a colonoscopy one of the greatest gifts you can give to yourself really yes really colon cancer is one of the few cancers that is preventable and a colonoscopy without question can prevent colon caster how suspicious polyps are removed during the procedure and that's how we're going to talk a lot about that this evening we're going to kind of show you the instruments that are used during a colonoscopy and during this hour we have two physicians that are answering your question on prevention diagnosis and treatments of colon cancer as you know the show is live so if you have some questions that you'd like to call and ask us this evening give us a call at 881-013 we're also streaming live on youtube and if you go to pbselpaso.com we're streaming live there as well so in case you don't have a tv and you're watching this on your phone etc you are welcome to do so and call in your questions this evening's program is underwritten by dr richard mccullum and for the first time he is not here on a show that he's sponsoring because we were only allowed to have two docs on uh because it is the day and time of covid still and uh we're going to talk to you about some registration options too in a little while um we also want to say that texas tech university health sciences center is helping to underwrite the show and as always the el paso county medical society is bringing this to you for many many years now i'm katherine berg and you're watching the el paso physician so we are talking about colon cancer this evening we're talking about diagnosis and treatment but before we get started with that you see that we still have our mass on and that is a good thing el paso is doing really really great with vaccination rates and that's fantastic if for some reason you have not registered yet and you'd like to get registered there are two places that you can go there's a website that makes it super easy it's ep think of el paso epcovidvacine.com and right as you go into that website it says register for covid vaccine right on the front page that's great to walk through and follow the prompts from there if you'd rather telephone and know that you'll be on hold for a little while so there's some patience that's required there telephone number is 915-212-1032 again 9152 and we'll talk about that several times throughout this evening so we have with us a veteran doctor and a doctor who is got all the toys here which i'm very excited about we have dr antonio mendoza lad who is a gantr gastroenterologist specializing obviously in i would say this is a a nod to dr mccollum he calls you guys the tummy docs he calls himself a tummy doc and then we have dr isan abiyati also gastroenterology tummy doc on that note i would love to talk about you both have the same discipline on paper but what is it that you do maybe a little bit differently from one another i know we're talking about colon cancer this evening we're going to try to keep most of the questions there but all day every day what do you do and is it any different now than it was before covid i guess in terms of the way to summarize what we do all day is we see patients in our offices all related to any kind of gi related problems from your oropharynx all the way to the anus pretty much every single organ in gi system is what we cover and we do probably half the time seeing patients in the clinic or the office and the rest of the time is doing the procedures which is the bulk of the of the therapeutic aspect and why colonoscopy is so important in preventing cancer very nicely explained and uh with you dr albayati is it the same is it again you brought the instrument here today and i guess what i try to do um usually we have two different disciplines on or at least a team with uh the people that are coming in to see you have clinical sometimes it's it's for the screening and then we talk about treatment as well um will you be able to give an answer that's similar to that or so yeah we do the same thing um we have clinical duties patients in the office or in the hospital cover the consult service at umc and we have teaching duties as well we teach medical students paula foster school of medicine and we work with and train the medical residents and the gi fellows and if we have spare time we'll do clinical research especially in gastroenterology i like that if we have spare time you guys don't have spare time no actually uh research is something that we always talk about and kind of toward the end of the show when we have an idea of some of the treatments and just the new things that are going on because there's quite a few new things that are happening in the world of treatment um i'd like to talk about just the role of the colon so we're looking at we were talking about the entire gi tract and you've got the small intestines large intestines colons rectum etc because we're talking about colon cancer and there is rectal cancer as well but colon cancer is what is kind of the start of night what is the role once food once whatever you've eaten has gotten to the colon and why is that the place that cancers are most likely to be found in the gi tract well the primary role of a colon is to absorb water i would say that's the most important physiological role of the colon itself in the gi tract now as time has as science evolves we've started to discover that beyond the absorption of water the colon plays a very important role in maintaining what we call a gi microbiota microbiota is the the number of bacteria that we have normally in the gi tract and these are prove have been proven to be very important because they've been associated with a myriad of conditions and traits and things that we are constantly learning from at this point so i would say observation of water and maintaining a healthy gi flora that those would be to me the most important roles of the colon itself so that that brings me to what i feel like hasn't been uh something that's been advertised up until about a decade ago or maybe five years ago because now uh you're hearing on advertisements and seeing in newspapers and what have you that there's probiotics and prebiotics uh make sure you have this this system good and we were talking to one of the staff members here at pbs earlier that was on a you know a bunch of antibiotics for a while that kind of