Ask the Experts: Colorectal Cancer
Watch our Facebook live Q&A (August 3, 2021) with colorectal surgeons,
a cancer nurse navigator, and American Cancer Society representative.
The transcript is below the video.
Emily Thurston: Good evening, welcome to this ask the expert event focused on colorectal
cancer tonight, a panel of experts will share helpful information about
color rectal cancer screening diagnosis and treatment.
We will also answer your questions live to submit a question for our panel
simply drop it in the chat here on Facebook let's meet our panelists
first we have
Dr. Kiyana Baldwin Young a general surgeon and colorectal specialist with Mary Washington General Surgery.
Also, from Mary Washington General Surgery, we have
Dr. Daniel Geisler. Dr. Geisler is a general surgeon, colorectal specialist and board-certified
colorectal surgeon. Both surgeons are fellowship trained in minimally
invasive colorectal surgery.
Next, we have
Tiffany Farrell, cancer nurse navigator from the Mary Washington Healthcare Regional Cancer
Center. And finally, we have Juanita Thompson, Cancer Control Strategic
Partnerships Manager for the American Cancer Society. She's also a
member of the Virginia Colorectal Cancer Roundtable. Welcome and thanks
for joining us this evening.
Dr. Baldwin Young, I’d like to start the program with you this evening
by telling our viewers a little bit about colorectal cancer, what is it
and why a screening for colon and rectal cancer is so important.
Dr. Baldwin Young: Colorectal cancer is a disease, where cells inside of the colon and rectum,
also known as the large intestine, grow abnormally. Most of the time colorectal
cancers are diagnosed using colonoscopies. A colonoscopy is a test where
a scope or tube that's flexible and long that has a light and a camera
in it is used to look inside of the large intestine.
As the colonoscope goes through the large intestine, if any abnormalities
are encountered, then those abnormalities are either removed or biopsied.
A biopsy is when a small piece of the tissue is removed and that tissue
is sent to a pathologist, which is a doctor that looks at it under a microscope
to tell us what that tissue is.
Colonoscopies can be used as a screening test a screening test is used
to look for a disease, a person doesn't have symptoms from yet. All
colorectal cancers come from polyps. Polyps are small masses that typically
don't cause any symptoms and most of the time are not cancerous. During
a colonoscopy if a polyp is removed you're actually preventing colon
cancer. You're not giving that polyp the chance to turn into cancer.
In addition to polyps you might even find cancers early. This is really
important, because if a cancer is found early, then we can treat it early
and have a better chance for curing that cancer.
When we wait for cancers to cause some to cause symptoms, then by that
point the cancer has probably progressed. Most colorectal cancers don't
cause any symptoms.
With a screening test, there are certain indications to do a screening
colonoscopy, the most important is age, so the current age that we recommend
starting screening colonoscopy is the age of 45. This is a relatively
new change. We used to recommend starting screening colonoscopies at the
age of 50 but we've noticed that more and more younger people are
being diagnosed with colorectal cancers and polyps. You may have to talk
to your gastroenterologist or your colorectal surgeon about what is your
out-of-pocket costs, because not all insurance companies are covering
the cost of colonoscopies at the age of 45. But more and more insurance
companies are jumping on board with this new age recommendation.
There are other indications to proceed with the screening colonoscopy,
but these are for people who are at higher risk of developing colorectal
cancer, such as people with family histories of colorectal cancers and
certain types of polyps, family histories of hereditary syndromes that
are associated with colorectal cancer, personal histories of polyps or
colorectal cancer or inflammatory bowel disease like Crohn's disease
and ulcerative colitis.
Now that's for screening colonoscopy, but we can also use colonoscopies
for diagnosis. We diagnose people with colonoscopies when they're
already complaining of symptoms. I already mentioned that a lot of colorectal
cancers, especially in the early stages, do not cause any symptoms, but
if colorectal cancer causes symptoms, someone may notice a change in their
bowel movements. That might mean constipation or diarrhea.
Someone may even notice a more narrowing or thinner stools like the size
of the pencil. They may notice blood from their rectum or blood in the
stool. A lot of people think that bright red blood from their rectum means
they must have hemorrhoids. That's possible but it's also possible
that blood, even bright red blood, from the rectum or stool could be from cancer.
