Live colonoscopy

[Marci Dodson] Welcome to the UC Irvine Health
live streaming of a colonoscopy. We’re live streaming this procedure today as part of colorectal cancer awareness month. To spread awareness of how colonoscopy is an important, painless procedure that actually can prevent colon cancer. We want
to demystify the procedure and answer your questions about colonoscopy and about colon and rectal cancers. You’re joining us in the UC Irvine Health H.H. Chao Comprehensive Digestive Disease Center, or CDDC for short. We’re in one of our
outpatient procedure rooms. Let me introduce you to the two doctors who are
involved in today’s procedure. First we have Dr. Kenneth Chang, a renowned
gastroenterologist and director of the CDDC. He’s going to be performing the
colonoscopy. And on the table here we have Dr. C. Gregory Albers, also a renowned
gastroenterologist, who has lectured extensively on colon cancer and
colonoscopy. But today the tables are turned and Dr. Albers is the patient and
has agreed to have his colonoscopy livestreamed without any sedation so that
he can participate in the conversation and answer your questions about colonoscopy
and colon cancer prevention. And Dr. Chang do you want to introduce the rest of the
team? [Dr. Kenneth Chang] Yes, to my right is Tony, he’s our GI tech, and Eliza next to him is our GI nurse, and we’re here to do this
procedure for Dr. Albers. About 10 years ago, Dr. Albers had a small precancerous
polyp, which I removed and so he’s now here for his regularly scheduled follow-up
surveillance colonoscopy. [Marci] Anyone watching this live can
participate in this conversation, get on Twitter and send us your questions and
comments, #UCIHealthChat. We’ll convey them to Dr. Albers and to Dr. Chang. Dr.
Chang are we ready to begin? [Dr. Chang] Yes, first I want to …
Marci, do you want to introduce the audience to a little bit of the
instrumentation. Part of the demystifying of colonoscopy is the instruments
themselves, people think that they may be larger than they truly are. So the
colonoscope is a thin, flexible tube with essentially a video camera at the end of
it. Let me show you what the scope looks like. So as you can see it’s quite thin,
it’s about a centimeter in thickness and very flexible, there is a CCD video camera
right at the tip, which allows us to see in high definition. Which you’ll be
watching in a short while. Now there are various instruments that we can put
through the scope for removal of polyps and so on, we can wash, there’s a
windshield wiper, it’s quite a sophisticated instrument. In addition, our
group here at UC Irvine has been involved in various research to see if we can even
increase the polyp protection rate, and one of the instrumentations that we have
is this endocuff, it’s a simple little cuff and it has these little soft prongs
and these help to push folds, so we can see around folds, sometimes polyps can
hide behind the folds as you’ll see so we simply slip that on. And that helps to as
we come back, helps to push the folds so that we can see behind them. So that’s an
introduction to the instrumentation. Very slim and comfortable. So now we’ll go
ahead and start the procedure, we first place the scope through the anal canal and
into the rectum, and right now we are…we’re in the rectum now, and I’m
going to put some nice lube. Now there’s several ways of performing the
colonoscopy, now we’re in the rectum, the colon is five to six feet in length, and
we’re going to journey through the entire colon, we’re going to go upstream, so to
speak, starting from the rectum and through the splenic flexure, hepatic
flexure and cecum, these are the four parts of the colon that are attached, the
colon is a floppy tube, and we’re putting a scope through a floppy tube to inspect
every square inch of the colon looking for either cancer or precancerous polyps. So
one of the ways we do that is … now the colon normally is collapsed or flat, so we
can either put air, now we don’t use air anymore here, we use CO2, because CO2
dissipates very quickly so patients are much more comfortable and when they wake
up there’s much less recovery and bloating so there’s practically no bloating when
they wake up. The newest method is called underwater colonoscopy where we simply
infuse sterile warm water, which helps to open the bowel, and because it’s warm,
it’s very soothing and it cuts down on the spasms and it cuts down on the patient’s
sense of discomfort, so it’s the most comfortable way of doing a colonoscopy,
using a warm sterile water immersion. So here we go, we’re infusing some warm water
and what we’re doing is looking for the lumen, which is the central part, so that we
can safely move the scope and advance it up throughout the colon. And what you’re
seeing here is just a normal lining of the colon, it’s called the mucosa. And the
colon has these what we call haustra or these muscular rings that propel the stool
southbound, and from time to time you’ll see us just gently advancing the scope
through these muscular rings. [Marci] So how are you doing Dr. Albers? [Dr. Gregory Albers] I’m doing great, I can feel the warm water, no pain, no discomfort, maybe just a little rectal pressure but
