Many people are too embarrassed or fearful to discuss colon cancer with their family or doctor. But the reality is that regular and proactive screenings are one of the most powerful weapons we have in preventing it. We're going to talk about it today with Dr. Damian Fernandez, a gastroenterologist.

This is “Healthy Conversations,” a podcast presented by Adventist Health. My name is Prakash Chandran.

So first of all, Dr. Fernandez, it is great to have you here today. I wanted to start by asking who should get colon cancer screening? 

Dr. Damian Fernandez: Anybody above the age of 45, according to the American Cancer Society. Before it was 50, but based on the new information and incoming and up-to-date information and studies that we've been getting, it was decided that 45 was a better age to capture and prevent colon cancer.

Prakash Chandran: Okay. And why exactly is it so important to get colon cancer screening?

Dr. Damian Fernandez: It's all about prevention. So we do colonoscopies. That's a procedure that we do to prevent colon cancer. And basically, the whole point is to find polyps, which is basically a small little benign growth in the colon. And if you leave that polyp go unchecked for five to 10 years time, let's say, that can eventually lead to colon cancer.

So it's a very slow growing cancer, and we can easily intercept it, easily remove it, and in a safe manner, and this will avoid the whole heartache and the chemotherapy and the radiation that can come along with colon cancer treatment.

Prakash Chandran: Do we have any idea of what exactly causes these polyps or colon cancer in general?

Dr. Damian Fernandez: It's a mix of things. A lot of them are sporadic, so you basically have genetic mutations that occur spontaneously in the body, and that predisposes you to developing these polyps and eventually colon cancer. And there are certain lifestyle Things that also puts you more at risk, such as obesity, smoking, drinking, alcohol eating red meat, such as beef, pork, lamb, any processed meats and so forth.

Prakash Chandran: So how common is a colon cancer diagnosis in this country?

Dr. Damian Fernandez: it's the third most common cancer in men and women. One in 23 men will have it. One in 25 women will have it. And unfortunately, it's the second most common cause of cancer death in the United States in both women and men. Let's say in 2021, it's estimated that around 53,000 deaths will occur because of colon cancer.

Prakash Chandran: Which is why, I think, that you're mentioning it's so important to get those screenings, because it is a slow-growing cancer. So sooner that you're screened, the sooner it can be discovered, and you can remove those polyps, isn't that correct?

Dr. Damian Fernandez: Absolutely. We can avoid the whole colon cancer just by doing the screening, removing the polyps, preventing it from growing into colon cancer. Absolutely.

Prakash Chandran: Okay. So when we talk about the screening itself, talk to us a little bit about the different types of tests or methods that there are.

Dr. Damian Fernandez: So the gold standard is the colonoscopy. That's where we introduce a scope into the rectum and we basically traverse the entire colon, the entire large intestine looking for polyps. So that affords us diagnostic capabilities. We can diagnose you with polyps and even, you know, God forbid, colon cancer. But it also affords us the ability to remove the polyps and take biopsies if we find anything including inflammation.

The other tests that we have are fecal occult blood tests of the stool. So FIT test or FOBTs. Those tests for microscopic blood in the stools. And that could be a sign of a bleeding polyp or bleeding cancer. Now, if that's positive, you know, the road leads to colonoscopy. And those, you'd only have to do it every year and there's no preparation involved. There's also the CT colonography that you would do. It's a CT scan, basically, a specialized CT scan. It does require preparation. You'd have to do that every five years. It's great for finding polyps over a centimeter that are raised above the mucosa. However, it doesn't see the flat ones all that well. And again, it's that one's positive, you have to get a colonoscopy. 

There's also a flexible sigmoidoscopy. That's where you only go up partially into the colon. I do not suggest this. It's kind of akin to getting a mammogram of only one breast versus both breast. It's basically an incomplete inspection of the colon. It leaves out about half of the colon that's not inspected and, you know, potential pathology, malignancy, or polyps. 

There's also a capsule endoscopy where you swallow a little tablet with a lightened camera on both ends of the tablet. And it basically films your entire gastrointestinal tract as it makes its way down. And then it relays those images to our computer and then we can read it again and see if there's any pathology that way. Again, if that's positive, we'd have to undergo colonoscopies.

I don't know if you noticed, but all of these alternatives, they all point towards a colonoscopy in the end, which is the gold standard. And, you know, it gives us the ability to remove those polyps and take biopsies.

Prakash Chandran: Yeah, that makes sense. So colonoscopy is the gold standard. How often should you get a colonoscopy?

