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Scott Webb: Among cancers that affect both men and women, colorectal cancer is the third leading cause of cancer deaths in the US according to the American Cancer Society. Colorectal cancer affects people in all racial and ethnic groups and is most common in people age 50 and older. Routine testing can prevent colorectal cancer or even find it at an early stage when it's smaller and easier to treat. And joining me today to take us through things is Dr. Isaac Payne. He's a Doctor of Osteopathic Medicine and a fellowship-trained colorectal surgeon.

Scott Webb (Host): Welcome to LifeCast, the podcast from Infirmary Health. I'm Scott Webb.

Scott Webb: Dr. Payne, thanks so much for your time. We're going to talk about colorectal cancer. And I know that March is Colorectal Cancer Awareness Month, so it's a good time to do one of these, to talk about what is it exactly and how is it screened for. And of course, people are going to want to know about the prep and is it as bad as they've heard and so on. So, just so we get a little foundation going here, what is colorectal cancer? What does that mean and what are the risk factors?

Dr. Issac Payne: Colon cancer or rectal cancer, it is, I believe, the third leading cause of cancer in the United States. It's one of the top two or three causes of cancer-related deaths in the United States as well. So approximately about 20 to 30 years ago, we noticed there was a sharp decline in the cancer-related deaths related to colon cancer. And we can actually contribute a lot of that most prevalently to screening, but also in terms of risk awareness, in terms of risk factors related to colon cancer, most notably decreasing in smoking. But as well, we can also contribute that to colon cancer awareness, screening techniques, early adoption of these techniques at earlier ages. And so, what we do now is we have a multitude of different screening modalities that we can use that patients can follow up with their primary care providers to discuss any type of colon cancer screening options available for them.

I would say the most widely used screening mechanisms that most physicians adopt is screening colonoscopy. And screening colonoscopy, actually the American Cancer Society as well as other adoption agencies have actually recommended or changed the recommendations for colon cancer screening with colonoscopy. In the past, it was at age 50. But now, they actually have recommended, because colon cancer is diagnosed earlier and earlier now, colon cancer screening at age 45, most prevalent actually in the non-Hispanic black population.

Scott Webb: Yeah. Obviously, there could be a multitude of risk factors, but smoking, you know, when I host these, it's always at the top of the list. No medical providers encourage smoking. They all recommend, highly recommend stopping smoking, quitting smoking, smoking cessation. So, smoking one of the biggest risk factors. What are some of the other risk factors? Whether that's race, ethnicity, family history, maybe all the above, maybe you can take us through those.

Dr. Issac Payne: You kind of hit the nail on the head on those top two. Family will probably be one of the major predominant. Not only just family with colon cancer, but family that has a history of multiple colon polyps, family with history of multiple advanced polyps, also family with other cancers. Breast cancer, history of ovarian cancer, uterine cancer are actually additional cancers that put people at risk for some form of a hereditary colon cancer. Non-Hispanic black population as well is a risk factor. Here in Alabama, it's actually one of the bigger risk factors is because, in our non-Hispanic black population, cancers are actually diagnosed at a later stage. And there are some socioeconomic factors that contribute to that. But most definitely, racial factors contribute to that. Yes, sir.

Scott Webb: Yeah, they definitely do. And we could do an entirely separate podcast, you know, on racial and ethnic disparities in medicine and healthcare. And you mentioned screening and how it used to be 50 was sort of the magic age for that, and now the recommendation is younger 45. I'm assuming then if somebody has a family history, there's a history of cancer, a history of colon cancer, that screening could take place even earlier, right? Maybe even before 45.

Dr. Issac Payne: It does, and it all depends upon the age of the family member that was diagnosed. So for instance, let's say a family member was diagnosed at age 50 with colon cancer, then the adopted guidelines are that patients should be screened at least 10 years earlier than that direct family member. And in case scenario, that family member should ideally undergo some screening at 40 years of age.

Scott Webb: Yeah. And you mentioned the screening colonoscopy, which is really the gold standard, and I know there's some other options and maybe we can talk about those, like Cologuard, things like that. But sticking with screening colonoscopy, take us through that, right? People have heard horror stories about the prep. And I know personally, it's not as bad as I thought it was going to be. But what's involved in terms of the prep, the actual screening, what do folks need to know? Like, can they drive themselves? Do they need to make sure they have a ride? Take time off of work? Take us through that whole process.

Dr. Issac Payne: Once I see patients after they've completed their bowel prep, they come to me and ask me what the next steps are. And I say, "Well, the hard part's pretty much already over." And so, yes, there are some duties that the patient obviously is obligated to do prior to. And we oftentimes do a conglomeration or different bowel preparations. And most oftentimes we can give a formulation that is called a soup prep that we often give, and we give this in a divided dose. We give it in the morning as well as in the evening time prior to the endoscopy.

