good evening.

>> Thank you so much for watching HealthLine on PBS for a way.

And I'm your host Mark Evans.

So nice of you to watch tonight we have a very important topic .

>> It is Colorectal Cancer Awareness Month and that's what March stands for .

We have a very special physician in tonight.

He's been on the show before.

His name is Dr.

Soon already a colorectal surgeon.

>> Great to have you back, Doctor.

Thank you, Mark.

And I remember the last time you were on the phone wouldn't stop ringing.

People had so many calls.

This is such an important subject and one that's ignored by people.

I mean many, many times and sometimes it's ignored too late for too long and then it gets to be too late.

So that's what we want to avoid tonight.

So thank you for joining us during this very special month.

I want to go ahead and open up the phone lines.

The number is on your screen at 866 rather than two six seven 866- (969) 27 two zero.

That line will be open for you for the next half an hour.

We don't stop down for commercials or anything like that because we are a public television but we have a lot of questions to ask here and I'm sure you have a lot of questions so please call and we'll go ahead and get your question aired and that's what the show is all about.

>> So Doctor, let's talk about Colon cancer.

>> Where does it rank on the list of most common and most deadly cancers?

Yes, in men colon cancer is the third most common deadly cancer third after prostate and lung and in women it's again the third most common cancer after and lung cancer.

>> Oh my goodness.

Yes.

So I didn't rank that high but a lot of well we'll get into that some dietary issues and environmental issues and a thing called gut microorganisms that was new to me when I did some research for the show today and we're going to be asking about that.

>> So what are the risk factors?

>> Who's most prone to get colon cancer?

So traditionally age has been considered the risk factor.

So most of the colon cancers that are diagnosed are after 65 years of age I would say almost 80 percent of colon cancer was diagnosed over 65 to 68 years old.

>> Patients now coming to the risk factors other than age genetic risk factors if there is any history of colon cancer in the family, especially the first degree relatives like parents, siblings, children that certainly carries a high risk for colon cancer and it doesn't matter if it's the father or the mother.

>> It could be either one.

It could be that one.

OK.

So other than that dietary factors do play a strong role especially with the current trend of fast food, processed food and increased red meat.

Certainly we have seen an uptick in colon cancer incidence.

Studies have shown that every four ounces of increase in red meat increases the risk of colon cancer by almost 12 percent.

>> 12 percent.

Yes.

Um, and then alcohol does play a role as well.

Uh, 10 grams of alcohol per day increase the risk for colon cancer by seven percent the lifetime and what is 10 grams?

>> Let's convert that into American measurements here.

The alcohol content would come to like one ounce of the alcohol o like a shot like a shot.

OK, so one of those yes.

>> A day.

Oh wow.

Would increase the risk for colon cancer by almost seven percent percent more than the average risk.

>> The average risk for colon cancer in an average patient is about three to five percent over a lifetime.

>> Hmm.

Yeah and you I don't know if you did this intentionally or not.

>> You went to dietary but the lifestyle has something to do with this.

What do you mean by that?

So, um, they're all interlinked diet and lifestyle, sedentary lifestyle, um has been shown to be associated with increasing colon cancer risk.

Um that increase desk jobs and people getting consumed by social media.

There's been less of physical activity and that has been shown to contribute to the increased risk.

In fact studies have shown that people if they increase their physical activity, the risk of colon cancer goes down by 19 percent.

So it's such an important contributor to colon cancer risk.

>> Yeah, well some of these numbers you're bringing to us are rather staggering.

>> And then we have next on the list Enviromental are we talking about work and work hazards possibly or yes.

>> This is something that we don't know specifically what exactly contributes but we do see certain occupations um, have us at a higher risk for colon cancer.

Again, environmental will also interlink the amount of physical activity are doing the dietary factors they all come into the play and that as well.

>> Okay, So that all ties in together then of course we have what I mentioned earlier got microorganisms and I think the last time I did the show might have been with you maybe another physician that didn't even come up and talking to you in the green room before the show started you said this has kind of been in focus for many researchers for the last decade or so.

