Colorectal cancer is a disease that can affect anyone, although the risk increases with age. According to the CDC, Colorectal cancer is the second-most common cause of cancer-related deaths in the United States in both men and women combined and is known as a "silent" disease because it often does not produce symptoms, until the cancer is difficult to cure.
In this segment, Jatinder Pruthi, MD., board certified Gastroenterologist and a member of the medical staff at Palmdale Regional Medical Center. explains that if the cancer is found and treated at an early stage, before symptoms develop, the outcomes may be much better.
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Important Information About Colon Cancer
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Learn more about Jatinder Pruthi, MD
Jatinder Pruthi, MD
Jatinder Pruthi, MD, is board certified in Gastroenterology and a member of the medical staff at Palmdale Regional Medical Center.Learn more about Jatinder Pruthi, MD
Transcription:
Melanie Cole (Host): According to the CDC, of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and women. My guest today is Dr. Jay Pruthi. He’s a gastroenterologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Pruthi. What are you seeing today in terms of colon cancer? Are we seeing on the rise or in decline?
Dr. Jay Pruthi (Guest): Thank you, Melanie, for inviting me to the talk. The colon cancer good news is that it is declining due to the more awareness thanks to the media campaigns and screening. A lot of people are aware of it, participating in the screening, and the colon cancer is declining. That’s the good news. Now the question is, what is colon cancer? Colorectal cancer - we combined it, colon and rectum cancer - is a disease in which the cancer cells form in the inner lining of the colon or rectum, so together the colon and the rectum make up the large bowel or the large intestine. So, this is the second leading cause of cancer deaths in this country and it is very important that we pay attention to it, do the screening, do our part, so that we can prevent the deaths from colorectal cancer.
Melanie: So, what are some of the risk factors? What would predispose somebody to increase their risk of colorectal cancers?
Dr. Pruthi: The risk factors for colorectal cancer are any family history of colon cancer, personal history of colon polyps or colon cancer, smoking, obesity, sedentary lifestyle, and hereditary of other cancer syndromes. These are some of the important risks factors. Some of them we can modify and some of them we can’t modify--like family history, you can’t modify, but the lifestyle modifications we can do, so that we reduce the risk for colorectal cancer.
Melanie: So, Dr. Pruthi, let’s get into the screening because this has been called one of the best screening tools of this age right now because it actually has been said that this can prevent colon cancer. Let’s talk about a colonoscopy. What is involved and who should have their first colonoscopy when?
Dr. Pruthi: That’s a very important question. What are the strategies for reducing colorectal cancer? So everybody at age 50 should undergo a screening colonoscopy. What is a screening colonoscopy? It’s very simple. People drink liquid to clean out the colon the day before the procedure. There are different kind of preparations for the colon cleaning available. Once the colon is cleaned, out somebody has to bring you to the endoscopy center or the hospital GI lab where we have an anesthesiologist or the nurse anesthetist who will give sedation to the patients. Generally, there is very minimal discomfort or no pain, then we have large cable-like tubes with a radio camera on the tip that are called “colonoscopies”. So, once the patients are sedated we go through the rectum with this radio camera and look at the whole colon. The colon and the rectum are the large intestine, they are about five to six feet long. We look at the whole colon very carefully. The idea is to look for the polyps because most of the colon cancers start as small polyps. Polyps are small growths; rectal polyps are mushroom-like growths. They start from the colon mucosa and then they continue to grow progressively and become cancerous. So, for example, if a polyp starts to form today it may take about five to ten years before it turns into cancer. So, that means we have this opportunity - this window of opportunity - where we can intervene, go in, find these polyps, and remove them before people have any symptoms, because by the time you develop symptoms from colon cancer, it may be too late, the cancer has spread. So, before you have any symptoms, we want to get there and get these polyps out. Now, once we remove the polyps, we send the polyp for testing and then determine what type of polyp it is and then recommend further screening intervals for colonoscopy depending on the type, size, shape, and number of polyps. So, this is a very, very effective strategy. About 75% of colorectal cancer can be prevented through the screening colonoscopy; one method for screening colonoscopy.
