Joey Wahler (Host): How soon it's treated could be the difference between life and death. So we're discussing colorectal cancer. Our guest is Dr. Jennifer Nguyen. She's a Colon and Rectal Surgeon for Mount Carmel Health System. This is Wellness In Reach, a Mount Carmel podcast. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Nguyen. Welcome.

Jennifer Nguyen, MD: Hi, Joey. Thanks for having me today.

Host: Great to have you aboard. We appreciate it. So first, what are the common symptoms of colon cancer that patients and their families should be aware of? Keeping in mind, of course, that often there are no obvious signs, right?

Jennifer Nguyen, MD: Yeah, that's what I was actually going to start with was that oftentimes patients don't know that they have colon cancer until it's more advanced because they're not showing any symptoms. But symptoms that patients should be aware of include unexplained weight loss, abdominal cramping, changes in your stool.

So what I'm talking about is your stool used to be bulkier and now it's thinner or it's more liquidy than it had been previously. And then also, patients will occasionally notice blood in their stool or that they've noticed that it's become darker or more red colored. And that's something that they should come and get checked out. 

Host: I alluded to this a moment ago and hoping you can follow up here. How much better are in fact, the odds of effectively treating colon cancer if caught early enough? 

Jennifer Nguyen, MD: So the five year survival rate for colon cancer, if it's stage one or stage two, is about 90%. As well as for rectal cancer, it's around 90 to 91%. So if you catch it early, that's fabulous because the five year survivability just decreases the further along the cancer is. So for example, stage three, where it's invaded the lymph nodes, that survivability is about 70 to 75%. 

Host: So, you're mentioning there that the longer it progresses, the better chance that it will have spread, right?

Jennifer Nguyen, MD: Correct. 

Host: How about the latest guidelines for colorectal cancer screening and at what age should routine screening begin? Here in recent years, it's changed, because there's been a rise in these cases, hasn't there been? 

Jennifer Nguyen, MD: That's true. We are catching colon cancer at a younger age. But the nice thing is that we're also catching it earlier. So the rate of death from colon cancer has actually been decreasing, even though it still remains to be the second highest cancer related mortality within our country. In regards to screening, within the last 10 years, screening guidelines have changed. It used to be that most people would start about the age of 50 and we've recently within the last 10 years dropped it to about 45. Whether or not you should start earlier is dependent on if you have a family history of colon cancer or other cancers that might be related to colon cancer. If you have Crohn's disease or ulcerative colitis or other genetic mutations that might predispose you to colon cancer, then you might start earlier as well. 

Host: The screening gold standard, if you will, is of course a colonoscopy. So give people an idea of what's involved in that. It seems like many dread it, but also are not necessarily that well informed if they haven't had it, right?

Jennifer Nguyen, MD: Yeah, so let's start with how cancer starts because I think that's really important in the discussion of a colonoscopy and how cancer starts is it's usually from a cell that's developed a bunch of genetic mutations or changes and over time it's lost its ability to recognize that it shouldn't keep growing.

And so these cells just keep propagating and they eventually become a polyp and over the span of 10 to 20 years, those polyps might become a cancer. The nice thing about a colonoscopy, which is why we say it's the gold standard, is that we can remove these polyps before they become cancer, we can identify other issues going on as well, and we can diagnose other issues that you might be complaining about. 

So what ends up happening, is the day before, for most patients, you'll be on a clear liquid diet. You will take a bowel prep, which honestly is not nearly as bad as it used to be in the past. So in the past, patients would complain about having to take four liters of fluid, didn't taste good, and it's a lot of volume all at the same time. But we have a lot of new options now that takes that burden out of taking the prep for the colonoscopy. 

On the day of the colonoscopy, you'll come to the place where we do the colonoscopy and you'll need to have a ride home. And then you are usually under anesthesia. And then we do the colonoscopy from there. 

Host: Now I can tell people Doctor, from personal experience, multiple times with a colonoscopy, the anesthesiologist puts you out. You're out, feel nothing, realize nothing during the procedure and the next thing, you know, you open your eyes and it's all done with and there's typically zero pain. So really the prep the day and night before, cleaning out your system, that's more involved and more uncomfortable by far than the procedure itself.

Jennifer Nguyen, MD: Yeah, and I've had my colonoscopy done too. It really wasn't nearly as bad as I thought it was going to be. I've heard patients say, and I have to agree with them, that it's the best sleep you'll ever have. And they just knock you out and you wake up and it's like nothing ever happened.

