and good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne.

I'm Mark Evans.

Your host along with our special guest tonight, Dr. Jeremy Wilson and he is a general surgeon and tonight's topic since it is Colorectal Cancer Awareness Month we're talking about Kolaric Cancer and we'll talk about some other cancers of the colon as well as we go along just to let you know it is a live show of course and we always take phone calls but tonight to be a little bit different we have some technical difficulties.

We tried so hard to fix before the show started but we're able to do that so those will be fixed.

I'm sure tomorrow morning.

So we do have a few questions in the can, so to speak from people who have actually known about the topic we'll talk about tonight and emailed those and or gave us word of mouth so we'll go ahead and address those tonight as well.

But in the meantime, Dr. Wilson, thank you so much for joining us.

Thanks.

>> You were here a couple three months ago or something like that.

A very interesting conversation and we are going to talk specifically about colon cancer tonight and because you've had a lot of experience with that, I have you as a general surgeon and these days they pretty much have colorectal surgeons pretty much aren't targeted for that particular entity.

>> Is that correct?

It depends on your geography really.

If you're close to a city then you know most of the time you're going to have a colorectal surgeon available to you for certain types of cancer operations, especially cancers.

You definitely want to have someone that has a lot of experience such as a colorectal surgeon.

>> If you're more out in a rural area you may get the general surgeon.

But don't worry, general surgeons do have that same knowledge, have done a lot of the same types of operations .

>> Right.

Well, good we're in good hands tonight and we thank you for being here.

Let's go ahead and start with some basic colon cancer stats, some statistics if you don't mind.

>> Colon cancer right now at least in America is the number three most common cancer for both men and women is the number two cause cancer deaths in men and women expected to be well over 100000 cases diagnosed this year of colon cancer and close to 45 50000 of cancer.

>> Oh wow.

Yeah.

And I just before the show started I was able to get some statistics from the American Cancer Society who of course is sponsoring Colorectal Cancer Month.

>> Right.

They are predicting that the number of colorectal cancers in the United States and this might be fresh news to you and it's fairly I haven't seen this come up yet until today but about one six five.

Well, I'm going around it not to 107 thousand new cases of colon cancer, 54000 of those in men, 52 thousand or close to 53000 men women and about 46000 new cases of cancer in men the 27000 range and the eighteen thousand range for women.

>> So that's quite a bit I mean when we're talking about millions of people of course in the United States but that's that's a very high number and that doesn't even talk about the number of deaths right.

>> Can occur from those cancers.

Correct.

So we're going to talk about prevention.

We're going to talk about treatment.

They've come a long, long way as you can attest.

Yes.

Especially in the last decade or so and how to to treat colon cancer as well as help people survive many, many years after they have conquered it.

>> So that's out of the way and now there are six basically from what I can count and you're the doctor.

>> You're the physician.

So you correct me if I'm wrong but there are about six different types of colorectal cancers to my knowledge what I can count today.

>> The main one that people focus on when we're talking about colon cancer in general is what are called adenocarcinoma.

That's the one that most people will equate with colon cancer.

There are other cancers that can affect the colon as well.

>> They can also affect other parts of the body though, such as a gastrointestinal stromal tumor which can occur, you know, stomach on down carcinoid tumors.

I've identified several of those in my career during colonoscopy but they can occur anywhere else that can occur in the upper GI tract that can occur in the lungs lymphoma lymphoma can occur anywhere.

But I've seen a few cases of colon involvement with lymphoma and you know, always got our prayers and our thoughts and for mayor of our city, Mayor Tom Henry recently diagnosed with well I don't know if it's been recent but he made a public announcement a couple weeks ago about him having stomach cancer.

>> So that isn't necessarily caused by the colorectal cancer.

>> That's an entity of its own.

Is that right for the most part, yes.

You know, there are different types of stomach cancer as well.

There's one that is associated with the H. Pylori infection.

Some of the other ones you know, there are some polyps that can develop in the stomach progressed to a cancer very, very similar to what a colon cancer does, OK?

It just depends on the type.