>> That is true, Mark.

This is something that's new going on for a while.

The gut the bowels are full of bacteria almost every gram of the Bible contains contain a billion microorganisms.

Now that's such a staggering number there they do secrete chemicals, neurotransmitters that affect the nerves and then they also lead to reprocessing of the diet.

Like if you use red meat the red meat then gets processed into something else what we call as nitrosamines with the aid of these bacteria and that is what contributes to colon cancer.

So the bacteria just by the metabolism and the enzymatic activity they do change the environment within the bowels that increases the risk for normal bowel cells turning into something mischievous like polyps and then cancers.

>> OK, we're going to talk about colonoscopy and the polyps and the cancers in just a few minutes.

I did want to tackle something though.

I saw something earlier too young onset colon cancer.

>> What's the young onset mean in this case?

Yes.

You brought a very important topic here.

We have seen of late younger people younger than this and less than 50 years old people getting colon cancer and cancer.

Um, people might have noticed recently many celebrities who have been really young like in 30s and 40s getting colon cancer and dying from that.

So the young onset colon cancer is people getting colon cancer less than 50 years of age and there is a lot of research going in as to why this is happening.

There is a projected estimate that by 2030 at least one in 10 colon cancer diagnosis is going to be a young onset colon cancer.

Oh, that's kind of one in four cancer will be younger than 50 years of age.

So that's definitely a concerning trend here and this has been seen across the world not just in North America, Europe, Australia, Southeast Asia.

People think this is because of the birth cohort of the younger generation.

They all face similar changes in lifestyle like diet the way the work is changing sedentary lifestyle, obesity everything contributes to the increased incidence of colon cancer at younger ages.

>> OK, interesting information here, Doctor.

By the way, if you have a question of course the number is on the screen.

We're taking your calls about cancer, colon cancer in particular and cancer screening.

It's 866- (969) 27 two zero.

Dr. Reddy is with us this evening.

If you just tuned in.

>> So let's go ahead and go on down to the next question.

What are the symptoms of colon cancer?

>> Interestingly, colon cancer remain silent until it gets to the stage where it's a little bit advanced.

Then people will get symptoms.

It manifests as it could be anything subtle from changing bowel habits.

Someone who is going regularly every day could start doing that and may go to the bathroom every three days or such a subtle change can indicate something's wrong.

One of the common symptoms the bleeding blood in the stool um constipation and abdominal pain.

But by the time these symptoms really appear that means the cancer has grown to an extent that it's affecting the mechanisms of the bowels.

>> OK, and what can be done.

Um, so the uh one interesting thing of colon cancer is that it's preventable uh by screening but detection early detection so that we can find the cancer before it's too advanced and then we can treat it appropriately and that's what we're going to talk about the screening modalities.

>> Yeah.

And let's go ahead and get into that.

So how is a colon cancer actually diagnosed so in the early nineties our research has shown that colon cancer develops from polyps no polyps or small bumps that people can get in their colon more akin to like pimples or skin tags on the skin just like that.

These are little bumps in the colon that initially are very um benign and then slowly over a period of time they can turn into cancers as you can see in this picture on the screen the top two pictures that the polyp at this stage that little swelling is still benign.

It hasn't turned into cancer and we can get it out by doing a colonoscopy which is a procedure to go inside the colon with a camera, look at those polyps, find them and take them out the bottom picture that is cancer and there is a time frame during which the polyp can donate to cancer and since it's a slow growing process, we have a chance there to intervene and stop that process and get the polyps out so thereby we prevent the cancer and you have to do any sectioning of the intestines or the bowels, whatever you remove a cancer.

>> Oh well for cancer surgery may be needed but as far as the polyps are concerned, we can take them out during colonoscopy with simple techniques.

Um, but when it turns into cancer then we do some tests to assess the stage.

But the mainstay of colon cancer treatment these days is an operation where you go and take out that offending segment of the bowel.

