Transcription:
Colorectal Treatment Options

Bill Klaproth (Host): Colorectal cancer is the second leading cause of cancer death among men and women combined in the United States. And hearing that you have cancer can be a frightening experience. But one way to reduce your fear and anxiety is to learn about the condition and your treatment options. So, what do you need to know about colorectal cancer and the treatment options? Let’s find out with Dr. Nadir Edmond Adam a dual board certified general surgeon and colorectal surgeon at Dignity Health. Dr. Adam, thank you for your time. So, first off, can you explain to us what is colorectal cancer?

Nadir Adam, MD (Guest): Colorectal cancer is a malignant tumor of the colon and the rectum. And by malignant tumor we mean the tumor that can spread outside of its origin. If it’s in the colon, it can grow more and can go to the lymph nodes outside the colon or even to the distant organs, to the liver, to the lungs or to the brain.

Host: So, that’s why it’s really good to catch it early, right?

Dr. Adam: That’s why screening for the colorectal cancer is important because this is how we catch it early and actually to catch the source of it in most of the cases would be the polyps in the colon. This way screening for the colorectal cancer is highly recommended since the colorectal cancer is a common tumor and if caught early, the five year survival is more than 90% while if it’s caught late like in stage 4, the survival drops to 30%, five year survival 30%.

Host: So, those figures are quite startling. So, let’s stay with screening then. What types of screenings are available?

Dr. Adam: So, screening for colon cancer is recommended for age starting at 50 years old or older or earlier than that for certain conditions when there’s a positive family history of colon cancer; it should be started ten years before that or if there is precancerous conditions already with the patient like ulcerative colitis or colon polyps. Now for the screening tests we have the stool test which includes the fecal occult blood and the Cologuard. The difference fecal occult blood will detect for the blood is recommended yearly. Cologuard is testing for the abnormal DNA material in the stool and is recommended every three years. If both those test or one of them is positive, patients should undergo the gold standard screening test which is colonoscopy.

The other screening test is sigmoidoscopy, which is limited colonoscopy, just limited to the left side of the colon which is the site of the cancer in more than 50% of the cases and that should be repeated every five years. Now the next one is a barium enema. If we are doing the sigmoidoscopy, we have to do the barium enema to visualize the whole colon and that’s also every five years. Again, if the barium enema, any abnormality in the barium enema, patients should go to the gold standard screening test which is a colonoscopy.

Now the next screening test is the gold standard which is colonoscopy. Colonoscopy meaning visualizing the whole colon. It will need bowel prep and special preparation. Usually it is done under conscious sedation, sometimes under general anesthesia, if depends. During the test, we will visualize the whole colon, remove any polyp, take any biopsies that are needed during the colonoscopy. If the patient cannot tolerate colonoscopy, there is the last one which is a CT colonography which is using the CT scan technique for examination of the colon by insufflating air into the colon and visualizing it through the CT scan. Again, if the CT colonography is positive, colonoscopy is highly recommended. So, in summary, the gold standard is colonoscopy whenever it is possible.

Host: Right so many different screening options are available. So, as a person that’s had a colonoscopy, I urge you as Dr. Adam has said, the colonoscopy is the gold standard. Do the gold standard. It’s not that difficult. Get yourself a colonoscopy. So, Dr. Adam let me ask you this. Are there any symptoms that are involved with colorectal cancer at all?

Dr. Adam: We don’t like the patient to wait for those symptoms because once the symptoms appear, it means the disease is there. The screening is still the gold standard. So, whenever there is a positive family history of colon cancer, I urge everybody to go an start seeing a surgeon or general surgeon at least to get more information when I should start screening. For the average people, they should start at 50 years old.

