Transcription:
Colorectal Cancer Awareness and Surgical Options

Deborah Howell (Host): A look at colorectal cancer treatment and surgical options on this episode of Curating Care, a podcast brought to you by St. Clair Health. Expert Care from people Who Care. I'm Deborah Howell, and joining me today is Dr. Scott Holekamp, a board certified colorectal surgeon at the St. Clair Medical Group. Welcome Dr. Holekamp.

Dr Scott Holekamp: Oh, thank you. It's great to be here this morning.

Deborah Howell (Host): Wonderful to have you. St. Clair takes great pride in delivering expert care from people who care. Your board certified in both colon and rectal surgery and general surgery. You are named a top Doctor by Pittsburgh Magazine in 2022. I'm hoping you can tell us about how the level of expertise you bring to the services you provide is a big benefit for your patients?

Dr Scott Holekamp: One of the things that we spend a lot of time with the organ, that is the colon. And by doing so, we bring an added benefit, in my mind because that's all we focus on. So the diseases we treat, like diverticulitis, Crohn's disease, colon cancer, and some of the perianal diseases, those things, can be treated by many doctors. But I do think that because we focus on it, we're able to really spend our time zeroing in on those issues, studying the literature that surrounds those problems, and really giving them, simple but effective things that really make those kinds of diseases better.

Deborah Howell (Host): Sure. Now on the care side, the thing that makes St. Clair Health what it is and separates it from other healthcare systems, you bring personal experience to the table, both empathy and understanding of exactly what you're advising patients of., Regarding everything from cancer screening to surgery, how do your own experiences help you connect with patients and curate treatment plans to their needs and goals?

Dr Scott Holekamp: Well, I'm glad you say that because one of the things that I feel very strongly about, when it comes to colon cancer and many of the colon issues is one of the difficult things for patients is getting colonoscopies. And my personal experience when I was in my training, I saw some blood in my stool, which is one of the reasons that you might get a colonoscopy. And it prompted me to get a colonoscopy to make sure there was nothing, concerning occurring. And I was able to do that. And fortunately everything turned out well. One of the things that I really try to emphasize in the care that we give is that colonoscopies for colon health and for colon cancer are so important.

And screening in general, there's a lot of different ways to screen the colon. There's a lot of different options. The one we focus on mostly is the colonoscopy as the gold standard. And my experience, led me to believe when I had some bleeding, that that would be the right answer. And so that's what I did. I really do feel strongly about it, and that's what I advise my patients to when it comes to that kind of screening.

Deborah Howell (Host): Now, March is National Colorectal Cancer Awareness Month. Colorectal cancer is highly preventable and treatable when caught early, but only if the public knows about their risk and screening options in the first place. So I'm hoping you can tell our listeners about the screening options that are available to them.

Dr Scott Holekamp: So there are, multiple screening options. So we talked a little about colonoscopy and a colonoscopy allows the person performing the colonoscopy to look at the lining of the colon to look for little lesions that, can go on to become malignant. At the same time of doing the screening, those lesions can be removed if they see them. It does require a prep and many times requires anesthesia, which makes people uncomfortable sometimes. But we find that it's, by far the gold standard. There are multiple other options for people who either don't want to undergo a colonoscopy or cannot for whatever reason.

Couple of those ways are fecal tests that check for dna and there are multiple options on the market that your doctor can recommend, that can look for DNA of cancer in your stool or look for blood in the stool or look for other molecules in the stool. That would give you a sense that you might have a polyp or a cancer. Those are good, those have to be more frequent because they're not quite as sensitive. But for some patients, they do really like it. There's also special CT scans that can be done a standard CT scan is not a good test, but there are some specialized CT scans that can look for lesions as well. in my mind, those are the three mainstays, and really it comes down to colonoscopy.

Deborah Howell (Host): And at what age should screening start and how often should they be screened?

Dr Scott Holekamp: Recently we have seen a move to younger patients with colon cancer. And because of that, we have moved the screening guidelines up and the national guidelines have all moved to the age of 45 for the general population. So people who are at general risk should start screening at 45.

Deborah Howell (Host): And I also understand that insurance companies are now covering colonoscopy, starting at age 45 instead of 50?

