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Online Chat - Hope In the Fight Against Colon Cancer

Online Chat - Hope In the Fight Against Colon Cancer

Friday March 9, 2012

Dr. Dujovny:
 Welcome to today’s online chat on the digestive system. I am Dr. Nadav Dujovny, a fellowship trained colorectal surgeon. I’m here to answer any questions or concerns that you may have about colon cancer, and how it is treated.

Comment From Kristy:
Hi! I am a 38 yr old female with no family history of colon ca. I had a colonoscopy 4 yrs ago and had a large pre ca polyp removed. The Dr. Recommended follow up in 3 yrs, but because of becoming pregnant they instructed me to follow after having the baby. I was wondering if there are any risks waiting until my baby is 6 mo old, she is 2 mo old now ( as I am breast feeding), since I am already 1 yr late. Thanks.

Dr. Dujovny:
It is better to have your follow-up colonoscopy sooner because of the precancerous colon polyp, and because you were so young when they found it.

Dr. Dujovny:
The, medications for the colonoscopy will stay in the system for about a day, in terms of breast feeding.

Comment From Marlene:
Because I am high risk for colon cancer I have been placed on Colazal. I am wondering what the side effects may be? and can I take this drug safely for a long period of time?

Dr. Dujovny:
Marlene, Colazal is safe to use long term. It is basically an anti-inflammatory drug for the inside of the colon. There can be some side effects, like headache and hair loss, but they are uncommon.

Spectrum Health:
FACT: Estimated new cases and deaths from colon and rectal cancer in the United States in 2011:

New cases: 101,340 (colon); 39,870 (rectal)

Deaths: 49,380 (colon and rectal combined)

Comment From Karen:
I have an ileostomy - how is it possible to maintain and even gain weight when the food goes through your system in 2 to 3 hours?

Dr. Dujovny:
If you are having a lot of liquid output, you can slow things down by increasing fiber in your diet and taking fiber supplements. In terms of weight maintenance, the small bowel is the only place where your nutrition is absorbed. The colon only absorbs water.

Comment From Cy:
What foods should be avoided with lymphocytic colitis?

Dr. Dujovny:
No specific foods. Everyone is a little bit different. Typically, this is treated with medication for a couple of months, and then it goes away. It is best to avoid NSAIDs (e.g., ibuprofen, Motrin, etc.). If you find a food that doesn't agree with you, you need to stay away from it.

Spectrum Health:
FACT: Among cancers that affect men and women, colorectal is the third leading cause of cancer-related deaths in the U.S. Early detection saves lives, and colon cancer screening is one of the most important things you can do to protect your life and the lives of those you love. It has been stated that ninety-five percent of colon cancer cases are curable if detected and treated early.

Comment From Cy:
What studies and outcomes are there that long-term use of statins can be the cause of lymphocytic colitis?

Dr. Dujovny:
I am not certain of the relationship between statins and lymphocytic colitis. Feel free to contact my office and I can research this for you. My number will be posted at the end of this chat. Thanks, Cy.

Comment From Zekesmom:
Do you have any theories about why some people don't get a colonoscopy, when it can prevent cancer?

Dr. Dujovny:
Many people are unaware of its benefits. People are afraid of the prep and the procedure. They do not realize that the procedure, itself, is safe and comfortable. They also don't realize that colon cancer is often times preventable by removing precancerous polyps.

Dr. Dujovny:
Also, if you find early cancer, it is very curable. This is important to know.

Comment From Robert:
After colon rectal surgery , 18 months ago, I seem to not have the energy I used to, should I take vitamins ?exercise? P.S.I am really impressed with the medical facilities in Grand Rapids and the high quality of care.

Dr. Dujovny:
Robert, it depends on the type of surgery, but you should be feeling back to normal by now. I would see your physician to make sure that nothing else is going on, but vitamins and exercise are certainly good things to do.

Comment From Karen:
What is the name of the follow-up blood test after colon cancer surgery?

Dr. Dujovny:
After colon cancer surgery, the blood test is a CEA level. This is a tumor marker that can be seen in the blood and can look for any evidence of recurrence. It is typically done every 3 to 6 months for five years after surgery.

Comment From Marlene:
If anyone out there is worried about having a colonoscopy - Don't Be! I've been having them every 2 years for many years and you don't feel a thing. After each time I'm amazed that I'm all done and ready to go home again.

Dr. Dujovny:
Usually, people feel as if they just took a nap and can't believe that the whole procedure is already over.

Spectrum Health:
FACT: Signs and symptoms of colon cancer include: a change in bowel habits, including diarrhea or constipation, or a change in the consistency of your stool for more than a couple of weeks; rectal bleeding or blood in the stool; persistent abdominal discomfort, such as cramps, gas, or pain; a feeling that your bowel doesn’t empty completely; weakness or fatigue; or unexplained weight loss. Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine.

Comment From Sarah:
What is the difference between colitis and Crohns disease?

