Colorectal cancer is the third most common cancer in both men and women, however, with early detection and treatment, colon cancer can be caught early and even prevented from happening.
Dr. Love Dalal discuses what to expect during a colonoscopy, and how this gold standard screening tool can actually help prevent colon cancer.
Colon Cancer and Colonoscopies
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Learn more about Love Dalal, MD
Love Dalal, MD
Dr. Love Dalal is a gastroenterologist in Oroville, California and is affiliated with Oroville Hospital. He received his medical degree from N.H.L Municipal Medical College and has been in practice for more than 20 years. He is one of 2 doctors at Oroville Hospital who specialize in Gastroenterology.Learn more about Love Dalal, MD
Transcription:
Melanie Cole (Host): Colorectal cancer is the second leading cause of cancer related deaths among men and women combined. However, there are tests that can actually prevent or detect colon cancer at its earliest stages. My guest today is Dr. Love Dalal. He’s a gastroenterologist with Oroville Hospital. Dr. Dalal, tell us about colon cancer, the prevalence of it and some of the risk factors for colon cancer.
Love Dalal, MD (Guest): Colon cancer is the second most common cancer and it is also the second most common cause of death among the cancers that not only in the country but all over the world. As far as the incidence of colon cancer is concerned, it increases with the age. If you are 50 years old, at 50 years about 50 people will get cancer among the 100,000 population, but if you are 70 then 70-75 people will get colon cancer among people with 70-75 years among 100,000 people. But if you are 80 or 85 the incidence goes up steeply and then about 350 people will get colon cancer out of 100,000 people who are alive at 85 years. The risk is common among men and women so, it’s not different.
As far as the United States is concerned; in 2018, about 150,000 cases of colon cancer were diagnosed out of it 100,000 were colon cancer and 50,000 were rectal cancer. Annually about 50,000 of these people died of colon cancer.
As far as the risk factors of colon cancer are concerned; there are two main types of risk. First type is some genetic disorder, so genetic abnormalities which usually cause colon cancer in younger people. Some of these hereditary, some of these are genetically engineered cases.
As far as common cases are concerned; the risk factors will include obviously, the age. As the age increases the risk increases. The other main risk factor is African Americans. African Americans have 20 -25% higher chance of getting colon cancer than the white people. Obesity and diabetes are risk factors. Red meat is also a risk factor. Tobacco and alcohol consumption also are risk factors for colon cancer. These are the common risk factors we talk about in our everyday practice for colon cancer.
Host: Then let’s talk about the tests that can be done to detect and diagnose colon cancer. Speak about a colonoscopy Dr. Dalal. When is somebody supposed to get their first one and then let’s talk about the procedure itself and really, how easy they are.
Dr. Dalal: So, colon cancer testing can be done in multiple ways and obviously colonoscopy is the most popular method to check about the colon cancer screening. But there are other screening tests also. The stool tests are considered as common tests like checking for evidence of blood in the stool and also now there is a test which can detect DNA in the stool for the cancer cells. So, these are for the stool tests.
For the direct visualization tests, colonoscopy which includes examination of the entire colon and sigmoidoscopy which includes the last one third of the colon are popular. And there is a test known as CT colonography where you can do a CT scan and the CT scan can help diagnose colon cancer. So, there are various types of the cases and colonoscopy is the most popular and perhaps the best. However, we always believe that patients should undergo some form of testing rather than no form of testing. People come and tell us that they are not willing to undergo colonoscopy because of various reasons and we tell them that at least undergo a stool exam or an x-ray rather than not doing anything and sitting tight.
As far as the colonoscopy it self is concerned; it is recommended at the age of 50 to all men and women as per the US Preventative Task Force Guidelines. American Cancer Society in 2018 came out with new guidelines recommending that the screening should be started at age 45 because more and more younger people are now diagnosed with colon cancer.
