Selected Podcast
Colorectal Cancer Awareness
Dr. Lorenc Malellari discusses colorectal cancer, the importance of colonoscopies, and the recent advances in colon surgery.
Featured Speaker:
He is Board Certified in General Surgery and Colon and Rectal Surgery and a Fellow of the American College of Surgeons and American Society of Colon and Rectal Surgeons.
Lorenc Malellari, MD
Lorenc Malellari, MD graduated medical school at Robert Wood Johnson Medical school in NJ and completed residency training at New York Medical College at Westchester Medical Center. Fellowship training in Colon and Rectal Surgery at UC Irvine focusing on the management of colon and rectal cancer and minimally invasive surgery.He is Board Certified in General Surgery and Colon and Rectal Surgery and a Fellow of the American College of Surgeons and American Society of Colon and Rectal Surgeons.
Transcription:
Colorectal Cancer Awareness
Bill Klaproth (Host): Hearing that it's time for you to get a colonoscopy gives many people an uneasy feeling. However, getting screened is one of the most effective ways to prevent colon cancer. Here to talk with us about colorectal cancer awareness and screening is Dr. Lorenc Malellari, a Colorectal Surgeon at Dignity Health. Dr. Malellari, thank you so much for your time. First off, why is colon cancer so deadly?
Dr. Lorenc Malellari (Guest): Hi, Bill, and thank you for having me. Colon cancer is, unfortunately, a very deadly disease. It is the second cause of cancer-related deaths in the United States and is the third most commonly diagnosed cancer in the United States, actually. Most people don't realize this, but more people die from colon cancer than die from prostate cancer or even breast cancer. It's, unfortunately, a fairly deadly disease, but it's a disease that we can prevent and treat if we can catch it early. Hence the awareness month that we're getting into.
Host: So important. Speaking of awareness and catching it early, can you tell us then why colorectal screenings are so important?
Dr. Malellari: Colorectal cancer is one of those cancers that we know exactly where it develops, how it progresses, and how it's going to start from normal tissue to cancer. Because we know this, we have developed ways to identify patients who are at risk of developing colorectal cancer. We do this test through screening tests. There are a total of three types of tests that we have currently. One is a stool test. There's a number of them. And there's the endoscopic test, which is a colonoscopy that most people dread when they hear the word. There's also a radiological test. These tests are to identify those abnormal lesions in the colon that can turn into cancer, and hopefully, find them and remove them before they do turn into cancer.
Host: And are the screenings really important because there aren't really any definable symptoms?
Dr. Malellari: Unfortunately, colorectal cancer is a bit of a silent disease. There are very few if any, symptoms that will develop at least early on when cancer is growing. Most people experience things like bleeding when they go to the bathroom, changes in their bowel habits — diarrhea, constipation — change in the caliber of the stool, or cramping, and vague abdominal pain. Weakness and weight loss are also commonly seen in patients with colorectal cancer. As you can tell from what I just mentioned, these are very common, very nonspecific types of symptoms. Because you're having diarrhea, constipation, or changes in your bowel movements does not mean you're going to have colorectal cancer. That's what makes this disease, unfortunately, difficult to diagnose without a screening test.
Host: Right. It could be a bad night out or something.
Dr. Malellari: Exactly.
Host: You have those symptoms, oh my. Is it a good rule of thumb then if these symptoms persist for longer than a couple of weeks or a period of time that's when you should consider seeing a doctor?
Dr. Malellari: Absolutely. Whenever changes like this happen, they should never be persistent. Any symptoms that are new and do not go away after a short period of time should always be discussed with a physician to look for a different cause for those symptoms. Unfortunately, cancer is one of them and should not be dismissed.
Host: Mm-hm. And Dr. Malellari, in general then, at what age should people start getting screened?
Dr. Malellari: Screening age is currently being recommended by a number of surgical and oncological societies as part of guidelines that we recommend patients follow. The current guidelines recommend anyone at age 50 start getting a screening colonoscopy. Having said that, more recently we've been finding that a lot of patients under 50 are developing colorectal cancers. Approximately 10% of new colorectal cancers in the US are now being found in patients less than 50. The American Cancer Society has lowered its screening guidelines to 45.
The screening tests are varied, as I mentioned earlier, but at least an initial screening should be started at age 50 or 45. There are a number of patients that have other risk factors which makes them more prone to develop polyps and cancer, and their screening recommendations are actually even lower.
Host: If you have a history of colon cancer, you should be screened earlier then. And earlier you were talking about the three different types of tests, but the gold standard by far is the colonoscopy. Can you tell us what is involved in a colonoscopy?
Dr. Malellari: It is the gold standard, Bill. The reason for that is a colonoscopy is actually a dual type screening tool. Not only will it diagnose a disease like cancer, for example, but will also treat it. It will treat it by removing those lesions, not just finding them. That's the only tool we have that can do both of those things.
During a colonoscopy — there are a lot of myths out there as far as what a colonoscopy is like, and people don't want to get it done because of what they hear. But basically, what is involved is the initial stage of cleansing the colon from the solid stool or debris that's in there. Usually, the next day, the physician is able to place a flexible camera, basically, through a tube to visualize the inner lining of the colon and the rectum. Just to give you an idea, the colon is approximately five feet long. It's a bit of a long ways to go all the way out to the other end, but a colonoscopy is able to do that very, very quickly and very easily.
