Selected Podcast
Colon Cancer: Learn more about screening, signs, and symptoms
Dr. Thomas Nicholson leads a discussion focusing on colon and rectal cancer, including when you should receive screenings, and the treatment options and procedures available at UPMC.
Featuring:
Thomas Nicholson, MD
Thomas Nicholson, MD, specializes in colon and rectal surgery and is board-certified in surgery by the American Board of Surgery and colon and rectal surgery by the American Board of Colon and Rectal Surgery. He practices at Leader Surgical Associates-UPMC and is affiliated with UPMC West Shore, UPMC Memorial, UPMC Harrisburg, and UPMC Community Osteopathic. Dr. Nicholson earned his medical degree at the Pennsylvania State University College of Medicine. He completed his residency at WellSpan York Hospital and a fellowship at Georgia Colon & Rectal Surgical Associates. Transcription:
Bill Klaproth: So I'm just going to say it. You're not allowed to get colon cancer. Why. Well, we have the gold standard of screening. It's called the colonoscopy and you can catch colon cancer before it starts. That's why everyone should pay attention and get their colonoscopy. And while March is colon cancer awareness month, anytime is a good time to talk about colon health.
So let's talk about the importance of colon cancer screening. And we're going to talk about the new guidelines, which is saying we should all start getting our colonoscopies at age 45. So we're going to talk about this with Dr. Thomas Nicholson, a colon and rectal surgeon at U P M C.
This is Healthier You, a podcast from UPMC in Central Pennsylvania. I'm Bill Klaproth. Dr. Nicholson, thank you so much for your time. It is great to talk with you on such an important topic. So before we get to the new guidelines of colon cancer screening, dropping them from 50 to 45, let's talk about the special care that you provide at UPMC. So first off, why should people choose UPMC for their colon and rectal care?
Dr. Thomas Nicholson: I think one of the advantages is that it's a specialty group. Our practice is set up not necessarily for general care, but for specialty care. So from our standpoint, from the surgery department, I do only colon and rectal surgery, so I don't do any other types of general surgery at all from that standpoint. And then we also, within the department have gastroenterology too, again, specifically dealing with colon and rectal issues.
Bill Klaproth: So it sounds like you've got a multidisciplinary team on board.
Dr. Thomas Nicholson: Right. I mean, that's how we've designed our practices, is instead of just having five or six general surgeons in our group covering all different specialties, we have specialties covering all areas of general surgery.
Bill Klaproth: So it's fair to say then you combine all of your specialists' knowledge and expertise together to come up with a personalized cancer treatment plan for each individuals. Is that right?
Dr. Thomas Nicholson: Yes. We do the screening portion here with colonoscopy and treatment. And then we also have the affiliation with the Hillman Cancer Center. So if we do find something that needs further care, we work very closely with them to be able to not only provide great care, but in a timely and efficient manner.
Bill Klaproth: Right. And as you said, you're a specialist in colon and rectal care. So UPMC is the place to go. So let's talk about these new guidelines. So before it was always, "Hey, when you hit 50, it's time to get that colonoscopy, right?" Well, it sounds like the guidelines have changed and now they've lowered it from 50 to 45. Can you explain that to us?
Dr. Thomas Nicholson: Well, I think the initial age at 50, the way we chose that is the peak incidence for colon cancer for men and women were 62 and 63. And on average, it takes about probably about 10 to 12 years to form a cancer on average. So if you frameshift everything from 62 to 63, subtract 12, and that's how we ended up at 50 to start. That's how that became the standard of care. But I would say, over the last five years or so, we've seen an increase in incidence of colon cancer, not only in 40-year-olds, but actually even down into 30-year-olds. Currently, we have unfortunately been treating cancer in very young patients. As we screen more, I think we found that, even in 20 and 30 year olds were picking up early polyps. So I think the fear of missing somebody that's a younger person is the motivation to get that down to 45, which I think is appropriate for what we've been seeing, the 45. And actually, there's a little bit of a tendency maybe that we should be starting at age 40, but it was tough enough to get it down to 45.
Bill Klaproth: Well, with the incidence of this happening in younger people as well, that just seems to make sense. So people of average risk of colon cancer then really should begin their screenings at age 45. And if somebody is in a high risk category, that changes everything, right? If somebody is in their thirties, but has a high risk factor, then they should be getting that earlier. Is that correct?
Dr. Thomas Nicholson: Yeah. The rule that we go by is 10 years before the diagnosis of a cancer. So if a first-degree relative, a mom, dad, brother, or sister was diagnosed and had an unfortunate cancer, let's say, at 45 years of age, then we would recommend screening at 35 years of age. So frameshift everything 10 years from the age of diagnosis. So if you fall into that category, that's the rule of thumb that we go by.
