Selected Podcast
Colon Cancer Awareness – Options Following Your Screening
In this episode, we will focus on what findings of a colonoscopy mean, a patient’s next steps based on findings, the surgical component of colon cancer, why the role of a colorectal surgeon is so important, certifications and accreditations that validate our work, and our collaboration with oncologists, pathologists etc.
Featuring:
Dan Goldman, MD
Daniel Goldman, MD, received his medical degree from Ross University School of Medicine and completed his general surgery residency at UPMC in Central Pa., followed by his fellowship in colon and rectal surgery at Thomas Jefferson University Hospital. Dr. Goldman’s clinical interests include the robotic minimally invasive management of colorectal cancers, diverticulitis, and other disorders of the colon and rectum. He is a member of the American Societyof Colon and Rectal Surgeons, the American College of Surgeons, and the Pennsylvania Medical Society. Transcription:
Bill Klaproth (Host): So, you went in, you had a colonoscopy and now you're waking up from that deep slumber and there, the doctor is ready to give you the results. So, what are the potential results after a colonoscopy? That's what we're going to focus on on this podcast, what happens after the screening. So, let's find out what Dr. Daniel Goldman, a colorectal surgeon at UPMC.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Goldman, thank you so much for your time. We appreciate it. So, that's what we want to focus on, what happens after the screening. But before that, I just want to catch everyone up on the latest guidelines when it comes to colon cancer screening. Can you share those with us?
Dan Goldman: Thanks for having me. So, the current guidelines are for people who have no family history of colon cancer. They're not having any GI problems and they've never had a colonoscopy before, and that would be at 45 years old.
Bill Klaproth (Host): Okay. So, it is younger now. We want people to start at 45 years of age for their first colonoscopy. So, thank you for sharing that, Dr. Goldman. And as I said, we want to focus on what happens now after the colonoscopy. So, I've had one done, I'm talking from firsthand experience. You wake up, you feel great. It's like the best sleep you've ever had in your life and the doc is standing there and then you get the, "Hey, all clear" or "We found something" or... So, tell us what happens when you greet a patient after colonoscopy. What are the potential outcomes that you share?
Dan Goldman: Absolutely. So, every patient will be a little different, for the most part. If there are no polyps, it was a great prep and there are no family history or other concerns, then most people would be 10 years. After that, if someone had a couple polyps that were removed, it would depend on the size of polyps, where the polyps were, the pathology of the polyps. And that would really determine whether or not it was done again in one year, two years, three years, five years, sometimes seven years. It can be a pretty broad range, just like the polyps in terms of number and size that we find. And it's really tailored to the individual based on the colonoscopy.
Bill Klaproth (Host): Okay. And if you find a polyp, you take it out right then and there. Is that correct?
Dan Goldman: That is absolutely the goal. Anytime we go to do a colonoscopy for screening purposes, if we find polyps, we remove them. Now, there are some circumstances where they're either too big or they're in a location that it makes it difficult to remove, so sometimes we have to do some special things outside of the colonoscopy. But vast by far and away majority, we're able to remove the polyps at the time of the colonoscopy.
Bill Klaproth (Host): Okay. So, you come in and you tell the person, "Hey, we found three polyps. So, we removed them," and then you send them out for a biopsy. Is that correct?
Dan Goldman: Yes, sir. Everything we remove gets sent to the pathologist and they basically look at it and tell us what type of polyp it is. There are usual polyps that we expect to see. Sometimes there can be unique polyps that still aren't that bad, but we don't see them that often. But most of the polyps are usually, you know, kind of what we expect and we can kind of tell and have a good idea. But the pathologist is ultimately the one that will give us answer.
Bill Klaproth (Host): Okay. So, either it's all clear, we've found no polyps, no prior history, you're in good shape. Or we found some polyps, we removed them. Say, you get the answers back from the pathologist, they're benign. Then, you'll make a call, "Hey, I'm going to see you back in three or four or two years," or "I'm going to put you on a yearly," right? Then, you'll make that call once you hear back from the pathologist, if it's not cancer.