Now, for the symptoms we have seen case with the symptoms that they come. Alarming symptoms are blood from the rectum or bleeding from the rectum. The other one is altered bowel habits. Somebody that with the usual bowel habit and then starts to have oh I am constipated; I have difficulty with the bowel movements. Lower abdominal pain is less, also can be a symptom. The other things are if the patient starts to be more like easily gets tired, what we call anemia because colon cancer, the left colon if they bleed, they will cause bleeding per rectum. The right colon if they bleed, they will cause anemia. So, those are the most common symptoms that should be direct attention for the colon cancer. But again, I would say, screening and prevention is better than the symptomatic cancer.

Host: So, if someone is experiencing bleeding, is that when they would see a general or colorectal surgeon?

Dr. Adam: Any bleeding per rectum should be evaluated by general surgeon or to be more specific by colorectal surgeon after patient is evaluated by his primary care provider. Because hemorrhoids can be there but still the cancer can be there causing the trouble. So, if there is a hemorrhoid and with bleeding per rectum, it’s the wrong assumption to make that the hemorrhoid is the source of the blood. Still, I encourage the patient to ask the primary care provider to be referred to colorectal surgeon for further evaluation.

Host: What about treatments for colorectal cancer? Can you explain those to us?

Dr. Adam: Now treatment of the colorectal cancer once we diagnose colorectal cancer and I mean by the diagnosis is a biopsy, after biopsy we go to the second stage of it and it is all the treatment or management in general. After the diagnosis, we will go to the staging of the cancer and by staging we mean how far is the cancer grown already. Usually, we divide it into four stages. Stage one when it is early colon cancer. The cancer is still only in the wall of the colon. Stage two, it is deeper in the wall of the colon, but did not involve the lymph nodes outside the colon. Stage three when the cancer involves the lymph nodes outside the colon and stage four which is the most advanced one when the cancer involves distant organs like the liver or the lung or the brain.

Treatment of the colon cancer, we have three modalities, surgery, chemotherapy and radiation therapy especially for the rectal cancer.

Host: Okay.

Dr. Adam: Which one we start with; it depends on the stage of the cancer. For the early stage cancer, we start with the surgery and surgery it can be resection or even can be endoscopic if it is very early cancer in a polyp that can be removed through the colonoscopy and we just do surveillance after that. That’s also acceptable.

More advanced cancer stage two, now it needs resection to evaluate for the lymph nodes. If it is more advanced like locally advanced cancer, sometimes neoadjuvant chemotherapy which means giving chemotherapy in advance before we do the surgery. Sometimes we do neoadjuvant radiation therapy especially for the rectal cancer to shrink the cancer, downstage the tumor and then do surgery. They found that the recurrence is less with that policy.

So, in general, we have surgery, chemotherapy, radiation therapy, combination of those three factors. What to start with? Usually we encourage that a good communication between the surgeon and the oncologist once cancer is diagnosed for planning of the treatment.

Host: Dr. Adam, if you could wrap this up for us. Give us your final thoughts on colorectal cancer.

Dr. Adam: So, here’s the thing. Again, prevention. The best treatment is prevention. Because colon cancer is a completely preventable disease. Screening for the colon cancer through the colonoscopy is possible, can be done, I will not say easily, but can be done. It needs to be done after the age of 50 and if it is negative every 10 years. If it is positive for polyps, it depends how many polyps, one to two the colonoscopy should be repeated in five years. if it is three plus, then the colonoscopy should be repeated in three years. Now if it is a polyp that is bigger than one centimeter or a certain type of pathology, we call adenomatous polyp, then we might repeat the colonoscopy in one year.

It’s completely preventable and if the people are aware that once they reach that age 50 years, let them ask their primary care provider now what about the screening for the colon cancer.

Host: I think what you said there is so important. This is completely preventable. So, please get yourself screened. Dr. Adam, thank you so much and to do that, all you have to do is call 209-564-3700 for an appointment. Once again, 209-564-3700. Dr. Adam said it. it is completely preventable. Get yourself screened.

And if you want to learn more about colorectal cancer and colonoscopy please visit www.dignityhealth.org. And if you like what you’ve heard, if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.