not at all, not a problem, a really very interesting experience and I’m really glad
I’m here. [Dr. Chang] This is like a colon spa. [Marci] Most patients, the vast majority of
patients, are sedated when they have a colonoscopy. But you’re not having
sedation today. Can you tell me why you volunteered to have this done? [Dr. Albers] Well, March is colon cancer awareness month, and what better way to celebrate the month than to have a colonoscopy? Pretty
simple. I really wanted to respect the patients who have come before me, I’ve
done many colonoscopies on them, about thirty thousand. I try to inspire those
that are on the edge maybe considering colonoscopy and just try to demystify it
and show them that this is something that everyone can and probably should get done. [Marci] If a patient is sedated, what is it like
for them, Dr. Albers? [Dr. Albers] Well, the patient if under sedation, there’s different levels of sedation, one is moderate sedation, we use intravenous
medications to keep them comfortable in a twilight sleep and then there’s another
where we use an anesthesiologist where the patient has a deeper level of sedation.
Generally, patients wake up and they don’t even recall the procedure. Quite often
people want to see the pictures to even say that I did a procedure on them, so
it’s that much of an easy procedure for the patient under sedation. [Dr. Chang] Patients are very comfortable. It’s an outpatient procedure. And those who elect to go under twilight sedation are very
comfortable, we give them the option, patients the option of being more alert
and watching on the screen like we’re doing right now, or some patients say,
“Hey, you know what, just I’d like to take a nice nap and wake me when it’s over,”
and that’s perfectly fine as well. [Dr. Albers] We’re seeing more and more people actually electing to do it without sedation at all and it’s not for everyone
by any means but for those patients who are so motivated, it’s a very, I think a
very rewarding procedure to see your colon on TV, this is the first time I’ve done it
un-sedated and it’s quite fascinating. [Dr. Chang] You’ve never seen your colon before? [Dr. Albers] Not on TV, not like this, it’s pretty
amazing. [Marci] So what’s the age that someone should undergo a colonoscopy for the first time? [Dr. Chang] So colon cancer, Marci, is the second leading cause of cancer death in the United States, this year approximately one
hundred and fifty thousand patients will get diagnosed with colon cancer so it is a
national killer. Sadly, colon cancer could essentially be preventable because almost
every colon cancer arrives from colon polyps, and that’s what we’re doing today.
Now, studies have shown that 90 plus percent of patients who are diagnosed with colon cancer are already beyond the age of 50, so the recommendation according to all of our
societies is that patients who have no increased risk of colon cancer, this is
the average anybody at the age of 50, should get a screening colonoscopy. That’s
why 50 is chosen. Now, if you’re African American, they have a higher colon cancer
risk so the recommendation is at age 45. And then obviously if you have a familial
risk, one degree, first degree relative, or two first degree relatives with colon
cancer, then you want to get your colonoscopy 10 years before that relative
was diagnosed with colon cancer. So if they were diagnosed at age 50, you want
to get your colonoscopy at age 40. So essentially for most people it’s once you
hit the age of 50, happy birthday, come get your colonoscopy. [Marci] And then afterwards to have it redone again. [Dr. Chang] Yeah, so if your colonoscopy is clean, as we’re hoping to see with Dr. Albers here, then you are scheduled to come back in 10 years. So it’s a once in 10 year screening procedure. If however, we find
polyps, depending on how many and the size, up to three small polyps we say come
back in five years, if we see greater than three polyps or a large polyp, then we
say come back in three years. So … [Marci] Where are we now? [Dr. Chang] We’re at the very top of our colon. What we’re seeing in the middle of the screen is what we call the appendiceal orifice. That’s where the appendix comes out of the colon, and that happens at the very, very
top of the colon, at the beginning of the colon. So that’s one of the landmarks that
tells us we’ve actually seen all of the colon that we need to see and we’ve
reached our destination, so to speak. So at this point the prep has been very very
good, I don’t know what you ate last night [Dr. Albers] That is gold specks, I think. [Dr. Chang] But now our job is just to slowly come back and we get two looks at least of every square inch of the colon, one on the
way in and one on the way back, the way back is a more careful inspection, and in
the right side of the colon, which is where we are now, we want to inspect this
area at least two times if not three, because the miss rate is highest on the
right side of the colon. Now, up on the left side of the screen … let me see if I
can show that to you. Here, at around 10 or 11 o’clock, I’m going to change the
filter on the imaging. Can you see the little nubby things on the left side?
