Virtual Colonoscopy for Cancer Screening

Virtual colonoscopy is a procedure that is done to look for polyps inside your colon. Polyps that grow on the inside lining of the colon sometimes turn into colon cancers. The American Cancer Society recommends that men and women begin screening for colon cancer at age 50. If you have a family history of colon cancer or are at high risk for other reasons, your health care provider may want you to begin screening even earlier. Virtual colonoscopy every five years is one of several screening options.

Procedure overview

Virtual colonoscopy is a special X-ray examination of your colon using low dose computer tomography, also called a CT scan.

Reasons for the procedure

Colon cancer is the third most common cancer in men and women. The reason for virtual colonoscopy is to find polyps before they become cancer or to find colon cancer at an early stage when it can be treated most successfully. Colon polyps that are found by virtual colonoscopy can be removed (using conventional colonoscopy) before they turn into cancer.

An older and still common type of colonoscopy, called conventional colonoscopy, is also done to screen for colon cancer. This procedure is done by placing a long, flexible, lighted scope and tiny camera into the colon so that the doctor can look at the colon directly and remove any polyps that are present. It is more invasive and more expensive than a virtual colonoscopy and requires sedation.

Virtual colonoscopy has several advantages over conventional colonoscopy:

• Virtual colonoscopy is less uncomfortable and less invasive than conventional colonoscopy and does not require any pain medication or anesthesia.

• Virtual colonoscopy takes less time and poses less risk of puncturing the colon.

• Virtual colonoscopy may be used in people who have problems such as swelling, bleeding, or breathing difficulties and who may not be able to tolerate conventional colonoscopy.

• Virtual colonoscopy may be able to show areas of the colon that conventional colonoscopy can't reach.

More Information About Colon Health from Johns Hopkins Medicine

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Risks of the procedure

Virtual colonoscopy is a safe procedure, but it's not without risk. Conventional colonoscopy, however, also has some drawbacks. Among the risks and disadvantages of virtual colonoscopy:

• During virtual colonoscopy, a small, short tube is placed into your rectum so that carbon dioxide can be pumped into your colon. This inflates your colon so that polyps or other growths are more easily seen. Pumping air into the colon carries a very small risk that it may cause a rupture. But the risk is thought to be much less than with conventional colonoscopy.

• Because polyps or suspicious growths cannot be removed or biopsied during virtual colonoscopy, you may still need to have a conventional colonoscopy if large polyps or other suspicious areas are detected.

• Virtual colonoscopy can miss some polyps that may turn into cancer if they are smaller than 10 mm. (Some of these may or may not be detectable by conventional colonoscopy.) 

• Unlike most other screening tests, virtual colonoscopy uses X-rays to create pictures of the colon and rectum. Radiation received during virtual colonoscopy is small, but it could be dangerous for pregnant women. If you are or could be pregnant, you should discuss this risk with your health care provider before the procedure.

• Virtual colonoscopy is still fairly new, and it may not always be covered by medical insurance.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your health care provider before the procedure.

Before the procedure

Before having a virtual (or a conventional) colonoscopy, you will need to have a bowel prep. A bowel prep is a way of emptying  your colon so that the CT images will be clear. Here is what is often involved with a bowel prep:

• Your health care provider may ask you to limit your diet to clear liquids such as water, Gatorade, or clear broth for a day or two before the procedure.

• The day before the procedure, you will be given a strong laxative in pill form or powder dissolved in liquid to help you empty your colon. You will likely have several loose or liquid bowel movements in the following hours. 

• Just before the procedure you may be given a type of liquid to drink called contrast media that helps any residual stool in your colon appear brighter for the X-rays.

Always tell your health care provider about any medications you are taking and if you've had any reactions to contrast media for other X-rays in the past.

During the procedure

In most cases you will go to the radiology department of a hospital or medical center. The actual procedure takes only about 10 to 15 minutes. This is what usually happens during a virtual colonoscopy:

• The thin tube will be placed into your rectum to inflate your colon with carbon dioxide. You may feel a slight fullness.

• A radiologist will position you face up on a table that slides into the CT scanner.

• The radiologist will leave the room and the CT scanner will be operated from a separate control room. You will be able to hear and talk with the staff.

• The table will move into and through the scanner. You may hear some whirring and clicking noises.

• You may be asked to hold your breath at times.

• The scan may need to be repeated while you lie face down.

After the procedure

In most cases you should be able to return home without assistance and resume your normal diet and activities. Medications and special instructions are usually not needed, but always check with your health care provider and the radiology staff if you have any questions.

Make a Health Promise

Colorectal cancer is the third most common cancer in the U.S., excluding skin cancers. Early detection is vital, and a screening is recommended every 10 years, starting at age 50. Those with a family history of colorectal cancer should be screened starting at age 40, or 10 years before the youngest case in the family, whichever comes first.

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