Colonoscopy is done for colon cancer screening. A lot of people believe that colonoscopy is done to find out colon cancer which is not correct. Colonoscopy is done for the screening and by colonoscopy we are trying to find out colon polyps. Colon cancer begins in 90% of the time from a colon polyp and hence, if you can remove a polyp, the chance of colon cancer is eliminated. Colonoscopy looks at the colon polyps and colonoscopy can remove most of the colon polyps and that is how colonoscopy is very useful and is recommended to everybody around the age of 50.
Host: Tell us a little bit about the prep. People get concerned that that’s the worst part and when I’ve had my colonoscopies, Dr. Dalal; you wake up and you say okay when are you going to start, and you doctors say well we are already done. But the prep seems to be what keeps people from taking this exam. Speak about what’s going on with preps these days.
Dr. Dalal: Yeah so, I think the prep is difficult because the conventional prep which we have been using for the last 25 years contains a gallon of liquid which if I have to describe it tastes like seawater or salt water. And if you have to drink one gallon over a period of seven or eight hours; sometimes people find it difficult because the liquid is not very palatable. That scares people off.
Newer preps are available and newer preps are now coming out in smaller and smaller volumes. So, the acceptability is increasing. However, a lot of insurance carriers do not approve the newer preps and they still want us to use the older preps so, that’s why there is slight hesitation. But with the newer preps, I hope that the number of people getting screened will go up and I had my colonoscopy done at the age of 50, my colonoscopy I had got done at 60 and both of the times, I had taken the conventional one gallon prep and I know how difficult it is. But we always try to reassure the patient and convince the patient that this is the best for him. The clearer the prep, it is easy for us to see, easy for us to perform the procedure, the time of the procedure is less, the discomfort is less, the anesthesia risks are less. So, if you drink the prep correctly, everything else is like piece of cake.
Host: Tell us a little bit about the polyps that you do see sometimes. Are all polyps precancerous? Are some just completely benign? What do you want the listeners to know, if you do tell them well, I took out a couple of small polyps?
Dr. Dalal: Yeah so, polyps are classified into five different types. One of the types is not cancerous. If you leave it inside; it’s never going to turn into cancer. Out of the other four types, not all polyps turn into cancer. According to the science, only one out of 15 or one out of 20 polyps will turn into cancer. However, I have no way to find out or no way to tell my patients just by looking at the polyp or even after taking them out which one was bad, and which one was good. Because all look alike. So, when we see the polyps, all polyps must be taken out and subjected to analysis. So, if you have larger polyps, yes, they are bad and if you have bad type of polyps on the biopsy, obviously they are bad but once we have removed the chance of colon cancer is eliminated. So, all polyps must be removed and are removed and subjected to analysis which we can reassure the patient that there is no risk of developing colon cancer at that point when all the polyps have been removed.
Host: Now, onto some prevention tips Dr. Dalal. Can diet help to prevent colon cancer and or polyps and when do you advise people to visit a gastroenterologist? Sometimes, you see bleeding, you see blood in the toilet, but often it could be hemorrhoids. So, please just speak about when you think it’s important to see a gastroenterologist and if diet can affect the colon that way.
Dr. Dalal: Yeah so, I’ll answer the second question first when to see a gastroenterologist. Yes, anytime you experience rectal bleeding, it is abnormal. So, you have to see the gastroenterologist when you are experiencing rectal bleeding. Yes, hemorrhoids are the most common cause of rectal bleeding, but unless you get yourself checked, it is not possible for anybody to say that it is coming from hemorrhoids and not from a polyp or a cancer or a colitis or Crohn’s disease. So, any rectal bleeding which is ongoing is abnormal and the patient must see a gastroenterologist as soon as possible and get himself or herself checked and make sure that we are not dealing with any serious condition and we can appropriately treat the patient.
