Amanda Wilde (Host): The second leading cause of cancer death in the United States is colorectal cancer, affecting both men and women equally, but the same symptoms can be interpreted differently depending on whether the patient is male or female. Fellowship-trained colorectal surgeon, Dr. Whitney Guerrero, is here to discuss symptoms, risk factors, treatment options, and preventive measures women can take to reduce their cancer risk.

This is Hello Healthy from Dignity Health. I'm Amanda Wilde. Welcome to the podcast, Dr. Guerrero.

Dr. Whitney Guerrero: Thank you so much for having me, Amanda.

Host: Well, thank you for taking the time. Let's start with definitions. What is colorectal cancer?

Dr. Whitney Guerrero: So, colorectal cancer is actually two separate things. Colon cancer is cancer of the lining of the colon, which is close to the end of the GI tract. Rectal cancer is a cancer of the lining of the rectum, which is the very last part of the GI tract. The other difference between colon cancer and rectal cancer is that colon cancer is most frequently treated with chemotherapy, surgery, or a combination of the two, while treatment for rectal cancer can involve radiation therapy as well.

Host: How is it diagnosed?

Dr. Whitney Guerrero: Colorectal cancer is diagnosed with a colonoscopy and a biopsy.

Host: Do colorectal cancer symptoms differ between men and women or are they the same?

Dr. Whitney Guerrero: So, both men and women present similarly when they have colorectal cancer. Some of the most common symptoms include rectal bleeding or abdominal pain or changes in your bowel habits.

Host: So, women and men tend to have the same symptoms. Are there current screening guidelines for colorectal cancer? I know when you get of a certain age, you are recommended to get a colonoscopy once every five years, is it?

Dr. Whitney Guerrero: So, the screening guidelines for colorectal cancer actually depend on a couple of things. The first thing we consider is whether you have any history of cancer in your family. That will make you an exception to the rule. If you don't have any cancer in your family, then we call you an average risk individual. And for average risk individuals, colon cancer screening starts at age 45.

Now, if you have a symptom of colon cancer, like abdominal pain, abdominal bloating, we say distention, new constipation, new rectal bleeding, that's something that you'll want to have your doctor address and evaluate, no matter what age you are. 

Host: So, the main diagnostic tool of colorectal cancer is colonoscopy and biopsy, you said. Are there lifestyle changes or other preventive measures women can implement in daily life to reduce cancer risk.

Dr. Whitney Guerrero: The best advice that I have for all patients, but especially women, is to make sure that you maintain an active lifestyle. And as far as your diet, make sure you're treating your food like it's fuel. The best advice that I've heard is from Michael Pollan. He's a journalist and a professor at UC Berkeley. His famous quote is eat food, mostly plants, not too much. So, we are wanting to emphasize whole foods, foods that are close to how they appear in nature rather than more highly processed foods. And a plant-based diet is never a bad idea. For women especially, a diet high and fiber is going to give you the greatest benefit against preventing colorectal cancer. We also know that a high calcium diet, and you can find calcium from dairy, we prefer low fat dairy, it can also be protective. The thing that we do know is a high fat diet will actually increase your risk for colorectal cancer. That is also true for a diet high in red meat or processed meat.

As far as staying active, it's especially important for women to include resistance training in their exercise routine. Things like Pilates-- I love Pilates-- and weight training are really important to maintain lifelong muscle and bone health. And the reason this is important is because I know from experience that my patients who lead an active lifestyle before their diagnosis and before surgery almost always feel better sooner and heal faster.

Host: So, it's just being in general better health. And that's a lot of what these podcasts boil down to is leading a healthy, more active life and having a good plant-based Mediterranean type diet. But nevertheless, people still get diagnosed with colorectal cancer, even those who might be following those guidelines. For those people who are diagnosed, what treatment options are available?