Melanie: So, before we get to what the polyps even mean, Dr. Pruthi, when we’re talking about screening, please reiterate how easy-- because people think that the whole biggest part of a colonoscopy that’s going to be so bad is the prep, but it’s not that big of deal. It’s important that they realize. Then, I’m sure you’ve heard when people say, “Okay, doctor, when are you going to start?” and then you tell them you’re already finished. It’s such an easy test so just reiterate about the prep and how it’s not that difficult to do.
Dr. Pruthi: Yes. Prep, of course people report that this is the most difficult part, but I tell you it is good to clean out the colon once in awhile. A lot of people feel much better after cleaning the colon, actually. Prep is very easy nowadays. Previously, we used to have large gallon of drink to take and clean out the colon. Now there are different kind of preparations available which are smaller in quantity and you can chase it out with large amount of water or Gatorade or any other kind of electrolyte solution and clean the colon out. Of course, you still have to clean the colon out. Now, what we recommend generally is people go on a clear liquid diet 24 to 36 hours before the procedure so that there is less material to push out and then the preparation becomes easy.
Melanie: It really is no big deal and I want to reiterate to the listeners that this is an important screening. Now, Dr. Pruthi, if you find a polyp and you send them for testing at the lab, what is it that you are looking for? Are all polyps cancerous?
Dr. Pruthi: No, not all polyps are cancerous. The polyps can be different kind of polyps. There can be hyperplastic polyps and adenomatous polyps. Adenomatous polyps are the ones which are precancerous polyps. Then, there are tubulovillous adenomas, then we can get into technical terminology, but the bottom line is any polyp is no good. Now, we’ve got to find all the polyps and remove them then the doctor can tell you, depending on the pathology report that what type of polyp it was and what is a further strategy for surveillance colonoscopies, follow-up colonoscopies.
Melanie: If you do find that one of those polyps was cancerous or precancerous, does that mean that treatment will be started? And speak about treatment for colon cancer just a bit.
Dr. Pruthi: Sure. Now, if there is a polyp, even though it was precancerous polyp and it has been removed completely, then you are set; then nothing to worry about. Then, we do colonoscopy in three to five years depending on the number of polyps. If the polyp markings are cancerous, that means there is a colon cancer there that has not been completely removed then we go further. Now, if the cancer is very superficial, it’s still in the superficial very top lining of the mucosa, we can go and do endoscopic mucosal resection to remove that part of the superficial lining endoscopically without undergoing major surgery. That takes care of it. Now, if the cancer cells are penetrating deeper, the stage is higher, then we can do surgery, segmental resection, we call it “segmental resection”. Where there’s a polyp or there’s a small cancer that we have detected early, what I do is we put a tattoo mark inside with an India ink so that the surgeon when they do laparoscopic surgery they can recognize that segment of the colon and they cut out a few inches of the colon, if it’s early cancer, and then they connect inside of it. There is no need for colostomy bag in that situation. Once it is gone then pathology stages tell us that there’s a need for chemotherapy or no. If the colon cancer is very localized and there are no lymph node involvement, then there’s no need for chemotherapy. But if we are diagnosing it at a later stage where it has gone beyond the colon wall and there are lymph nodes around it, then we send the patient for chemotherapy. The chemotherapy is also very successful nowadays. The survival has improved over the last few years.
Melanie: In just the last few minutes, Dr. Pruthi, what would you like to tell people who are concerned about their risk for colon cancer and the importance of screening?
Dr. Pruthi: Yes, risk for colon cancer is family history and men and women both are at equal risk. We used to think men are at higher risk but men tend to get colon cancer at an earlier age than women, but women live longer so they catch up with men. So, the total number of cases in men and women is equal. Anybody with a family history of colon cancer or family history of colon polyps is at risk. If there’s a history of endometrial cancer, ovarian cancer diagnosed before age 50 is a risk factor so these people should go for screening early. Patients of African American inheritance, they are at high risk also because they get colon cancer at a younger age so American College of Gastroenterology recommends that they should go for colon cancer screening at age 45 rather than age 50. Everybody, everybody, average Joe walking down the street at age 50 should come for colon cancer screening. It is very important. It can save lives. Seventy-five percent of the colon cancer can be prevented with screening colonoscopy. Screening colonoscopy as we talked about is very easy, you clean out the colon, come to the endoscopy center or the hospital GI lab, give you anesthesia, do the colonoscopy, get the polyps out, and out you go.