>> But the one we are talking about tonight in particular is the one that starts with polyps, is that correct?

That is the main one.

The majority of colon cancers are what are called adenocarcinomas and those are the ones that we believe start as polyps and the idea with the screening programs is to identify it and remove it at that polyp stage and therefore it never gets a chance to turn to cancer.

>> OK, I've read that if you're current on your colonoscopy that's going to decrease your chance of getting colon cancer by about 69 percent, your chance of dying from colorectal cancer about 68 percent.

>> And we talked about something in the green room where we met before the show started.

>> You mentioned 1990 people born in 1990 and I found that I said I wrote that down here.

I said well I want a question mark.

I want to ask about that.

So people born in 1990 we were talking about when should the average risk person start with colon cancer screening and previously it had been 50 because we saw most of the colon cancers and folks over 50 recently within the past several years they've actually recommended lowering that screening age to begin at 45.

>> OK. And a statistic that I read that kind of helped back that up was that it said that folks that were born around 1990 have a two times higher risk for developing colon cancer in their life and a four times higher risk for developing cancer during their lifetime compared to somebody that was born in 1950.

>> That is amazing and why is that?

I think a lot of it has to do with diet environment you know, the obesity crisis that has really gotten out of hand within the past several years and we're seeing some of I don't want to say benefit from that because it's not really a benefit but some of the consequences well, we have a question that we retrieved before the show and regarding screening and temas ask how early should I screened for colorectal cancer if runs in my family?

>> Which is a great question.

That is a great question.

There's not a straightforward easy answer to that.

>> It's going to depend on who in your family had colon cancer .

>> Is this a first degree relative or was it my great aunt three times removed?

OK, the other key is what age were they diagnosed with the colon cancer?

>> If you have a first degree relative that was diagnosed under age 60 that's going to be a whole lot higher risk and then the more relatives that you start adding into that equation is going to increase the risk even more.

>> But as a general rule of thumb, what we tell people is if there's a colorectal cancer in your family, you should start screening at age 40 or 10 years younger than the younger the youngest person that was diagnosed whichever comes first.

>> OK, how about how long does it take for instance when a polyp pops up, if you will, and it is been designated as a cancerous polyp, how how long does it take for that polyp to actually graduate into cancer?

>> Well, they used to tell us that it took about 15 years or so that they thought to go from this adenoma test polyp or the precancerous type to a full blown cancer and that's where they came up with that whole 10 year interval and colonoscopy.

>> You know, again, just like anything else though, everything is just kind of fluid and there are some certain types of polyps that are a higher risk that would progress more rapidly if you have some genetic predisposition, it may be progressed more rapidly but just kind of as a general rule that's the number that we use.

>> You've already kind of skimmed over and I was going to ask so we can talk about in more in depth right now but who is most at risk for colorectal cancer?

>> Everybody really has some degree of risk.

You know, we don't say no one's at zero risk.

>> We call average risk patient which is going to be the general population or higher risk.

>> So everybody from that age 45 up needs to be in screening.

The goal with screening programs is to get a greater than 80 percent compliance with the screening and right now in the U.S. we're right about two thirds about a third of people that are eligible for screening haven't been screened but that's rather startling.

>> Yeah.

And you know, really it's to get screened.

I mean we're talking about a colonoscopy, is that correct?

That's one of the methods for screening.

>> There are others as well with the the blood collarless.

Right.

Fecal immunohistochemistry test.

So we just say fit test because that's easier to say.

I'm glad you said the longer one not me.

>> Okay but yeah fit test once a year colonoscopy every 10 years based off of your personal and family history.

>> You know if you have polyps you're going to have to come back sooner than 10 years or if there's a family history going to have to come back sooner than 10 years the fittest every year and if that's positive has to be followed up with a colonoscopy.

>> There's the newer test which is testing for different DNA mutations in the stool collagen the brand.

>> I don't know if we can say that.

Well, there's not that many out there, OK?

Not to be competition but that that's every three years, you know that that needs to be applied a little more a little more scrutiny though because if you do have risk factors you really shouldn't have a color guard because it may not give you a true result.