messed up his system i would love to since you touched base on that what is a prebiotic what is a probiotic and when do people take those and what does it help in your system so you're right in the past 10 years i would say there's been a boom in the what is advertised to the general public about prebiotics and probiotics i guess it is related to also the boom in the research that has been going on in the in the microbiota area so a prebiotic is basically a substance that that promotes the development of healthy bacteria in the colon and a probiotic is is a healthy bacterium or a specific kind of bacterium that is healthy for your colon and for your organism so yes it's been advertised heavily the use of probiotics but as everything that gets um i would say non-controlled advertisement it sometimes it's taken out of place and patients need to understand that the reasons and um yeah the reasons behind taking probiotics or prebiotics need to be there not necessarily just because the advertisement says take one a day because you'll feel better so it's important for them to consult their physicians and understand why and when they are used and that's such an important point which is why i wanted to bring that up because again for a long time i just heard probiotic probiotic and now prebiotics are kind of being entered into the i guess the marketing system right when you think about the marketing machine um that this is something you just don't take blindly um you've got the little drinks too so i'd like to bring that up here and there because i know that that's going to be some of the questions uh later on as well um let's see dr abayati if we can talk about screening guidelines i know that you've got uh some stuff here but guidelines for screening of almost anything seems to be not controversial but changes a little bit from year to year but um there may be actually if you could gracie in the back if you can put up chart number one which is the blue chart and we can talk about uh the ages of when people start uh being diagnosed with colon cancer and we can talk about that and the screening at the same time okay so if you bring the first slide this shows you that incidence of colon cancer is way higher after the age of 50. so colon cancer is common after the age of 50 and as we age incidences higher and higher um in the recent years there has been an increase in incidence in people younger than 50 and it's up to about 51 percent increase this is a very high number very large number but with all this increase still the people above age of 50 have higher incidence okay now since the 80s the incidence of colon cancer in this group above 50 has decreased significantly and about in the 2000s this decrease has been decelerating decelerating really fast so why it's because we're doing screening it's because we are preventing cancer before it happens it's because we are removing polyps polyps are small tiny tumors that haven't made it to become cancer yet so if we remove them you patients will not have colon cancer and that is like the like in a nutshell why we're here this evening um so when you have that that you go to the doctor at 50 and there's a lot of screenings that people just kind of get at 50. so if you can describe to our audience someone who is maybe 49 or they're 52 and haven't done it yet describe to them the procedure describe them several days leading up to and then the procedure of a colonoscopy so they they have in their mind what's what's going to be happening okay so before that i'll go to this but okay if someone is nervous and thinks oh but do i have to have it at 50 what if i'm 49 what if i'm 48. so great news now we are going to going to start screening at 45. so before because of all this increasing incidence in younger age group since 2018 the american cancer society recommended that we start at 45. and then the u.s preventive task force recommended that in october of last year wow okay and just this month the american cancer um the american college of gastroenterology released new guidelines that we are going to start screening at 45. i love that because i was looking at the curve earlier when that was on you have to put it on the air again but we're looking at the curve starting at like 49 is when uh that starts really bumping up like 48 49 and then into 52 and so that's that that nice little hiccup that's there so apps i'm i'm glad that that's official i know that we've talked about that on this program a couple of times that if there is any kind of uh genetic reason or if there's any symptoms you may have and we're going to talk about some high risk and some symptoms too but i'm glad to hear that what i'll do is wait to go through the colonoscopy for a moment and ask dr mendoza lad if you can describe some high risk factors for people who who just may not know if there's a family incident et cetera but if you can explain some of those to our audience so some of the most common high risk factors that we look for screen for in the general population is first first-degree relatives who have been diagnosed with colon cancer and at what age typically what we go by is any first-degree relative who is diagnosed younger than 60 years old mandates that the screening starts at an early age and an early age depends on what the actual age of the first degree relative was so i'll give you an example if my father was diagnosed with colon cancer when he was 45 as dr by albaye just mentioned we're moving the the screening guidelines to 45 but guess what that patient if sorry in this case me if my father was diagnosed at 45 i need to start screening 10 years younger than the age at what at which my father was diagnosed i should not wait until 45 or 50 because my risk is way higher so that's the recommendation we give people if you have had a first degree relative with cancer younger than 60 you need to get your screening 10 years younger than the age of the diagnosis of your relative or 45 whatever comes first because it may be the case that my father was diagnosed at 55 so at that point 10 years younger is 45 and that comes first than 55. so exactly that's one common high-risk scenario the other high-risk scenarios are genetic syndromes and these are conditions that run in families and they're inherited they're in your genes there's not much