Dr. Damian Fernandez: It all depends. Let's say you have your initial colonoscopy and we find nothing, then every 10 years. But let's say you have family history of colon cancer, then you'd want it at least every five years. But let's say you have a colonoscopy, it really all depends on the types of polyps, the size of the polyps, what the pathology shows of the polyps. So if it's hyperplastic, which has a very low potential for malignancy, and then you go up into the tubular adenomas, the tubular villous adenomas, you know, the serrated polyps, these all have a higher propensity to turn into colon cancer. So based on the size, the amount of polyps, the pathology, we might tell you to come in in one year, three years, five, seven, and ten years.

Prakash Chandran: So are there any signs or symptoms that one might experience if they have colon cancer?

Dr. Damian Fernandez: Yeah. Changes in your bowel habits. So if all of a sudden you experienced diarrhea or now all of a sudden you're constipated. Let's say the caliber of your stools was once thick and then now, it's maybe like pencil-like, that's a sign. If you have blood in your stools, if you have abdominal pain, weight loss, if you're not feeling yourself, fatigue, malaise, these are all signs that you have colon cancer.

So if you have any of these signs, you should go see your physician and try to get evaluated. But another concern is with colon cancer, you might not have any symptoms at all. So that's why it's very important that whether you are experiencing symptoms or not, at the age of 45, you need to come and get screened.

Prakash Chandran: So when it comes to doing these colon cancer tests and screenings, I imagine that there is a comprehensive set of equipment that is used to do so. Can you talk a little bit about what is available to you at the Tenet Health Central Coast Hospitals?

Dr. Damian Fernandez: The latest and greatest. All of our scopes are brand new. Our processors are the most powerful and also brand new. All the tools that we use to take biopsies, to remove the polyps, we all have you know, the latest tools for that. But we also have advanced equipment as well. So we do have that capsule endoscopy and that can be done to evaluate the small bowel, which isn't reached with upper endoscopy or the colonoscopy. We also have a thing called Bravo study, and that's basically a little monitor that we put into the esophagus and that'll measure the acidity levels and it gives us more an advanced diagnosis and equipment for diagnosing gastroesophageal reflux.

We also have an equipment called manometry and that helps us diagnose motility issues. Let's say you have difficulty swallowing, that will give us more information on, you know, how your esophagus is working and further treatment depending on those results.

Prakash Chandran: So you've talked about the advanced equipment that you have as well as the multidisciplinary specialized gastro team.

Dr. Damian Fernandez: Well, we definitely treat our patients as a whole. We take our patient's perspective, their comforts, including cultural, languages spoken, religion, and we basically integrate everything, you know, they are as a person and try to give them tailored medical care. 

So if they're uncomfortable with the colonoscopy, we give them alternatives. If they are comfortable with the colonoscopy and they require a female gastroenterologist, because of religion or just basic comfort, then we have a female gastroenterologist. If they, you know, feel more comfortable speaking in French, Spanish, Arabic, or English, you know, we have staff and physicians that speak all of those languages.

So we're a very completely inclusive team. We provide the utmost quality of care as far as our endoscopic practices, and the proof of that is we're part of this endoscopy unit recognition program done by the American Society of Gastrointestinal Endoscopy and that basically hold us accountable for these practices as well.

And not only that, but we're completely surrounded by an extremely professional staff and nurses that give us the most support for us to provide and concentrate on the job at hand, which is providing excellent care and preventing colon cancer. 

Prakash Chandran: Yeah, that makes a lot of sense to me. Just before we close, I'm sure the audience is wondering, do you have any parting words of wisdom around the prevention of colon cancer, like things that they can do or things that they might be proactive about?

Dr. Damian Fernandez: Yeah, the number one way to prevent colon cancer is to get your colonoscopy. We've already discussed that. But basically, the other ways that, you know, you can do at home is maintain a healthy lifestyle. You want to eat plenty of fruits and vegetables. You want to decrease your red meat intake. You want to avoid the processed meats. You want to get regular exercise. If you are a little overweight or obese, you want to lose that weight. If you smoke, everybody knows you got to stop. And even a moderate amount of alcohol intake has been associated with increased colon cancer. So these are all ways that you can prevent colon cancer.

Prakash Chandran: Well, Dr. Fernandez, I really appreciate your time today. And I learned a lot from this insightful conversation. That's Dr. Damian Fernandez, gastroenterologist. Thanks for checking out this episode of Healthy Conversations.

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