Colorectal cancer screening is important for everyone, especially if you are age 50 years or older.
But it is especially important if you have risks for colorectal cancer.
Some of those risks are being age 50 years or older, personal history of colorectal polyps, personal history of colorectal cancer,
personal history of inflammatory bowel disease (IBD), and Crohn's disease and ulcerative colitis.
Dr. Roger Klein is here to discuss Colorectal cancer prevention tips.
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Colorectal Cancer Prevention Tips
Featured Speaker:
Learn more about Roger S. Klein, MD
Learn more about Overlook Medical Center
Roger S. Klein, MD
Roger S. Klein, MD, FACP, has expertise in inflammatory bowel disease, diseases of the liver, colon cancer screening, gastroesophageal reflux disease, and gastrointestinal bleeding. In addition to his position at Summit Medical Group, Roger S. Klein, MD, FACP, is Section Chief in the Division of Gastroenterology and an attending gastroenterologist at Overlook Hospital in Summit, New Jersey. Dr. Klein also is an attending gastroenterologist at Mount Sinai Medical Center and an assistant clinical professor of medicine for Mount Sinai School of Medicine in New York City.Learn more about Roger S. Klein, MD
Learn more about Overlook Medical Center
Transcription:
Colorectal Cancer Prevention Tips
Melanie Cole (Host): Colorectal cancer is the third most common form of cancer in men and women in the United States. Yet, it’s one of the most preventable forms of cancer. Colonoscopies and a diet that’s high in fiber can go a long way to making sure that your colon stays healthy. Today, my guest is Dr. Roger Klein. He’s a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Klein. So, people here the word “colonoscopy” and they go running in the other direction. I, personally, think they’re a “nothin’”. It’s the prep everybody doesn’t like. So, speak about colonoscopies. What are you looking for?
Dr. Roger Klein (Guest): Well, when we do a procedure, we’re typically looking for polyps which are benign pre-cursers to colon cancer. By doing regular, routine surveillance colonoscopy and removing polyps, we can prevent the majority of colon cancers. As you said, really, the biggest block that people feel is the prep. Really, what that involves is being on a clear liquid diet the day before the procedure and there are a variety of preparations that can be used from lower volume preparations to preps that, typically, are about 2 liters. Really, the outcome of all of those preps is diarrhea which is what upsets people or discourages them from the procedure. It’s really a relatively minor nuisance in the scheme of having the colonoscopy and preventing colon cancer. The exam’s really need to be done fairly infrequently and a normal person with no additional risk factors and no family history, sometimes the time between procedures can be up to 10 years.
Melanie: So, let’s start with that. When should you get your first colonoscopy if you are somebody with no family history of no colon cancer?
Dr. Klein: With no family history, the typical screening age is 50. There is a slight aside to that. People who are African-American may have a slightly higher risk and some studies suggest starting at 45. For the general population, most people would argue age 50. With a family history, the age would be younger.
Melanie: So, if you have the family history, you could start younger and now, with the Affordable Care Act, colonoscopy is part of a wellness preventive plan so it should even be covered under most insurance plans, yes?
Dr. Klein: Correct. Even today, with most insurance plans, a colonoscopy at age 50 done for screening purposes is considered preventive care and, generally, whatever deductibles apply to insurance don’t apply to routine preventive care. So, it should be affordable, really for everybody to have that routine screening.
Melanie: I love that because it’s certainly such a preventive way—it’s actually a colon cancer preventative thing that you doctors are doing. So, now, tell us—because I imagine a lot of people say, “Okay. When are you going to start?” and you say, “I’m already finished.” Then, we get the little pictures. What are we seeing?
Dr. Klein: Well, in the pictures, what we do is, we typically document what we’re seeing in the procedure. So, we advance the scope around the length of the colon and, typically, we find that we’re at the end of the colon by looking at the opening to the appendix—what we call the “appendiceal orifice” and the ileocecal valve which is the opening where the small intestine joins the colon. Sometimes, as an additional part of the exam, the endoscopists will go into the small intestine to examine that, particularly if the patient has a history of diarrhea or if there’s a possible question of inflammatory bowel disease or Crohn’s disease. So, we will mark that spot with a photograph to identify that we’re there. We know that we’re there at that time. Then, we withdraw the colonoscope and that’s really where we do the majority of our exam is we’re withdrawing the scope from the colon looking for polyps. If we do see polyps on the way in, we’ll remove them at that time as well. For the most part, the real exam, is as we’re withdrawing the scope and it’s one of the important aspects of the exam—taking adequate time to look at the colon, at all of the walls of the colon and at all of the turns. People think of the colon as just a long pipe but it really has turns. It has crevices and you really need to examine carefully for polyps, particularly some of the flatter polyps that we find now.
