Thrive by IU Health

March 16, 2022

Colorectal screening: Nurse navigator stresses care ‘down there’

Colorectal screening: Nurse navigator stresses care ‘down there’

It’s a topic that makes a lot of people cringe, but colorectal screenings are an essential part of cancer prevention and early detection.

By IU Health Senior Journalist, T.J. Banes,

Parents of newborns celebrate their first soiled diaper. When they become toddlers, there is open conversation about potty training. But at some point, talking publicly about “poo” becomes a taboo.

“Nobody wants to talk about their stool. People are afraid to tell practitioners and family members that they have blood in their stool or a change in bowel movements. If we talked more freely about it we could catch things early on,” said IU Health Nurse Navigator, Michelle Juan. She joined IU Health in 2000 and for the past three years has worked with Dr. Douglas Rex and treatment of advanced colonoscopy and inherited colorectal cancer syndromes.

Hereditary nonpolyposis colorectal cancer (HNPCC/Lynch syndrome) causes an increased risk of developing certain cancers including colorectal cancer. Family adenomatous polyposis (FAP) is characterized by the development of hundreds of thousands of polyps in the colon that can develop into cancer if untreated.

Juan works with patients who have been diagnosed with large colorectal polyps that need removed. Other patients have previous incomplete colonoscopies where there’s a risk of missed precancerous polyps and colorectal cancer. They come to IU Health for advanced specialized endoscopic procedures.

For many patients, that sounds a little scary or overwhelming. That’s where Juan comes in. A large part of her role is educating patients and dispelling their fears.

First come the basics: The colon is the longest and largest part of the large intestine and performs the final process of digestion. That’s where the poo comes in. The best way to ensure the colon is healthy is to have a colonoscopy. The Centers for Disease Control and Prevention (CDC) recommends colorectal screenings for adults ages 45-75.

During a colonoscopy, patients receive anesthesia so they do not feel discomfort or pain. A physician guides a thin tube with a camera through the colon to check for polyps or unusual growths. The physician also removes polyps during the colonoscopy and checks for cancer cells. Patients with normal test results only need colonoscopies every ten years starting at age 50.

“I say this to anyone who will listen to me, ‘this is one thing you can do for yourself that can prevent colon cancer. We know it usually arises from polyps so if you can catch them while they’re small then you can prevent cancer,’” said Juan.

There are three areas that patients tend to focus that prevent them from getting a screening.

First, they feel like the colonoscopy is invasive. “They can’t imagine a scope down there or someone seeing that part of their body,” said Juan. “If we clearly communicate ahead of time, we can help decrease that anxiety. It’s no different than a mammogram, or prostate check.”

Second, people dread the prep. The key to a successful screening is to have a clean colon. That involves taking laxatives 24 hours in advance to empty the bowels.

“There are two types of polyps. Some people think of it as a balloon or bubble coming out of colon wall but there are also flat polyps that are harder to see. So a super clean colon allows for better screening,” said Juan. “I remind patients that it is temporary. It’s mind over matter. Our nurses do a great job helping patients choose the right prep for them and scheduling a time that is convenient for them. If they want to be near a bathroom on a Sunday, we’ll schedule the procedure for a Monday.”

The other concern for some patients pertains to economics. Some insurance won’t cover the screenings. Juan serves on a number of professional organizations and keeps an eye on community, local, and national health initiatives to assist those at risk and underserved. The Colorectal Cancer Alliance offers the Blue Hope Financial Assistance Fund and Screening Support.

“The main thing I want to stress is getting a screening is a way you can be proactive with something that pertains to your body,” said Juan. “This is something that can be prevented and detected early.

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