Cancer of colon or rectum is one of the most common forms of cancer. Risk of the cancer increase once a person reaches late 40s and beyond. Gastroenterologists are usually the first to detect this problem, as a result of a colonoscopy. With better screening and earlier treatment, the death rate from this disease has continued to decline.
Donald Petroski, MD, discusses colonoscopy, how easy and painless this procedure is and how it is the very best way to reduce your risk of colon cancer.
Selected Podcast
Colon Cancer Screening: A Colonoscopy Could Save Your Life
Featured Speaker:
Donald Petroski, MD
Dr. Donald Petroski is a gastroenterologist in Willingboro, New Jersey and is affiliated with Our Lady of Lourdes Medical Center.Transcription:
Melanie Cole (Host): According to the American Cancer Society; colorectal cancer is the third leading cause of cancer related deaths in the United States. But how do you even know if you are at risk and if so, is there anything you can do to prevent it? My guest is Dr. Donald Petroski. He’s a gastroenterologist at Lourdes Medical Center of Burlington County. Dr. Petroski, what are the risk factors of colon cancer?
Donald Petroski, MD (Guest): The biggest risk factor that people have is age. It starts at age 50, by age 65, the greatest risk of developing colorectal cancer occurs. We start screening processes of course earlier because of this. Other risk factors include family history, genetic risk factors for colorectal cancer, inflammatory bowel disease; but I remind my patients who have no symptoms when I ask them about screening, age is a big factor. Many people do not show an interest in doing any form of screening because they have no symptoms and they forget that colorectal cancer is a preventable disease and anyone over the age of 50, for the average population, over the age of 45 for the African American population, means they should qualify and request and or follow the instructions of their doctor to get colorectal cancer screening done.
Melanie: And I love that you said it can prevent cancer because people do not understand that. So, let’s speak about colonoscopy for a minute. You mentioned the first one at age 50, if you are African American at 45. People are so scared of the prep, but the test is so quick and easy. Speak about colonoscopy and what they can expect.
Dr. Petroski: Having undergone at least three colonoscopies in my lifetime, despite my young age; colonoscopy is the gold standard nationally and internationally to detect colon polyps which are little benign tumors that we feel are the precursors of a colorectal cancer. The removal of a polyp in a person with no symptoms means if we do a good prep, we spend plenty of time looking, we search and remove polyps; we essentially can prevent cancer. The idea is to do colonoscopy in a screening manner depending on the age of the individual and prevent the development of polyps, prevent polyps from staying in the colon and developing cancer eventually. This is a preventative option for patients and waiting to have symptoms is a dangerous thing and it is all preventable. Other screenings we do look for cancer. This essentially takes a normal patient; no symptoms and we can prevent the cancer from even developing. It is noted that 70% of the people we find colorectal cancer, really have no factors that put them at risk other than age. They have no family history, no Crohn’s disease, etc. and we find them for colon rectal cancer. We feel that the 60% that we have been finding that qualify for screenings must be pushed to 80% nationally to save more lives and over the years, since 1975 until the past couple of years; we have dropped the rate of colorectal cancer at least 33% by the screening process and colonoscopy is that major form of protection.
Melanie: Tell us a little bit about the prep. Because that seems to be what people fear the most. And I would imagine as someone who has also had many colonoscopies in my young life, that I wake up and say when are you going to start, and the doctor says I’m already done. But it’s just the prep that people are so scared of. Why do you think that that is? And are there new preps coming down the line that will make it just a little bit easier?
Dr. Petroski: Having performed close to 35,000 colonoscopies in my time, prep that we provide for patients is a very annoying thing to have to take. The issue is that our – there are at least multiple choices that a doctor can use to allow a good bowel prep. The critical fact that we need at GI doctors, is to have a good clean colon to be able to see polyps, not to miss anything that could go on to cause a problem down the road for the patient, but a poor prep prevents us from doing a good job and saving this patient from developing colorectal cancer. It’s difficult to take. I ask them to take a liquid diet, breakfast lunch and dinner. There are various volumes of preps that can be used by the doctor. One complaint I more commonly hear, is I get nauseated when I take this. So, I give them a medicine for nausea before they start. They are able to get down the prep effectively. I ask them not to take it all at once, like the package insert says. I spread it out over a number of hours. We have several options in this country. I use the afternoon for half the prep, the early evening for the second half. Some doctors will have them take half the night before, half the morning of the procedure. There are ways the doctor can get around that annoyance of having to take the prep, but I have had no difficulty personally taking it without any need but I’m not sure if prep is the whole issue.
