Thank you for watching this program tonight with the best physicians of the region.

My name is Dr. Luis Munoz.

I'm the president of El Paso County Medical Society.

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We at El Paso County Medical Society invest in community education with our programs.

I hope you'll find this program very informative, with great medical advice and great medical information.

Thank you again for watching this program tonight.

And have a great night.

Hi, I'm Kathrin Berg the host and a moderator for the El Paso physician.

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A colonoscopy.

One of the greatest gifts that you can give to yourself to save your life.

Colon cancer is one of the few cancers that's preventable.

A colonoscopy, without question, can prevent colon cancer.

And you may ask why was because suspicious polyps can be removed during the procedure before they turn into cancers.

During the next hour, we have physicians answering questions about prevention, diagnosis and treatment of colon cancer.

This evening's program is underwritten by Texas Tech University Health Sciences Center and also Dr. Richard McCollum.

And we also want to thank the El Paso County Medical Society for bringing the show to you each and every month.

But evening, I'm Kathrin Berg, and you are tuned into the El Paso physician.

Thank you for joining us tonight.

We're going to be talking about colon cancer prevention diagnosis and management.

With me this evening, we have two veterans and somebody who's brand new.

So this is going to be a lot of fun.

We have Dr. Sherif ElHanafi and he is a specialist with gastroenterology.

He is also an advanced endoscopes who is trained at the Mayo Clinic.

And your colleagues has told me that you used to do some transplant surgeries and stuff, too.

And he's rolling his eyes because they're bragging on you and you're like, No, stop.

Not anymore.

And then we have Dr. Robles over here, Dr. Alejandro Robles, who's like, I'm just a normal guy.

But then Dr. Guzman like, Oh, he's great.

So we have a good panel tonight.

Again, gastroenterology and then Doctor Jesus Guzman, who is a gastroenterology fellow.

So still somewhat in training.

And if you notice his coloring today, he is Texas Tech, born through and through from El Paso as well.

Thank you so much for being here with us.

And this is going to be a great show.

So we often, prior to us airing or being on, we talk about things that we are going to discuss throughout the program.

So the first thing is the colon in the digestive tract.

There's all kinds of stuff.

There is the small intestine, the large intestine, there's the colon, there's a rectum, there's this, that and the other.

So I would like to ask Dr. El Hanafi, if you can describe to our audience of everything in the digestive tract.

What does the colon do and why is it so important to have screenings so yeah, thanks for having us then.

So Colon is a very important part of the digestive tract.

It called it's a large intestine.

It starts from the end of small intestine and goes till the illness and rectum.

So the role of colon is very important in the main role of colon is to absorb water and the digestive material goes from small intestine, very liquid liquid material, and the colon absorbs the water and to make it little bit in solid form and other function of the colon is to absorb some electrolytes and nutrients.

Mm hmm.

So this is this is a mean to a function of the colon.

And it also has some microbiota, which can maintain and maintain the balance of our body microbiota.

Great.

Nicely explained.

And as I was talking about a few moments ago, so we hear about and know about colon cancer, but we don't hear or know any thing about small intestine cancer or large intestine cancer.

Is that even a thing or why is it and how is it that colons are where the cancers grow?

And Dr. Robles I'm just going to throw that your way.

If you'd like to take that now.

Absolutely.

So I'm.

There are cases of small intestinal cancers.

These are rare, though, in nature.

It's the colon.

It's a little bit more common site to get these type of cancers, actually, that they're most common side of cancer in humans.

So it's something that's out there.

So again, the cancers do exist in the small bound, but it's definitely way more common in the large intestine.

Okay.

Gotcha.

And Dr. Guzman, I'm just going to get you into the loop here, and I'm going to start with the kind of the hard question, the controversial questions is of screenings.

So screenings change an awful lot with all kinds of oncology.

And years ago, colon cancer started screenings at about 50.

And I want to say last year that went the recommendation went down to 45.

Can you just in I don't know, involve our audience in what the different screenings are and have been and why is it now 45 instead of 50?

Oh, definitely.

So there's different screening modalities.

We have different screenings, which are some are stool based and some are direct visualization.

The stool based studies are pretty much taking a part of the stool and detecting blood.

We have something called the quack of a fecal occult test.

This pretty much used a chemical staining to be able to detect blood in the stool.

We have the FIT test.

The fit test is a little bit.

It's better.

The reason being, it has a higher detection rate than the previous quack ever test.

So this one in itself uses antibodies to detect blood in the stool.

And then that this one you do it approximately every year.

Both of these are done every year to be able to detect colon cancer.

And are these done in a doctor's office?

No sample the fecal occult test.

How how is that done?

Is that something that you can mail in?

It is definitely is.

So essentially, it's something that you could do at the privacy of your own home.

Okay.

Usually you receive a package.

The directions are very relatively simple.

You get a package at home and when you go to the restroom, you'll take a small little brush and inserted into the store and put it into a little container.

Okay.

And that container, you Ziploc back and then you mail it back.

Gotcha.

Okay.

And that in itself, you do it in a one step process and that is enough.

And you do it once a year.

Okay.

Gotcha.

And then you were talking about the FIT test after that.

And if you can also describe how that's done.

So that is the FIT test.

Okay.

FBT test is more of a chemical staining that you use a small sample.

That's right.

Okay.

Okay.

