Evo Terra (Host): This is Putting Your Health First. I'm Evo Terra. And with me is Dr. Jaime E. Sanchez, a double board-certified colon and rectal surgeon from Health First, as we talk about signs of colon cancer you shouldn't ignore. Thanks for being here, Dr. Sanchez.

Jaime E. Sanchez, MD: Thank you. It's a pleasure.

Host: So, how common is colorectal cancer today? I hear those numbers are increasing. And also, why should we be paying attention to this?

Jaime E. Sanchez, MD: Sure. Well, colon cancer is part of a constellation of cancers that we call colorectal cancers. So, cancers of the colon and the rectum, which is all really the colon, just specialized parts. And it's very frequent that we'll see patients with colon cancer. As a matter of fact, it's the third most commonly diagnosed cancer in the United States, and is the second leading cause of cancer death in the US as well. So, it's a fairly common cancer. I'm certain that you know someone who has cancer or has a friend who has a family member who has cancer of the colon, so quite prevalent.

Host: Now, again, I hear there are rising cases amongst younger adults. So, what's happening? I thought this was an old person disease for me.

Jaime E. Sanchez, MD: Well, that's true. What we've seen over the last thirty to forty years is actually a decrease in overall incidence of colorectal cancer. And that's for a very good reason. We implemented in the United States, we're very lucky to have the healthcare that we do in that we have really strong public health initiatives that tell people, "Get screening colonoscopies." And for several decades, you heard, "When you turn 50, you're going to need that colonoscopy." And the point of the colonoscopy is to look for, hopefully, polyps that might be pre-cancerous and lead to colon cancer in the future.

But if you catch them early and you remove them, then you prevent yourself from getting colon cancer, and that's excellent. So since we really implemented those kind of screening guidelines, we've seen a tremendous drop in colon cancer because we're getting to polyps before they have a chance to become a tumor. That all makes sense. So, why this increase, that you've heard of, Evo? Well, we don't exactly know. But in the last number of years, what we've been seeing is an increase in colorectal cancers in the young. And what do we mean by young? Less than fifty years old. So, we have seen an increase in these cancers to the point that has pushed us to drop the screening age to 45 years old.

So if you used to hear, "Get a colonoscopy by 50," the new mantra is, "Get a colonoscopy by 45," if you're otherwise perfectly healthy and don't have predispositions like a strong family history for colon cancer or some kind of genetic condition. As a matter of fact, even though colon cancer continues to decrease overall, especially in the older population, it's increased to the point where at least 20% of the diagnoses that we see now are in patients less than 55-year-olds. Just imagine that. This is something that for a long time you were preparing for your colonoscopy at age 50. And now, we're saying, "Hey, get it before that, maybe even sooner."

Host: So, what are the most common or early symptoms that people might experience and it could be colon cancer that people are way too easy to dismiss? 


Jaime E. Sanchez, MD: Well, here's where things become interesting and sometimes a little sad and tragic. Colon cancer in general is silent. So, patients will very often come to me and say, "I don't understand why I need a colonoscopy, and I don't understand what they just found on my colonoscopy, but I've been perfectly fine. Until my colonoscopy or until my gastroenterologist said something, I was doing perfectly fine." And that's because these tumors, they arrive in the colon, and you're not going to feel anything. And unless they particularly grow to a size or configuration where they bleed, you may not see anything. So, you don't see anything, you don't feel anything until when? Until it's big enough, advanced enough you symptoms that are of concern. So to answer your question, you see blood in the stool that doesn't improve, meaning it just doesn't happen once sporadically and then continue, and then just improved where you might attribute it to a hemorrhoid. You can attribute some bleeding to a hemorrhoid perhaps once. That's not something you want to continue attributing unless you figure out that you indeed don't have some other reason for bleeding. If abdominal pain is recurrent, if symptoms of bloating or feeling like things aren't being digested well, inability to pass gas or go to the bathroom, outside of an occasional constipation, basically symptoms that happen and then continue to progress or do not improve should raise alarm.

Host: So, your standard GI distressful things and a few extras llike the bleeding. But when it is a chronic recurring, maybe not chronic, but definitely a recurring condition, that's when you should see someone, yes?

Jaime E. Sanchez, MD: Absolutely. You know, in the past, we would think if you have a little bright red blood from bleeding and you were a younger adult, well, you were probably constipated, had a little bit of difficulty going to the bathroom, you know, maybe had some trauma, you wipe, you see some blood from hemorrhoids, okay. But as we talked about just a little earlier with the increasing, rise in colon cancer in younger adults, we can't really think that anymore. We have to be concerned. So, perhaps something that's associated with what we just spoke about isn't a big deal one time, but certainly more than once or recurring, I would get checked out.

Host: Sure, sure. What about more subtle symptoms? I'm thinking, you know, fatigue, unexplained weight loss. Do those connect to colon cancer?

Jaime E. Sanchez, MD: They very much connect to colon cancer. As a matter of fact, one of the first things that a doctor will begin to think of is if you tell them, "Hey, I have unexplained weight loss," not, "I've been working out and really trying to lose weight. I want to get fit again. I'm watching my diet." Those are all great things to lose excess weight and be fit, heart healthy, et cetera. But if you start to lose weight that's unintended, virtually, any healthcare provider is going to immediately think, "Okay, there's at least some concern potentially for cancer." And colon cancer is one of the common ones where, like we talked about, is relatively silent. So if you're having unintended weight loss of any significant amount, certainly ongoing, you're not trying to lose it, it would bring up some concern to perhaps if you haven't had a colonoscopy certainly see your doctor.

