What You Don’t Know About Colorectal Cancer Can Hurt You

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to our show. This is your weekly dose of wellness. I am Deborah Howell, and today's guest is Dr. Imad Shbeeb, medical director of the colorectal surgery program at the MemorialCare Todd Cancer Institute at Long Beach Memorial, and he's here to talk to us today about colorectal cancer. Welcome, Dr. Shbeeb.

Imad Shbeeb, MD: Thank you. Good morning.

Deborah Howell (Host): Glad to have you. Colorectal cancer is a pretty uncomfortable topic for most people to talk about, but it is a very serious issue. Colorectal cancer is the third most commonly diagnosed cancer in the U.S. behind only lung and prostate cancers in men and lung and breast cancers in women. So let's do a little bit of talking about it, even though it's a bit uncomfortable. First off, what is colorectal cancer?

Imad Shbeeb, MD: So colorectal cancer is cancer of the large intestine. That is the lower part of the digestive system. Rectal cancer is cancer of the last several inches of the colon. It's called rectum.

Deborah Howell (Host): Just the last few inches. I didn't know that. Okay. So what are some of the most common signs and symptoms of colorectal cancer?

Imad Shbeeb, MD: You know, some of the signs and symptoms are, number one, change of bowel habits, like change of the frequency. or consistency of the stool, rectal bleeding or blood in the stool, some weakness secondary to anemia, secondary to a blood loss, possible persistence, abdominal discomfort like cramps or increasing stress pain, feeling that the bowel has not completely emptied. We call it a medical term for that, it's tenesmus. Most patients with colorectal cancer at their early stage, they do not have any symptoms. And that's the scary part.

Deborah Howell (Host): You know, it's such a sneaky disease, isn't it?

Imad Shbeeb, MD: Say that again?

Deborah Howell (Host): It's such a sneaky disease, isn't it?

Imad Shbeeb, MD: It is. Yeah.

Deborah Howell (Host): Well, since colorectal cancer is the second leading cause of cancer death in the U.S., what makes this disease so hard to combat?

Imad Shbeeb, MD: So that's because most patients with early stage of cancer, they do not have any symptoms.

Deborah Howell (Host): Mm-hmm. Yeah. Well, and then we're there, and then all of a sudden there are symptoms. And my question to this is, is this disease hereditary?

Imad Shbeeb, MD: You know, most colorectal cancer is sporadic. That means it's not hereditary, more than 90%.

Deborah Howell (Host): Okay.

Imad Shbeeb, MD: Only about 5% to 10% of colorectal cancer believe to be hereditary. The most common syndrome of hereditary colorectal cancer called DELYNS, L-Y-N-S, L-Y-N-T-H syndrome, that contributes to about 30% of colorectal cancer. The other syndrome is familiar, adenomatosis, polyposis, or FAP, F-A-P, which accounts for about 1% of colorectal cancer.

Deborah Howell (Host): Okay, so the great majority is not hereditary. So what are some of the risk factors that can potentially cause colorectal cancer?

Imad Shbeeb, MD: Very good question. So most colorectal cancers occur after age 50. So age is the one significant risk factor. More than 90% of colorectal cancer occurs after age 50.

Deborah Howell (Host): And that's something we can't control. We're going to age.

Imad Shbeeb, MD: Right. African Americans are at increased risk. Obesity, obesity, family history of colorectal cancer or personal history of cancer in the same patient. Some inherited symptoms like what I mentioned above, history of inflammatory bowel disease such as ulcerative colitis, history of diabetes, smoking, increased alcohol intake, diet, high with meat and fat and low fiber is a respect.

Imad Shbeeb, MD: It's very, very important to know your family history when it comes to this disease, isn't it?

Imad Shbeeb, MD: Absolutely.

Deborah Howell (Host): So at what age should a person get a screening test to prevent colorectal cancer, especially if you fall into the category of your mother or your father or your grandfather had it?

Imad Shbeeb, MD: Okay, if you don't have any family history of colorectal cancer, for the average patient, the recommended screening test to be started at age 50. For those patients who have a family history of colorectal cancer, then the screening test should start at the earlier age. It depends on the age of the first degree relative at what time they have their colorectal cancer. Usually we start about 10 years earlier. So if your first degree relative had to stay at age 45, then the screening started at age 35.

Deborah Howell (Host): Okay. And what does the screening involve?

Imad Shbeeb, MD: Usually, there's a lot of methods we use to screen colorectal cancer. The most common, the gold standard of screening for corrector cancer is the procedure called colonoscopy, where you use a tube with a camera placed inside the rectum, and advance and the whole colon is examined.

Deborah Howell (Host): Okay. And often polyps are removed and preventive measures can be taken?

Imad Shbeeb, MD: Correct. The purpose of the screening is to look for polyps because polyps are benign, lumps of cells that occur in the colon and they last for several years. They grow and then they may turn to become cancer. So this is the beauty about this because colorectal cancer is prevented from preventable disease. If you remove the polyps, you prevent the occurrence of coronal cancer.

Deborah Howell (Host): Because the polyps will never fall out, you know, by themselves. They have to be removed.

Imad Shbeeb, MD: They don't fall out by themselves, correct.

Deborah Howell (Host): That's right. Okay, because I know that was a myth for a while. Let's talk about some treatment options. First of all, surgery.

Imad Shbeeb, MD: Right. So if a colonoscopy found polyps, most of those polyps can be removed during the colonoscopy, so the surgery will not be needed, will be avoided.

Deborah Howell (Host): Okay.

Imad Shbeeb, MD: If colorectal cancer was diagnosed, then surgery most likely will be indicated. And we have a host of options for surgical treatment these days. The most advanced treatments that we use are involving minimally invasive surgery to make smaller incisions to remove the piece of the intestine. And that will have the advantage of surgery, quicker recovery on the part of the patient, smaller incision, less and more comfort recovery, and less hospital days, et cetera.

Deborah Howell (Host): Are these done robotically, or are they done manually?

Imad Shbeeb, MD: Those could be done laparoscopically, or could be done robotically, or could be done manually. And the hybrid methods mean combination between laparoscopic and robot.

Deborah Howell (Host): Okay. So it's a much, much better day to be a patient if you are diagnosed with this type of disease. And really, nothing should scare you about going for a screening. It should really only enlighten you. And information is power.

Imad Shbeeb, MD: Information is power.

Deborah Howell (Host): So for our general listeners who are listening, where could you suggest they go to learn more about this terrific problem in our country?

Imad Shbeeb, MD: Long Beach Memorial Hospital has a site called memorialcare.org forward slash TTI. Also, there's another site called cancer.org. And the third place that they can go to is Coulomb Cancer Alliance, which is ccallianc.org.

Deborah Howell (Host): Thank you. So patients can get the help they need and the support that they crave.

Imad Shbeeb, MD: Absolutely.

Deborah Howell (Host): All right. Well, thank you so much, Dr. Shbeeb, for coming on the show today. We learned a lot. We thank you for being here.

Imad Shbeeb, MD: My pleasure.

Deborah Howell (Host): To learn more or to listen to a podcast of this show, please visit memorialcare.org. And as the good doctor suggested, cancer.org is a good place to start if you have more questions. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have yourself a fantastic day and get your screenings!