Melanie: Now, sometimes you spot internal or external hemorrhoids. Should people be worried about that when they see those?
Dr. Klein: No. Hemorrhoids are seen fairly frequently and, especially after taking the prep and having frequent diarrhea, the hemorrhoids which are really what we call “vascular cushions” can be engorged. So, that’s really not a sign of any pathology and of no concern. If somebody is having ongoing issues related to hemorrhoids, pleading or discomfort, that’s something that can be dealt with through a colorectal surgeon separately.
Melanie: So now, speak about the polyps that you find because there are a few different kinds. People hear you say, “Well, I removed a few little polyps” and that’s good news that you were able to remove them but what do those polyps signal? Some are cancerous and some are not? Or, pre-cancerous?
Dr. Klein: Correct. Some polyps are what we describe as adenomatous polyps which a pathologist defines as dysplasia and dysplasia means pre-cancerous change. When we examine the colon and we see polyps, visually examining the, we can’t tell definitively whether or not they’re adenomatous polyps or not. The other type of polyps will sometimes be what we call “hyperplastic polyps” or sometimes “inflammatory polyps” which really have no malignant potential. Typically, the larger polyps that we see that measure over a centimeter, usually are adenomatous. Those are the polyps that we’re really screening for. So, anytime we do see a polyp and do remove it, we send that to a pathologist to look at, examine, see if it is an adenomatous polyp and make certain that there is no sign of advance dysplasia or the development of an early cancer within that polyp. There are different types of polyps that we do see within the colon. There are polyps that grow in stalks that we describe as pedunculated polyps. Then, there are flatter polyps. Each of them have different techniques that we use to remove those.
Melanie: If somebody has polyps and you’ve removed them, does that change the amount of time between colonoscopies?
Dr. Klein: Yes. Depending on the number of polyps and the size of polyps removed, that would determine when you would be asked to come back for a follow up procedure. Typically, if there are a few smaller adenomatous polyps, the recommendation would be to come back in 5 years. Sometimes, if there’s a larger polyp or multiple polyps, we might recommend 3 years. If there’s a particularly large polyp or a polyp that has to be removed in pieces and the endoscopists couldn’t be 100% sure that the entire polyp as removed, you might be asked to return anywhere from 6 months to a year. So, it really depends on the findings at the time of the procedure but most people would be asked to come back with polyps, at a 3-5 year interval.
Melanie: How important, Dr. Klein, is a diet high in fiber to help keep our colon clean?
Dr. Klein: Well, I think we’ve been finding more now that there are some environmental risk factors that really can play a role in colon cancer prevention and eating of the healthy diet composed of fresh fruits and vegetables, whole grains, limiting red meat, especially processed meats, limiting alcohol consumption, all are environmental factors that can help reduce colon cancer risks.
Melanie: So, if you were to tell somebody your best advice for reducing their risk of colon cancer starting at a young age—because young people don’t necessarily think this is something that can happen to them. What do you tell everybody, doctor?
Dr. Klein: Well, again, the most important things are leading a healthy lifestyle. A well-balanced diet with lots of fresh fruits and vegetables. Again, limiting red meat. Men are at somewhat higher risk for colon cancer who drink heavily so limiting drinks to no more than 14 drinks per week; not smoking cigarettes and getting regular exercise and maintaining a healthy weight area all factors that can reduce colon cancer risk. The biggest risk factor that people have is genetic risk. So, knowing your family history and making certain that you’re not at a higher risk and don’t need to start screening at an earlier age is something that’s very important to keep track of.
Melanie: Such great information, Dr. Klein. In just the last minute, why should patients come to Summit Medical Group for their care?