we can do about that there are different ways of inheriting them some of them are a little more they penetrate higher more frequently than others it all depends on the the pattern of inheritance that that they have but these genetic syndromes just to mention a couple of them we have one that is called lynch syndrome in these in this condition patients we recommend that patients start screening in their early teens and that means 15 20 years old and we recommend these patients to get a colonoscopy at least once every two years better if it is once a year so how would someone know if their child has lynch syndrome is that something that's very specific to spot it is very it's very specific so the parents are usually the ones that know if they've never been die i mean if they've been diagnosed before sometimes those mutations happen in the novel way the novo means none of my parents had it and i just unlucky person that got it for some reason and what are the symptoms of lynch syndrome so there's really not much symptoms except the fact that you have a higher risk of developing tumors in different organs of your body not necessarily only gi it's associated to genital cancers gastric cancers some eye conditions well i guess the accommodation is a little more frequent in the other frequent genetic syndrome but um it's just something that the family should be aware of and it should pass on the information to their offspring because that's going to make a very important impact on how they're going to be screened during the rest of their lives right the other condition is fap fap stands for female adenomatosis animal dose polyposis syndrome and that is say that slower again fap familiar adenomatous polyposis polyposis okay and that puts you also at a higher risk of colon cancer uh same about the same age screening guidelines about early teens 15 and above once a year patients with fap are recommended if they know already that and i guess that's my biggest question so going back to lynch syndrome and also to fap how does a parent or the child no like what what are the symptoms what what is happening in their body that thinks okay well we need to figure out if we have lynch syndrome et cetera so how does one know again so it's related to the kind of tumors and cancers they're associated to so okay jen into urinary tumors uh colonic tumors gastric tumors okay uh so one the lynch syndrome is associated with some sort of some specific kind of bone lesions that we call a stimus so it's it's not a diagnosis that you're going to be able to make on one visit and say oh yes you have those you have to have you have to take in consideration the whole picture of the patient okay gotcha all right let's talk about let's talk about the toys in the colonoscopy okay so we have a scope and um it looks scary on the table but if we talk through it and explain what is happening with the scope where it's going etc that's what i would love for the audience to be able to see and understand because also you brought with you and i love that you have some biopsy forceps you have a snare and then again the scope so let's start off with the scope okay and um again let's walk through what the procedure is like okay so first of all it's not scary at all good for you okay it's not i've been through it it's all good okay so before the patient sees the scope on the day of the colonoscopy um they will be screened by our nurse and they will go through their medical history medications and then maybe if they need some lab work they will have them so that's about a week before they come okay and if any of our patients is thinking well should i delay my colonoscopy just because of covet and maybe it's a little bit risky to do it right now we are screening all our patients for covet before they come for the procedure and we're making sure all our patients are negative to protect them to protect our staff and everyone if you could throw in at this point too all of your staff has been vaccinated just let's throw that out to the audience and let everybody know that too and when that has taken care of exactly so when the patients are coming they are really comfortable i know that the numbers of screening nationwide plumped it severely so we're calling all our allies to help us get us back on track to screening and we are actually doing way better now we're screening hundreds every month uh hundreds of patients so the patient comes on the day of the procedure the day before they were only drinking liquids no solid foods and they drank the prep okay so talk about the prep um if you don't mind because that's people like oh the prep but the importance of a proper prep um and if you know i'll just kind of start this too this is a general lay person i mean the pep just it just makes you you have constant diarrhea for a good what 12 14 18 hours something like that but that's a good thing i know this is a colon cancer show and it's everything you want to know about the colon and more so we talk about that kind of stuff but it's to keep the colon or get the colon completely clean so that you can see what's going on in there yeah some people like oh the prep but it's worth it and you know totally you can think about it as being a healthy cleanse absolutely once every five years yes okay i thought i'd throw that out there exactly it's not as bad as people think a lot of patients come and they say it wasn't bad right yeah so it's one night as you said they drink uh different amounts depending on the type of prep could be four liters two liters uh come in different flavors okay uh i always tell the patients put some eyes for some reason taste better they they go through it better so the importance is that i need to see the colon clean right i need to not miss any polyp so polyps are sometimes just two three millimeters and we're taking them out so if the common is completely clean that will help me do my job exactly okay and if you haven't prepped right you're gonna have to do it again yes so that's so so so important and i know that's you know we've talked about this on different shows too but it's worth just really doing the prep and doing it right exactly okay so then we talk to the patient sometimes this is the first time we meet these patients and we talk to them we ask them some questions the anesthesiologist