Colorectal Polyps: What You Need to Know

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Colorectal polyps are excess tissue that can form in the lining of the colon or rectum. While most are harmless, some can develop into cancer. Here’s what you need to know about polyps.

Causes, Risk Factors, and Symptoms of Colorectal Polyps

Polyps occur when certain mutations in genes cause uncontrolled cell growth. This continued growth can turn into groups of tissue- polyps- in your large intestine. Some of the risk factors for polyps include family history, being 50 or older, obesity, low exercise levels, and tobacco or alcohol use.

In many cases, polyps may not cause any symptoms at all. You may find you have a polyp only after an examination like a colonoscopy. However, in some cases polyps do cause symptoms. These include rectal bleeding, pain, changes in bowel habits, and a change in stool color (red streaks or black stool).

Neoplastic Polyps

One of the two main kinds of polyps is neoplastic. Neoplastic polyps have the potential to become cancerous. Within this classification, there are a few additional types of polyps. Adenomas are the most common type of polyp, making up around 70% of polyps. When found, it’s tested for cancer. It can take many years for these kinds of polyps to become cancerous, so with proper screenings they can be taken care of before they become a major problem. Serrated polyps are the second main type of neoplastic polyps. These can become cancerous depending on their location and size. Larger polyps have a higher risk of becoming cancerous.

Non-neoplastic Polyps

In comparison, non-neoplastic polyps usually do not turn cancerous. One common kind, hyperplastic polyps, are small and very rarely become cancerous. Another type, inflammatory polyps, are common in people with inflammatory bowel disease. These do not grow like other polyps- they develop in response to chronic inflammation. They tend to be benign. One final type is hamartomatous polyps. These may occur as part of a genetic syndrome, and tend to be benign as well.

Reducing Risk and Preventing Colorectal Cancer

In general, there are several lifestyle and screening measures you should take to reduce the risk of polyps and colorectal cancer. Eating fruits and vegetables and reducing fat intake are key dietary steps that can help you remain healthy. In addition, you should limit alcohol and tobacco consumption. Plus, staying active is a must.

You should also consider your risk for colorectal cancer or polyps based on family history. In some cases, you may want to pursue genetic counseling if your family has a history of colon polyps. Additionally, if you have a hereditary disorder that causes polyps, you may need earlier and more regular screenings.

Screenings themselves are a key aspect of preventing colorectal cancer. The colonoscopy remains the gold standard for screenings. It allows doctors to both detect and remove polyps to prevent colorectal cancer. In fact, annual colonoscopies reduce cancer incidence by around 89%. Screenings are now recommended earlier- at GHP we endorse annual colonoscopies for all patients ages 45-75. Visit our website to learn more.

Our experienced team at GHP has years of experience screening for and treating colorectal cancer. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Colorectal Cancer and Age, Race, and Ethnicity

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Colorectal cancer is not experienced equally by everyone. In the past several years, younger people have experienced increased colorectal cancer rates and deaths. Additionally, Black people and American Indians experience more cases of this cancer and related deaths. Here’s what you need to know about how this disease affects different people.

Colorectal Cancer in Younger Adults

Rates of colorectal cancer have been on the rise for younger and younger adults over the last several years. According to the American Cancer Society, while rates for adults 50 and older have fallen due to increased screenings, the opposite trend has occurred for younger adults. Recently, people 65 and older have experienced a decrease of around 3% per year from 2011 to 2016. In contrast, people ages 50 to 64 have seen rates rise by 1% per year in the same time frame. People under 50 have actually seen rates rise by 2.2% per year in the same window. Clearly, younger adults are seeing steeper increases in cases. Death rates have followed similar patterns. Death rates for colorectal cancer also vary by age group. Between 2008 and 2017, death rates fell by 3% per year in people 65 and older and dropped by 0.6% in people 50 to 64. However, they rose by 1.3% in people younger than 50.

Fortunately, colorectal cancer can be very treatable if it’s caught early. Younger adults should be aware of warning signs. These include changes in bowel movements (particularly over two weeks or more), rectal bleeding, unusual stools, and tiredness or low energy. If they have any of these symptoms, they should see their doctor.

