Melanie Cole (Host): Colorectal cancer is one of the five most common cancers in the US, yet it is often highly treatable if it’s found and treated early, but because many people are not getting tested the way they should, only about 4 out of every 10 cases are diagnosed at this early stage when treatment is most likely to be successful. My guest today is Dr. Einar G. Lurix. He’s a gastroenterologist with Greenville Health System. Welcome to the show, Dr. Lurix. So tell us about colon cancer and who is most at risk?
Dr. Einar G. Lurix (Guest): Yes, good morning, and thank you for having me here today. Colorectal cancer is a disease of the colon where cells of the colon or rectum divide uncontrollably, ultimately forming a malignant tumor. The colon and the rectum are parts of the digestive system which take up nutrients from food and water and store solid waste until it passes out of the body. Most colorectal cancers begin as a polyp, a growth, in the tissue that lines the inner surface of the colon or rectum. Polyps may be flat or raised. Raised polyps may grow into the inner surface of the colon like mushrooms without a stalk, or grow and become a tumor.
Basically, people that are more likely to develop colorectal cancer is anyone. Everybody has an increased risk for developing colorectal cancer. There are certain subgroups that are more likely to develop cancer, like those people with genetic abnormalities or those with ulcerative colitis or Crohn’s, but everybody has an increased risk of developing colon or rectal cancer.
Melanie: Is there a genetic component to it?
Dr. Lurix: There is. There are genetic predispositions for people to have colon cancer. In fact, there is a gene link that is being studied in all people who develop colon cancer to see if their lifetime risk after having colon cancer is increased for further colon cancers and also to see if their children may be more susceptible to colon cancer. Also, individuals who have over their entire lifetime greater than ten precancerous polyps are suggested to be studied for the same gene as they may also have an increased risk in not only themselves but also their children.
Melanie: So there happens to be a wonderful screening tool for this type of cancer. Who should get screened and explain to us a little bit about colonoscopy?
Dr. Lurix: Sure. Colonoscopy is a very safe, very effective measure to screen for colon cancer. It’s recommended that all individuals aged 50 and above have a screening colonoscopy, African Americans starting at age 45. Those individuals with a family history of colon cancer at an age younger than 60, or two or more individuals in their family with colon cancer, to be screened at age 40, or ten years younger than that individual was diagnosed with lung cancer.
It’s a very safe and a very effective tool. It’s a procedure where you’re made entirely comfortable during the procedure by an anesthesiologist. The procedure doesn’t take very long, anywhere from 15 minutes to 45 minutes to an hour, where during the entire time you are asleep, you feel comfortable. When you wake up, you feel fine, and somebody drives you home due to the sedation, and then you go about the rest of your day as normal other than not driving. It’s very safe, very comfortable, very easy to do the procedure.
Melanie: People don’t often realize how quick and easy, and I bet you’ve heard, Doctor, that when people wake up, they say, “When are you going to start?” But it seems that the hardest part for people to stomach, as it is, is the prep, so speak about what’s going on in the world of colonoscopy prep these days because they think of the big gallon, but there are other preps available now?
Dr. Lurix: That is correct. The worst part of the whole procedure is the day before where you have to drink a liquid diet to make sure that your colon is clean along with a bowel purging substance that will clean out your colon. The purging substance originally was a very large substance, and that’s why most people fear it because they picture the substance that was originally given to everybody, which basically tastes like salt water and I really wouldn’t want to wish that on anybody. We typically do not use that one nowadays. There are many more alternatives that are available—anywhere from a half-gallon prep that tastes like vitamin C or orange juice to one that’s only two 5-ounce glasses that also tastes more like a beverage called Tang, a sweet beverage that kids used to drink.
They’re very, very pleasant compared to what they used to be. There’s even a bowel purge that’s present nowadays that’s only pills. The problem with the pills is not everyone can use the pills for bowel prep, and it can worsen kidney disease, and they are quite numerous pills. The pills are for those who are afraid to do a liquid.
Melanie: Well as somebody who had a few of these I can tell the listeners that it is an actual good feeling. You feel cleansed, and you feel clean, and it lasts for a good couple of days so no, it’s not bad to clean out your colon every once in a while, that way. Now, speak, Dr. Lurix, about what you find when you’re in there? We all get these beautiful colored pictures when we’re done. And what is a polyp? What do they tell you as our doctor?
Dr. Lurix: Out of people that are screened, between 25 and 35% of women and 25 to up to 45% of men have a precancerous lesion called a polyp, and there are different types of polyps that we do find when we’re inside the colon, the most common one being a tubular adenoma. Tubular adenomas are either flat or raised lesion, and they tell us that when you do have a tubular adenoma, you have an increased risk for developing colon cancer. The reason for the colonoscopy when we find these raised lesions, we remove them, thus decreasing that risk by removing the precancerous lesion that’s present.