Melanie: And, why should they come to Palmdale Regional Medical Center for their care?
Dr. Pruthi: Palmdale Regional Medical Center is the major healthcare provider in this area. We have good equipment, compassionate care. Our staff is very good, and we do our best to help the patients.
Melanie: Thank you so much, it’s such great information, so important for listeners to hear, Dr. Pruthi. 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 of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks for listening.
Melanie Cole (Host): According to the CDC, of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and women. My guest today is Dr. Jay Pruthi. He’s a gastroenterologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Pruthi. What are you seeing today in terms of colon cancer? Are we seeing on the rise or in decline?
Dr. Jay Pruthi (Guest): Thank you, Melanie, for inviting me to the talk. The colon cancer good news is that it is declining due to the more awareness thanks to the media campaigns and screening. A lot of people are aware of it, participating in the screening, and the colon cancer is declining. That’s the good news. Now the question is, what is colon cancer? Colorectal cancer - we combined it, colon and rectum cancer - is a disease in which the cancer cells form in the inner lining of the colon or rectum, so together the colon and the rectum make up the large bowel or the large intestine. So, this is the second leading cause of cancer deaths in this country and it is very important that we pay attention to it, do the screening, do our part, so that we can prevent the deaths from colorectal cancer.
Melanie: So, what are some of the risk factors? What would predispose somebody to increase their risk of colorectal cancers?
Dr. Pruthi: The risk factors for colorectal cancer are any family history of colon cancer, personal history of colon polyps or colon cancer, smoking, obesity, sedentary lifestyle, and hereditary of other cancer syndromes. These are some of the important risks factors. Some of them we can modify and some of them we can’t modify--like family history, you can’t modify, but the lifestyle modifications we can do, so that we reduce the risk for colorectal cancer.
Melanie: So, Dr. Pruthi, let’s get into the screening because this has been called one of the best screening tools of this age right now because it actually has been said that this can prevent colon cancer. Let’s talk about a colonoscopy. What is involved and who should have their first colonoscopy when?
Dr. Pruthi: That’s a very important question. What are the strategies for reducing colorectal cancer? So everybody at age 50 should undergo a screening colonoscopy. What is a screening colonoscopy? It’s very simple. People drink liquid to clean out the colon the day before the procedure. There are different kind of preparations for the colon cleaning available. Once the colon is cleaned, out somebody has to bring you to the endoscopy center or the hospital GI lab where we have an anesthesiologist or the nurse anesthetist who will give sedation to the patients. Generally, there is very minimal discomfort or no pain, then we have large cable-like tubes with a radio camera on the tip that are called “colonoscopies”. So, once the patients are sedated we go through the rectum with this radio camera and look at the whole colon. The colon and the rectum are the large intestine, they are about five to six feet long. We look at the whole colon very carefully. The idea is to look for the polyps because most of the colon cancers start as small polyps. Polyps are small growths; rectal polyps are mushroom-like growths. They start from the colon mucosa and then they continue to grow progressively and become cancerous. So, for example, if a polyp starts to form today it may take about five to ten years before it turns into cancer. So, that means we have this opportunity - this window of opportunity - where we can intervene, go in, find these polyps, and remove them before people have any symptoms, because by the time you develop symptoms from colon cancer, it may be too late, the cancer has spread. So, before you have any symptoms, we want to get there and get these polyps out. Now, once we remove the polyps, we send the polyp for testing and then determine what type of polyp it is and then recommend further screening intervals for colonoscopy depending on the type, size, shape, and number of polyps. So, this is a very, very effective strategy. About 75% of colorectal cancer can be prevented through the screening colonoscopy; one method for screening colonoscopy.
Melanie: So, before we get to what the polyps even mean, Dr. Pruthi, when we’re talking about screening, please reiterate how easy-- because people think that the whole biggest part of a colonoscopy that’s going to be so bad is the prep, but it’s not that big of deal. It’s important that they realize. Then, I’m sure you’ve heard when people say, “Okay, doctor, when are you going to start?” and then you tell them you’re already finished. It’s such an easy test so just reiterate about the prep and how it’s not that difficult to do.