Yes, diet definitely plays a role and there is a lot of scientific data for prevention of colon cancer. As I discussed earlier that 90% of colon cancer starts from a polyp and diet can prevent polyps. Obviously, if you stop tobacco and you stop alcohol, that helps us, but proactively, physical activity can reduce the risk of development of colon cancer. Diet which is high in fruits and vegetables gives protection from colorectal cancer and there are numerous studies on the fiber supplements which can prevent development of polyps and development of cancer. Ideally, people should take anywhere from 25 to 30 grams of fiber by mouth every day and that will definitely give you some protective effect. Some data suggests that folic acid and calcium can also prevent colon cancer and you should take diet rich in folic acid and calcium. Similarly, the same thing can be said about vitamin D and finally, aspirin is supposed to prevent colon cancer and colon polyps and it is recommended like prevention of heart attack, aspirin is also recommended as part of prevention of colon cancer protocol.
Host: So, if you would wrap it up for us Dr. Dalal, as a gastroenterologist what is one most important thing that you would like people to know about colon cancer, the tests available to detect it or catch it at its earliest stages, really your best advice.
Dr. Dalal: So, I think the thing which I would say is that all the women do mammography for the breast cancer; the mammography is done to detect early breast cancer. On the other hand, colonoscopy is done to prevent colon cancer. So, there is a vast difference between mammography and colonoscopy. Mammography is not done to prevent breast cancer, but it can detect early breast cancer where cancer has already been established. While colonoscopy is much more beneficial in the way that it can prevent colon cancer by detecting and removal of the colon polyps. So, colonoscopy must be done when recommended by your provider. If you are not willing to undergo colonoscopy, please select an alternative testing and get yourself tested and prevent yourself from developing colon cancer.
Colon cancer, once developed, has good response to treatment. So, that also is reassuring. If this cancer is not spread outside the colon; five year survival is about 90-91% which also is helpful. And as far as my one and final deepest concern; regular exercises, high fiber diet, lot of fruits and vegetables are very strongly recommended, avoid alcohol and tobacco and check with your doctor and find out if aspirin is appropriate for you and that will also help you preventing colon cancer.
Host: Thank you so much Dr. Dalal for joining us today and sharing your expertise and telling us ways that we can prevent colon cancer and how easy the tests are that are available to detect it and catch it at its earliest stages. Thank you again, for joining us. You’re listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information, please visit www.orovillehospital.com, that’s www.orovillehospital.com. I’m Melanie Cole. Thanks so much for tuning in.
Melanie Cole (Host): Colorectal cancer is the second leading cause of cancer related deaths among men and women combined. However, there are tests that can actually prevent or detect colon cancer at its earliest stages. My guest today is Dr. Love Dalal. He’s a gastroenterologist with Oroville Hospital. Dr. Dalal, tell us about colon cancer, the prevalence of it and some of the risk factors for colon cancer.
Love Dalal, MD (Guest): Colon cancer is the second most common cancer and it is also the second most common cause of death among the cancers that not only in the country but all over the world. As far as the incidence of colon cancer is concerned, it increases with the age. If you are 50 years old, at 50 years about 50 people will get cancer among the 100,000 population, but if you are 70 then 70-75 people will get colon cancer among people with 70-75 years among 100,000 people. But if you are 80 or 85 the incidence goes up steeply and then about 350 people will get colon cancer out of 100,000 people who are alive at 85 years. The risk is common among men and women so, it’s not different.
As far as the United States is concerned; in 2018, about 150,000 cases of colon cancer were diagnosed out of it 100,000 were colon cancer and 50,000 were rectal cancer. Annually about 50,000 of these people died of colon cancer.
As far as the risk factors of colon cancer are concerned; there are two main types of risk. First type is some genetic disorder, so genetic abnormalities which usually cause colon cancer in younger people. Some of these hereditary, some of these are genetically engineered cases.
As far as common cases are concerned; the risk factors will include obviously, the age. As the age increases the risk increases. The other main risk factor is African Americans. African Americans have 20 -25% higher chance of getting colon cancer than the white people. Obesity and diabetes are risk factors. Red meat is also a risk factor. Tobacco and alcohol consumption also are risk factors for colon cancer. These are the common risk factors we talk about in our everyday practice for colon cancer.