Bill Klaproth: And Dr. Nicholson, we know that you're a specialist when it comes to providing comprehensive colorectal and anal care. Can you tell us what other specialties you provide as well?
Dr. Thomas Nicholson: I like to say that we specialize obviously with screening colonoscopies to be able to do that. Colon surgery, we do a lot of minimally invasive both for colon and rectal surgery with the robot. We specialize in minimal invasive treatment for this. We do see a lot of diverticulitis in Central Pennsylvania, so not only non-surgically, but surgically, with diverticulitis. And then we also do the typical anorectal, hemorrhoids, fissures, anything anorectal that would require treatment. The one thing that we do a lot is pelvic floor treatment, patients that have fecal incontinence or urinary incontinence, or the very underdiagnosed situation that we have lot of very good treatments for that, both non-surgical and also surgical that's very, very nice. I mean, that's been life-changer for a lot of patients.
Bill Klaproth: Yeah, you cover a wide range of specialties. You were mentioning everything from pelvic floor issues to diverticulitis. So certainly, UPMC is the place to come. So let's talk about more of that when it comes to diagnosis and treatment of colon cancer.
Dr. Thomas Nicholson: Yeah. We do find on colonoscopy somebody that comes in without any symptoms, there's usually about a 20% chance that we will find a polyp. which is a precursor to colon cancer. Colon cancer and rectal cancer go through a series of about five steps from a polyp and that changes into a cancer. So if we do find on colonoscopy a polyp that's relatively small, we're able to remove them at that time and then put those patients on a closer surveillance, maybe every two to three years or five years, depending on how big the polyp is and how many. And then if we do get further along with larger polyps, we have gastroenterologists that are able to do some advanced polypectomy to keep patients from having surgery. And then if patients do need surgery, then again, we do a fair amount of minimally invasive laparoscopic or robotic surgery to treat that.
Bill Klaproth: Right. So the gold standard, of course, is the colonoscopy. We know that. I have friends that say, "I don't want to get it. I've heard the prep is bad. I don't want to go through the prep. I don't want to drink the stuff." And I'm like, "What are you doing?" I mean, the colonoscopy is the gold standard. You should not be allowed to get colon cancer because the screening is so good. Can you talk about how the prep is not a big deal and everybody should just get over that and go get the darn test?
Dr. Thomas Nicholson: Yeah, that's a good point. I mean, I think the prep, there are different versions. I mean, the ones years ago where they'd have to drink two of the big gallons of what would taste like salt water. But now most of the time, most of us that are doing colonoscopies is mixing the Gatorade with MiraLax, which is a very sort of patient-friendly prep because of the taste. There are some smaller, less volume preps that are out there that require prescription. So if you're able or willing to spend a little bit extra money on the smaller preps, that they're there. But I agree with you, that the fussiness about taking the prep is a little too much compared to what we're finding, because the key thing is if there is something there is to pick it up before it becomes symptomatic or become a cancer, like you said, yes.
Bill Klaproth: Absolutely. And what are the symptoms we should be looking out for?
Dr. Thomas Nicholson: The thing that's very tough is patients that have any type of bleeding. I mean, we get patients that come in that assume it's coming from hemorrhoids or just get a little irritation. Any anybody that has any bleeding, even though it most likely is most of the time going to be related to that, is an indication to be sure that it isn't something else. The concern is that you see bright red blood and it's like, "Ah, it's just some irritation of the hemorrhoids. I'll be fine." But any symptom should at least warrant the thought of getting and hopefully to go with a colonoscopy, but bleeding is one of them. Any change in bowel function where you're normally going two or three, now after you go in per week, that if that changes to less or more, either diarrhea or actually constipation that goes with it. Another common is patients notice darker stools or something that changes with the color with it. And then obviously, anything that would deal with belly pain or that aspect.
Bill Klaproth: Right. And the screening is crucial because you can successfully treat up to, I believe, 90% of patients. Is that right? So if you catch it early, this is very treatable.
Dr. Thomas Nicholson: Oh, yeah. Yeah. I mean, if you catch this at early stages, one, hopefully you get it while it's a polyp before it becomes a cancer. So when you take out the polyp, then you've halted the progression of the cancer, so you've prevented that. Just as a side note, we've seen over the last probably 10 years, every year at least a 1% decrease in the incidence of cancer. And that's because of the amount of screening that we've done. So the incidence of colon cancer has significantly gone down. And if you look at anything of any procedure out there that's designed for screening, colonoscopy is the only one that's been shown to decrease the incidence of that disease. That's because we're taking out polyps and preventing things. So of anything that we do, PSA, mammograms, chest x-rays, whenever you want to talk about screening, colonoscopy is the only one that's been shown to significantly decrease the incidence of the disease.