That’s the small bowel. The small bowel mucosa have villi, and these villi increase the absorptive surface area of the small intestine. The colon we said is
5 feet long, the small intestine is 20 feet long. But with the presence of the
villi, the surface area is the size of a football field. So the small bowel is just
a crazy surface area, it has a crazy surface area to absorb all the nutrients
that we take in. We’re going to go back and take a second look through that right
colon. Again, we come up to the appendix here. We can wash and move any small
debris. we just don’t want to miss a polyp that may be hiding behind stool. [Marci] What would a polyp look like? [Dr. Chang] A polyp would look like a growth. There’s two versions. One is more of like a cauliflower with a stem and a head, and
the others, which are now known to be harder to find and more risky, are the flat
sessile serrated adenomas, those polyps are like dropping the pancake on the
kitchen floor and the kitchen floor is yellow. So harder to find and harder to
remove. But we have a very high rate of detecting even these difficult polyps
within our faculty. Which gets to the whole concept of adenoma detection rate.
We now have report cards or quality measurements for what determines a good
colonoscopy. So it’s not just the fact that you did it, but over time that you
were able to find a certain percentage of polyps which statistically should be what
you find. And nationally, the criteria is you need to find at least 25 percent of your
patients in this screening venue, you should be able to find an adenoma polyp or
a precancerous polyp. So amongst our faculty we’re between 30 and 55 percent. Dr. Albers has one of the highest adenoma detection rates, I think, in the country. What is your ADR? [Dr. Albers] 49 percent. [Dr. Chang] So we take care in really trying to look for these polyps. Again, over to the left that’s the small bowel, and sometimes we
can just take a peek into the small bowel. All right, so this is the small bowel, and
if I turn on the narrow band imaging, that’s just a button I push to change the
filter and you can see how it can highlight the contrast and that’s how we
detect these difficult to detect polyps. We have high-definition imaging, we have
narrow-band imaging, we have underwater magnification. These are all techniques
that improve the detection rate. So the things that factor into finding polyps
is a good prep, and Dr. Albers has a beautiful prep, the time, studies have
shown that if I take less than six minutes coming back and looking, I’m going to find
less polyps which makes sense. If I take six minutes or more, then I’m going to
find more polyps, so time is important. [Twitter] We have a Twitter question here that’s right on that subject. From Twitter, if benign polyps are found, does that mean
you’re at risk for colon cancer or is it normal to find polyps? [Dr. Chang] By normal, typically about 30 percent of men and 20 percent of women on a screening colonoscopy will have polyps. Now they
don’t belong there so they’re not normal but that’s the typical statistics. Once we
find these polyps, we remove them completely. So a colonoscopy is not only a
diagnostic test, it’s a therapeutic test. We detect and we remove the polyp on the
same procedure. So not only do we know that these are precancerous polyps, but
the risk is gone once they’re removed. [Marci] And we may not find any here today but can you describe how you remove a polyp? [Dr. Chang] Sure we have different instrumentations that we put through the working channel to the small little channel we can put these
forceps, biopsy forceps, or these snares that loop around. We can actually show you a biopsy forcep. So this is the third time now I’m coming back through that same
right colon. Taking a very careful look. And I’m switching between high-definition
white light and now narrow-band imaging, and now high-definition white light. So
this is what a biopsy forcep looks like, if you can open that, see it opens and
closes, opens, closes, and we can just advance that through the working channel
of the scope, and it goes through the entire length of the scope and pulls out
the polyp and removes it. We also have the snares, the loops that likewise go
through, and just cut the polyp. When the polyps are removed the patient does not
feel it at all, which is a good thing. The only pain that the colon feels is stretch. That’s why we take a lot of care in not using room air. We use CO2. We use water,
warm water, so that the patient doesn’t feel uncomfortable with the stretch. Are
you feeling uncomfortable? [Dr. Albers] No, I feel perfect, it’s amazing. [Dr. Chang] Now the other thing you see over on the right side of the screen, here and there you’ll see these little blue hands,
