The American Cancer Society believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. TMC gastroenterologists screen for cancer using colonoscopy or flexible sigmoidoscopy. In both of these procedures, the physician can both screen for colon polyps and remove them. Polyps are small growths that can become cancerous over time. Removing polyps can help prevent colorectal cancer from ever starting.
Listen as Richard K. Saltz, MD explains that cancers found in an early stage, while they are small and before they have spread, are more easily treated.
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Can You Prevent Colon Cancer?
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Learn more about Richard K. Saltz, MD
Richard K. Saltz, MD
Richard K. Saltz, MD is a Gastroenterologist and a member of the Medical Staff at Texoma Medical Center.Learn more about Richard K. Saltz, MD
Transcription:
Can You Prevent Colon Cancer?
Melanie Cole (Host): According to the American College of Gastroenterology, colorectal cancer is the number two cancer killer in the United States, yet it is one of the most preventable types of cancer. My guest today is Dr. Richard Saltz. He’s a Gastroenterologist and a member of the medical staff at Texoma Medical Center. Welcome to the show, Dr. Saltz. Who is at risk for colon cancer? Is there a genetic component to it?
Dr. Richard K. Saltz (Guest): There is a genetic component, but the major genetic risks produce the cancer in only about 10% of people. Most people are susceptible to this problem based upon age with genetics being a smaller factor.
Melanie: So, we know that there is a screening for colon cancer -- It’s one of the very few out there that’s actually been touted as a prevention type of screening -- tell us who should get a colonoscopy and when should they start them?
Dr. Saltz: Well, the simplest number to remember is age 50 where most people for an average risk. We should qualify that by saying that African Americans should be tested at age 45 and some people think possibly even younger than that for that subgroup. But the average risk group begins at age 50. That’s not to say that some cancers don’t occur before then, but most of the cancers that occur in young people – teens, twenties, thirties – are the genetic ones, which represent only 10% of the total cancer occurrences.
Melanie: So if you’re supposed to begin at age 50, how often thereafter?
Dr. Saltz: Well, it depends on whether you remain in the average risk category. If you have a completely normal exam, that is no precancerous polyps are proven on biopsy; then you continue with average risk screening, which is a ten-year interval – 50, 60, 70, sometimes 80. There are some societies that suggest that we’re not obligated to do the screening after 75, but the main rule of thumb that we use for the older age group is that if we think someone has a ten-year lifespan potential, then we keep offering the screening, even at age 75 to 85.
Melanie: So let’s discuss the screening colonoscopy. People tend to be afraid of it just because of the prep; they hear about, so explain how a colonoscopy works and what’s going on with the prep these days?
Dr. Saltz: Well, the prep is a very, very important part of the exam. In order for the doctor to do a high-quality exam, a very good prep must be completed, that is the bowel has to be cleansed so that it’s virtually empty in the large intestine and rectum. To accomplish this, we have most people start one day before with a clear liquid diet – jello, broth, tea, coffee is also included as a clear liquid, but no milk or creams. Patients are then advised to do a lavage laxative-type prep. The most effective type prep is called the split dose prep, one where they’ll take half of the laxative the evening before and half early in the morning on the day of the exam. In the past, most people have used a large volume jug of prep, which they sometimes find difficult to complete. There are, however, in recent years, several newer, small volume, better tasting preps that are much better tolerated and people say, “If I had known that this was available, I wouldn’t have put off getting my exam.”
Melanie: So the prep notwithstanding -- and I personally, in my own opinion, do not feel it’s that big of a deal, and I’ve had quite a few colonoscopies -- but once the prep is done, then what can they expect on the day of the procedure? What is that like?
Dr. Saltz: The day of the procedure, it’s preferred to have the exam in the morning hours, although some are scheduled in the early afternoon. The patient comes in to be registered. They change, sign consent forms – they receive an intravenous needle in the vein of the arm to administer the sedative anesthetic. The anesthetic is not given until the doctor comes in the room and addresses the patient.
