Episode 42: Colon Cancer on the Rise: Why It's Hitting Younger Generations and How to Fight Back with Dr. Reema Patel

Colon cancer rates are rising in younger adults—and it’s a trend we can’t ignore. In this episode, we sit down with oncologist Dr. Reema Patel to discuss why this is happening, which lifestyle and genetic factors increase risk, and what you can do to protect yourself. We also talk through screening tests, why they matter, and how catching colon cancer early changes everything. This is an important conversation you won’t want to miss.

Colon cancer is no longer just a disease of older adults—protect yourself by knowing the risks and taking action early!

Resources to learn more about colon cancer:

American Cancer Society

Patient Resources at Fight Colorectal Cancer

Community support resources for colon cancer:

ColonTown

FIGHT Colorectal Cancer

The Colon Club

Colorectal Cancer Alliance

thestartinggatepodcast.com

Email us with questions and topics you want us to cover at
contact@thestartinggatepodcast.com

Follow us on social media @thestartinggatepodcast




The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Colon Cancer with Dr. Reema Patel

[00:00:00] 

Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting game. We're your host, Dr. Kitty Dotson and Dr. Sarah Sheets. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome back to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. So we're continuing our series on gut health this week, and we're addressing a topic that has been getting a lot of press because it seems like it's increasing in frequency, especially in younger adults, which is alarming.

And this is colon cancer. We're gonna talk today about what are the risk factors for colon cancer, what are the trends we're seeing and who this is affecting, and then we're gonna discuss. What are the recommendations for screening? What are the potential early signs of colon cancer you could possibly see?

And we'll also get into how lifestyle affects your risk for colon cancer. We're really 

excited to bring an expert in this [00:02:00] topic. Dr. Rema Patel. I'm super excited to have her here today. She was actually my upper level when I was a resident, and Dr. Patel is a hematologist, oncologist and assistant professor in the division of medical oncology at the University of Kentucky.

Dr. Patel, can you tell our listeners about you as well as how you became an oncologist that specializes in this field? 

First of all, thank you guys for having me so much. So happy to be here and talk about this really important topic. But I actually became interested in oncology early on in medical school and pursued that passion during residency and then.

Gastrointestinal tumor just became an interest of mine as I was going through my cancer training. So it is a group of diseases that we actually have a lot of chemotherapy options for radiation and surgery options for. So it was nice that I could always do things with my partners and come up with plans together in a very multidisciplinary fashion with a group of folks that way we can always put our minds [00:03:00] together for the best plan for patients.

So that was really an attractive part of why I started doing GI cancers. 

And on that, so you treat lots of different types of GI cancers. Today we're gonna focus specifically on colon cancer. Can you just give a brief description of what cancers fall into that colon cancer 

Yes. Category. So colon cancer actually refers to both colon and rectal cancer and we sometimes clump them together in, call them colorectal cancer.

Really colon cancer is cancers of the large intestines. So anything that starts after the small intestines is done all the way to the rectum. So that's in between section. And then the rectum is the very last part of the colon before it gets down into the anal canal.

And that small section right there is called the rectum. So these are slightly different in terms of how these cancers behave. And so we do actually treat them slightly differently. But often we clump them together 'cause [00:04:00] many of the treatment options are the same. 

And is colon cancer the same as a polyp?

If someone's had a polyp or has a family history of polyps, is that cancer? Great question. 

So fortunately polyps are not cancerous, however. Sometimes larger polyps or sometimes they're called adenomas. When you get a sample back, a testing result back those can be high risk for cancer in the future.

So we call these pre-cancerous lesions and they often need closer follow up and surveillance by a provider to make sure that they're not something that are concerning down the road. 

 , I think we just jump right into this because I think this is something that people just have on their mind because we are seeing colon cancer happen in younger patient populations than we ever did before. I know this has changed even in my time of when I started med school to today.

What are these risk factors and trends that we're seeing in patients who have colon cancer today? 

[00:05:00] So first I'll talk about what we would consider, quote unquote the normal regular onset colon cancer. And then we'll talk about early age onset colon cancer. 'cause they are a little bit different.

So often colon cancer is a disease of patients as they get older. So the average age is around 66, which is why often screening starts before that time period occurs. So simply put, the older you get, the more likely you are to develop this type of cancer. And that's for a multitude of different factors.

As we age, things change in our body, which puts us at a higher risk for cancer development. But we can also have genetic syndromes and things like that can put us at higher risk, a developing colon cancer, and those patients would need to be surveillanced earlier. And then you have this whole separate category of early onset colon cancer as well.

And these are patients who are developing cancers at the age of 50 or younger. And that's sort of the thing that's been in the media most recently is this rising incidence. [00:06:00] And those numbers are scary in how fast this has risen over time. The last data I saw was that.

Between the ages of 30 and 40, the risk of colon cancer has gone up by 185%. Oh my gosh. 

 Yeah. I'd heard someone born in the nineties is twice as likely to get colon cancer. Is someone born in the 1950s? 

I would believe it. I have not seen that effect myself, but I would totally believe it. I'm digesting that.

That was way higher than I expected. 

Oh, it's happened so fast and I think people want answers, and unfortunately when it comes to getting answers, we need time to be able to do the research to actually figure out what things are making this impact.

But we are starting to find some of these answers and researching them in more depth so we can make changes. what are some of these things that we're noticing that could be risk factors we need to start considering 

a great question. I've already mentioned the genetic syndrome, so it is important if you have any family member it has previously had.

Colon cancer, pancreatic cancer, breast cancer, that they ideally would've been tested [00:07:00] for anything that could have been passed down from family member to family member. We call that germline testing. And if there's a family member that is positive for that, that would change and put your risk higher as a blood relative.

