Stool Tests for Colorectal Cancer

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Stool Tests for Colorectal Cancer

Test Overview

A stool test is one of many tests used to look for colorectal cancer. These tests may find cancer early, when treatment works better. Colorectal cancer affects the large intestine (colon) and the rectum.

There are two kinds of stool tests used in Canada:

  • Fecal occult blood test (FOBT). For this test, you put tiny samples of your stool on a special card or cloth and send it to a lab. The lab uses chemicals to find blood that you can't see with the naked eye. With some test kits, you can add the chemicals yourself at home. FOBT tests don't cost much. This test should be done every year after age 50.
  • Fecal immunochemical test (FIT). This is a test that may be easier to do at home than FOBT. There are no drug or food restrictions, and collecting a stool sample may take less effort. But it costs more than FOBT. This test should be done every year after age 50.

Blood in the stool may be the only symptom of colorectal cancer, but not all blood in the stool is caused by cancer. Other conditions that can cause blood in the stool include:

  • Hemorrhoids. These are enlarged, swollen veins in the anus. Hemorrhoids can form inside the anus (internal hemorrhoids) or outside of the anus (external hemorrhoids).
  • Anal fissures. These are thin tears in the tissue that lines the anus (anal sphincter) up into the anal canal.
  • Colon polyps. These growths of tissue are attached to the colon and often look like a stem or stalk with a round top.
  • Peptic ulcers. These sores form when the digestive juices made in the stomach eat away at the lining of the digestive tract.
  • Ulcerative colitis. This type of inflammatory bowel disease (IBD) causes inflammation and sores (ulcers) in the inner lining of the colon and rectum.
  • Gastroesophageal reflux disease (GERD). This is the abnormal backflow (reflux) of food, stomach acid, and other digestive juices into the esophagus.
  • Crohn's disease. This type of inflammatory bowel disease causes inflammation and ulcers that may affect the deep layers of the lining of the digestive tract.
  • Use of ASA or non-steroidal anti-inflammatory drugs (NSAIDs).

Stool tests may be used to check for colorectal cancer, but they are never used to diagnose it. Other tests for colorectal cancer include flexible sigmoidoscopy, colonoscopy, and CT scan (virtual colonoscopy).

Which screening test you choose depends on your risk, your preference, and your doctor. Talk to your doctor about what puts you at risk and what test is best for you.

For more information on tests for colorectal cancer, see:

Click here to view a Decision Point. Colon Cancer: Which Screening Test Should I Have?

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  Colon Cancer: Which Screening Test Should I Have?

Why It Is Done

Stool tests are done:

  • To look for signs of cancer. FOBT and FIT tests are useful to screen for colon cancer, because tissue or polyps with cancer are more likely to bleed than normal colon tissue. If bleeding is found, more tests will be done to find the cause. It's important to call your doctor if a home test shows blood in your stool. A home test doesn't replace the need for a regular examination by your doctor.
  • To help find the cause of abdominal pain.
  • To check for the cause of anemia.
  • As part of a routine physical examination for those with a higher chance of getting colorectal cancer, especially at age 50 and older.

How To Prepare

Since colorectal cancers do not bleed all the time, FOBT and FIT tests are done over several days on different stool samples. This increases the chance of finding blood in your stool if it exists.

You may need to avoid certain foods for 2 to 3 days before the test. This depends on what kind of stool test you use. If you aren't sure, ask your doctor.

Do not do the stool tests during your menstrual period or if you have active bleeding from hemorrhoids. Also, do not test a stool sample that has been in contact with toilet bowl cleaning products that turn the water blue.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is Done

FOBT

You will need to collect stool samples over three different bowel movements on three different days. The test kit includes a wooden applicator and test cards. Be sure to follow the instructions that come with your test kit, including any instructions to avoid certain foods in the days before the test.

