Colon Cancer and the Importance of Screening
From the Show: SolutionHealth
Summary:
Air Date: 3/5/21
Duration: 10 Minutes
Dr. Kaczanowski discusses colon cancer, and when you should get screened.
Transcription:
Caitlin Whyte (Host): According to the CDC, regular screening beginning at age 50 is the key to preventing colorectal cancer and finding it early. So, today we are talking about those screenings, how they save lives and what your options are with Dr. Michael Kaczanowski. He is Board Certified in Internal Medicine and Gastroenterology, and he is a Gastroenterologist at Solution Health. This is the Solution Health podcast from Solution Health. I'm your host, Caitlin Whyte. So, Doctor to start us off, tell us how screening saves lives.
Michael Kaczanowski, MD (Guest): Well, the vast majority of colorectal cancers develop from small precancerous polyps. Polyps are growths that form in the lining of the colon, right? Now, colon cancer screening tests can detect these polyps and cancers. And if a polyp is found, it's removed to try to prevent it from becoming something worse. So, regular screening for and removal of polyps reduces your risk of developing colorectal cancer by about say 90% with a colonoscopy. Similarly, if a cancer is found, it can be treated hopefully at an earlier stage than would have been found otherwise. Early detection of cancers that are already present in the colon increases the chance of successful treatment and decreases the chance of dying as a result of the cancer.
Host: So, I decided to have the screening, next step. What are my options?
Dr. Kaczanowski: So, there's several. There are several tests that are commonly used for colon cancer screening that can detect these precancerous polyps or adeomas then it can lead to cancer prevention or detect cancers at an early more treatable stage. First, you should always discuss with your healthcare provider, the available options and choose a testing strategy that works best for you. Then like most things in medicine, there are several options and each has its own pluses and minuses. First is colonoscopy. This is a procedure where a doctor using a thin flexible fiber optic camera sees the lining of the entire colon and the rectum.
It's the most sensitive test allowing for detection of the very smallest or earliest of the polyps which can be removed right then during the procedure. With sedation, it's perfectly comfortable. The downside is, you'll need to take a laxative to clean your bowels the night before. And there's a small risk of complications like bleeding or perforation.
Next is CT colonography, sometimes it's called virtual colonoscopy. This is a test that uses a CAT scan to take images of the entire colon to make 2d and 3d images. The major advantage is that it doesn't require sedation and it's non-invasive. Downside, you still need the clean-out and any questionable finding is going to require following up with a colonoscopy.
Third one is something called FIT DNA or fecal immunochemical testing. This is sometimes called Cologuard. It's on TV a lot. This is a test where you collect a small stool sample at home and mail it off to be tested. And they look for microscopic traces of blood and genetic markers looking for cancer cells. And it finds about 93% of colon cancers. It does a little less well looking for precancerous polyps. And it's maybe a little bit prone to false positives. There's a couple other tests, but they're less often used.
Host: So is one screening enough or should I be screened more often?
Dr. Kaczanowski: Well, it depends on the screening strategy that you choose and the results of that test. Generally speaking, we like to think of colonoscopy as the gold standard. Because while it like everything else has its pluses and minuses, it is the most sensitive and it has a very defined set of guidelines for followup. But by itself, it's a pretty good test.
Host: And when it comes to colon cancer, what are the stages?
Dr. Kaczanowski: So, there's a few stages to colon cancer. Starting off maybe before becoming a cancer, is this polyp that we were talking about. Most colon cancer, the vast majority of colon cancers develop from non-cancerous growths called adenomas, 95% of them. Stage one, colon cancer is in situ. This is where a cancer is formed, but it's limited to the polyp. It's growing inside the polyp, but not growing inside the colon or rectum walls. Stage two is local growth. It's now growing beyond the polyp into the walls itself, stage three is regional where it gets into the tissue, into the lymph nodes. And then unfortunately, stage four is distant where it's spread beyond the colon into the other parts of the body, like the liver or the lungs.