But like I said, we moving away from the FBT test just because that one requires dietary restrictions, such as not eating meat, because that can cause what we call a false positive.

So and then you have to do three in a row, actually, to be able to increase the sensitivity of this study.

So we're moving away from that and we're moving more to the FIT test, has a better detection rate.

It's still something that's done once a year and it's something that you can do simply at home.

Okay.

And we have other studies that you can do every three years.

It has a little bit higher sensitivity.

When we say sensitivity is how good is it at detecting something?

So the DNA test is something that uses other components, is still the antibody test, but now it's looking for altered DNA, things that we can see in cancers, different mutations.

So this one is is also really good as in itself.

But so that's why you can spread out the screening interval to about every three years.

Okay.

And now we move on to the ones that we as a gastroenterologists prefer.

Exactly.

And so I do want to very much talk about the gold standards.

Yes.

That that are being done.

So these tests are for people who, for whatever reason, have reservations.

And we're trying to teach people let's not have reservations, because this is the again, colonoscopies can prevent cancers because they take a a pilot before anything can start.

So would you like to continue or do you need a break and know Dr. Robles talk or go?

He's got he's got his notes and everything.

Yes.

Well, it's something about your notes.

It's actually something very important just because.

So one thing that I really want to emphasize is that the FIT test, the DNA fit test it all.

These are screening.

Mm hmm.

If there is a positive value in any of these, that still needs a colonoscopy.

Bingo.

Yes.

So it serves no purpose.

If you do the test and it's positive and don't get anything after it, because the whole point is to be able to detect cancer early and be able to if it's something it's a large polyp that we can remove, treat it.

If it's an early cancer, detect it early.

And this is why we prefer a colonoscopy.

Of course, the fact that that's true to us, it's the gold standard, it says, because in this it's a very low risk procedure.

It's it doesn't have many complications.

And by doing so, you we can actually detect cancer early or detect precancerous growths, early polyps.

Right.

And we can remove them.

Right.

And by removing them, that that essentially we remove that risk.

And that's why these if you get it, the one done and you have nothing there.

Mm hmm.

Then you can screen every ten years.

You now, depending on the amount of polyps we see that, then the screening interval changes.

But it's all dependent on what we find.

And you get direct feedback right away after the colonoscopy.

As I get something, we can do the colonoscopy and then we can talk to you right after the procedure and tell you what we found.

So I've had two colonoscopies.

And I'm saying this as a layperson, because I think it's very important.

We're asking doctors the questions of what to do.

But just as a layperson this time around, I literally had everything to prep was over the counter, which is fantastic.

I got the stool softeners over the counter.

I had electrolyte drinks to drink and life is good.

And it's a it's a lovely little cleanse.

You know, last time I did not have a polyp that was found.

This time I did.

And to your point, immediately after the procedure, the the nurse came and talked to me.

The doctor came and talked to me.

The polyp was benign later.

But the bottom line is it was a ten year description first time around and now I take it again in five years.

And the prep, it really isn't that bad.

You have diarrhea.

Yes, but it is.

I mean, I like being very specific and bold and blunt on this show.

You have diarrhea for a good 12 hours.

Everything's nice and clean.

You go in, you go nighty night for 5 minutes.

And they do the test and life is good.

I think the amount of prep is the most difficult part, you know, in the process.

Is that bad?

Yeah, exactly.

But really, it's fine.

Exactly.

And, Doctor, how is ElHanafi?

I would love for you.

Since you have this lovely tool in front of us.

We've got the colony's scope.

Correct.

So this is what the colonoscopy is.

And if you could actually build in a little bit more of what I talked about with the prep, there's anything I forgot or didn't.

Feel free to talk about that.

And then I'd like to show the audience what it is that that you're actually doing during the colon.

Absolutely.

So to to, to have a good quality put on this copy, you need.

You need a good prep.

Mm hmm.

We need to see.

This is all about visualization.

How we need to see your lining of your coat on.

Do it.

And by the way, I'm not interrupting, but I am interrupting because we have some graphics that are going to pop up, and it's graphic Number four shows several normal colons and then will show some polyps, too.

As you're speaking, we're going to go back and forth between these two.

Exactly.

So before we do, the procedure is some preparation.

We ask our patient to for the day before the procedure, to eat clear liquid diet.

Mm hmm.

So there is a little bit on the softer side and start taking some a major solution to help them get the stool out and clean it.

So it is everything started the day before the procedure.

If you don't have constipation, the risk factor for poor prep.

Then once you had the prep, you show up to the day to the endoscopy unit and and it's easy.

A doctor will see you to evaluate you before the procedure.

Then you go to the endoscope room and and it is a doctor will give you a medication to make you sleepy and comfortable.

Mm hmm.

Well, this procedure.

You will not feel it, you will not remember what happened.

Right.

Everything under sedation.

I kind of want to remember, because that way I can tell the show.

I even told them as said, Hey.

But yeah, it really is.

Again, to your point, and as a layperson, people who have not had this before.

It's it's so important.

Exactly.

So once so our patient is sleepy and comfortable.

We use this to with camera.

It is a very flexible tube which has light source here and the channel for our an instrument.

So sorry to where Diego is over in the corner.

So this this tube is designed to be very gentle for the colon and to go very gentle.

So so we start from there.

Rectum go up, up.

All the way through this he come or terminate ilium the right side of the current, using just you to go gently and come out gently so that you this this, this fiber optic tube has some weight is here help us to go right and lift up and down and we have suction and a channel which you can pass or our instrument like snares and forceps or clips which we're going to show later.

