Transcription:
Colorectal Cancer in Younger Adults

Maggie McKay (Host): It's another Hello Healthy. I'm your host, Maggie McKay. Getting a colonoscopy is crucial in detecting colorectal cancer early on. But sometimes people are hesitant or they put it off, especially younger adults who may feel like it's not a cancer typically associated with their age group.

But is that a myth? Today, my guests are Dr. Lorenc Malellari, a colorectal surgeon with Dignity Health, and colorectal cancer survivor, Angie Gentry. This is Hello Healthy, a Dignity Health Podcast. Thank you both for being here to help clarify what younger adults need to know when it comes to this potentially deadly disease.

Angie, tell us a little bit about yourself. How old are you? What's your occupation? Are you married? Your hobbies?

Angie Gentry: So originally, I'm from Colorado. I went to the Colorado School of Mines. I was an athlete growing up. I swam competitively. I moved out to Bakersfield, California in 2010 and met my husband here. We got married in 2019. And currently, all of our time is really filled up with our rambunctious 18-month-old. And we also have two hunting dogs and a kitty. And yeah, all of our time has basically gone to our family.

Maggie McKay (Host): Congratulations!

Angie Gentry: Thank you. So just trying to spend as much time staying active and being outdoors and just enjoying our time together as a family.

Maggie McKay (Host): Absolutely. So March is Colorectal Cancer Awareness month. What is so important, doctor, to bring to light when it comes to colorectal cancer?

Lorenc Malellari: Hi, Maggie. Thank you for having us. Yes, of course, the cancer is a cancer of the colon and rectum as the name states, but it is a cancer that's much more common that usually most people are aware of. About 150,000 people get diagnosed with his cancer every year and about 50,000 of them pass away from it. It is the third most commonly diagnosed cancer in the US and the second leading cause of cancer-related deaths in the United States. It's a much more common cancer than most people realize.

Maggie McKay (Host): I didn't know there was so many deaths from it.

Lorenc Malellari: It is more than it should be, because colorectal cancer is a very well-known cancer that we can detect, prevent and cure, especially when we catch it early. Unfortunately, one in three people who are supposed to be up-to-date on their screenings in the US have not had a screening yet.

Maggie McKay (Host): And what is the difference between colon cancer and colorectal cancer?

Lorenc Malellari: Colorectal cancer basically encompasses the colon cancer group and the rectal cancer group. So it's just nomenclature distinction, but it is the same cancer.

Maggie McKay (Host): It is. Okay. And Angie, what symptoms did you experience that brought you to Dr. Malellari?

Angie Gentry: Yeah. So I have a semi-unique situation. Actually, I had valley fever, which is kind of local to the Kern area for two and a half years. And I had a surgery to remove some of the valley fever and was coming off of a medication associated with that. And what happened was I had a bunch of symptoms coming off that medication, and one of those was bleeding in my stool. And so I had just assumed for a while that it was associated with that medical history that I had going on. But over a few months, the bleeding became more frequent in my stool and it led me to get a colonoscopy about four or five months later. But at the same time, my husband and I had decided we wanted to start a family.

And going into the colonoscopy, they asked that famous question, is there any way you could be pregnant? And I said, you know, "We've tried once, but there's just no way I'm pregnant, but I better do the test anyways." And of course, it came back, that one time was all it took, and we were pregnant. So it was a blessing that we were able to get pregnant so fast, but also a little bit of a curse for me, because what that did was delay my colonoscopy for a year, had to go through the pregnancy. I had to get enough breast milk, you know, saved up so I could have enough to get through the procedure, things of that nature. So a year later, I actually got the diagnosis that I had the colon cancer, which led me to Dr. Malellari for the surgery.

Maggie McKay (Host): Did you ever think someone as young as yourself would face something like colorectal cancer?

Angie Gentry: Definitely not. I think it was a shock in so many ways because I did come from a very healthy background, right? I was a competitive athlete my whole life. I love the outdoors or staying active, eating healthy. All of that encompasses for me to get this diagnosis at this age, I almost didn't believe it. I think between the time that I came out of the colonoscopy, until the time I got the confirmation that it was cancer, I probably came up with any and every excuse in this world that it had to be something different. It was just a disbelief at the beginning.

Maggie McKay (Host): Oh, my gosh. That's so scary, especially when you're just starting a family. Doctor, for Angie, she had no prior family history. So for others with no family history, what signs and symptoms should they be watching out for?

Lorenc Malellari: Yeah. So unfortunately, colorectal cancers have very mild, if any symptoms, especially early on in the disease. Common symptoms that we associate with colorectal cancer include changes in bowel function, bleeding with stooling, fatigue, unexplained weight loss, abdominal pain, cramping, constipation, diarrhea. And as if you can tell by the list that I'm going through, a million other things will have similar symptoms. And thankfully, most of the time, these symptoms do not mean that you have colorectal cancer. But unfortunately, it is possible. And as Angie mentioned, even young patients should not dismiss the symptoms, especially if they persist and do not go away.

