Jan 24, 2019
Why are more people younger than 50 developing colorectal cancer? Dr. Brian Bello discusses the disturbing trend.
Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.
Host: Thank you for joining us today. We’re talking with Dr. Brian Bello, a colorectal surgeon at MedStar Washington Hospital Center. Welcome, Dr. Bello.
Dr Bello: Thank you.
Host: Today we’re talking about why more younger patients are dying of colorectal cancer. Once considered an older person’s disease, patients in their 30s and even 20s are being diagnosed with colorectal cancer, which is baffling the medical community. A 2017 study found that, after years of decreasing mortality rates, colorectal cancer deaths in adults age 20 to 55 increased 1 percent per year from 2004 to 2014. Dr. Bello, what do you think caused this seemingly sudden spike in colorectal cancer deaths?
Dr Bello: That’s a tough question to answer. Many people have been looking at this. The answer is really unclear. We think it’s probably a combination of factors. I think if we look at the population now compared to 15 years ago - the population is more obese, that’s probably the driving factor. Patients diets are different than they were 15 years ago. People may not be exercising as much. And then there’s maybe genetic factors that we quite don’t understand. But we are looking at this very closely, but I think the number one issue is probably diet and weight.
Host: Is this something that you’re seeing in patients locally in the Washington DC area?
Dr Bello: Well, certainly people now are asking about it. Many patients come in and have read about this New York Times study and ask do they need a colonoscopy or they have friends that have recently been diagnosed with colon cancer and they are asking if they need one. So, certainly more people are asking about it. I think the key take-home lessons are people need to be educated about what signs and symptoms to look out for. So, if young people are experiencing abdominal pain that’s chronic, that doesn’t go away, or if they have rectal bleeding or unexplained anemia or weight loss, providers should be more willing to provide or give education about a colonoscopy.
Host: What do you mean by unexplained anemia?
Dr Bello: Yeah, usually this blood work is done by a primary care physician and it’s usually a yearly blood work laboratory value that can be checked. If a patient’s blood count is lower than normal and there’s not a good reason for it, then we need to investigate other causes of the blood loss.
Host: How has the increase in colon cancer changed the screening recommendation?
Dr Bello: Currently we’re not changing our screening recommendations. Usually the screening for Americans is everybody over the age of 50 needs a colonoscopy, which is the gold standard for colon cancer screening. For younger patients, as I mentioned earlier, we look for signs and symptoms. If they have concerning things that are chronic, then we recommend a colonoscopy. If we started screening earlier, that would probably mean more unnecessary tests - tests that are very costly and these tests that we do aren’t without risk. We do the CT scans for many reasons, and sometimes we’ll pick up things that are of benign cause, meaning that there’s nothing really to worry about but that usually prompts more tests which mean that patients are paying maybe more money, and these things are clinically relevant, meaning that you could find like a cyst in your liver and then we do additional tests and you really didn’t need to look at that at all. So, we try to avoid unnecessary tests just because they’re costly and could provide risk to the patient. In today’s field of medicine, we’re trying to be more cost efficient, cost effective. So, right now we haven’t changed our screening recommendation - we’re just looking for signs and symptoms - if these younger patients have those, then we recommend a colonoscopy.
Host: How can a young adult patient determine whether they’re at risk for developing colorectal cancer early in life?
Dr Bello: So, one thing that we always look for in these patients are a good family history. So if a patient has any family history of colon cancer in their family, especially relatives that were diagnosed at age 50 or younger, we’re more likely to recommend a colonoscopy. And again, those signs and symptoms that I had mentioned already - bleeding, abdominal pain, weight loss - those are the things we look out for.
Host: What can patients can to reduce their risk of developing colorectal cancer?
Dr Bello: Yeah, we always recommend a healthy lifestyle. Number one is definitely watch what you eat. So, we try to encourage people to eat a high-fiber diet, try to avoid fatty food, avoid fried food. In addition, we recommend that people exercise. Also, we recommend no smoking and try to avoid a lot of alcohol use.
Host: How does smoking and alcohol use affect the colon?
Dr Bello: So, that’s a good question. It’s unclear but we know that people that smoke more are at significantly increased risk of many different things - heart problems, stroke - but specifically for colon cancer we find that there’s an increased risk. It’s an unclear connection. It might have to do with some weird effect that smoking has with the bacteria in the colon or the lining of the colon. It’s unclear. But we just know that from studies there’s an association with it.