Most of the times we're able to put the barrel back together so they are back to their normal bowel habits without much change in their lifestyle.

>> OK and with what you call the colostomy bag, was that required for dealing in certain cases customers may need to be done again early detection of colon cancer the higher the chance that you may not need colostrum.

>> OK, we'll talk more about detection just a second.

We do have a call coming in from Liz and she prefers her voice not being on the air and that's fine.

>> So we've transcribed the questions says here can hemorrhoids lead to colon cancer?

>> That's an excellent question.

Uh, well, hemorrhoids do not lead to colon cancer.

That's a whole different problem.

Hemorrhoids are something that we all carry but they can get bigger and cause issues of bleeding.

However, any bleeding should not be simply attributed to hemorrhoids.

Hemorrhoids can cause bleeding and they're the most common cause for bleeding.

But we should not assume this hemorrhoids any blood in the stool.

We should think the worst and make sure it is not colon cancer.

>> So it's a good thing to think about hemorrhoids but at the same time we've got to make sure we don't miss colon cancer .

>> That's a whole different subject there hemorrhoids and we'll have to tackle that one of these days.

All right.

So phone lines are still open for you as the calls are coming in.

>> Do you want to go ahead and mention we talking about the colonoscopy and you know and I was telling you prior to the show that my poor mother was a registered nurse and I think I mentioned that sometimes doctors and nurses are the the worst patients and she just never thought she just never wanted to go through that.

>> So we coached her into it in her final years of life and luckily her very first colonoscopy she came out everything was great so negative and then after that she was more willing to go in because it's kind of scary as far as the procedure and you listen to people tell you about this and tell you about that.

>> I've had one in fact I might be overdue for one but I remember just getting an I.V.

Next thing I was talking the kind doctor I was out like a light woke up in recovery and I think the whole process I was there for a whole three hours had somebody take me home.

>> I had to eat first and to stop at a restaurant first but it actually was not a bad experience at all.

>> So what do you think is the main reason people are scared about this?

>> Yes.

Mongu some the procedure exactly.

Well well the main concern that people have is the preparation for the colonoscopy in order for us to get those beautiful colon pictures and to find the polyps we need to make sure the colon is completely free of stool and to achieve that we give what is called a bowel prep.

Essentially it's a big dose of laxative to make people go and clear the colon of the stool and that is what scares people because now you're going to the bathroom 20 times in the night getting everything cleaned out.

You've got to drink a big volume of liquid with a laxative and that's where people sometimes can get a gastric upset to get nausea and they're worried about it.

Um, however, things have changed in the past.

Bowel prep used to be a definitely nasty one nowadays with the uh, advances in the bubble prep it's the lesser volume, more palatable and easy easily tolerated.

So I've seen, uh, many patients now tolerated better with good results.

Um, other than that the procedure itself takes about half an hour.

Most of the colonoscopy are done with sedation so people don't really feel anything.

Um and that gives a good chance for the doctor to check the colon and do what needs to be done to remove the polyps and they go home and they can go back to work the next day and I didn't have any residual effects side effects from the procedure but is there any possibility if especially if they went and they did get three polyps from my bowels and they were all benign but they warned me about possibly having some blood pass and I actually didn't have any that I knew of , you know?

>> So you know, it was easy peasy and I'm glad they got those out.

>> So then they're going to be checking for some again soon, I'm sure.

Yeah.

All right.

We have uh let's see.

>> Oh, I thought we had another call coming up.

Looks like we're we're loading up another question.

We'll go to another one here on my paper.

>> So we're talking about the preparation.

So it's usually the day before and it's you drink it and go to the restroom quite a bit, get yourself cleaned out you go and have a colonoscopy done and then you can eat after that.

>> Yes.

OK, that's kind of sounds like a good idea.

>> All right.

So let's get into the actual treatment of colon cancer now you explain to that if you go too far sometimes there's nothing that can be done.

So that's why we're talking about the prevention today.