There are other symptoms that colorectal cancer can cause like abdominal
pain, bloating, nausea, vomiting, anemia, fatigue, or unexplained weight
loss. So if you're experiencing any of these symptoms, or you meet
any of the indications, you should most definitely talk to your primary
care doctor if you don't have a gastroenterologist or colorectal surgeon.
And this is really important, because up to two-thirds of people who died
from colorectal cancer, their deaths could have been prevented if only
they had gotten a colonoscopy on time.
A lot of people also ask, is there anything they can personally do to decrease
the risk of developing colorectal cancer, other than getting a colonoscopy
on time. Well, there are certain things that put you at increased risk
for developing colorectal cancer like being overweight, living a sedentary
lifestyle meaning having decreased activity, smoking, drinking a moderate
to high amount of alcohol, or eating a diet that's high in red meat
or processed meats, such as hot dogs and lunch meats. So if you want to
decrease your risk in these areas, you can lose weight, exercise—we
recommend exercising for 30 minutes at least three times a week—stop
smoking, decrease your alcohol intake, and eat a high fiber diet, a diet
high in fruits and vegetables and multi grains and try to limit bread
and meat and processed meats to no more than two to three times a week.
The other risk factors that increase your risk of colorectal cancer are
things that you can't change like getting older, or having a family
member that had colon cancer, or having other medical problems like inflammatory
Emily Thurston: Thank you, Dr. Baldwin Young, that's great information. I want to go
back to something that you touched on with regard to getting those screenings
and catching cancer early. So, in the event that someone has put off getting
a colonoscopy, they might be at a different stage, they might have had
one of those polyps develop into cancer.
Can you talk with our audience a little bit about the different stages
of colon and rectal cancer and how they might be treated differently.
Dr. Baldwin Young: Absolutely. So colorectal cancer goes from Stage I to Stage IV. Stage I
is the earliest stage and Stage IV is the most progressive stage or furthest
stage. There are three factors that we look at when we're considering
the stage for colorectal cancer. We look at the extent of the tumor so
we look at how many layers through the wall of the colon has the tumor
grown or invaded.
We also look at the number of lymph nodes that are involved, if any are
involved. Lymph nodes are small glands that are throughout our body, including
around our intestine. And it's one of the first places that colorectal
cancer can travel to. And the last thing we look at are metastases. Has
the cancer spread to other parts of the body, particularly other organs.
Two of the most common places that colorectal cancer spreads to is to
the liver and to the lungs.
So when we look at these different factors, we’re able to calculate
someone’s stage, which also helps us calculate their survival rate,
their five year survival rate.
So Karen, if you could pull up the graph showing the survival rate for
the various stages. You can see that Stage I has a 90% five-year survival
rate, whereas Stage IV has a 10% or less survival rate. This goes back
to the earlier point that the faster you find cancer and treat it, the
better chance you have a cure. This also goes towards, what do we recommend
as far as treatment.
So the goal of surgery is to remove all of the cancer as best possible.
In the earlier stages, the cancer is localized and it's easier to
remove all of the cancer, so we usually don't recommend any other
treatments. Whereas some people with stage II cancer and many people with
Stage III cancer, as the cancer has progressed, it's going to be more
difficult to cure them with surgery alone, so we often recommend treating
them with chemotherapy and/or radiation.
These are other treatments that are used to kill cancer cells in the body
that may be left behind, despite surgery. Now, by the time we get to Stage
IV colorectal cancer, the cancer has already spread to other organs, so
it's more difficult to remove all of the cancer from the body.
So, in those cases in fact surgery may not even be beneficial, and we would
recommend possibly just treating with chemotherapy and/or radiation alone.
Unfortunately, in those cases there are cases that we can't necessarily
cure the patient.
Emily Thurston: Thank you, Dr. Baldwin Young. Dr. Geisler, we've been talking about
colorectal cancer as kind of one word to describe these types of cancers,
but how do rectal cancers differ from colon cancers?
Dr. Geisler: So the typical colon is about four to six feet long. That's the large
intestine with the last six to eight inches of it being the rectum. The
symptoms of colon cancer versus rectal cancer, sometimes are similar but
oftentimes are quite different. Just as every patient is different, the
cancers are different, as well, and the treatment options for those differ
quite a bit.