The actual procedure itself is not very long as far as time is concerned, and patients will usually receive medications to relax them during this procedure. A lot of patients don't even really remember the actual procedure. Some do, but the majority don't. The most difficult part that most people have issues with is usually the day before, which is the cleansing as I mentioned earlier. Even on that front, we've actually made some improvements with the type of cleansing agent that we have to make it a little bit more comfortable for patients.
Host: And you mentioned lesions, are those the same thing as polyps?
Dr. Malellari: That's correct. Polyps or lesions basically just mean something — an abnormal tissue. Something that's not supposed to be there.
Host: When you find a polyp, do you generally remove it then and there? Is that what you were saying?
Dr. Malellari: That's correct. That's the treatment portion of a colonoscopy. When you see a polyp during a colonoscopy, we have tools to remove it right then and there. The polyp is retrieved — the tissue is retrieved and sent to the pathologist for evaluation. The pathologist will confirm whether the polyp has any tumor in it or not.
Host: Okay, really good to know. If there is a tumor in it is that when you say come back for screening — not in ten years, but five years, or three years? Is that what happens next?
Dr. Malellari: That's correct. Depending on what the pathology will show of the polyp, then the recommendation for the next colonoscopy is made. If that polyp is benign, meaning it doesn't have any tumor cells in it and doesn't show signs of converting into cancer, then the usual recommendations are a repeat colonoscopy in three to five years. If the polyp shows tumor cells, then sometimes there's further treatment needed including surgery, and repeat colonoscopies are done more frequently, even up to six months to a year afterward.
Host: Okay, got you. And last question, Dr. Malellari — and thank you for your time today. When it comes to treatment of colon cancer, can you talk about minimally invasive surgery and the benefits of that?
Dr. Malellari: Yeah. We've made quite a few strides in the surgical treatment of colorectal cancers, and one of them has been the improvement in our technology and our technique. That involves minimally invasive options. This includes laparoscopic surgery, which most people have heard of, but also robotic surgery, which is the newest minimally invasive surgery available for colorectal cancers. What this involves is removing a portion of the intestine or the colon where the cancer is located through small incisions in the abdomen rather than those big, open incisions that we used to do a while back.
The benefits of that are several. The benefits to the patient — obviously, when you have smaller incisions in your abdomen the pain is going to be significantly less. When your pain is significantly less, you will be able to get up and move around much sooner. You'll be able to leave the hospital much sooner and get back to your normal life and your family. We still do the right surgery for cancer, meaning there's no drawback to minimally invasive surgery. We have those options available here, at Dignity Health, as well.
Host: That is really good news. I am happy to hear about those advancements. And Dr. Malellari, thank you so much for your time again today. We appreciate it. For more information, please visit DignityHealth.org, that's DignityHealth.org. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.
Colorectal Cancer Awareness
Bill Klaproth (Host): Hearing that it's time for you to get a colonoscopy gives many people an uneasy feeling. However, getting screened is one of the most effective ways to prevent colon cancer. Here to talk with us about colorectal cancer awareness and screening is Dr. Lorenc Malellari, a Colorectal Surgeon at Dignity Health. Dr. Malellari, thank you so much for your time. First off, why is colon cancer so deadly?
Dr. Lorenc Malellari (Guest): Hi, Bill, and thank you for having me. Colon cancer is, unfortunately, a very deadly disease. It is the second cause of cancer-related deaths in the United States and is the third most commonly diagnosed cancer in the United States, actually. Most people don't realize this, but more people die from colon cancer than die from prostate cancer or even breast cancer. It's, unfortunately, a fairly deadly disease, but it's a disease that we can prevent and treat if we can catch it early. Hence the awareness month that we're getting into.
Host: So important. Speaking of awareness and catching it early, can you tell us then why colorectal screenings are so important?
Dr. Malellari: Colorectal cancer is one of those cancers that we know exactly where it develops, how it progresses, and how it's going to start from normal tissue to cancer. Because we know this, we have developed ways to identify patients who are at risk of developing colorectal cancer. We do this test through screening tests. There are a total of three types of tests that we have currently. One is a stool test. There's a number of them. And there's the endoscopic test, which is a colonoscopy that most people dread when they hear the word. There's also a radiological test. These tests are to identify those abnormal lesions in the colon that can turn into cancer, and hopefully, find them and remove them before they do turn into cancer.
Host: And are the screenings really important because there aren't really any definable symptoms?
Dr. Malellari: Unfortunately, colorectal cancer is a bit of a silent disease. There are very few if any, symptoms that will develop at least early on when cancer is growing. Most people experience things like bleeding when they go to the bathroom, changes in their bowel habits — diarrhea, constipation — change in the caliber of the stool, or cramping, and vague abdominal pain. Weakness and weight loss are also commonly seen in patients with colorectal cancer. As you can tell from what I just mentioned, these are very common, very nonspecific types of symptoms. Because you're having diarrhea, constipation, or changes in your bowel movements does not mean you're going to have colorectal cancer. That's what makes this disease, unfortunately, difficult to diagnose without a screening test.
