Joey Wahler (Host): Regular screenings are crucial to help prevent it, so we're discussing colorectal cancer. Our guest, Dr. Shishin Yamada. He's a general surgeon with Silver Cross Hospital. Welcome to Silver Cross Hospital's IMatter podcast, where medical experts bring you the latest information on health topics that matter most to you and your family.

I'm Joey Wahler. Hi, Dr. Yamada. Thanks for being with us.

Shishin Yamada, MD: Good morning, Joey. Thank you for having me today.

Host: Thanks for hopping aboard. So first, what makes for a healthy colon? Is it mainly about diet or is there a little more to it than that?

Shishin Yamada, MD: There's a lot of things that make a healthy colon, and some of the big things that we don't know why is that colon cancer is increasing in those under 50. And we want to make those people healthy. I'm hoping that you and I might be able to save a life here today sometime in the future. We don't know exactly why that's increasing. We're worried about things like you could shake a stick at; you know, obesity, high sugar, processed foods, too much meat, too much alcohol. Those are all factors and sedentary lifestyle is another one. But we're worried about those. It's not just genetics and we don't know why the rates that are under 50 years old have increased so much. It's more than just genetics.

Host: I'm going to ask you about that age difference coming up in a moment, but first to touch on something you just mentioned, you kind of listed some of the lifestyle factors that go into this. What would you say is maybe from your experience, the one thing that maybe people don't take into account enough when it comes to thinking about gut health?

Shishin Yamada, MD: I think the biggest thing is that a lot of people ignore their own symptoms and signs. That's one of the biggest things is talking with your doctor. If something changes, communicate. Talk with your doctor about it. Talk to someone about it and get yourself checked out. That's one of the things that we do see often with colon cancer is that people say I wish I'd come sooner. I wish this hadn't got to this point and it's very treatable when treated early.

Host: Because if you have gastro issues, that can affect more than just your stomach, right?

Shishin Yamada, MD: That is correct. It can affect more than your stomach. It can affect your energy levels. You can become weak. You can become anemic. Obviously, we're trying to save a life here, so we don't want it at the point where you're near death.

Host: Now, a colonoscopy is, of course, the gold standard, if you will, of colon screening. So, for those unfamiliar, in a nutshell, what's involved in that?

Shishin Yamada, MD: So, our colonoscopy, we call it, in medicine, we call it the gold standard. It's the best test that we have, and it's been out there for 50 plus years. In a colonoscopy, we take something that's a camera, it's flexible, it's about the size of my finger. My finger's small, it's not as big as this, but it's a small camera that's flexible with a fiber optic light and a fiber optic image that's brought back.

You go through a colon cleansing. We're cleaning out the colon so that we can look at all the walls of the colon, looking for any lesions or any other issues with the colon. There are channels where we can actually take biopsies and treat many things, including sometimes a very early colon cancer without the need for surgery in some cases.

Host: And for the patient, I know from self experience, a colonoscopy is really a very quick and easy procedure, right?

Shishin Yamada, MD: That's correct. What people complain about is the bowel prep, but during the colonoscopy, you don't hear a lot of complaints about that. It is a very safe procedure. We do give sedation nowadays to make people feel very comfortable. The prep that they complain about what that means is that the colon's job is to reclaim water.

After food goes into your mouth, into your stomach, your stomach turns that solid material into liquid material by adding acid. Your small bowel strips out the nutrients. The liquid waste goes into your large intestine, or the colon. And the colon's job, like the sewage treatment plant, reclaim 80 percent of the water.

Now, most of the problems in your colon, most of your problems in your gut, from your mouth to your anus, those occur in the colon, just like most of the problems in your house would occur in the sewage line, not in the clean water line. So that's why we do want to clean out the sewage line, so to speak, by getting a colonoscopy prep.

And that clears it out so that we're not looking at mud, we're looking at the clean walls of the colon. So that's the only part that people complain about, that's, it's not as bad as it was years and years ago. We don't have you drink a gallon or a bucket of cleanser. It's shrunk down now. So it's much less, it's more like a two liter bottle.

So think of a pop bottle, that's what you've got to drink the afternoon before. It's a lot easier than it used to be. So we get less complaints and we do have people saying this is a lot easier than it used to be.