Once we see the polyp, we decide what we need to do.

If we need to remove it or if we cms, we need to take biopsy of it.

And most of the time more than 50% of people has normal colon.

But once we see the polyp, we this is the time we act on it.

And Dr. Robles, I think he can show us some of the instrument.

Absolutely.

I mean, so this is just kind of one of the instruments that we can actually fit with the colonoscope and it's actually helps us remove the polyps is it's more like you can kind of see it's actually more like a lasso type of object, kind of wrap, wrap it around the polyp that you'll be able to see in one of the images.

We then close in.

Our assistance usually are a huge helpers in this as well as the nurses, and once we cut it, we're able to remove the polyp and send it to the pathologist to see what it consist of.

So yeah, and we have various other instruments as well.

Sometimes we have to remove very large polyps in which we have to close the area of the bow that we just cut.

In that case, after that we finish removing the polyp.

We like to close the area just to prevent any subsequent type of bleeding that can happen In this case.

Again, we also have what we called clips that have sex.

Plus now these things, when you if you've had a colonoscopy and you see the images, they look huge.

They're really not that big.

Actually.

They're little, little tiny things.

They'll stay there.

They fall off.

You won't even notice that.

So but again, this little area here, this little thing here, it helps us close the bow exactly where we remove the polyps.

So.

Okay.

So on that note to, is there a categorization that occurs when you're moving the polyp?

Is there a Yeah.

The tissue know describe how the yes with the womb.

Yeah, absolutely.

So depending on the size of the polyp, if it's a smaller type of polyps, we tend to just cut it bleach a little bit.

But we cut now the bigger polyps, they tend to have a little bit more vessels in them.

They tend to have higher risk of bleeding in those.

We use heat cutters as we cut.

Now sometimes we leave it there, but again, once we cut our eyes, we stop limiting.

We may still close it with some clips just to prevent any subsequent bleeding in the in the future, which is pretty much the biggest risk that we run here.

Super low risk, but it does exist.

So we'd like to prevent any of these type of complications.

So describe it.

You said you like to close it with clips.

Is that something that stays then in the.

Yeah, no, it stays in the colon for a while.

The most of the most of these clips will fall off after a few weeks and you will not even notice it fell off.

There's of course, times where you go back in there, there might be a clip that is still there.

But again, these are tiny little clips.

They're benign.

They're not going to cause any problems or complications, but they're designed to eventually fall off with time.

Okay.

And if I have it correct, I know that when you have people in general and I have several clips in my breast tissue because I've had some biopsies and they leave a clip there so that when they go back and do another mammogram, there's a clip and it will be there for the rest of my life.

And the reason I say that is because people think, well, oh my gosh, a clip still there.

It's perfectly fine.

And that's exactly what they're designed for.

It's perfectly fine.

These clips, they don't interact.

You can undergo MRI's if they ever have to, you know, for any other reason.

So again, they don't interact, they don't cause problems.

You're not going to have issues in the airport.

You'll be fine.

You can have issues in the airport.

That's a more common question.

How do you think is it really and we use it only in certain circumstances.

What is the point of his back?

Right.

So but most of the people had small polyps.

Yeah.

So like more than like 20% of normal people or 20 to 30% as polyps, very limited number of these polyps are big.

Okay.

So we need to put clips to close area of research.

And so as Dr. Robles said, so we have a lot of tools to help us to do.

The colonies could be safely right.

And it is evolving and a lot of new techniques.

So it is almost safe, safe modality nice.

So it's lovely to when we look at this, the program and again looking at the graphics for is everything's clean fibers.

There are some polyps.

Number six is where polyp removal is happening.

Yes.

And then number seven is what we don't want to see.

And these are cancers and so for the most part, if you have not had a colonoscopy until your 67-80 and boom, you go in there this could be the problem.

But if you're having a colonoscopy at age 45, as we were talking about, they tend to start if there's even anything there.

Absolutely.

So actually, do you want to add in that?

So we do start screening at age 45.

It was decreased from age 50 recently because of the higher incidence rates of colon cancer is actually going up.

Screening works again because we remove these pre-cancerous polyps and at the same time we can find early cancers where we can treat it and, you know, even be more successful with us with a treatment.

But I do mention that these polyps take years to form.

It takes years for them to become cancerous.

So there's definitely time for, you know, to catch these things to prevent complications.

So that's why we kind of pursue and, you know, tell individuals to make sure you get screening.

So, you know.

Right.

And you have a great graphic, you know, graphic number eight shows that as the screenings are going up, the cancer rates are going down precisely each year.

Absolutely.

Absolutely.

So, you know, I do want to mention that statistics for colon cancer is the second most common cause of cancer death in men and women combined.

But it can go down and we can prevent it with colonoscopy.

As you know, as the trends have shown here in this graph, it's actually going down.

You screen, more rates go down.

So it helps.

And this is great to talk about it.

And I know sometimes it's uncomfortable and you swivel in your chair a little bit and you talk about diarrhea during prep.

But I'll tell you what, it's a lifesaver.

And I think it's great that we're here talking about it.

And I want to add just small thing, what Dr. Guzman said.

And Doctor, obviously screening has impact and that decreased the incidence of colon cancer.

So what I say, colonoscopy is perfect is a gold standard, but whatever available, use it.

