Colorectal (colon) cancer is one of the most commonly diagnosed cancers in the United States.
However, advances in detection and treatment have dramatically improved outcomes, particularly in the earlier stages of the disease.
We’ve all heard the mantra: Cancer screening saves lives. And it does, especially with colorectal cancer.
Regular colonoscopies have been proven to reduce the risk of colorectal cancer death by up to 70 percent.
Genetics, family history, age or environmental/lifestyle factors can each increase your risk of colorectal cancer.
Kurt A Melstrom, M.D is here to discuss colon cancer and how, with a few changes in your diet, a little exercise and regular screenings, you can decrease your chances of getting colon cancer.
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Colon Cancer: What You Need To Know
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Learn more about Kurt A. Melstrom, Jr., M.D
Kurt A Melstrom, MD
Kurt A. Melstrom, Jr., M.D., F.A.C.S., is an assistant clinical professor in the department of surgery, specializing in colorectal surgery. Dr. Melstrom graduated Phi Beta Kappa from Cornell University in Ithaca, NY, prior to receiving his medical doctorate from Weill Cornell Medical College. He completed his general surgery residency at Loyola University Medical Center, where he also pursued a fellowship in trauma and burn research. In 2011, Dr. Melstrom completed his second residency in colon and rectal surgery while training at New York-Presbyterian Hospital/Weill Cornell Medical Center and Memorial Sloan-Kettering Cancer Center.Learn more about Kurt A. Melstrom, Jr., M.D
Transcription:
Colon Cancer: What You Need To Know
Melanie Cole (Host): Colorectal cancer is one of the most commonly diagnosed cancers in the United States. However, advances in detection and treatment have dramatically improved outcomes, particularly in the early stages of the disease. My guest today is Dr. Kurt Melstrom. He’s Assistant Clinical Professor in the Department of Surgery, specializing in colorectal surgery. Welcome to the show, Dr. Melstrom. Tell us a little bit about colon cancer and the diet link. Is there a link between colon cancer and the diet that we consume as Americans?
Dr. Kurt Melstrom (Guest): Sure. No, there definitely is a link. There have been many studies to date and there's no really great evidence or magic bullet that says, “We have to eat this,” or otherwise everybody would be doing it but there definitely is a link between a high fat diet and increased rates of colon cancer and increased red meat intake--a lot of red meat intake. One of the reasons we see this is just the western diet that we’re fed and rates, while significant in eastern countries, aren't nearly the rates that we see here.
Melanie: And what about in terms of things that help with colon cancer? Fiber? People hear about probiotics and fiber and things along those lines. Can they help reduce the risk?
Dr. Melstrom: So, the studies aren't nearly as good for fiber. Fiber certainly will help for other things. Definitely are very helpful in avoiding diverticulitis or diverticulosis. However, not nearly as definitive of a link between that and colon cancer. The one dietary intake that does seem to have or play a role in reducing the amount of colon cancer is high calcium intake.
Melanie: That's interesting. So, let's talk about prevention. We have at our means these days one of the best diagnostic tools in the cancer world, it would seem to me. So, speak about screening for colon cancer and how really easy this is.
Dr. Melstrom: Yes, screening is extremely important. Colon cancer had been rising over the last several decades. However, in the last twenty years, we've seen a decrease in the amount of colon cancer and the reason is the early prevention and the colonoscopy. Right now, the major societies in America recommend a colonoscopy starting at age 50--40 if you had a family member. It's a quick and easy way to get it early lesion before it turns into cancer. A lot of patients do have some hesitancy going into it. They hear a lot of bad stories about the preparation. Now, you do drink a medication that helps clean you out. It gives you diarrhea for approximately 12 hours before the procedure. But, in the long run, a little sacrifice goes a long way.
Melanie: Well, I'm certainly someone who has mine every three to five years because I have a family history. What role does genetics play? Colonoscopies are so easy--not nearly as scary as people think. So, what's that role of genetics and should you be having colonoscopies either earlier or more often because of a family history?
Dr. Melstrom: Sure. So, there are several genetic diseases where you will acquire a colon cancer very much earlier in life. Those being what's called HNPCC or familial adenomatous polyposis. However, most patients will present much, much earlier with that and the family history will be so great that you will know that. Otherwise, there certainly is a link between having a first degree family member--that being a father or mother or a brother or a sister. However, the links aren't quite as strong for that. The only recommendation that we say to have an earlier colonoscopy is if a first degree family member had a colon cancer that was under the age of 50 as well. In terms of the intervals between colonoscopies, right now major studies recommend five to ten years and that seems to be still an okay interval for patients who do have a family history.
Melanie: So, tell us about treatment options. With colonoscopies, you remove polyps which can be pre-cancerous or benign. Tell us a little bit about those polyps so that people don't worry about them so much and that you are taking them out when you do that. And then, what if they are cancerous?