Dr Scott Holekamp: Absolutely they are, insurance companies, like patients don't want their patients to have colon cancer. So if the guidelines indicate that that is warranted, they're been very good about that. Good partners in that. One other thing I wanna point out is that, there are other reasons to get a colonoscopy even earlier than that. And those things are, family history that puts you at an increased risk that would be a family history of colon cancer, colon polyps. A personal history that puts you at a higher risk like you've had polyps yourself, you have certain diseases.

Or symptoms that you have like bloating or bleeding or weight loss, or a change in bowel habits. Although those symptoms can be symptoms and colon cancer, it's also important to note that most people who have colon cancer or colon polyps have no symptoms. So symptoms aren't a good way to decide that you need a screening. But if you do have symptoms, we screen people earlier.

Deborah Howell (Host): And then if you start at 45, how often should you be screened after that initial one?

Dr Scott Holekamp: It really has to do with your risk profile. In other words, do you have a family history or do you have a illnesses that would predispose you to getting colon cancer, or what did they find during the colonoscopy? that would be the, other reason that we would change it. People want to know is it, will it always be 10 years or five years? And it's very variable. And so it's hard for somebody to say, it'll be five years, it'll be 10.

Deborah Howell (Host): Now, while highly treatable, when caught early, colorectal cancer is still one of the most common types of cancer. Are there any symptoms to look for?

Dr Scott Holekamp: I'm glad you asked that question because the answer is yes and no. First of all, the vast majority of people who get colon cancer have no symptoms, no can symptoms whatsoever ever. And people come to my office who have gotten a screening colonoscopy and they've found to have cancer. Say very commonly, I never had any symptoms. I can't believe this is happening because they sit and they have no symptoms at all, and they're talking to me. So it's important to realize the reason screening exists is because symptoms are hard to detect.

But that being said, there are some symptoms. Of course, any bleeding in your stool, any bleeding from the rectum is important and should be addressed. That's the first thing, and that should be addressed with screening or seeing your doctor. Also symptoms that could go along with it are weight loss or bloating, abdominal pain, nausea, vomiting. These are all things that can go along with it. But the big thing to remember is that symptoms aren't the best way to find it. Screening is. That's very important.

Deborah Howell (Host): All right. Let's get into some of the surgical options you use at St. Clair Health to treat colorectal cancer. There are five options to explore. If you could just very briefly, tell us about polypectomy, first of all.

Dr Scott Holekamp: So polypectomy for us can be done lots of ways, but most of the time it either uses an endoscope or some other scope that you do like during a colonoscopy to snare and remove a polyp. It's simple. It should have no bleeding. It should have no pain. It should be like nothing happened. It's usually part of a routine colonoscopy.

Deborah Howell (Host): Okay. Next is endoscopic Mucosal resection?

Dr Scott Holekamp: Yeah, so that is something that, our endoscopist colleagues do very commonly for more advanced polyps. Again, they do it during a colonoscopy, but it might be a second procedure after the original colonoscopy. Most of the time that's done by our endoscopic colleagues.

Deborah Howell (Host): And they use special tools in this case?

Dr Scott Holekamp: Special tools. That is correct. they use a special scope, special kinds of techniques to do that, it's an advanced, technique that our, gastroenterologist here at St. Clair do use.

Deborah Howell (Host): Okay, let's move on to partial colectomy?

Dr Scott Holekamp: So partial colectomy is taking out a segment of the colon, and we can do that for both benign and malignant disease. We do that for colon cancers, diverticular disease, Crohn's disease. This is taking out a disease segment of the colon. In this case of colon cancer, there's a cancer in the middle of it, and there are multiple lymph nodes that we would take along with it. This can be done a number of different ways. This can be done laparoscopically, and so laparoscopic means we use a small camera, usually in the belly button, and then two other smaller ports that allow us to manipulate the cancer and remove it, and we remove the segment of the colon.

The hope is that we can do it and put the bowel back together in such a way that it's, you would not need an ostomy or a bag. You can just put it back together and you can continue to move your bowels the way you did when you were born. Same kind of

Deborah Howell (Host): Okay. Which brings us to ostomy.

