SCREENING TESTS – BASIC (Rs 2, 500)
Cancer Antigen (CA 19-9)| Full Blood Count (FBC)| Consultation

SCREENING TESTS – EXECUTIVE (Rs 32, 000)
Gastroscopy| Colonoscopy| Cancer Antigen (CA 19-9)| Full Blood Count (FBC)| Consultation

SCREENING TESTS – EXECUTIVE (Rs 52, 000)
PET Scan| Gastroscopy| Colonoscopy| Cancer Antigen (CA 19-9)| Full Blood Count (FBC)| Consultation

What is Screening?

Screening is the process of looking for cancer in people who have no symptoms. Several tests can be used to screen for colorectal cancer. The most important thing is to get screened, no matter which test you choose.

Positron Emission Tomography (PET) Scan

PET scan is a type of test that create 3 dimensional (3D) pictures of the inside of your body.

The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal. It’s used to help diagnose some conditions including cancer. It can also help to find out where and whether cancer has spread.
It usually takes between 45 and 60 minutes. You will be in the department for at least an hour beforehand. This is because you have an injection of a radioactive liquid (radiotracer) before the scan.

PET scans are often combined with CT scans to produce more detailed images. These are called PET-CT scans.

A PET scan can help to:

⦁ show up a cancer
⦁ find out how big it is and whether it has spread (stage a cancer)
⦁ show whether a lump is cancer or not
⦁ decide the best treatment for your cancer
⦁ show how well a treatment is workingAfter you have had treatment for cancer, a CT scan may show that there are still some signs of the cancer left. But this may not be active disease. It could be scar tissue left over from cancer killed off by your treatment.

A PET scan can show whether this tissue is active cancer or not.
PET scans are sometimes used to look for cancer in the lymph nodes in the centre of the chest.

Preparing for your PET scan

1. For most PET scans, you need to stop eating for about 4 to 6 hours beforehand. You can usually drink unflavoured water during this time.
2. You might have instructions not to do any strenuous exercise for between 12 and 24 hours before the scan.

In specific cases :

Call the number on your appointment letter if not eating is a problem for you, for example if you’re diabetic. You might need to adapt your diet and sugar control and your appointment time could change.

Some people feel claustrophobic when they are having a scan. Contact the department staff before your test if you’re likely to feel like this. They can take extra care to make sure you’re comfortable and that you understand what’s going on. Your doctor can arrange to give you medicine to help you relax, if needed.

what to expect at the hospital when getting a PET scan for Stomach/colorectal cancer:

Your radiographer might ask you to change into a hospital gown. You have to remove any jewellery and other metal objects such as hair clips, coins, belts and a wired bra. Metal interferes with the images created by the scanner.

You have an injection of radiotracer about an hour before the scan. You have the injection through a small plastic tube in your arm (cannula). It’s only a small amount of radiation.

You need to rest and avoid moving too much during this hour. This allows the radiotracer to spread through your body and into your tissues.

The radiotracer is a radioactive sugar. The one commonly used is called FDG (fluorodeoxyglucose). Cancer cells are very active when they are growing and reproducing in a specific area. They need energy to grow. So, active cancer cells take up the FDG which then shows up brighter on the scan.

In the scanning room

• Your radiographer takes you into the scanning room. The PET machine is large and shaped like a doughnut.
• You have most scans lying down on the machine couch on your back.
• Once you’re in the right position, your radiographer leaves the room. They can see you on a TV screen or through a window from the control room. You can talk to each other through an intercom.

Having the PET scan

• The couch slowly slides backwards and forwards through the scanner. The machine takes pictures as you move through it.
• The scan is painless but can be uncomfortable because you have to stay still. Tell your radiographer if you’re getting stiff and need to move.
• It’s not particularly noisy but you’ll hear a constant background noise. In most places the radiographer will be able to play music for you.
• When it’s over, your radiographer will come back into the room and lower the couch so you can get up.

This 3-minute video shows you what happens when you have a PET scan or PET-CT scan.

After your PET scan:

1. Your radiographer removes the cannula from your arm before you go home. You can then eat and drink normally.
2. The radiation in the radioactive tracer is very small. Drinking plenty of fluids after your scan helps to flush the radiotracer out of your system.

The radioactive tracer gives off very small levels of radiation that go away very quickly. As a precaution, you should avoid close contact with pregnant women, babies and young children for 6 hours after the scan.

You need someone to take you home and stay overnight if you’ve had medicine to help you relax (sedative).

