I got the chance to talk with Dr. W. Travis Dierenfeldt, a GI specialist, and you know me…so from here on we’ll call him “Dr. D” :-)
He’s performed over 30,000 endoscopic (that camera attached to a tube that goes up your you-know-what) procedures with the majority of those being colonoscopies.
He’s a great doc, a good guy and willing to take the time to answer a lot of questions we don’t think (or face it, we’re too embarrassed) to ask, so please, read on…
Me: According to the CDC (Center for Disease and Control), there are three primary reasons a person can get colorectal cancer:
- Family history of colorectal polyps or colorectal cancer.
- Inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
- A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome). (Just 5% of colorectal cancers are linked to these genetic syndromes.)
Me: What do you say to all that stuff we can’t pronounce?
Dr. D: It is a lot, isn’t it. Let me see if I can break it down. When we see someone who might need colon cancer screening, we asses their risk for getting colon cancer and categorize their risk as Average Risk or High Risk. A High Risk person would be someone with the above risk factors; personal or family history of colon cancer or polyps in what we call a “first degree” (parent, child, sibling) relative, inflammatory bowel disease or other types of cancer. And then as you mention, the genetic syndromes. However, most people that develop colon cancer have NO risk factors whatsoever and are asymptomatic (show no signs) until it is too late and the disease is quite advanced. Unfortunately, in many cases they don’t have symptoms until it is too late.
Me: There is a family history of cancer, but none for colon cancer, so why would/did I get it?
Dr. D: The bottom line is that we don’t know why people get colon cancer. There is a genetic aberration (oddity) in the cells that line the colon, things go haywire and the cancer develops. Luckily, for most people, it grows slowly and starts out as a polyp and over a 7 to 10 year period the polyp turns into cancer. However, especially in younger people, the polyp progresses much more quickly or you can develop a cancer without the polyp to cancer progression.
Me: They say my cancer grew from a polyp. What exactly is a polyp, what causes them and are they all cancerous?
Dr. D: A polyp is a growth in the colon. Not all are cancerous but most of them are precancerous. It is the precancerous polyps that we are looking for when we perform a colonoscopy so that they can be removed before they turn into cancer. We don’t know what causes them.
Me: Why should anyone with no history of colon cancer bother getting screened for it?
Dr. D: In reality, they are at the highest risk. As I mentioned above most people who develop colon cancer don’t have a family history of colon polyps or cancer.
Me: How many cases do you know of where someone with no family history of it, gets colon cancer?
Dr. D: A lot. It happens all the time. As I have seen so many people with colon cancer, I can’t give you a specific number, but that is frequently something I get asked after the cancer is discovered. Why me? I don’t have a family history of colon cancer.
Me: Sometimes people with the symptom of rectal bleeding will brush it off as hemorrhoids. I did and that country singer, Wade Hayes, says he did too. Is there a simple way for the average person to discern between the two or should you always contact your GP if you see any blood in your poo or on the toilet tissue when you wipe?
Dr. D: You should always see your doctor and have it checked out. Without an adequate evaluation and examination by your primary care provider, there is no way to distinguish between the two. In addition, keep in mind that hemorrhoids are very common, so just because you have hemorrhoids doesn’t mean you can’t have colon polyps or colon cancer as well.
Me: Truer words never spoken Dr. D. That was exactly it in my case. I remembered a doctor mentioning it during a physical in my 20’s, so I just assumed the stress I was under was causing it to flare up.
That said, when should someone under 50 years old consider getting a colonoscopy?
Dr. D: If you are under 50, you should consider getting a colonoscopy for the following reasons:
- If you have any unexplained GI symptoms including abdominal pain, diarrhea, constipation, blood in the stool, excessive gas and bloating, or change in bowel habits.
- If you are asymptomatic (no signs), a colonoscopy would be recommended if you have a family history of colon polyps or colon cancer. A history of inflammatory bowel disease such as crohn’s disease or ulcerative colitis.
So we’re clear, a family history of cancer other than colon cancer doesn’t increase your risk and not an approved indication for screening. However, if you yourself have had cancer then it may warrant one. Oftentimes if someone has ovarian cancer or uterine cancer or cervical cancer that requires an abdominal surgery, they will be referred for colonoscopy beforehand to make sure there is not an accompanying disease there– even if under the age of 50.
Once you reach 50 years old, even if you have no family history of colon polyps or cancer you should schedule the appointment. It is covered by all insurance companies so far as I know. There are no excuses. Get the test. Get the polyp. Get the Cure (slogan from a few years ago).
Me: How many cases do you know of where someone under 50 gets colorectal cancer?
Dr. D: I see this quite a bit as well. Many people will present with rectal bleeding or worse yet severe anemia with associated weight loss. And, in most cases the cancer is already fairly advanced. The sad part is that they have been seeing their doctor and a lot of times, their doctor doesn’t think about colon cancer as a cause of their anemia or symptoms either—because unfortunately, a lot of doctors, like patients, think—well I’m not 50 so it can’t be cancer.