Dan Goldman: Yeah. Most of the time, if we just take out a couple polyps, they would probably be a five-year colonoscopy timeline. But certainly, it would depend on the size and the specific type.
Bill Klaproth (Host): Okay. So then, what if it comes back and it says, "Yeah, the polyp, it is cancerous. This is cancer," what then?
Dan Goldman: Yeah. So as a colorectal surgeon, this is unfortunately something we see frequently. Thankfully, colon and rectal cancer on a routine basis, we don't find one every day, but we certainly deal with them every week. We like to have the pathology, so we don't usually guess based on the colonoscopy. So, we'll have you see us in our office and we'll discuss the pathology. The advantage to being treated at UPMC colon and rectal surgery is that myself and my two partners, Andrew Richards and Jadd Koury. We're both certified in general surgery and colon and rectal surgery. This is all we sort of deal with and we deal with it routinely.
Bill Klaproth (Host): So Dr. Goldman, if it is cancer then, what are the surgical components of colon cancer? What are the treatment options? What do you do?
Dan Goldman: Yeah. So, that's a great question. And there's a difference kind of between colon cancer and rectal cancer. Either way, we first have to do what we call stage it by getting imaging. And that's just to make sure it hasn't spread anywhere. It's to make sure there isn't anything else inside the belly that we can't see on the colonoscopy. And based on the staging, we can then recommend whether or not we first do surgery or if we would recommend something like chemotherapy or radiation first.
Bill Klaproth (Host): Okay. If it does come down to surgery, what is that? Can you give us an overview of that?
Dan Goldman: So again, myself and my two other partners are minimally invasive colorectal surgeons. So when it comes to surgery, we try and use the smallest incisions that are necessary. I myself am a robotic colorectal surgeon. So, I use the robot on a majority of my cases to assist me. And we remove the portion of colon that has the cancer and a majority of the time we're able to reconnect your bowel, so that you do not necessarily have to have a bag. In certain circumstances, it might be required. But a vast majority of the time, we're able to put the pieces back together.
Bill Klaproth (Host): Which is great news. And you can do this now using robotic surgery and minimally invasive surgery, as you said.
Dan Goldman: Yes, that's one thing that myself and my partners try and do, is to minimize the sort of trauma or damage or minimize the size of the surgery that you have to go through if you do have a cancer.
Bill Klaproth (Host): Absolutely. And that's why you want an expert doing this. So, can you talk about the role of a colorectal surgeon doing this and why that's so important?
Dan Goldman: Absolutely. So as colorectal surgeons, this is really all we do. I would say, between my partners and I, we're doing colon surgery every week. And this is what we're trained to do. We did extra training for these particular procedures and scenarios because it can be extremely nuanced or specific per each individual. And that's what we have training in. And specifically when it comes to rectal cancer, we have a comprehensive rectal cancer program here where it involves all of the surgeons, all of the medical oncologists, all the radiation oncologists, pathologists, radiologists. So if you come to one of us for an opinion for rectal cancer, you're really getting the opinion of the entire UPMC system.
Bill Klaproth (Host): So, that's interesting. So, you are collaborating then with the oncologists, with the pathologists to discuss that specific patient and the treatment for that person.
Dan Goldman: Absolutely. And we tailor it to the individual, for sure.
Bill Klaproth (Host): So, you mentioned earlier certifications. Can you share the certifications and accreditations that validate your work?
Dan Goldman: Absolutely. So, both myself, Adrew Richards, Jadd Koury, we're all board-certified in general surgery. And then, we did an extra specialty training year. It's called fellowship in colon and rectal surgery specifically. And the three of us are also board-certified in colon and rectal surgery, which is a separate board certification as well.
Bill Klaproth (Host): So, really important you want your colorectal surgeon somebody that's accredited. You talked about fellowships, somebody that's constantly working on their education and understanding the latest and newest ways to treat colorectal cancer. Is that right?
Dan Goldman: Absolutely. And held to certain academic and technical standards.
Bill Klaproth (Host): Right. Well, this is really great information. And I did want to touch on this too, what is the difference between the stool tests that you see advertised on TV versus the colonoscopy? Can you give us that information?
