Maggie McKay (Host): There's a lot to know about colon cancer prevention, treatment, recovery, and that's just for starters. So today, we're going to find out more with Dr. Seema Gandhi.

Welcome to Total Health Talks, your Cook County Health Podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Seema Gandhi about tackling colon cancer. Thank you so much for being here, Dr. Gandhi.

Seema Gandhi, MD: Thank you, Maggie. I'm so happy to be here with you.

Host: Would you please introduce yourself?

Seema Gandhi, MD: So, my name is Seema Gandhi. I'm the interim chair of our Division of Gastroenterology and Hepatology here at Cook County Health.

Host: So, what exactly is the colon? What are common colon problems?

Seema Gandhi, MD: The colon is also known as the large intestine. It's kind of the last stop in the digestive process. It's where we form stool. And before we have a bowel movement, this is where our stool is processed. The colon can be the site of a lot of digestive disorders. I think a lot of people are very familiar with certain things like diverticulosis, irritable bowel syndrome, constipation, and then namely colon cancer.

Host: And who develops colon issues and how common are they?

Seema Gandhi, MD: So, colon issues can actually be quite common. Irritable bowel syndrome is actually known to be in about 40% of adults, and that often affects our colon. So, you may have symptoms of diarrhea or constipation. Diverticulitis is actually quite common, especially in an older population above the age of 75. But colon cancer unfortunately is becoming more and more common, particularly among Americans and, sadly, even among younger adults.

Host: Let's jump in more specifically to colon cancer and the issues around there. What are the signs and symptoms and how much do people need to worry about this in general?

Seema Gandhi, MD: Here's the most alarming thing about it, Maggie, is that colon cancer by and large is asymptomatic. Typically, symptoms of colon cancer don't appear until colon cancer is quite advanced. So, when you're at usually stage I or stage II cancer, patients may actually have no symptoms at all, which Is the most alarming thing about it.

I often hear patients say, "Well, I felt fine," that's the most important reason why we need to prevent colon cancer. If we wait for it to be symptomatic, it's often more advanced. Colon cancer, when it is symptomatic, can have symptoms including blood in the stool. Usually that persists, not just for one day, but often either daily or intermittently for weeks or months. You can have abdominal pain, weight loss, constipation, or even changes in the way your stool can appear.

Host: Is it preventable?

Seema Gandhi, MD: So colon cancer is completely preventable. It's one of the cancers that we actually screen for. So, when we do screening exams, we do exams on patients that have no symptoms at all. So, think about it as the equivalent of women getting mammography for breast cancer, doing prostate exams for preventing prostate cancer, and the same is true of colon cancer. There are several ways to screen for colon cancer. There are so many options that we really encourage our patients to get some type of screening just because it is a preventable cancer.

Host: And there seems to be a sense out there that colon cancer is occurring more for people at younger ages. Is that a real phenomenon or are we just hearing more about young people? And is colorectal cancer more aggressive in younger people than those over 50?

Seema Gandhi, MD: Yeah. Sadly, it's not just a media bias, which sometimes we think, "Oh, the media are just reporting more about colon cancer," but there's actually quite a bit of data that not just in America, but in all countries, colon cancer is increasing among young patients. And we might wonder why. Because when I hear that, I worry because our recommendation actually is for patients at 45 or older to get colonoscopies that are average risk.

And so when we see patients in their 20s or 30s with colon cancer, we wonder, are we screening patients appropriately? Do we have the right recommendation? There is a multitude of factors as to why patients are getting earlier cancers. In the end, we don't know the exact answer. But I think a lot of scientists are theorizing that it's related to increasing rates of obesity, metabolic syndrome like diabetes, and probably related to diet, so increased intake of meat and other processed foods that can increase for chances of cancer.

Host: And Dr. Gandhi, what are the current guidelines as to when screening should begin? You touched on it a little bit. Are there groups of people that perhaps should be handled a little bit differently?

Seema Gandhi, MD: For sure. So, screening, all of our cancer societies and including our societies within gastroenterology, recommend everyone get a colonoscopy at the age of 45. So, there are many different screening exams that your doctor may talk to you about, and that can include a colonoscopy, which I think any gastroenterologist or medical professional will tell you is the best way to screen for colon cancer. It's a procedure where we take a scope that is a camera and a light at the end. We look up someone's bottom under sedation. The patient prepares by drinking a preparation to clean up their colon the day before. And so a colonoscopy is amazing because it allows us to look at the colon up close and personal and then see if there are any polyps.

So, polyps are growths in the colon that can actually over time, usually years, turn into cancer and we have the ability to not only see them, but then remove them at that time. So, think of them like pulling weeds in your garden. If we pull it out, then hopefully another one won't grow and they won't get bigger or progress to colon cancer.

There are other tests available, like a FIT test or a Cologuard test, which are stool-based tests. So, they're not as invasive, but they're also not as good at detecting cancer until it's more advanced. And I think that all of us can agree, we would like to prevent cancer, not just detect cancer. And so, we recommend at 45 or older, patients get colonoscopies, but then there are special situations. If you have a family history of colon cancer, a specific inflammatory condition like inflammatory bowel disease, you may need to get a colonoscopy earlier because your risk of colon cancer could be greater.

Host: And what are the screening options? Some people may feel intimidated when they hear about a colonoscopy. Are there alternatives to the colonoscopy? I mean, you just did mention a few. What are the pros and cons of choosing maybe one of those alternatives for somebody who really doesn't want to do the full on colonoscopy?