Just to give you some numbers and statistics, we're diagnosing colorectal cancer much more frequently now in younger patients than we did before. About 12% of all new diagnosis of colorectal cancer are currently occurring in patients who are less than 50 years old. This number was less than 6% in the 1990s. And we've seen an increase of about 2% or so every year in this age group.

Maggie McKay (Host): And why do you think that is?

Lorenc Malellari: Well, that's a good question. And unfortunately, we still don't know. There's a lot of research that's occurring right now to try and elucidate why we are seeing an increase in this diagnosis. There's theories and ideas out there, but we don't have any evidence to put on a particular factor. We do know however that the current estimation with the increase that we're seeing every year, the colorectal cancer diagnosis will be the leading cause of cancer deaths in people between 20 and 49-year-olds.

Maggie McKay (Host): Oh, my goodness. That's shocking.

Lorenc Malellari: It's scary. It is.

Maggie McKay (Host): It is scary. With those statistics, what is the age now that people should be screened?

Lorenc Malellari: That's a very good question. We had for the longest time recommended a screening test for colorectal cancer once you reach 50 years old. However, because of the findings that we've made recently with the increase rates in younger patients, the current recommendations are to get screened for colorectal cancer at 45 years old even if you have no symptoms, meaning average risk, none of the symptoms that I mentioned earlier, you should get screening test for colorectal cancer at 45 years old. Having said that, if you have symptoms or if you have family history or other risk factors for colorectal cancers, you should get screened sooner.

Maggie McKay (Host): Both my parents had colon cancer. They did not die from it, but I had to start colonoscopies early on just because of that family history. And I always tell people, "Start earlier than later," right? Because if you put it off, it could be deadly.

Lorenc Malellari: That's correct. If we can catch the cancers at an early stage, we can even prevent them because if we identify the polyps before they have a chance to turn into cancer, we can remove them right then and there. Also even if cancer is present, if we're able to catch it at an early stage, well, our current numbers tell us that we can achieve more than 90% cure rate. However, once the cancer advances in stages, that cure rate and that benefit from the treatment drops significantly.

Maggie McKay (Host): Wow. So it is so preventable. Just go in there and get that colonoscopy. Angie, you said you were in disbelief when you got your diagnosis. So how did your husband feel? How did he react?

Angie Gentry: I think it was just the flood of you have almost so many thoughts going through your head, you don't even know what to say, if that makes any sense. What's our future going to be like? How are we going to survive financially if something happens to me? I think from day one, he was, you know, the positive one that really put his foot down and said, "We're going to get through whatever we have to get through to get you on the other side and keep you here with our family." So I definitely appreciate that positive nature that he brought to the table, but I'm the planner, so he had a lot to combat there. So, you know, balancing out those emotions alone, going through our family for weeks and weeks and all of kind of, you know, waiting to see what was going to happen with the surgery. Was it going to show up in the lymph nodes? Did I have to go through chemotherapy? All of that was a lot.

Maggie McKay (Host): And with a brand new baby, I mean, that's a lot.

Angie Gentry: Yes. And I will say of all babies, ours, I think, might be the more wild one I've ever seen. So he was a lot to handle, that's for sure.

Maggie McKay (Host): Oh, no. I was hoping you were going to say he was the most perfect baby.

Angie Gentry: Oh no, no, that's not in his description at all. Perfect in other ways. Other ways.

Maggie McKay (Host): So Angie, what was your treatment plan? What was laid out for you once you were diagnosed and it was clear you had to take some action?

Angie Gentry: Right. So we did the surgery. The surgery had identified that it did spread to my lymph nodes. I think we took 20 lymph nodes out, if I remember correctly. And one of them did have the cancer, which resulted in me needing to go through the chemotherapy. That was the FOLFOX treatment. So it was six months of chemotherapy around every two weeks. Luckily, I didn't have to do any radiation. I think my margins generally were clear from the rectum area, so that wasn't required as part of my treatment plan, which was a blessing.

Maggie McKay (Host): Wow. And doctor, when should you seek medical attention for signs and symptoms, especially if the symptoms seemed normal?

Lorenc Malellari: Yes. So, unfortunately because the symptoms are so vague and so common for other reasons, the most important thing, number one, is pay attention to your body, pay attention to the signs that your body is giving you. If any of the symptoms that I mentioned earlier persist, do not resolve on their own, you should seek medical attention. You should talk to your doctor about getting evaluated to rule out some of the more dangerous diagnosis like colorectal cancer.

And I did want it to bring up the fact that unfortunately with everything that's going on in the world, colorectal cancer did not take a break with the COVID-19 pandemic that we went through. There was a significant drop in screening rates over the past year and two, because of the closures and isolation and quarantine that we had to do for the pandemic. In 2020 alone, it was estimated that the colorectal cancer screening dropped by 85%. And to put this, you know, into real people's numbers, is that almost a hundred thousand people did not get their screening colonoscopies or other screenings for colorectal cancer in 2020 alone. So there's a lot of work that we still need to get done to get patients screened for this very preventable disease.

Maggie McKay (Host): So there's a lot of catching up to do. Just going back to Angie's treatment, is that standard, what she got? What other forms of treatment are there for colorectal cancer?

