Transcription:
Colon Cancer and Colonoscopies

Scott Webb: Colonoscopies are both diagnostic and therapeutic, and that's why they're the gold standard in terms of diagnosing and preventing colon cancer. And joining me today to underscore these points is Dr. Mark Saxena. He's a gastroenterologist. And I'm joined by Dr. Ashlee Godshalk Ruggles. She's a board certified, fellowship trained colorectal surgeon, and they're both with Capital Health.

This is the Health Headlines podcast series from Capital Health. I'm Scott Webb.

Doctors, thanks so much for your time today. We're going to talk about colorectal cancer, colon screenings, colonoscopies.

But before we get rolling, let's talk about the incidence or prevalence of colorectal cancer.

Dr. Mark Saxena: Colon cancer is the third leading cause of colon cancer and colon cancer related death in men and women in the United States. So there are approximately 106,000 new cases of colon cancer that are diagnosed every year and approximately 46,000 cases of rectal cancer each year, and this is why it's very important, to be screened for colon cancer.

Host: Yeah, definitely. And we're going to get to that talk about screening and colonoscopy, maybe Cologuard, possibly. But before we get there, Dr. Ruggles, what are the risk factors? I assume we're thinking family history, genetics, smoking, you know, all the above. But from your perspective, from an expert's perspective, what are the risk factors for colorectal cancer?

Dr. Ashlee Godshalk Ruggles: Obviously genetics do play a role. So patients who have a family history of colon cancer or even just a family history of, you know, a large polyp that was removed in a parent or a sibling. But even with that being said, 96% of colon cancers have no genetic basis, so, even if you have no family history, that really doesn't you know, put you in a safe category, quote unquote.

The other patients that we always worry about are patients with like inflammatory bowel disease, Crohn's disease, ulcerative colitis. But even with that, I mean in the general population, we're seeing the incidence in certain age groups increase, at least in Western societies. And we're thinking a lot of that probably has to do with environmental factors, dietary factors. And there's a lot that really is just a part of our general everyday life that makes us high risk for colon cancer in general.

Host: And Dr. Saxena, generally speaking, when I speak with doctors like yourself, they almost universally say that, you know, colonoscopy really is the gold standard. It's the best way. So again, from your perspective, why do you believe colonoscopy is the best way to diagnose potential cancer?

Dr. Mark Saxena: Colonoscopy does serve a dual purpose role. It is a function of screening, meaning that we can detect polyps at an early stage and remove them to help prevent future risk of colon cancer. It can help diagnose colon cancer if that is present. But, the idea is not only is it diagnostic and a screening tool, but it also allows us to do something therapeutic, which is to remove the polyps and actually prevent future risk of colon cancer. Whereas the other modalities, which we describe as non-invasive colon cancer screening tools, don't allow you to make any therapeutic intervention at the time when you're doing the screening.

Host: Yeah, that's why colonoscopy is so great because it's diagnosis, it's therapeutic, and when we think about who should be screened, Dr. Ruggles, I know the guidelines have changed a bit over the years. Maybe you can take us through that. Who should be screened and when, and so on.

Dr. Ashlee Godshalk Ruggles: So, it used to be 50 years. Everyone knew when they turned the big 50, they had to go, uh, bye themselves a big jug of GoLYTELY from the pharmacy. Now they've seen in age group from 25 to 55, the incidence of colon cancer is increasing actually. In all other age groups it's going down, which we think is because of screening.

And when they started to see that trend, they changed the guidelines to 45. So, now when you turn 45, you have to, or should be talking to your doctor about getting your colonoscopy done.

Dr. Mark Saxena: The United States Preventative Services Task Force, the American Cancer Society, and the GI Society have all endorsed, starting colon cancer screening at the age of 45. And the maximum screening would be every 10 years for someone who's average risk at the age of 45. Some of the circumstances that we discussed before, may warrant screening more frequently than every 10 years.

The other possibility is starting screening early in individuals who have a family history of colon cancer, or one of those high risk conditions like inflammatory bowel disease or colon polyp or colon cancer syndrome that runs in the family.

Scott Webb: Yeah. So let's talk about the process. Take us through this doctor. I mentioned prep earlier and I know that's come a long way and is not nearly as bad as it used to be. And of course I have my own personal experiences, so that seems to be the thing that holds people up or gets them sort of worried about the colonoscopy, the actual process itself from what I hear and experienced myself, not so bad. Nice nap. And, maybe you can just kind of take us through this, the process from sort of, okay, you need a colonoscopy to when folks wake up and they're on their way home.

