Polyps are one of the most common colorectal conditions, occurring in 15 - 20 percent of the adult population. They can occur anywhere in the large intestine or rectum, but are more commonly found in the left colon, sigmoid colon, or rectum.
In this segment Steven Nurkin, MD, MS, FACS, gives you vital information on the importance of a colonoscopy for removing colon polyps before they become malignant which can effectively prevent cancer.
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The Facts About Colorectal Polyps
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His expertise is in minimally invasive approaches to tumors with advanced endoscopic, laparoscopic and robotic techniques. Advanced endoscopic procedures include: Endoscopic Mucosal Resection (EMR), Endoscopic Submucosal Dissection and Transanal Minimally Invasive and Endoscopic Microsurgery (Tamis/TEM).
Learn more about Steven Nurkin, MD
Steven Nurkin, MD
Steven Nurkin, MD is a fellowship trained surgical oncologist who specializes in gastrointestinal pre-cancerous conditions and cancers of the entire GI tract, with a focus in colon, appendix, rectum and anus.His expertise is in minimally invasive approaches to tumors with advanced endoscopic, laparoscopic and robotic techniques. Advanced endoscopic procedures include: Endoscopic Mucosal Resection (EMR), Endoscopic Submucosal Dissection and Transanal Minimally Invasive and Endoscopic Microsurgery (Tamis/TEM).
Learn more about Steven Nurkin, MD
Transcription:
The Facts About Colorectal Polyps
Bill Klaproth (Host): Polyps are one of the most common colorectal conditions occurring in 15-20% of the adult population. If a polyp is found early, doctors can remove it and stop colorectal cancer before it starts. Here to give us the facts on colorectal polyps is Dr. Steven Nurkin, Associate Professor of Oncology at Roswell Park Comprehensive Cancer Center. Dr. Nurkin, thank you so much for your time today. So, let’s start right here. What is a polyp?
Dr. Steven Nurkin, MD (Guest): Thank you very much for having me on here. So, a polyp is an abnormal growth of cells that occur within the lining of the colon or rectum and we have learned that they have some precancerous changes to them, now most polyps don’t become cancer but pretty much almost every cancer originates from a polyp. And we just don’t know which ones are the bad actors. So, we try to remove them all, whenever we see them, for that cancer prevention. So, they are an overgrowth of some abnormal cells that don’t belong there, that decide to go haywire and just start growing in the lining of your colon and they do have some precancerous changes to them and again, that is why we want to get them out when we can.
Bill: Well, those are good distinctions and good to know that a polyp doesn’t automatically mean cancer. So, do you remove them all the time or do you test some of them and if they are benign; do you leave them, or do they all have to come out?
Dr. Nurkin: So, it’s an interesting question. Where this stems from are from large population based studies and this is a bit difficult to study. We don’t know all the people that have them or the natural history to every polyp, but one of the most recognized studies, done here in the United States and there were similar studies done abroad; is called the National Polyp Study where they looked at over 10,000 people that had colonoscopies and they looked at specifically those that had specific polyps called adenomatous polyps and what they found was that if you had a colonoscopy with removal of a polyp, of this kind of polyp; you had a 53% reduction in dying from colorectal cancer over the next 15 years. And for that reason, it is felt that colonoscopy with removal of polyps prevents cancers and saves lives. So, there are polyps that come in different shapes and sizes. Most of them can be removed in their entirety where you don’t just biopsy them, sometimes, they are so small that even the biopsy means completely excising them because they are quite small. There are some that grow significantly larger that sometimes can’t be removed with standard colonoscopy techniques and require some more advanced techniques. And even when those advanced techniques can’t be performed, because of the size of the polyp or the difficult location; then even sometimes surgical resection is recommended, once again to reduce that risk of cancer formation.
Bill: Are there any symptoms with polyps?
