Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Amanda Wilde (Host): With proper screening, you can stop colon cancer early or amazingly even before it starts. Today, Dr. Samit Datta, a gastroenterologist at Skagit Regional Health, is here to answer all of our questions about colon cancer and screening.

Welcome to Be Well, the podcast from Skagit Regional Health. I'm Amanda Wilde. Dr. Datta, thank you for being here.

Dr. Samit Datta: It's my pleasure.

Amanda Wilde (Host): I understand colon cancer is one of the most treatable cancers, but it's still quite common, isn't it?

Dr. Samit Datta: So, it's fairly common. The lifetime risk of everyone in the United States is about 4%. It's the third most common cancer in men and the second most common cancer in women. And about 50,000 plus people die from colon cancer a year.

Amanda Wilde (Host): I think of colon cancer as sort of a sneaky one where you don't see symptoms until it's later on. What stage during colon cancer do symptoms appear and what are some of those common signs and symptoms?

Dr. Samit Datta: That is, I think, an accurate representation that it can be very sneaky. It usually doesn't present until it's a later stage. And it's typically around stage III or IV where the cancer would get big enough to cause symptoms. Before that, it's actually not causing any blockages or anything like that. So the symptoms can be very non-specific. As it gets toward those later stages, people may experience abdominal pain. They may notice that they're more constipated and that things aren't moving as well. Rectal bleeding is a common sign that does tend to occur more with later stage cancers because it wears on the wall of the colon itself to cause those symptoms. But really until then, people may not notice that they have it at all.

Amanda Wilde (Host): So you've answered the question of why it's important to be screened for colon cancer. Who should be screened and when in your lifetime should you be screened? After a certain age?

Dr. Samit Datta: Absolutely. So everybody should undergo colon cancer screening. The age at which people start getting their colonoscopies differs based on multiple factors. If there's no increased risk of colon cancer, which we'll talk about, then most people can start their colonoscopies at age 45. If they do have a family colon cancer, generally in a first-degree relative like mom or dad, then we'd recommend that they actually start having colonoscopies at the age of 40.

There are some genetic syndromes that increase the risk of colon cancer too. And those are a little bit more specific to individuals if that is present and they have a different schedule altogether, but those are the main categories for who needs to be screened.

Amanda Wilde (Host): And what are the screening options? We all know the word colonoscopy, but I believe there are other options as well.

Dr. Samit Datta: There are. So there have been several options that have been tested kind of throughout our time of trying to find the best way to do colon cancer screening, really nothing has beaten a colonoscopy and all the tests that come through the stool or through the blood have been compared to colonoscopies. And so the other ways of testing for it, there's a stool card test called the FIT test that people have to do every year. That's considered a similar tier test called a tier one screening test as a colonoscopy, as long as people do it every year.

There are tier two tests, which we consider not as good for detecting it because they may miss colon cancer. They may over diagnose or kind of underdiagnose whether or not people need to get a colonoscopy. And these are things like Cologuard and a flexible sigmoidoscopy. The Cologuard is similar to the FIT test. But they try to find if there's any genetic tissue in the stool that's consistent with colon cancer. The biggest problem that we've been seeing after this test came out is that there was a lot of false negatives. What that means is that people have colon cancer, but the test says that they don't. And that's why we generally don't recommend this as a screening test anymore, because we could potentially be missing 8% to 10% of people who have colon cancer with this test.

Amanda Wilde (Host): So colonoscopy is still the gold standard. Can you describe what a colonoscopy entails for those who have not had one?

Dr. Samit Datta: So, a colonoscopy involves a camera examination with a high-definition camera. That's kind of the name of the game now in 2022, where we evaluate all the walls of the colon to look for polyps, which are precancerous tissue. It's thought that it takes about five to 10 years for a polyp to grow into colon cancer. And at the time of a colonoscopy, we're actually able to remove those polyps and thereby actually remove that risk of cancer from that specific polyp.

So that's one of the reasons why I think it's just such a great test, is because as you kind of alluded to, it can literally stop colon cancer before it has a chance to occur. People have to do a good bowel cleanse, which is I think the most dreaded part of a colonoscopy for people. You know, I won't sugarcoat it, it does not taste good. But they have to drink a pretty poorly tasting substance to clean out their colons, but that allows us to get the best examination possible and remove those polyps.

During a colonoscopy too, we're able to remove big polyps. These are polyps that could potentially become cancer in a year or two. And we can actually prevent the need for colon surgery if we can find these big polyps before they have a chance to transform and remove them entirely, which I think if we can prevent surgery, that's a massive win in my book. And during the time of a colonoscopy, people generally get sedation. We have multiple ways of doing that. And so for the most part, people don't really remember the procedure. They don't really feel too much discomfort or pain, and they're able to go about their daily activities after the procedure. And obviously, we recommend that anybody who has sedation or anesthesia does not use any heavy machinery for 24 hours.

Amanda Wilde (Host): Always good advice. That's significant though. You can do the examination and take the polyps out. And some of those polyps are just preventing like an invasive surgery sometime in the future. So the key is getting those regular colonoscopies. How often should you get those?

Dr. Samit Datta: So in the general population, if there is nothing that's found, it's about every 10 years. For people who do have a family history of colon cancer, it's every five years. And then at the time of their colonoscopy, if the physician does find some polyps, then they'll give you a range of either three or five years about when to repeat the colonoscopy. Generally, if they find a lot of polyps or big polyps, they might want to repeat it sooner just to make sure that they got everything and that nothing has grown in that interval.

Amanda Wilde (Host): It sounds like it is slow-growing cancer in that you said it started with these polyps that could take 10 years to develop into cancer. So if you're getting regular screenings, you should really keep your cancer chances very, very low. But if you should find you have colon cancer, is that treatable?

Dr. Samit Datta: Absolutely. And I think that's one of the big things that we've been able to do, even if we diagnose colon cancer, we tend to catch it at the earlier stages when we do regular screening colonoscopies, a general surgeon is able to do surgery. Really, we're actually able to expand almost to all stages of colon cancer, because we also have a lot of good supportive treatments such as chemotherapy and radiation that can treat even if it is a later stage cancer.

Amanda Wilde (Host): So good to know. And so reassuring to know that we have this good screening process. Just one last question where there have been so many advances in surgical techniques in the last 10 years, treatment for various diseases, why is it that stuff you drink before the colonoscopy has not improved in all this time?

Dr. Samit Datta: It's an unfortunate truth of the medications. So the idea is that we're trying to deliver as much water to the colon as possible so that it can flush out all the stool. And so with that, it has to have a similar concentration to blood in order to kind of stay within the intestines and they get through. Our blood is actually very salty. It has a lot of sodium in it and things like that. And so that's why it tends to have a high concentration of salt-type compounds and thereby it can deliver all that to the colon. And so that is the unfortunate truth of colonoscopy.

Amanda Wilde (Host): Well, you know, after this conversation, I know it's totally worth that temporary discomfort. Dr. Datta, thank you for this comprehensive information on the facts of colon cancer.

Dr. Samit Datta: Absolutely. It's my pleasure to educate as many people as I can on the subject.

Amanda Wilde (Host): Visit SkagitRegionalHealth.org to learn more. Thanks for listening to Be Well, the podcast from Skagit Regional Health. And if you found be well helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Amanda Wilde, and we'll talk again next time.