Me: Does the FBOT (poop smear test) detect cancer in its early stages? If not, when?
Dr. D: Not sure of the statistics, but it misses just as many cancers as it detects. More than anything, I think if someone has a positive test, then it is enough to convince them to go ahead with a colonoscopy if they have been hesitant to have one before that time.
Me: Is the FBOT standard (you don’t even need to ask your doc for it) for all yearly physicals?
Dr. D: It should be starting at age 40. Be sure to confirm it with your doctor.
Me: Does smoking cause colorectal cancer?
Dr. D: Smoking does increase your risk for colon cancer.
Me: Does eating sugar cause colorectal cancer?
Dr. D: Eating sugar does not cause colon cancer.
Me: How fast or slow does colorectal cancer grow compared to other cancers?
Dr. D: Compared to most other tumors, it usually does grow slower. However, once a person has cancer and the lesion is no longer a polyp, it will grow much more rapidly and can spread quickly if not caught in time.
Me: Why would a woman get colorectal cancer, isn’t it a man’s cancer? Does it mean she has too much testosterone and not enough estrogen in her body?
Dr. D: Colon cancer affects men and women equally and the male and female hormones don’t really play a role. Other than the fact that a lot of men feel that they may be too macho and they don’t need a colonoscopy—but they are wrong! – By the way, what you are doing is great—the more people that get screened, the more lives can be saved!
Me: Thanks Dr. D. That is my goal and I am determined. For those that are already there, what do you think is the most effective/least invasive treatment for colorectal cancer?
Dr. D: Prevention is the key. As a gastroenterologist, I don’t treat the actual cancer once it is diagnosed, so I’ll leave that answer to the Oncologist.
Me: The latest statistics on colon cancer survival rates comes from the National Cancer Institute (NCI). I often see it quoted in articles I come across. It’s based on a sampling of 120,000 people diagnosed with colon cancer between 1991 and 2000, the five-year survival rates based on the stage of the disease are below.
Stage I Survival Rates – 93%.
Stage II Survival Rates – 72-85%
Stage III Survival Rates – 44-83%
Stage IV Survival Rates – 8%.
Me: Do you believe the odds of surviving colorectal cancer have improved since then? If so, why?
Dr. D: Yes I do, as the treatments have greatly improved. In addition to chemotherapy, there are many more surgical treatments available for metastatic disease—in the past if someone had a liver lesion or a lung lesion, nothing was done. Now there is literature to support surgical excision coupled with additional chemotherapy etc. I have had several patients, usually those less than age 50 when diagnosed, who have had partial liver resections and partial lung resections with good results.
Me: How could someone, who lives a middle of the road lifestyle like me have prevented getting colon cancer?
Dr. D: I don’t think you could have prevented it. It sounds like you just had bad luck and most likely an underlying genetic predisposition that we don’t quite understand yet. If everyone who was a middle aged female who eats occasional junk food, drinks coffee, drinks socially and has a hamburger twice a week would get colon cancer, our species wouldn’t survive. Now I am trying to be funny, but I don’t think it is working. The best advice I can give would be the following:
- If you have unexplained GI symptoms see your doctor. This could be constipation, diarrhea, gas, bloating, cramping or blood in the stool.
- If you see blood in your stool, definitely see your doctor.
- If you have a family history of colon polyps or colon cancer you should have your first colonoscopy 10 years before your relative was diagnosed or at age 40 whichever is earlier. So if your mother had colon cancer diagnosed at age 45 then you should have your first colonoscopy at age 35.
Me: Good effort. You will never catch me discouraging a doctor from expressing a sense of humor. On a more serious note though, if there is just one point that will sink when someone reads this, what do you hope it will be?
Dr. D: I hope that people will realize that colon cancer is a serious disease that you can die at a young age from, but it is a preventable disease if caught early. If we don’t look, we don’t know. Yes, you may think it’s embarrassing to get a colonoscopy, but you have to realize that this is what we doctors and the nurses we work with do every day, all day long. We don’t do it for fun, we do it save lives, possibly yours or someone you love, so there is nothing to be embarrassed about.
I hope this helps!
Me: Well, I feel smarter and definitely less reluctant to get my next screening, but some heads are thicker than others (I know mine was), so I’ll ask. Hey, you reading this, did we provide you with enough to convince you yet? Now will you go get that colonoscopy? Make the appointment. Then, pick out your two favorite peeps (who fit the screening criteria) and make sure they do too. You can take turns being the designated driver. Don’t know where to start? Click here.
Have more questions? Post them in the comment field below. Let’s get ’em all answered now, so there’s no room left for doubt or uncertainty.
– Dr. W. Travis Dierenfeldt is a board certified gastroenterologist who has performed over 30,000 colonoscopies and is an expert in colon cancer prevention. He is currently practicing medicine at The Gastro-Intestinal Consultants of Manhattan, Kansas.
He is the author of The Low FODMap Diet: 10 Rules for Living with IBS and designer of the renowned Six weeks to a calmer stomach program.