Host: Right. It could be a bad night out or something.
Dr. Malellari: Exactly.
Host: You have those symptoms, oh my. Is it a good rule of thumb then if these symptoms persist for longer than a couple of weeks or a period of time that's when you should consider seeing a doctor?
Dr. Malellari: Absolutely. Whenever changes like this happen, they should never be persistent. Any symptoms that are new and do not go away after a short period of time should always be discussed with a physician to look for a different cause for those symptoms. Unfortunately, cancer is one of them and should not be dismissed.
Host: Mm-hm. And Dr. Malellari, in general then, at what age should people start getting screened?
Dr. Malellari: Screening age is currently being recommended by a number of surgical and oncological societies as part of guidelines that we recommend patients follow. The current guidelines recommend anyone at age 50 start getting a screening colonoscopy. Having said that, more recently we've been finding that a lot of patients under 50 are developing colorectal cancers. Approximately 10% of new colorectal cancers in the US are now being found in patients less than 50. The American Cancer Society has lowered its screening guidelines to 45.
The screening tests are varied, as I mentioned earlier, but at least an initial screening should be started at age 50 or 45. There are a number of patients that have other risk factors which makes them more prone to develop polyps and cancer, and their screening recommendations are actually even lower.
Host: If you have a history of colon cancer, you should be screened earlier then. And earlier you were talking about the three different types of tests, but the gold standard by far is the colonoscopy. Can you tell us what is involved in a colonoscopy?
Dr. Malellari: It is the gold standard, Bill. The reason for that is a colonoscopy is actually a dual type screening tool. Not only will it diagnose a disease like cancer, for example, but will also treat it. It will treat it by removing those lesions, not just finding them. That's the only tool we have that can do both of those things.
During a colonoscopy — there are a lot of myths out there as far as what a colonoscopy is like, and people don't want to get it done because of what they hear. But basically, what is involved is the initial stage of cleansing the colon from the solid stool or debris that's in there. Usually, the next day, the physician is able to place a flexible camera, basically, through a tube to visualize the inner lining of the colon and the rectum. Just to give you an idea, the colon is approximately five feet long. It's a bit of a long ways to go all the way out to the other end, but a colonoscopy is able to do that very, very quickly and very easily.
The actual procedure itself is not very long as far as time is concerned, and patients will usually receive medications to relax them during this procedure. A lot of patients don't even really remember the actual procedure. Some do, but the majority don't. The most difficult part that most people have issues with is usually the day before, which is the cleansing as I mentioned earlier. Even on that front, we've actually made some improvements with the type of cleansing agent that we have to make it a little bit more comfortable for patients.
Host: And you mentioned lesions, are those the same thing as polyps?
Dr. Malellari: That's correct. Polyps or lesions basically just mean something — an abnormal tissue. Something that's not supposed to be there.
Host: When you find a polyp, do you generally remove it then and there? Is that what you were saying?
Dr. Malellari: That's correct. That's the treatment portion of a colonoscopy. When you see a polyp during a colonoscopy, we have tools to remove it right then and there. The polyp is retrieved — the tissue is retrieved and sent to the pathologist for evaluation. The pathologist will confirm whether the polyp has any tumor in it or not.
Host: Okay, really good to know. If there is a tumor in it is that when you say come back for screening — not in ten years, but five years, or three years? Is that what happens next?
Dr. Malellari: That's correct. Depending on what the pathology will show of the polyp, then the recommendation for the next colonoscopy is made. If that polyp is benign, meaning it doesn't have any tumor cells in it and doesn't show signs of converting into cancer, then the usual recommendations are a repeat colonoscopy in three to five years. If the polyp shows tumor cells, then sometimes there's further treatment needed including surgery, and repeat colonoscopies are done more frequently, even up to six months to a year afterward.
Host: Okay, got you. And last question, Dr. Malellari — and thank you for your time today. When it comes to treatment of colon cancer, can you talk about minimally invasive surgery and the benefits of that?
Dr. Malellari: Yeah. We've made quite a few strides in the surgical treatment of colorectal cancers, and one of them has been the improvement in our technology and our technique. That involves minimally invasive options. This includes laparoscopic surgery, which most people have heard of, but also robotic surgery, which is the newest minimally invasive surgery available for colorectal cancers. What this involves is removing a portion of the intestine or the colon where the cancer is located through small incisions in the abdomen rather than those big, open incisions that we used to do a while back.
The benefits of that are several. The benefits to the patient — obviously, when you have smaller incisions in your abdomen the pain is going to be significantly less. When your pain is significantly less, you will be able to get up and move around much sooner. You'll be able to leave the hospital much sooner and get back to your normal life and your family. We still do the right surgery for cancer, meaning there's no drawback to minimally invasive surgery. We have those options available here, at Dignity Health, as well.
Host: That is really good news. I am happy to hear about those advancements. And Dr. Malellari, thank you so much for your time again today. We appreciate it. For more information, please visit DignityHealth.org, that's DignityHealth.org. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.