Disparities Based on Race and Ethnicity

Along with age, looking at colorectal cancer rates and death rates based on race and ethnicity shows significant variation. The American Cancer Society’s data from 2012-2016 showed that rates were dramatically different based on race. Rates for Asian people and Pacific Islanders were the lowest at 30 per 100,000. Non-Hispanic white people had a rate of 39 per 100,000, and Black people had a rate of 46 per 100,000. Alaska Natives and American Indians had the highest rate, at 89 per 100,000. Death rates vary significantly as well- colorectal cancer rates are around 20% higher for Black people than non-Hispanic white people, but death rates are nearly 40% higher in Black people. Additionally, for Alaska Natives and American Indians, death rates are about double the rate for Black people.

Early Screenings Save Lives

While many of these statistics are troubling, we do know that screening early is an effective way to catch more cases of colorectal cancer. More and more organizations, including Gastro Health Partners, are pushing for earlier screenings and research on the disparities around this disease. Early screenings save lives.

Our experienced team at GHP has years of experience screening for and treating colorectal cancer. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Lynch Syndrome: An Overview

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Lynch syndrome is an inherited genetic condition that increases risk for colorectal and other cancers. It is the single most common cause of hereditary colorectal cancer. Here’s what you need to know about the condition.

What causes Lynch Syndrome?

Lynch syndrome, sometimes called hereditary nonpolyposis colorectal cancer, is inherited by children from their parents. It is inherited in an autosomal dominant pattern, meaning that only a single copy of the altered gene needs to be present. So, if someone inherits a mutation in a gene related to the syndrome, they will still have a normal copy. However, cancer occurs when a second mutation affects the normal copy of the gene.

The specific genes involved in the syndrome are all involved in repairing errors that occur during DNA replication. If any of the genes (MLH1, MSH2, MSH6, and PMS2) have a mutation, errors occurring in replication accumulate, which can end up leading to uncontrolled cell growth and cancer.

Complications from Lynch Syndrome

If you have Lynch syndrome, you have a higher risk of developing colorectal cancer, and developing it at a younger age. People with the syndrome also have a higher risk of developing kidney, stomach, brain, liver, uterine, and some skin cancers. There are several other inherited conditions that can increase your risk of colon cancer, but this syndrome is the single most common. A rough estimate is that around 3% of all colorectal and endometrial cancers are caused by the syndrome. Around 1 in 279 people in the United States have Lynch syndrome.

In addition, having Lynch syndrome has impacts on the rest of your family. First, a positive diagnosis means that your blood relatives may have a chance of having the syndrome. In addition, any children you may have are at a higher risk of having it. If one parent has a genetic mutation related to the syndrome, a child has a 50% chance of inheriting it. This is because the syndrome is autosomal dominant, as discussed previously. You may want to meet with a genetic counselor to talk through these implications if you have a Lynch syndrome diagnosis.

The Importance of Family History

Since you inherit Lynch syndrome, knowing your family history related to colorectal cancers is crucial. If your family has a history of colorectal or endometrial cancer, you should talk with your doctor to evaluate your risk. In particular, you are more likely to have the syndrome if your family has a history of colorectal cancer at a young age, endometrial cancer, or other related cancers.

Your doctor may recommend a genetic evaluation of your family history and risk. Genetic counselors can help you understand Lynch syndrome and whether genetic testing is a good option for you. Usually, family members with the syndrome share the same specific genetic mutation. If any of your family members have a known a syndrome mutation, you may be tested for the same mutation if you are pursuing genetic testing.

The good news is that we can prevent a lot of the cancers caused by Lynch syndrome with early screenings. Screening early and often can help catch cancer early and lead to better outcomes.

Our experienced team at GHP has years of experience screening for and treating cancers caused by Lynch syndrome. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Colorectal Cancer Screening at 45

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Colorectal cancer screening is a crucial step to identify cancer early and save lives. Previous medical guidance has dictated that screenings should start at age 50 in most cases. However, the American Cancer Society now endorses screenings starting at age 45. Gastro Health Partners endorses this approach as well. Here’s an overview of why screening is so important, and what your options are.

Colorectal Cancer

Colorectal cancer, sometimes called colon cancer, is cancer that occurs in the rectum or colon. Abnormal growths called polyps can grow in the colon or rectum and become cancerous. When this happens, cancers grow into the wall of the colon or rectum over time. They then have the potential to spread into lymph vessels or blood vessels and travel to other parts of the body.