>> Yeah, that's what I've heard a risk factors colonoscopy is is the recommendation for cancer screening and I have to tell you I live in an apartment style condo building and we have a lot of older people in my building.

It's not a senior citizen home or anything like that but you see those boxes all the time and these cubbyholes, these people, they get their mail and it's like well at least at least they're trying to you know.

>> Right.

Be preventative.

You know.

So and that may not be the best way the most thorough way but at least they are trying.

>> Sure.

You know, like you said, colonoscopy is the gold standard.

It's what they call a one step test for screening in that you do the colonoscopy if you find polyps you can actually remove them then whereas if you do a fit test or collagen and it comes back positive then you have to go for a colonoscopy.

>> So and I think the biggest problem with the colonoscopy is is the prep as people have said but it has not gotten better.

>> It depends on how you define better.

OK, you know, taste wise.

Sure.

And there are some things that you can do that are tasteless and colorless and tastes like whatever you mix it in but the effect is the same and the effect is just to get you cleaned down you have to get cleaned out in order for a colonoscopy to be effective.

The colonoscopy is only going to be as good as what we're able to see at the time of the procedure if we're dealing with, you know, trying to look through all kinds of stuff, you may miss that polyp that you know down the road could potentially turn to something.

So it's very important to complete the prep and complete as instructed within the past several years they've actually changed to what's called a split dose prep whereas you know, before you used to be, you know, six p.m. and then you take all your prep and that was it when they found it, you know you're going 12 plus hours with no prep and by the time you get to your colonoscopy a lot that proximal right colon is filled again and so you could be missing polyps and therefore missing, you know, potential development of cancer in those reas.

So now they're recommending that you do that half your first dose the evening beforehand and then the other half you're doing anywhere from six to eight hours before your actual procedure time.

>> And the idea is you still want to have that fresh prep in that proximal corner.

>> Right.

And I always thought that when you drank it all there was a lot it's a lot to drink at once but a whole lot of peope aren't real happy when you say you have to get up at three a.m. drink the rest.

>> Yes, I think I'd rather do that to be honest with you.

>> Different strokes.

Yeah.

And it's a one time thing.

You know, ideally in the average person if they don't have polyps you're doing it once every 10 years.

>> So it's not like something that you're doing for I'm sorry but the way they put you to sleep you're not totally under ight.

>> You're right.

Is it a conscious sedation?

It is.

>> Most of what we do now is what's called a monitored anesthesia.

So there's actually an anesthesia provider giving what's called a Propofol or Diprivan which is a continuous infusion.

So you're a little deeper than you used to be back in the 90s, early 2000s runs continuously so you get a lot less of the waking up during the procedure that we used to get.

You know, we would do the other we would do a combination of a benzodiazepine and then a pain medicine doesn't give you that lingering, you know, kind of hangover type effect which still have to have someone driving home after the procedure.

You still shouldn't plan on doing any sort of , you know, serious activity or work against any documents though.

>> Is it OK to go ahead, eat right after the procedure?

You can we usually tell folks though you want to start out on the light side if you eat something heavy right after your scope, you're probably going to take afterwards.

>> OK and yeah, we get a lot of phone calls when they say oh, I went to the you know, Pizza Hut afterwards the book that's when I did but I did OK and I did so I didn't eat them by that evening you should be able to have back to your own restricted diet.

>> OK, very good.

Very good when it sounds like there come along with that as time goes along it seems like it's it's a cinch you know so there's an interesting fact that I came across too I want to address tonight was why does being black increase the risk pof colorectal cancer?

>> There's probably some pre disposig genetic component but a big part of it too is that in the African-American community there's a lot less likely to get their screening done.

>> So you know, it's one of those things we're getting access to the care and having, you know, the ability to get a screening test be that a colonoscopy or the fit test or collagen or what have you.

>> OK, all that's always intrigued me the the risk factors we talked a little bit about that of course the age a little bit about the family history.

>> Yeah.

But there's quite a bit more to add to that list.