Dr. Nurkin: So, for small ones, often not and that’s why screening is so important. We really try to push our population and our patients to get appropriate screening because often they don’t present with symptoms. When they get larger, sometimes, they can and that’s usually in the form of sometimes some bleeding, change in bowel habits, sometimes anemia will get picked up on some bloodwork, other types of screening can sometimes identify polyps as well. Not just with your standard – your gold standard colonoscopy, there are some other tests out there that people may have seen and heard about whether on TV commercials or during their research of sometimes testing your stool either for blood or for DNA, those kinds of things. And sometimes, those tests can pick up polyps. But usually, when they become larger is when they start to develop symptoms. So, that’s why it is recommended to get screening of course, when appropriate but then also if you are starting to have those symptoms of maybe some bleeding or abdominal cramps or a change in bowel habits, or anything like that; some of those similar or unexplained weight loss or a loss of appetite, those kinds of things; that is signifying something going on maybe in the GI tract where you really should let your doctor know and sometimes that will prompt a workup.
Bill: It’s good to have that checked out. So, Dr. Nurkin, can you share with us the latest screening guidelines?
Dr. Nurkin: Yeah. So, it really is based on the individual’s risk. So, there are people with – that are considered average risk, so those that have no personal or family history of polyps or cancer or medical conditions that increase your risk of developing colorectal cancer; such as inflammatory bowel disease, like ulcerative colitis, Crohn’s disease. So, if you are average risk with no family history and no personal history of polyps or cancer; then right now the national recommendations are to start screening at age 50 with a colonoscopy. If you have some increased risk factors; such as some of those medical conditions or family history or certain hereditary conditions; then those screening guidelines change, but it is based on your individual risk, that you really should speak with your doctor about.
What is of note and importance is that we are starting to see an increase in early onset colorectal cancer; which is quite alarming. I’m often seeing patients diagnosed in their thirties and forties even with colorectal cancer and like I said, it’s quite alarming even to the point of where these are in people that maybe don’t even have some hereditary conditions and we still don’t know definitively the reason for this. But we are trying to learn more and more about it. But the issue is that often if you are in your thirties or forties and you maybe have some bleeding that continues, that’s going on for a while; what’s worrisome is that sometimes these people are discussing it with their physicians, and because they are maybe on the younger side and thought to not have – at risk for colorectal cancer; they are just being told that maybe it’s a – it’s probably just a hemorrhoid, don’t worry about it. And unfortunately, these patients are coming in with later stage disease because they are not getting worked up as you would appropriately get worked up if you were older than 50. So, it is concerning. And it is something that we have to educate physicians about, general practitioners and also the community about getting appropriate workups even if you’re under the age of 50.
Bill: So, if you do have high risk for colon cancer, obviously you need to discuss that with your doctor and then they will certainly move that screening up from 50 to whatever it is, sometime earlier in your life and these are slow growing, right because if you go in at 50 and you have the colonoscopy and you get the all clear, traditionally it is okay we will see you in 10 years. So, these things are slow growers. If one is found, does that window close then, if you remove a polyp? What is the timeframe for getting the next one then.
Dr. Nurkin: Right. It does change depending on your individual risk and also what’s found at that individual scope. So, if that colonoscopy is performed and it does find multiple polyps at that time; then yes, the interval for your next scope will change. And depending on what is found and how many polyps are found and if these are some higher risk polyps or not, so for that reason, yes, the interval will change depending on what’s one your first your individual risk but then also what is found on colonoscopy.
Bill: So. Dr. Nurkin, you were talking about this being discovered earlier in life. Are there general lifestyle changes or dietary changes or things we could potentially do to ensure colon health?
Dr. Nurkin: It’s a great question. One of the most important thing that we are always trying to look for not just for the treatment of cancer, but cancer prevention and with regards to colorectal cancer which is if you eliminate some small skin cancers that are removed every day; colorectal cancer is the third most common cancer in men and women in the United States and what’s even more important and needs to be recognized is that it’s one of the most preventable with screening for sure, so screening is one of the more important things that you could do. With regards to prevention, other than appropriate screening, is good heart healthy living that a lot of the population knows about, is also very similar or what is good for your colon health. So, stop smoking, I’m going to say that again, stop smoking, whatever you can do to be able to quit that awful habit. Not only does it increase your risk of so many other diseases aside from COPD and cardiovascular risks, but it also increases your risk of colorectal cancer or colorectal polyp and cancer recurrence. So, definitely stop smoking. Diets high in fruits, vegetables, avoiding some of the red processed meats. Again, that doesn’t mean that you can’t have a steak once in a while, but things in moderation for sure. Life is for enjoyment also. I tell that to my patients all the time. But really your diet should focus on good heart healthy eating which includes fruits, vegetables, try to get up, try to stay active. Sedentary lifestyles, obesity also are associated with development of colorectal polyps and colorectal cancer. So, good overall health is also good for your colon.