and that was the endocuff we talked about that we put on the tip of the scope so as
we … let me see if I can demonstrate that for you. As we slide by these large folds,
you see the purple hands there? The right side? See how they’re pushing the
folds aside and allowing me to see behind the folds so that the polyps that are on
the other side will be revealed. So we have some helping hands inside the colon. [Dr. Albers] We’re doing a lot of research here at UC Irvine using these adjunctive tools including the endocuff and it has shown
significant improvement in detection of polyps in men and women and especially in
the right colon we have the folds that are deeper and the flatter polyps tend to hide
behind folds. [Dr. Chang] I think we have a polyp here. [Dr. Albers] We got lucky. Everything is relative, I guess, but … [Dr. Chang] So this is a small, flat polyp. It’s
maybe two to three millimeters. And let’s pinch using the biopsy forceps. It’s a
small polyp so this should, with one of two bites we should be able to remove that
safely. [Dr. Albers] There are no pain receptors on the inner parts of the colon so I’m not even feeling anything when Dr. Chang takes that off. [Dr. Chang] So it slid back a little bit just by
peristalsis. [Marci] Where are you roughly in the colon? [Dr. Chang] We’re near the hepatic flexure, so it’s the right side of the colon just under the liver. So again, it was a small
two-millimeter polyp, we just need to re-localize it since with a little
peristalsis, the scope got pushed further downstream. [Marci] After we catch this polyp, we’re going to talk about how you prepare for a colonoscopy okay? [Dr. Albers] Sounds great. [Marci] Let’s get this first. [Dr. Chang] Great. You took some … what did you take last night? [Dr. Albers] Well I took … I actually donated one of my kidneys to my wife a few years ago I only have one kidney, and because of that,
I wanted to be extra safe so I took four liters of the bowel prep, the jug prep so
to speak, called GoLYTELY, probably the most misnamed medication in history. But
that being said, I took half last night and then half at around three or four this
morning, and the splitting of the dose really makes a big difference. I know
there’s some specs of gold in there and I’m not sure what that is, to be honest
with you, but, for the most part it really makes a much, much better difference if
you split dose the bowel prep. So I did use about four liters of GoLYTELY bowel
prep but there are other options for patients. Anything including a lower
volume bowel prep. One called Suprep, to MoviPrep. Some
people a lot of patients like a Miralax prep where it’s mixed with Gatorade. But I
wanted to take the safest one possible for my kidneys. [Marci] And the idea is to induce a lot of
diarrhea? [Dr. Albers] Right. All about prep. Got to get rid of all the stool, so I go on a clinical diet the day before the procedure, although
we’re doing research here at UC Irvine with Dr. Samarasena as a lead
researcher, actually one of my colleagues, showing that actually a low residual bowel
prep can lead to just as good a cleansing. Thus, I think in the future, we may be able
to even forego the clinical diet the day before. [Marci] And eat what? Some low-residue … [Dr. Albers] Low-residual diet, right. [Marci] Which would be like white bread [Dr. Albers] bread, bagels. So things like that, yeah. [Marci] So it’s not quite the deprivation the day before, making the patient a little bit more comfortable and and maybe a little less reluctant to undergo the colonoscopy. And the bowel prep is really important because … What happens if you don’t have a good bowel prep? [Dr. Albers] Yeah, if you don’t have a good bowel prep, you obviously can’t see around. You can’t see well. Polyps may be hidden by stool. We can actually clean the bowel as we can see here, so if there’s some small little
residual parts, we can actually clean very easily. But if it’s coated with a large
amount of stool, it’s very difficult to see so it really is important for the
patient to do a really good job of the bowel prep. I did my very best, and I think
I would actually grade myself as having a grade … we use a Boston Bowel Prep Score and I would give myself ‘three.’ Not that I’m biased, but … [Marci] And what’s the highest score? [Dr. Albers] Three. [Marci] And are we back to the polyp? [Dr. Chang] Yeah, so we went all the way back up so as I come back the second time, I don’t want to miss it. It’s a bit of a needle in the
haystack. It’s only two millimeters in size, so we’re going to carefully all eyes,
we have eight pairs of eyes here we’re going to find that little two-millimeter