or if we are doing the sedation we'll talk to the patient as well and then they go to the procedure room the procedure in general will last anywhere between 15-20 minutes if there are polyps it depends on how difficult the polyp is to take on average between three to five minutes okay that's on average and um we this is the colonoscope these are my controls so this is how i move the scope in different direction so the patient is laying on the table on the left side so these are my controls and this is the tube that i will be driving through the colon of the patient okay it has it has a camera a light and a channel where i can pass all these instruments through right okay i love that you brought this okay so we drive the colonoscope from the end of the colon which is the rectum all the way to the beginning where it meets the small intestine sometimes we take a peek on the small intestine the reason why is for screening colonoscopy it's just to confirm that we finished the colon okay if we find polyps then depending on the size on the shape uh on the characters of the polyp we will decide how to take it out this is the fun part for me yeah okay so we've got the uh the biopsy forceps you said and then we've got the snare all right so when would you use which one okay let me remove this for a second so the biopsy forceps will use it for simple small polyps that are about less than three four millimeters so this is how it looks like and when it opens it's about five millimeters at least less than one centimeter it has two arms and we appreciate it patience waiting for the focus there we go it's starting to get there okay but yeah and it just we attach it to the polyp close it pull it back and it will cut the polyp amazing okay so that's the job of the biopsy and we can use them alone we can use them with electricity with kotari different types of so that was my next question so as you snip the polyp off um cauterizing that area meaning burning the the flesh in that area so that it um is completely sealed tell me about that so yes that's absolutely right we don't our target is not to burn the flesh um when we take a polyp out there could be a blood vessel there that may bleed immediately or later so the cauterization helps obliterate the blood vessel close the blood vessel okay rather more than just burning all the tissue around so when we close the blood vessel we prevent immediate or delayed bleeding okay okay and that happens with every polyp that's removed that is an automatic so yeah so if the polyp is very small um doesn't look like that it penetrated a lot in the tissue we can do it without most of the polyps are done without cauterization okay okay because the risk of bleeding in these procedures very very small okay okay so about less than one in every thousand case will have a risk of bleeding gotcha and with all the new technologies that we can control bleeding it's a very small risk right okay good to hear that okay um so then this nail right yeah so the snare is another tool it is like a loop or lasso metal that cuts poles so when we ask our technician to open the snare for us and they got me a big snare oh yeah so yeah so this is this is a big one right okay um you the usual snares that we use all the time are 11 millimeters they are small this is either 27 or 30. so but you can see i think it's better for the screen so you can see how it's like a loop okay uh the polyp is inside it okay and we close it okay when we close it it depends again um we will see in one of the slides there is a scissile polyp there is a pedankulated polyp for pedunculated polyps most of the time we can use cauterization because the polyp in the in this pedicle and the stock there are blood vessels so we can obliterate them and gracie if you don't mind um we'll have at the ready the third slide that we have because i just think this is a perfect time to talk about them since we're talking about these procedures too so there we go look at those beautiful things all right so uh dr adebayotti have a good time explaining what these are okay so on your left side you see a pedenculated polyp so to the right corner where there is a tiny green thing uh this is the pedicle okay and then the red part is the polyp itself so when you said the pedicle just like it's it's a it's like a top like a stock sticking out from connecting the polyp to the wall of the column okay so um we put the snare around it and we close the snare we use cauterization and we cut it okay so that's an example of a potentiated polyp on the right side is an example of a flat polyp yeah i thought this was interesting we talked a little bit about this prior to the program um but i love how you're able to raise this yeah so when it's flat there is risk that first we will not get it completely and the second risk is that maybe there is some penetration and when we cut and cauterize we might cause a perforation so what we do is we inject liquid under it and we raise it up separated from the rest of the wall of the colon and we do the same thing we snare it until it's closed and we cut with electro with cauterization sometimes now we're cutting even without cauterization and we can see the underlying tissues and this way we prevent losing part of the polyp we prevent perforation so here's a question when you say that's a flat polyp i know that looking at that it's not flax you've already injected the fluid into there um when you have and i've seen many pictures of polyps throughout the years right so you've got a regular polyp that you can see there when you say it's a flat polyp this is just something that it's not the size necessary you're talking about it's the shape of how it's laying in the colon is that correct if you can explain a little bit about what a what a regular polyp would look like versus a flat follow-up and then how you all see and distinguish between the two yeah so there are many things there there's the in collated polyp which has a pedicle a stock there is the scissile polyp which is like a cluster of grapes that is raised right uh and there is the flat that we call laterally spreading maybe okay so these are the shapes and in each one there is also different things that we look at before we decide to remove it so how the crypts inside it look like this all makes us change our