Bill: Well Dr. Nurkin, thank you so much for your time today. We appreciate it. For more information visit www.roswellpark.org , that’s www.roswellpark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
The Facts About Colorectal Polyps
Bill Klaproth (Host): Polyps are one of the most common colorectal conditions occurring in 15-20% of the adult population. If a polyp is found early, doctors can remove it and stop colorectal cancer before it starts. Here to give us the facts on colorectal polyps is Dr. Steven Nurkin, Associate Professor of Oncology at Roswell Park Comprehensive Cancer Center. Dr. Nurkin, thank you so much for your time today. So, let’s start right here. What is a polyp?
Dr. Steven Nurkin, MD (Guest): Thank you very much for having me on here. So, a polyp is an abnormal growth of cells that occur within the lining of the colon or rectum and we have learned that they have some precancerous changes to them, now most polyps don’t become cancer but pretty much almost every cancer originates from a polyp. And we just don’t know which ones are the bad actors. So, we try to remove them all, whenever we see them, for that cancer prevention. So, they are an overgrowth of some abnormal cells that don’t belong there, that decide to go haywire and just start growing in the lining of your colon and they do have some precancerous changes to them and again, that is why we want to get them out when we can.
Bill: Well, those are good distinctions and good to know that a polyp doesn’t automatically mean cancer. So, do you remove them all the time or do you test some of them and if they are benign; do you leave them, or do they all have to come out?
Dr. Nurkin: So, it’s an interesting question. Where this stems from are from large population based studies and this is a bit difficult to study. We don’t know all the people that have them or the natural history to every polyp, but one of the most recognized studies, done here in the United States and there were similar studies done abroad; is called the National Polyp Study where they looked at over 10,000 people that had colonoscopies and they looked at specifically those that had specific polyps called adenomatous polyps and what they found was that if you had a colonoscopy with removal of a polyp, of this kind of polyp; you had a 53% reduction in dying from colorectal cancer over the next 15 years. And for that reason, it is felt that colonoscopy with removal of polyps prevents cancers and saves lives. So, there are polyps that come in different shapes and sizes. Most of them can be removed in their entirety where you don’t just biopsy them, sometimes, they are so small that even the biopsy means completely excising them because they are quite small. There are some that grow significantly larger that sometimes can’t be removed with standard colonoscopy techniques and require some more advanced techniques. And even when those advanced techniques can’t be performed, because of the size of the polyp or the difficult location; then even sometimes surgical resection is recommended, once again to reduce that risk of cancer formation.
Bill: Are there any symptoms with polyps?
Dr. Nurkin: So, for small ones, often not and that’s why screening is so important. We really try to push our population and our patients to get appropriate screening because often they don’t present with symptoms. When they get larger, sometimes, they can and that’s usually in the form of sometimes some bleeding, change in bowel habits, sometimes anemia will get picked up on some bloodwork, other types of screening can sometimes identify polyps as well. Not just with your standard – your gold standard colonoscopy, there are some other tests out there that people may have seen and heard about whether on TV commercials or during their research of sometimes testing your stool either for blood or for DNA, those kinds of things. And sometimes, those tests can pick up polyps. But usually, when they become larger is when they start to develop symptoms. So, that’s why it is recommended to get screening of course, when appropriate but then also if you are starting to have those symptoms of maybe some bleeding or abdominal cramps or a change in bowel habits, or anything like that; some of those similar or unexplained weight loss or a loss of appetite, those kinds of things; that is signifying something going on maybe in the GI tract where you really should let your doctor know and sometimes that will prompt a workup.