So that's one thing we always monitor for is genetic syndromes. And the more we're learning about genetic syndromes and as our databases are growing with the information that we have, we're finding more and more links. So it is important to continuously have this discussion to make sure that we're not missing anybody and not testing people at the right time.

So genetic syndromes would be one. But also things like inflammatory bowel disease. So this is Crohn's disease, ulcerative colitis. Those actually do put increased risk of colorectal cancer as well. The reason for this is because the inflammatory bowel disease damages the lining of the colon making it more susceptible for cancer development.

And then you also have type two diabetes. So a lot of the things surrounding how type two diabetes happens the pathology, the physiology behind it, the inflammation behind type two [00:08:00] diabetes are also very similar risk factors for development of colorectal cancer. So we know that having diabetes can put you up potentially up to two times the risk of developing colon cancer versus someone who didn't have type two diabetes.

So those are sort of the more common risk factors I guess we would think about. But the things that we don't often think about are things like our lifestyle. the food you eat is really what you are. And that is no less true than in colon cancer. How much movement we have also has a big impact on our colon cancer risk.

And then we also have to be concerned and worry about. Our gut microbiome, so this is not something we talk about very often, but it's really the collection of bacteria that are supposed to be there in your gut. ? There are some bacteria that are good for us and others that are not.

you really wanna optimize the good bacteria when you can and decrease the bad bacteria because those bad bacteria also put you at risk. the gut microbiome is a large population of [00:09:00] essentially bacteria, microorganisms that live in our gut, that are supposed to be there. They have a function in immunity, how the gut cells actually work.

So they're supposed to be there to help with normal function. However, we know that through multiple studies over the last probably 10 to 15 years, especially in the last five years. The gut microbiome is involved in the formation of colorectal cancer and then how it actually progresses through its course as well.

there are very specific bacteria that can be detected in patients who have colorectal cancer that are not found in patients who don't have cancer. So we know that there's a set of bacteria and microorganisms that are propagating or creating a positive environment for the colon cancer to develop.

And the idea that we have now as we're learning more about this is how can we modulate or adjust the gut microbiome so we can set up a negative system for colon cancer. And [00:10:00] so we don't promote the cancer development. And there's a lot of clinical trials that are looking at probiotics.

What is the right mix of probiotics? Yeah, because that's 

what's tough. Probiotics come in so many different, so many, and 

, We do have some strains of bacteria identified, but then can we actually put them in a capsule form and are they easily digested and then taken in by the gut? So those are things that we still don't know yet.

So this is why the clinical trials portion of this is really important, that if there's an opportunity to study this, we would like to be able to study this. So we know that patients are getting the right combination. In a probiotic so that we're setting them up for the best possible 

outcomes.

So just simplifying a little bit of what you're saying is you can have a certain set of bacteria that live in your gut that make it easy for a cancer to develop. And you can have other sets of bacteria that make it much more difficult for a cancer to develop. And so we're doing research [00:11:00] looking into can we supplement those good bacteria so it makes people's colon less likely to have a cancer start from the first place.

Correct. And another thing though that we know is also the type of diet that you have can feed the good bacteria, but can also feed bad bacteria. So modulating your own diet can be very beneficial. So for instance, a diet that is high in fiber, so plenty of fruits, vegetables, legumes, nuts in your diet actually feed the good bacteria.

Whereas a lot of things such as processed foods, red meat actually can feed the bad bacteria. So when we have patients that are concerned about how do we best optimize our nutrition, often I tell them, do plant-based doesn't mean you have to go vegetarian or vegan. But ideally you do a plant-based diet with lean meats like chicken and fish over the red meat options if possible.

And if you need more [00:12:00] help for thinking about how to increase your fiber and you did not listen to last week's show, go back and listen to that because Emily McGlone gave us a lot of great ideas on how to increase fiber in our diet. Can we talk a little bit more about the red meat controversy and how that is involved in cancer risk?

Yes. So this is a super good question. Unfortunately the problem with red meat. Is that it can significantly increase your risk by up to 30% of colon cancer development. And part of the reason why is because that it actually causes a pro-inflammatory gut. So essentially it causes a lot of inflammation.

The breakdown of red meat is also very hard for our gut. So red meat actually tends to sit in our gut longer. So not only is it causing inflammation, but it's staying there longer and causing prolonged inflammation. So that's something that we do have to be aware about is that red meat is hard for us, but it also causes a lot of inflammation and that sets up [00:13:00] essentially the perfect storm over prolonged periods of time for cancer development.

And are the red meats equal? If you have a grass fed beef versus a hot dog, is that the same risk? 

okay, here's what I'll say. Processed meat for the mere fact of also being processed and having a lot of chemicals that we can't trace is probably gonna put you at a higher risk.

I will say though, clinical trials often don't pull apart red meat from grass fed animals versus processed red meat is sort of all clumped together in one category. So I wouldn't be able to 100% say Yeah they never 

distinguish lean versus not correct. that's always an argument that people have related to that.

So it just, we still need more research in that aspect, but They unfortunately have always just lumped it all together. 

And there is a recommendation, so they say 70 grams. If you were to pick your 70 grams, then I would pick that lean grass fed red meat versus. [00:14:00] The hot dog that is in a process package that has then been grilled in the heat.

So those are, there's those two different varieties. And if you have the option to pick the cleaner version, I would pick the cleaner version. 

And you just mentioned heat. Is is that something that plays a role in? So 

mostly for the fact that smoked and probably charred food items are going to maybe not necessarily put you at higher risk of just colon cancer, but also gastric cancer as well.

So stomach cancer. So we do try to recommend avoiding really charred and smoked meats if we can, for those cancers as well. 

So maybe we need to think of some more fun things to put on the grill in the summer. 