The only discomfort that patient might experience is from the initial injection of the anesthetic. In a few people, not everyone, there could be a burning in the arm where the sedative is given. Typically if they put it in the small vein in the wrist or hand, that’s more likely to occur. But for most people, there’s no discomfort, and there’s no discomfort at all throughout the remainder of the procedure.
The medication that we use at Texoma Medical Center is called Propofol, and it’s a drug that produces a deep level of sedation. We don’t use the conscious sedation, which was done for many, many years, and is still done in some parts of the country, but in our experience, patients greatly prefer the deeper sedation, so they have no recall, no experience of any bad effects or feeling from the examination, no pain.
Melanie: So then they wake up, and they ask you, “Dr. Saltz, when are you going to start?” And you say, “I’ve already finished—“
Dr. Saltz: Exactly.
Melanie: [LAUGHS] -- and you give them pretty little pictures. What is a polyp? If you happen to find one while you’re in there, what is it that you’ve taken out?
Dr. Saltz: Anything that we identify as a bump or that appears to be a possible thickening of the lining or growth, we will call it a polyp, and we will take a biopsy of it. Polyps range in size from very small, tiny, to almost an inch in size and they can be cut off, or they can be simply biopsied without any discomfort to the patient.
Melanie: So what do those polyps show? What are they all about?
Dr. Saltz: Well, the tiny, tiny ones sometimes are insignificant, and they’re just a thickening of normal tissue. Those people we say we thought there was a polyp, but it turned out it was insignificant. The technical medical term is usually hyperplastic or normal tissue. We tell them, “You’re okay, you come back in ten years,” but there are growths that are true polyps, that is they have the potential to get bigger and bigger and eventually a risk developing cancer within the. There are different types of those polyps that we distinguish under the microscope that tells us a little bit about that risk. Some of them, the most common, are called tubular. Others, more significant that tend to grow a little more rapidly are called villous, and then there’s a special type that’s called sessile serrated, which can occur on the right side of the colon, and that’s particularly important because those are often flat and hard to see and covered by mucous. The mucous seems to attach there, and if they haven’t done the good prep, that can be missed. I get particularly concerned about that type of polyp because it’s the type that the endoscopists who are not extensively trained to look for subtleties, often miss. It’s those misses that could produce the development of cancer within one or two years after an exam, and then people say, “Well, how is that possible that I developed cancer within one or two years after an exam?” Because it was an unusual, difficult to identify the type of polyp that only an experienced endoscopist can truly find.
Melanie: So after the procedure and you’ve discussed the polyps with them, and then they maybe have their follow-up in however many years based on the results, what else do you tell them about maybe nutrition – is that myth that nutrition and fiber can help with colon cancer prevention?
Dr. Saltz: Well, I think the horse is out of the barn at the point in your life that you have the polyps. That’s probably a little bit late, but when we think about younger generations clearly obesity, which is an epidemic in this country, and sedentary lifestyle, lack of activity – is considered a risk factor, so we do find more cancers in those people. There are other nutritional issues, but you can’t just adjust your diet and think you’re going to reduce your risk of cancer starting at the age of 50. You really have to start much younger.
Melanie: So why don’t you wrap it up for us? Give your great advice about colon cancer prevention and what you want people to know who are at risk for colon cancer are of the screening age, what would you like them to be aware of?
Dr. Saltz: They must do some type of screening examination. Colonoscopy is the gold standard. It finds the most polyps, the most cancers, and it is both diagnostic in finding it and therapeutic in treating it. By removing a polyp, you prevent it from becoming cancer. There are other screening options that are available to individuals who, for a variety of reasons, might be hesitant, and particularly in the older age group, if they have reasons to be concerned about other medical problems, there are several other screenings that could be done, although they’re not preferred. Anyone age 50 who’s in good health, that’s absolutely no excuse for not having the screening colonoscopy. It is so sad when I see people several times a year coming in in their 60s who skipped the first exam, and I have to tell them I just found cancer.
Melanie: And why should they come to Texoma Medical Center for their care?