For the next 24hours you also shouldn’t:

⦁ drive
⦁ drink alcohol
⦁ operate heavy machinery
⦁ sign any legally binding documentsMost airports have sensitive radiation monitors, which may pick up the trace of radiation following your test. If traveling abroad within a week of your scan, it’s a good idea to take your appointment letter with you.

Possible risks:

A PET scan is a safe test for most people. But like all medical tests it has some risks. Your doctor and radiographer make sure the benefits of having the test outweigh these risks.

• Pregnancy

Pregnant women should only have the scan in an emergency. There’s a risk that the radiation could harm the developing baby. Contact the department beforehand if you’re or think you might be pregnant.

• Breastfeeding

If you’re breastfeeding, let the department know a few days before your appointment. They will let you know if you need to stop breastfeeding for a length of time after having the radioactive drug. You might need to store enough expressed milk for at least one feed.

• Radiation

Exposure to radiation from the radiotracer during a PET scan slightly increases your risk of developing cancer in the future. Talk to your doctor if this worries you.
Bruising and swelling

You might get a small bruise around the area where they put the needle in.
There’s is a risk that the radioactive tracer will leak outside the vein. This can cause swelling and pain in your arm but it’s rare.

• Allergic reaction

Rarely, people have an allergic reaction to the radioactive tracer. This most often starts with weakness, sweating and difficulty breathing. Tell your radiographer immediately if you feel unwell.

Getting your results

Your scan will be looked at by a specialist doctor and you should get your results within 48 hours. You won’t get any results at the time of the scan.
Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact them if you haven’t heard anything after 48 hours.

CA 19-9 Test for Stomach/Colorectal Cancer

What is a CA 19-9 test?

This test measures the amount of a protein called CA 19-9 (cancer antigen 19-9) in the blood. CA 19-9 is a type of tumor marker. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in the body.

Healthy people can have small amounts of CA 19-9 in their blood. High levels of CA 19-9 are often a sign of pancreatic cancer. But sometimes, high levels can indicate other types of cancer or certain noncancerous disorders, including cirrhosis and gallstones.

Because high levels of CA 19-9 can mean different things, the test is not used by itself to screen for or diagnose cancer. It can help monitor the progress of your cancer and the effectiveness of cancer treatment.

What is it used for?

A CA 19-9 test may be used to:
⦁ Monitor pancreatic cancer and cancer treatment. CA 19-9 levels often go up as cancer spreads, and go down as tumors shrink.
⦁ See if cancer has returned after treatment.
The test is sometimes used with other tests to help confirm or rule out cancer.

Why do I need a CA 19-9 test?

You may need a CA 19-9 blood test if you’ve been diagnosed with pancreatic cancer or other type of cancer related to high levels of CA 19-9.

These cancers include:

 bile duct cancer, colon cancer, and stomach cancer.
Your health care provider may test you on a regular basis to see if your cancer treatment is working. You may also be tested after your treatment is complete to see if the cancer has come back.

What happens during a CA 19-9 test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You don’t need any special preparations for a CA 19-9 blood test.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

If you are being treated for pancreatic cancer or other type of cancer, you may be tested several times throughout your treatment.

After repeated tests, your results may show:

⦁ Your levels of CA 19-9 are increasing. This may mean your tumor is growing, and/or your treatment is not working.
⦁ Your levels of CA 19-9 are decreasing. This may mean your tumor is shrinking and your treatment is working.
⦁ Your levels of CA 19-9 have not increased or decreased. This may mean your disease is stable.
⦁ Your CA 19-9 levels decreased, but then later increased. This may mean your cancer has come back after you’ve been treated.

If you do not have cancer and your results show a higher than normal level of CA 19-9, it may be a sign of one of the following noncancerous disorders:

⦁ Pancreatitis, a noncancerous swelling of the pancreas
⦁ Gallstones
⦁ Bile duct blockage
⦁ Liver disease
⦁ Cystic fibrosisIf your health care provider suspects you have one of these disorders, he or she will probably order more tests to confirm or rule out a diagnosis.

Colonoscopy

A colonoscopy is a way for your doctor to see the entire large intestine. It can help find the cause of problems in a part of the intestine called the colon.

How a colonoscopy works

Your doctor places a thin, lighted tube through your anus and rectum up into the colon. Before the procedure, you get a sedative and pain medication to make you more comfortable. The colonoscopy tube has a small camera on it. It shows your doctor images of the inside of your colon as the tube moves through. The doctor can also take a small sample of tissue through the tube to examine later. Getting this type of sample is part of a test called a biopsy.

Who does my colonoscopy?