Seema Gandhi, MD: So, we definitely have alternatives that are stool-based. Usually, the interval that we recommend is on an annual basis. We can do something called a FIT test, a fecal immunochemical test. And it's a stool-based test and essentially looks for blood in your stool. The other option is a Cologuard test and that looks at different changes in DNA that can happen when polyps become cancerous.

The downside of these tests is often they're not very sensitive or specific and they perform best unfortunately once someone already has cancer. Like I said, if you are trying to prevent colon cancer for this test to be positive, it usually turns positive when you're pretty close to getting cancer or already have cancer. And then, the next recommended step would be a colonoscopy.

So, I think there can be a lot of fear when it comes to colonoscopies, and I want to reassure everyone listening, they're so simple to do. The hardest part can be drinking the prep. But I had my colonoscopy for my first time this past year, and I have to say it was a very humbling experience to drink that prep. I don't know if you've had one yet, Maggie, but it really is the hardest part. The colonoscopy was so easy.

Host: I have done many, Dr. Gandhi, because both my parents had colon cancer. So, I have done probably five or six already. And it's true. I tell my friends, "It's not a big deal. It's just drinking the stuff." And it depends on your doctor. I mean, there are some who I've tried every possible option, because there are different drinks you can take, but that is the hardest part.

Seema Gandhi, MD: Yeah. There's a lot of fear. And I want to reassure patients, anyone who has ever had any screening exam, like a mammogram or even after giving birth to two children, a colonoscopy is a walk in the park. It is so much easier than any of those things. And it's over before you know it. The best thing about it is that if you have a normal colonoscopy, you don't need to come back for 10 years. So, it may be one day of uncomfortable prepping, but the peace of mind you get out of it, I think is worth the short-term difficulty. And colon cancer, unfortunately, is the number one cause of colon death for men under 50 and the second leading cause of cancer death for women. So, that's an important number for us to remember because this is a real cancer that happens very, very commonly in our American population. And it's very easy, I think, to stick our head in the sand and think if we don't think about it, then it won't hurt us, but unfortunately it can.

Host: Absolutely. Right. Just get the screening for goodness sake. You pretty much answered this, I think, but anything else to add if you have a family member who has had colon cancer, what you can do to make sure it doesn't happen to you, or you are more at risk of getting it, right?

Seema Gandhi, MD: You are. I actually got my screening exam just because a sibling of mine ended up having a larger polyp during her colonoscopy, so that meant that my recommendation was to get it at a younger age. And I do have to get it at a more frequent interval, because if there is a family history, you may have some type of genetic predisposition for polyps to turn to cancer faster. In general, your gastroenterologist will advise you on how soon your interval should be, and that can be depending on how many polyps they find or how clean your colon was during the procedure.

I would say that there's a lot of data to show that diet and exercise have a huge impact, not only on colon cancer, but any cancer. Avoiding red meat and processed meats can actually be protective against colon cancer. But I think that in general, avoiding a lot of the risk factors that we all know are very dangerous for our health, like obesity and diabetes, controlling those things as best as possible is important. That being said, even if you have those risk factors, it's really important for you to discuss a colonoscopy with your doctor. I think everyone understands the importance of a colonoscopy and wherever you get your colonoscopy is the best place for you to get it done.

Host: Right. Well, you just mentioned tips for keeping a healthy colon. Diet and exercise, right, basically? I mean, how often should we be exercising?

Seema Gandhi, MD: Yeah, definitely diet and exercise. I think that our recommendation at this point is anywhere from 30 to 60 minutes every day, which is hard. I know I don't meet that Maggie, but at the very least, I think being mindful of our diet and honestly keeping our weight under control is really important. I think that, as I mentioned before, it's probably the reason why younger patients are getting more aggressive colon cancers than we've ever seen in the past. And it probably does have to do with the rising rates of obesity. There's not great science that proves it, but I think that's what everyone's theorizing. And I think that it's important for us to do that healthy combination of diet and exercise to keep all of our other medical conditions as well controlled as possible.

Host: Exactly, right. It's important for everything, especially as we age. So, what is the key takeaway that people need to keep in mind as they think about this issue in their own health and that of their family?

Seema Gandhi, MD: The first thing I would encourage you to do is to first talk to your doctor, but also talk to your family members. I think, sometimes there can be a bit of a stigma about colon cancer. I think it's important to know if your family members do have a history of colon cancer or even polyps, because it may mean that you need your colonoscopy sooner and more frequent. But most importantly is don't hesitate to get screened. Ideally, everyone gets a colonoscopy, and I know that not everybody will for varying reasons. I would encourage everyone to get some type of screening test, even if it's a FIT test, that stool-based test I mentioned. But ideally, a colonoscopy is the best way to screen. It's the gold standard by any group of physicians you ask.

And I would say don't hesitate. Often I have patients say, "Let's discuss it in a year," or "I'm not ready to think about it," or "I'm too scared to think about." And my answer is, this may be scary, but cancer is so much scarier. My goal is to hopefully detect polyps or cancer as early as possible because cure is possible, but the longer we wait and the more advanced cancer is when we find it, the chance of cure is so much lower.

Host: Exactly, about the scary part. It is not scary. It's just the unknown. Once you've done one, you're like, "All right. So, I have to drink this stuff," that's it. Thank you so much for sharing your expertise. This has been so informative and we really appreciate your time.

Seema Gandhi, MD: Thank you, Maggie. It was a pleasure.

Host: Again, that's Dr. Seema Gandhi. And as we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.