Dr. Pruthi: Yes. Prep, of course people report that this is the most difficult part, but I tell you it is good to clean out the colon once in awhile. A lot of people feel much better after cleaning the colon, actually. Prep is very easy nowadays. Previously, we used to have large gallon of drink to take and clean out the colon. Now there are different kind of preparations available which are smaller in quantity and you can chase it out with large amount of water or Gatorade or any other kind of electrolyte solution and clean the colon out. Of course, you still have to clean the colon out. Now, what we recommend generally is people go on a clear liquid diet 24 to 36 hours before the procedure so that there is less material to push out and then the preparation becomes easy.
Melanie: It really is no big deal and I want to reiterate to the listeners that this is an important screening. Now, Dr. Pruthi, if you find a polyp and you send them for testing at the lab, what is it that you are looking for? Are all polyps cancerous?
Dr. Pruthi: No, not all polyps are cancerous. The polyps can be different kind of polyps. There can be hyperplastic polyps and adenomatous polyps. Adenomatous polyps are the ones which are precancerous polyps. Then, there are tubulovillous adenomas, then we can get into technical terminology, but the bottom line is any polyp is no good. Now, we’ve got to find all the polyps and remove them then the doctor can tell you, depending on the pathology report that what type of polyp it was and what is a further strategy for surveillance colonoscopies, follow-up colonoscopies.
Melanie: If you do find that one of those polyps was cancerous or precancerous, does that mean that treatment will be started? And speak about treatment for colon cancer just a bit.
Dr. Pruthi: Sure. Now, if there is a polyp, even though it was precancerous polyp and it has been removed completely, then you are set; then nothing to worry about. Then, we do colonoscopy in three to five years depending on the number of polyps. If the polyp markings are cancerous, that means there is a colon cancer there that has not been completely removed then we go further. Now, if the cancer is very superficial, it’s still in the superficial very top lining of the mucosa, we can go and do endoscopic mucosal resection to remove that part of the superficial lining endoscopically without undergoing major surgery. That takes care of it. Now, if the cancer cells are penetrating deeper, the stage is higher, then we can do surgery, segmental resection, we call it “segmental resection”. Where there’s a polyp or there’s a small cancer that we have detected early, what I do is we put a tattoo mark inside with an India ink so that the surgeon when they do laparoscopic surgery they can recognize that segment of the colon and they cut out a few inches of the colon, if it’s early cancer, and then they connect inside of it. There is no need for colostomy bag in that situation. Once it is gone then pathology stages tell us that there’s a need for chemotherapy or no. If the colon cancer is very localized and there are no lymph node involvement, then there’s no need for chemotherapy. But if we are diagnosing it at a later stage where it has gone beyond the colon wall and there are lymph nodes around it, then we send the patient for chemotherapy. The chemotherapy is also very successful nowadays. The survival has improved over the last few years.
Melanie: In just the last few minutes, Dr. Pruthi, what would you like to tell people who are concerned about their risk for colon cancer and the importance of screening?
Dr. Pruthi: Yes, risk for colon cancer is family history and men and women both are at equal risk. We used to think men are at higher risk but men tend to get colon cancer at an earlier age than women, but women live longer so they catch up with men. So, the total number of cases in men and women is equal. Anybody with a family history of colon cancer or family history of colon polyps is at risk. If there’s a history of endometrial cancer, ovarian cancer diagnosed before age 50 is a risk factor so these people should go for screening early. Patients of African American inheritance, they are at high risk also because they get colon cancer at a younger age so American College of Gastroenterology recommends that they should go for colon cancer screening at age 45 rather than age 50. Everybody, everybody, average Joe walking down the street at age 50 should come for colon cancer screening. It is very important. It can save lives. Seventy-five percent of the colon cancer can be prevented with screening colonoscopy. Screening colonoscopy as we talked about is very easy, you clean out the colon, come to the endoscopy center or the hospital GI lab, give you anesthesia, do the colonoscopy, get the polyps out, and out you go.
Melanie: And, why should they come to Palmdale Regional Medical Center for their care?
Dr. Pruthi: Palmdale Regional Medical Center is the major healthcare provider in this area. We have good equipment, compassionate care. Our staff is very good, and we do our best to help the patients.
Melanie: Thank you so much, it’s such great information, so important for listeners to hear, Dr. Pruthi. 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 of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks for listening.