Host: What makes MedStar Washington Hospital Center the best place to seek screening and treatment for colorectal cancer?
Dr Bello: Well, here at MedStar Washington Hospital Center, we have a multidisciplinary team. That means we have experts in different fields - like surgeons, gastroenterologists, medical oncologists, pathologists, radiologists - that all see a lot of colon cancer and rectal cancer. So, we just do a lot of high volume. We do this day in and day out and we’re just specifically looking at colon cancer. Because of that I think we see better results and better outcomes for patients. Another thing we do at MedStar Washington Hospital Center is we promote the use of laparoscopic surgery. So that is surgery that we use very small incisions to do major, complex abdominal surgeries in. So we can do, for example, a colon resection with 3 or 4 very small incisions, and when we do this, patients tend to do a lot better. They have less wound complications, we can feed those patients earlier, and they tend to get out of the hospital much faster. So that is another thing we do at Hospital Center that makes it a great place to go for your colon cancer surgery.
Host: What is a colon resection?
Dr Bello: So, a colon resection is a surgery where we remove part of the colon and the fatty tissue surrounding the colon. Usually treatments for colon cancer or other colon problems. So, the old fashioned incisions usually were anywhere from your sternum to your pubic bone. But usually now we can do them with some stab incisions, which are about a centimeter and maybe one other incision that’s maybe 4 or 5 centimeters, where we pull out that part of the colon.
Host: Are you currently doing any research on colorectal cancer that you’d like people in the community to know about?
Dr Bello: Yes, I have research interests in colon cancer, specifically about screening, which we’re talking about today. Specifically, we’ve been looking at why people aren’t getting their colon cancer screening. So, again, everybody over age 50 should have some sort of colon cancer screening, whether that be the gold standard with the colonoscopy or some sort of stool test. It should be done. But for some reason people aren’t getting them done. Approximately 40% of patients across the U.S. and in DC don’t get the appropriate colon cancer screening. So, we’ve done some surveys to find out why. The number one reason why people don’t get colon cancer screening is that they felt that they weren’t educated about it, they didn’t know about it, their primary care physician didn’t tell them about it. Those are the driving factors, but we’ve also found things like people were worried about the bowel preparation they have to do before a colonoscopy or they were worried about procedural risks or they just didn’t like talking about their GI system.
Host: How do all of the surgeons and physicians work together to provide a team approach to care for colorectal cancer?
Dr Bello: So, usually when somebody is diagnosed with colon cancer, we present each of these cases at a multidisciplinary tumor board. We review the CT scan images, the biopsies, and we come up with an individualized treatment plan for the patient. And that’s when everybody can chime in and give their recommendations and we come up with one plan for each individual patient.
Host: Could you share some screening or treatment success stories from your young adult patient population?
Dr Bello: I was involved in the treatment team of a young 20 something year old gentleman. He had some routine blood work done, which showed anemia. His primary care physician recommended that he get a colonoscopy. Unfortunately, that colonoscopy showed multiple large polyps throughout his colon and many of the biopsies showed that these polyps had pre-cancerous cells in them. So then he was referred to me and then I recommended that he undergo a colon resection and we did that. We did that with small incisions called laparoscopic surgery. He did great post-op and now he’s on a very good surveillance plan where we’re doing routine colonoscopies. He did great. If he doesn’t get that blood work or if he doesn’t get a colonoscopy, these polyps would have likely have turned in to cancer by now and then a lot more difficult to treat. Thankfully, we caught them early, and we did his surgery early, and now he’s doing great.
Host: In those younger patients, where they have unusual lab testing, is surgery usually the best option to treat them?
Dr Bello: Oh, hopefully, if the lesions are small, like if they’re just polyps, we can remove those with a colonoscopy. Only if these polyps grow very large or they are cancerous do we recommend surgery. The goal of the colonoscopy is to find these polyps and to remove them at the same time.
Host: So the colonoscopy can serve both as a screening tool and as a preventive measure?
Dr Bello: Yeah, what’s really good about colon cancer screening is, if you get a colonoscopy, we’re able to find these polyps before they turn into cancer - that’s the key.
Host: Thanks for joining us today, Dr. Bello.
Dr Bello: Thank you very much.
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