary, fine instruments can also be inserted via the endoscope. With their help, the doctor can take tissue samples and cut out intestinal polyps for an accurate laboratory analysis. In almost all cases, intestinal polyps, which are harmless, are the starting point for colon cancer. The precaution therefore also consists in removing suspicious polyps.
The colonoscopy is generally very low-risk. Sometimes, however, the endoscope injures the intestinal wall. Serious complications are rare with this examination. The great benefit of colonoscopy in colorectal cancer screening clearly outweighs any risks.
Legal entitlement: women aged 55 and over and men aged 50 and over are entitled to at least two colonoscopies. If the first colonoscopy remains normal, the second colonoscopy will be paid for by the health insurance companies after ten years at the earliest (colon cancer develops only slowly). As an alternative, anyone who does not want to have a colonoscopy has the right to an immunological test every two years.
Digital rectal exam
In the digital rectal examination (DRE), the doctor uses a finger to scan the inside of the rectum for changes. Usually the patient lies on the left side of the body on the examination table. Alternatively, an examination while standing with the upper body bent forward is possible. The doctor then carefully inserts a finger rectally - i.e. over the anus - (with gloves and lubricant). He carefully feels the wall of the rectum. The examination only takes about a minute.
The digital rectal examination is very important: Colorectal cancer often develops in the rectum (rectal cancer). It can sometimes be felt directly during the examination. That is why doctors recommend all people over the age of 50 to undergo a digital rectal examination once a year.
However, palpation of the rectum is no longer part of the statutory program for early detection of colon cancer. Depending on the situation, doctors will still carry out the examination. For example, when examining the prostate in men or as part of the gynecological examination in women. The health insurance companies do not cover the costs.
Colon cancer screening in high-risk patients
If you have first-degree relatives (parents, children) who are already suffering from colon cancer, you are considered a risk patient. Then you should have the colonoscopy at an age ten years before your relative's age of onset - but no later than 50 years of age. For example, if your father was diagnosed with colon cancer at the age of 55, you are recommended to have a colonoscopy at 45 years of age. If your father was 75 when the diagnosis was made, you should still have a colonoscopy by 50 at the latest.
People who are suspected or proven to have certain genetic changes that are associated with an increased risk of colon cancer are also considered to be at risk. It is about genetic changes that can lead to hereditary nonpolypous colorectal carcinoma (HNPCC, also called Lynch syndrome) or familial adenomatous polyposis (FAP). Individual colon cancer screening is recommended for the affected risk patients. This can mean, for example, that the doctor advises a risk patient to have a repeated colonoscopy at short intervals. With proven risk genes, a colonoscopy can also be useful at a young age.
An individualized intestinal cancer screening plan is also advisable for the chronic inflammatory bowel disease ulcerative colitis.
It is best to clarify whether the statutory health insurance will assume the costs before the examination.
Colon cancer screening: what can I do myself?
Effective colorectal cancer screening does not only include participation in the recommended early detection examinations. Everyone can take precautions against colon cancer with a healthy lifestyle:
- Avoid nicotine and alcohol. Both luxury foods increase the risk of colon cancer and other cancers.
- Eat a low-meat, high-fiber diet with plenty of fruit and vegetables. A diet rich in meat and fat and low in fiber promotes the development of colon cancer.
- Sedentary lifestyle is another risk factor for colon cancer. So be physically active on a regular basis!
The bad influence of an unhealthy diet and lack of exercise is due to the fact that they slow down the transport of food residues through the intestines. Any pollutants and toxins in the stool then remain in contact with the intestinal mucosa for longer and can damage it more easily.
Obesity and type 2 diabetes (type 2 diabetes) also promote the development of colon cancer due to increased insulin levels (insulin generally stimulates cell growth). Obese people and diabetics should therefore take colon cancer screening very seriously.
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