Dan Goldman: That's a great question. So, the stool test is really good at finding cancers. The unfortunate thing is it doesn't prevent cancer. With the colonoscopy, I can go in and you're not having any problems and I can find the polyps that could become cancer and remove them before they become cancer. The stool test is really good at finding cancers. But unfortunately ,it doesn't do anything to prevent the cancer. So, that's why I'm kind of a big believer in being proactive with colonoscopy, so that we can prevent as many cancers from happening as possible.
Bill Klaproth (Host): Absolutely. And I know a lot of people don't like the prep. Oh, the prep, the prep. I'm telling you, from my standpoint, I've had a colonoscopy, the prep wasn't bad at all. It wasn't bad. It wasn't a big deal. And you want the gold standard of screening, which is the colonoscopy. That's what you want. Do it right. That's my opinion, but that's the way to do it.
I have a friend of mine who says you're not allowed to get colon cancer because the screening is so darn good. I mean, you would agree with that, right? So when you put it that way, you know what, this is one of the most preventable cancers that we have. And the colonoscopy is the gold standard of screening. Catch it early and not even have to worry about it then. Is that right?
Dan Goldman: I completely agree with you. And I think we do a disservice calling it a screening colonoscopy, and I think we should rename it and call it a prevention colonoscopy. That's what differentiates it from other screening tools. But absolutely, it's a very preventable cancer, it's a very treatable cancer and that's honestly why I chose this field.
Bill Klaproth (Host): I love that. Yeah. Right. Well, that's easy to understand. You're able to catch cancer early. Prevention, they always say, is the best form of medicine. But if you can catch cancer early and stop someone from getting cancer, that's got to be an unbelievable feeling. So Dr. Goldman, thank you so much for your time and sharing that with us. And I know you said you work with two other colorectal surgeons. If you could introduce them to us and share their names, we would appreciate that as well.
Dan Goldman: Absolutely. Andrew Richards and Jadd Koury, along with myself, we're all the colorectal surgeons at the UPMC Central Pennsylvania area. I work very closely with them. We talk all the time and, like I said, our training are all up to the same standards essentially. And they're really great guys to work with as well.
Bill Klaproth (Host): Absolutely. Well, that's good to know. So, thank you so much for taking your time to talk with us about colon cancer screening and what happens afterwards. We appreciate it. Dr. Goldman, thank you so much for your time.
Dan Goldman: All right. Thank you. Appreciate it.
Bill Klaproth (Host): And once again, that's Dr. Daniel Goldman. And for more information, please visit upmc.com/centralpacolon. 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 (Host): So, you went in, you had a colonoscopy and now you're waking up from that deep slumber and there, the doctor is ready to give you the results. So, what are the potential results after a colonoscopy? That's what we're going to focus on on this podcast, what happens after the screening. So, let's find out what Dr. Daniel Goldman, a colorectal surgeon at UPMC.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Goldman, thank you so much for your time. We appreciate it. So, that's what we want to focus on, what happens after the screening. But before that, I just want to catch everyone up on the latest guidelines when it comes to colon cancer screening. Can you share those with us?
Dan Goldman: Thanks for having me. So, the current guidelines are for people who have no family history of colon cancer. They're not having any GI problems and they've never had a colonoscopy before, and that would be at 45 years old.
Bill Klaproth (Host): Okay. So, it is younger now. We want people to start at 45 years of age for their first colonoscopy. So, thank you for sharing that, Dr. Goldman. And as I said, we want to focus on what happens now after the colonoscopy. So, I've had one done, I'm talking from firsthand experience. You wake up, you feel great. It's like the best sleep you've ever had in your life and the doc is standing there and then you get the, "Hey, all clear" or "We found something" or... So, tell us what happens when you greet a patient after colonoscopy. What are the potential outcomes that you share?
Dan Goldman: Absolutely. So, every patient will be a little different, for the most part. If there are no polyps, it was a great prep and there are no family history or other concerns, then most people would be 10 years. After that, if someone had a couple polyps that were removed, it would depend on the size of polyps, where the polyps were, the pathology of the polyps. And that would really determine whether or not it was done again in one year, two years, three years, five years, sometimes seven years. It can be a pretty broad range, just like the polyps in terms of number and size that we find. And it's really tailored to the individual based on the colonoscopy.