Patients the day before, they'll stay on a clear liquid diet. We really educate the patients that their bowel does need to be as clean as possible prior to endoscopy, only because we know that's a big predictor on the success rate of colonoscopy in order to successfully surveil the patient. But it's a task that most patients can endure, that once they get into the endoscopy suite the next day, they're quite relieved. And the reason for that is because again the hard part is over. Most oftentimes, you ask the patient and it's not as bad as what it's led to be from a lot of patients.

Yes, you'll come to the endoscopy suite the day of the endoscopy, you'll undergo your endoscopy. And most oftentimes, the patients say that's the best nap that they've ever had, the best sleep that they've ever had. And it's a relatively pretty straightforward procedure. The patients will have to have somebody drive them to the clinic, as well as drive them home only because sedation is involved. It's a relatively painless procedure. And most oftentimes, odds are with screening, patients have good results post endoscopy.

Scott Webb: Yeah, they definitely do. And what are some of the signs and symptoms if somebody has been putting off getting screened, right, at 45 or 50? Let's say, they're into their 50s and they haven't been screened, are there any signs and symptoms that maybe they should get in there and get this done in terms of whether they have some polyps, whether they're cancerous or not? How would somebody know that maybe the clock is ticking and they need to be screened?

Dr. Issac Payne: The biggest contributing factors that we look for is actually rectal bleeding. And oftentimes, the misconception is, and a lot of times when patients do actually have advanced cancers, they contribute it to some form of benign nature, whether it be hemorrhoids or they think that might have been their diverticulitis that have been acting up. And so, the big tell is rectal bleeding, whether it be a bright red blood or dark red blood. We ask questions if it's mixed with stool or not mixed with stools. We ask patients about abdominal pain, lower abdominal pain. We ask patients about constipation, change in bowel movements. We look for a change in caliber of the stools. Is it a thin stool or is it a normal-appearing stool? Those are big factors that we look for.

Scott Webb: Yeah, I see what you mean. So, we've talked about screening and who should be screened and the importance of early screening and all of that. So now, let's talk about how you treat colorectal cancer.

Dr. Issac Payne: So, the good news is with colon cancer and rectal cancer, as we know, it's a very survivable cancer. Regardless of what stage, still colon cancer or rectal cancer is a very treatable disease. Colon cancer is treated differently on the most part compared to rectal cancer. But for colon cancer, let's talk about that one. Surgery is the mainstay. And so, we offer a multitude of different options for patients. But in my opinion, the gold standard now is for a minimally invasive colon surgery. And that involves removing a section of the colon. We use different type of cancer guidelines or cancer surgery-related guidelines to ensure that we've done true cancer operation. But that involves removing a section of the colon as well as incorporation of a particular lymph node basin that's around the colon itself.

It's a relatively, despite what maybe popularity ,people say, a pretty straightforward operation that, as long as it can be achieved in a minimally invasive technique, most patients endure the operation pretty well, and they actually have a pretty fastidious recovery and get back to their normal daily routine within a relatively short period of time.

Oftentimes patients will come in and ask me what stage the cancer is, and I can't give them that exact answer. We may have ideas. Once cancer's diagnosed, we do certain staging techniques, we do CAT scans and all of that, and we can have an idea about maybe the stage of it is. But we truly won't know until one to two weeks after surgery. And that's all based upon pathology and if lymph nodes have been involved by cancer or not. If lymph nodes are involved by cancer, the next step is any form of systemic chemotherapy. And there are some standard regimens that we use for colon cancer.

Scott Webb: Yeah. I just want to have you talk a little bit about the treatment that folks can get at the Infirmary Cancer Care Center, Infirmary Health, and what kind of services and support that you offer there.

Dr. Issac Payne: I think we pride ourselves on offering standard of care and even beyond standard of care. Within the Infirmary Cancer Care, there is quite a few trials that we have, clinical trials that we can offer patients that I think are quite beneficial and the results of those I think are going to be pretty astounding down the line that are going to change some ways that we practice colon cancer in the future. But also, our robotics program here at Infirmary. I can't tell you, I think that I just saw some statistics the other day that our ability to achieve a minimally invasive colon cancer surgery is actually significantly greater than what your average population is within our country.

Scott Webb: Yeah, that's perfect. That's what we want, of course, right? We don't want this at all. But if we have it, diagnosis, treatment, healing, all good stuff. Doctor, thanks so much for your time today. You stay well.

Dr. Issac Payne: Yes sir. Thank you.

Scott Webb: And for more information, call 251- 435-CARE. That's 251-435-2273 or visit infirmarycancercare.org.

And if you enjoyed this podcast, please share on social media and subscribe, rate, and review on your favorite podcast apps. This is LifeCast, the podcast from Infirmary Health. I'm Scott Webb. Thanks for listening. Stay well.