Dr Scott Holekamp: So ostomies are a way, if for whatever reason, the bowel cannot be reconnected, it allows us to move our bowels through the skin into an appliance that collects it so that you can, dispose of it, I think is the best word. Of course, most people would rather try to avoid an ostomy, and we do try our best in cases that it's possible to avoid them. But in some people it's necessary. And we have a staff here that helps us make that process as seamless as there's a whole group of people here who help do that.

Deborah Howell (Host): Wonderful because I'm sure it takes a village to get somebody through that big change in life.

Dr Scott Holekamp: Yes, absolutely. And St. Clair fortunately has invested in that village, they've made that possible.

Deborah Howell (Host): Lovely. finally, minimally invasive surgery.

Dr Scott Holekamp: we talked a little bit about this, but I'd like to expand on. So, When you're doing a segmental resection of a colon or the rectum or the bowel, that can be done, I'd like to say in three different ways. The first is the most traditional, where you make an incision, go in and by hand, take out the piece of bowel or, organ that you wanted to do That is a traditional way that we were all trained, where you make a fairly large incision go in, in the last 10 or 15 years, it's become very common to do more laparoscopic or smaller incision techniques.

Because of the rapid improvement in the technology, we've been able to really utilize small incisions and minimize people's hospital stay because we have less pain. There's less physiological impact on the patients. They do much better and they have fewer complications. Less hospitals stays, if we can make smaller incisions, laparoscopic surgery. probably the most common right now. But robotic surgery is also, very much on the rise and has a lot of good options.

What we do is we use robotic surgery for some of our surgeries. We also do laparoscopic for some of our surgeries. It just kind of depends on what is best for the patient. We're fortunate you're here to have all those options at our disposal.

Deborah Howell (Host): And I understand that, St. Clair recently invested in the latest state-of-the-art Da Vinci surgical system. What are some of the benefits of this surgical method?

Dr Scott Holekamp: The Da Vinci system is a phenomenal system. It allows us to, get good look at the pathology we're working at, and get very close and do very tedious and minute dissections. It also has, very advanced cameras that are in three dimensions, so we're working using wrist. Robotic like instruments, and we're doing it in three dimensions. It's still me doing the surgery, but it allows us to be much more accurate and precise in the way we do it. it is amazing technology I'm amazed by it, even as I do it very frequently, weekly we do it and it's always amazing to me.

Deborah Howell (Host): I can hear your awe. That's amazing. I'm glad you have that at your disposal you know, the St. Clair Hospital Cancer Center is affiliated with UPMC, Hillman Cancer Center. Thanks to this unique affiliation, surgeons from St. Clair, partner with radiation and medical oncology experts from UPMC, Hillman Cancer Center. Can you talk about the team-based approach you use when determining the best treatment plan for a patient?

Dr Scott Holekamp: We have a phenomenal relationship both with the medical oncologist and the radiation oncologist. we all have each other's cell phones and talk every day, about patients in real time. So it's nice we have. what I would call offline. This is the patient's in my office and I want to talk to them about the way I'm gonna treat this, or how we're gonna manage this, or what we need to do going forward. We talk to those people every single day. It is wonderful.

In a more formal approach, we have a cancer conference where we all get together and we review difficult or interesting cases where we're trying to figure out what the best plan is or to highlight some of the things that we're trying to do better or where we wanna make improve. It is the way cancer care should be done everywhere. It's not always the way places do it, but way it should be. It is really great.

Deborah Howell (Host): I hear, your passion in every word. Is there anything else you'd like to add to our conversation?

Dr Scott Holekamp: I think that the care here at St. Clair Hospital is phenomenal and I think that the things you've highlighted, The investment they've given in, patient care side and the technology side and the focus that they've had on these team approaches has really brought some great care and great options to patients with cancer.

Deborah Howell (Host): Well, Dr. Holekamp, I wanna thank you so much for sharing your expertise and your advice with us today. Just a true pleasure to have you on.

Dr Scott Holekamp: Well, thank you so much. I really do appreciate your time.

Deborah Howell (Host): To contact Dr. Holekamp, call 412-572-6192 or visit stclair.org. And if you found this information helpful, please share it with others, especially on your social media. Thanks for listening to Curating Care brought to you by St. Clair Health.