Oncology (General Cancer)/Colon Cancer concerns


QUESTION: Hello Dr Higby,

My name is Russ. I have a concern and wanted to see if you could offer some input. I'm a 40 yr old man basically in good health. Had my last physical and blood work back in early March and all was well. I do have a history of GI problems including food intolerances, IBS, straining to pass hard stools, dysbiosis, fissures and hemmorhoids. In 2010 I had my first colonoscopy when I was 35 and it was negative. I went because i have a family history of colon cancer...my maternal grandmother, maternal great grandmother and paternal grandmother died from the disease.  My mother and aunt get screened regularly and they are fine. In any case 2 years ago I had a fecal occult blood test (3 yrs post colonoscopy) and there were trace amts of blood in my stool.  I am fairly certain that the blood came from my fissure since it was flared up around the time I collected the stool specimen.  I took another fecal occult test 2 months ago and once again it was positive.  I visited my colorectal dr last friday and he discovered an internal hemmorhoid, but not sure how long its been there.  In any case, I am now very nervous so i scheduled my 2nd colonoscopy at the end of the month.  My question is could the hemmorhoid have caused the positive test result even if there was no visible sign of blood when wiping after BMs?  Since its only been 5 years what is the likelihood of having a bleeding polyp or something worse right now? I would very much appreciate your insight.  Thank you for your time.

Warm regards,


ANSWER: If you had a negative colonoscopy two years ago, I strongly doubt that the blood is related to a polyp or a cancer.  In fact it would be extremely unlikely.  More likely is the possibility that you have some kind of internal hemorrhoid, and these can bleed small amounts intermittently.  You certainly can have "occult blood" which means there are no signs of it to the naked eye.  That's why we have the stool tests that react to very small amounts of hemoglobin. If I were your doc, I might advise you to take stool softeners every day to the degree that you have a soft, easy to pass stool.  This might allow some healing of whatever is causing the intermittent bleeding.  Hope this helps.  

---------- FOLLOW-UP ----------

QUESTION: Thanks Dr Higby for the quick response! Actually my colonoscopy was 5 years ago (in 2010) - 2 years ago is when i had my 1st fecal occult positive test, but as i mentioned im pretty sure my fissure was flared up at the time

Sorry.  The general guidelines are that if you have polyps a colonoscopy every five years is suggested after age 40.  However, with your history, it might be better to be a little more aggressive, so given the FOB and the fact that five years have gone by, and you have a strong family history, I'd recommend another colonoscopy.  The rest of my advice stands.  I suspect you have intermittent small amounts of bleeding from either or both fissure and internal hemorrhoid.  Even with your family history you might have a polyp at this point but it would be very small and not likely to bleed.  Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.


I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.


I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

American Society of Clinical Oncology

New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

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America's Best Physicians, last 14 years

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