A doctor called a gastroenterologist, or GI doctor, usually does a colonoscopy. This type of doctor specializes in the digestive system.  A surgeon may also do the procedure. Your team will also include a nurse and possibly an anesthesia specialist.

Getting ready for a colonoscopy

You will probably have your colonoscopy at a doctor’s office or hospital. Getting ready is important, because your colon needs to be as clean as possible. This will allow the doctor to see the colon well. So when you schedule your colonoscopy, you will get detailed instructions on how to prepare.

Here are some things to keep in mind:

⦁ Tell your doctor about all the medications you take, including any vitamins, herbs, or supplements. Be sure to ask if you should take them on the day of the test. If you take a blood thinner or daily aspirin, you might need to stop several days before the procedure.
⦁ Tell the doctor about any drug allergies or medical conditions you have.
⦁ You will need to avoid solid food for 1 to 3 days before the procedure. You may drink clear liquids up to a certain time. These may include fat-free bouillon or broth, black coffee, strained fruit juice, or gelatin.
⦁ You will need to take a laxative or give yourself an enema at a certain time before the colonoscopy. Your doctor’s office will tell you what to use. The laxative is a pill or a powder you mix with water before drinking. A laxative speeds up the process of waste leaving your colon and it will make you have more bowel movements than usual.
⦁ Arrange for a friend or family member to drive you home. You will be sleepy after the procedure.
⦁ You will be asked to sign a consent form before your colonoscopy. It will state that you understand the risks and benefits of the colonoscopy and agree to have it. Your doctor or nurse will explain the procedure before you sign the form, and you can ask questions.

Talk with your health care team about any concerns you have about the colonoscopy.

During the procedure

You should expect the procedure to take about 30 to 60 minutes. When you get to the hospital or doctor’s office, you will change into a hospital gown. You will be in a private room with a sheet draped over your body.

The nurse or anesthesia specialist will give you pain medication and a sedative. You will get this through an intravenous tube, or IV. The IV goes in a vein in your arm. You might feel a small sting from the IV needle when it goes in.

To start the procedure, the doctor blows some air through the small tube into your colon. This inflates the colon slightly so the doctor can see better. You might need to change your position during the procedure. This is to help the doctor move the colonoscopy tube or get a better view. If you are asleep, the doctor or nurse will help with this.

If you have an abnormal growth, or polyp, in your colon, the doctor will remove it. Or they may take a small sample of tissue. This is not usually painful, and the doctor will stop any bleeding. If the growth is too large or complicated to remove during the colonoscopy, doctors may remove it later.

During the procedure, you may feel discomfort from lying still for a long time. If you are awake, you may have some cramps. If so, tell your nurse. You can also take slow, deep breaths to relax.

There is a small risk that the tube used for a colonoscopy might puncture the colon. This is rare, but you might need surgery to repair it if this happens. Talk with your health care team if you have concerns about this.

After the procedure

You will stay at the hospital or doctor’s office until you are fully awake. You should not drive a vehicle, operate machines, or make important decisions the rest of the day. A friend or family member can drive you home.

You can expect to go back to normal activities the next day.

Contact your doctor immediately if you have:

⦁ Severe abdominal (belly) pain
⦁ A fever
⦁ Bloody bowel movements
⦁ Dizziness
⦁ WeaknessGastroscopy

A gastroscopy is a test that looks at the inside of your food pipe (oesophagus), stomach and the first part of your small intestine (small bowel).A doctor or specialist nurse (endoscopist) does the test.

They use a long flexible tube which has a tiny camera and light at the end. This tube is called a gastroscope or endoscope.You may also hear this test called an oesophagho gastric duodenoscopy (OGD).Why you might have a gastroscopy

You might have a gastroscopy to find out the cause of symptoms such as:

⦁ abnormal bleeding
⦁ indigestion
⦁ low levels of iron (iron deficiency anaemia)
⦁ difficulty swallowing

Preparing for your test

• You might have blood tests beforehand to check your blood levels and how well your blood clots.

• Tell your doctor if you’re taking medicines to thin your blood such as warfarin.Your doctor will tell you if you need to stop taking these or any other medicines for a while before your gastroscopy.

• You can’t eat for 6 hours before the test, but you might be able to drink sips of water up to 2 hours beforehand.

• Your doctor or nurse gives you written instructions about this before your appointment.Talk to your doctor if not eating could be a problem for you. For example, if you have diabetes.What happens?

• Most people have a gastroscopy as an outpatient, which means you go home the same day. The test takes up to 15 minutes. But expect to be in the hospital for several hours.