decision of how to remove it or sometimes even we don't remove it certain shapes tell us that there is too much penetration into the wall this patient needs to go to surgery or this patient needs a consultation from our advanced endoscopist like dr lat to remove it in a very specialized way okay you know what that is the perfect transition to dr ladd i feel like i haven't talked to you in 20 minutes um let's talk about colonoscopy has been performed now we have a polyp in there that you were talking about drug about iot um that okay dr lads got to go in there and really perform surgery take the pollop out and i'd like to also talk within that how you do that procedure differently from this if it is different from this and then how the biopsies occur like where do you send them how do you send them how long does it take etc so that's why colonoscopy is the the piler of cancer prevention because like dr albari just beautifully explained polyps come in different size shapes colors i wouldn't say flavors because that's not yeah but there's a there's a variety in which each polyp can grow and depending on the size and the shape of the polyp that's how we decide which instruments we're going to be using the beauty of colonoscopy is that it has evolved from a mere diagnostic procedure to now a procedure that is therapeutic in i would say a good percentage of maybe six at least 50 percent of the times maybe more and the reason it has evolved is specifically because you were trying to provide patients with a minimally invasive approach to remove pre-malignant polyps and even malignant polyps depending on depending on how deep they are in the wall of the colon dr albayani explained that we inject fluid to separate them from the rest of the colon the colon is made up of four layers the most important layer is them well they're all important but the layer we're mostly looking for and looking at when we're doing a procedure like that is the muscle layer that covers think of it as the as the stiff layer that makes makes the colon wall resistant inside towards the what we call the lumen towards the inside of the colon is the innermost layer which is the mucosa and the submucosa that fluid that's real by ali shown there is injected into the submucosal space the submucosal space is normally no more than microns which is a thousand of a millimeter but when we inject it with fluid we expand it and that gives us a space for us to cut and cut safely by not cutting the muscle if we cut the muscle we end up with a hole in the colon and that's not right exactly so with a colonoscopy you can remove a tiny polyp with a biopsy forceps like he just explained or you can do what we call now microsurgery we are able to remove polyps that otherwise i would say five ten years ago were being referred and stillers being referred for major surgeries just because uh there may not be the expertise or there may not be the awareness that these opponents can be removed with a colonoscopy now those therapeutic colonoscopies may take longer and they have a higher risk of perforation meaning because sometimes the the dissection of the tissue is a little difficult and we end up causing the perforations of the colon or bleeding because the bigger the polyp gets the harder the the to remove it is however the message that i want to send to our viewers tonight is that if you've been diagnosed with any kind of polyp and been offered a refer for surgery just seek a second opinion because we're open here at texas tech to take your your second opinion where we'll be able to glad to consult on you because i can tell you the majority of these polyps are removable without a colonoscopy rather than having to send the patient for a major invasive surgery and i'm so glad that you brought that up and that's what i'd like to ask about when is it time to have a surgery and so again that's what's changing we talked a little bit about that before the show as well that every year there's a little bit something more that these instrument instruments can do um what i'd like to do because this is i feel like we're going so far into the show already i'd like to talk about treatment so once there is a polyp that was removed biopsied now we know that there is a cancer we know that it is malignant um from there let's talk about some treatment options and if you'd like feel free to use a case study in your head that you have no names no particulars but how and because there's so many different treatments as well so you're welcome to start on that and feel free to if we talk specifically about a malignant polyp what we look for is the appearance of the polyp there are ways of telling how deep that polyp is going into the layers of the colon the holy grail is the muscle layer once we can establish that the polyp is already attached too hard or too deep or even way beyond the muscle that means that polyp cannot be removed endoscopically anymore that polymer that tumor is going to need surgery okay again when you say surgery let's talk about so because now it is in the muscle layer and um i'm thinking about sectioning too and when you know people that i've known have had a section of their you know even if it's four or five inches of their colon removed resections stitching etc talk a little bit about that as well surgery basically involves removing a part of your colon and that's why the the approach has shifted so much because i would say 20 years ago a polyp that was not necessarily malignant it was just large enough that we couldn't resect with a snare would have gone to surgery and that means a completely benign lesion not benign but with the potential of becoming cancer but it's not a cancer it's being subjected to a major operation where half of the colon is removed where a big portion of the colon is removed when nowadays we can remove them endoscopically without you having to go to a major surgery so when we talk about surgery in terms of colon cancer it's usually i would say for the most part it's divided into the left side or right side what we call colectomy colectomy is a word for removing part of the colon okay so depending where the colon is that's the what's going to determine what section of the colon is going to go when the surgeon goes in and takes it out gotcha so their surgery there's endoscopy