I think that people that are reluctant to have it done, are concerned about finding something. They really don’t want to know that there may be something that could cause trouble. They wait, and I have seen my fair share of people who get into trouble and could have easily been prevented from getting colon cancer by being aggressive and following the recommendations now nationally which is screening. Screening is best done by a colonoscopy, but there are other alternatives; a stool check for blood, which is not as accurate a test we can do, but there is also Cologuard which is a blood DNA testing you can do to screen a patient. Now neither one of these tests meet the accuracy of the colonoscopy, but there are people with fear to get studied. They really don’t want to know. But there are options other than colonoscopy that can be done. If you want to save a life, please follow some of the recommendations offered by family doctor when they decide to either order a test on their own or refer the patient to a GI doctor for a colonoscopy. There’s options other than the colonoscopy. I don’t recommend them. Because I know it’s the best way to save a life, but if we start and find something in the lesser testing, we may be able to convince patients to go do a more thorough study which would be a colonoscopy.
Melanie: Dr. Petroski, if someone does plan on having that or if they haven’t had one yet; what are some of the signs and symptoms that would send them to see GI? When do you worry about rectal bleeding, because that’s an area of confusion as well, if people have hemorrhoids, then they say oh well it’s bright red blood, it’s just hemorrhoids, I don’t have to worry. What do you tell them when they say that?
Dr. Petroski: I think that any symptom, rectal bleeding included, change of bowel habits, weight loss, anemia, those people have symptoms that concern a primary doctor and or even a GYN doctor and they refer the patient to the GI doctor for assessment. My feeling is, that if a patient has some bleeding, and I suspect it’s hemorrhoids, and even during their examination at the visit when I am seeing the patient in consultation, I recommend colonoscopy because I feel this is a golden opportunity to make sure that that patient is free and clear of any risk.
And I can site two patients I did one time, a 40-year-old woman and a 42-year-old woman, did not know each other, showed up the same day at the office. I set them up for colonoscopy and they agreed to it because I said if I find nothing, I’ll get you to a surgeon and he will take out those hemorrhoids. They said great. When I did the procedure on both, one had 8 polyps the size of golf balls in the colon that I removed. It took quite a while to get them out. Two of those polyps, big polyps had cancer on it. The other patient had a stage 1 colorectal cancer. And that was ten to fifteen years ago. Both women are alive, and they came in at 40 and 42 because they said, you know my bleeding is persisting, maybe I should get it checked out. And those two people are alive to this day because they were proactive in responding to rectal bleeding.
Again, the screening process is get a patient before they ever have symptoms. But if they have some symptoms, please do not delay because it can make a difference in survival. Early detection, stage 1 is 90-95% survival. You wait until stage 4, when they have serious symptoms that are protracted, it could be a 10% survival. And so therefore, symptoms are definitely a reason for a patient to want to be checked and a primary doctor would want to refer a patient, but we want to take care of these people. If we want to save lives before that ever happens and that’s the whole goal of colorectal cancer screening at the age of 50 for the average population and we want to get the again, African Americans in earlier because malignancies they develop in the colon tend to be much more aggressive.
Melanie: Wonderful information Dr. One last question before we wrap up. If you have found polyps, then does that change the screening years that go by before their next screening?
Dr. Petroski: Yes. I determine what the polyp looks like. I wait until I see the patient in follow up and depending on the type of polyp I took out; I said of these five types of polyps, this is the one that has zero chance to go cancer, this is one that has 25%, 50%, and a certain we discovered over the past five years has over 75% chance of going cancerous. So, those people are going to be screened at one to three years, depending on the type. There are ones that are maybe a very small benign one, we can wait five years. But waiting ten years is a disaster. I’m even concerned about the recommendations for ten-year intervals after a normal colonoscopy. Because I know that in two years after I’m done with that patient, a new polyp can develop and if it sits there for eight years, I’m worried about what I will find the next time. I think we have to be very proactive with these patients and of all the testing for screening, we do as doctors; this again, colorectal cancer screening of the various types is the one way to make a difference in survival for these people.