• First you meet your nurse who asks you about your medical history and any allergies you might have. They may check your blood pressure and heart rate.Your nurse or endoscopist explains the procedure and asks you to sign a consent form. This is a good time to ask any questions you might have.Some endoscopy units may ask you to change into a hospital gown, but you can usually have the test in your own clothes.

• Usually you’re awake when you have the test, but you can choose to have medicine to relax you. These make you drowsy (sedation).If you have any false teeth or wear glasses you need to remove them for the test. Your nurse puts a plastic guard in your mouth to protect your teeth from the gastroscope.Having the test awake.

• Your endoscopist sprays the back of your throat with local anaesthetic to numb it and make it easier to swallow the tube. This may make you cough, your eyes may water and it may taste bitter.You then lie on your left side.It takes a few minutes for your throat to go numb.

How it happens :

Your endoscopist passes the gastroscope into your mouth and down your throat to the oesophagus. The tube is slightly bigger than a pen and will be uncomfortable but shouldn’t be painful.They ask you to swallow as the tube goes down. They can see the images from the gastroscope on a television screen. They may put a small amount of air into the tube to help them see your oesophagus, stomach and duodenum.

This might make you feel like burping.Your endoscopist takes samples (biopsies) through the gastroscope of any abnormal areas. This shouldn’t be painful.At the end of the test, your endoscopist gently removes the gastroscope.Having the test while drowsy.

You lie down on the couch.Your nurse puts a small plastic tube (a cannula) into a vein in your arm. They then inject the sedative into the cannula. It takes a few minutes for you to get more relaxed, this makes you drowsy.

You are still able to follow instructions from your endoscopist and nurse.They give you oxygen through a small plastic tube with prongs that sit just inside your nostrils.

They also put a clip on your finger to check your oxygen levels and heart rate.Your endoscopist then passes the gastroscope down your throat.

After your test

Your nurse or endoscopist will talk to you about how the test went, if they took any biopsies and when to expect the results.You might have some bloating and discomfort lasting a few hours after the gastroscopy.

If you haven’t had sedation, you can usually go home shortly after having the test. You won’t be able to eat or drink until the local anaesthetic spray has worn off. This takes about an hour.

If you had sedation, you stay in the endoscopy unit for an hour or two to recover. You may not remember much (if anything) about the test. You’ll need a friend or relative to take you home and stay overnight.

For 24 hours after having sedation, you shouldn’t:

⦁ drive
⦁ drink alcohol
⦁ operate heavy machinery
⦁ sign any important documentsPossible risks

Gastroscopy is a very safe procedure but your nurse will tell you who to contact if you have any problems after the test.

Your doctor will make sure the benefits of having a gastroscopy outweigh the possible risks.

Full Blood Count (FBC)

A full blood count (FBC) is a common blood test that your doctor may recommend to:

⦁ Help diagnose some blood cancers, such as leukemia and lymphoma
⦁ Find out if cancer has spread to the bone marrow
⦁ See how a person’s body is handling cancer treatment
⦁ Diagnose other, noncancerous conditions

A FBC measures the amount of 3 types of cells in your blood:

⦁ White blood cell count. A white blood cell count, also called a leukocyte count, measures the total number of white blood cells in a sample of blood. These cells protect the body from infection by attacking invading bacteria, viruses, and other foreign materials in the body. Some white blood cells can also attack cancer cells.

⦁ White blood cell differential. A white blood cell differential measures the number of each type of white blood cell. There are 5 major types of white blood cells, and each type plays a different role in protecting the body. Your doctor can learn valuable information about your health by measuring the levels of these cells:
⦁ Neutrophils
⦁ Lymphocytes
⦁ Monocytes
⦁ Eosinophils
⦁ Basophils

⦁ Red blood cell count. Red blood cells carry oxygen throughout your body. A red blood cell count, also called an erythrocyte count, measures the number of red blood cells in a sample of blood.

There are several ways to measure red blood cells.

Two of the most common are:

⦁ Hematocrit (Hct), the percentage of your blood that is made up of red blood cells

⦁ Hemoglobin (Hgb), the amount of the protein in red blood cells that carries oxygen

⦁ Platelet count. A platelet count measures the number of platelets in a sample of blood. Platelets help to stop bleeding by forming blood clots.The amounts of each of these types of cells have a normal range.

Your health care team will note this range on your FBC lab results. A range is used instead of a specific number because a normal amount is different for each person.
By the time stomach/ colorectal cancer signs and symptoms develop, the cancer is usually too advanced for curative treatment. Studies show stomach/ colorectal cancer screening reduces the risk of dying of stomach/ colorectal cancer.