So the the best test is a test available for you.

You can do so in any screening test is good, but you just do one of them and it will go from there.

If it is positive, you will need potentially.

But if it is negative with assured so.

So anything is better than nothing, right?

Mr.

Agreed.

Agreed On the note of someone not having done anything yet and say they're 65 years old, have not had a colonoscopy.

What are some of the signs and symptoms of colorectal cancer?

What is it that people can look out for that maybe have not had a screening yet, but they should think, okay, well, maybe, maybe it's time?

Good question.

So actually, when it first start off, so just to be aware, early onset, when it's early on, there's no symptoms.

Okay.

There's no symptoms at the end.

This is why I emphasize the importance of screening.

But now the what we call the red flag alarm type of symptoms, when we start seeing blood in the in the stool on the toilet, change in stool, calibers, change in our habits, abdominal pains, new onset constipation used to having daily bowel movements.

Now you're going to the bathroom every 2 to 3 days.

So these are all signs and symptoms.

They should be discussed with your provider, your primary care provider, as to pursue further action and find what's causing these things.

Right.

And now let's talk about treatment.

So treatment and management so we were talking about prevention.

Diagnosis is what's happening here.

Now we have someone who had some polyps removed, they are cancerous and now what?

And so I know that's different for every person.

I'm in full respect to that, depending how many the size, etc.. Who wants to start that?

And then we'll we'll go from there.

So so it depends what's any any single remove from the body was in for pathology.

So small polyps usually it is pre-cancerous there is some benign polyps is even not pre-cancer.

You just we would be like normal tissue but there is some pre-cancerous polyp.

It depends on the size and the morphology and the type and our pathology.

So if it is pre-cancer, we recommend repeat surveillance here in shorter period than ten years.

So some people come at seven years, some come at five and come at three, some come at 20 or shorter.

So it depends on the pathology.

So this is a polyps which are different from cancer.

Okay.

So so this is most of the people, like like more than 30, 30 to 50% of people that may have this benign pre-cancerous polyp.

Okay.

So that almost sounds for me oxymoronic because it's benign.

Pre-cancerous.

So benign to me, sounds like there's no cancer at all.

But pre-cancerous.

Is that eventually of a polyp stays in there long enough, it will become cancerous.

Yeah, right.

So I just want to clear up why that word is the way it is So I think benign is not precancerous.

Pre-cancerous is before to become cancer if left there for a longer period.

So but they are not cancer yet.

That's why we are doing a screening.

Look for this type of polyps which you can by removing this polyps will prevent colon cancer.

Okay.

The best treatment for any disease is prevention.

So we are trying to prevent cancer.

Right.

So this is why we are here today.

Okay.

So now we're looking at someone polyps, like you said, cancer, cheaper things.

Now we're looking at colon cancer.

What are options there?

So we're looking at surgery.

We're looking at.

Yes.

Etc., etc.. And again, everyone's different, but just throw out some.

Yeah.

No, absolutely.

So a lot of it also depends on the location.

But just and, you know, just in general terms, the first thing we want to figure out is how how for how how much To that extent is it mostly just in the colon as a kind of maybe spread just outside of corneal has a spread diffusely throughout the body now knowing these things will change the management course so early stage cancers meaning it's just kind of mostly localized in the colon.

The treatment is actually surgical resection.

So surgical resection is considered curative for these type of cancers.

Again and again, these are the early cancers.

So again, why screening is important because we can capture these cancers at that stage now when it's spread a little bit more than that, in addition to surgical interventions that may be required, this is where our colleagues come into play.

And this is a multidisciplinary type of approach with social workers, oncologists, surgeons.

It may involve chemotherapy, immunotherapy.

There's a lot of new medications coming into the to the field of how to manage them.

You know, a lot of great success with these medications.

But again, it's going to vary quite a bit from one person person depending on genetic testing that they do on the cancer and things like that.

So, okay, so that you opened up a whole can of worms there.

So is there an automatic genetic testing on a malignant polyp, cancer, etc.?

Is that an automatic thing or is that something that people will may or may not know?

Absolutely.

So anytime the cancer is diagnosed and the pathologists immediately run genetic tests on it.

Okay.

And this facilitates the management for the oncologists for cancer and a little bit.

So how is that done?

And if you don't know.

But like I said, it's not like I know that's your specialty.

This is multidisciplinary.

Experts on the other side.

Okay.

You are, you know, experts on these type of things.

So again, that's why it involves you know, everybody plays a role right here in the management.

That's well, see, I just I feel like we don't hear enough of that, at least right now.

We hear a lot about in female cancers, breast cancers, you know, gynecological cancers.

We know it exists.

We call in cancers.

But I feel like we don't hear about the genetic testing a lot with colon cancer.

So the next time we do this, I'd love to know a little bit more and get some more information.

I think I think it is it is, as you said and doctor said, they do it routinely for any cancer and it help to personalize the treatment and the oncology or cancer.

Doctor, can choose which type of treatment and it can give and also it can help to us to see if the family members of this person need a screening or immediate action as well.

So it guide us from where is this what the background of this cancer.

So it is evolving and in in most of the tertiary care centers and academic centers, they do this as a standard of care.

I am taking notes as you're speaking, Dr. Robles, I'd love for you to talk a little bit more about the surgical resection.

And again, you were talking about a certain section of the colon.

Depending how much is affected, how is that resection being done?