and i would say that's pretty much the two options now within endoscopy there are different ways of treating these polyps we cut them out of the snare we take them out with a biopsy forceps sometimes we need to do what we call dissection which involves some other instruments that we don't have here tonight but the principle is still the same we separate the polyp from the muscle layer and then we expand that space and that gives us a space to basically cut it out right exactly um i've got some questions here from the audience and it's not necessarily cancer related however i want to talk about some symptoms of colon cancer or just colon issues question here from the audience is why does my stool come out flat on one side um and not on the other and i the question you know the under question is with the colon or where the rectum is shaped is that something that should be of worry yeah this is a worrisome sign okay so what we call change in vowel habits and change in his tool caliber okay so it's not necessarily maybe phrased well that like flat on one side regular on the other way something changed yeah something okay my bowel habits changed so that's worrisome and patients should seek medical advice if they have this issue so if patients have advanced cancer so now we are talking beyond polyp beyond large polyps even now there is a mass that is taking most of the circumference of the colon when this tool comes down the colon it will be reshaped according to how much space it has to pass through exactly so some patients would even describe their stools as pencils okay so that's so this is something that they need to concentrate right okay so that's what the patient means i hope she or he do not have colon cancer right okay but there are other things like spasm um maybe they are not drinking enough water so i don't want to scare them but maybe that's why the uh so let's let me throw this out there they need to come in they need to consult the gastroenterologist asap right go and get a colonoscopy asap the person who wrote in that question very very important um another question here from the audience what is the difference between a home colon test and a colonoscopy actually that's a good question because i know that uh several shows that we've done before um have talked about that and really the the caveat of that question is how accurate is one test compared to the other who wants to take that one dr mendoza that's yours i can tell you briefly there are uh different ways that we use the screen there's the difference between screening and treating polyps right the screening is looking for them treating this when we actually remove them so in terms of screening there are non-invasive methods which is probably what this person is referring to which are basically cards uh that this tool gets put in a specific card a special card it gets sent to the laboratory and it gives you a probability of what the the risk of you having cancer is no test is perfect right even though the colonoscopy is the best one like drawback said sometimes the bullets are too small sometimes they are in a different in a difficult angle and we may miss them right and there's i like your word though probability it's not technically a string everything that we do in medicine is about probability right there's no perfect test every different every kind of test has its pros and cons what we go by is the sensitivity the sensitivity is basically how likely is it to find cancer when cancer is really there in my colon so those little cards uh the two major uh versions are is one that is called the fit and the other one is called the dna test the dna test is a newer test fitness has been in place for a while i want to make sure that the audience may understand there's a big difference between a fitness and a piccolo cold blood test which is a very the oldest way of checking for colon cancer but that at this point i would not advise anyone to use it so in terms of the non-invasive we have the fit test and the dna test okay those cards can be done at home get sent to a lab and the lab will tell you either they're positive or they're negative and again that has to be interpreted in the whole taking into account a whole picture of the patient because that that positive may imply a certain probability based on your risk factors right and and the ultimate thing is those things are pretty good i wouldn't i'm not going to say that they they're they're bad tests to take but the best one is a colonoscopy and remember that if you up through one of those and if they're positive you're going to have to go get a colonoscopy exactly and again with the colonoscopy we're talking about prevention if there is a paul up there during the colonoscopy it's taken care of if it's if it's one that it doesn't require surgery and for the most part that is the case if there are polyps and i would like to say too um so with breast cancer and prostate cancer that's like a yearly every other year screening this is if you're completely clean if there are no polyps whatsoever is that still recommendation of five years every five years or every ten years if you are clean completely and you don't have a family history then ten years okay okay if you have a family history like the lad was saying and that person is younger was younger than 60 then it's every five years even if you had a clean colon okay if that person was older than 60 when they were diagnosed with colon cancer then with a clean colon you still do your colonoscopy every 10 years so the urging here is if you haven't had a colonoscopy please go and get one if there's nothing there you can wait 10 years to get another one but at least you have your baseline and at least you know there's something about that uh question here from the audience too how important is diet in avoiding polyps in colon cancer and i love this especially in people who are aged 80 and over number one good job for getting the 80 thanks for calling in because 80 is now the new 60 right now 100 is the new 80. it's great um but in general risk factors are one thing but there's also the idea of how to eat we always talk about more fiber we talk about exercise and this could be a time to talk about that a little bit dr mindos alad sorry so what the role of diet is diet is super important it's