Yes. Lots of fruits and vegetables, tons of fruits and vegetables on the grill are amazing.

Another risk factor I think you had mentioned, but I would like to unpack a little bit more is as sedentary lifestyle, how does that relate [00:15:00] to our colon? 

So unfortunately when you have a sedentary lifestyle, which means you are not moving much throughout the day , there's a lot of things packaged in with that.

Maybe we're not exercising when we're having a sedentary lifestyle. We're maybe even eating a lot more junk food when we're, snacking and just watching TV or even working on a computer at work. That's considered a sedentary lifestyle, but all those things are setting you up for this perfect storm of.

Cancer development. But the opposite is true, that if you're exercising you're actually creating an environment where you're decreasing inflammation in your body, you're also having positive circulation of sort of good healthy blood through your system all the time. That's well oxygenated. So you're allowing sort of junk to be taken out of your system and clean, healthy stuff being put back into your system 'cause you're circulating blood in that fashion.

So keeping up a normal activity level or even a strenuous activity level is beneficial 'cause you're getting benefits from a [00:16:00] inflammatory standpoint. 

Yeah. So exercise is going to decrease colon cancer risk, but it's also probably gonna have an effect on your weight. And is weight Yes.

Linked at all to, to risk. 

And again, very similar, you're gonna start seeing a pattern here. Obesity also internally sets up a very pro-inflammatory system. So if you're exercising and you're decreasing your obesity risk, but you're also moving more and just leading to a healthier lifestyle, then really the idea is to decrease that inflammatory sort of syndrome in our body that's happening.

So anything that's leads to decrease in inflammation and increases in healthy nutrients getting to our body is really putting your body and your gut in the best sort of protective situation. It can be in 

another bucket as well that I think previously we were a little bit more lenient on and now our feeling it should maybe should be a little bit stricter is alcohol.

What, so what are we seeing when it comes [00:17:00] to alcohol and colon cancer risk? 

Yeah, so alcohol hadn't been studied for a long time in colon cancer because we really didn't think that either alcohol or smoking had. Huge risk factors, but we are learning that actually moderate to heavy alcohol consumption actually increases your risk to one and a half times for someone who's versus someone who's not.

Drinking. And that's even one standard drink per day can increase your risk. And that's something that technically we say is okay, one drink a day is okay. But a problem with that is actually decreases folate absorption. And again, folate is a very needed mineral for healthy gut function. And so we're taking away healthy minerals when we're putting alcohol in our systems.

Now the good thing is though the effects of alcohol can be reversed. If you wanna say that, quote unquote, to some degree, research has shared that if you stop drinking the risk for these alcohol related cancers, and that's not just colon cancer, but a variety of other cancers, it declines over time.

So it's not gonna happen immediately, but months, years down the road, you are going [00:18:00] to mitigate some of that risk. If you stop drinking. 

 And is that the same with smoking as well? 

Yeah. People who tend to smoke have a higher risk of actually developing colon polyps that have a pre-cancerous risk to eventually develop into colon cancer.

So not necessarily a colon cancer risk, but a colon polyp risk. It's a little bit different. But we have a study that's actually from Europe that tracked 60,000 people for long-term, for an average of 15 years, and they found that they had a 20% risk of developing more colon polyps than their counterparts who weren't smoking.

So that's just something to keep in mind is that a 20% risk is one in five people. not a small number that can be affected by these lifestyle things. 

Some other things that are talked about sometimes in the supplement world is vitamin D and calcium.

Where do we stand with those two things now? I 

think this is a great question. There's actually a lot of positive data for vitamin D and calcium supplementation. There's [00:19:00] recommended guidelines now on how much we should be recommending to folks. And so for vitamin D we actually say a thousand to 2000 milligrams per day.

And then calcium a thousand IUs per day. We know that this is actually again, setting your gut up for being in its most healthy condition possible to feed that good bacteria as well. So that is why we have actually set standards for how much we're recommending. And is 

this from a cancer prevention or is this for patients with colon cancer?

It is from a cancer prevention actually. So vitamin D , has been shown to have some prevention benefits. So we are recommending it for that purpose. And obviously you have other positive side effects of bone health and things like that as well. Again, a lot of these can come from plant-based diets as well.

Yeah. So you don't always have to supplement with actual vitamins. You can actually get this through your diet 

Vitamin D is just the hard guy. I can get the calcium, but vitamin DI gotta have a little help, 

help here and there.

 I do wanna touch on fiber just really quickly 'cause we mentioned fiber earlier. But [00:20:00] we do have a recommended amount for that. Anywhere from 35 to 40 grams of fiber. A day is beneficial. Again, gonna set up that positive gut environment also helps with good stool output, so that's important.

One thing I will say to make folks happy is that. Coffee has been linked to possible protective benefits. So now this is black coffee. So if you're adding a ton of sugar and creamer that may go into that processed food category. So please don't negate the positive benefits of black coffee.

And the data says that, if you drink black coffee, great, you're probably giving yourself some protection. But if you're not someone that normally drinks coffee, please don't go and start drinking two cups of coffee , every day. But it can be beneficial so you don't have to stop your coffee if that's your vice in life.

No I love 

that. I love hearing positivity about coffee. Going back to the fiber, so that recommendation you said, that's actually for women specifically, substantially higher than [00:21:00] even just the general recommendation of 25 going up to that 35. Just wanted to note that for our listeners, so even more fiber than we're usually preaching about on this show may be beneficial to decrease that colon cancer risk.

Is it a linear relationship? If you are someone that's going from, let's say, the average person in America is probably getting around 12 grams of fiber, so if they go from 12 to 25, are they seeing a benefit or do we really need to get all the way to, 35 before we see that reduction in risk?