Bill: It’s good to have that checked out. So, Dr. Nurkin, can you share with us the latest screening guidelines?
Dr. Nurkin: Yeah. So, it really is based on the individual’s risk. So, there are people with – that are considered average risk, so those that have no personal or family history of polyps or cancer or medical conditions that increase your risk of developing colorectal cancer; such as inflammatory bowel disease, like ulcerative colitis, Crohn’s disease. So, if you are average risk with no family history and no personal history of polyps or cancer; then right now the national recommendations are to start screening at age 50 with a colonoscopy. If you have some increased risk factors; such as some of those medical conditions or family history or certain hereditary conditions; then those screening guidelines change, but it is based on your individual risk, that you really should speak with your doctor about.
What is of note and importance is that we are starting to see an increase in early onset colorectal cancer; which is quite alarming. I’m often seeing patients diagnosed in their thirties and forties even with colorectal cancer and like I said, it’s quite alarming even to the point of where these are in people that maybe don’t even have some hereditary conditions and we still don’t know definitively the reason for this. But we are trying to learn more and more about it. But the issue is that often if you are in your thirties or forties and you maybe have some bleeding that continues, that’s going on for a while; what’s worrisome is that sometimes these people are discussing it with their physicians, and because they are maybe on the younger side and thought to not have – at risk for colorectal cancer; they are just being told that maybe it’s a – it’s probably just a hemorrhoid, don’t worry about it. And unfortunately, these patients are coming in with later stage disease because they are not getting worked up as you would appropriately get worked up if you were older than 50. So, it is concerning. And it is something that we have to educate physicians about, general practitioners and also the community about getting appropriate workups even if you’re under the age of 50.
Bill: So, if you do have high risk for colon cancer, obviously you need to discuss that with your doctor and then they will certainly move that screening up from 50 to whatever it is, sometime earlier in your life and these are slow growing, right because if you go in at 50 and you have the colonoscopy and you get the all clear, traditionally it is okay we will see you in 10 years. So, these things are slow growers. If one is found, does that window close then, if you remove a polyp? What is the timeframe for getting the next one then.
Dr. Nurkin: Right. It does change depending on your individual risk and also what’s found at that individual scope. So, if that colonoscopy is performed and it does find multiple polyps at that time; then yes, the interval for your next scope will change. And depending on what is found and how many polyps are found and if these are some higher risk polyps or not, so for that reason, yes, the interval will change depending on what’s one your first your individual risk but then also what is found on colonoscopy.
Bill: So. Dr. Nurkin, you were talking about this being discovered earlier in life. Are there general lifestyle changes or dietary changes or things we could potentially do to ensure colon health?
Dr. Nurkin: It’s a great question. One of the most important thing that we are always trying to look for not just for the treatment of cancer, but cancer prevention and with regards to colorectal cancer which is if you eliminate some small skin cancers that are removed every day; colorectal cancer is the third most common cancer in men and women in the United States and what’s even more important and needs to be recognized is that it’s one of the most preventable with screening for sure, so screening is one of the more important things that you could do. With regards to prevention, other than appropriate screening, is good heart healthy living that a lot of the population knows about, is also very similar or what is good for your colon health. So, stop smoking, I’m going to say that again, stop smoking, whatever you can do to be able to quit that awful habit. Not only does it increase your risk of so many other diseases aside from COPD and cardiovascular risks, but it also increases your risk of colorectal cancer or colorectal polyp and cancer recurrence. So, definitely stop smoking. Diets high in fruits, vegetables, avoiding some of the red processed meats. Again, that doesn’t mean that you can’t have a steak once in a while, but things in moderation for sure. Life is for enjoyment also. I tell that to my patients all the time. But really your diet should focus on good heart healthy eating which includes fruits, vegetables, try to get up, try to stay active. Sedentary lifestyles, obesity also are associated with development of colorectal polyps and colorectal cancer. So, good overall health is also good for your colon.
Bill: Well Dr. Nurkin, thank you so much for your time today. We appreciate it. For more information visit www.roswellpark.org , that’s www.roswellpark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.