one of the main factors associated to the incidence of cancer however it's difficult to establish up to what percent the diet alone influences your risk for cancer but it's definitely there in general we advise to avoid uh frequent and heavy consumption of red meats which has been associated with an increased cancer risk and but normally at age 80 we don't necessarily recommend screening for tumors anymore because and it all depends on how healthy the patient is at 80 because we have to take into consideration that at 80 years old if we were to find something patients that may not be a good candidate for surgery may not be a good candidate for chemotherapy so at this point the actual benefit of the colonoscopy is not it gets lost basically outweighs the risk benefits outrageous but diet is definitely very important and we just in general advice i would advise stick to a vegetarian diet i know that's easier to say than done but that would be my my own personal recommendation okay gotcha uh dr albayati we're kind of at the 13-minute mark so i wanted to just say if there's something that we have not covered yet i'd like to cover it now we still have some questions here from the audience that we can talk about um but just in case is there anything that we haven't talked about yet or is there something else that you'd like to expand on that we talked about earlier um i think we covered colon cancer screening screening methods um what i would like to tell the audience is i think we've been doing this colon cancer screening and awareness march is the month of colon cancer awareness and it started in february of 2000 and since then it's been growing advocates and doctors caregivers patients and survivors we're rallying and promoting awareness for colon cancer fundraising everyone wears the blue ribbon um so educating about colon cancer so if any of the audience is watching and says oh every year i see catherine tell us about colin kansas i will get it and i don't get it right so maybe our audience wants to say okay this year i'm going to get my colon cancer screening whatever test it is colonoscopy preferred um a lot of insurance plans have preventive uh service uh covered so this is the greatest gift you can discover really and there's a lot of work by gi societies and this is a little political but a lot of gi societies are working hard to cover any to help cover any other hidden fees so when the procedure becomes therapeutic and this is reality we have to admit it sometimes the patient has to pay a little bit out of pocket okay but still remember if you had to pay a small amount it's totally worth it it's a great investment and it com it is not at all comparable to the amount of um cost and suffering patients have when they have colon cancer right exactly yes absolutely documented i want to echo this and i i think i've been saying this for the past few years that i've been in this show the best screening test is the one that gets done yes it doesn't matter if you are if you're afraid of the colonoscopy for your we try to make it as friendly and as easy an experience for you but you still have your own reservations talk to your primary doctors we spoke about the non-invasive ways of checking yourself they're perfectly okay know that colonoscopy is the best one but it's not for everybody but if you're not if you're a physical colonoscopy get it done be a the stool dna or the fit just get it done it doesn't matter if you don't get a colonoscopy you need to get checked once you fall into that age range or if you have specific risk factors get it done exactly uh question here from the audience and we've talked a lot about cancers but let's talk about diverticulitis we hear about that all the time is that a precursor to any type of cancer in the colon who would like to take that one drug tea so a diverticula is an out pocket from the colon think of when you inflate a balloon there's so much pressure that the balloon pops out okay okay so it's a wear and tear with age um the muscular layer is weaker there is some defect points so there will be these out pockets these are called diverticular diverticula we can live with them nothing happens for years they can bleed because sometimes they have some blood vessels that become very superficial they can bleed and they can also have a complication called diverticulitis which is an infection basically um it could be simple uh treated with oral or iv antibiotics or it could be complicated with an abscess formation so a lot of bus accumulates in the infected area and causes an abscess for perforation that will need surgical intervention does a person know like are there symptoms with divert okay so what are some of the symptoms that people can look out for so almost all because we don't say always almost all patients with diverticular diverticulosis have some sort of constipation okay mild or severe okay could it happen without yes and what is it that causes the constipation because like to me it's like a lack of moisture um what is it that in diverticulizes that causes the constipation so to answer what causes constipation there are different categories for constipation okay one of them less moisture absolutely the other is less mortality of the gi tract less coordination of muscle okay action less personalises that move or an obstruction and that's what we're talking about here obstruction like cancer so so these are some causes but what causes diverticulitis is sometimes stasis of stool in these diverticula so it doesn't move and it's full of bacteria can cause the uh infection okay what's this is there pain that's associated so you've got constipation constipation is one thing okay um if you if they don't bleed if they are not infected then constipation is the only thing ah if they bleed then patients will see blood coming out and they will know that there is something so that's a symptom okay the other symptom is pain and fever and that happens when it's infected okay so here's a question if you have some of these symptoms because and you hit you hit it earlier too there's so many things like oh that'll go away ah that'll go away um and maybe dr mendoza land tell the audience when it's time to i should go get this checked out we had that question here earlier about the shape of the stool which is one thing