Dr. Saltz: Well, we are highly skilled endoscopists with advanced training, and we are paying attention to all of the factors that are important in finding small, hard to find polyps, particularly of the type that I discussed. We have equipment that allows us to do the job very effectively.
Melanie: Thank you, so much, for being with us today, Dr. Saltz. You’re listening to TMC Health Talk with Texoma Medical Center, and for more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much, for listening.
Can You Prevent Colon Cancer?
Melanie Cole (Host): According to the American College of Gastroenterology, colorectal cancer is the number two cancer killer in the United States, yet it is one of the most preventable types of cancer. My guest today is Dr. Richard Saltz. He’s a Gastroenterologist and a member of the medical staff at Texoma Medical Center. Welcome to the show, Dr. Saltz. Who is at risk for colon cancer? Is there a genetic component to it?
Dr. Richard K. Saltz (Guest): There is a genetic component, but the major genetic risks produce the cancer in only about 10% of people. Most people are susceptible to this problem based upon age with genetics being a smaller factor.
Melanie: So, we know that there is a screening for colon cancer -- It’s one of the very few out there that’s actually been touted as a prevention type of screening -- tell us who should get a colonoscopy and when should they start them?
Dr. Saltz: Well, the simplest number to remember is age 50 where most people for an average risk. We should qualify that by saying that African Americans should be tested at age 45 and some people think possibly even younger than that for that subgroup. But the average risk group begins at age 50. That’s not to say that some cancers don’t occur before then, but most of the cancers that occur in young people – teens, twenties, thirties – are the genetic ones, which represent only 10% of the total cancer occurrences.
Melanie: So if you’re supposed to begin at age 50, how often thereafter?
Dr. Saltz: Well, it depends on whether you remain in the average risk category. If you have a completely normal exam, that is no precancerous polyps are proven on biopsy; then you continue with average risk screening, which is a ten-year interval – 50, 60, 70, sometimes 80. There are some societies that suggest that we’re not obligated to do the screening after 75, but the main rule of thumb that we use for the older age group is that if we think someone has a ten-year lifespan potential, then we keep offering the screening, even at age 75 to 85.
Melanie: So let’s discuss the screening colonoscopy. People tend to be afraid of it just because of the prep; they hear about, so explain how a colonoscopy works and what’s going on with the prep these days?
Dr. Saltz: Well, the prep is a very, very important part of the exam. In order for the doctor to do a high-quality exam, a very good prep must be completed, that is the bowel has to be cleansed so that it’s virtually empty in the large intestine and rectum. To accomplish this, we have most people start one day before with a clear liquid diet – jello, broth, tea, coffee is also included as a clear liquid, but no milk or creams. Patients are then advised to do a lavage laxative-type prep. The most effective type prep is called the split dose prep, one where they’ll take half of the laxative the evening before and half early in the morning on the day of the exam. In the past, most people have used a large volume jug of prep, which they sometimes find difficult to complete. There are, however, in recent years, several newer, small volume, better tasting preps that are much better tolerated and people say, “If I had known that this was available, I wouldn’t have put off getting my exam.”
Melanie: So the prep notwithstanding -- and I personally, in my own opinion, do not feel it’s that big of a deal, and I’ve had quite a few colonoscopies -- but once the prep is done, then what can they expect on the day of the procedure? What is that like?
Dr. Saltz: The day of the procedure, it’s preferred to have the exam in the morning hours, although some are scheduled in the early afternoon. The patient comes in to be registered. They change, sign consent forms – they receive an intravenous needle in the vein of the arm to administer the sedative anesthetic. The anesthetic is not given until the doctor comes in the room and addresses the patient.
The only discomfort that patient might experience is from the initial injection of the anesthetic. In a few people, not everyone, there could be a burning in the arm where the sedative is given. Typically if they put it in the small vein in the wrist or hand, that’s more likely to occur. But for most people, there’s no discomfort, and there’s no discomfort at all throughout the remainder of the procedure.