Well certainly if you have a personal history of polyps in the past especially they had numerous polyps, longstanding inflammatory bowel disease B that you know Crohn's or even more so ulcerative colitis.

>> There are some genetic syndromes that can run in families that are strongly associated with colon cancer development and I read something to that not only obesity and three or more alcoholic drinks a day can also be a proponent of smoking and smoking as well.

>> You know, absolutely.

The radiation treatment for cancer directed at the abdomen to treat previous cancers right.

Especially if it was done during childhood.

>> If you had a childhood, you know, Hodgkin's or something and you had radiation that does increase your risk for if it was abdominal radiation, colon cancer, if you did have that as your young adult instead of waiting until you're forty five, I'm sure the doctors would recommend that you would be checked absolutely right.

>> Doctor is going to know that history and know that you know that is a higher risk factor for you and you should start your screening earlier.

>> OK, that's good advice and a little more intense rather than the every ten year.

All right.

We have another call coming in.

This is from Jose who actually alerted us of this question before tonight's show started.

By the way, if you're just joining us, our phone system is not working tonight.

>> It worked perfectly last night but it's not working tonight and we'll get that rectified for our next show.

>> But we did have some calls that calls us some questions that came in off the air as well as a previous prior to this evening.

So Jose is asking what are some symptoms of colorectal cancer I should look for and in fact I was getting ready to ask you about symptoms.

>> You know, I tell patients if you're waiting for symptoms it's probably pretty late and it's not too late.

>> It's never too late but it's later in the game.

Certainly you want to pick these things up earlier and ideally at the polyp stage then you don't even have a cancer.

But we always ask patients have you been having, you know, abdominal pain change in bowel habits?

Are you noticing any bleeding change in stool know those sorts of things?

You know, unexplained weight loss things in that nature we had a position on who was on many, many times Dr. Jim Ettlin I'm sure you know he is now I wound care doctor since retired as a colorectal surgeon but he always had a saying if there's blood in your stool it is not a good thing ever.

>> No and don't just say oh it's just hemorrhoid because that's what we hear all the time.

>> It's just a hindrance.

I didn't worry about it.

It's only a hemorrhoid once you prove that it's not all these other things.

>> Yes.

So you know, symptom wise it's just going to depend on what part of the colon is affected as well.

If it's the proxima that right colon you're probably not going to have too much in the way of symptoms but what you'll end up with is an anemia and we don't know why you know your blood counts are low so you end up doing this guy work up and you find oh gosh, there's a tumor in the right colon.

It is more towards the end of the colon.

That's when you're going to start getting more of the bleeding or some of those obstructive type symptoms where you know, hey, I'm only having, you know, these thin pencil thin stools or you know, the only thing getting through is, you know, loose stuff.

>> And so a lot of it is going to depend on the location.

OK, very good.

Another question we have for you, Melinda, is ask us when I hear about colon cancer and you might have touched on this earlier in the show but she may not have caught it when she hears about colon cancer.

>> It's usually in men.

How often do women get colon cancer?

It's the number three cancer is number three in both men women number one is lung in women number twos number three colon and number two is prostate number three colon.

>> Oh yes.

So and I think you had the more recent numbers on colon cancer in women from the year 2024.

>> No, absolutely.

Fifty two thousand three hundred and eighty women would be diagnosed with that this year.

>> Yeah.

All right.

So again no yeah.

That is a significant number especially and that's not deaths.

>> I mean no that's just new diagnosis.

No diagnosis.

So I break this down.

>> I don't think I've ever asked this question before and the number of times I've done shows on cancer in general.

But can you explain what the four stages of cancer and you can relate that to Colon cancer if you like with with regards to colon cancer most often we're talking about the adenocarcinoma like you talked about and that's what we think, you know, begins as a polyp and then kind of progresses on from there.

>> These are coming off of the lining of the colon are called the mucosa.

>> There are different layers to the bowel wall if it's just confined to that mucosal layer can be considered stage one once it starts getting more into the muscle around the colon that's putting more into a stage two and these are kind of rough estimates because each stage can be broken down into a sub stage one of the earliest places that a cancer is going to spread is going to be to surrounding lymph nodes.

