Transcription:
Colon Cancer Screening Could Save Your Life

Melanie Cole: Did you know that 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 and they are nothing to be afraid of. My guest today is Dr. Javier Ruiz, he’s an oncologist with the Littman Cancer Center of St. Luke’s Cornwall Hospital. Dr. Ruiz, welcome to the show. Let’s talk about some of the risk factors first. Of colon cancer, what are some of the most worrisome or concerning risk factors that you want listeners to know about?

Dr. Javier Ruiz, MD (Guest): Well, in terms of risk factors when it comes to deciding whether a colonoscopy is right for you or not, the big major one that the doctors are going review with the patient is the age. Older age is important. The great majority of people diagnosed with colon cancer are older than 50. So, although it can happen in younger people, it does happen less frequently. Also, if the patient is of the African American race, they do have a greater risk of colon cancer than do people of other races. A very important part of the past medical history is if the patient has a history of colorectal cancer, obviously, or polyps. If you already have cancer or you have adenomatous polyps; you will have a greater risk of colon cancer in the future. Inflammatory intestinal conditions are also known to increase your risk of colon cancer, that will include things like ulcerative colitis, and Crohn’s disease. Another risk factor will be inherited syndromes that increase the risk of colon cancer. When I say inherited syndromes, these are things that are passed on from generation to generation. They are genetic. It is within your genes.

So, there are syndromes, one of them called familial adenomatous polyposis and another one called hereditary nonpolyposis colorectal cancer which is also know as Lynch syndrome; they will increase your risk of colon cancer. So, it’s very important to know that part of the history. Family history along with that but just as we mentioned, of colon cancer; it’s important, if a parent, a sibling or a child has that disease, then other family members will have an increased risk of colon cancer.

Diet, we are getting more and more data that it plays an important role and in general, most people know that low fiber and high fat diet is not good. So, although there are some mixed results, the general consensus is that that will increase your risk of colon cancer. Also high in red meat or processed meat, it’s no good in terms of diet, so those are things that a doctor will review in the history to have an idea of the risk for colon cancer and the importance of screening.

If the patient has a sedentary lifestyle that can in general, inactivity can actually increase your risk of colon cancer. So regular physical activity is important. Diabetes, insulin resistance has also shown to increase your risk of colon cancer. Obesity, also increases your risk of colon cancer and also increases the risk of dying of colon cancer when compared with people considered normal weight. Smoking is a big one too. Increased risk of colon cancer is seen in these patients who smoke for many years and alcohol can also increase your risk of colon cancer. And last but not least, radiation therapy too for cancer to the area of the abdomen will also increase your risk of colon cancer. As you can see all this important information that will be in the medical records on a detailed history by the doctor will push, try to convince and push the patient to get that colonoscopy. And even if you don’t have any of these long lists of risk factors, if your age is 50 or more, your doctor will be discussing it with you. That is the standard of care. And it’s very important.

Melanie: So, now colonoscopy is considered preventative and after the age of 50 you all would like everybody to get a colonoscopy. Are there some things, symptoms, things that we should worry about before you and I talk about colonoscopy, which we will; are there some signs of things that are worrisome because people hear bleeding from the rectum, they see bright red blood and then they freak out and think they have got colon cancer, when in fact it could be a hemorrhoid. How do we know the difference and when we should call a doc and say I think I need a colonoscopy?

Dr. Ruiz: Right, excellent question. I mean you should always call your doctor no matter what if you have any kind of symptoms. The worse thing that a patient can do, and this is what I see day in and day out is that they just dismiss it or play it down. They say well, I’ll deal with it next week, I’ll deal with it next week and before you know it two years have passed by and you are still having the same symptoms. So, it never hurts to be safe, it never hurts to just inform yourself, understand the symptoms that you are having, don’t simply assume that my family member had the same thing so therefore I’ll be fine. Because it will be a completely different story. So, what patients need to understand is a lot of patients when I refer, or I discuss with them a screening colonoscopy; they say but I feel totally fine. But that’s their biggest mistake. I mean that’s the reason it’s a screening test. You should be feeling fine and the idea is to detect something early where there are no symptoms.

Melanie: So, let’s talk about the test itself. People are afraid, they think not only is it going to hurt, but that they have heard that the prep is such a big deal which it’s really not and this test is a piece of cake. Most people wake up and say when are you going to start. Speak about the test itself, the prep and why this is such an important screening tool.