Bill Klaproth: Yeah. It's a good one. And we all should take heed and get that now. Especially when we hit 45, it's good to get in there and get that done. Dr. Nicholson, thank you so much for your time. This has really been informative. Thank you again.
Dr. Thomas Nicholson: You bet.
Bill Klaproth: And once again, that's Dr. Thomas Nicholson. And for more information, please visit upmc.com/centralpacoloncare. That's upmc.com/centralpacoloncare. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth: So I'm just going to say it. You're not allowed to get colon cancer. Why. Well, we have the gold standard of screening. It's called the colonoscopy and you can catch colon cancer before it starts. That's why everyone should pay attention and get their colonoscopy. And while March is colon cancer awareness month, anytime is a good time to talk about colon health.
So let's talk about the importance of colon cancer screening. And we're going to talk about the new guidelines, which is saying we should all start getting our colonoscopies at age 45. So we're going to talk about this with Dr. Thomas Nicholson, a colon and rectal surgeon at U P M C.
This is Healthier You, a podcast from UPMC in Central Pennsylvania. I'm Bill Klaproth. Dr. Nicholson, thank you so much for your time. It is great to talk with you on such an important topic. So before we get to the new guidelines of colon cancer screening, dropping them from 50 to 45, let's talk about the special care that you provide at UPMC. So first off, why should people choose UPMC for their colon and rectal care?
Dr. Thomas Nicholson: I think one of the advantages is that it's a specialty group. Our practice is set up not necessarily for general care, but for specialty care. So from our standpoint, from the surgery department, I do only colon and rectal surgery, so I don't do any other types of general surgery at all from that standpoint. And then we also, within the department have gastroenterology too, again, specifically dealing with colon and rectal issues.
Bill Klaproth: So it sounds like you've got a multidisciplinary team on board.
Dr. Thomas Nicholson: Right. I mean, that's how we've designed our practices, is instead of just having five or six general surgeons in our group covering all different specialties, we have specialties covering all areas of general surgery.
Bill Klaproth: So it's fair to say then you combine all of your specialists' knowledge and expertise together to come up with a personalized cancer treatment plan for each individuals. Is that right?
Dr. Thomas Nicholson: Yes. We do the screening portion here with colonoscopy and treatment. And then we also have the affiliation with the Hillman Cancer Center. So if we do find something that needs further care, we work very closely with them to be able to not only provide great care, but in a timely and efficient manner.
Bill Klaproth: Right. And as you said, you're a specialist in colon and rectal care. So UPMC is the place to go. So let's talk about these new guidelines. So before it was always, "Hey, when you hit 50, it's time to get that colonoscopy, right?" Well, it sounds like the guidelines have changed and now they've lowered it from 50 to 45. Can you explain that to us?
Dr. Thomas Nicholson: Well, I think the initial age at 50, the way we chose that is the peak incidence for colon cancer for men and women were 62 and 63. And on average, it takes about probably about 10 to 12 years to form a cancer on average. So if you frameshift everything from 62 to 63, subtract 12, and that's how we ended up at 50 to start. That's how that became the standard of care. But I would say, over the last five years or so, we've seen an increase in incidence of colon cancer, not only in 40-year-olds, but actually even down into 30-year-olds. Currently, we have unfortunately been treating cancer in very young patients. As we screen more, I think we found that, even in 20 and 30 year olds were picking up early polyps. So I think the fear of missing somebody that's a younger person is the motivation to get that down to 45, which I think is appropriate for what we've been seeing, the 45. And actually, there's a little bit of a tendency maybe that we should be starting at age 40, but it was tough enough to get it down to 45.
Bill Klaproth: Well, with the incidence of this happening in younger people as well, that just seems to make sense. So people of average risk of colon cancer then really should begin their screenings at age 45. And if somebody is in a high risk category, that changes everything, right? If somebody is in their thirties, but has a high risk factor, then they should be getting that earlier. Is that correct?
Dr. Thomas Nicholson: Yeah. The rule that we go by is 10 years before the diagnosis of a cancer. So if a first-degree relative, a mom, dad, brother, or sister was diagnosed and had an unfortunate cancer, let's say, at 45 years of age, then we would recommend screening at 35 years of age. So frameshift everything 10 years from the age of diagnosis. So if you fall into that category, that's the rule of thumb that we go by.
Bill Klaproth: And Dr. Nicholson, we know that you're a specialist when it comes to providing comprehensive colorectal and anal care. Can you tell us what other specialties you provide as well?