So that's actually a super good question. We do know that patients who are getting 20 to 30 still have benefit. So I think if you're in that, range that is recommended for women, you're not doing a disservice to yourself by any means. But I think there is maybe some linear benefit to it, which is why they've raised the recommendation to 35 at minimum.

35 grams is a lot to take. And especially if you're at 12 Yes. Especially if you're at 12, that is a massive jump up. So it's, it's baby habits and, adding [00:22:00] an extra cup of blueberries or, switching from white to whole wheat, things like that. So it's baby steps along those ways to get there.

But I do think it's important to try to really get into the twenties and thirties if we can. The 45 I think would be really hard to get, but that's a lot of fiber. That's a lot of 

fiber. Yeah. Okay. So we've talked about all these lifestyle things and then we've talked about, we're seeing such higher rates of colon cancer in younger people.

I don't feel like all younger people just have so much worse of a lifestyle. What's the difference? 

 The answer is we don't know. We do feel like that processed foods probably is a large part of a player in here again, because it alters the gut microbiome so much.

But you're right, a lot of younger people are healthy and don't necessarily have a sedentary lifestyle. They're active and things like that. So I still think there are things within our environment that we maybe don't have a great grasp on at this point in time that could be affecting our gut [00:23:00] health, which is then leading to unfortunately setting us up for cancer development down the road.

One thing that we touched upon briefly before we started the podcast was plastics and microplastics. A lot of those things are really becoming more mainstream in the popular media, and so will we eventually find a link to microplastics in colon cancer development down the road?

It's a possibility or could there be some other thing that we don't know yet? We also know that a lot of what happens in cancer cells in general can be due to some chemical exposure 20 years ago that we would've had no idea about now. So there are things that happen in our environment that we may have been exposed to as well.

And then there's things that happen just within our own gut cells. So we call this in a fancy word, epigenetic changes. So things that are happening within the cells, the healthy gut cells themselves that are making them turn into cancerous cells these can be mutations that develop over time, things like that.

And [00:24:00] there may be a higher predilection in younger patients to develop these mutations early on, which then leads to early onset colon cancer. So there's a lot of black boxes and question marks still, unfortunately. Yeah, sounds 

like a lot more research to come on that. So I think what I take away from that is there's probably a lot that we don't know and some exposures and things that are outta my control.

So I probably need to focus my efforts on what are the things I can control and exercise fiber, reducing alcohol, those kind of things were our best bet to try to work on prevention. 

100%. 

 And then that takes us into our next topic is screening. And Early detection is huge for this specific type of cancer.

'cause there's many cancers that we do not have great screening tools, but colon cancer we do. So could you give our listeners an overview of colon cancer screening guidelines , and then we'll talk about the options they have because there are other things other [00:25:00] than colonoscopy, which many people are familiar with.

But. This is critical, especially in this environment that we are today to be sure we're getting our screening done. 

So the first thing I'll say, 'cause I know we're gonna talk about our options, is the best screening test is the one that you'll do. We can talk about colonoscopies until I'm blue in the face, but if you're not gonna do them, it's not gonna help us.

So we really, I think talking about these options is gonna be really important. And for someone who takes care of colon cancer on a day in and day out basis, I am happy to report that the age of colonoscopies has now gone from 50 to 45. Especially because we see these early onset colon cancer.

So the current recommendation is if you're 45 or older, you should be screened for colon cancer and you should at least get screened until the age of 75. If a patient who's 75 wishes to continue getting screening, that is a discussion between them and their provider, but at least from 45 to 75, you should get screened.

And there are very particular reasons also why you should get screened. Family history, as [00:26:00] we've already touched on many individuals, if they have a positive family history for colon cancer, pancreatic cancer, things like that, then there's recommendations to start the colon cancer screening process even earlier, up to five to 10 years earlier.

So you may need to start something in your thirties if that's the case. So that's really important to keep in mind. And then very similar for the genetic syndromes as well, so family history and genetic syndromes. Very similar guidelines that if you have someone or genetic syndrome, you may wanna start five to 10 years ahead of time.

And so insurance will pay for your colon cancer screening starting at 45 now or earlier if you have a family history. Yes, 

they will. This is considered preventative screening. Covered by Medicare, Medicaid, and all major insurances. 

And this is a reason to be sure that you're discussing with your healthcare team, your family history.

'cause some people don't mention that there has been a family member with colon [00:27:00] cancer or even a family member who's had lots of polyps as well, because that can change when and how frequently you get your colon cancer screening. So be sure you're communicating that in your doctor's visits.

Now, when it comes to options, yes. What are the options that people have today? As you said, it all matters of what you're willing to do, but how complicated each of these may be for a patient. 'cause I think sometimes we just say no and are unaware of the actual time commitment it may have.

 I'm gonna take these into two separate categories. first category is things that we have to do in a clinic or hospital setting. And then the second one is things that we potentially could do at home. 'Cause that realm of testing has really increased in the last five years or so.

the gold standard is considered the colonoscopy. So the colonoscopy is where you have to have this two three day prep. You have to clean out your whole colon. And then we go through this process of getting a colonoscopy done by a [00:28:00] specialist who performs this all the time with the idea. If there's anything of concern, they will take a sample or a biopsy of it and then send it off for testing 

. And ideally if a colonoscopy has come back clean, you need to do one once every 10 years. So not too bad. But if we do find things like polyps, adenomas. . Then there may be a recommendation to do it again in three, five years as well.

So there could be more frequency involved depending on what we find. The next option is called a capsule colonoscopy, where you have a very special device that you're going to essentially swallow. And it actually just takes pictures as it's going through your entire gut. And you eventually will have it come out in a stool output in a day or two.