Screening is important because it can prevent the development of colorectal cancer and more widespread cancer in the body. If caught early, colorectal cancer is often very treatable. For example, during a screening, precancerous polyps in the colon or rectum can be removed before they become cancerous. Screening is a life-saving preventative measure: in this case, there is a 90% survival rate when cancer is found and treated early on. It is also helpful because many people will not exhibit symptoms until their colorectal cancer has progressed significantly. Getting screened can help doctors catch and treat cancer before it develops or spreads significantly.

Who Should be Screened and When?

Screening is the key prevention strategy for all adults. Everyone should get a screening regularly at a certain point. As mentioned before, the previous guidance was most people should be screened starting at age 50. Now, guidance has shifted to starting at age 45.

Additionally, other factors can influence when and how often you should be screened. If your family has a history of colon cancer, if you have had polyps, or if you have an inflammatory bowel disease or some genetic disorders, you may need to be screened earlier and/or more often.

Types of Screening and How Often to Get Screened

There are a few main screening options. You should talk with your doctor to determine the best path for you. As alluded to, the colonoscopy is the gold standard for screenings. During a colonoscopy, your doctor is able to look at your entire colon and can remove polyps. You may only need a colonoscopy once every 10 years if you have a negative screening. Another screening option is a Flexible Sigmoidoscopy, which is performed every 5 years with negative screenings. The downside of this method is that it doesn’t give a full view of the colon like a colonoscopy does. Only the lower parts of the colon are viewable with this test.

There are also a few stool-based screenings available. With stool tests, you collect a stool sample at home and send it in to your doctor for analysis. This method does not identify abnormalities as effectively as a colonoscopy. Doctors may also pursue follow-up testing if they confirm a positive result. There are a few other screening options that may be available as well, like a Capsule Endoscopy or a CT Colonography. Your doctor will recommend the best option based on your specific case.

Getting screened for colorectal cancer is an extremely effective way to prevent cancer. Our experienced team at GHP has years of experience performing screenings. We can help establish the best plan of diagnosis and care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Featured press release: DHPA Supports USPSTF Recommendations to Begin CRC Screening at 45, Calls for More Research on Disparities in Communities of Color

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The Digestive Health Physicians Association recently announced its support for the U.S. Preventive Services Task Force (USPSTF)’s draft recommendation to begin colorectal cancer screenings at age 45. Gastro Health Partners endorses these changes as well. Read more about the DHPA’s support for the changing guidance in this press release:

“Washington, DC – The Digestive Health Physicians Association (DHPA) voiced its support for a draft recommendation by the U.S. Preventive Services Task Force (USPSTF) that Americans begin screening for colorectal cancer at the age of 45, an update of 2016 guidelines that had recommended that adults without risk factors for CRC should begin screening at age 50 and continue periodically until 75.”

Click here to read the full press release

Remembering Chadwick Boseman and the Importance of Colon Cancer Screening

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The loss of Chadwick Boseman on Friday, August 28th came as a tragic surprise to the world. Only 43 years old, the actor, writer, and director had made a name for himself through his leading portrayals of American heroes such as Jackie Robinson in 42 (2013), James Brown in Get On Up (2014), and Thurgood Marshall in Thurgood (2017). His most iconic role was that of superhero T’Challa in Black Panther (2018). This role cemented his place in the Marvel franchise and the hearts and minds of people worldwide. Boseman’s cause of death was colon cancer, of which he had privately fought for four years prior.

This form of cancer is the third most commonly diagnosed and second most likely cause of death in men and women. Boseman’s death serves as a moving testament to our own mortality and the silent struggles many face. It also is a reminder to practice preemptive measures against this aggressive form of cancer. 

About Chadwick

Chadwick Boseman was born in 1976 in Anderson, South Carolina. He attended Howard University, where he pursued the dream of becoming a director. After graduating, he moved to New York City, where he wrote and directed plays, teaching acting on the side. It was only once he was cast in a recurring role on ABC’s “Lincoln Heights” that he began to consider a career as an actor.

On a whim, he moved to Los Angeles, acting in a number of roles before his breakout lead as Jackie Robinson in 42. Brian Helgeland, the writer of 42, noticed Boseman’s talent and stage presence immediately. “It’s the way he carries himself, his stillness — you just have that feeling that you’re around a strong person…” In the following years, Boseman continued to gain widespread acclaim, earning MTV Movie Award’s “Best Hero” title in 2018 and the top award of Outstanding Performance at the 2019 SAG Awards. Indeed, it felt as though Boseman’s career was just beginning.