Dr. Thomas Nicholson: I like to say that we specialize obviously with screening colonoscopies to be able to do that. Colon surgery, we do a lot of minimally invasive both for colon and rectal surgery with the robot. We specialize in minimal invasive treatment for this. We do see a lot of diverticulitis in Central Pennsylvania, so not only non-surgically, but surgically, with diverticulitis. And then we also do the typical anorectal, hemorrhoids, fissures, anything anorectal that would require treatment. The one thing that we do a lot is pelvic floor treatment, patients that have fecal incontinence or urinary incontinence, or the very underdiagnosed situation that we have lot of very good treatments for that, both non-surgical and also surgical that's very, very nice. I mean, that's been life-changer for a lot of patients.
Bill Klaproth: Yeah, you cover a wide range of specialties. You were mentioning everything from pelvic floor issues to diverticulitis. So certainly, UPMC is the place to come. So let's talk about more of that when it comes to diagnosis and treatment of colon cancer.
Dr. Thomas Nicholson: Yeah. We do find on colonoscopy somebody that comes in without any symptoms, there's usually about a 20% chance that we will find a polyp. which is a precursor to colon cancer. Colon cancer and rectal cancer go through a series of about five steps from a polyp and that changes into a cancer. So if we do find on colonoscopy a polyp that's relatively small, we're able to remove them at that time and then put those patients on a closer surveillance, maybe every two to three years or five years, depending on how big the polyp is and how many. And then if we do get further along with larger polyps, we have gastroenterologists that are able to do some advanced polypectomy to keep patients from having surgery. And then if patients do need surgery, then again, we do a fair amount of minimally invasive laparoscopic or robotic surgery to treat that.
Bill Klaproth: Right. So the gold standard, of course, is the colonoscopy. We know that. I have friends that say, "I don't want to get it. I've heard the prep is bad. I don't want to go through the prep. I don't want to drink the stuff." And I'm like, "What are you doing?" I mean, the colonoscopy is the gold standard. You should not be allowed to get colon cancer because the screening is so good. Can you talk about how the prep is not a big deal and everybody should just get over that and go get the darn test?
Dr. Thomas Nicholson: Yeah, that's a good point. I mean, I think the prep, there are different versions. I mean, the ones years ago where they'd have to drink two of the big gallons of what would taste like salt water. But now most of the time, most of us that are doing colonoscopies is mixing the Gatorade with MiraLax, which is a very sort of patient-friendly prep because of the taste. There are some smaller, less volume preps that are out there that require prescription. So if you're able or willing to spend a little bit extra money on the smaller preps, that they're there. But I agree with you, that the fussiness about taking the prep is a little too much compared to what we're finding, because the key thing is if there is something there is to pick it up before it becomes symptomatic or become a cancer, like you said, yes.
Bill Klaproth: Absolutely. And what are the symptoms we should be looking out for?
Dr. Thomas Nicholson: The thing that's very tough is patients that have any type of bleeding. I mean, we get patients that come in that assume it's coming from hemorrhoids or just get a little irritation. Any anybody that has any bleeding, even though it most likely is most of the time going to be related to that, is an indication to be sure that it isn't something else. The concern is that you see bright red blood and it's like, "Ah, it's just some irritation of the hemorrhoids. I'll be fine." But any symptom should at least warrant the thought of getting and hopefully to go with a colonoscopy, but bleeding is one of them. Any change in bowel function where you're normally going two or three, now after you go in per week, that if that changes to less or more, either diarrhea or actually constipation that goes with it. Another common is patients notice darker stools or something that changes with the color with it. And then obviously, anything that would deal with belly pain or that aspect.
Bill Klaproth: Right. And the screening is crucial because you can successfully treat up to, I believe, 90% of patients. Is that right? So if you catch it early, this is very treatable.
Dr. Thomas Nicholson: Oh, yeah. Yeah. I mean, if you catch this at early stages, one, hopefully you get it while it's a polyp before it becomes a cancer. So when you take out the polyp, then you've halted the progression of the cancer, so you've prevented that. Just as a side note, we've seen over the last probably 10 years, every year at least a 1% decrease in the incidence of cancer. And that's because of the amount of screening that we've done. So the incidence of colon cancer has significantly gone down. And if you look at anything of any procedure out there that's designed for screening, colonoscopy is the only one that's been shown to decrease the incidence of that disease. That's because we're taking out polyps and preventing things. So of anything that we do, PSA, mammograms, chest x-rays, whenever you want to talk about screening, colonoscopy is the only one that's been shown to significantly decrease the incidence of the disease.
Bill Klaproth: Yeah. It's a good one. And we all should take heed and get that now. Especially when we hit 45, it's good to get in there and get that done. Dr. Nicholson, thank you so much for your time. This has really been informative. Thank you again.
Dr. Thomas Nicholson: You bet.
Bill Klaproth: And once again, that's Dr. Thomas Nicholson. And for more information, please visit upmc.com/centralpacoloncare. That's upmc.com/centralpacoloncare. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.