Transcription:
Colorectal Surgery, Colonoscopies, Colon Cancer

Joey Wahler (Host): Well, colon cancer is one of the leading causes of cancer deaths in the United States. When actor Chad Boseman died in 2020 from colon cancer at age 43, it made the public realize the disease is increasingly affecting younger people.

So, we're discussing colon health and colorectal surgery. Welcome to Crouse HealthCast, a podcast brought to you by Crouse Health. I am Joey Wahler. Our guest, Dr. David Nesbitt, a Colorectal Surgeon with Crouse Health. Dr. Nesbitt, thanks for joining us.

David Nesbitt, MD (Guest): Thank you Joey.

Host: First, how important are colon health maintenance and possibly surgery to diagnose and if needed address colon disease and illness?

Dr. Nesbitt: Well, very important. We have over 30 year data now on colon prevention. Really we're talking about colonoscopies would be the gold standard, as far as colon screening, and we know from, you know, 30 year data that we are preventing people from developing colon cancer later in life. So, the data does show that we have made some inroads and some successes in reducing the colon cancer rate.

But as you mentioned, the younger population, that's the one that is actually growing a bit. So, that's why early colonoscopies are highly recommended, especially if there's a family history or if there are any symptoms. In fact, most of the national guidelines have now changed from routine colonoscopy screening from age 50 now to age 45. That was last summer that those recommendations were put through.

Host: I want to ask you about that and the lowering of that age, and colon cancer affecting younger people in just a moment, but first, before we go any further, for those unfamiliar, I mean, I know, firsthand that a colonoscopy is about as simple and painless a procedure as there is. Tell people, Doctor for those unfamiliar, what exactly is a colonoscopy simply put, and why is it so important.

Dr. Nesbitt: Well, it's a direct visualization of the inner lining of the large intestine or colon. And so we can look for polyps, which are a little benign growths on the lining of the colon, but if left in place, those polyps can potentially turn cancerous over time. And, so when we go in with a scope and visualize the lining of the colon, while we're visualizing, we can also take these polyps out, in the vast majority of cases without rescheduling, as you know, to a separate procedure.

And I also know from personal experience, colonoscopies are really quite easy. You're sedated and asleep for it. It's about a 20 to 30 minute procedure. I honestly, I think the hardest thing about a colonoscopy is just scheduling a day off. We all have busy schedules, but once you have the date scheduled, it's really pretty smooth.

People know, that they do have to do a clean out the night before. Those have improved significantly over the past five to 10 years. And then you come in the next day and have the procedure done, yeah.

Host: And there's also something called an advanced colonoscopy. What's that?

Dr. Nesbitt: Yeah, so advanced colonoscopies. So, in most cases we can take polyps out right at the time of the procedure, at the time of the colonoscopy. If a polyp is maybe deemed too large to take out through a colonoscopy or is a little more challenging or particularly a flat polyp, then we can do what's called an advanced colonoscopy. It's almost like a little mini surgery through the colonoscope where we can dig a little deeper in the colon wall. This would be something to save somebody from a surgery. As long as it's benign, we can take a larger polyp out with some of these advanced colonoscopic techniques.

The colon is about a cardboard thickness. It gets a little thinner as you get a little bit higher up in the colon or large intestine, but roughly about a cardboard thickness, but we have some advanced colonoscopic techniques, that we do at the hospital. It generally in and out just like a colonoscopy.

But where we can cut into the layers of that cardboard thickness without creating a hole or a puncture in the colon and get these larger polyps out. So, that's what we use these advanced colonoscopic techniques for.

Host: Gotcha. Now we mentioned a moment ago that colon cancer is affecting people younger than ever. I'm wondering why is that, number one? And number two, we also touched on insurance companies now covering colonoscopies, starting at 45 instead of 50, which was the previous accepted minimum. So, why is this happening younger and how much of a difference are you seeing it make in terms of people coming forward for colonoscopies, now that they have the coverage at a younger age?