But what will we think about? We'll think about, okay, you haven't had a colonoscopy in a certain period of time or you've never had one, that's going to be a must because we just don't know.

Host: A lot of these symptoms you're talking about seem fairly benign. But again, if they're persistent, we want to see someone. But what about symptoms that come up and we should just stop what we're doing and seek medical care immediately?

Jaime E. Sanchez, MD: Sure. Well, a huge loss of blood while you're going to the bathroom is something to be concerned about. Whether you think it's a hemorrhoid or not, that just doesn't matter. Get checked out because no one's going to fault you for seeing a bunch of blood, being concerned, and having it turn out to be something more benign. That's perfectly fine. We're going to be relieved. You're going to be relieved. Great. The concern is if something like that happens, that's pretty atypical. It's not really normal. So, getting checked out for a large amount of blood that you're passing or consistently passing an abdominal pain that really causes you concern, you can't walk, you're having trouble eating, you feel like you're blocked up, can't pass gas, can't go to the bathroom, and it's causing you distress. Those are all very reasonable things you should really go get checked out, because even though they might be innocuous, they could be a sign of something more sinister.

Host: Sure. Earlier, you had mentioned that I and likely know someone, and I do know someone who's had colorectal cancer. But I don't know what the surgery looks like. And I know there are probably lots of things that you can tell us that we don't want to hear, but kind of a broad level, what does surgery look like for someone who has colon cancer?

Jaime E. Sanchez, MD: Well, let me tell you this. It's certainly not what most people think it is. Surgical techniques and advancements in surgeries have been outstanding in the last twenty years, the last ten years, even the last five years.

Most people who have a colorectal operation, even most people who have it for cancer, are going to have a much lesser time of what they probably imagine they're going to go through. Most of the techniques in modern medicine, certainly in the United States, by a board-certified colorectal surgeon, will likely be minimally invasive.

What does that mean, minimally invasive? Well, at some point, we have to be able to access the colon that's inside the abdomen. So, an incision will be required of some kind. Most colorectal surgeons that are performing these advanced procedures are doing it through very small incisions. In my patients, I will often operate through an incision that's a couple to three centimeters. So, we're talking about an inch and a half to two inches, sometimes even smaller.

And that's through a laparoscopic minimally invasive technique. One that I do is single site. Many of my colleagues do multi-port single site, which are small incisions, perhaps the size of a pen. And then, there's a vast amount of colorectal surgeons who will also perform this minimally invasive through some techniques you may have heard of robotically assisted or the surgical robot.

So when you use these techniques, you're, number one, reducing pain, trauma to the abdomen, risk of complications like infection and hernias in the future, and you're able to perform these procedures inside the abdomen a very sophisticated way, where you remove the portion of the colon that's affected with the tumor, as well as all of the associated lymph nodes.

And then, vast majority of the time, put the patient back together. What that means is to be reconnected or in continuity so that they don't wake up with a bag. A lot of patients are terrified of, "Doctor, am I going to have a bag, a colostomy, an ileostomy?" Even if they don't understand what it is, they've heard of it, and it sounds terrible, and they don't want to be deformed.

But rest assured, the vast majority of patients are going to be in the hospital just a few days. They're going to be eating and drinking a regular diet within the first to two or three days, walking around feeling like themselves in a couple of weeks. In my experience, the vast majority of my patients are back to normal life feeling like the operation's a bad memory in just about a month.

Host: And that's exceptional news. Yeah, I hadn't heard it was quite that positive for things. But you're right, there's a lot of advancements happening in medicine. So, that excites me. We're just about out of time here. Is there one thing you should tell someone about colon cancer? And if so, what would that be? 

Jaime E. Sanchez, MD: It's going to be this, Evo. Colon cancer is silent until it's not. And when it's not, it tends to be more advanced. So, the one takeaway here is get your screening colonoscopy. Get that at age forty-five if you're otherwise healthy and don't have any other family history of colon or other cancers that could be related. You don't have a genetic condition. You don't have inflammatory bowel disease. And if you do have those conditions, get it at least ten years earlier than what you might imagine the youngest person in your family, for example, or talk to your doctor. Because what I would like to really convey is that it is so much better to get that colonoscopy, find that polyp before it ever becomes a tumor, and us never meet than have to sit down and have that conversation of, "Hey, now we need to do an operation or a treatment for colon cancer because that colonoscopy was missed."

So, colonoscopies prevent colon cancer, pure and simple. The takeaway is get your colonoscopy. 

Host: Very good advice. And as someone who's had more than one of those, I will tell the people listening out there, it's a whole lot easier than your friends make it out to be. It's really, really no big deal. Anyhow, Dr. Sanchez, thank you very much for being with me today.

Jaime E. Sanchez, MD: It was such a pleasure. Thank you, Evo.

Host: Once again, that was Dr. Jaime E. Sanchez, a double board-certified colon and rectal surgeon from Health First. For more information about or if you have a concern and would like to schedule an appointment with Dr. Sanchez or a primary care provider, please visit hf.org/findadoc. Again, that's hf.org/findadoc. If you have a concern and would like to schedule an appointment with Dr. Sanchez or a primary care provider, please visit hf.org/findadoc. hf.org/findadoc. If you enjoyed this episode, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Evo Terra. This has been Putting Your Health First. Thanks for listening.