Dr. Melstrom: Sure. So, most colonoscopies, about 70%, I would say, will come back clean. However, if you do have a polyp, it's nothing to worry about. Nothing to lose sleep over. We are able to remove those polyps completely and they are considered pre-cancerous lesions but they still are in the benign state, meaning if left in place over the course of about ten years--which is why we use that ten year interval or so--they could lead to cancer. If a polyp does harbor cancer in it, it depends on how deep and how long it's been there, how invasive it's gotten. There are certainly some early cancers that are in polyps that we can remove completely with just the colonoscopy. However, if it has invaded into the colon wall, then the next step is a surgery.
Melanie: What's involved in that? People hear that right away, Dr. Meltsrom, and they think colostomy bags. They get very scared. Tell us about what goes on in treatment?
Dr. Melstrom: Sure. So now, that's my specialty. That's what I do and I'm seeing patients every day who I take to surgery. Again, it's certainly something that patients are very apprehensive about but much easier once you get through the whole process. The only chance of you needing a colostomy or a bag that will come out the side of your abdomen is if the cancer is so large that it's completely unresectable or if it's so low, close to your anal canal that we have to take that out. The majority of patients will not need that. For someone diagnosed with a colon cancer, chances of them needing a colostomy is in the single digits. Most of the time, we are able to take the cancer out completely and attach the colon back together. We use staples to put everything back together.
Melanie: Well, that's certainly encouraging, Dr. Melstrom. It really is. What's on the horizon for treatment of colon cancer? It's a scary diagnosis but you're this amazing surgeon and really giving hope to people that this isn't necessarily life-threatening all the time.
Dr. Melstrom: If we can catch a colon cancer in its earlier stages, the chance of survival is very, very high--80% to 90%. One of the things that is on the horizon and has already come into play, is better chemotherapy options. In the 1990’s and early 2000’s, two new chemotherapy drugs came out that really helped eradicate any extra cancer cells that are around. From the surgery standpoint, major breakthroughs have been accomplished in the techniques of how we do surgery. I've been trained in doing minimally invasive cancer surgeries now where we’re not making a large open incision down the middle of the abdomen. Instead, we are using a small camera blowing the belly up with air, doing all the work on the inside and that leaves the patient with a small incision.
Melanie: That's great news to hear. In the last few minutes, please give listeners your best advice and hope about colon cancer and why they should come to City of Hope for their care.
Dr. Melstrom: Sure. If you are ever diagnosed with colon cancer, understand that while a serious disease, the majority of them are still curable. If it becomes to an incurable stage, we still have a large amount of options to keep the cancer at bay or keep it dormant. Even if it stays in the body, you can live a significant amount of time with it in place. City of Hope is a special place in that we are a cancer-only hospital. We are a small hospital but our entire focus is just cancer. We have excellent surgeons, colorectal surgeons, like myself, as well as liver surgeons where if the colon cancer spreads--it usually goes to the liver--and a wide array of medical oncologists that are all giving new and different chemotherapy options. The City of Hope has been known for discovering and inventing new, novel chemotherapy drugs.
Melanie: Thank you so much for such great information, Dr. Melstrom. You're listening to City of Hope Radio and for more information you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Colon Cancer: What You Need To Know
Melanie Cole (Host): Colorectal cancer is one of the most commonly diagnosed cancers in the United States. However, advances in detection and treatment have dramatically improved outcomes, particularly in the early stages of the disease. My guest today is Dr. Kurt Melstrom. He’s Assistant Clinical Professor in the Department of Surgery, specializing in colorectal surgery. Welcome to the show, Dr. Melstrom. Tell us a little bit about colon cancer and the diet link. Is there a link between colon cancer and the diet that we consume as Americans?
Dr. Kurt Melstrom (Guest): Sure. No, there definitely is a link. There have been many studies to date and there's no really great evidence or magic bullet that says, “We have to eat this,” or otherwise everybody would be doing it but there definitely is a link between a high fat diet and increased rates of colon cancer and increased red meat intake--a lot of red meat intake. One of the reasons we see this is just the western diet that we’re fed and rates, while significant in eastern countries, aren't nearly the rates that we see here.
Melanie: And what about in terms of things that help with colon cancer? Fiber? People hear about probiotics and fiber and things along those lines. Can they help reduce the risk?
Dr. Melstrom: So, the studies aren't nearly as good for fiber. Fiber certainly will help for other things. Definitely are very helpful in avoiding diverticulitis or diverticulosis. However, not nearly as definitive of a link between that and colon cancer. The one dietary intake that does seem to have or play a role in reducing the amount of colon cancer is high calcium intake.
Melanie: That's interesting. So, let's talk about prevention. We have at our means these days one of the best diagnostic tools in the cancer world, it would seem to me. So, speak about screening for colon cancer and how really easy this is.