Dr. Klein: I think we offer a great type of comprehensive care here. We have wonderful gastroenterologists here. We have a great ambulatory surgical center here. Because we’re a large multispeciality group, we can get the immediate input from other physicians when we’re doing a procedure or right afterward. So, in the worst case scenario, finding a colon cancer, a larger polyp where we may need a surgeon to be involved, we have wonderful colorectal surgeons who are here. They can come up, look at the procedure. If we do need to have an oncologist involved or any additional imaging or labwork, it can all be arranged fairly seamlessly and very efficiently. I think it makes the whole process when one is going through a difficult time with an illness much easier.
Melanie: Thank you so much, doctor, for being with us today. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
Colorectal Cancer Prevention Tips
Melanie Cole (Host): Colorectal cancer is the third most common form of cancer in men and women in the United States. Yet, it’s one of the most preventable forms of cancer. Colonoscopies and a diet that’s high in fiber can go a long way to making sure that your colon stays healthy. Today, my guest is Dr. Roger Klein. He’s a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Klein. So, people here the word “colonoscopy” and they go running in the other direction. I, personally, think they’re a “nothin’”. It’s the prep everybody doesn’t like. So, speak about colonoscopies. What are you looking for?
Dr. Roger Klein (Guest): Well, when we do a procedure, we’re typically looking for polyps which are benign pre-cursers to colon cancer. By doing regular, routine surveillance colonoscopy and removing polyps, we can prevent the majority of colon cancers. As you said, really, the biggest block that people feel is the prep. Really, what that involves is being on a clear liquid diet the day before the procedure and there are a variety of preparations that can be used from lower volume preparations to preps that, typically, are about 2 liters. Really, the outcome of all of those preps is diarrhea which is what upsets people or discourages them from the procedure. It’s really a relatively minor nuisance in the scheme of having the colonoscopy and preventing colon cancer. The exam’s really need to be done fairly infrequently and a normal person with no additional risk factors and no family history, sometimes the time between procedures can be up to 10 years.
Melanie: So, let’s start with that. When should you get your first colonoscopy if you are somebody with no family history of no colon cancer?
Dr. Klein: With no family history, the typical screening age is 50. There is a slight aside to that. People who are African-American may have a slightly higher risk and some studies suggest starting at 45. For the general population, most people would argue age 50. With a family history, the age would be younger.
Melanie: So, if you have the family history, you could start younger and now, with the Affordable Care Act, colonoscopy is part of a wellness preventive plan so it should even be covered under most insurance plans, yes?
Dr. Klein: Correct. Even today, with most insurance plans, a colonoscopy at age 50 done for screening purposes is considered preventive care and, generally, whatever deductibles apply to insurance don’t apply to routine preventive care. So, it should be affordable, really for everybody to have that routine screening.
Melanie: I love that because it’s certainly such a preventive way—it’s actually a colon cancer preventative thing that you doctors are doing. So, now, tell us—because I imagine a lot of people say, “Okay. When are you going to start?” and you say, “I’m already finished.” Then, we get the little pictures. What are we seeing?
Dr. Klein: Well, in the pictures, what we do is, we typically document what we’re seeing in the procedure. So, we advance the scope around the length of the colon and, typically, we find that we’re at the end of the colon by looking at the opening to the appendix—what we call the “appendiceal orifice” and the ileocecal valve which is the opening where the small intestine joins the colon. Sometimes, as an additional part of the exam, the endoscopists will go into the small intestine to examine that, particularly if the patient has a history of diarrhea or if there’s a possible question of inflammatory bowel disease or Crohn’s disease. So, we will mark that spot with a photograph to identify that we’re there. We know that we’re there at that time. Then, we withdraw the colonoscope and that’s really where we do the majority of our exam is we’re withdrawing the scope from the colon looking for polyps. If we do see polyps on the way in, we’ll remove them at that time as well. For the most part, the real exam, is as we’re withdrawing the scope and it’s one of the important aspects of the exam—taking adequate time to look at the colon, at all of the walls of the colon and at all of the turns. People think of the colon as just a long pipe but it really has turns. It has crevices and you really need to examine carefully for polyps, particularly some of the flatter polyps that we find now.
Melanie: Now, sometimes you spot internal or external hemorrhoids. Should people be worried about that when they see those?