And then these pictures get electronically sent. It's amazing over to a computer that a physician can then evaluate. We do recommend that if a capsule colonoscopy is being done, that it be repeated once every five years though, because sometimes when we're doing a capsule, it could [00:29:00] miss.

Nooks and crannies that we could actually see with a regular colonoscopy. So that's why there's a little bit more frequency if we do a capsule. 

Does insurance cover the capsule analysis screening? 

So it technically is the recommended screening tool. The capsule is somewhat more expensive. So I don't think all insurances will cover it.

So this would definitely be a discussion that you have with your provider that, Hey, is this an option for me and will my insurance cover it? 

And do you have to prep for that like you would a colonoscopy? You don't necessarily 

have to have the same type of prep, but I think they do still recommend that you have some level of clear liquid soft foods.

'cause it does make the capsule easier to pass and take better pictures. The next option is what we call the virtual colonoscopy, which is actually done by a CAT scan. This is also something that's newer in the last five to 10 years. For very similar reasons. It may miss small details though. So this is us just grabbing black and white and gray pictures after we've given some sort of oral [00:30:00] contrast to see the colon.

And so unfortunately, because it doesn't catch all the nooks and crannies again, it should be done once every five years. Then we have a couple of, at home tests that ideally if they're positive, you would still go on to one of these other three testing modalities.

So we can visually take a look. The first test that's been around for quite some time is a fit test. So essentially what we're looking for is microscopic traces of blood in stool. we will essentially give a card to patients and you just collect a small stool sample and you send it off with the card and they'll do the test in some place wherever you've mailed it to.

And they will come back with a result. If this is normal, then you have to do one every one to three years. Now they have a sort of next generation fit test, which is called the fit DNA. So not only will the fit DNA look for blood traces, but it'll also look for traces of DNA that could be related to colon [00:31:00] cancer.

If that test is negative, you have to repeat it once every three years. So a little bit less frequently 'cause it's getting a little bit more specific. And then we have tests that can be purchased as well, not necessarily just recommended by your providers. There's one that's called a cell-free DNA test.

The Shield is the company I think that makes it. But this was actually approved just in 2024 by the FDA, so a newer test on the market. But what it's looking for is what we call cell-free DNA. So again, it's looking for fragments of DNA that could be related to not only colon cancer, but even pre-cancerous cells.

So could we catch some of those polyps, adenomas that we would normally see on a colonoscopy? This is potentially looking for that as well. The test actually does have a high percentage of correctly identifying those who do not have colon cancer. So it still could potentially miss patients that do have colon cancer because we are depending on shedding through stool.

So this is another stool-based study. [00:32:00] But if it is truly negative, then again, repeat it once every one to three years. That's another option. 

So how accurate are things like the fit DNA and I think of the brand Cologuard? I'm not sure if there are other brands. Is Cologuard the only one?

Cologuard 

is one. And then there is another brand colo Sense. So Cologuard is also looking for DNA colo Sense looks for RNA. They actually have a, what we call a high negative predictive value. So if it's negative, you most likely truly do not have colon cancer. But if there are some patients that maybe have small tumors and things like that, and could we miss that small proportion of patients?

Yes. So it does have a high negative predictive value, but could we miss some very small cancers and things like that? Yes, we could. And then if any of these blood tests at home are positive, they should always be followed up with a more visual exam for sure. Like a colonoscopy. A flexible [00:33:00] sigmoidoscopy is also an option which is a mini version of a colonoscopy, if you will.

That could be an option to pair with some of these blood tests if they are positive or blood or stool test. 

And now advertised frequently are just blood tests for cancers. Where does that work in the realm of colon cancer? 

So the blood testing arena is becoming more and more popular.

We are already using this prime time in patients who we already know have cancer. So that's where we started with first with these blood tests. Are we a hundred percent catching cancers in patients who have no prior history of cancer with these blood tests? I don't think we're prime time yet for that.

If your primary care doctor says, Hey, there is a blood test that I could use to detect cancer and maybe not just colon cancer, but any cancer, I would still be slightly leery of that. There are a lot of things that can really confound the results that we [00:34:00] get on those studies and we have not quite figured out a way to how to really differentiate those confounders out yet.

So those tests are not really ready for prime time. So I would still say a stool-based test or an actual visual exam of the colon is the best way to go if we're talking about screening for colon cancer. 

 And these stool tests that you can do at home, just take a minute. They send you everything you need and instructions.

Yeah. They give you instructions. If you're not sure, I know Cologuard has a video on their website of, what's involved in it. It is not a big deal. You're not having to, do a whole lot of stuff with your poop, which can seem gross and intimidating. You can do it. So there's really absolutely no reason not to do this.

Really. It's true. There is really no reason not to do it. 

And if we go back to colonoscopy, because this is something I always talk to patients about, there's not many screening tests that also [00:35:00] can treat things when you're there. And so I think that's something that's really amazing about the colonoscopy as a screening tool is because if they see polyps there, they're able to.

Get the sample while they're in there. As well as remove other type of polyps. So, just feel like it, it does feel like a lot of work and effort, but it's something that can be worth your time and energy. Especially if they see something because they're able to get the sample then and there.

Exactly. , You can think about as a two in one that you're gonna take a look and make sure, but also if we need a biopsy, if we need to remove something, you're gonna get rid of it and you're gonna have an answer. So I think that's sometimes the harder part with these stool-based test is you send in the test, you get a positive result and then you're in a waiting game.

Yeah. Because then you have to do the colon, have to do the colonoscopy. You still have to do the colonoscopy. Exactly. But then you had to wait for it to be scheduled and stuff. And if I were just thinking of myself as a patient going through that scenario, I would probably just have very high anxiety in that waiting period to then get my colonoscopy done.

