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New Directions

Issue: Spring

Trust Your Gut: Take Colon Health Seriously

(l) Naveen Gupta, M.D. (m) Vivek Patil, M.D. (r) Gary Roggin, M.D.
March is National Colorectal Cancer Awareness Month. In case you’ve been putting off having a colonoscopy—there is no time like the present. The second leading cause of cancer-related deaths in the U.S., colorectal cancer claims more than 50,000 lives annually. The good news is that when detected early, colorectal cancer is highly preventable; the bad news is that too few people are having their colonoscopy. The Centers for Disease Control and Prevention (CDC) predicts that 60 percent of lives lost to colorectal cancers would be saved if more people had the life-saving procedure. The American Cancer Society recommends that men and women have their first colonoscopy at age 50 and earlier if symptoms are present. So why aren’t more people getting one? When compared to other preventive checkups and screenings, many complain the procedure is too invasive or the prep too difficult.

We asked several gastroenterologists on the Suburban Hospital Medical Staff to give us straight talk about colonoscopy and colon health.

“All aspects of the colonoscopic procedure continue to improve,” says Gary Roggin, M.D., a gastroenterologist in private practice in Bethesda. “The preparations to clean out the colon for examination are more palatable and smaller in volume. Currently, most physicians performing colonoscopy recommend that the prep should be administered in two parts—half taken the day before and the second half 4-6 hours prior to the procedure. This ‘split prep technique’ reduces the ingested volume required at each sitting and, more importantly, clears out the colon more completely, particularly on the right side. This provides the endoscopist improved visualization during the procedure.”

According to Dr. Roggin, patients can be safely sedated for the procedure and generally feel no pain. During the procedure, a flexible fiberoptic tubular instrument connected to a TV monitor is inserted through the rectum into the colon (large intestine), allowing the physician to examine the entire colon and the end of the small intestine. If precancerous polyps or other abnormalities are found, they can either be safely removed or a tissue sample can be obtained for microscopic analysis.

“With high-quality fiber-optic technology, we are finding and removing a greater number of polyps that would otherwise lead to cancer,” says Dr. Roggin. “Because of our enhanced ability to visualize the colon, it is now possible to extend the interval between colonoscopies in an average-risk, symptom-free individual to a 10-year interval, resulting in significantly fewer required examinations in a patient’s lifetime.

Who is at risk for colorectal cancer?

Individuals who are age 50 and older make up 90 percent of the cases of colorectal cancer diagnosed each year. Research tells us that lifestyle choices, such as smoking, eating a high-calorie, saturated-fat diet, physical inactivity and drinking alcohol in excess, can increase a person’s risk for colon cancer.

“People with family history of polyps or colon cancer or an underlying genetic condition such as familial polyposis syndrome are at a higher risk for developing colon cancer,” says gastroenterologist Naveen Gupta, M.D., in private practice with Ajay Bakhshi, M.D., in Bethesda. “African-American men and women have a higher incidence of colorectal cancer and higher mortality rates than do Caucasians. Therefore, it is recommended that African-American men and women who are free of symptoms have their first colonoscopy at age 45.”

What are common symptoms of colon cancer?

The most common symptoms of colon cancer are rectal bleeding, abdominal pain, weight loss, unexplained iron deficiency anemia and a change in bowel habits. Although it’s important to know the symptoms of colon cancer, Dr. Vivek Patil, a colorectal surgeon with Johns Hopkins Community Physicians in Bethesda, cautions, “Most of the time with colorectal cancer, symptoms are extremely vague or there are no symptoms at all until the disease is advanced.”

“This is the precise reason why we recommend screening for colon cancer, just like we do for diabetes, hypertension, cervical, breast and prostate cancer,” adds Dr. Gupta. “Early detection is the key.”

What are treatment options?

Significant advances have been made in chemotherapy options, but also in the way in which radiation therapy is delivered. Surgical techniques, including minimally invasive laparoscopy, a technique that Dr. Patil performs at Suburban Hospital, use smaller incisions and result in less post-operative pain and more speedy recovery time for most patients.

What can we do to prevent colon cancer?

The physicians all agree that most important in the successful treatment of colorectal cancer is finding the cancer and finding it early. Early detection and treatment might also help a patient avoid chemotherapy and radiation and decrease the likelihood that the cancer will recur. Colorectal cancer is often curable.

Because screening schedules vary depending on individual risk factors, it is important to talk with your doctor about your general overall health and risks for colon cancer and follow the recommended screening guidelines. To learn about the availability of reduced-cost colorectal cancer screening, call 1-800-477-9774.

Click here to read part II of our colon health coverage.

For a referral to a physician, call 301-896-3939.

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