Host: Then let’s talk about the tests that can be done to detect and diagnose colon cancer. Speak about a colonoscopy Dr. Dalal. When is somebody supposed to get their first one and then let’s talk about the procedure itself and really, how easy they are.
Dr. Dalal: So, colon cancer testing can be done in multiple ways and obviously colonoscopy is the most popular method to check about the colon cancer screening. But there are other screening tests also. The stool tests are considered as common tests like checking for evidence of blood in the stool and also now there is a test which can detect DNA in the stool for the cancer cells. So, these are for the stool tests.
For the direct visualization tests, colonoscopy which includes examination of the entire colon and sigmoidoscopy which includes the last one third of the colon are popular. And there is a test known as CT colonography where you can do a CT scan and the CT scan can help diagnose colon cancer. So, there are various types of the cases and colonoscopy is the most popular and perhaps the best. However, we always believe that patients should undergo some form of testing rather than no form of testing. People come and tell us that they are not willing to undergo colonoscopy because of various reasons and we tell them that at least undergo a stool exam or an x-ray rather than not doing anything and sitting tight.
As far as the colonoscopy it self is concerned; it is recommended at the age of 50 to all men and women as per the US Preventative Task Force Guidelines. American Cancer Society in 2018 came out with new guidelines recommending that the screening should be started at age 45 because more and more younger people are now diagnosed with colon cancer.
Colonoscopy is done for colon cancer screening. A lot of people believe that colonoscopy is done to find out colon cancer which is not correct. Colonoscopy is done for the screening and by colonoscopy we are trying to find out colon polyps. Colon cancer begins in 90% of the time from a colon polyp and hence, if you can remove a polyp, the chance of colon cancer is eliminated. Colonoscopy looks at the colon polyps and colonoscopy can remove most of the colon polyps and that is how colonoscopy is very useful and is recommended to everybody around the age of 50.
Host: Tell us a little bit about the prep. People get concerned that that’s the worst part and when I’ve had my colonoscopies, Dr. Dalal; you wake up and you say okay when are you going to start, and you doctors say well we are already done. But the prep seems to be what keeps people from taking this exam. Speak about what’s going on with preps these days.
Dr. Dalal: Yeah so, I think the prep is difficult because the conventional prep which we have been using for the last 25 years contains a gallon of liquid which if I have to describe it tastes like seawater or salt water. And if you have to drink one gallon over a period of seven or eight hours; sometimes people find it difficult because the liquid is not very palatable. That scares people off.
Newer preps are available and newer preps are now coming out in smaller and smaller volumes. So, the acceptability is increasing. However, a lot of insurance carriers do not approve the newer preps and they still want us to use the older preps so, that’s why there is slight hesitation. But with the newer preps, I hope that the number of people getting screened will go up and I had my colonoscopy done at the age of 50, my colonoscopy I had got done at 60 and both of the times, I had taken the conventional one gallon prep and I know how difficult it is. But we always try to reassure the patient and convince the patient that this is the best for him. The clearer the prep, it is easy for us to see, easy for us to perform the procedure, the time of the procedure is less, the discomfort is less, the anesthesia risks are less. So, if you drink the prep correctly, everything else is like piece of cake.
Host: Tell us a little bit about the polyps that you do see sometimes. Are all polyps precancerous? Are some just completely benign? What do you want the listeners to know, if you do tell them well, I took out a couple of small polyps?