Melanie: It’s such great information and so important for listeners to hear and take to heart. To schedule a screening appointment with the Lourdes Colorectal Specialist please call 1-888-LOURDES. That’s 1-888-LOURDES. Or visit www.lourdesnet.org that’s www.lourdesnet.org . Thank you so much Dr. Petroski. You are an excellent guest and thank you so much for being with us today. This is Lourdes Health Talk. I’m Melanie Cole. Thanks for listening.
Melanie Cole (Host): According to the American Cancer Society; colorectal cancer is the third leading cause of cancer related deaths in the United States. But how do you even know if you are at risk and if so, is there anything you can do to prevent it? My guest is Dr. Donald Petroski. He’s a gastroenterologist at Lourdes Medical Center of Burlington County. Dr. Petroski, what are the risk factors of colon cancer?
Donald Petroski, MD (Guest): The biggest risk factor that people have is age. It starts at age 50, by age 65, the greatest risk of developing colorectal cancer occurs. We start screening processes of course earlier because of this. Other risk factors include family history, genetic risk factors for colorectal cancer, inflammatory bowel disease; but I remind my patients who have no symptoms when I ask them about screening, age is a big factor. Many people do not show an interest in doing any form of screening because they have no symptoms and they forget that colorectal cancer is a preventable disease and anyone over the age of 50, for the average population, over the age of 45 for the African American population, means they should qualify and request and or follow the instructions of their doctor to get colorectal cancer screening done.
Melanie: And I love that you said it can prevent cancer because people do not understand that. So, let’s speak about colonoscopy for a minute. You mentioned the first one at age 50, if you are African American at 45. People are so scared of the prep, but the test is so quick and easy. Speak about colonoscopy and what they can expect.
Dr. Petroski: Having undergone at least three colonoscopies in my lifetime, despite my young age; colonoscopy is the gold standard nationally and internationally to detect colon polyps which are little benign tumors that we feel are the precursors of a colorectal cancer. The removal of a polyp in a person with no symptoms means if we do a good prep, we spend plenty of time looking, we search and remove polyps; we essentially can prevent cancer. The idea is to do colonoscopy in a screening manner depending on the age of the individual and prevent the development of polyps, prevent polyps from staying in the colon and developing cancer eventually. This is a preventative option for patients and waiting to have symptoms is a dangerous thing and it is all preventable. Other screenings we do look for cancer. This essentially takes a normal patient; no symptoms and we can prevent the cancer from even developing. It is noted that 70% of the people we find colorectal cancer, really have no factors that put them at risk other than age. They have no family history, no Crohn’s disease, etc. and we find them for colon rectal cancer. We feel that the 60% that we have been finding that qualify for screenings must be pushed to 80% nationally to save more lives and over the years, since 1975 until the past couple of years; we have dropped the rate of colorectal cancer at least 33% by the screening process and colonoscopy is that major form of protection.
Melanie: Tell us a little bit about the prep. Because that seems to be what people fear the most. And I would imagine as someone who has also had many colonoscopies in my young life, that I wake up and say when are you going to start, and the doctor says I’m already done. But it’s just the prep that people are so scared of. Why do you think that that is? And are there new preps coming down the line that will make it just a little bit easier?
Dr. Petroski: Having performed close to 35,000 colonoscopies in my time, prep that we provide for patients is a very annoying thing to have to take. The issue is that our – there are at least multiple choices that a doctor can use to allow a good bowel prep. The critical fact that we need at GI doctors, is to have a good clean colon to be able to see polyps, not to miss anything that could go on to cause a problem down the road for the patient, but a poor prep prevents us from doing a good job and saving this patient from developing colorectal cancer. It’s difficult to take. I ask them to take a liquid diet, breakfast lunch and dinner. There are various volumes of preps that can be used by the doctor. One complaint I more commonly hear, is I get nauseated when I take this. So, I give them a medicine for nausea before they start. They are able to get down the prep effectively. I ask them not to take it all at once, like the package insert says. I spread it out over a number of hours. We have several options in this country. I use the afternoon for half the prep, the early evening for the second half. Some doctors will have them take half the night before, half the morning of the procedure. There are ways the doctor can get around that annoyance of having to take the prep, but I have had no difficulty personally taking it without any need but I’m not sure if prep is the whole issue.