So once, uh, for instance, uh, went to the doctor and they said you got colon cancer.

>> So what do we do?

What's our first step?

The first step is the diagnosis obviously.

So when we do colonoscopy we take some biopsies of the mass the cancer that goes to the lab and we get results which confirms that it's cancer and the next step is to stage it by staging we mean we want to check and make sure it hasn't gone anywhere else because that's what cancers do they spread so we want to find out if that has happened or not.

So we do CT scans of the chest and the belly to make sure it hasn't gone far away to the liver or lungs.

Uh, once we ascertain that it has not gone anywhere else then surgery can potentially cure it.

So the next step will be to work up for an operation to go in and take out a portion of the colon uh with the cancer out so that we we can reattach the bowel together or in some instances have to do a colostomy.

Um, certain cancers like cancers in particular may need some chemotherapy or radiation up front to shrink the tumor and then we do surgery um once we get the colon out that is sent to the pathologists who give us some additional information based on that some people may need some chemotherapy afterwards to finish the treatment.

>> OK, so we're talking about uh a lot of post uh up post appointments.

I was going to say operations but uh post appointments and that is just to basically keep you on track and know that you're healing correctly and getting the treatment that you need.

>> Very good.

And of course I would think that any time I'd go back you'd be checking to see if there's any changes negative or positive.

>> Absolutely.

Yeah, OK. All right.

Well we have another call coming in and it's from Jim this time he says this coffee have any negative effects on the colon.

>> Good question.

I got to know that.

Well, thankfully, Jim, it does great coffee place I make that to coffee has no impact on colon cancer.

Um, so no need to worry about that.

The main dietary risk factors are red meat that has definitely been shown to be associated with an uptick in colon cancer.

What is it about the red meat thing?

Is it is that the what they're injecting the animals with?

>> I mean it's not just red meat, is it?

I mean it's got to be something else.

Yeah.

The red meat is full of , uh, myoglobin the protein and certain ways of cooking it like barbecue.

Uh, that can turn down the uh the myoglobin and do toxic compounds like a mine's nitrosamines whole and they can interact with the gut bacteria and the resulting compounds they stimulate the cells to grow too fast.

>> Um and that's how it uh it results in colon cancer.

OK, so Char broiling steaks or any type of red meat is not a good thing.

>> It tastes good.

Yeah anything in moderation is OK but too much of that can potentially lead to colon cancer uh something you don't want to do and more than a couple of times a week or so uh maybe once that might be OK more or less the better the less the better.

OK, all right.

All right.

I don't want to put you in a in a weird position to answer that question.

>> So the prevention let's get back to some of these risk factors that we talked about earlier in the show genetic.

>> Yeah.

There's not a whole lot you can do.

I mean you are what you are you know, the only thing you can do really is just to be aware.

>> Correct that your parents one of one or both parents had this and this is something you should tell your physician exactly.

>> Yes.

Although we may feel that there's not much to do with genetic risk factors, there's a lot we can do.

No one is to find out how much risk you carry.

My simple questions like asking your family whether anyone had colon cancer and if there is any history of colon cancer in your family you can do genetic testing and find out if you have those genes that put you at risk for colon cancer.

If you do have those genes then we can put people on aggressive surveillance regimen, do colonoscopies more frequently so we can catch that polyps and cancers ahead of time.

>> OK, well how often for instance if I were a high risk patient apt to get colon cancer, how often do I need to see a physician and be checked so an average patient gets a colonoscopy every 10 years provided there are no polyps.

Once people start getting polyps then do colonoscopy at least every five years.

OK now people with family history colonoscopy are recommended to be on at least ten years before the family member got cancer or at 40 years of age colonoscopies need to be done started and then at least every five years and in certain rare genetic conditions they may need to be done every two years or every year sometimes.

>> Well, if they find that you have polyps, they go ahead and take them like they did with me.

>> You go back every five years or so the polyps.

>> Does it take that long for them to develop in cancer?

Correct.

