Transcription:
What Are Your Options for Preventing Colorectal Cancer?

Melanie Cole (Host): Colorectal cancer is preventable. You can learn more here about the symptoms and the best screenings and options to protect yourself. My guest is Dr. Charles Friel. He's the Chief of Colon and Rectal Surgery at UVA Health System. Welcome to the show, Dr. Friel. Let's first talk about commons signs and symptoms of colorectal cancer. Then we're going to move on to the screening process.

Dr. Charles Friel (Guest): The first thing to really understand is that a lot of times, there are really no signs and symptoms of colorectal cancer. I think the most important kind of risk factor is age. As we get older, this is something we need to think about. Fifty is the key age to remember. Having said that, certainly, if you have any kind of changes in your bowel habits, if you see blood in your stool, if you see a change in constipation, perhaps your stool becomes a little bit smaller or thinner, or you have crampy abdominal pain or chronic anemia, all those things can be symptoms of colon cancer. If you have any of those things, then you should be evaluated by your doctor, and your doctor may suggest a test such as a colonoscopy. But not all people have symptoms, so just keep that in mind.

Melanie: Dr. Friel, you mentioned blood in your stool. Hemorrhoids cause blood. People freak out. They see blood. They run to a guy like you and say, "Oh my god." Is there a difference that you can tell when you see blood like that?

Dr. Friel: There can be. There are classic findings of hemorrhoids where there's a little blood on your toilet paper. But I think a common mistake is that people just dismiss blood in the stool as being hemorrhoids. While it's most common, especially if you're young, that you have a little blood from hemorrhoids, it really should be evaluated. Unfortunately, I've even seen very young people with colon cancer. Just don't dismiss your bleeding as your hemorrhoids, and get it evaluated, because it could be a sign of colon cancer.

Melanie: You mentioned 50. When should people start getting screened? I get my colonoscopies every three years. Because things run in my family, I started younger. But what time should people typically start getting their colonoscopies?

Dr. Friel: Now, you raise a very important point. The first risk factor, as I talked about, is age. We screen people who are considered to be moderate risk for colon cancer. All of us, by definition, become moderate risk at age 50. I think for the general population, you should remember age 50. You should be getting your first screening test. Most of the time, that involves colonoscopy, but there are other options, and you can talk to your doctor about those other options. However, some people are at higher risk. Family history can be significant. If you have a family member who has colon cancer, your doctor may recommend that you begin screening earlier. That could be typically at age 40. Other risk factors are some genetic disorders that are associated with colon cancer. If you have any genetic disorders, you might be getting a screening earlier. Certain diseases like ulcerative colitis can put you at risk factor for colon cancer. There are other higher risk factor groups, and you just discuss these with your doctor and they would make recommendations. But 50 is the key age to remember.

Melanie: Let's give a quick running definition of the colonoscopy. It's not nearly as bad as people think. The prep is really only the bad part. You're not even awake for most of it. They say bye-bye and you're out, and when you wake back up, it's already done. Tell people how easy this great preventive screening test is, Dr. Friel.

Dr. Friel: Absolutely right. It's a pretty straightforward test. I have had one myself. As you pointed out, I think even the prep, people can tolerate pretty well. But I think that's the most difficult part for people. It is critically important though that you work hard at your prep because we need a nice, clean colon to get a good look at your colon. If you don't do a good prep, then you will have a poor test. If you have a poor test, it really is not as effective for you. So work hard on your prep. But once you get to the procedure room, we do give you some medications which make you nice and sleepy. Most people don't remember anything. The next thing they do is they wake up and the first thing they ask me is, "Have you started yet?" and by then, the test is over.

Melanie: It's so easy. It really is. Now, what if you tell them that you've found polyps? Is that something to be scared of?

Dr. Friel: Actually, we don't want to have polyps if we can avoid it. But if there is a polyp in your colon, you want it removed. One of the real advantages of colonoscopy is not only are we looking for an early cancer. Hopefully, if you have polyps, we'll find your polyps and we can remove your polyps. Polyps are not cancers, but we do consider them to be pre-cancerous. If you remove the polyp, we can in fact potentially prevent a cancer from forming in you over time. While none of us want to have polyps, you shouldn't be afraid of them. If they're in you, we want to remove them, and we can do that easily with a colonoscopy.

Melanie: Then you test the polyps, make sure that these are benign, nothing that we should be scared of. What if, God forbid, they're malignant?

Dr. Friel: As you just pointed out, polyps, by definition, are considered to be benign. They're considered to be pre-cancerous. A malignant polyp just has a little bit of cancer in it. By definition, then you actually technically have colon cancer. Most of the time, that may involve an operation, but sometimes not. But most of the time, that's going to involve an operation, and that is something that I do on a regular basis. We can cure many, many people with colon cancer. It's not something to be afraid of. It's a treatable disease. You just need to consult your doctors, and they can help you with that.

Melanie: Treatments. You can have surgery to remove any of the cancers that you see. What else? Is there chemotherapy involved? Radiation? People are scared of this cancer, Dr. Friel, and you're giving us a lot of hope and positive messages. Continue that. Speak about the treatments.

Dr. Friel: I think it's really important to understand that getting a cancer diagnosis is extremely difficult, and it can be quite scary. But colon cancer is a very treatable disease. It almost always involves an operation where we remove the colon cancer itself. Most of the time, we can put your colon back together so you don't have to have any bag—the other thing that people are really quite frightened about. Is that the case all the time? Unfortunately, it's not. But for most patients, we can take the piece of the colon out and do this without any significant long-term problems. As far as other treatments are concerned, it really depends on the stage of your colon cancer. If you have a little bit more advanced disease, which is still curable, we will frequently use chemotherapy. As for radiation therapy, it usually revolves around people who have what we call rectal cancer, which is just a slightly different version of colon cancer. But oftentimes, we will use radiation for rectal cancer.

Melanie: Are there drugs that, like with breast cancer, maybe you go on tamoxifen for five years or something? And then what's the follow up?

Dr. Friel: Yes. We don't typically leave you on long-term medications for colon cancer, but it is important that you have continued follow-up. Some cancers can come back, but we actually have pretty good treatment for that too. The most common place that a colon cancer will come back is in your liver. Here at University of Virginia, we've got several specialists who are liver surgeons who can remove these cancers from your liver, and you can still have a very good long-term result. It is important that we do frequent surveillance of your entire body, which will probably include a CT scan. The other thing that's important is, as just you pointed out, you get your colonoscopies every three years. If you've had a previous colon cancer, you are at risk to develop another colon cancer in the future or another polyp. We probably would put you on a schedule. We would be doing more frequent colonoscopies for the rest your life.

Melanie: When patients are choosing UVA for their colorectal cancer screenings and treatment, what can they expect?

Dr. Friel: I think what you can expect is a comprehensive team of doctors that's thinking about you personally. We try to look at your case individually. We have a multidisciplinary tumor board that will include doctors that are gastroenterologists; it will include surgeons like myself, who operate almost exclusively on the colon; and we have liver specialists; an oncologist who will be looking at your case and thinking about you and thinking about all the options that are available to you. We try to treat you in a comprehensive manner with all doctors that are really thinking about this disease, that are specialists in their area.

Melanie: In the last 20 seconds, Dr. Friel, best advice on colorectal cancer screening and prevention.

Dr. Friel: Probably the most important thing is that you do get your screening. Remember, age 50 is the year. When you get your 50th birthday, that's your birthday present: a colonoscopy.

Melanie: I love that advice. That's great advice. Give yourself a 50th birthday present that's going to give you many more birthdays. Get your colonoscopy. It's easy. It's not as difficult as you might think. It could save your life. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.