Colon Cancer with Dr. Vaid
On this week’s episode of Bariatric Friday, Kemal Erkan sits down with Dr. Sachin Vaid to talk about the very important topic of colorectal cancer. Many of these cases can be preventable, treatable, and manageable when addressed earlier. Traditionally, colorectal cancer has been seen as a condition mainly affecting older populations. However, there has been a concerning rise in colorectal cancer rates among the younger generation. There are multiple contributors that are theorized to be behind this rise, namely more processed diets and sedentary lifestyles. Previously, the recommended screening guidelines were to get colonoscopies at age 50, but now with these increased incidences, the age has now dropped to 45.
Erkan starts off the session by asking how colon cancer presents and what it looks like. Dr. Vaid sets the stage by describing the life cycle of a cell. Normally, cells should be created, live, and then die. In certain cases, however, cells undergo mutations in which they live, proliferate, and turn into polyps, adenomas, or tumors. Polyps are lumps of cells, some of which may be precancerous, and some are simply inflammatory. All cancers are categorized into stages, with Stage I having more positive survival rates. Once Stage III is reached, this is where there may be lymph node involvement and survival rates drop. It is absolutely essential to catch cases as soon as possible, as earlier stages have a much better prognosis. In Stage I and early Stage II, no chemotherapy is needed. After that point, chemotherapy will most likely be required for treatment.
Erkan then inquires about whether or not patients would be able to discern if they have colon cancer without a colonoscopy. Dr. Vaid affirms that there are other tests that can be run, such as a fecal occult blood test. These tests detect hidden, microscopic blood in stool. If blood is found, it can indicate colorectal cancer, polyps, or some other form of GI bleeding. However, colonoscopies are the gold standard of testing. Other tests may indicate that there is the potential of cancerous material, but cannot confirm 100%. There is also the Cologuard test, which may seem attractive due to not needing prep beforehand. Dr. Vaid says he does not recommend this test. It is good for finding colon cancer and advanced polyps, however, fails to detect precancerous polyps. Those smaller polyps are what we want to find, so that we can take care of those before they turn into cancer. The Cologuard test can also miss up to around half of advanced polyps as well, which make it more unreliable.
Next is the topic of hemorrhoids. If you have rectal bleeding and it does not resolve within a couple days to a week, you should see a gastroenterologist or a colorectal surgeon. Some individuals may push off seeing a doctor for their rectal bleeding, assuming that it is “just hemorrhoids.” However, especially if the bleeding is recurrent, that is when you should see a specialist. Now what are hemorrhoids, exactly? Everyone has hemorrhoids; they are anatomical features of our body. They are swollen blood vessels in the rectum or anus that can become symptomatic due to straining or chronic constipation. However, they are very treatable and can usually be remedied with home care.
The risk factors for colon cancer are obesity, sedentary lifestyle, low-fiber and high red meat diet, and smoking/alcohol. Obesity is a pro-inflammatory state metabolically, which then also causes more inflammation in your colon. Bariatric surgery can be a great tool not only in weight reduction, but lowering the associated colon cancer risk as well. Adding fiber to your diet also helps feed the beneficial microbes in your gut. Over time, consuming a variety of plant-based fibers helps maintain microbial diversity and a stronger gut lining.