polyp. So on the first time that we saw it was … Oh here it is. [Dr. Albers] There it is. And you can see how the endocuff makes a big difference in how it helps to hold back those folds. [Dr. Chang] Alright, open. [Dr. Albers] Beautiful. [Dr. Chang] Close. We just glanced it. But that helps to mark it as well. [Marci] You didn’t feel anything then? [Dr. Albers] No, not at all. [Dr. Chang] Close. So everything is magnified so you see a little bit of bleeding there, but with a little bit of lavage and time, the
bleeding spontaneously stops. And Dr. Albers did not feel this at all. [Marci] And now what happens to that tissue that you just removed? [Dr. Chang] So that polyp that was safely removed goes to Pathology. They then create a pathology slide and it’s a two to
three-day process to create a slide and look under the microscope, look at the
cells to determine what kind of polyp this may be. There are three kinds of polyps. A
hyperplastic polyp, which is benign and not pre-cancerous, the adenomas polyp
which is benign and precancerous, and then there’s the sessile serrated adenoma,
which is benign but revved up towards cancerous. [Marci] And how long does it take for each type of those polyps to develop into a cancer? [Dr. Chang] Into a cancer? So a polyp of this size, if we had not removed it, 10 to 15 years could become a cancer. Not all polyps become cancers, but almost all cancers came from polyps. [Dr. Albers] The so-called flatter, sessile serrated
polyps typically can have a timeline of two to five years to develop into cancer, so
they’re really important. [Dr. Chang] Here you can see that the bleeding has stopped and then I can safely come back. i don’t need to suture it, I don’t need to
close it. Only very, very large polyps do we need to actually close the wound, and
this is a simple biopsy so we’re safe. [Marci] We have some more Twitter questions here. Dr. Albers, will you feel any discomfort after this colonoscopy? [Dr. Albers] I anticipate none at all. With the CO2, I’m probably not going to pass much gas at all and I anticipate going about my day
regularly. I drove myself here and I’m going to drive myself home, and do a little bit of work
afterwards, but I anticipate no discomfort, no problems, no issues
whatsoever. [Dr. Albers] Now if you were under sedation, things would be a little different for you today. [Dr. Albers] Yeah. If I was under sedation I would actually be getting a ride home and I would have a recovery time of at least a
half hour, just to make sure everything is looking good and my vital signs are stable
before going home with a driver. And we also tell patients not to drive for at
least 24 hours after the procedure and not to make any important decisions like
buying a house or something like that just in case of the sedation. [Marci] I have another question here. Why don’t you take this one, Dr. Chang. I hope I pronounce this right. I had a erythematous
mucosa in the rectum, what does this mean and how is it treated? [Dr. Chang] Erythematous mucosa is non-specific. It just means a little bit red on endoscopy, and sometimes a little bit red could be
inflammation or it could be something of concern, so we would typically biopsy that,
and if the biopsy is reassuring that there’s no concern for polyp tissue and no
diagnosis of inflammatory bowel disease, then it could be some irritation. Sometimes
even the prep itself could irritate. So we’re just going slowly back, our purple
hands are moving the folds so that we can see behind them. Oh, I think … No, no see? That was a fake out. That was a mucous ball that pretended to be a polyp but we were
able to move that along with just lavaging it. [Dr. Albers] Dr. Chang, can you tell what type of polyps they are by just looking at them? [Dr. Chang] You know we, with the advancing technology, we’re getting closer and closer to about a 90 percent predictive even
without removal. We’re not quite there yet, not quite ready for prime time
using imaging only, so currently the standard of practice is to remove the
polyp. But there’s a lot of intense research that we’re doing here as well so
that we can diagnose these polyps with a virtual biopsy or by imaging technology. [Marci] Dr. Albers, I know you have a phrase
that you like, PT3 about the marks of a good colonoscopy. Can you briefly explain that? [Dr. Albers] Yeah I say PT3 is cancer free, or PT3 is a mark of a good colonoscopy. Really right now, we really … it’s quality. Because a
colonoscopy by itself is good, but we want quality colonoscopy, and that really is kind of a marriage of good bowel prep on the patient’s part and then on the physician’s
part, it’s times. Dr. Chang talked about, we like at least six to eight minutes
during the withdrawal time, we’re way over that for sure so we’re fine there, but also it’s
technique of withdrawal, it’s using a good technique to look around, look at all the
corners, look around the folds, maybe double backing on oneself to look at it.