Dr. Ruiz: Okay, so the colonoscopy exam is basically, they use what is called a colonoscope which is a long flexible tube which is inserted into the rectum. There is a tiny video camera at the tip of the tube which that allows the doctor to detect changes or any abnormalities inside of the entire colon. It takes the actual test, takes about 30-60 minutes on experienced hands which they will be – a gastroenterologist does this test almost every day. The screening generally is repeated every ten years if they don’t find any abnormalities.

Now in terms of the pros of this test, it’s a very sensitive test, in terms of it’s the most sensitive test in terms of colon cancer screening. The doctor will be able to see your entire colon and rectum. The cameras are very sensitive, and they give you a very clear view of your colon. If they see any abnormal tissue like a polyp; then they can biopsy and remove it through the scope. The cons are that if the exam might not detect small polyps or cancers. It is not 100% certain if they do it, that they are going to detect everything. But they are pretty thorough, pretty good test in general. So, the thorough cleansing of the colon which is what we call the prep, is one of the things that patients don’t like, but in my experience, after recommending hundreds of patients for colonoscopies, it’s something that patients tolerate well.

It may be a little bit of an inconvenience, but the benefit outweighs any kind of inconvenience. Sometimes they do require some diet changes. Absolutely and some medications may have to be held. But it’s something that is very temporary without any harm to the patient. One of the things that patients shy away is sedation. There is always the question of am I going to be sedated, some patients obviously are reassured by the fact that they are going to be sedated, other patients are afraid of being sedated. And it can take several hours to wear off, but they have to understand that the sedation is something that is a very safe procedure, it’s done on thousands of patients every day, throughout the nation and it’s done on a very safe setting under the supervision of physicians.

Obviously, if you are sedated, it may cause some inconvenience in terms of work schedules and so forth because someone else may have to drive you home, so scheduling is important or being organized for that is important. So, patients tend to procrastinate because they don’t get their act together in terms of getting all of that that needs to be done to make it happen. And as you had mentioned before, there could be extremely rare complications like any procedure and there could be some bleeding from the site where the biopsy was taken. If there is a little tear on the colon, that can also cause some bleeding and scare the patient. And a lot of patients just because of the nature of the procedure, they may feel some cramping, or some bloating after the procedure, but then again, very temporary and you will be going back to your business shortly after the procedure. So, I really, really encourage everyone that is at least above age 50, to get the colonoscopy if they haven’t had one.

Melanie: Well absolutely and as someone who has had colonoscopies before, it’s absolutely a piece of cake and nothing to be afraid of. But what about polyps Dr. Ruiz? If they find a polyp, what does that mean?

Dr. Ruiz: Yeah, the polyps are basically what we call a small benign, noncancerous clump of cells. That’s the best way to describe it to the patients. And another way I describe it to the patient is basically some changes in the cells within the polyp that could have become a cancer. So, when the gastroenterologist goes in and sees a polyp, and removes that polyp, that polyp if it had not been removed, if they go back a year after or two years later, they will see that it would turn into a cancer. So, and that’s the amazing thing of the test right there. That if the doctor goes in and removes a polyp, I always tell my patients, well right there, your life was just saved. Because if you had not had that test, that would have turned into a cancer that could have cost your life. So, that is the most powerful statement right there in terms of building an argument for a colonoscopy. So important.

Melanie: It certainly is. So, wrap it up for us Dr. Ruiz, if you are over the age of 50 or have any of the risk factors that you have so succinctly mentioned here today and what do you want listeners to know about colon cancer and colon cancer screening?

Dr. Ruiz: What I tell my patients, please do not procrastinate and don’t be looking for some old story to justify not doing it. The last thing you need to do is to procrastinate on that and then present to the emergency room with symptoms that could be alarming, could be suspicious and then later on finding out that you have colon cancer where if you had done it five years prior, they would have found a little polyp that would have been removed end of story. So, so, important. Encourage your parents, encourage your grandparents, encourage your spouse, and do it yourself when your doctor tells you to do it. Because this is the power of clinical science or medicine. Take advantage of the advances that have been discovered, the studies that have been done on thousands of patients and that have saved costless lives. So, easy to do, doesn’t take that long and will potentially give you years of life.

Melanie: Thank you so much Dr. Ruiz for being with us today and such an important topic. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information please visit www.stlukescornwallhospital.org that’s www.stlukescornwallhospital.org. I’m Melanie Cole. Thanks so much for tuning in.