Colon Cancer Screenings

Chadwick Boseman’s untimely death shines a light on the very serious risks of colon cancer. According to the Colon Cancer Coalition, one in 24 people develop colon cancer, with an equal risk in males and females. There are often no signs or symptoms associated with the onset of the disease. Therefore, diagnosis can be late, worsening chances of remission. A lot of people are only diagnosed through routine screenings, which doctors recommend to begin at 45 years of age. Many people fail to follow through with these recommendations. According to The National Colorectal Round Table, “if 80% of the eligible population was screened at the age of 50, the number of colorectal cancer-related deaths could be cut by 230,000.” Thus, following through with basic preventative measures can drastically reduce incidence.

Prevention

Prevention can begin at any age. Regular exercise, good diet, not smoking, and limiting processed foods/red meats can reduce the risk of developing colon cancer. Colon cancer does run in the family. Those with relatives who have had it have a 2 to 3 times higher chance of developing the disease.

You can dramatically reduce the risk of developing colon cancer. Educate yourself on personal risks and stay up-to-date with colon cancer screenings. For more information on colon cancer prevention and screenings in Kentucky and Southern Indiana, you can schedule an appointment with a gastroenterologist at Gastro Health Partners. Contact an office near you today for details.

Featured article: Colon cancer screening should start at 45, government panel recommends

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Colon cancer screening guidelines are changing, and starting screenings earlier will help save lives. Gastro Health Partners fully endorses these changes. Read more about the changing guidelines in this featured article from NBC News:

Colon cancer screening should start at 45, government panel recommends

Screening for colorectal cancer should start at age 45, five years earlier than is currently recommended, according to draft guidelines from the U.S. Preventive Services Task Force.

The update was prompted by recent studies showing the rate of colorectal cancer rising in younger people, according to the draft, published Tuesday.

Click here to read the full article…

 

What is Colorectal Cancer?

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Colorectal cancer refers to a cancer that starts in the colon or rectum. While cancers that start in either place may be called colon cancer or rectal cancer, respectively, they are often known collectively as colorectal cancer because of similarities between the cancers. 

Here’s what you need to know about colorectal cancer. 

Causes and Risk Factors

Scientists are not exactly sure what causes colorectal cancer. We do know that colorectal cancer begins when healthy cells’ DNA mutates. These cells can then overgrow and divide, creating tumors. Cancerous cells can also destroy healthy tissue and travel to other parts of the body and form deposits. However, there are several well-documented risk factors. These include being over 45, having diabetes, smoking, drinking alcohol, having a high-fat diet, having an inflammatory bowel disease, and having a family history of colon cancer or polyps. 

Types

Most colorectal cancers (around 96%) are Adenocarcinomas. This kind of cancer starts in mucus-producing cells which lubricate the colon and rectum. 

There are a few other kinds of colorectal cancers that are much more rare. Lymphomas, cancers of immune system cells, can start in the colon or rectum (although they typically start in lymph nodes). Carcinoid tumors start from hormone-producing cells in the intestine. Gastrointestinal stromal tumors start from cells in the colon wall, and while most are non-cancerous, some can be. 

Symptoms

It’s common for colorectal cancers to have few symptoms until they have advanced. There are some potential warning signs, but they may be indicators of other issues. These symptoms include lower abdominal pain, blood in stool, bloating, cramps, vomiting, unexplained weight loss, and changes in bowel functions. As always, it’s best to consult a medical professional to determine what your symptoms are caused by. 

Diagnosis

The best way to cure colon cancer is to identify it at an early stage. However, since symptoms may not present early on, doctors recommend screenings for healthy people, usually beginning around age 50. People with more risk factors, as discussed above, may be advised to be screened at a younger age. 

A colonoscopy is one of the most common methods of screening. This involves using a scope to examine the inside of the colon. Your doctor can pass tools through the scope to take tissue samples if they see something suspicious. Biopsies of these tissue samples can help determine if cancer is present. Doctors also may remove polyps found during a colonoscopy to prevent them from becoming malignant. 

Treatment and Prevention

There are three main treatments for colorectal cancer- surgery, chemotherapy, and radiation therapy. These three treatment options are often used together in various combinations, depending on a patient’s situation. The best treatment options for each person depends on factors including overall health, the cancer’s stage, and whether the cancer is recurring. 

Localised, small, early-stage cancer in a polyp can be removed during a colonoscopy. A more invasive surgical procedure called a partial colectomy can remove the cancerous area of the colon and some surrounding healthy areas. This can prevent the cancer from growing back. Lymph nodes near the surgical site are removed and tested. Surgery can also be pursued to relieve symptoms and provide comfort for people in very poor conditions. 