So it’s not just time, but it’s technique. And finally the other T, it’s time,
technique and technology. And the technology we’re using today is the
endocuff to help us out to see us around the corner so I think these adjunctive
technologic advances are going to help us to actually see polyps better and narrow-band imaging. So technique includes double or triple looks in the right colon, sometimes retroflexion in the right colon, use of carbon dioxide and underwater colonoscopy. But also the whole issues of using narrow-band imaging and
the endocuff have really enhanced our visualization for flat, and especially flat
polyps in the right colon. So PT3, is cancer free. It’s kind of a little thing I
put together and I think it’s one of my fellows so I have to give her credit, but
I think it’s a very valid marriage of technology and effort, because we have to
work as a team. Both patients, I guess myself now, and Dr. Chang as the physician
and the nursing staff. [Marci] And when you’re doing a colonoscopy you’re not just looking for polyps, what else do you look for during a colonoscopy,
Dr. Chang? [Dr. Chang] Yeah so the common findings other than polyps would include diverticulosis. This is the outpouches that are caused by weakening of the muscle. The colon is a muscular tube, and as we get older, our
muscles atrophy. So a part of aging is the formation of these diverticulum or
diverticulosis, when we have many of them. So we make note of that. Dr. Albers does
not have any diverticulosis, so he’s got a young colon. And then we also look for
hemorrhoids. Hemorrhoids are right at the exit point in the anal canal, so they can
cause itching and bleeding and prolapse so we assess the size and presence of
hemorrhoids. And we also look for these, what we call arteriovenous malformations. These are the tufts of blood vessels that can sometimes pop up to the surface. For
example here are some blood vessels and we turn on narrow-band imaging and we can see these blood vessels, but that’s normal. With AVMs, these blood vessels engorge and pop to the surface and they can bleed so we make a note of that, and if the patient
has a history of bleeding we can simply coagulate them during the colonoscopy. So
there are other things we can detect. Also signs of inflammation. Patients with
diarrhea may have different forms of inflammatory bowel disease, and we can
make note of that and also take biopsies to confirm that. Did I miss anything, Greg? [Dr. Albers] No, well I mean even patients with normal colonoscopies and some patients with diarrhea, we take biopsies looking for
microscopic colitis too. So the scope has the ability to see everything, and it’s our
ability to interpret what we’re finding and seeing, plus the ability to take
biopsies and take out polyps. So I think the key is that we’ve seen a decline in
colon cancer especially over the past 10 years of almost a half million people, and
that’s because of colonoscopy and polyp removal. So what we’re really doing is,
it’s not just cancer protection, we call it colon cancer screening, but it’s really
colon cancer prevention that we’re doing right now, and I wanted to emphasize that.