Dr. Ashlee Godshalk Ruggles: It's really not as bad as it used to be. We have made advances in medicine in very big ways, but those advances also lend themselves to easier preps. You know, there are many different preps, which is nice because I'm able to really tailor the options to what my patients care about. Some worry about how much do I have to drink. And so there are some kind of lower volume preps. Others are very worried about, oh my gosh, the flavor. And so in that regards, there are other preps that really don't taste as bad or you can kind of mix it with whatever you want to.

So you control the flavor. In general, you are going to be drinking some kind of liquid to kind of start the process going to just clean things out. Although there is now a pill prep, which a lot of patients have asked me about and I have actually done colonoscopies on patients of mine who have had the pill prep and it's a lot of pills, but if taking pills isn't an issue for you, it really worked quite well.

And so, typically the day before your colonoscopy, you're gonna be clear liquid diet only. That really means anything you can see through. So you can still have your coffee in the morning, but just no cream, but you can put sugar in it. You can have jello, popsicles, you know, water, apple juice, cranberry juice, Gatorade, ginger ale. I mean really any liquid that's see through, broth. I also did a colonoscopy and the day before I kind of subsisted on chicken broth, which really wasn't that bad. And then around evening time, dinner time-ish, typically you're gonna be starting the actual prep, that's when you're drinking all this stuff or taking the pills.

A lot of people associate this with like the time they had the worst GI bug and it's really not like that. It shouldn't cause horrible belly cramping. You feel a little queasy maybe. And then you just have to go to the bathroom pretty frequently. The next morning you're gonna wake up, you'll get over to the hospital, they put an IV in you, and then you get the best nap of your entire life during the colonoscopy.

So honestly, I don't remember anything from when I was rolled back. I kind of fell asleep immediately and then I woke up in the recovery room. No pain. I didn't feel anything during it. You really shouldn't be aware, really shouldn't feel anything, even if you do kind of stir a little bit, cuz it's a kind of like a heavy twilight sedation they call it.

But honestly, most patients afterwards say that it was not nearly as bad as they had thought.

Scott Webb: Right, and with things like, Cologuard or something like that, you know, if it does come back positive let's say, you're still gonna have to go back for the colonoscopy anyway, so you might as well, you might as well just skip those steps and go right for it. There's a reason, it's the gold standard, the standard of care and recommended by everyone, like yourself, every doctor, like yourself.

Just wanna have you talk about treatment options. So let's just say that you remove some polyps, they send them for biopsies. If someone is diagnosed with colon or rectal cancer, what are their options?

Dr. Ashlee Godshalk Ruggles: Typically, if diagnosed early, then the option is surgery. And I know, you know, having surgery on the colon seems like a very big deal, and I don't want to minimize it. But we've made really huge advances, in treating colon cancer. I'm a colorectal surgeon and I do almost all of my surgeries minimally invasively.

I actually use something called a da Vinci robot that allows me to make very tiny incisions, to really do very kind of sophisticated and complicated surgery. And a lot of times if we remove the cancer and the lymph nodes around the cancer and they don't show any spread, then that's really all the treatment the patient needs.

Now if things are a little more advanced, obviously at times there are you know times where we would do chemotherapy. If it's a cancer in a specific location, typically rectal cancer, which is like the lower part of the GI tract, radiation might be involved. But, you know, we've made really, really huge advances in colorectal surgery.

Still a lot of them are being done open, but there are definitely many, many colorectal surgeons who specialize in minimally invasive approaches, and the patients just do really well after those surgeries. Typically, my patients are staying in the hospital for two days, give or take. They're, drinking liquids right away, eating very quickly, up and out, moving around in the hospital, walking around, going up and down stairs. So it's not the whole, not being able to eat for a week, bedrest for two weeks kind of situation, a lot of people think about when they think about surgery.

Scott Webb: Yeah. And Dr. Saxena, as we wrap up, just wanna have you encourage folks to get screened because it's never too late, right?

Dr. Mark Saxena: No, it's never really too late and you can always come in and detect something at an earlier stage than if you wait longer. So it's always a great idea to come in, even if you're past your time when you're supposed to initiate colon cancer screening. Early detection is always better. And, we have lots of therapeutic options, either during a colonoscopy to remove a polyp or if something is at a more advanced stage, surgery and other options which can help to prevent more significant complications from colon polyps and colon cancer. So, yes, always great to come in, get screened at an early stage.

Scott Webb: Good stuff today, doctors. Thanks for your expertise and you both stay well.

Dr. Mark Saxena: Okay. Thank you so much.

Dr. Ashlee Godshalk Ruggles: All right, you too. Take care.

Scott Webb: And to schedule a colonoscopy, visit capitalhealthcancer.org/colonoscopy or call 609-303-4444.

And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics. This is The Health Headlines Podcast from Capital Health. I'm Scott Webb. Stay well.