Host: Yes, I'm sure that that's a relief for many. So at what age should someone start getting a colonoscopy and just how much does family history play a factor in that?

Shishin Yamada, MD: So, the two questions are very good questions that I'm glad you asked. Family history plays a big role in that. One in three colon cancers are family related at the time of diagnosis. So, if you have a family member who has colon cancer, we recommend starting screening 10 years before they did. So, that's very important the 10 years beforehand, if you have a family member, you should get checked out.

Now, your other question about when to start, that actually changed recently. So the U.S. Preventive Task Force, and I know I've been saying this for a couple years before it happened, in 2021, they decreased that from starting at age 50 down to age 45. And in general, we recommend screening all the way up through age 75, and after 75, from 75 onwards to 85, we look at and say, that's a decision based on how strong you are to tolerate that.

But yes, we're now starting at age 45 because we're seeing younger and younger people pop up with colon cancer.

Host: And that's what I alluded to earlier when I said I wanted to come back to that and you did it beautifully right there. The fact that one factor has occurred, people getting it younger, has resulted in needing colonoscopies earlier, so people really need to keep that in mind, right?

Shishin Yamada, MD: Yes, they do. For example, I had one young lady who gave her permission to talk about her. She was 20 at the time of diagnosis and she had just had a brand new baby. I mean, we are seeing this pop up in younger and younger people and it's a pleasure that, to see that she's had her baby. She's growing up.

She's a young mother that she is cured now of her colon cancer years and years later. So it is popping up in younger and younger people. And to kind of bring this home to say, you know, how much so, colon cancer is the number one cancer related death for those under the age of 50 now. Thirty years ago, it used to be number four, but according to the American Cancer Society, it has popped up for the number one cause under 50 for men.

Now, other cancer deaths for women, it's still neck and neck with breast cancer. Breast cancer is still the number one for women under age 50, with colon cancer number two. And it's a shock to see this change in my 18 years at Silver Cross Hospital here to see that those numbers have shifted so much.

So we are seeing it in younger people. I do hope we get this word out to the younger people and I do hope that they you know, pay attention to what's going on with their life, their body, and their lifestyle. We can talk about those kind of signs and symptoms whenever you're ready. So.

Host: So one more thing before we move on to talking more about colon cancer. Colonoscopy may find conditions short of cancer. So, what are a few of those? And in a nutshell, how are they treated?

Shishin Yamada, MD: So colonoscopies can also find benign lesions. They find things, most of the time what we find is a polyp. So most of the time we have a normal colonoscopy. About six percent of the time we may find something like a polyp. Polyps are considered precancerous.

There can be good polyps, there can be what we call benign polyps most of the time, but every now and then there can pop up to be a premalignant polyp. And occasionally we find ones that actually have a cancer growing within them. You can think of polyps almost like weeds. We don't want them invading our lawn, but when we do see them we want to know, is this taking over the lawn?

Is this becoming a cancer? Is this precancerous? And those are the ones that we want to biopsy, check, we do an analysis of them by pathology and we look and say how many, what type, and can these turn into a cancer?

Host: Now, if someone does get colon cancer, tell us please, Doctor, what some of the symptoms are. But it's important to note also, isn't it, that sometimes someone may have no symptoms, right?

Shishin Yamada, MD: That's correct. Sometimes people may have very few or mild symptoms. Main symptoms that we really look for that we want to know, and we're going to talk about this non sexy subject called poop. Okay, so, the main things that we're really looking for are, is somebody having rectal bleeding? If you have rectal bleeding, we've had many people that say this is just a hemorrhoid.

But if this rectal bleeding is lasting more than, let's say, two weeks, you should probably have it checked out. And that could mean, typically, a colonoscopy is what we would recommend if it's ongoing rectal bleeding. We look at other things like whether this is blood that you see in the stool, the toilet, or in the toilet paper.

If it's going on, get it checked out. Talk to a doctor about it. We look at other things such as unusual stools. So, if there is a growth in the colon, it may sometimes cause your stools to change color if it's bleeding. If the blood is red, we think of red blood, but if it is higher up in the colon and gets partially digested, that iron gets stripped out and it becomes more like iron ore.