The medication that we use at Texoma Medical Center is called Propofol, and it’s a drug that produces a deep level of sedation. We don’t use the conscious sedation, which was done for many, many years, and is still done in some parts of the country, but in our experience, patients greatly prefer the deeper sedation, so they have no recall, no experience of any bad effects or feeling from the examination, no pain.
Melanie: So then they wake up, and they ask you, “Dr. Saltz, when are you going to start?” And you say, “I’ve already finished—“
Dr. Saltz: Exactly.
Melanie: [LAUGHS] -- and you give them pretty little pictures. What is a polyp? If you happen to find one while you’re in there, what is it that you’ve taken out?
Dr. Saltz: Anything that we identify as a bump or that appears to be a possible thickening of the lining or growth, we will call it a polyp, and we will take a biopsy of it. Polyps range in size from very small, tiny, to almost an inch in size and they can be cut off, or they can be simply biopsied without any discomfort to the patient.
Melanie: So what do those polyps show? What are they all about?
Dr. Saltz: Well, the tiny, tiny ones sometimes are insignificant, and they’re just a thickening of normal tissue. Those people we say we thought there was a polyp, but it turned out it was insignificant. The technical medical term is usually hyperplastic or normal tissue. We tell them, “You’re okay, you come back in ten years,” but there are growths that are true polyps, that is they have the potential to get bigger and bigger and eventually a risk developing cancer within the. There are different types of those polyps that we distinguish under the microscope that tells us a little bit about that risk. Some of them, the most common, are called tubular. Others, more significant that tend to grow a little more rapidly are called villous, and then there’s a special type that’s called sessile serrated, which can occur on the right side of the colon, and that’s particularly important because those are often flat and hard to see and covered by mucous. The mucous seems to attach there, and if they haven’t done the good prep, that can be missed. I get particularly concerned about that type of polyp because it’s the type that the endoscopists who are not extensively trained to look for subtleties, often miss. It’s those misses that could produce the development of cancer within one or two years after an exam, and then people say, “Well, how is that possible that I developed cancer within one or two years after an exam?” Because it was an unusual, difficult to identify the type of polyp that only an experienced endoscopist can truly find.
Melanie: So after the procedure and you’ve discussed the polyps with them, and then they maybe have their follow-up in however many years based on the results, what else do you tell them about maybe nutrition – is that myth that nutrition and fiber can help with colon cancer prevention?
Dr. Saltz: Well, I think the horse is out of the barn at the point in your life that you have the polyps. That’s probably a little bit late, but when we think about younger generations clearly obesity, which is an epidemic in this country, and sedentary lifestyle, lack of activity – is considered a risk factor, so we do find more cancers in those people. There are other nutritional issues, but you can’t just adjust your diet and think you’re going to reduce your risk of cancer starting at the age of 50. You really have to start much younger.
Melanie: So why don’t you wrap it up for us? Give your great advice about colon cancer prevention and what you want people to know who are at risk for colon cancer are of the screening age, what would you like them to be aware of?
Dr. Saltz: They must do some type of screening examination. Colonoscopy is the gold standard. It finds the most polyps, the most cancers, and it is both diagnostic in finding it and therapeutic in treating it. By removing a polyp, you prevent it from becoming cancer. There are other screening options that are available to individuals who, for a variety of reasons, might be hesitant, and particularly in the older age group, if they have reasons to be concerned about other medical problems, there are several other screenings that could be done, although they’re not preferred. Anyone age 50 who’s in good health, that’s absolutely no excuse for not having the screening colonoscopy. It is so sad when I see people several times a year coming in in their 60s who skipped the first exam, and I have to tell them I just found cancer.
Melanie: And why should they come to Texoma Medical Center for their care?
Dr. Saltz: Well, we are highly skilled endoscopists with advanced training, and we are paying attention to all of the factors that are important in finding small, hard to find polyps, particularly of the type that I discussed. We have equipment that allows us to do the job very effectively.
Melanie: Thank you, so much, for being with us today, Dr. Saltz. You’re listening to TMC Health Talk with Texoma Medical Center, and for more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much, for listening.