Chemotherapy is another treatment option, often used after surgery to destroy remaining cancer cells. If the cancer has spread beyond the colon lining, this may be recommended. 

Radiation therapy utilizes beams of intense energy to destroy cancer cells. Radiation may be utilized before surgery to reduce tumor sizes, or after surgery to kill off remaining cancer cells. 

Preventing colorectal cancer is extremely important, and it starts with screening (as discussed above). Additionally, you can reduce your risk of developing colorectal cancer by avoiding smoking, reducing or avoiding alcohol consumption, staying active, maintaining a healthy weight, and eating a healthy diet. 

Our experienced team at GHP has years of experience helping people manage and treat colorectal cancer. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

 

Mailing Your Poop Could Cost You

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Breast cancer reared its ugly head in my 50th year. By the time a lumpectomy and radiation were over, I was in no mood, emotionally or financially, for a colonoscopy.

Then anesthesia failed when a dear friend went in for her first colonoscopy. The pain was so bad, it traumatized her – and scared me, so I again postponed having one of my own.

This fall, when I went in for my annual physical exam, my doctor, Holly Bermel, reminded me I was overdue for the procedure most of us 50 and over are prodded to get.

The good news, she said, was that she could order the in-home Cologuard test used by millions.

Sending one’s poop via UPS for testing is an odd experience, let me tell you. Stranger still is what has happened since.

In the medical community, Cologuard has generally been considered a good thing: It detects genetic mutations commonly seen in colon cancer and detects blood in the stool. Medicare and many private insurance plans cover the test if it’s performed once every three years.

But agreeing to that cheaper, easier DNA screening for colorectal cancer can cost consumers much more in the long run. If that test comes back positive, as mine did, some insurers and Medicare will no longer cover as a preventive service the colonoscopy that your doctor will inevitably order next.

Read More…

October’s MD Update: Dr. Jones Speaks “Going on Offense Against Cancer”

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Our very own Dr. Whitney Jones graced the cover of MD-Update’s October issue.  Read about how he embraces preventative measures to beat colon cancer before it starts in the following article.

“We spend a lot of money on healthcare and health insurance. The problem is, we’re not spending enough on prevention.”— Whitney Jones, MD

 In the movie “Karate Kid,” there’s a scene where Mr. Miyagi asks the title character if he’s training to fight. In his light bulb moment, the student responds that he trains, “So I won’t have to fight.”

Make no mistake, Whitney Jones, MD, knows how to treat cancer. He’s trained for it and has years of experience in it. But it’s a fight he would prefer doesn’t take place.

“We’re going on offense against cancer,” says Jones, a gastroenterologist at Gastroenterology Health Partners (GHP) in Louisville. “We are working on becoming the number one state and the first in the nation to develop programs where we can use genetic testing. We spend a lot of money on healthcare and health insurance. The problem is, we’re not spending enough on prevention. The cost of cancer treatments totally overwhelms the cost of prevention.”

That has been the central message and purpose of the Kentucky Colon Cancer Prevention Project, which Jones helped found in 2004. The project’s work includes education, advocacy, survivor support, and health system change.

“It put the work of the state in front of the legislature,” Jones says, noting that a diverse group of leaders from across the state formed the project’s advisory committee. “It added a mix of healthcare, politics, and business that was catalytic.”

The project has received state funding as well as additional funding from the Kentucky Cancer Foundation, which Jones also helped found in 2012. “We have helped pay for a lot of uninsured people to get colorectal cancer screening,” Jones says.

The impact of the Colon Cancer Prevention Project is reflected in the state’s improvement versus the rest of the country. Jones notes that Kentucky ranked 49th out of 50 in the nation in colon cancer prevention statistics when the project was launched. The state also had the highest rates of incidence and mortality in the nation. Earlier this year, Kentucky ranked 17th best in the nation in the same colon cancer related categories and earned an American Cancer Society Achievement Award for the most improved state in the nation for colorectal screening over the past 15 years.

“When we started our work at the Colon Cancer Prevention Project, there was a huge gap between what could be done and what we were doing,” Jones says. “It’s been a broad coalition, including many of our state leaders and city officials. I think it’s proven that Kentucky can address its own problems, we can develop solutions, we can implement them locally, and we can save lives and save money.”

Read the full article here: