Transcription:
Colorectal Cancer in Women

Melanie Cole (Host): Thanks so much for tuning into Back to Health, the podcast that brings you up to the minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weil Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you. I'm Melanie Cole, and on this Women's Health Wednesday, we're discussing women's colorectal health and cancer treatment.

That's what's on the docket for this podcast. And joining me is Dr. Heather Yeo, she's an Associate Professor of Surgery and Population Health Sciences at Weill Cornell Medical College, Cornell University, and an Associate Attending Surgeon at New York Presbyterian Hospital, Weill Cornell Medical Center. Dr. Yeo, thank you so much for joining us today. So let's talk about colon cancer in women. We've heard about it a lot in men. Is it more prevalent in women? Are we more at risk for it? Tell us a little bit about if that's true and if so, why?

Heather Yeo, M.D., M.H.S., M.B.A., MS (Guest): Hi, Melanie. Thank you so much for having me today. Really happy to be here to talk about colon cancer. Colon cancer is the second most common cause of cancer related deaths in the United States. And so it's a really important topic. Actually colon cancer itself is about equally prevalent in men and women. It's about 4.3% of men will get colon cancer and about 4% of women get colon cancer. So it's pretty close from a gender standpoint. But one of the things that's really important, is that we know that the outcomes tend to be slightly worse in women. And so it's really important that individuals pay attention to the potential signs and screening so that they can get diagnosed and treated in an appropriate time.

Host: Are there certain risk factors that put us more at risk? Things we do, lifestyle, heredity. What puts us more at risk?

Dr. Yeo: Yeah. So, we know that there are a number of, and in fact, much of colon cancer is attributable to lifestyle and dietary factors. We know that the amount of red meat for example, that you consume, higher amounts of red meat puts you at higher risk for colon cancer. The amount of dietary fiber that we get affects whether or not we are at risk for colon cancer. In fact, there's an inverse relationship. So, people who eat higher fiber diets have a lower risk of colon cancer. And then like many other cancers, there's an affiliation with smoking, as well as high alcohol consumption can put individuals at risk.

Host: So as we're going to talk about obviously colonoscopies and that sort of thing, before we get to that, what would send us to the doctor, Dr. Yeo? Are there signs and symptoms of colon cancer? Because I mean, I've had babies and hemorrhoids kind of come with the game there. Right? And we see that bleeding in the toilet and go, oh my God. What are some of the symptoms that we really need to pay attention to? And is that the kind of thing that we rush off to our doctor because of?

Dr. Yeo: It is complicated and that's probably one of the reasons that colonoscopy is so important is that a lot of the signs and symptoms in colorectal cancer are late or are ignored because individuals think that, you know, the bleeding is just from hemorrhoids. So yes, one of the most important things to be aware of is that new or changes in your bowel habits, new constipation, new diarrhea, new pain or even bleeding hemorrhoids that don't go away after you try and improve your diet. All of those things are signs, but they're kind of the later signs, which is why screening is so important in colon cancer.

Host: Well, let's talk about that then. At what age are we supposed to be screened? Now as myself, 57 years old, I've had many of them because Crohn's and things run in my family. And I can tell the listeners how easy these are, but tell us a little bit about the importance of colonoscopy for colon cancer screening and when we're supposed to have our first one.

Dr. Yeo: So up until about five years ago, the general guidelines were that at the age of 50 years old, you should start your screening for colon cancer. But we did notice over the past decade that in the one group that colon cancer was increasing was the group we weren't screening in the 40 to 50 year old group.

And so both the American Cancer Society, which published their guidelines, I think about three or four years ago now, and the US Preventative Task Force, which actually just recently published their guidelines have now lowered the screening rate to 35 and up. The reason for that is we know that colon cancer, traditionally, we would first see in individuals between, you know, their late fifties to sixties.

It takes about 10 years to go from a polyp to cancer. But as we've seen the increase in the younger age group of colon cancer, they just recently revised those guidelines. So, individuals 45 and up, both men and women should be getting screened for colon cancer.

Host: Wow. That's so interesting that it's been lowered and so important because this is one test that we have that can actually prevent cancer. I'd like you to tell people about the test itself, because it seems like it's got a bad rap because of the prep. But personally, I don't mind it. It makes me feel clean. You lose a pound or two I mean, and then you get a good nap. Right? It's a good nap afterwards. So tell people about the prep, what's going on and why this is such an easy test to do.

Dr. Yeo: Yeah. I mean, the patients do say that actually their biggest complaint is the prep. So it's not that the prep is without any issues, but I think that it's well worth what you have to go through for the prep. As you said, there are multiple different types of preps. Most of what they do is they help clean out your GI tract.

And that does mean for better or worse that you gotta, you know, you do clean out your GI tract. So you spend a little time the night before on the toilet, cleaning until things are clear enough that we can suction them out with a colonoscope and actually take a good look at the intestinal, of the wall of the different parts of the colon.

But overall though, I mean the risk of a complication is low and a colonoscopy is not only a screening test, as you alluded to earlier, it's a screening and treatment test. If you are in there and you see polyps, we can take them out. It's, it's one of the screening tests that we know that actually is shown to improve survival and decrease rates of cancer. Because while they're in there, almost always the polyps that are in there, can be removed. So you both, you know, screened and treated the pre-cancers.