The other lesions that might be present are a hyperplastic polyp, which if they’re found in low quantities, and only on the left side of the colon, have little to no issue and typically aren’t removed, or are only removed just to verify.
The third type of polyp, which is called Sessile serrated adenoma, which does pose a slightly higher risk than a tubular adenoma, but are much more rare than a tubular adenoma or colon polyp.
Melanie: What should we know? When you find the polyps, and this is what makes this an amazing screening test because you can actually take those out while you’re in there, thereby hoping to prevent colon cancer in the first place, but tell us about what you do? You take these polyps out, and then you test them to see what kind they are?
Dr. Lurix: That is correct. We remove them during the procedure, which is very comfortable. You will never know you had a polyp removed. You don’t feel it afterward. We take it out with either a forceps or a stair, which to you, you will never know or feel, and then we send it off to the pathologist as it’s collected through the colonoscopy and sent to a collection tube and given to a pathologist. The polyp is then tested to make sure that it is that type of polyps, one of those three different types and then that will tell us the risk of developing colon cancer in the future and will give us an idea of when your next screening colonoscopy needs to be.
Melanie: Typically, polyps grow slow, correct? So that’s why there’s this long gap between the need for colonoscopies?
Dr. Lurix: That’s correct. A typical polyp takes about what they estimate ten years from the development of a polyp into developing colon cancer. The polyps that are a centimeter in size or greater develop much more rapidly than cancer. That’s why we recommend removing all colon polyps, particularly those that are over a centimeter in size. That also determines your frequency of follow-up for colonoscopy. If you have polyps over a centimeter in size, we like to do it a little more frequently than if you have smaller polyps. Numbers also play a role in how frequently you need a colonoscopy. If you have multiple colon polyps, meaning more than three, then we do recommend more frequent interval screening because it suggests that your body may produce polyps more frequently than others.
Melanie: Are there some red flags, Dr, Lurix, that you’d like to tell us about that would signal, you know what, get in and see a GI and get this checked out. Are there some things you want people to know about?
Dr. Lurix: Definitely. There are many red flags to be aware of that indicates you definitely need a screening colonoscopy. However, do not just use these red flags that I’m about to say as your only indication to have one as there are several individuals that I have done a colonoscopy on and have found cancer or multiple precancerous polyps who had none of these red flags. The most common red flags are blood in your stool. That includes even bright red blood as people will assume it’s just a hemorrhoid. Don’t always just assume it’s hemorrhoid without being sure. Change in bowel habits, which means you normally go every day and now you go every third day, or now you’re going several times a day, that could be a sign or an indication of colon cancer. Or a change in the consistency of your stool where you used to have a normal bowel habit, and now the stool is more thin, or ribbonlike, can be a sign of colon cancer.
Another indication or sign can be abdominal discomfort or weight loss. That can be a sign of colon cancer. Those are all symptoms or signs that we are concerned about that would indicate a colonoscopy for further evaluation.
Melanie: We don’t have a lot of time left, Dr. Lurix, but where does nutrition and dietary information play a role in keeping our colons healthy? Do you advocate certain fibrous diets or things that you want people to know, to hopefully prevent colon cancer?
Dr. Lurix: Yes, definitely. A high-fiber diet has been shown in many research studies to prevent colon cancer, and fiber is particularly better from food sources and not necessarily fiber supplements, so fiber out of nutrition has shown to decrease the risk of colon cancer. We’ve also shown that diets high in red meat have an increased risk of colon cancer, so we do recommend decreasing your consumption or red meat. We know that people who smoke more or are heavy drinkers also have an increased risk of developing colon cancer and it recommends to not smoke and to use only moderate use of alcohol.
Melanie: So, wrap it up for us then with your best advice about preventing colon cancer, getting your screenings, when you should get them, what you want the listeners to know about colon cancer and colonoscopy.
Dr. Lurix: Colon cancer is currently one of the highest found cancers within the US population, ranking number three in the cancers that we find, and it’s very preventable. The procedure that we do, the colonoscopy, is very safe, it’s very benign, and the prep that most people are worried about is really benign compared to what we used several years ago. Being that it’s such a safe and preventable cancer, even if we find it in the very early stages, it’s very easily treatable. If it’s an early stage cancer, it’s curable up to 90%, which is very, very high, so I highly recommend—even if you’re worried that you have symptoms or even especially if you don’t have symptoms to begin your screening colonoscopy. Ask your family members has anyone had colon polyps or colorectal cancer to determine when that first screening will be and discuss with your doctor. As a very treatable and very curable disease, it’s something that really we should not be suffering as much from within the United States.
Melanie: Thank you, so much, for being with us today, Dr. Lurix. That’s great information. For more information on colorectal cancer screening you can visit ghs.org/Colonhealth. This is Melanie Cole, and you’re listening to Inside Health with Greenville Health System. Thanks for listening.
Einar Lurix, MD, is a gastroenterologist with Greenville Health System. Find out more about colonoscopies and colon health here.