Dr. Melstrom: Yes, screening is extremely important. Colon cancer had been rising over the last several decades. However, in the last twenty years, we've seen a decrease in the amount of colon cancer and the reason is the early prevention and the colonoscopy. Right now, the major societies in America recommend a colonoscopy starting at age 50--40 if you had a family member. It's a quick and easy way to get it early lesion before it turns into cancer. A lot of patients do have some hesitancy going into it. They hear a lot of bad stories about the preparation. Now, you do drink a medication that helps clean you out. It gives you diarrhea for approximately 12 hours before the procedure. But, in the long run, a little sacrifice goes a long way.
Melanie: Well, I'm certainly someone who has mine every three to five years because I have a family history. What role does genetics play? Colonoscopies are so easy--not nearly as scary as people think. So, what's that role of genetics and should you be having colonoscopies either earlier or more often because of a family history?
Dr. Melstrom: Sure. So, there are several genetic diseases where you will acquire a colon cancer very much earlier in life. Those being what's called HNPCC or familial adenomatous polyposis. However, most patients will present much, much earlier with that and the family history will be so great that you will know that. Otherwise, there certainly is a link between having a first degree family member--that being a father or mother or a brother or a sister. However, the links aren't quite as strong for that. The only recommendation that we say to have an earlier colonoscopy is if a first degree family member had a colon cancer that was under the age of 50 as well. In terms of the intervals between colonoscopies, right now major studies recommend five to ten years and that seems to be still an okay interval for patients who do have a family history.
Melanie: So, tell us about treatment options. With colonoscopies, you remove polyps which can be pre-cancerous or benign. Tell us a little bit about those polyps so that people don't worry about them so much and that you are taking them out when you do that. And then, what if they are cancerous?
Dr. Melstrom: Sure. So, most colonoscopies, about 70%, I would say, will come back clean. However, if you do have a polyp, it's nothing to worry about. Nothing to lose sleep over. We are able to remove those polyps completely and they are considered pre-cancerous lesions but they still are in the benign state, meaning if left in place over the course of about ten years--which is why we use that ten year interval or so--they could lead to cancer. If a polyp does harbor cancer in it, it depends on how deep and how long it's been there, how invasive it's gotten. There are certainly some early cancers that are in polyps that we can remove completely with just the colonoscopy. However, if it has invaded into the colon wall, then the next step is a surgery.
Melanie: What's involved in that? People hear that right away, Dr. Meltsrom, and they think colostomy bags. They get very scared. Tell us about what goes on in treatment?
Dr. Melstrom: Sure. So now, that's my specialty. That's what I do and I'm seeing patients every day who I take to surgery. Again, it's certainly something that patients are very apprehensive about but much easier once you get through the whole process. The only chance of you needing a colostomy or a bag that will come out the side of your abdomen is if the cancer is so large that it's completely unresectable or if it's so low, close to your anal canal that we have to take that out. The majority of patients will not need that. For someone diagnosed with a colon cancer, chances of them needing a colostomy is in the single digits. Most of the time, we are able to take the cancer out completely and attach the colon back together. We use staples to put everything back together.
Melanie: Well, that's certainly encouraging, Dr. Melstrom. It really is. What's on the horizon for treatment of colon cancer? It's a scary diagnosis but you're this amazing surgeon and really giving hope to people that this isn't necessarily life-threatening all the time.
Dr. Melstrom: If we can catch a colon cancer in its earlier stages, the chance of survival is very, very high--80% to 90%. One of the things that is on the horizon and has already come into play, is better chemotherapy options. In the 1990’s and early 2000’s, two new chemotherapy drugs came out that really helped eradicate any extra cancer cells that are around. From the surgery standpoint, major breakthroughs have been accomplished in the techniques of how we do surgery. I've been trained in doing minimally invasive cancer surgeries now where we’re not making a large open incision down the middle of the abdomen. Instead, we are using a small camera blowing the belly up with air, doing all the work on the inside and that leaves the patient with a small incision.
Melanie: That's great news to hear. In the last few minutes, please give listeners your best advice and hope about colon cancer and why they should come to City of Hope for their care.
Dr. Melstrom: Sure. If you are ever diagnosed with colon cancer, understand that while a serious disease, the majority of them are still curable. If it becomes to an incurable stage, we still have a large amount of options to keep the cancer at bay or keep it dormant. Even if it stays in the body, you can live a significant amount of time with it in place. City of Hope is a special place in that we are a cancer-only hospital. We are a small hospital but our entire focus is just cancer. We have excellent surgeons, colorectal surgeons, like myself, as well as liver surgeons where if the colon cancer spreads--it usually goes to the liver--and a wide array of medical oncologists that are all giving new and different chemotherapy options. The City of Hope has been known for discovering and inventing new, novel chemotherapy drugs.
Melanie: Thank you so much for such great information, Dr. Melstrom. You're listening to City of Hope Radio and for more information you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.