Dr. Dujovny:
Sarah, colitis is inflammation of the colon. There are two main types, which include ulcerative colitis and Crohns. Ulcerative colitis is only in the colon and Crohns can affect the entire GI tract.

Comment From Sarah:
What is the difference between diverticulitis, and diverticulosis?

Dr. Dujovny:
Diverticulosis are pockets on the colon wall. They are common as people get older. They are more common in western society because of a lack of fiber in the diet. These pockets can become infected or perforate, and that is diverticulitis.

Comment From Annabella:
My doctor referred me to a gastroenterologist for my crohns. Why do you think I would be referred to them instead of you?

Dr. Dujovny:
Well, Annabella, gastroenterologists' specialty is the medical management of Crohns. My specialty is the surgical management of Crohns. We work closely together in our Digestive Disease Institute for a multispecialty approach to care for Crohns patients.

Comment From Sarah:
How can you tell if you have diverticulitis through a CT scan?

Dr. Dujovny:
The CT scan will show inflammation around the colon and can oftentimes show the pockets, as well.

Comment From Sarah:
And should I be having a colonoscopy more often than every 10 years if I do have diverticulosis?

Dr. Dujovny:
Diverticula are not precursors for colon cancer, and that is why it is typically done every ten years. However, sometimes, with extensive diverticulosis the prep quality may not be great or may be difficult to visualize in the colon. An earlier follow up may be warranted.

Spectrum Health:
FACT: What you eat may play a role in your risk of colon cancer. Colon cancer may be associated with a high-fat, low-fiber diet and red meat. However, some studies have found that the risk does not drop if you switch to a high-fiber diet, so this link is not yet clear.

Comment From John Paul:
My father in law has stage 3 colon cancer. What are his chances of beating this?

Dr. Dujovny:
It is hard to say with just that information alone. However, if it was resected entirely, he should go on to have followed up chemotherapy. Chemotherapy, these days, is a lot more effective than it used to be. Usually the outlook is okay, but it is hard to say without any further information.

Comment From Sue:
In what cases would you choose to do a brium enema instead of a colonoscopy?

Dr. Dujovny:
The best indication for a barium enema is when you know you are not able to get all the way around with a colonoscope. That typically occurs less than 5% of all colonoscopies. Overall, the barium enema is not that great, and if you were to choose to do something other than a colonoscopy, I would recommend the CT colonography (virtual colonoscopy).

Spectrum Health:
FACT: Certain genetic syndromes also increase the risk of developing colon cancer. Two of the most common are:

Familial adenomatous polyposis (FAP)

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome

Comment From JG:
Can you address genetic predisposition to colon cancer?

Dr. Dujovny:
Hereditary colon cancer is only about 5% of all colon cancers. There are some familial causes that are not truly hereditary. This is about 20% of all colon cancers. The vast majority are sporadic and without any identifiable cause.

Comment From Zekesmom:
My earlier comment got lost: I agree with Marlene that a colonoscopy is no big deal. I also want to say that the prep is no big deal, either. Yes, it's inconvenient, but that's about all.

Dr. Dujovny:
Thanks, Zeekesmom!

Comment From Dave:
Does diet have a big effect on being at risk? or is it more family history?

Dr. Dujovny:
A high fiber diet and reducing fat and meat will help. Exercise has also been found to be very important in reducing overall cancer risk. Family history is just as important, and there is always the combination between genetics and environment.

Comment From Chris:
How long is your colon?

Dr. Dujovny:
An average colon is about 3 to 5 feet in length. The small bowel is about 12 to 15 feet in length.

Dr. Dujovny:
You don't need any colon to survive.

Comment From Matt:
I heard there is a new procedure instead of a colonoscopy, where they inflate your colon? Do you know anything about this?

Dr. Dujovny:
You are talking about the CT colonography/virtual colonoscopy, Matt. They inflate the colon and take a CT scan at the same time. They reconstruct images to make it look like a colonoscopy. It is helpful. However, if they find anything on that test, you would need to have a standard colonoscopy. Also, during the test, they cannot do any therapeutics such as removing polyps or taking biopsies, if necessary.

Comment From Joe:
How is it possible to survive without a colon?

Dr. Dujovny:
The colon's only job is to absorb water and to transport stool out of the body. All your nourishment and nutrition is absorbed in the small bowel. If you don't have a colon, the small bowel will be able to absorb the necessary water.

Spectrum Health:
FACT: A colonoscopy is an internal examination of the colon (large intestine) and rectum, using an instrument called a colonoscope. The colonoscope has a small camera attached to a flexible tube. Unlike sigmoidoscopy, which can only reach the lower third of the colon, colonoscopy examines the entire length of the colon.

You will lie on your left side with your knees drawn up toward your chest. After you have received a sedative and pain reliever, the colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and sometimes into the lowest part of the small intestine.

Comment From Robyn:
I heard you have a genetics clinic. Can you tell us a little bit about that?