I think that people that are reluctant to have it done, are concerned about finding something. They really don’t want to know that there may be something that could cause trouble. They wait, and I have seen my fair share of people who get into trouble and could have easily been prevented from getting colon cancer by being aggressive and following the recommendations now nationally which is screening. Screening is best done by a colonoscopy, but there are other alternatives; a stool check for blood, which is not as accurate a test we can do, but there is also Cologuard which is a blood DNA testing you can do to screen a patient. Now neither one of these tests meet the accuracy of the colonoscopy, but there are people with fear to get studied. They really don’t want to know. But there are options other than colonoscopy that can be done. If you want to save a life, please follow some of the recommendations offered by family doctor when they decide to either order a test on their own or refer the patient to a GI doctor for a colonoscopy. There’s options other than the colonoscopy. I don’t recommend them. Because I know it’s the best way to save a life, but if we start and find something in the lesser testing, we may be able to convince patients to go do a more thorough study which would be a colonoscopy.
Melanie: Dr. Petroski, if someone does plan on having that or if they haven’t had one yet; what are some of the signs and symptoms that would send them to see GI? When do you worry about rectal bleeding, because that’s an area of confusion as well, if people have hemorrhoids, then they say oh well it’s bright red blood, it’s just hemorrhoids, I don’t have to worry. What do you tell them when they say that?
Dr. Petroski: I think that any symptom, rectal bleeding included, change of bowel habits, weight loss, anemia, those people have symptoms that concern a primary doctor and or even a GYN doctor and they refer the patient to the GI doctor for assessment. My feeling is, that if a patient has some bleeding, and I suspect it’s hemorrhoids, and even during their examination at the visit when I am seeing the patient in consultation, I recommend colonoscopy because I feel this is a golden opportunity to make sure that that patient is free and clear of any risk.
And I can site two patients I did one time, a 40-year-old woman and a 42-year-old woman, did not know each other, showed up the same day at the office. I set them up for colonoscopy and they agreed to it because I said if I find nothing, I’ll get you to a surgeon and he will take out those hemorrhoids. They said great. When I did the procedure on both, one had 8 polyps the size of golf balls in the colon that I removed. It took quite a while to get them out. Two of those polyps, big polyps had cancer on it. The other patient had a stage 1 colorectal cancer. And that was ten to fifteen years ago. Both women are alive, and they came in at 40 and 42 because they said, you know my bleeding is persisting, maybe I should get it checked out. And those two people are alive to this day because they were proactive in responding to rectal bleeding.
Again, the screening process is get a patient before they ever have symptoms. But if they have some symptoms, please do not delay because it can make a difference in survival. Early detection, stage 1 is 90-95% survival. You wait until stage 4, when they have serious symptoms that are protracted, it could be a 10% survival. And so therefore, symptoms are definitely a reason for a patient to want to be checked and a primary doctor would want to refer a patient, but we want to take care of these people. If we want to save lives before that ever happens and that’s the whole goal of colorectal cancer screening at the age of 50 for the average population and we want to get the again, African Americans in earlier because malignancies they develop in the colon tend to be much more aggressive.
Melanie: Wonderful information Dr. One last question before we wrap up. If you have found polyps, then does that change the screening years that go by before their next screening?
Dr. Petroski: Yes. I determine what the polyp looks like. I wait until I see the patient in follow up and depending on the type of polyp I took out; I said of these five types of polyps, this is the one that has zero chance to go cancer, this is one that has 25%, 50%, and a certain we discovered over the past five years has over 75% chance of going cancerous. So, those people are going to be screened at one to three years, depending on the type. There are ones that are maybe a very small benign one, we can wait five years. But waiting ten years is a disaster. I’m even concerned about the recommendations for ten-year intervals after a normal colonoscopy. Because I know that in two years after I’m done with that patient, a new polyp can develop and if it sits there for eight years, I’m worried about what I will find the next time. I think we have to be very proactive with these patients and of all the testing for screening, we do as doctors; this again, colorectal cancer screening of the various types is the one way to make a difference in survival for these people.
Melanie: It’s such great information and so important for listeners to hear and take to heart. To schedule a screening appointment with the Lourdes Colorectal Specialist please call 1-888-LOURDES. That’s 1-888-LOURDES. Or visit www.lourdesnet.org that’s www.lourdesnet.org . Thank you so much Dr. Petroski. You are an excellent guest and thank you so much for being with us today. This is Lourdes Health Talk. I’m Melanie Cole. Thanks for listening.
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