um if someone you know may have diverted you have diverticuli that may be infected and you know and you know the question i'm asking all of us are kind of like oh that'll go away oh next week i'll be fine or whatever when is that point will you call for help i would say always look out for what we call the alarm symptoms alarm symptoms meaning changing the bowel habits like the trial biology just mentioned bleeding by rectum unintentional weight loss weight loss persistent abdominal pain and if you are completely asymptomatic regardless of your status just go get checked at 45 or earlier if you have a high risk for that but the symptoms when they actually happen because not they don't happen in all patients but i would say those would be the ones that we worry about if a patient is exhibiting any of those in any combination they should go checked immediately exactly and again the screening guidelines have been changed from 50 to 45 which i think is so due in time i feel like that should have been happened a good ten years ago i'd like to talk about uh so again from the audience the the idea of blood in the stool and then let's do talk about hemorrhoids because that could be also very confusing because that's on the outside that is something that is not colon related but rectum related but i'd like to just touch base on that drawer by see you get that one so at the end of the rectum the veins that drain the rectum are called hemorrhoids okay and we all have them because the blood has to be trained in a way or another so these veins drain directly with a lot of pressure and again wear and tear these veins can become larger okay and they become what we call hemorrhoids hemorrhoids could be something that the patients see are protruding outside they could bleed the blood inside them can get thrombosed so they become painful okay they can cause itching and or maybe they are un not visible they are inside okay but they still cause bleeding or pain the best way to treat hemorrhoids is to try to avoid them to become enlarged from the beginning so avoid constipation eating high fiber diet drinking a lot of water and once they happened if there is bleeding or pain they the first step is to treat them medically with medications local therapy some endoscopic therapy as well and if all this doesn't work then surgery is the treatment okay and the bottom line is too if there is some kind of blood that is like one of the biggest indicators hemorrhoids sometimes if you're feeling something sometimes that's a good sign because that's something you can feel a lot of times other things you can't i'd like to touch base really quick on inflammatory bowel disease because that again we're talking about symptoms risk factors when do i go to the doctor et cetera if you can just explain what um inflammatory bowel disease is and how that is different or again if any of these things are precursors to cancer so inflammatory bowel diseases i guess a very good example of how different factors come into play into causing a condition inflammatory bowel disease is a condition that affects different parts of the gi tract and since we're talking specifically about the colon let's talk about that we don't know exactly what causes it however we know there are things that come into play number one genetics number two what your gut microbiota is number three what your diet is number four what your um i don't know if i mentioned this in the beginning but what your genetic makeup is okay so it is basically a uh inflammation of the layers of the colon that can manifest it manifests itself by pain bleeding weight loss so those are all the same things that i mentioned so that's why not one symptom is specific for a specific condition right that's why it's important for you to consult your physician and get an idea of what the possibilities are we again we as physicians we always work on the base on probability if i get a patient tonight in my office complaining of these symptoms rectal bleeding weight loss diarrhea i'm going to think about a few things depending on what how old the patient is what the genetic composition of that patient is what the job of that person is so it's all about having that mindset of not putting it away not not thinking it's gonna get better nothing is gonna go away go get yourself checked out absolutely again and again diet is a big thing too we only have two minutes i want to touch really quick on crohn's disease uh because again it's all related there what is crohn's disease so crohn's disease is another one of two forms of inflammatory bowel disease could be ulcerative colitis where it involves the colon only or crohn's disease crohn's disease is also an autoimmune disease that at one day an environmental factor comes to a patient that is genetically susceptible for the disease so the autoimmune system is activated it could hit anywhere from the mouth to the anus and can cause ulceration inflammation different than ulcerative colitis it causes also strictures and fistulas right and in that aspect it's a little bit more complicated in fistures and i'm going to just because we're running out of time are like little pockets is that correct or am i saying fistula is a tract that connects between a mucosal tissue okay the colon yes to the skin okay or to another uh organ another tube okay so we're talking about some obstructions there too um we're running out of time my apologies i feel like this is that show that you can always ask so many questions and this was just cancer man we have colin shows us all kinds of fun stuff there i want to say thank you very much to dr mendoza lad also to dr albayati and to dr richard cullum who is underwriting this show this evening we miss you um i can't wait till we have three docs back on again it'll be really nice and again if you have not registered for a coven vaccine but would like to the website for that is ep coveted vaccine.com also a telephone number 915-212-1032 and i have to give out to a shout out to brenda for answering phones today very very much appreciate that again we are looking at every adult at the end of march that is able to get vaccinated so again to register for that ep covidvaccine.com you've been watching the el paso position thank you so much for joining us and good evening [Music] [Music] [Music] you