Search for tag: "gastroenterologist"

Interviewer: You may have heard of the news stories about the dramatic rise in colorectal cancer in younger adults. Some perspective and what you need to know next on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Colon cancer used to be something that most people didn't really start worrying about until after they turned 50 or maybe 40 if they had a family history. But doctors are seeing more and more younger people developing the disease earlier in their lives. Dr. Andrew Gawron is a gastroenterologist at University of Utah Health and some perspective on this. First of all, the headlines that I'm seeing about "Dramatic Rise in Colorectal Cancer in Younger Adults," is that accurate?

Dr. Gawron: It is accurate. The data that was published recently this year does show that, especially in younger patients, there has been an increase in the incidence, which is the new cases, of colorectal cancer in young adults. I think it's important to remember that colon cancer is still very rare in this population, and so, therefore, it's hard to know how many new cases we're going to see in the future. But we did see an increase of about 1% to 3% in those younger patients with this new study.

Interviewer: I feel like maybe there are two things going on in this study, and help clarify this for me. I feel like one issue is that Gen-X and millennials are going to be more likely to develop colon cancer than other generations after they turn 50. And then I think the second part felt to me like there are more people under the age of 50 than normal developing signs of colorectal cancer as well.

Dr. Gawron: I think that's accurate, based on the reading of the study, that we are going to see more. I think that the important thing to take home from this study is that colorectal cancer is a preventable, but serious disease. Right now, even though there's this what we call "dramatic increase," even though that dramatic increase is basically an increase from, like 1% to 3%, which translates into about 10,000 cases per year.

So on a population level, meaning that if you look at the entire population of young people, it's not a very common cancer. Now, again, if you're that one person, though, that develops colon cancer, you don't care about statistics.

Interviewer: Right. The statistics don't do you much good. So for those that are going to be more likely to develop it after 50 or you expect to see more people after 50 develop it, they would have a colonoscopy probably, some sort of screening that would protect them. But what about these cases before the screening happens at 50, you know, people that are developing in their 20s or 30s? What can they do?

Dr. Gawron: So right now, I think there are a number of things that we can do as both patients and doctors. First is just to be more acutely aware of symptoms of colorectal cancer.

One, dramatic change in your bowel habits, bleeding from your bowels, unexplained weight loss, loss of appetite as well as any type of change in your bowel habits that is not related to bleeding, such as prolonged constipation or diarrhea. These are all symptoms that may kind of be brushed off as an infection or essentially food intolerance, but if they occur for a period of time, even, you know many, many weeks, it'd be good to see a doctor or get yourself checked out.

Interviewer: And even if you see a doctor, I've read a couple . . . there was a "Times" article, for example. They talked about a 24-year-old woman. She had blood in her stool, and she went in. And the doc couldn't see any hemorrhoids, but that's what he diagnosed her with. And is it true that doctors . . . it's unexpected, so they're not really looking for it, so you might have to get a second or third opinion if you're that concerned.

Dr. Gawron: I think it's very important to be your own advocate, and younger people with symptoms often have delays in diagnosis because cancer is rare and not usually the first thing we look for or treat for. But if you're concerned and worried, be your own advocate. Don't feel afraid to get a second opinion. Don't feel afraid to go to your primary care doctor and say, "I really want to get referred to a specialist to have this evaluated." As a patient, as a young adult, you want to make sure that the most serious diagnoses are not missed if you are really concerned about your symptoms.

Interviewer: Got it. And if you have a family history of it, you should probably be more acutely aware. Screening guidelines say you should start at 40 in that case. But I've read a statistic somewhere, and tell me if this is true, 70% of colorectal cancers aren't related to family history.

Dr. Gawron: That's true. So we don't quite know all of the genetic factors that are playing a role in these cancers that are developing in young people. In fact, it appears that most of the cancers may be what we call "sporadic," meaning that they just are onset. But I think that's because we don't yet understand the genetic risk factors, and that's something that, hopefully, in the future will allow us to personalize screening.

I do want to say one thing, that family history is important, and I think it's important to, along with those warning signs and symptoms, to understand your actual family history. Many patients that I see do not know if somebody had polyps or somebody had cancer in their family, so having an understanding of what people actually had. For example, your parents when they had a colonoscopy, just ask them what was found, and so that you know to tell your doctor. And that will then allow us to have a better risk assessment when you come to see us in the office.

Interviewer: Got it. So I feel like the two takeaways are, one, that you should be aware of the warning signs, and even if you're a younger adult, pay attention to those warning signs in a way that you might not have normally done so because the research is showing people are developing it younger and younger. And then lifestyle choices make a huge different.

Dr. Gawron: Right. Again, the main point is to remember is I don't think you need to be walking around being scared you're going to develop colorectal cancer. It's still very rare in patients that are young, and you should go about your life as you normally would.

But be aware of these very serious symptoms that might need to be evaluated, and healthy lifestyle choices are important, not smoking, avoiding processed meats, having a healthy diet, exercise, maintaining a healthy weight, and again, understanding your family history and asking your older relatives about their colonoscopies and what was found.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Cancer of the esophagus, what you need to know after diagnosis. That's next on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. John Weis is an oncologist at Huntsman Cancer Institute. Dr. Weis, for a patient that was told they might have cancer of the esophagus, I'm sure it's pretty scary and they've got a lot of questions. So I wanted to dive into some of the questions that your patients might have, and I think the place to start first is how do they generally end up in your office?