With colon cancer we like to stage these the best we can, prior to doing
any surgery, and that oftentimes includes a CAT scan to see if there's
any distant spread. And if there's not then, more often than not,
we opt to proceed with surgery and reserve other therapies, such as chemotherapy,
for the patients with no positive disease.
For rectal cancer, on the other hand, if it's a low enough rectal tumor
we know through the German study that patients actually do better with
radiation and chemotherapy.
I am very flattered to be part of this forum today and I love my new home
and Mary Washington. I feel very strongly about our whole support group.
I think we have some of the best oncologists, definitely some of the best
nurses and nurse navigators for cancer.
With rectal cancer, and if it is a what we describe as a low and unfavorable
cancer, we oftentimes opt for radiation and chemotherapy first. One of
my favorite parts of my job is repeating a scope, with a family member
in the room after they've completed the adjuvant therapy and having
a family member always timidly say, “Is where the tumor was?”
because we get tremendous results with radiation and chemo and not at
the harm of the patient. Radiation and chemotherapy in our field is usually
very, very, very well tolerated, and it does help us fight the battle
and not treat the tumor. That gives us a chance at beating the tumor.
Emily Thurston: Thank you. We’ve talked a little bit about surgery as part of a multi-disciplinary
approach to treating these cancers. Dr. Geisler, can you talk a little
bit about what the recovery from colorectal surgery might look like?
Dr. Geisler: It's phenomenal! As a kid I was hit by a car so I've got an incision
on my belly, a big incision. I've had bowel obstructions; they're
not fun. Dr. Baldwin Young and myself pride ourselves in doing minimally
Unfortunately, in the US, still the majority of these surgeries they're
going through a big incision. And it's quite amazing to see how patients
do when you can minimize the size of the incision and see how quickly
they can bounce back.
Typically, we can work through a one-inch incision with a couple other
small incisions and even do single-incision laparoscopic surgery to where
there's minimal pain. It's still considered major abdominal surgery.
I stress to my patients, it's much bigger than a gallbladder and or
an appendix, that we’re taking out a significant portion of the
intestine, we're putting things back together and that area needs to heal.
Fortunately, in the least invasive ways we can have as good of results,
as any. I’m hopeful that the simple facts of laparoscopy, easy,
quicker recovery, less pain, quicker return home, all of those things
and better cosmetics are just the tip of the iceberg.
There have been several studies showing the 70- and 80-year old patients
are more likely to beat advanced colon cancer if it's done laparoscopically
and that's, for the simple historic fact that when we do open surgery,
those patients are more likely to need rehab or even go to a nursing home.
When we do things laparoscopically it's phenomenal to see these patients
of all ages, especially the elderly patients bounce back, up moving around
saying, “When can I go home?” And they truly do tremendously
well. As far as my new home at Mary Washington and at Stafford Hospital,
I feel blessed that the support staff has been so phenomenal.
I had always told patients, if we do a 3-inch incision, expect five to
nine days in the hospital, six weeks limiting your activity and not lifting
more than 15 pounds. Laparoscopically it's two to four days in the
hospital and I've been in practice elsewhere for about 15 plus years.
I've had more patients go home day two here then throughout the rest
of my career just because of our fast track in the nursing care and getting
the patients up and getting them back to their quality of life, they had
Emily Thurston: That’s outstanding. So even with a serious surgery like this, as
you mentioned, people can experience some great benefits from minimally
invasive procedures, even going home earlier than anticipated.
So you talked a little bit about some of the expectations that a patient
can have from their treatment and specifically surgery, but are there
any other considerations that you'd like our audience to know about
treatment, before, during or after surgery for colorectal cancer?
Dr. Geisler: Yes, I think, patients do best, well-educated patients always do the best,
but also a team approach always facilitates the patient's whole progress,
through the procedure. Again, we will have a cancer navigator talk later,
in my office we do have someone doing genetic counseling for colorectal
cancer patients as well as breast cancer patients, and honestly from all
the big academic places I've worked at, I feel like there is more
individualized patient care and team approach to where we're Tiger
Texting behind the scenes to medical oncologists, radiation oncologists,
nurse navigators and really helping the patients get through this the
best they can.