Now obviously that's different for every person and every [00:36:00] patient, but. That would just be very anxiety provoking for me. So I'd 

think I would just say, let's just skip to the colonoscopy. Me too. Now when it comes to colonoscopies, I know one of the biggest hurdles is that prep before. And making sure you do it right.

And that's something that I know as primary care, you're always like, you have to do you, 'cause you wanna have that good prep before, otherwise, you know you're gonna have to come back sooner. So 

that is something. Or they, or sometimes they would just straight up send you home that true and say, you are not prepped, let's reschedule for next week.

And then you're missing work again and you have to get the prep again. And so if you're gonna do it. Do it right? 

Yes. And the other tip I always tell people is pay attention. A lot of times there'll be dietary recommendations of what you should eat the week before your colonoscopy, 'cause it's gonna help make that prep easier if you're following those recommendations.

And if you've had a colonoscopy in the past where the prep wasn't great always making sure that you are getting advice on how to adjust this time around so you do have a good [00:37:00] prep because everyone responds a little bit differently to those. 

And I will say there are a lot of options for the prep now as well, so I do agree 100%.

If you can take what we call a low residual diet, so things that are gonna be easy to digest and then get through your system and you have a good bowel movement, that's fantastic. And I usually recommend if your own provider has not made this recommendation, I would say three to four days before you start your colonoscopy prep, start a low residual diet.

Softer foods easy to digest, easy to get outta your system. And so when you do start that colonoscopy prep, it just makes it so much easier. But the other thing is there's a lot of options for colonoscopy preps now too. So if you had one years ago and it caused terrible abdominal cramping, ask your doctor, there's some pill and now liquid versions as well that you could do like a combination of.

So there's quite a few options in different formulations. So if one didn't work for you or if it caused a lot of side effects, let your provider know so they can find a better solution for you. 

[00:38:00] Yes, 

they are way more options now and I think sometimes people worry is it gonna be painful or uncomfortable for them to do it?

 Super good question. I'll just say my mom recently has had quite a few colonoscopies every time she has 'em, she feels even more comfortable because I think they just, they know, right? The individuals who are doing these tests. They know that colonoscopies are dreaded, so they're gonna try to make this as painless as possible for you.

So you'll have an opportunity to meet all the providers who are gonna take care of you. That's nursing staff, anesthesiologists, the actual doctors that are gonna be doing the colonoscopy. So you know, when you feel comfortable with your providers, but also they're gonna be sure that they're gonna give you plenty of medications to help treat anxiety, help treat pain.

Sometimes even before they roll you back into the procedure room, they'll go ahead and give you something to make you a little bit more relaxed. And then when you're in the actual procedure room, they'll go ahead and give you something to help make you sleepy so that you really don't remember.

And the idea is to really [00:39:00] say, can we make you pain-free? But also you're just not gonna remember what happened, which is great. And they're really good at doing that kind of stuff and you just talk to them and let them know what your concerns are. 'cause everybody will come and meet you and you just let them know what your concerns are and they'll be sure to address it.

And then I think after the fact even folks can be really concerned, am I going to have abdominal pain or bloating and things like that? Often most patients don't. The abdominal pain, bloating, things like that are very minimal. They may have a little bit of bleeding afterwards, but a day at max and then it goes away.

And they're always gonna give you instructions on things that you should more immediately call the provider for. , They have a lot of safety precautions in place as well to make sure that you're having a pleasant as possible experience and during a colonoscopy, but also it's done safely.

And with your best interest in mind, 

I'll say one question I would get a lot from patients is it general anesthesia? And no, it is not. General anesthesia also, can I drive home afterwards? And the answer is [00:40:00] no. You cannot drive yourself home after the colonoscopy. Even though the types of anesthetic that they give you does wear off pretty quickly.

So you should be pretty with it But they will not let you drive home. Or call an Uber driver. Yes, they will not let you call an Uber driver. So make sure you have to have someone there to check you out. Yes, you need a ride. 

You also, they recommend not signing any legal paperwork for 24 hours afterwards if you did not know that.

Yes. So yes, like I said, lots of safety precautions in place. 

As we move out of the screening what are some of these symptoms that should make people go to their doctor and be concerned, Hey, maybe I needed this checked out for possible colon cancer. '. With social media today, there's lots of scary things and scary stories that people put out there that it really has people concerned.

But what are those major things that you feel like, hey, if this is occurring, you should be talking to your doctor about it? 

Yes, there are a red [00:41:00] sir, there's the red flag symptoms that we'll call them. So dark stools. So these can be like super dark brown or even black stools would make me worried.

Bright red blood either on the stool or in the toilet bowl that you notice. And any change in stool habits. So whether you start having urgency change in consistency, shape frequency, those things should also alert you that, hey, this is not my normal stooling habit. Any abdominal pain or bloating would be a reason as well.

But also one of the things that we don't think about is anemia can be a presenting symptom. Most patients wouldn't know that they're anemic because that's often something that we diagnose on lab work. But symptoms of anemia would be a fast heart rate. So you feel your heart racing. You may become short of breath.

You may notice that you have persistent unrelenting fatigue that isn't getting better. But this is really an easy, simple, you know, you go to your primary care and say, Hey, I'm not really feeling well. They can check a lab and you would know that you're anemic. And or [00:42:00] then explained unexplained weight loss.

And I think there is something to be said about unexplained weight loss. We have a rising trend in using some of these newer weight management agents. Certain medications and patients sometimes will attribute a lot of their weight loss to these new medications that they're using.

But I do think that there is a healthy amount of weight loss that's happening on these medications, and then there's excessive weight loss. If there's anything more than you or your provider expected, then we should do a little bit of, deeper digging as well to make sure that there's not anything of concern.