And when iron comes out of the ground, it usually looks like a black powder. So if you see black or dark stools, that's another reason to get checked out. Is there occult blood in your stool? The ones that we're not seeing that's digested. The other unsexy stuff that we talk about with poop is if there's something growing in there, is it acting like a pasta maker?

Is your stool coming out like a pencil? Is it coming out like a pasta ribbon? Is this new? So we're really looking, are there changes in your bowel habits? Is there something new that's going on? Is there something that's compressing this? We also look at if there's something growing in there, it could cause constipation.

Or is there diarrhea? Are you having very loose stool? Because blood can sometimes do that when it's mixed in with the stool. It can lead to lots of diarrhea.

Host: And so if you do have colon cancer, how is it typically treated and how much does the stage it's in affect that?

Shishin Yamada, MD: The stage does affect it, and by stage we look and see is it an early stage or an advanced stage. So there are four different main stages, but we'll just go with early and advanced. Early stage usually the tumor or cancer is located in one specific area. That's the best time for surgery up front and first.

That's when typically we can remove the cancer in a block without affecting nearby important life preserving organs. If the cancer is advanced and we find it that it is already spread to nearby organs, we have to decide, and usually we do this at our tumor board, this cancer is advanced, it's spread to nearby organs or lymph nodes. Can we remove that safely or should we try to treat that with something like chemotherapy first to shrink it? Once it's shrunk to a point where it can move it in a block and get it all, that's when we would typically go with surgery second after chemotherapy.

Host: And so just a couple of other things. Early prevention, as you well know, is so important in so many areas of medicine, but it seems when it comes to preventing colon cancer; it's so crucial as we touched on at the top. Talk to us about just how crucial it is.

Shishin Yamada, MD: So early prevention is what we strive for in medicine. The sooner you can pick up something and find it, especially with a colonoscopy, the sooner that we can treat it and get onto it and get you back to your life. So whoever we are treating, that's what we're shooting for.

We are diagnosing colon cancers earlier and earlier, including those that are younger and younger, and they have a better survival and better outcomes when we can catch it earlier and at an earlier stage in the progression of this cancer, before it's spread, before it's gone elsewhere.

Host: And finally, Doc, in summary here, you've mentioned it a few times and so it's a good place to close. When we talk about people getting colon cancer at a younger and younger age, from your particular experience, any thoughts on why that is?

Shishin Yamada, MD: Oh, another good question. The, why, we kind of alluded to things like sedentary lifestyle, lack of exercise, which is kind of the American thing now. We know that healthier people do better. Lack of exercise and sedentary lifestyle, that leads into exercise. We know mom was right that the more fruits and vegetables that you eat, the healthier you are, the more healthy foods that you eat, those that are healthier do better.

I wish there was one thing that we could point at and say, here's what you need to change. But in general, probably the biggest promise would be be healthy, exercise, eat healthy. We don't know how much of the processed foods, red meats, but they, and smoking and drinking, but they do definitely play a role into colon cancer.

We know that those are risk factors. How big of a risk factor? We don't know. We know that probably the single biggest change that you can make besides quitting smoking, moderate drinking, moderation in drinking, and eating healthy and exercise would be the best recommendations we can make and getting checked out if you see those symptoms that we talked about.

Get communicating with your doctor and getting checked out and getting a colonoscopy.

Host: Eat healthy, exercise, and get regular checkups. Those seem to be the keys in just about every area of the medical world, don't they, Doc?

Shishin Yamada, MD: Yes, it goes beyond colon cancer, to be honest. We all want to do that and it's not an easy road, but that's what we're striving for, make people live longer.

Host: Amen. And you mentioned at the top of our conversation that hopefully we can save a life or two, and I'm right along with you on that goal here today. Well, folks, we trust you're now more familiar with colorectal cancer. Dr. Shishin Yamada, thanks so much again.

Shishin Yamada, MD: Thank you. Thank you, Joey.

Host: And for more information, please visit silvercross.org/colonoscopy. Again, that's silvercross.org/colonoscopy. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of this edition of Silver Cross Hospital's IMatter Health Podcast.