Lorenc Malellari: Yeah. So, Angie's diagnosis involved cancer of the colon. And the specific region is called the rectosigmoid area, which involves initial treatment through a surgical resection. And Angie received the robotic surgical resection of her cancer location.

Now, if the cancer has been diagnosed in the rectum, that treatment sometimes will include chemotherapy and radiation prior to surgery. But because it's the same cancer in terms of the location of the colon and the rectum, the chemotherapy treatment and surgery treatment is usually offered and provided to most patients. The need for chemotherapy, however, depends on the staging of the cancer. If the cancer is localized to the colon, then surgical resection or removal alone is basically the treatment or the cure for that stage.

Once the cancer cells have left the location where they started in the colon and they've reached the lymph nodes or other parts of the body, then unfortunately we need a more global treatment for this cancer. That's where chemotherapy comes in. The rectum is a bit of a special place because of the location of where the rectum is. The pelvis is a very small area, which allows for the cancer to quickly spread to the regions outside of the rectum. And also we know that patients who have rectal cancer have poorer outcomes compared to colon cancer, even with the same stage. And that is the reason why radiation is added to that particular diagnosis.

Maggie McKay (Host): So would you call Angie lucky?

Lorenc Malellari: Very lucky. I wish we had been able to have had their colonoscopy a year earlier. Hopefully, I would have had the chance to remove this cancer before it had reached the lymph nodes. But I'm glad that. You know, we're able to identify it and treat it and now she can enjoy her family and her rambunctious baby.

Maggie McKay (Host): Angie, the big question, how are you feeling now?

Angie Gentry: Yeah. So I think energy levels are back. I do have some longer-term effects with neuropathy that still kind of persists from a physical perspective. I think the harder things, the emotional side, right, is whether it's the neuropathy taking away something from me out of my day that I'm used to having, all the small things, buttoning my kid's shirt or getting into a cold pool with him or whatever it may be, it makes all of that a little bit harder, so just trying to remain positive through that. And then, you know, all the checkups, the blood tests, the colonoscopy, anything that's coming, just trying to keep your mind free from any worry or anxiety, things of that nature. Probably, the mental side is where the struggle continues to be going forward. But physically, I'm doing much better.

Maggie McKay (Host): I'm so happy to hear that. How often do you have to get colonoscopies now?

Angie Gentry: So I just had my annual checkup, and Dr. Malellari, you can check me on this, but I think the frequency will slow as time goes on if I'm doing well with my tests.

Lorenc Malellari: Yeah. So maybe I can answer that question. So basically, for patients who have a diagnosis of colorectal cancer, we'll usually proceed with a colonoscopy immediately after their treatment has completed. So in terms of Angie, a year from surgery is when she had a repeat colonoscopy. And after that, then we proceed with continued monitoring. But as far as colonoscopy is concerned, depending on what we find on the previous colonoscopy will determine when the next one is done, meaning that if we find more polyps or abnormal lesions or masses in the colon, that may require more frequent checks or more frequent colonoscopies. But if we don't find anything abnormal, then we can stretch those series of testing up to three to five years or more.

Maggie McKay (Host): Doctor, in closing, what would you say is the most important thing when it comes to colorectal cancer, preventing it?

Lorenc Malellari: I think the most important thing is being aware of it. Making sure that you're listening to your body, you're paying attention to what your body is really telling you and talk to your doctor about it. Talk to your doctor about what you're feeling, what you're experiencing. Sometimes things that you're used to may appear to be normal, may not necessarily be normal. So don't be afraid to talk to your doctor about symptoms that you're feeling, whether it involves your bowels or whether it involves your abdomen or your belly, or whether it involves things like, for example, losing weight when you weren't trying to lose weight.

I did want to make sure that I spoke about a free virtual education presentation that we have set up with Dignity Health on March 1st. It's going to be at 12:00 PM via Zoom. It's free obviously, and it's open to everyone to register. Again, RSVP at dignityhealth.org/bakersfield/events. And for those who do join us, they have the option to sign up for a free at-home colorectal cancer screening kit as well.

Maggie McKay (Host): That's wonderful. Thank you. That's very good information. And Angie in closing, what would you say to someone putting off a colonoscopy?

Angie Gentry: So I feel like there's probably a hundred reasons that someone might delay it, right? Whether it's the fear of someone explaining what happens in a colonoscopy or the prep associated with it, or just pride in general. But I can guarantee you, if you can avoid chemotherapy and get in early, get your colonoscopy done, even if it results just kind of in the surgical procedure having to happen, that would be so much better for you just to push yourself, to get through that colonoscopy, to get your diagnosis and get where you need to be, and hopefully prevent some of that other treatment to have to occur. I can tell you, you know, that six months going through chemotherapy was by far the hardest six months of my life and the hardest six months of my family's life, hopefully. So it's a hundred percent something you need to consider. Don't delay. Kind of advocate for yourself and get in there and get it done.

Maggie McKay (Host): Thank you both so much for being here, Angie, for sharing your story and, doctor, for your expertise on colorectal cancer. To find out more, go to dignityhealth.org/bakersfield/roboticsurgery. This is Hello Healthy, a Dignity Health podcast. I'm Maggie McKay. Thank you for listening and be well.