And then when and if do people need a colossal colostomy bag?

Yeah, sometimes not sometimes.

Yes.

And I just think people are curious as to how that whole process.

Absolutely.

So, again, we again, we run with our base how far a lot of decisions are.

Colorectal cancer surgeons make these decisions.

But yes, sort of the coin of the cancer is more on your right side of the bowel.

You know, it may involve removing the whole side of that right side versus on the left side.

Now, the intention, the main intention here is to be able to hopefully connect the bowel together and avoid the creation of a colostomy.

Okay.

So that's the main intention.

We want to prevent that.

But in some cases where maybe it was an emergent it's a type of obstructed shin in which there was not enough time to prepare the bowel for the surgery.

And these are the cases in which an individual may end up with a colostomy.

Now these colostomy again with the intention, is at first it may only be a temporary measure, but unfortunately a lot of times it becomes a permanent stay.

Yeah.

And so when you say a permanent stay and I'm thinking to once you have this surgery and it's a resection and this person, then every two, three or four years gets another colonoscopy.

Oh, yeah, that would be the retesting.

And then from there, is there anything different in the way they're being tested?

So absolutely.

So after surgery, after removal of the tumor of the cancer that's there, there actually, you're screening changes.

Remember, we were mentioning that you're screening varies depending on how many polyps you have.

Right.

Once you're diagnosed with colon cancer, you kind of put in a different screening type of program where we first do another screening colonoscopy one year after your treatment.

And after that we do it in three years and thereafter you do it every five years.

As long as you have normal colonoscopies, we repeat a little bit more frequent, even though we removed the fact that you developed a cancer in the first place, puts you at risk and might be a genetic component that predisposes you colorectal cancer.

So we want to prevent it and catch it early so you do get screened more often.

Okay.

Dr. Guzman, I just need to bring you back in the loop.

So let's talk about someone who has had colon cancer, has had a resection sectioning of the colon, who now is, you know, one year, three year, five year beyond.

Is there something that this patient is doing?

Treatment's the wrong word.

But, you know, maintenance wise going forward, if they've already had cancer, it's already been treated.

They're in remission.

How and let's say again, to be 65 is super young, but it's retirement age.

I feel like, okay, this is the good age.

Is there management that they're going through going forward through the rest of their lives other than just going to their colonoscopy?

So if they're but if the surgery goes well and then they receive chemotherapy and they're now in remission, they live completely normal lives.

Now, if you're asking as far as what can they do to prevent it from coming back, it goes back to that whole bit there being modifiable risk factors and non modifiable risk factors.

So and it's the routine stuff that is good overall.

Like obesity is something that we can work on.

Something such as sedentary lifestyle.

You know, if you exercise, that always plays a good part into reducing your risk.

Smoking, smoking, quitting smoking is going to help you prevent becoming the risk of of colon cancer.

So those are things that we can that they can do as individuals to re decrease their likelihood of redeveloping or developing more colon polyps.

But mainly it's for for colon cancer.

Okay.

So these are the modifiable things that they are able to do in their just routine lifestyle to be able to to try and prevent this from happening again.

Gotcha.

So let's talk.

Yes.

And one more thing, please.

And very important as well, the compliance with that screening as in as in you have to be there if it's okay at one year, at three years, and then every five years, because cancers can come back.

And their idea is that if we're able to, you everything well and if we detect a growth early, we can treat early.

So we are talking about risk factors.

I don't know if we actually did talk about risk factors, but the highest risk factor for colon cancer is having it once before.

On that note, what are other risk factors?

You talked about obesity in general.

Are there some that we haven't discussed yet that we should bring up?

Yeah, I think factors, Yeah.

I think one of the also the important risk factor, if you have family history of colon cancer, if one of your first degree relative has colon cancer, so are at risk.

So you'll need to be screened earlier and more frequent.

So so if you have like one sibling or one one of your immediate relatives, you'll have to ask your primary physician how soon I need to be screened and how frequent.

We'll let you know when you come for a screening release, when know how frequent you need to be screened.

Because genetics is one of the important risk factor for colon cancer.

Okay, super important.

Their risk factor.

I'm not sure if that's what we should call it, but I do want to talk about IBS, which is irritable bowel syndrome, because I feel like a lot of people have this issue and a lot of people think, oh my gosh, is this going to lead to something worse?

Doctor Robles, you said, Aha!

And started smiling and nodding.

So guess who gets that question?

Oh, that's that's fine.

Great.

Let's talk about let's talk about IBS.

So irritable bowel syndrome to not be confused with inflammatory pre bout disease because when you abbreviated IBS.

Yes, yes, yes.

Please do that.

Yes.

So in first discussion, irritable bowel syndrome, we consider this it's very bothersome syndrome that's out there.

It's a common syndrome.

100% agree with you.

But at the same time it does not really carry any risk of developing any sort of cancers.

It's something that we want to manage symptoms wise, either with medications through, you know, dietary changes, but again, does not increase the risk of developing any sort of cancer again.

But at the same time, we want to improve the quality of life.

So this is something that we also deal with as gastroenterologist.

Now, the other condition, the IBD, which is inflammatory bowel disease, to not be confused with IBS, this is what we call it, either Crohn's disease or ulcerative colitis.

Now these conditions does increase the risk.

Colorectal cancer individuals with these conditions actually do undergo screening more frequently, and at a younger age we usually start screening this.

