Amanda Wilde (Host): Welcome to Wellness in Reach, a Mount Carmel podcast. I'm Amanda Wilde, your host. My guest is Dr. Jennifer Nguyen, Colon and Rectal Surgeon from Mount Carmel Health System. We're talking about colorectal cancer and how to catch it early when it is most treatable. Dr.  Nguyen, thank you for being here.

Jennifer Nguyen, MD: Amanda, thank you for having me.

Host: I'm really looking forward to this conversation. It applies to a lot of us, I think of a certain age, but that's actually my first question. What is the average risk for adults and when should we start colorectal cancer screenings?

Jennifer Nguyen, MD: So Amanda, I'm glad you asked, because of within the last 10 years, the guidelines have actually changed and so they lowered the age for screening colonoscopies for an average risk patient. So that age now though, in which start screening is actually 45 when it used to be 50.

Host: And who is at-risk?

Jennifer Nguyen, MD: Honestly, everybody's at-risk, but patients who have strong family history of colon cancer, for example, or have a family history of high-risk polyps, those patients are at higher risk and they would actually start screening earlier, either 10 years before the age of diagnosis of their family member, or they would start screening at the age of 40.

Host: And what is the screening process?

Jennifer Nguyen, MD: There are multiple things that people can do to screen. I know that a lot of patients prefer to do the Cologuard, which is I think becoming increasingly popular. But as a colorectal surgeon, my recommendation is to undergo a colonoscopy. It gets a bad wrap because the prep is the worst part, honestly.

And then the colonoscopy itself is fairly simple, but typically you would start the prep the day before the colonoscopy. You would have a driver bring you in. And then on the day of the colonoscopy, we put you to sleep and we do the colonoscopy. And it's usually done within about 15 minutes or so.

Host: So colonoscopy is really the gold standard.

Jennifer Nguyen, MD: I would say it is. And the reason for this is because when you do something like a Cologuard, there's a timeframe in which a polyp can be taken out before it becomes a cancer. And the nice thing with the colonoscopy is we can just take out those polyps early on before they have that potential to become a cancer.

Host: So the advantage of the colonoscopy is it's both a screening tool, but you can actually do procedures during the process.

Jennifer Nguyen, MD: It's both screening and therapeutic at the same time, and diagnostic so.

Host: Are there symptoms of colorectal cancer that patients and families should watch out for? And are there early symptoms that differ from later symptoms?

Jennifer Nguyen, MD: So I usually tell patients that if you have rectal bleeding, we are catching colon cancers at earlier ages nowadays, and it's starting at earlier ages. So we recommend that any patient with rectal bleeding at least come to be evaluated in our clinic so we can determine if you need a colonoscopy or not.

The scary thing is a lot of times with early colon cancer, you don't actually have any symptoms, and then by the time you start showing symptoms such as anemia or abdominal pain, loss of appetite or weight loss, it's a lot more advanced.

Host: Are colorectal cancer symptoms similar to IBS, which a lot of us have?

Jennifer Nguyen, MD: They can be very similar. Sometimes you'll notice changes in your stool such as diarrhea or difficulty having bowel movements, crampy abdominal pain. Typically, irritable bowel syndrome or IBS is a diagnosis after you've ruled everything else out.

Host: So what are the recommended follow-up steps for patients after they've had cancer treatment?

Jennifer Nguyen, MD: So the recommended follow-up would be that you would follow us closely with your colon and rectal surgeon as well as your oncologist. And the reason for this is because you'll need routine lab work, including tumor markers. You'll need CT scans. Sometimes you'll need MRIs at certain intervals, and then you'll also need follow-up colonoscopies.

Typically, for a patient with colon cancer, it would be one-year after treatment has been completed, followed by three years, and then you would go every five years after that.

Host: So that's the aftercare. But going back to before care, is there anything we can do to lower our risk like diet, exercise, lifestyle factors, are there changes we can make there to lower our risk of colorectal cancer?

Jennifer Nguyen, MD: It's been shown that diets that are high in processed meats and high in red meats, they have a higher risk of developing colon cancer. And it's also a higher risk in patients who drink even a moderate amount. The recommendation for us is usually a high fiber, low fat diet. And then also having an active lifestyle is the best things that you can do to decrease your risk.

Host: So there are ways we can be proactive in our colorectal care. Part of that is screening as we were discussing earlier. How can primary care doctors encourage patients to get screened and understand the importance of early detection?

Jennifer Nguyen, MD: I think that education piece is so important on all levels. I think one of the biggest things is having that conversation about the risk and the benefits of Cologuard versus a colonoscopy. And one of the big things I think is a sticking point is that from Cologuard's data, it misses about 60% of all the advanced polyps and advanced polyps are polyps that we could have taken out through the colonoscopy before they had that chance to become cancer.

It also misses about seven to 8% of all cancers, and I think when you lay that information out, the data suggests that it would be more beneficial for patients to undergo a colonoscopy. I stated earlier that the prep is something that patients are usually most dreadful about, but we also have a lot of other prep options now, not just the four liters of GoLYTELY that we used to give patients.

Host: So, it helps to talk to your doctor about what options are available, when you should get screened, your family history. So the more information, the better and the more education the better. Speaking of that, are there common myths about colorectal cancer or screening that patients do have?

Jennifer Nguyen, MD: I have not really heard of any common myths. The process of the prep has changed a lot and I think a lot of people are still hearing the old stories, like I said, of having this giant jug of prep that they have to drink.

And I think that's probably the biggest misconception is that that's the only prep available still.

Host: It never hurts to find out what's available to you. And you have now made us aware that we need to educate ourselves on what is available now and not listen to some of the old stories.

Jennifer Nguyen, MD: Yeah.

Host: Well, Dr.  Nguyen thank you so much for your insights and helping us understand screening for colorectal cancer.

Jennifer Nguyen, MD: Yeah, it was my pleasure to be here. Thank you for having me.

Host: That was Colon and Rectal Surgeon, Dr. Jennifer Nguyen. Early detection can save lives. Don't wait for symptoms. See if it's time for your colonoscopy, and take the first step toward prevention. Learn more@mountcarmelhealth.com/colorectalcancer. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you.

Thank you for listening to Wellness in Reach, a Mount Carmel podcast.