Host: Well, you're right. Everybody doesn't love the prep, but it's not a big deal and what an important test this is. So you mentioned if there's polyps, tell the listeners, Dr. Yeo, what are polyps? What does that mean? Are they precursors for cancer? Do we worry about them? What's going on with polyps?

Dr. Yeo: There are different types of polyps. By definition, a polyp is just kind of a growth of extra tissue in the colon. Sometimes it can be there because of inflammation or infection or Crohn's, or inflammatory bowel disease, but oftentimes, and most often, these polyps are growths that are precursors to cancer.

And as I mentioned earlier, it takes from a polyp to a cancer between five and 10 years to form. So, if you start your colonoscopy early, you can actually prevent a cancer, five to 10 years before it might've affected your life.

Host: And now after these polyps are found, maybe they're cancerous. Maybe they're not, just benign. That's what we hope. But if God forbid, we find out we have colon cancer, what are some of the latest, most exciting treatments that you can tell us about? And the latest advances in treatment options.

Dr. Yeo: Yeah, I think this is really important and if there are people that are going to get diagnosed with colon cancer and get their screenings late for whatever reason. If that happens, one of the things I tell patients is the reason that I do colon cancer as a specialty is if diagnosed early and even in some late cases, treatment with both chemotherapy and or surgery, depending on what is needed, even for the most advanced stages, there are examples of cure.

Over the past decade, we've improved our chemotherapy regimens. There are certain immune therapies that can be used for certain types of colon cancer. And even our techniques are much different from a surgical standpoint than they used to be. A colon resection, 10, 15, probably more like 15 years ago used to mean a large incision, a long recovery. We're now often able to do more minimally invasive surgeries, whether or not that'd be laparoscopic or robotic. And patients are recovering much faster. And the outcomes have improved over the past 15 years.

Host: It certainly is an interesting and exciting time to be in this field. And Dr. Yeo, one of the most important things that we've really learned is this multidisciplinary approach for patients with colon cancer. Tell us a little bit about why this type of approach is so important for these patients with many different specialists involved.

Dr. Yeo: Yeah. I mean, you said it exactly right. It is important for patients for a number of reasons. number one, we know that patients that are treated in a multidisciplinary center with specialists in all the different areas, radiation oncology, oncology, medical oncology, surgical oncology, and genetics; when all of the teams work together, we know based on looking nationally that patients do better when they're treated at a multidisciplinary center.

And I mean, if you think about it, it makes sense. You get a lot of smart people in the room who are a specialist talking about each of the patients and the different aspects of their care. And you know, that they're going to get discussed and they're going to get the top care. It's really important.

Rectal cancer in particular, which I'll mention is an area where we have a lot of innovation, lately and there's a lot more used, as I mentioned before, we used to do large surgeries. We're now using techniques with radiation and chemotherapy to shrink down the cancers. And in some cases they may shrink enough that surgery is not needed.

That is kind of still an exploratory area. And really depends on the very particular type of cancere. But by working with a multi-disciplinary team, you can understand all your choices, all your options and whether or not you are a potential candidate for a trial of one of the newer techniques or therapies.

Host: What a good point you just made and that can really open up that armamentarium of therapies available for colon cancer. Before we wrap up, can we prevent polyps? Can we prevent colon cancer? I'd like you to speak to us about lifestyle and behaviors. And as you are an expert in Population Health Sciences, tell us what you know, and what you'd like us to know about women, especially, we're the caregivers to the world. We have to take care of ourselves. Be our own best health advocate. Before we can take care of the ones we love. What do you want us to do for ourselves?

Dr. Yeo: Yeah, I think that's really important. We touched on it a little bit earlier. A lot of colon cancer can be attributable to lifestyle and environmental changes. So it's important that we try and modify the ones that we can. So the things that we know is that high meat diets puts you at higher risk for colon cancer and particularly red and processed meats.

And that goes up incrementally for every portion you have in a week. We know that higher fiber diets are better for individuals. And in fact, the more grain fibers that you eat, the lower your risk of colon cancer. We know that sugar and processed sugars in particular, puts you at higher risk for colon cancer.

We know that obesity puts individuals at a higher risk of colon cancer. And again, exponentially, probably having to do something with insulin processing because we know insulin affects cancer growth. And like multiple other cancers, high amounts of alcohol and caffeine increase the risk of colon cancer. So what, I just generally try and tell my patients you know, I'm all for moderation. I'm never taking away anyone's last cup of coffee or last glass of wine. But I do think minimizing our risks by minimizing sugar intake, red meat intake, alcohol intake can potentially help us prevent colon cancer and make sure to get screened with that colonoscopy.

Host: Well, 100% agree, and thank you so much, Dr. Yeo, for sharing your incredible expertise with us today. Colonoscopy is such an important screening tool and thank you so much for describing it for us and Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. We're so glad you could join us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast-growing audience of women, looking for knowledge, insight, and real answers to hard questions about their bodies and their health. Please download, subscribe, rate, and review Back to Health on Apple podcast, Spotify and Google podcast.

And for more health tips, go to Weillcornell.org and search podcasts. And parents definitely, don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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