Individuals either eight years after they were diagnosed and we screen every 1 to 2 years I'm going to jump in just because I know people are asking, how are you diagnosed with IBD with inflammatory hoary bowel disease?

Like how is that diagnosed?

Meaning what are the symptoms for someone to have to go in and go, Something's wrong.

How am I diagnosed?

Absolutely.

So again, lot of these symptoms start with rectal bleeding and diarrhea.

Okay, I don't worry.

Some symptoms that we mentioned earlier.

Hey, you really should be kind of talking to your doctor about these things and these right away draws red flags.

We again, we're always thinking colon cancer, but at the same time, we're also thinking there are other conditions like inflammatory bowel disease.

Now, at this time we do a colonoscopy, which is very helpful in helping us remove polyps, but at the same time being able to diagnose other conditions.

In these cases, we see inflammation in the colon.

We are able to take biopsies, we do some additional lab tests, some additional stool studies that can help us verify and confirm the diagnosis of IBD inflammatory bowel disease.

Okay.

You know, on that note, Dr. Guzman, you get one now, too.

How does one be diagnosed with IBS?

Even though it's relatively benign, It's it's a bothersome type thing.

You know, it's like it's always an issue, is that it is.

And then one thing I want to expand this first for IBD, it's it's an autoimmune disease.

Essentially your own body is attacking the colon and that and that's what causes inflammation and that's why the constant inflammation can lead to cancer.

So why it's important to get patients with IBD under control as far as getting on therapy, that needs to be done.

And that's why once there's a lot of inflammation and ulceration, when they start having the bleeding or they start having all this diarrhea, now IBS is a it's a it's a It's something that is a diagnosis of exclusion, weaknesses of exclusion as far as there's there's we have certain criteria that we use to for patients with IBD, but typically with IBS.

But the majority of the time is when we have ruled out things that are of concern such that would be more, I guess, critical to their care as far as like the inflammation with IBD.

So usually we see a make sure that it's not an infectious etiology that they've been having.

Like if let's say for example, if they have IBS with diarrhea.

Mm hmm.

Okay.

Because there's two types, there's IBS with diarrhea, and I'd be at IBS with constipation as see have one or the other or a mix or mix.

But for what?

If you have somebody that comes in with IBD, IBS, which is with diarrhea, we try to make sure that it's not an infection from, you know, you check your stool studies, make sure you don't have some type of infection.

We look through your medication.

We sometimes do a colonoscopy to make sure that it's not something else that's going on in the colon, such as microscopic colitis.

Once we've ruled out those things and any organic causes to the the diarrhea, then that's when we fall into the area of IBS.

Okay.

And at that point, it's a lot of treating the symptoms where we essentially try and control the diarrhea.

And it is which Dr. MACCALLUM would be here, because this is one of those things that, oh, he loves talking about this.

Yes, it's it's the gut brain.

Right.

The gut brain.

Gut brain.

So, yeah, this in itself is where that that pathology falls under.

Okay.

And same thing for the constipation type.

I don't know if in in the old days was is IBS now what you guys are waste.

I'm 57 years old.

I'm the old lady here but nervous stomach.

You remember when your parents, your grandparents, all He's got a nervous stomach.

Oh, she has a nervous stomach.

Is IBS what we used to call in the old days?

Nervous stomach?

Yeah, I would.

I would definitely agree with that nervous stomach.

Okay.

It is a condition that's more common.

And, you know, individuals who may have anxiety, things like that.

And a lot of the medications we use for IBS are actually anxiolytic type of medications to help with that brain interaction.

Same chemicals that are released in the brain are released in the in the gut and can can cause the symptoms so we can control the symptoms through these types, similar medications.

So it always made sense and I think Dr. McComb is one that that brought that up one time.

We are we are still we have a little bit of time.

But I do want to bring up Crohn's disease because I feel like we hear about it a lot.

We hear about an advertising on television, this and that and the other, who's going to who wants that one.

So Crohn's disease is is part of IBD.

So it is a type of IBD who's a mean.

So we're talking inflammation.

Inflammation, Yeah.

Soldiers, ulcerative colitis and Crohn's disease is all too like did you say it's say they get ulcerative ulcerative colitis.

Colitis.

Okay.

And the other type is Crohn's disease.

Oh then let's do talk about the differentiation of the two.

Okay.

So both of them called IBD inflammatory bowel disease as Dr. Guzman and Dr. Robles said.

So this is some the immune system get confused and start attacking the lining and layers of the colon.

So there is some trigger happen and make the immune system who's attacked the mucosa of the colon and causing chronic inflammation.

So this is what's called IBD.

Crohn's is relatively different from ulcerative colitis.

Ulcerative colitis is most of the time limited to the colon and it doesn't involve the small intestine, but Crohn's can involve all the digestive tract from mouse awareness and it can cause.

So say that again, Crohn's disease can affect from the mouth to the anus.

So the entire digestive tract, the entire digestive, okay, the small intestine and the colon are the most common sites, but can become anywhere.

Okay.

And ulcerative colitis limited to the quarter to the colon.

So when you say literally from the mouth to the anus and let's travel right now from the mouth to the esophagus into the belly, what is it that that we're looking for?

Again, the mucosal lining is that the issues there, there.

Yeah.

It is not common to be so focused and strong, but can be There is fear.

So you most of the time it is is a large intestine, the colon and small intestine.