Bill Klaproth (Host): Okay. And if you find a polyp, you take it out right then and there. Is that correct?
Dan Goldman: That is absolutely the goal. Anytime we go to do a colonoscopy for screening purposes, if we find polyps, we remove them. Now, there are some circumstances where they're either too big or they're in a location that it makes it difficult to remove, so sometimes we have to do some special things outside of the colonoscopy. But vast by far and away majority, we're able to remove the polyps at the time of the colonoscopy.
Bill Klaproth (Host): Okay. So, you come in and you tell the person, "Hey, we found three polyps. So, we removed them," and then you send them out for a biopsy. Is that correct?
Dan Goldman: Yes, sir. Everything we remove gets sent to the pathologist and they basically look at it and tell us what type of polyp it is. There are usual polyps that we expect to see. Sometimes there can be unique polyps that still aren't that bad, but we don't see them that often. But most of the polyps are usually, you know, kind of what we expect and we can kind of tell and have a good idea. But the pathologist is ultimately the one that will give us answer.
Bill Klaproth (Host): Okay. So, either it's all clear, we've found no polyps, no prior history, you're in good shape. Or we found some polyps, we removed them. Say, you get the answers back from the pathologist, they're benign. Then, you'll make a call, "Hey, I'm going to see you back in three or four or two years," or "I'm going to put you on a yearly," right? Then, you'll make that call once you hear back from the pathologist, if it's not cancer.
Dan Goldman: Yeah. Most of the time, if we just take out a couple polyps, they would probably be a five-year colonoscopy timeline. But certainly, it would depend on the size and the specific type.
Bill Klaproth (Host): Okay. So then, what if it comes back and it says, "Yeah, the polyp, it is cancerous. This is cancer," what then?
Dan Goldman: Yeah. So as a colorectal surgeon, this is unfortunately something we see frequently. Thankfully, colon and rectal cancer on a routine basis, we don't find one every day, but we certainly deal with them every week. We like to have the pathology, so we don't usually guess based on the colonoscopy. So, we'll have you see us in our office and we'll discuss the pathology. The advantage to being treated at UPMC colon and rectal surgery is that myself and my two partners, Andrew Richards and Jadd Koury. We're both certified in general surgery and colon and rectal surgery. This is all we sort of deal with and we deal with it routinely.
Bill Klaproth (Host): So Dr. Goldman, if it is cancer then, what are the surgical components of colon cancer? What are the treatment options? What do you do?
Dan Goldman: Yeah. So, that's a great question. And there's a difference kind of between colon cancer and rectal cancer. Either way, we first have to do what we call stage it by getting imaging. And that's just to make sure it hasn't spread anywhere. It's to make sure there isn't anything else inside the belly that we can't see on the colonoscopy. And based on the staging, we can then recommend whether or not we first do surgery or if we would recommend something like chemotherapy or radiation first.
Bill Klaproth (Host): Okay. If it does come down to surgery, what is that? Can you give us an overview of that?
Dan Goldman: So again, myself and my two other partners are minimally invasive colorectal surgeons. So when it comes to surgery, we try and use the smallest incisions that are necessary. I myself am a robotic colorectal surgeon. So, I use the robot on a majority of my cases to assist me. And we remove the portion of colon that has the cancer and a majority of the time we're able to reconnect your bowel, so that you do not necessarily have to have a bag. In certain circumstances, it might be required. But a vast majority of the time, we're able to put the pieces back together.
Bill Klaproth (Host): Which is great news. And you can do this now using robotic surgery and minimally invasive surgery, as you said.
Dan Goldman: Yes, that's one thing that myself and my partners try and do, is to minimize the sort of trauma or damage or minimize the size of the surgery that you have to go through if you do have a cancer.
Bill Klaproth (Host): Absolutely. And that's why you want an expert doing this. So, can you talk about the role of a colorectal surgeon doing this and why that's so important?