Dr. Whitney Guerrero: Well, the first thing I want to say about a colorectal cancer diagnosis is you hear a lot of talk about prevention. You hear a lot of talk about pursue a healthy diet. I talk about it all the time with my patients. But number one thing, it's not your fault. You didn't do anything wrong. This is something that can happen to anybody.

And most cases of colorectal cancer are what we call sporadic, meaning there was no reason for someone to get it. It's not hereditary. It's not inherited. It just happens. So, the most important thing is focus on mental health. Do not blame yourself because you did not do anything wrong.

Treatment options depend upon the specific characteristics of the cancer that you have. Like we discussed earlier, the treatment options can include surgery, chemotherapy, radiation, and we can use those in different combinations and in different sequences. The most important thing to consider when you're diagnosed is to make sure that you have a team that you can trust. You'll have a medical oncologist who's in charge of chemotherapy, a surgeon who's in charge of surgery, potentially a radiation oncologist who will be in charge of delivering that radiation therapy. But the most important thing to know is that they all work together to come up with the best possible treatment plan for the specific characteristics of the cancer that you have.

Host: So, very individualized, team-based care. What would you like women in particular to know about colorectal cancer?

Dr. Whitney Guerrero: Oh, there are so many things. The most important thing is screening saves lives, men and women. It's never too early to talk to your doctor about screening. I don't care if you're 25 years old, if you have something that is making you nervous, or if you just want to talk about it with your doctor, we are happy to talk to you because screening saves lives.

Another thing would be-- I tell all of my patients this-- fiber is a girl's best friend. We talked about fiber before, but I can't say it enough. Fiber, fiber, we love it.

I also want to say that women especially have bodies that are incredible, that are built to change and adapt. And we go through so many things in our lives. So if something feels like it's not right, It might not be, and it's worth discussing, because you know your body better than anyone else. It is your right and your responsibility to advocate for yourself and talk to your doctor about it. Even so if you do bring a concern to your doctor and you think they don't understand how important it is to you or how uncomfortable you are, just tell us. We want to know. Our entire job, our entire reason for coming into this profession is to help people. And everybody has good and bad days. And if you feel like you're not being understood, it's okay to advocate for yourself and say, "Hey, listen, hold on a second. This is different for me."

For example, I had a patient who had some rectal bleeding just after bowel movements. And initially, her doctor told her, "Oh, that's okay, it's probably hemorrhoids," which is not the wrong answer. It probably is hemorrhoids. Not all cases of rectal bleeding are cancer. Common things being common, that's not what it is. But she really felt like something was off. And she was young. She was in her 30s. And she's like, "You know what? Please just take a look at this for me." And her family practice doctor, who happened to be one of my good friends, said, "Okay, you know what? You know your body." And this woman in her 30s did have colon cancer, but we caught it extremely early because her doctor took her seriously. She got her colonoscopy. And now, she's doing great. So, never be afraid to advocate for yourself.

Another thing that I would like to mention is colon cancer is being diagnosed in people who are younger and younger. And I think that we are maybe lagging behind this a little bit, because one of the things that we need to discuss with a young person who's diagnosed is fertility preservation. This goes for men and women, but especially women because we are the ones who carry the babies, if that's what we decide to do. And if a young woman thinks that there might ever be a time in her life when she wants to have biological offspring, it's really important to consider what treatment for colon cancer can do to affect your fertility risk.

But most importantly, the big takeaway, your body is yours, and you have lived in it your whole life. And when something is wrong, we are here to help you and it is our pleasure and our joy to keep you healthy.

Host: Thank you so much for this great information, Dr. Guerrero. Really appreciate your time and your insight and the work you do at Dignity Health.

Dr. Whitney Guerrero: Well, thank you so much for having me to talk about this extremely important topic.

Host: That was fellowship-trained colorectal surgeon, Dr. Whitney Guerrero. For more information, visit dignityhealth.org/bakersfield/cancercare. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. This is Hello Healthy, a Dignity Health podcast.