Dr. Dujovny:
For those patients who are risk or may have a hereditary colon cancer syndrome, we have a cancer genetics clinic to investigate that possibility. We also see other cancers in the genetics clinic, because Lynch syndrome or HNPCC is associated with other cancers such as uterine, ovarian, or stomach.

Comment From Guest:
This may be a strange question, but does being a smoker make you more likely to get colon cancer like it does other cancers?

Dr. Dujovny:
Smoking is associated with at least nine cancers. Smoking does increase the risk for colorectal cancer.

Spectrum Health:
FACT: Almost all colon cancer starts in glands in the lining of the colon and rectum. When doctors talk about colorectal cancer, this is usually what they are talking about.

Comment From Karen:
I heard bacon is linked to colon cancer? Any truth to that?

Dr. Dujovny:
I have no knowledge of bacon's link to colon cancer. However, a diet high in fats and meats does increase the risk of colon cancer.

Comment From Ellen:
In what part of the colon are the most polyps found?

Dr. Dujovny:
It used to be thought that most polyps were in the left (distal) colon and that is why flexible sigmoidoscopes were performed more routinely. However, it has been shown that at least 40% of advanced polyps or cancers are actually in the proximal colon above the level splenic flexure, and that is why colonoscopies are done routinely now.

Comment From Robyn:
Is there any prep for the virtual colonoscopy?

Dr. Dujovny:
It is basically the same prep as for a colonoscopy and you have to cleanse yourself. Also, during the procedure, liquid and air are inserted and it can be quite uncomfortable because it is not typically done with sedation.

Spectrum Health:
FACT: You have a higher risk for colon cancer if you:

Are older than 60

Are African American or of eastern European descent

Eat a diet high in red or processed meats

Have cancer elsewhere in the body

Have colorectal polyps

Have inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Have a family history of colon cancer

Have a personal history of breast cancer

Comment From Calvin:
What is your opinion of colon cleaning teas & treatments ?

Dr. Dujovny:
Typically, I recommend a high fiber diet and fiber supplementation to help keep things moving. If you need something from time to time to help clean things out, that is okay. However, it should not be typically done on a consistent basis.

Comment From Karen:
Is it unusual for a person to elect to keep their ostomy rather than have the resection done and risk complications?

Dr. Dujovny:
Every surgery has risks and we have to weigh the risks and benefits of any operation. If a person is healthy and content with their stoma, then there is no reason to subject them to an unnecessary operation.

Comment From Robyn:
I've heard of Lynch syndrome, but what is it exactly? And if you have lynch syndrome, do you have colonoscopies more often?

Dr. Dujovny:
Lynch Syndrome is a hereditary colon cancer syndrome. People with Lynch can have up to 80% lifetime risk of developing colon cancer. Therefore, the recommendation is to have a colonoscopy done every one to two years, depending on your age.

Dr. Dujovny:
Ideally, if a polyp is encountered, it can be removed before it becomes a cancer and surgery can be spared.

Comment From Brooke:
Can I get a colonoscopy if I'm pregnant?

Dr. Dujovny:
You can. But we need to discuss all the risks prior to proceeding. And the colonoscopy would be recommended if you having any symptoms such as rectal bleeding and change in bowel habits.

Spectrum Health:
FACT: There is no single cause of colon cancer. Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer.

Comment From Ben:
Why are African Americans at higher risk?

Dr. Dujovny:
It is thought to be more of environment and diet. However, we do not know for sure. It has been found that African American men, in particular, will have more advanced colon cancers at a younger age.

Dr. Dujovny:
There is actually a recommendation for African American men to begin screening colonoscopies at age 45.

Spectrum Health:
FACT: Smoking cigarettes and drinking alcohol are also risk factors for colorectal cancer.

Comment From Chris:
What is the connection between breast cancer and colon cancer?

Dr. Dujovny:
There is no definite association between breast and colon cancer. There has been thought that there may be some predisposition between the two, but that has not been truly shown.

Dr. Dujovny:
There are similar risk factors in terms of obesity and diet.

Dr. Dujovny:
However, ovarian and uterine cancer is moderate risk factors, and any patients who have a history of those cancers should have a colonoscopy done at least every five years.

Comment From Bob:
What determines if a polyp can be removed during colonoscopy or if surgery is needed?

Dr. Dujovny:
The size and location are the biggest determinants if it can be removed during a colonoscopy. If it is too large, it is not saving to remove that way for fear of a complication such as bleeding or perforation. That is when surgery to resect that segment is more appropriate.

Comment From Karen:
I just wanted to say that I am proud of having you as my surgeon. You are an amazing man and thank you again for your care.

Dr. Dujovny:
Thank you for taking the time to participate in this online chat. I trust that I have been able to answer your questions. An office evaluation is the best way to determine the appropriate treatment plan for medical conditions of the colon. If you would like more information or to schedule an appointment, please call my office at 616.267.7100. We are located at 4100 Lake Drive S.E. in Grand Rapids, and we also see patients in Greenville. You may also visit shmg.org to learn more.

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