Dr. Dalal: Yeah so, polyps are classified into five different types. One of the types is not cancerous. If you leave it inside; it’s never going to turn into cancer. Out of the other four types, not all polyps turn into cancer. According to the science, only one out of 15 or one out of 20 polyps will turn into cancer. However, I have no way to find out or no way to tell my patients just by looking at the polyp or even after taking them out which one was bad, and which one was good. Because all look alike. So, when we see the polyps, all polyps must be taken out and subjected to analysis. So, if you have larger polyps, yes, they are bad and if you have bad type of polyps on the biopsy, obviously they are bad but once we have removed the chance of colon cancer is eliminated. So, all polyps must be removed and are removed and subjected to analysis which we can reassure the patient that there is no risk of developing colon cancer at that point when all the polyps have been removed.
Host: Now, onto some prevention tips Dr. Dalal. Can diet help to prevent colon cancer and or polyps and when do you advise people to visit a gastroenterologist? Sometimes, you see bleeding, you see blood in the toilet, but often it could be hemorrhoids. So, please just speak about when you think it’s important to see a gastroenterologist and if diet can affect the colon that way.
Dr. Dalal: Yeah so, I’ll answer the second question first when to see a gastroenterologist. Yes, anytime you experience rectal bleeding, it is abnormal. So, you have to see the gastroenterologist when you are experiencing rectal bleeding. Yes, hemorrhoids are the most common cause of rectal bleeding, but unless you get yourself checked, it is not possible for anybody to say that it is coming from hemorrhoids and not from a polyp or a cancer or a colitis or Crohn’s disease. So, any rectal bleeding which is ongoing is abnormal and the patient must see a gastroenterologist as soon as possible and get himself or herself checked and make sure that we are not dealing with any serious condition and we can appropriately treat the patient.
Yes, diet definitely plays a role and there is a lot of scientific data for prevention of colon cancer. As I discussed earlier that 90% of colon cancer starts from a polyp and diet can prevent polyps. Obviously, if you stop tobacco and you stop alcohol, that helps us, but proactively, physical activity can reduce the risk of development of colon cancer. Diet which is high in fruits and vegetables gives protection from colorectal cancer and there are numerous studies on the fiber supplements which can prevent development of polyps and development of cancer. Ideally, people should take anywhere from 25 to 30 grams of fiber by mouth every day and that will definitely give you some protective effect. Some data suggests that folic acid and calcium can also prevent colon cancer and you should take diet rich in folic acid and calcium. Similarly, the same thing can be said about vitamin D and finally, aspirin is supposed to prevent colon cancer and colon polyps and it is recommended like prevention of heart attack, aspirin is also recommended as part of prevention of colon cancer protocol.
Host: So, if you would wrap it up for us Dr. Dalal, as a gastroenterologist what is one most important thing that you would like people to know about colon cancer, the tests available to detect it or catch it at its earliest stages, really your best advice.
Dr. Dalal: So, I think the thing which I would say is that all the women do mammography for the breast cancer; the mammography is done to detect early breast cancer. On the other hand, colonoscopy is done to prevent colon cancer. So, there is a vast difference between mammography and colonoscopy. Mammography is not done to prevent breast cancer, but it can detect early breast cancer where cancer has already been established. While colonoscopy is much more beneficial in the way that it can prevent colon cancer by detecting and removal of the colon polyps. So, colonoscopy must be done when recommended by your provider. If you are not willing to undergo colonoscopy, please select an alternative testing and get yourself tested and prevent yourself from developing colon cancer.
Colon cancer, once developed, has good response to treatment. So, that also is reassuring. If this cancer is not spread outside the colon; five year survival is about 90-91% which also is helpful. And as far as my one and final deepest concern; regular exercises, high fiber diet, lot of fruits and vegetables are very strongly recommended, avoid alcohol and tobacco and check with your doctor and find out if aspirin is appropriate for you and that will also help you preventing colon cancer.
Host: Thank you so much Dr. Dalal for joining us today and sharing your expertise and telling us ways that we can prevent colon cancer and how easy the tests are that are available to detect it and catch it at its earliest stages. Thank you again, for joining us. You’re listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information, please visit www.orovillehospital.com, that’s www.orovillehospital.com. I’m Melanie Cole. Thanks so much for tuning in.