Dr. Weis: They end up in my office in two fashions. The most common fashion is somebody that has symptoms. They have difficulty of swallowing solids or liquids. It may be they throw up blood, those kind of things. But mostly it's difficulty with swallowing and weight loss. The other way is people that are diagnosed by screening where they have known Barrett's esophagus or get endoscopies screening test.

Interviewer: And that is generally done by another physician. So they've found something and then they would refer them to you?

Dr. Weis: Right. The gastroenterologist would likely see them. If they're diagnosed with early stage esophageal cancer, limited to the lining of the esophagus, they would normally treat that themselves. If it's more advanced stage, they would refer them to myself, a surgeon, and a radiation therapist.

Interviewer: So by the time somebody comes to you, has it been pretty much just determined that they do have some form of cancer, or is that still up in the air?

Dr. Weis: When they come to me, generally, they have been told they have cancer.

Interviewer: Okay. And at that point, what is the discussion that you have with that patient?

Dr. Weis: There are certain principles of oncology that are important. In order to prognosticate, you start with a diagnosis. And then you stage. Staging may involve an endoscopic ultrasound or an ultrasound test, or CAT scans, or even a PET scan to find out how extensive it is. Generally, we try and divide the disease into several categories: superficial, local, regional, and distant.

Interviewer: And when it comes to esophageal cancer then, is it something that they did? Is that a question that you commonly get?

Dr. Weis: Well, that's an interesting question. It leads into a relatively long discussion. But I think I would like to talk about that.

Interviewer: Okay.

Dr. Weis: There are clearly things and I'm a bad example that being overweight, the highest quartile of weights in this country have about eight-fold risk of esophageal cancer. Smoking and alcohol are strongly associated with a type of cancer called squamous cell. Reflex esophagitis, Barrett's esophagus, hiatal hernias are more associated with adenocarcinomas. The squamous cell carcinomas, the smoking-alcohol-associated tumors, have been falling in incidence in this country. They're still very, very common in the east northern France, Eastern Europe, Asia. But in this country, adenocarcinomas are rapidly dominating the picture.

Interviewer: And when it comes to cancer of the esophagus, how serious is this type of cancer? Because some cancers . . .

Dr. Weis: Esophageal cancer is a lethal cancer. It's a very dangerous cancer.

Interviewer: Quick moving?

Dr. Weis: It's aggressive, but it's also . . . tends to be very difficult to treat in a curative fashion. There are about 16,000 cases of esophageal cancer in the United States each year and about 13 and half thousand deaths each year, which tells you that the incidence and the death rate are not that different.

Interviewer: So that must be very stressful for an individual that comes in your office when they've got that diagnosis because it is so aggressive and it can be so deadly?

Dr. Weis: Right. And the first question is, usually, can it be cured? That really is it the salient question. And that depends on the stage. If it's spread beyond local regional disease, disease confined to the area of the esophagus, then it's probably not curable. So the next question people usually ask me, what are the goals? And I think the important separation is whether your goal is cure and whether your goal is palliation either by keeping somebody alive longer or reducing their symptoms. The amount of toxicity you're willing to accept as a patient or doctor depends on what your goal is.

Interviewer: And what are the treatment options for cancer of the esophagus?

Dr. Weis: For the early stage, a mucosally-confined tumor, they can be simple things like a brachytherapy, mucosal resection, local radiation. All of those things have a potential to cure very early stages.

Interviewer: What are some common things that you see patients go through when they've been diagnosed with this type of cancer and you're having the conversation with them? Are there kind of any kind of common trends?

Dr. Weis: Well, they come to me for treatment. And so I can quote statistics to patients. The problems is statistics don't apply to a given individual. The given individual won't be 70% cured or 30% cured, he will be 100% cured or 100% not cured. And so the fundamental question is, "Do you want to treat aggressively to try and cure something, or do you not want to cure it?" And then, the question they will often ask me, "What is my lifespan if I don't do anything?"; And the problem is their lifespan if they don't do anything is likely to be short, in three to six months. And so it seems to me there's no downside to rolling a dice to try for a much longer lifespan.

Interviewer: Got you. Somebody's at the beginning of this journey. What would you like to make sure that they keep in mind or know at this point?

Dr. Weis: They should always know that they're in control and that the oncologist is not their mother and not God, so I don't get to tell them what they have to do. They should know clearly what the goal of therapy is, whether the goal is cure or palliation. They should know that the ultimate decision about how much toxicity they're willing to tolerate is theirs. My recommendations are my recommendations. When you treat a patient as a cancer specialist, you don't know what the outcome will be. You can make recommendations, but in the final analysis and if God wants you, He's going to get you whether I give you chemotherapy or radiation, or surgery. If it's not your time, you get to stay here. I think you use the tools that have been provided and try to make yourself live longer and healthier.

But as a general rule, you retain control of your life. I'm always a little uncomfortable when somebody says to me, "I'll do whatever you tell me to do." I would like them to know what they're doing. I do think the concept of informed consent for anything is sort of a misnomer though. I'm not sure anybody could know what they're getting into when they started this journey with chemotherapy, radiation, and surgery. I think the decision you make as a patient is do you trust the providers providing your care? You sign the document because it's medical-legally required. But the fundamental decision is not that you know all the side effects of chemotherapy. And so you trust that people are trying to help you.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.