This is, you know, yes that polyp may or may not have developed into cancer in the future,
but taking it out, it’s gone and I’ll have to come back at some point in the future,
generally in maybe five years, if it comes back as adenoma. But the key is that polyp
removal equals cancer prevention and that’s a principle used. [Dr. Chang] Here at UCI CDDC, we’re passionate about
this, and one of our stated, we have three stated vision goals, and one is to create a
colon cancer free Orange County. Which is hypothetically possible … if everyone who
should be screened is and everyone gets a quality colonoscopy, we can significantly
reduce the deaths related to colon cancer. And a major landmark article in 2012
showed that colonoscopy not only decreases colon cancer, which makes sense because
you remove the precancerous polyps, but they actually confirmed that it decreases
death from colon cancer, so we’re actually decreasing death and extending life here
in Orange County. [Dr. Albers] So across the United States, I think
right now, about 60 to 65 percent of people participate or are up to date in colon cancer
screening in one form or another. Maybe about 30 percent of people have not participated
for one reason or another, and that’s one reason why we’re here today is to
demystify and show people that this is a straightforward procedure that anyone can
undergo, and to enter into that screening process. There are opportunities that
really prevent even more cancers in the future. [Dr. Chang] Does this mean next time you’re going to do mine? [Dr. Albers] I think so, yeah. It’s payback. [Dr. Chang] I’ve already had two. I’m a little older than that guy over there. [Marci] Colonoscopy obviously is a major way to prevent colon cancer, are there other things people should be doing to prevent
colon cancer? [Dr. Albers] Well I always kind of, one way to think
about it is that colon cancers are related to certain things that we can change and
certain things we can’t change. So the age is a factor, family history is a major
contributing factor. Some patients have a family genetic syndrome where there is a
single gene disorder so seeing a geneticist for some high, high risk
families is an essential part of it. There are certain things that we can do as
patients and myself, and I usually kind of think of it as what we can do to prevent heart
disease we can do to prevent colon cancer. So things like maybe a high-fiber diet might
be a potential benefit, a low red meat diet, exercise, not being sedentary, fruits and
vegetables, probably beneficial, fish, omega-3 fatty acids might be beneficial
and even red wine might be, have shown in grapes, and there’s resveratrol in it. So
there’s a number of factors that might be potentially useful. They’ve done a lot of
research here at UC Irvine about chemoprevention, and it’s ongoing currently
right now as well too. Baby aspirin, of note, does help prevent colon cancer. [Dr. Chang] I know you’re going to be really sad, but our journey is over, we’re back in the rectum and we’ve completed the colonoscopy, but we can certainly continue to talk. [Dr. Albers] Sure. Or get Tweets. [Marci] Let’s see. I’m trying to see if we have any other questions here. What about Lynch syndrome? I’ve heard about Lynch syndrome, how does that figure into colon cancer? [Dr. Albers] Lynch syndrome accounts for about two to three percent of all cancers and that’s a syndrome where patients inherit, if you
will, one hit in a gene that might contribute to the risk of cancer. So over
time, that patient develops another mutation in the same gene on the opposite
chromosome and that accelerates the patient developing polyps.
Those polyps have what’s called DNA mismatch repair, so they don’t repair the
DNA, and they can develop cancer at a very rapid age. So those patients and those
families can undergo genetic testing and can actually find the gene for it, and
those patients who have the gene can undergo surveillance colonoscopies
beginning at the age of 20 or 25, much earlier, and they’re also at other risks
for uterine cancer, sometimes kidney cancer, and stomach cancer, small bowel
cancer. So those patients need to be a part of a very progressive, comprehensive
screening program. [Marci] Early stages of colon cancer really
doesn’t give the person any symptoms, is that correct? [Dr. Chang] That’s right. So we, in terms of specific
symptoms that would alarm the patient to colon cancer, they’re quite nonspecific.
One of the most common ways a patient presents is unexplained anemia,
meaning that suddenly their hemoglobin instead of being 13 or 14, which is normal,
is now 9 or 10, and their doctors may say, “Oh you’ve got low iron.” That is a red
flag for colon cancer. My own father’s story is just that. He had anemia, he had
iron deficiency, and what did his doctor do on the east coast? Gave him iron. So I
said, “Dad, here’s the airplane ticket, come to California and we’ll do your
colonoscopy.” That was 10 years ago, Dad is a colon cancer survivor, but he had
advanced colon cancer, he had surgery and chemotherapy, fortunately, it’s a blessing
that he’s alive and that’s what propelled me to get into this field because there’s
a lot of work to be done in preventing the spread of disease. So anemia that’s
unexplained to me is colon cancer until proven otherwise, certainly if there’s
blood in the stool, constipation and diarrhea can be symptoms but that’s so
non-specific, unexplained weight loss that’s also rather non-specific. So really
the vast, vast majority of folks if you want to prevent colon cancer just come at
age 50 to be screened and that should take care of things. [Dr. Albers] The other thing is know your risk I
think, talk with the doctors if there’s a family history, certainly start earlier,
African Americans start at age 45 and it’s also important to recognize some of the
signs of colon cancer. We’re seeing a decline of colon cancer across the board,
in patients 50 to 60 to 70, but we’re actually seeing a rise in younger patients
under the age of 50, so we’re actually seeing a rise, we’re not sure exactly why.