But those would be the big red flag symptoms I 

would call out. And one thing I just wanna put out there too is not everyone that's having blood in their stool has colon cancer, so don't freak out if you do see blood. It's very common for people to see blood intermittently, whether they've got a tear in the rectum or a hemorrhoid or other things that can happen.

Don't overly worry, but also don't ignore it and talk to your doctor about it so they [00:43:00] can decide is this something that we need to worry about and investigate further or not? 

Yeah. And I'm glad you brought up the anemia one because I feel like that was one that a many times people would be found to have anemia or iron deficiency and not really getting appropriate workup from a GI standpoint.

 I'm glad you brought that up because if we're losing blood we gotta figure out where it's going. And sometimes that can be our, 

Colon and especially I think now that we are having to think about it more in young patients. Typically in young women, we think that's due to menstrual losses, but I think now we're gonna all have to be more conscious to, to say, is it menstrual loss?

Or do we need to be thinking about colon cancer too? 

And so many of us don't actually, pay attention always to our stooling habits. Especially in a young woman, it would be really important to then say, okay, let's talk about your bowel habits and let's really dig into are you going every day?

What does your stool look like? Because there could be more clues in that history that we would otherwise have missed if we just said, Hey, this is a menstrual [00:44:00] bleeding and we're okay. We're done with that. So sometimes I do think it warrants further digging into the history to make sure everything is okay.

And now that we have all these stool tests, I think it makes it easier to rule things in or out. Yeah, exactly. 

 Patients in general, but especially young patients, if you are worried, please do be your own best advocate because you're living in your body, so if there's symptoms that are persisting that are not getting better over time, please make sure that you're being heard and you're getting tested to make sure, like you mentioned, there are some things that happen, like a little bit of rectal bleeding that goes away because of hemorrhoids and things like that. But if it is persistent getting worse over time, please do advocate for yourself to get it checked out. Because I still think that even though it's in the public media, not all of us still think of that as a possibility for a young patient because it shouldn't be happening to young people.

Yeah. We went decades with it not happening. So now it's a change of thought. It's a 

change of thought. Exactly. And can you tell us a little bit about why it is so important for [00:45:00] people not to ignore it and for us to find it as early as possible? 

 As I mentioned, there are many options for patients once they have been diagnosed with colon cancer.

But the general rule in colon cancer, but also really any other cancer is if we are to detect it the earlier and the smaller, we detect the better outcomes patients have. And I think that's so incredibly important to say for really any of our screening studies, whether that's colonoscopies, mammograms, the reason these tests are in place or these screening guidelines are in place is we know that if we can catch a small, our patients have long-term better outcomes.

And so that's why, being alert to some of these symptoms is really important. But the other thing is it also allows us to potentially do less invasive things to help treat whatever we're dealing with. So sometimes it's a surgery and then it's done and we don't have to worry about chemotherapy or radiation and that would be perfect.

So if we can get away with doing the least amount in terms of interventions that [00:46:00] can have a lot of side effects for patients as well, but also have great outcomes, that's what we would love to do for our patients. 

So you mentioned potentially. Finding it early surgery might be the only thing that you might have to do.

Correct. And does that mean, so if you were to have surgery for this, does that mean that you're gonna have an ostomy or, and when I say that, where your colon is connected to the outer skin of your stomach and the stool goes into a bag. Is that always what needs to happen after a colon cancer?

That's a great question and I think that is a fear for a lot of folks, but that's not necessarily true. We often need an ostomy purely due to the location of where the colon cancer is. So sometimes it is not possible when we do a surgeries to put the pieces of colon back together after we've taken out the cancerous portion.

And in that scenario we would have to do an ostomy or sometimes if a tumor is large or too large for us to do a surgery on right now, we may have to divert [00:47:00] around it. And have an ostomy for a short amount of time. And then the idea is that once we start treating the cancer, we can reverse the ostomy.

So an ostomy is not always permanent either, but it really depends on the location, what the treatment plan for you is going to be going forward. So all of that is taken into consideration, 

I think. It's great to know that it isn't necessarily something that you would have to have forever.

Correct. Correct. 

And just treating colon cancer in general even in those later stages, we have so many more options today for patients. Could you just give a little bit of not too medical of an answer there, but I do think that it's a field that has grown a lot over the last couple decades.

Now you're really getting into my daily bread and butter. No, this is this is really, to be an oncologist right now is a very exciting time. Because things that. Even in my training, I did not think we were going to be able to treat patients for we are now able to treat patients for. [00:48:00] And that is just incredibly exciting.

And so many of the options, I talk about chemotherapy, but it's not just chemotherapy anymore. We have immunotherapy which can utilize the power of your own immune system to fight the cancer. We have what we call targeted or personalized options. 

They may still be IV therapies or pill therapies, but they are specific to mutations that your colon cancer harbors. There's also radiation. There's different surgery modalities. We do these fancy things called hepatic pumps. There's so many things that we do now for patients to not only help treat their cancer, but also help them live longer and improve their quality of life.

The more we learn, the more we're becoming better at this. Again, we don't have it all figured out unfortunately. I wish we did. But we are definitely year by year, sometimes even month by month I feel like, which is great learning new things , that are helping patients down the road in the future, which is fantastic.

And because we [00:49:00] always like to tie this in, what are some of those lifestyle things that when people have, made it through their treatment and they're trying to stay in remission, what are those things that you're really encouraging patients to pick up as habits to help reduce that risk of a recurrence?

Great question. So exercise actually is a lot of proven data. The studies coming out have been amazing. So they've existed in breast cancer for some time now that patients who in breast cancer should they develop a exercise program at the beginning of their cancer course or even throughout their cancer course.