Dan Goldman: Absolutely. So as colorectal surgeons, this is really all we do. I would say, between my partners and I, we're doing colon surgery every week. And this is what we're trained to do. We did extra training for these particular procedures and scenarios because it can be extremely nuanced or specific per each individual. And that's what we have training in. And specifically when it comes to rectal cancer, we have a comprehensive rectal cancer program here where it involves all of the surgeons, all of the medical oncologists, all the radiation oncologists, pathologists, radiologists. So if you come to one of us for an opinion for rectal cancer, you're really getting the opinion of the entire UPMC system.
Bill Klaproth (Host): So, that's interesting. So, you are collaborating then with the oncologists, with the pathologists to discuss that specific patient and the treatment for that person.
Dan Goldman: Absolutely. And we tailor it to the individual, for sure.
Bill Klaproth (Host): So, you mentioned earlier certifications. Can you share the certifications and accreditations that validate your work?
Dan Goldman: Absolutely. So, both myself, Adrew Richards, Jadd Koury, we're all board-certified in general surgery. And then, we did an extra specialty training year. It's called fellowship in colon and rectal surgery specifically. And the three of us are also board-certified in colon and rectal surgery, which is a separate board certification as well.
Bill Klaproth (Host): So, really important you want your colorectal surgeon somebody that's accredited. You talked about fellowships, somebody that's constantly working on their education and understanding the latest and newest ways to treat colorectal cancer. Is that right?
Dan Goldman: Absolutely. And held to certain academic and technical standards.
Bill Klaproth (Host): Right. Well, this is really great information. And I did want to touch on this too, what is the difference between the stool tests that you see advertised on TV versus the colonoscopy? Can you give us that information?
Dan Goldman: That's a great question. So, the stool test is really good at finding cancers. The unfortunate thing is it doesn't prevent cancer. With the colonoscopy, I can go in and you're not having any problems and I can find the polyps that could become cancer and remove them before they become cancer. The stool test is really good at finding cancers. But unfortunately ,it doesn't do anything to prevent the cancer. So, that's why I'm kind of a big believer in being proactive with colonoscopy, so that we can prevent as many cancers from happening as possible.
Bill Klaproth (Host): Absolutely. And I know a lot of people don't like the prep. Oh, the prep, the prep. I'm telling you, from my standpoint, I've had a colonoscopy, the prep wasn't bad at all. It wasn't bad. It wasn't a big deal. And you want the gold standard of screening, which is the colonoscopy. That's what you want. Do it right. That's my opinion, but that's the way to do it.
I have a friend of mine who says you're not allowed to get colon cancer because the screening is so darn good. I mean, you would agree with that, right? So when you put it that way, you know what, this is one of the most preventable cancers that we have. And the colonoscopy is the gold standard of screening. Catch it early and not even have to worry about it then. Is that right?
Dan Goldman: I completely agree with you. And I think we do a disservice calling it a screening colonoscopy, and I think we should rename it and call it a prevention colonoscopy. That's what differentiates it from other screening tools. But absolutely, it's a very preventable cancer, it's a very treatable cancer and that's honestly why I chose this field.
Bill Klaproth (Host): I love that. Yeah. Right. Well, that's easy to understand. You're able to catch cancer early. Prevention, they always say, is the best form of medicine. But if you can catch cancer early and stop someone from getting cancer, that's got to be an unbelievable feeling. So Dr. Goldman, thank you so much for your time and sharing that with us. And I know you said you work with two other colorectal surgeons. If you could introduce them to us and share their names, we would appreciate that as well.
Dan Goldman: Absolutely. Andrew Richards and Jadd Koury, along with myself, we're all the colorectal surgeons at the UPMC Central Pennsylvania area. I work very closely with them. We talk all the time and, like I said, our training are all up to the same standards essentially. And they're really great guys to work with as well.
Bill Klaproth (Host): Absolutely. Well, that's good to know. So, thank you so much for taking your time to talk with us about colon cancer screening and what happens afterwards. We appreciate it. Dr. Goldman, thank you so much for your time.
Dan Goldman: All right. Thank you. Appreciate it.
Bill Klaproth (Host): And once again, that's Dr. Daniel Goldman. And for more information, please visit upmc.com/centralpacolon. 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.