So when we start involving those surrounding lymph nodes that's going to be stage three and then when it goes to other organs most commonly liver that's going to be stage four metastatic at that point if it gets in the stage four not to be dark if you will.

>> Is it reversible?

Are there there are oh yeah.

There are definitely treatment options.

You know when we start talking about some of the later stage twos and the stage threes that's when we start involving chemotherapy in addition to surgery with stage four, you know, likewise you're going to get surgery for the primary colon cancer.

You're going to end up with chemotherapy but then depending on where it is potentially even resect that metastatic deposit.

>> There are people I know that have had stage four colon cancer that had their colon resection had to have part their liver removed as well and they're doing great.

>> And that brings me to another question I meant to ask you earlier when we talk about polyps now if someone has a polyp with cancerous polyps, do you go in and take the cancerous polyp out or do you have to do the resection if it's a cancer confined to just a polyp and it has not gone through into the muscle layer that a lot of folks will tell you, you know, the polyp back to me alone is sufficient.

This is one of those things though that you know, in the hospitals, especially in bigger systems we have what are called tumor boards and these things before the tumor board where they're surgeons as oncologists there's you know, radiologists, there's radiation oncology and all these different specialties.

Talk about that particular case and then decide is that pull it back to me alone enough or you know, should they have other testing?

Should they have other surgery?& If we're starting to talk about an invasive cancer not just confined to a polyp, then yeah, that part of the colon needs to be resected and then afterwards depending on stage you may need to have for the treatment be that chemo or what have you.

>> I say when we're talking about surgeries for colon cancer, it's based off of the blood supply to that particular segment of the colon because not only do you have to respect where the tumor is, you have to get what's called a negative margin so both upstream and downstream as well as around or circumferential margin you also need then we talked about the different stages.

You have to have lymph node along with that.

>> So that's the lymph nodes are going to follow that blood supply.

So when you resect that particular segment you take the blood supply with it.

Ideally be able then to hook the colon back together.

>> OK, well you explain or hook the small intestine into it if you need to.

>> OK, cancer is a little different.

Yeah I would imagine and Olenna that's going to depend on you know just how high up it is as to whether or not you can restore continuity of bowel or if you have to have colostomy afterwards.

>> Right OK well we're getting toward the end of the show and of course I I along with our viewers I'm sure are saying OK, how can I prevent this colorectal cancer?

>> So give us the thing on that biggest thing is screening get screened.

You know, like I said, there's about a third of the population that is eligible for screening that hasn't been screened yet.

>> And what about diet?

>> Diet plays a big part and I think you alluded to it a bit as well with seeing some these abnormal polyps, even cancers in younger folks.

>> Our diets aren't great.

>> Is that because of red meats and processed foods are a lot of red meat.

A lot of processed foods are going to be bad.

Our diets are very fiber deficient as well so we need to increase fiber.

Watch that red meat watch a lot of the process stuff you mentioned, you know, smoking alcohol, some of these other environmental things modifiable risk factors we call things that you can control yourself.

>> You can't control your genetics but you can control and which putting in your body how you're exercising you know, are you monitoring your weight?

>> Are you doing things to try to keep yourself healthy in other ways?

How does the facet of exercise going to help keep you from getting cancer?

Why is that?

I mean just across the board for all cancers why is exercise?

>> I think a lot of it has to do with weight.

OK, you know if you're carrying excess weight it's good for you.

It's bad not just for cancers but for orthopedic problems, joint problems, you know, back pains and things like that.

Also, you know, folks that are exercising are a little bit more cognize about what they're eating, about what they're drinking.

You know, they're less likely to be smokers.

I think they're all kind of plays into that same effect.

All right, Dr Jeremy Wilson, thank you so much for being with tonight.

>> Please come back again.

I'd love to be coming very, very good at this.

I appreciate it.

All right.

And we thank you for watching tonight and we hope that you'll join us again next Tuesday night at seven thirty four HealthLine on PBS Fort Wayne, I'm Mark Evans wishing you a great night and great health as well