Yeah, the polyps are slow growing so they go through these phases where the cells clump of the former polyp and then they slowly become a bigger polyp and then the the genetic changes get more concentrated and results in the pathway where they turn into cancers.

So that takes about three to five years.

>> That's why we recommend colonoscopies in certain intervals.

OK, I was wondering about that because if you've got polyps I mean you're bound to get them again.

But as long as you know the medical science knows that they're not going to develop into cancer right way, that's that's actually kind of comforting.

>> So but let's go on.

We've got about five minutes left in the program and I want to talk about because I discovered some things doing some research today and just in talking with you so the new medical advances and positive result research results what are we getting out of this in our research these days?

>> Yes, there are many advances.

Let's start with the screening advances we all know colonoscopy is the best way to screen for colon cancer but there may be certain patients who may not be able to do it so we do have stool based screening tests now which are getting really more accurate.

>> Initially we used to have fecal occult blood tests and the tests which were good at detecting but not really a specific one.

Now we have stool based DNA tests that detect DNA that comes from polyps which are getting more and more accurate so so that's getting better.

So we have more tools in our kit to detect colon cancer in addition to colonoscopy which is the gold standard uh, when it comes to diagnosis there are better imaging studies, better scanning modalities.

We can pick up these cancers um earlier and accurately treatment with more and more minimally invasive surgeries and robotic surgeries.

These studies being done with less pain, less hospital stay and patients can go back to work very soon.

And of course there's chemotherapy advances which are even in stage four cancer with cancer spread everywhere.

Chemotherapy is keeping those cancers under control and people get to live longer.

So much so that even in stage three cancer people are living at least seventy five percent.

People can live at least five years after treatment and I have a very close friend who had stage three cancer diagnosed had surgery and it been more than 12 or 13 years ago and he's doing great and he's very, very adamant about going to his colorectal surgeon and having his colonoscopy and in fact he's an advocate of that.

>> All right.

So some take home oh wait a minute.

We've got a call coming in and we've only got a couple of more minutes left and I want to make sure we address this call Dave would like to stay offline as many of our callers tonight have wanted to do but he says should I keep getting a colonoscopy every five years even if it keeps coming back negative?

Well, Dave, um, it all depends on what was found during your previous colonoscopies.

>> If you had any polyps at any of those colonoscopies, then we would recommend that you get it every five years if the colonoscopies were normal and if no one in your family had colon cancer then you probably can get it done every seven to 10 years seven to 10.

>> OK, now I want to go back to something very important that we talked about earlier in the show because of this the new age of the screening used to be what 55?

>> It used to be 50 to be 50 and now we are suggesting what 40 or 45?

It's now forty five.

Forty five seeing all the uptick in colon cancers, the US Preventive Services Task Force recommended that we bring down the colon cancer screening cutoff age to 45.

So and that's been the standard of care now and that's because of the young onset colon cancer increases.

>> Yes.

And that is based basically you would say it could be well several things but mainly genetic lifestyle and dietary oh alcohol that too.

>> Oh yes.

OK, yeah we mentioned that earlier in the show.

>> Right.

We have about 20 30 seconds for some final comments from you.

Some take home points for our viewers.

>> Well, colon cancer is very prevalent cancer in our communities here but preventable and it's treatable.

So compared to some other cancers which could be a very deadly colon cancer still has the opportunities that we can intervene and we can make a difference in people's lives and we have the tools these days.

>> We have the expertize.

We have the professionals and there's no reason why you shouldn't go in and talk to your doctor if you've got these issues.

>> Absolutely.

Yeah.

It's not an embarrassing, embarrassing thing.

It could be a life saving doctor.

>> Thank you so much for being thank you.

You're welcome.

Thank you.

Truly appreciate it.

And it is colorectal Cancer Awareness Month.

>> So make that appointment if you're overdue if you haven't had any screening whatsoever, make an appointment to see your doctor and see what they can do.

>> What's the first step and we thank you for watching tonight .

>> We'll see you next Tuesday.

Until then, good night and good