Dr. Nesbitt: Well, to answer the last question, most people are fairly comfortable coming in, even at a younger age, particularly if there's symptoms. Even without symptoms to come in at a younger age, most of the primary docs are recognizing that patients should be screened sooner. So, there is a growing comfort level with an awareness of unfortunately, you know, some celebrities succumbing to the disease, there is an increasing awareness. So, more and more people coming forward to get early screening.

As far as why we're seeing it in younger people, that is not a clear answer. We're learning more about the genetics of colon cancer. There are several genes that may play a role, but even in somebody that doesn't have a family history, they may be first person in the family, they may be the person that experiences that first DNA mutation. So, there's a lot that we don't know about the genetics of colon cancer yet, even in 2022. A lot of it we think is diet related. Although that's not clear, we know that too much red meat, not enough fiber, can lead to polyp formation.

But even vegetarians can develop polyps. We know that. Smoking and alcohol historically have been thought to be low risk factors, but now they're coming a little bit more to the forefront of perhaps being more significant risk factors. I mentioned diet too. There was a paper I read a couple of months ago. I think it was out of the UK that talked about for example, high fructose corn syrup. And so I don't want to place all the blame on one sugar compound that is causing all of the increase in younger population, but there are things like that. Processed foods and these kinds of things that we think are contributing to the younger population getting polyps and colon cancer.

Host: Now if someone is so afflicted, you of course do surgery for colon cancer, as well as for colitis, diverticulitis as well. And I know you're a big fan of robotic surgery, which can be done for all of those right? So, what are the benefits there?

Dr. Nesbitt: Robotic surgery. So, the key is, just to back up briefly, the key if somebody is so afflicted, then we want to catch it as early as possible. Because, it can be very treatable and curable, particularly if we, catch it early. So, robotic surgery, we've been doing it at Crouse Health for over 12 years now. And we have an amazing team, from pre-op preparation to the actual operating room. I have a whole team that I'm really lucky to work with and post-op care. Robotic surgery, it does reduce the length of stay that people are in the hospital. It cuts down their recovery as far as feeling back to normal. Usually within a few weeks, people are feeling very functional after surgery. They're taking a lot less narcotic pain medication. Some patients take even no narcotic pain medication once they leave the hospital, just depending on their pain tolerance level.

So, for a lot of reasons, from a patient standpoint, the robotic surgery is very very helpful. I think from the surgeon standpoint, and especially if we're talking about colon cancer, the surgery is very precise. We feel like we're getting more lymph node information, in terms of the colon cancer cases. We're getting better margins. We can dissect lower into the pelvis and tight spaces like the pelvis. There's a lot of benefits for both the patient and the surgeon doing robotic surgery.

Host: And then finally, some of your patients are treated at Crouse with a multidisciplinary approach. For instance, Crouse has a monthly tumor board to address gastrointestinal cancers. Tell us about that.

Dr. Nesbitt: My practice, for example is, I strictly do colon and rectal surgery, but we work very closely with the gastroenterology group, we work very closely with the oncology group and so even though we're separate groups affiliated with Crouse Health, we touch base with each other. And so with the multidisciplinary tumor board, it meets once a month and there's a radiologist there, there's a pathologist there, so we can review biopsy slides. We can review MRIs and CAT scans and we can discuss anything from the straightforward colon cancer cases to some of the more complex cases that really particularly we need to talk about with each other to figure out what is the next best step for the patients.

So really, even though we're in separate groups, the doctors work very closely with each other. And so this tumor board is very helpful in that regard.

Host: So, for the colorectal diseases we've discussed again, early detection clearly is key. And if needed, as you can tell folks, surgery is faster and easier than ever, including robotic surgery. Dr. David Nesbitt, Colorectal Surgeon at Crouse health. Thanks so much again.

Dr. Nesbitt: Thank you for having me.

Host: And to learn more or request an appointment with Dr. Nesbitt, you can call 315-458-2211. That's 315-458-2211. If you found this podcast helpful, please do share it on social media. And thanks for listening to Crouse HealthCast. I'm Joey Wahler.