So we really have to be alert for symptoms. We can’t just say, “Oh, I’m 35,
I can’t get colon cancer,” because that’s just not true. Rectal cancer in men,
especially, so we have to be very concerned. [Dr. Chang] Our faculty are really working hard to
get this kind of risk information out to Orange County community. One of our
faculty, Dr. Bill Karnes, is heading up the Atlas Program and that’s just about to
launch. We’ve been years in preparation with various grant awards and so on. So
the idea is, on a simple iPad in a doctor’s office or on a website, you can just
answer a few simple questions and it will tell you your individualized risk for
developing colon cancer. If you were to do that and your risk was 12 percent, I think you
would get yourself in for a colonoscopy. So that community knowledge and awareness
is critically important, and we’re passionate about getting that out there. [Dr. Albers] I think that UC Irvine is, I’ve been
here for 15 years, and I’ve really seen the passion and the commitment at all levels
from our GI department, my GI colleagues, our researchers in regards to colon
cancer, risk assessment, genetics, colon cancer treatment. We have one of the top
surgical colorectal surgical teams in the world, in my opinion. And the oncology
team, we work together under Dr. Chang’s leadership under the CDDC, so it’s a
comprehensive approach to colon cancer. What we really want to do is to reach out
to community physicians and to get the patients of the community, because we’re
all in this together. To be honest with you. I got my polyp taken out, I’m taken
care of, but I feel well, I’m perfectly fine now. We really want to get the word
out to other people to participate and get checked. [Marci] One more quick Twitter question, how long, in
feet, is the journey through the colon? [Dr. Chang] So the colon is five to six feet long
and as we talked about, we went in reverse, the journey. So we started down
in the rectum and went up the left side, reached the spleen, right under the
spleen, went across the abdomen, went right under the liver and then went down
towards the appendix. So that entire journey is five to six feet in length.
Typically, it takes about 20, 30 minutes, we took a little bit longer since we were
babbling, and depending on how many polyps we remove and so on, it could take a
little bit longer. But in general it’s a very well-tolerated procedure and we’re
trying to remove the stigma of “You’re going to put what up my what?” [Marci] Okay, so this concludes our live stream
of a colonoscopy from the UC Irvine Health H.H. Chao Comprehensive Digestive Disease
Center. I want to thank the doctors and the staff involved. Dr. Chang, thank you
very much. Especially Dr. Albers, thank you. Did you have any other things, last
words you wanted to say before we signed off here? [Dr. Chang] Get your colonoscopy. [Dr. Albers] Get checked, know your risk. Thank you for participating. [Dr. Chang] And if you’re young, think about your parents and your loved ones and just prompt them to get their colon screened.
We have fantastic gastroenterologists throughout Orange County there’s no reason why people
shouldn’t get screened and unfortunately now only half the people who should get
screened are actually getting screened. [Dr. Albers] And we really want, there’s a new dictum
for the United States, it’s “80 by 18.” So by 2018, we really want to get at least 80 percent
of people who are at risk for cancer to be screened, now we here in Orange County, we
want to be 100 percent, we want to be cancer-free here in Orange County. United States, we
want to be at least 80 percent. Let’s be a leader in Orange County and work together. [Marci] And we invite you to continue this
conversation with your family and friends and on Twitter, you can continue to send
your tweets to #UCIHealthChat. This can be viewed again, we’re going to put this
up on our YouTube channel, and that address is
Thank you very much for joining us this morning and have a good day. So long. [Dr. Albers] Thank you, everybody. Thank you.

Leave a Reply

Your email address will not be published. Required fields are marked *