And then maintain that they actually do have decreased recurrence rates, which is, and it's beautiful. Fantastic. Yeah, it's fantastic. It's fantastic. And now we're seeing it across the spectrum. We're seeing that data in colon cancer also prove to be true that if you are exercising before or pick it up during your course of care , there is decreased risk of the tumor coming back in the future.

So a healthy lifestyle really [00:50:00] does make the biggest difference. I often tell my patients, the healthier you are going into this, the healthy you are going to be on the other end of this when we're talking about cancer treatment. Doing that sort of moderate, multiple times a week to strenuous a couple times a week exercise, balancing that with , muscular strength training, balance training, all of those things are super, super important for the best possible outcomes.

Also, though, it makes you really great surgical candidates. So if surgery is something that you are interested in. Being strong and fit and healthy actually makes you a really great surgical candidate And the ability to tolerate the surgery much better with faster recovery times.

Also, it helps with the tolerance of chemotherapy and some of these targeted therapies. So not only are we preventing disease, but we're actually decreasing recurrences and we're able to tolerate the therapies and interventions better when we're stronger, healthier, fitter. From the get go. 

And I think that's for people who are in [00:51:00] a season of life, feel like they have no control over anything that's going on with their body.

It's great to be able to counsel them, be like, Hey, there is this thing that you can do. Yes. And actually make a difference in your outcomes. , I hope they keep studying and pushing this because it's remarkable data that's coming out with exercise, 

not to mention it's probably gonna help mood and yes.

Sleep and other things that might be struggling during this time.

And there's so much research now, even our national Health Institute is interested in looking at wearable devices. So like our Fitbits, our Apple watches, our Ora rings. And gathering that data in patients who do have a more active, healthy lifestyle versus those who are more sedentary and looking at their outcomes in cancer.

And we're already seeing that data pan out that overall they're doing better from multiple facets, from sleep, from mood, from tolerance purposes as well. I think we're using the technology that we have now as well to , corroborate some of that stuff that we think should happen anyway.

So I think that's really exciting that there's a lot of research behind this. 

Are there [00:52:00] any misconceptions that you think people have about colon cancer that you wanna clear up?

I think misconceptions is that once you've been diagnosed with any kind of cancer, really, but especially colon cancer, there's nothing we can do.

There's plenty we can do still. So I think it's really important to advocate for yourself to do preventative things, to do the colonoscopies at the right timeframe. But if you have been given a diagnosis of colon cancer to really also seek a second opinion if you feel like a second opinion is warranted.

Because I think that you will only. Know if you ask the questions and if you talk to the people that potentially can provide you those answers. that's one thing is there are things to be done. Just have to find the people that are able to give you that correct information. Biopsying or taking tumors out does not lead to more potential of spreading the cancer.

That is a old wives tale that has continued to propagate over time. But biopsying or removing tumors [00:53:00] does not cause cancer to spread. So I think that's a, that's a big misconception. And the other one I wanna point out that I think is really important is to feel that you're alone.

When patients have cancer, they really feel like they're isolated because they may not know anybody that's gone through it. Or they don't have any family support that really understands what going through cancer treatment is like. Please don't feel like you're alone. There are so many groups out there now.

And with the beauty of technology you have these right at your fingertips on your cell phone, on the computer. There are so many advocacy groups that are available such as Colon Town, such as Fight Colon Cancer, the Colon Club the Colorectal Cancer Alliance, where you can get information, find other folks that have been through what you were going through to find a community.

So do not feel like you're going through this alone. 

I love that. And since you just mentioned some of those resources, are there any other resources if someone's wanting to learn more about colon cancer [00:54:00] risk and prevention that they can go to that you feel like are reliable? Yes. 

So fight colon cancer.

And then the American Cancer Society probably have some of the best resources that are also broken down in a more common language so it doesn't have a ton of medical lingo in it, which is really nice. It's really made for our patient population to read, digest and take that information in.

And then if you've been diagnosed, I think colon Town and the Colon Club are really helpful to find that community and they also have really good scientific data behind them. 

You gave us a lot to digest. Pun intended. But I think what we can take away is, number one, know your family history, because that may change when you're screening.

If you don't have a family history, take advantage of this new lower age of screening and you need to be screening at 45. And then you have lots of options for screening. You can do a colonoscopy or there's lots of things that you can even [00:55:00] do at home that are not gonna take away any time or, take away from work or anything else that may be keeping you from wanting to do the colonoscopy.

So take advantage of that. Do not ignore any symptoms that you may be having that Dr. Patel told us about today. Whether that is blood in your stool or losing weight unintentionally, or maybe an anemia that. Your medical professional hasn't really addressed with you, so make sure you're not ignoring any of those symptoms.

And if you have any concerns, bring it up to your doctor. Luckily, this is something that we have a lot of preventive measures to take, so I think we, we learned how important exercises both in prevention as well as in treatment, and then how important fiber is and avoiding certain foods like processed red meats and just ultra processed foods in general.

So going back to all of our thoughts about using a whole food plant forward diet, and if you need any [00:56:00] other tips on how to get fiber into your diet, we have multiple episodes on that, but particularly last week, our guest did a wonderful job explaining that. 

so thank you for coming on our show and we're gonna continue our gut health series and actually do a little bit of a different version of GI condition. We're gonna talk about fatty liver next week. We have Kyle Bloomfield, who's a local expert who sees patients on a regular basis that are dealing with fatty liver.

And we're gonna talk about those lifestyle factors that can make a difference related to that condition as well as it also unfortunately is on the rise in Americans. So be sure to tune in if you like what you heard today. Be sure to share this episode, like it give us feedback. We wanna hear from you, and feel free to send us a text with any episode ideas that you may have for upcoming shows.

We'll look forward to talking to you all next week. See you next time.