Host: And if polyps come up in my colonoscopy or my other screening, but they're not considered cancerous. Why should I still have those removed?
Dr. Kaczanowski: Well it really comes back to what polyps are and why we get them. So, going back a little bit, polyps come in two basic flavors. Hyperplastic polyps, completely benign. They can never become cancers. Adenomas on the other hand, can. It turns out that about 95% of sporadic colon cancers began their life as a small benign adenoma. Just finding something on one of these tests sometimes it's very difficult just by looking to tell the difference between a hyperplastic polyp and the adenoma.
Why we get these polyps in the first place has to do with progression and a little sprinkling of genetics. So, the cells that make up the colon are programed from the very beginning, deep down in a gland, somewhere to proliferate and then differentiate. And as they move towards the surface, they stop proliferating and differentiating and eventually they die and exfoliate. It's very programmed life, death of cells. It's what they do. When there's a mistake in the genetics or what we call a mutation, this programming doesn't really happen right. And they don't die off quite right. And eventually you end up with a small blob of cells. Now, most adenomas never degrade into cancers, but they absolutely have the potential to over time. That's why it's so important to look for them, find them, remove them before they ever get that chance.
Host: And what advice would you give to patients who are unfortunately diagnosed with colon cancer?
Dr. Kaczanowski: Follow up with your doctor. That's the best thing to do. There's so many wonderful treatments now. Things have come such a far away, even in just the last few years, new treatments are available. All sorts of therapies. The future is very bright.
Host: Well, Doctor wrapping up here, is there anything else you'd like to add to our conversation about screening and colon cancer?
Dr. Kaczanowski: Probably the best piece of advice I can give is don't be afraid of colon cancer screening. I hear it all the time, even from people in my own family that they are just either embarrassed or afraid. Don't be. The real scary thing is colon cancer. Colon cancer screening, not so scary.
Host: Well, Dr. Kaczanowski, thank you so much for your time and for these reminders to stay on top of our screenings and stay in touch with our doctors. For more information, you can always visit This email address is being protected from spambots. You need JavaScript enabled to view it. . And this has been the Solution Health podcast from Solution Health. I'm your host, Caitlin Whyte. Stay well.
Caitlin Whyte (Host): According to the CDC, regular screening beginning at age 50 is the key to preventing colorectal cancer and finding it early. So, today we are talking about those screenings, how they save lives and what your options are with Dr. Michael Kaczanowski. He is Board Certified in Internal Medicine and Gastroenterology, and he is a Gastroenterologist at Solution Health. This is the Solution Health podcast from Solution Health. I'm your host, Caitlin Whyte. So, Doctor to start us off, tell us how screening saves lives.
Michael Kaczanowski, MD (Guest): Well, the vast majority of colorectal cancers develop from small precancerous polyps. Polyps are growths that form in the lining of the colon, right? Now, colon cancer screening tests can detect these polyps and cancers. And if a polyp is found, it's removed to try to prevent it from becoming something worse. So, regular screening for and removal of polyps reduces your risk of developing colorectal cancer by about say 90% with a colonoscopy. Similarly, if a cancer is found, it can be treated hopefully at an earlier stage than would have been found otherwise. Early detection of cancers that are already present in the colon increases the chance of successful treatment and decreases the chance of dying as a result of the cancer.
Host: So, I decided to have the screening, next step. What are my options?
Dr. Kaczanowski: So, there's several. There are several tests that are commonly used for colon cancer screening that can detect these precancerous polyps or adeomas then it can lead to cancer prevention or detect cancers at an early more treatable stage. First, you should always discuss with your healthcare provider, the available options and choose a testing strategy that works best for you. Then like most things in medicine, there are several options and each has its own pluses and minuses. First is colonoscopy. This is a procedure where a doctor using a thin flexible fiber optic camera sees the lining of the entire colon and the rectum.
It's the most sensitive test allowing for detection of the very smallest or earliest of the polyps which can be removed right then during the procedure. With sedation, it's perfectly comfortable. The downside is, you'll need to take a laxative to clean your bowels the night before. And there's a small risk of complications like bleeding or perforation.