Host: I actually remember when I had my first one, just before the anesthesiologist put me under, there was some sort of light music playing in the background, something very soothing. And so he said to me, Mr. Wahler, we're going to put you under, you're going to go to sleep. And the next thing I knew, I heard the same type of music playing, my eyes opened, and you know my question was, I said, when are we starting?

And they said, you're all done. I actually did not realize that it had come and gone because the process is so smooth.  

Jennifer Nguyen, MD: Well, yeah, it is, and I'm really glad that it went smoothly for you as well as it did for me. 

Host: So, a colonoscopy can actually reveal some other gastrointestinal conditions that are less serious than cancer. So what are a few of those so that people know it's not just to guard against cancer, that a colonoscopy can be helpful. 

Jennifer Nguyen, MD: Yeah, so we look for polyps because sometimes those can cause bleeding even if they're not a cancer. They can cause bleeding. We look for what's called diverticulosis, which are pouching of your colon typically is related to the low fiber diet and the Western diet as well as chronic constipation.

We can look for inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis. And then there's a plethora of other things that we can look for in addition to these. But I think those are the biggest ones. 

Host: How effective are lifestyle changes in reducing the risk of developing colorectal cancer and what specific changes do you recommend there?

Jennifer Nguyen, MD: So for patients, I recommend a high fiber diet, a lot of fruits and vegetables, minimizing red meat and processed meat. It's not clear exactly why it happens, but it's been shown that red meat is just really bad for your colon and increases the risk of colon cancer, even though we don't understand the pathway for it. 

Host: That's a dietary tip. Anything else from a lifestyle standpoint that people can do to cut down on the chances of this?

Jennifer Nguyen, MD: Yeah, minimize drinking. That's another lifestyle choice. And then also not having a sedentary life. So being active will also decrease your risk. 

Host: Maybe Doctor impress upon those joining us just how crucial it is to get that screening done, especially if you're predisposed, as you mentioned, as a high risk patient, or if you've reached around the age of 45, because we're not being overly dramatic when saying this can be a silent killer, right?

You might have stage three or four the first time you find out about it and you might be symptom free. And it's that screening that's going to be the only thing that makes the difference, right?

Jennifer Nguyen, MD: Yeah, I think it's actually very important to get screened. There's a 4% risk. If you don't have any genetic predisposition, there's about a 4% risk that you'll get colon cancer. And it is very treatable if caught early enough. A lot of times with, I'm talking about just colon cancer.

Rectal cancer can be treated a little differently. But for early stages colon cancer, a lot of times you just come in, we do the surgery, and many patients don't even need chemotherapy afterwards. So we essentially are able to cure your cancer with just surgery, and that's it, and I think that's amazing. 

Host: Absolutely amazing. Then in summary here, any misconceptions about colorectal cancer or the treatment of it that should be addressed in public health education? You mentioned even as a doctor that's in this very field that yours, when you had it done, went more smoothly than you expected it to, right?

Jennifer Nguyen, MD: I think a couple misconceptions is one, there are a lot of stool tests available. So Cologuard is something that we've been noticing a lot more patients using. And I think that's great because it has a high false positive rate. So it's going to send you to a colonoscopy, even if you don't necessarily have a cancer.

But I think a lot of patients think that they qualify for Cologuard, even if they don't. So if you have a strong family history of cancer, you aren't a candidate for Cologuard, and that you should just go straight to colonoscopy. I also think the Cologuard, though, is nice for patients who are apprehensive about a colonoscopy.

Because like I said, it will get you to a colonoscopy, even if you don't really want one. Other misconceptions are that all of a sudden you wake up and you have cancer. I think that's something I hear a lot from patients when they come in and they have a new diagnosis. They're like, has this been here for a year?

Like, when did this start? And it's actually a long standing grow process that it's happening. And so getting it caught early is really, really important. And making sure that you stay up to date with your routine screenings are also important. 

Host: No question about all of that. Well, folks, we trust you are now more familiar with colorectal cancer and its screening Dr. Jennifer Nguyen, valuable, really life-saving, potentially advice indeed. We thank you so much again.

Jennifer Nguyen, MD: Yeah, it was my pleasure.Thanks for having me.  

Host: Keep in mind again, if you or a loved one is at risk, don't wait, talk to your healthcare provider about colon cancer screening options as soon as possible.

Now, for more information on prevention, symptoms, and treatment, we ask that you visit mountcarmelhealth.com/services/colorectal-cancer. If you found this podcast helpful, please do share it on your social media. Thanks so much again for being part of Wellness In Reach, a Mount Carmel podcast.