A stool test, such as the Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT), is a non-invasive kit that can detect hidden blood in the stool often unidentifiable by the naked eye. It is a prevalent method used to screen for colorectal cancer or other fundamental issues that result in bleeding within the digestive system.
Receiving a positive FOBT/FIT result can be a scary moment for some people. However, it's essential to understand that a positive result does not necessarily indicate a dire medical condition like colon cancer. In this article, we'll focus on the crucial next steps to take if your FOBT/FIT result comes back positive, guiding you through the process and providing clarity during this potentially worrisome time.
There are two types of FOBT stool tests which can detect gastrointestinal abnormalities:
1. Fecal Immunochemical Test (FIT or iFOBT): the FIT utilises a spatula or brush to gather a specimen of your stool, which is then enclosed within a container for subsequent laboratory analysis.
2. Guaiac Fecal Occult Blood Test (gFOBT): the gFOBT entails applying a stool sample to the designated test card using an applicator, followed by sealing the card within a container for subsequent laboratory evaluation.
The FOBT is a general umbrella term that encompasses the FIT and gFOBT. Both are stool tests that serve as effective initial screening tools to identify potential gastrointestinal issues. However, FIT is more sensitive and specific compared to gFOBT, thus the former is generally more accurate.
The FIT reportedly has a moderate to high accuracy in detecting digestive disorders. Its efficacy as a first-stage screening tool has been backed up by robust clinical studies such as population-based randomised trials. For example, a 2013 study published in the reputable Singapore Medical Journal supports the finding that using the FIT can decrease mortality from colorectal cancer. This is because it contributes to the early detection of colorectal cancer, which often leads to more successful treatment outcomes.
In the study, 8% out of the 8,156 active participants received positive FIT results. After which, 494 of them underwent further diagnostic screening. Close to half of them were diagnosed with a digestive disorder following colonoscopy, which alligns with their positive FIT results.
Main takeaway: the FIT serves as a moderately accurate first-stage screening tool for colorectal abnormalities.
As colon cancer is the most prevalent cancer in Singapore, the Singapore Cancer Society distributes free FIT kits to encourage people to get screened. Singaporeans and Permanent Residents above 50 years old can conveniently collect FIT kits from designated pick-up points.
When blood is detected in your stool, you get a positive FOBT result. This could be an early indicator for a range of gastrointestinal conditions, including anal fissures, ulcers, polyps, haemorrhoids, and potentially colorectal cancer.
1. Do not panic and worry
If you have a positive FOBT result, remember that it is not an immediate cause for alarm. Since FOBT solely identifies the existence of blood, further examinations will be necessary to pinpoint the origin of the bleeding. FOBT may yield false-positive results because of non-cancer-related conditions causing gastrointestinal bleeding. In a similar vein, it can also lead to false negatives if your cancer or polyps do not bleed. Hence, it would be best to remain calm as further testing is required before a proper diagnosis can be made.
2. Book an appointment with a colorectal specialist
Contrary to common belief, you do not necessarily require a GP referral letter to see a colorectal specialist in a Singapore private clinic. If you would like to streamline the consultation process, you can book an appointment with a colorectal specialist directly after you get your positive FOBT results.
A colorectal specialist, also known as a colorectal surgeon or proctologist, is a medical doctor who specialises in the diagnosis as well as surgical treatment of gastrointestinal and digestive disorders. Hence, colorectal surgeons should be your go-to doctors for FOBT and colon cancer concerns.
3. Attend the colorectal specialist consultation
Depending on your health history and the extent of the positive FOBT result, your colorectal surgeon may recommend further tests with higher sensitivity. A common recommendation is a colonoscopy, the gold standard for detecting colorectal cancer, which enables direct visualisation of the colon.
If you are worried about your upcoming colonoscopy, actively asking questions about the details of the procedure during the consult can allay your anxiety since it may reduce your fear of the unknown. Although the fear of colonoscopy is common, it is actually a safe and straightforward procedure. Regardless of age or underlying medical problems, most patients can undergo colonoscopy safely.
4. Prepare for your colonoscopy
You need to adhere to some pre-colonoscopy procedures for a successful and stress-free colonoscopy. Adhere closely to the guidance of your colorectal surgeon. Staying compliant with these directions is essential for obtaining accurate diagnostic insights.
5. Attend your colonoscopy and book the next colonoscopy
Rest assured that colonoscopy is not painful. Patients undergoing colonoscopy will be given sedative drugs to minimise discomfort. The sedative drugs also have some amnesia effect to minimise memories of the event.
After the examination, it typically takes approximately one hour to initiate the recovery process from the sedative. As the complete effects of the sedative may persist for up to a day, it is necessary to arrange for someone to accompany you home. Refrain from driving, making significant decisions, or returning to work for the remainder of the day.
Finally, remember to book your next routine colon cancer screening appointment. For a colonoscopy performed with a well-cleansed colon and adequate polyp removal, the next scope can be performed in 5 years.
A positive FOBT result serves as a stepping stone toward proactive healthcare. It is meant to be an initial screening tool rather than cause immediate worry. The stool test kit result is insufficient for a diagnosis of colon cancer. Thus, follow-up tests with higher sensitivity are necessary.
For a safe and effective colonoscopy, book an appointment with colorectal surgeon Dr Aaron Poh, the Medical Director at Alpine Surgical Practice. He is a trusted colorectal specialist with a proven track record of doing colonoscopies.