Dr. Klein: No. Hemorrhoids are seen fairly frequently and, especially after taking the prep and having frequent diarrhea, the hemorrhoids which are really what we call “vascular cushions” can be engorged. So, that’s really not a sign of any pathology and of no concern. If somebody is having ongoing issues related to hemorrhoids, pleading or discomfort, that’s something that can be dealt with through a colorectal surgeon separately.
Melanie: So now, speak about the polyps that you find because there are a few different kinds. People hear you say, “Well, I removed a few little polyps” and that’s good news that you were able to remove them but what do those polyps signal? Some are cancerous and some are not? Or, pre-cancerous?
Dr. Klein: Correct. Some polyps are what we describe as adenomatous polyps which a pathologist defines as dysplasia and dysplasia means pre-cancerous change. When we examine the colon and we see polyps, visually examining the, we can’t tell definitively whether or not they’re adenomatous polyps or not. The other type of polyps will sometimes be what we call “hyperplastic polyps” or sometimes “inflammatory polyps” which really have no malignant potential. Typically, the larger polyps that we see that measure over a centimeter, usually are adenomatous. Those are the polyps that we’re really screening for. So, anytime we do see a polyp and do remove it, we send that to a pathologist to look at, examine, see if it is an adenomatous polyp and make certain that there is no sign of advance dysplasia or the development of an early cancer within that polyp. There are different types of polyps that we do see within the colon. There are polyps that grow in stalks that we describe as pedunculated polyps. Then, there are flatter polyps. Each of them have different techniques that we use to remove those.
Melanie: If somebody has polyps and you’ve removed them, does that change the amount of time between colonoscopies?
Dr. Klein: Yes. Depending on the number of polyps and the size of polyps removed, that would determine when you would be asked to come back for a follow up procedure. Typically, if there are a few smaller adenomatous polyps, the recommendation would be to come back in 5 years. Sometimes, if there’s a larger polyp or multiple polyps, we might recommend 3 years. If there’s a particularly large polyp or a polyp that has to be removed in pieces and the endoscopists couldn’t be 100% sure that the entire polyp as removed, you might be asked to return anywhere from 6 months to a year. So, it really depends on the findings at the time of the procedure but most people would be asked to come back with polyps, at a 3-5 year interval.
Melanie: How important, Dr. Klein, is a diet high in fiber to help keep our colon clean?
Dr. Klein: Well, I think we’ve been finding more now that there are some environmental risk factors that really can play a role in colon cancer prevention and eating of the healthy diet composed of fresh fruits and vegetables, whole grains, limiting red meat, especially processed meats, limiting alcohol consumption, all are environmental factors that can help reduce colon cancer risks.
Melanie: So, if you were to tell somebody your best advice for reducing their risk of colon cancer starting at a young age—because young people don’t necessarily think this is something that can happen to them. What do you tell everybody, doctor?
Dr. Klein: Well, again, the most important things are leading a healthy lifestyle. A well-balanced diet with lots of fresh fruits and vegetables. Again, limiting red meat. Men are at somewhat higher risk for colon cancer who drink heavily so limiting drinks to no more than 14 drinks per week; not smoking cigarettes and getting regular exercise and maintaining a healthy weight area all factors that can reduce colon cancer risk. The biggest risk factor that people have is genetic risk. So, knowing your family history and making certain that you’re not at a higher risk and don’t need to start screening at an earlier age is something that’s very important to keep track of.
Melanie: Such great information, Dr. Klein. In just the last minute, why should patients come to Summit Medical Group for their care?
Dr. Klein: I think we offer a great type of comprehensive care here. We have wonderful gastroenterologists here. We have a great ambulatory surgical center here. Because we’re a large multispeciality group, we can get the immediate input from other physicians when we’re doing a procedure or right afterward. So, in the worst case scenario, finding a colon cancer, a larger polyp where we may need a surgeon to be involved, we have wonderful colorectal surgeons who are here. They can come up, look at the procedure. If we do need to have an oncologist involved or any additional imaging or labwork, it can all be arranged fairly seamlessly and very efficiently. I think it makes the whole process when one is going through a difficult time with an illness much easier.
Melanie: Thank you so much, doctor, for being with us today. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.