  • Complete the identification information on the front of each card.
  • During a bowel movement, collect a small amount of stool on one end of an applicator. You might try catching the stool on some plastic wrap draped loosely over the toilet bowl and held in place by the toilet seat. If you use a container to collect the stool, first clean and rinse it well to get rid of any substance that may affect the test results.
  • Apply a thin smear of stool inside box A.
  • Reuse the same applicator to obtain a second sample from a different part of the stool. Apply a thin smear inside box B.
  • Close the cover of the slide.
  • The next two times you test your stool, complete the remaining cards in the same way.
  • Return all slides to your doctor either in person or by mail within 4 days of collecting the samples.
  • If your test kit has the developer solution, wait 3 to 5 minutes before you put 1 drop of the developer solution on the area with the stool. Put 1 drop of the developer solution on the control areas of the card so that you will know what positive and negative test results should look like. An area to read the results is found on the reverse side of the card. Turn the card over and read the results within 10 seconds.

Other ways to do FOBT:

  • Some kits instruct you to use a special cloth to wipe with after a bowel movement. After wiping with the cloth, you put the developer solution on it to check for colour change that means there is blood in the stool.
  • Other kits have a special test pad that you place in the toilet after having a bowel movement. The pad will change colour if the stool has blood in it.

If there is blood in your stool, call your doctor as soon as possible.

FIT

You will need to collect two stool samples for testing over different days. The test kit includes brushes and test cards. Be sure to follow the instructions provided in the test kit. The FIT test doesn't require a special diet in the days before you take the test.

  • Complete the identification information on the labels provided.
  • Flush the toilet before your bowel movement. After you go, put used toilet paper in the waste bag from the kit, not in the toilet.
  • Brush the surface of the stool with one of the brushes for about 5 seconds. If the stool is loose, use the brush to simply stir the water around the stool.
  • Remove the brush from the water, and gently shake it once to remove extra water and any clumps of stool.
  • Dab the end of the brush onto the test card for about 5 seconds. Close the flap on the card, and seal it with one of your labels.
  • Put the used brush into the kit waste bag, and throw the bag in the trash.
  • The next time you test your stool, complete the remaining card in the same way.
  • Put the test cards in an envelope, and mail it as soon as possible after you have collected your second sample. Your doctor will tell you your test results.

How It Feels

You may find it unpleasant to collect a stool sample for these tests.

Risks

These tests do not have any risks.

Results

For some FOBT kits, you can read the results yourself. Other tests, including FIT, are read by your doctor.

Stool tests
Normal:

A normal FIT or FOBT test means that there was no blood in your stool at the time of the test. Normal test results are called negative.

Abnormal:

An abnormal FIT or FOBT test means that there was some blood in your stool at the time of the test. Abnormal test results are called positive.

Normal results

If a stool test is normal, it does not always mean colorectal cancer or colon polyps are not present. That's because these tests can miss polyps and some cancers.

Talk with your doctor about how often you should do a test, depending on your age and any risk factors you may have for colorectal cancer.

Abnormal results

A colon polyp, a precancerous polyp, or cancer can cause a positive stool test. With a positive test, there is a small chance that you have early-stage colorectal cancer.1

Talk with your doctor about what test you may need next. Most of the time, an abnormal stool test means that you will need to have a colonoscopy.

What Affects the Test

Reasons you may not be able to have a stool test or why the results may not be helpful include:

  • Having blood in the urine, menstrual bleeding, hemorrhoids, an anal fissure, bleeding gums, or nosebleeds.
  • Having cleaning products in the toilet water at the time of the test.

What To Think About

  • Stool tests can produce false-positive and false-negative results.
    • False-positive means that the test may be positive when you don't have a polyp or cancer.
    • False-negative means that the test may be negative when you do have a polyp or cancer.
  • These tests may miss polyps and some cancers.

References

Citations

  1. U.S. Preventive Services Task Force (2002). Screening for colorectal cancer. Available online: http://www.ahrq.gov/clinic/uspstf/uspscolo.htm.

Other Works Consulted

  • Helfand M (2005). Colorectal cancer section of Adult preventive health care. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap. 5. New York: WebMD.
  • Leddin D, et al. (2010). Canadian Association of Gastroenterology position statement on screening individuals at average risk for developing colorectal cancer: 2010. Canadian Journal of Gastroenterology, 24(12): 705–714.
  • Levin B, et al. (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians, 58(3): 130–160.
  • Nadel MR, et al. (2005). A national survey of primary care physician's methods for screening for fecal occult blood. Annals of Internal Medicine, 142(2): 86–94.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Arvydas D. Vanagunas, MD - Gastroenterology
Last Revised May 26, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.