You see some ulceration, inflammation of the mucosa and it can appear in imaging or economics copy.

So here's the million dollar question.

How is that treated?

I'd imagine diagnosis is one thing, but if you have Crohn's disease and it's the entire tract, it's not like it's easy just to say, okay, we're going to focus here on all of us.

You again, when you nod, you get the I get the question.

So he's like, I'm okay.

So treatment of Crohn's disease, so treatment of Crohn's disease and ulcerative colitis, a lot of medications are used in both conditions.

Okay, okay.

We are talking biologic therapies.

These are medications that are designed to stop the inflammatory process that will originate which is your own body, creating this inflammation.

However, medications do vary quite a bit.

There's certain medications that we only use for ulcerative colitis that we do not use for Crohn's disease.

Now the fact that also the colitis is more is the it's just the large intestine.

The colon medications can involve oral medications, even enemas, meaning going in with medications through the anus into the rectum to squeeze an anti-inflammatory medication in there.

While Crohn's disease, again, it just involves more the small intestine.

The large intestine actually can even cause inflammation in the joints.

Inflammation in the skin can cause rashes can cause inflammation in the eyes of Crohn's disease, just As more systemic medications for Crohn's disease tends to be a little bit more of the biologic medications.

These are medications that we give either through an I.V.

or inject medications.

Very few oral medications for Crohn's disease.

You know, as time passes, they're definitely developing new medications that can eventually, hopefully one day just involved more medication.

But in the current timeframe, we're talking a lot of injected type of medications.

So question here, too, where does Crohn's disease come from?

Like how how does one get Crohn's disease?

Is that you just have that you got from grandma and grandpa somewhere along the way.

How How does one know if they're so risk?

So there's definitely familial component, but it's not that large of a plate here you have a family members of first degree family member has an inflammatory bowel disease, whether it's Crohn's disease or colitis.

There's about an 8% chance that your son or daughter can develop this same condition at the same time.

There's a lot of components that we still not know, don't know about what's originating this.

Some people assume it could be an infection that individuals got early on that just cost your body to go into overdrive.

And during that process of eliminating that bacteria, it started detecting your bio as foreign.

So then you start attacking it again.

We're still learning.

There's definitely theories.

We're not 100% sure.

But yeah, it's a it's an ongoing process to learn more.

So to be able to manage it better.

You know, I talk often on this program that next year, if we had this exact same program, there's going to be new stuff that you bring to the table and that that's what I'm doing as we do a colonoscopy type of a show every year and every year there's something new word about a 14 minute mark of the show ending.

And I know it goes by super, super fast.

On that note, we covered a lot, but I there's a lot on the table, too, that we'd like to either do a deeper dive into or something that we haven't yet covered.

And Dr. Helena, for you, because you are the the true veteran and the one that everybody like you on this table, you get to go first.

Is there something that we haven't talked about yet or something that you really want to cover a little bit more?

And I think I think we've covered most of the aspects of the colon cancer, but I would like to let our community know that there is a resources there for you if you don't have resources or insurance or their insurance doesn't cover screening, there is always resources.

Ask for it.

And this is a program we have in Texas Tech, you see as well there's which you can cover and help you to get screening for colon cancer.

The program is sponsored and you pay nothing, but you have to qualify for it so you can contact the Texas Tech doctor.

Local is is a principal investigator of this program to support you.

I'm sorry, Dr. Molokwo.

Jennifer Moloko.

Okay.

Family medicine .

Yeah.

Molokwu for ask for the program two for four for example just ask for program for free screening Yeah exactly.

Success.

So yeah it's called to the success program.

The program is called Success.

So it is available for people who are underinsured or uninsured.

And it was certain criteria.

You may get any type of screening there and they will help you.

They are very nice people.

So we are happy to to let you know about this program.

No, I'm super glad said that.

That's something that usually the doctors don't want to talk about insurance because it goes into a whole nother rabbit hole.

But I'm super happy that when that is brought up, because in and of itself, colonoscopies are intimidating, which is why we're talking about it.

But if that lessens just one less, you know, I have to pay for it, how much is it going to cost if there's a free program available?

That's great.

And again, it's called the Success Program at Texas Tech UMC.

And Dr. Google, you can just do the search engine on that and find out just the success program in El Paso, Texas Tech and UMC.

So, yep, glad you brought that up.

Dr. Robles, How about you?

Anything that.

No, I just want to reemphasize the importance of screening like Dr. ElHanafi, that you might have been saying.

I mean, screening is important and screening helps us prevent colon cancer.

It helps us capture colon cancer.

You know, when we talk five year survival for early stage colon cancer, I mean, we're talking about 90% of its cut early.

And again, when it's early, you're not having symptoms.

We're going to figure this out because you did a screening, colonoscopy and survival rate above 90%.

Now you wait.

We're starting having symptoms now.

It's very late.

Stage survival goes down to about percent, five year survival.

So there's definitely a lot of benefit in screening not just for yourself, but for family members who, you know, want to have you around for many years to come.

So just consider that into the equation.

Yeah, those people love you.

It's good to see you, Dr. Guzman.

Anything that you want to cover.

And I do want to touch base on diabetes.

We end because we do have a little bit time, and I feel like there is an issue with diabetes and in this whole situation too.

But.

Dr. Guzman something that we haven't touched base on yet that you'd like to or go deeper into now, I think just to emphasize everything that we've been talk about, I think we all grew up in, we talk from experience.

