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Melanie Cole (Host): According to the American Cancer Society, excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. My guest today is Dr. Marjun Philip Duldulao. He's a colon and rectal surgeon and a member of the medical staff at Palmdale Regional Medical Center as well as a member of the medical staff at Keck Medicine of USC. Welcome to the show, doctor. So, let's just talk about who is at risk for colorectal cancer.

Dr. Marjun Philip Duldulao (Guest): In general, the American population has been shown to be more at risk for colon and rectal cancers compared to the international populations and they mainly say that is maybe related to diet, lifestyle, and other sort of extraneous factors including genetics and such, but however, what we're noticing in our field and in operating on patients with colon or rectal cancers and treating them is that also, because of how we are screening and diagnosing these patients earlier, we're seeing a higher incidence with younger patients with colon or rectal cancer.

Melanie: Is there screening available for colorectal cancer?

Dr. Duldulao: Absolutely. The best screening is basically a physical examination by your primary care physician, but also colonoscopy that are at designated intervals of 50 years of age. Obviously, these can be tailored depending on whether the patient has any prior history or family history of colon or rectal cancer and that they should see their primary care or gastroenterologist at their earliest convenience at an appropriate time period.

Melanie: If somebody is diagnosed with colon cancer or colorectal cancer, then what do you tell them is the first line of defense? Because that can be quite a scary diagnosis.

Dr. Duldulao: It could be and the advantage about colon and rectal treatment today is that it's a multi-modal form of treatment. There are many aspects that need to be considered before treating a patient with colon or rectal cancer. However, the mainstay of treatment, especially for patients with newly-diagnosed colon cancer or rectal cancer, is surgical therapy.

Melanie: So, tell us about some of that surgical therapy.

Dr. Duldulao: So, nowadays, there are new studies that have shown that minimally-invasive surgery, such as laparoscopic or robotic surgery has shown to be as effective as prior surgical management such as a big, open surgery and that is we're able to minimally-invasive surgery and reduce the length of stay in the hospital after colorectal surgery.

Melanie: Dr. Duldulao, I want to jump back for just a second to symptoms because as we talked about screening and we talked about who is at risk, are there some symptoms that would send somebody a red flag? Send someone to the doctor to get checked?

Dr. Duldulao: Sure. Absolutely. Especially patients who are within 50-60 years of age, if they start noticing that they are having new onset rectal bleeding, prominent weight loss, new abdominal extension, localized abdominal pain, they should probably be screened, especially for colon and rectal cancer with a colonoscopy, by a gastroenterologist, or at least see the primary physicians in order to get the ball rolling, so to speak, and get into the appropriate screening therapy for their age and their risk factors.

Melanie: When you mention rectal bleeding, there's a myth going around that if it's bright red, or is it a myth that if it's bright red, it's just hemorrhoids? So, sometimes, people don't pay attention to it.

Dr. Duldulao: I think people should be very well aware about what has been happening with their bodies. Bright red blood can be a symptom of hemorrhoids, but, obviously you don't want to miss something that's much more profound and bigger. So, patients who are of the age of 50, so to speak, or have a family history, especially, of colorectal cancer, or have noted that other symptoms such as weight loss, fatigue, lack of energy, should probably be screened for something more like with a colonoscopy on top of any other physical exam in order to ensure that they don't have anything else other than a hemorrhoid. That's actually something that we get concerned about when, as a colon and rectal surgery, that patients have been noticing that they have these bleeding symptoms, but now they're just more fatigued, they have developed more profound systemic symptoms such as weight loss and fevers, and chronic abdominal pain and then, basically, they are found to have a much more advanced stage of cancer.

Melanie: If you're doing surgery for colorectal cancers, is a colostomy most often involved, or not always?

Dr. Duldulao: Not always and that's the beauty of working with someone who is a colorectal specialist in that we're able to sort of determine what is the best form of treatment for you and devise a best treatment plan, especially a surgical plan. In most cases, patients do not require a colostomy for after colon and rectal surgery.

Melanie: So, then, what is life like for someone with colorectal cancer and are there things that you like them to do, lifestyle wise, to help their treatment along?

Dr. Duldulao: We're not able to fully prevent colon or rectal cancer. There are many factors that lead up to a person who gets colon or rectal cancer. About 85% of these cancers are "sporadic" and can be due to multiple, different factors that could contribute. However, you know if you have a family history, if you are of the appropriate age, such as age of 50, and, basically, if you feel, or if you have any prior history of cancer anywhere else in the body, these are the patients that typically need to be screened early. However, when patients are being treated for colon or rectal cancer, the best thing to do to sort of help with their treatment is to ask questions of the doctor, find a very competent surgeon who can help you treat the colon cancer with surgery but, as well, being involved with the whole team of people who are trying to help them with their colon or rectal cancer.

Melanie: What advancements do you predict in the field of colorectal cancer? What do you see on the horizon?

Dr. Duldulao: So, what we're seeing now is that we're trying to be less invasive as far as the surgical treatment of colon and rectal cancer. If we do have the appropriate patient, where we do find early cancers, we may be able to one, to perform minimally-invasive surgery for these patients, either laparoscopic or robotic. However, there are newer techniques that are on the horizon that are coming where we could remove these tumors endoscopically and that would minimize the amount of scarring on the abdomen, as well.

Melanie: So, what do you say to people when they ask you about colorectal cancer? What do you tell them every day about what's going on in the field?

Dr. Duldulao: I tell them that treatment of colon and rectal cancer is not how it was 10-15 years ago. The surgeries are becoming more aggressive as far as how we are treating it minimally-invasive as well as the treatments for colon and rectal cancer such the chemotherapies and in certain cases with patients with rectal cancer, radiation therapy has improved throughout the last five to ten years. And so, I think the best advice that I could give for anybody who has undergone colorectal cancer, is to find a physician who is up-to-date, knowledgeable, and skilled in treating this disease process as there are many factors that can contribute to how patients do and improve their prognosis with their treatment.

Melanie: And why should they come to Palmdale Regional Medical Center for their care?

Dr. Duldulao: I think the advantage of coming to Palmdale Regional Medical Center is that all the resources are available to a patient. They can speak to an oncologist who would be involved if they need chemotherapy for the treatment of their colon and rectal cancer, as well as the surgeons at Palmdale are very advanced or are very skilled at minimally-invasive techniques in managing patients with colon or rectal cancer. That is one of our degrees of specialty. My specialty is to perform minimally-invasive surgeries for patients who have colon and rectal cancer, including laparoscopic and robotic.

Melanie: Thank you so much for being with us. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, you can go to www.palmdaleregional.com. That's www.palmdaleregional.com. Physicians are independent practitioners who are not employees or agents Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.