Next is CT colonography, sometimes it's called virtual colonoscopy. This is a test that uses a CAT scan to take images of the entire colon to make 2d and 3d images. The major advantage is that it doesn't require sedation and it's non-invasive. Downside, you still need the clean-out and any questionable finding is going to require following up with a colonoscopy.
Third one is something called FIT DNA or fecal immunochemical testing. This is sometimes called Cologuard. It's on TV a lot. This is a test where you collect a small stool sample at home and mail it off to be tested. And they look for microscopic traces of blood and genetic markers looking for cancer cells. And it finds about 93% of colon cancers. It does a little less well looking for precancerous polyps. And it's maybe a little bit prone to false positives. There's a couple other tests, but they're less often used.
Host: So is one screening enough or should I be screened more often?
Dr. Kaczanowski: Well, it depends on the screening strategy that you choose and the results of that test. Generally speaking, we like to think of colonoscopy as the gold standard. Because while it like everything else has its pluses and minuses, it is the most sensitive and it has a very defined set of guidelines for followup. But by itself, it's a pretty good test.
Host: And when it comes to colon cancer, what are the stages?
Dr. Kaczanowski: So, there's a few stages to colon cancer. Starting off maybe before becoming a cancer, is this polyp that we were talking about. Most colon cancer, the vast majority of colon cancers develop from non-cancerous growths called adenomas, 95% of them. Stage one, colon cancer is in situ. This is where a cancer is formed, but it's limited to the polyp. It's growing inside the polyp, but not growing inside the colon or rectum walls. Stage two is local growth. It's now growing beyond the polyp into the walls itself, stage three is regional where it gets into the tissue, into the lymph nodes. And then unfortunately, stage four is distant where it's spread beyond the colon into the other parts of the body, like the liver or the lungs.
Host: And if polyps come up in my colonoscopy or my other screening, but they're not considered cancerous. Why should I still have those removed?
Dr. Kaczanowski: Well it really comes back to what polyps are and why we get them. So, going back a little bit, polyps come in two basic flavors. Hyperplastic polyps, completely benign. They can never become cancers. Adenomas on the other hand, can. It turns out that about 95% of sporadic colon cancers began their life as a small benign adenoma. Just finding something on one of these tests sometimes it's very difficult just by looking to tell the difference between a hyperplastic polyp and the adenoma.
Why we get these polyps in the first place has to do with progression and a little sprinkling of genetics. So, the cells that make up the colon are programed from the very beginning, deep down in a gland, somewhere to proliferate and then differentiate. And as they move towards the surface, they stop proliferating and differentiating and eventually they die and exfoliate. It's very programmed life, death of cells. It's what they do. When there's a mistake in the genetics or what we call a mutation, this programming doesn't really happen right. And they don't die off quite right. And eventually you end up with a small blob of cells. Now, most adenomas never degrade into cancers, but they absolutely have the potential to over time. That's why it's so important to look for them, find them, remove them before they ever get that chance.
Host: And what advice would you give to patients who are unfortunately diagnosed with colon cancer?
Dr. Kaczanowski: Follow up with your doctor. That's the best thing to do. There's so many wonderful treatments now. Things have come such a far away, even in just the last few years, new treatments are available. All sorts of therapies. The future is very bright.
Host: Well, Doctor wrapping up here, is there anything else you'd like to add to our conversation about screening and colon cancer?
Dr. Kaczanowski: Probably the best piece of advice I can give is don't be afraid of colon cancer screening. I hear it all the time, even from people in my own family that they are just either embarrassed or afraid. Don't be. The real scary thing is colon cancer. Colon cancer screening, not so scary.
Host: Well, Dr. Kaczanowski, thank you so much for your time and for these reminders to stay on top of our screenings and stay in touch with our doctors. For more information, you can always visit This email address is being protected from spambots. You need JavaScript enabled to view it. . And this has been the Solution Health podcast from Solution Health. I'm your host, Caitlin Whyte. Stay well.