We grew up in communities here in El Paso.

And it is not to be fearful of this.

A lot of the times people are our fearful of saying, what if we go in and they find something?

Well, that's a good thing, because then you can make it go away.

Exactly.

It's it's about coming in and trying to get things diagnosed early or being able to prevent things like Dr. Ulanoff, you said prevention.

Prevention is the best the best treatment.

And just for the community to be reassured that we're here to take care of them and we're here to help them, and that this is something that is going to be beneficial for them in the long run.

Exactly.

And diet and I think about diet, too, because I know that with in El Paso, you two grew up here.

We have a lot of diabetes issues here in El Paso.

Does that factor in at all with colon cancer and if so, how?

Yes.

So diabetes is actually Doctor Who was mom was talking about the amount of viable risk factors.

So diabetes can actually founder both modifiable and non modifiable depending on what kind of diabetes.

But diabetes it has is a known risk factor for colon cancer again.

But again, diabetes is usually, you know, brought on through dietary changes.

So again, this all goes back to your diet.

You know, there's definitely healthy diet habits, including eating high fiber foods, your fruits or vegetables, keeping it low on the red meat and things and fatty foods.

Are these are risk factors.

And again, some are protective like the high fiber type of diet.

Now, this eventually protection, diabetes and again, some evidence that it can hopefully prevent colon cancer.

So excellent.

I'm glad we brought that up, too.

I do want to talk very quickly because we were talking about Crohn's disease and again in my head prior to coming to this program, I wasn't focused on anything but the colon.

But if we're looking at esophageal questions too, because just Barrett's esophagus, for example, or just heartburn or issues that just affect the the tract in general, where does that colon to, for example, if you have GERD and if you have a heartburn a lot, does any of this have to do with colon cancer later?

Because it is part of the entire system or does it not at all?

Not actually.

So if you feel something abnormal, get yourself checked.

Okay.

So usually reflux or Barrett's has no relation to colon cancer, but if you see something abnormal like you have abdominal pain that not going away or you feel like you are losing weight or have some blood in your stool, this is something is not permanent.

So blood and storage, not normal can be coming from your stomach and becoming from a result of this can be coming from the colon.

So you need to see a specialist and in El Paso have many, many good specialist in Texas state UMC or community or private people.

They are all great.

They are willing to help the community and it is not only one place or one person, it is many people available for you.

If you have any problems, just get it checked.

Scattered, checked all all through a case study out there, which is my own.

I was 48 years old and my dentist said, Kathrin you've got a growth on your tonsil.

And I literally had a polyp on my tonsil and I thought, I've never in my life heard that before.

So I had a partial tonsillectomy and the doctor said, You're only 48.

This is before the screening guidelines were at 45.

It's when the screening guidelines were 50.

And so at that point I thought, Oh, I'll get a colonoscopy at 48, which was good.

There was nothing there.

But now I just do it every five years because even though that's not in my colon, I get it.

It's on my tonsils.

But you said earlier, it is literally from the mouth to the anus.

So everything in between, if something a little bit odd and funky, if you're insurance covered, get it checked out.

And if not again, I'm going to keep talking about this.

The success program at Texas Tech and UMC.

Again, that is something that you can do screening for free.

Absolutely.

Okay.

We actually have a little bit of time.

And so I am going to ask couple of questions that we have from old shows.

We there are I don't want to focus too much on GERD but there's tell me about anti HI pylori treatment what is that exactly and I know it's not colon related but it is digestive you know and it's something completely different.

But I have it in my notes from four different places from the show we did last week.

If we talk maybe about Diverticulosis is something colon.

Also people ask, Well, okay, yeah, okay, let's do that then.

Yeah.

Yeah.

So H pylori is a bacteria in the stomach.

Okay.

That's actually the main cause of stomach cancer.

Oh, gee.

So completely different.

Okay, so complete.

Separate.

Yeah.

Yeah.

And we eliminate H. Pylori, we detect it, and we can decrease the risk of developing stomach cancer, so.

Okay, well, that's a little bit too easy of an answer.

That doesn't give me enough time.

But what I do want to say to the people that are watching right now, there is this program and both PBS's El Paso and the El Paso County Medical Society, as well as You Tube now has just a series of programs for the El Paso position.

So if you're watching the show and you didn't catch it all, you can go back to again, YouTube, El Paso or not, YouTube has YouTube and then go to the El Paso physician.

You can also go to PBS, El Paso dot org and then find the El Paso physician and then El Paso County Medical Society and find the logo there.

Because what they do have now and again, back in the old days, you had to get the little tape or the DVD, but you can go back and find colon cancer.

You can go colorectal cancer, you can go to any issue that we've talked about and they have things a log back and archived for years.

So you can kind of see the difference between this show, last year's show and the shows that we do and have come up as well.

So I want to say thank you so much for sticking around with us.

And you have been watching this program on colon cancer prevention, diagnosis and management.

Again, we've got shows that are coming up every single month.

And if there's ever a question that you have that you want to throw our way, you're more than welcome to call the El Paso County Medical Society.

Get that question to them and we can answer it either then through email or we can go ahead and answer it on the following show.

So thank you so much for watching.

I'm Kathrin Berg, and this has been the El Paso physician.

Hi, I'm Kathrin Berg Berg, the host of the moderator for the El Paso Physician.

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