Emily Thurston: Thank you, Dr. Geisler. Juanita, I’d like to shift gears and chat
with you a little bit about prevalence of these cancer cases. We talked
about the intricacies of screening, treatment, and recovery, but can you
tell us a little bit about how many people are experiencing these cancers
nationally and even in our area?
Juanita Thompson: Absolutely. Colorectal cancer is the third most common cancer in both men
and women in the United States. Routine testing can help prevent colorectal
cancer or find it at an early age, as Dr. Baldwin Young mentioned earlier.
When it’s smaller, it may be easier to treat. And if it's found
early the five-year survival rate is more than 90%. Many more lives could
be saved by understanding colorectal cancer risks, increasing screening
rates, and making lifestyle changes.
Although there is a large population nationwide and here in Virginia that
are affected by colorectal cancer, early detection, we believe that the
American Cancer Society, is key, whether it's access to care through
getting those preventive services, such as various options for screening,
as well as any needs that patients may have around transportation, the
American cancer society is here just to do what we can to help with saving
more lives faster.
Emily Thurston: That's great news, Juanita. Thank you so much for sharing.
Tiffany, you are a cancer nurse navigator with the Mary Washington Healthcare
Regional Cancer Center. Can you tell us a little bit about your role at
the Cancer Center and how you support patients who might be going through
a cancer journey?
Tiffany Farrell: There are four registered nurses that are nurse navigators here, and our
job is to just help patients, kind of guide them through the healthcare
program. Sometimes people just need help knowing what appointment to get
next and who to see, and we can help coordinate all of those.
Many times, we talk to a patient and we already have heard about them from
a couple of different physicians. And we just make sure that they get
what the what they need. We can be here as a general resource for education.
We have a ton of support services here. We have a nutritionist, we have
integrative medicine to help those going through the treatments: massage
and Reiki. We have a financial counselor, we have genetic counseling,
lots of different support groups, we have a licensed therapist here. So
we're just really here just to bring all the resources to the patient.
Emily Thurston: Thank you, Tiffany. I understand that the Mary Washington Healthcare Regional
Cancer Center is accredited by the Commission on Cancer. Can you talk
a little bit about what that means for our patients?
Tiffany Farrell: The Commission on Cancer is that a voluntary accreditation through the
American College of Surgeons. And that's important for people to know,
because it's a voluntary accreditation that our hospital participates
in. We use quality measures, we do improvement projects and goals, and
different community outreaches like this event.
And the whole point is that we hold ourselves to really high standards
to deliver the best patient care.
Emily Thurston: Thank you, Tiffany. Juanita, I’d like to go back to you. Tiffany
mentioned some of the resources that the Mary Washington Healthcare Regional
Cancer Center has available to patients in our community. But I’m
sure that the American Cancer Society has some resources as well. Can
you share those with our audience?
Juanita Thompson: Absolutely, we are very grateful for the partnership that we have with
Mary Washington Healthcare. We are a 24/7 organization and although we
are nationwide, we are represented in every community.
You can call us at two o'clock in the morning and get a live voice.
You can also access anything that you need on our website www.cancer.org.
We can answer questions through our live chat as well as be interactive
for some of our systems such as Reach to Recovery which connects patients
who are undergoing treatment with those in remission.
We have a number of programs that are free and available to anyone that
reaches out to us. This is something that we need importantly for fundraising
because this is what funds our mission, being able to give back to those
in need is something that American Cancer Society has done for a number
of years and we will continue to be the nation's leading organization
because of thoughtful acts like this. Making sure that we reach as many
people as possible, whenever a phone call or something comes through our
website, we want to make sure to make that human connection because being
diagnosed with cancer is not transactional, it is personal.
Emily Thurston: Absolutely. Thank you so much for sharing, Juanita, and I’m sure
a lot of folks in our audience are incredibly grateful for the resources
that our organizations offer.
We have unpacked a lot so far tonight, and we have a lot of questions from
our community, so I think we'll just dive right in. Dr. Baldwin Young,
some of our viewers have seen advertisements for at home colon cancer
screening tests. What advice might you offer someone who's trying
to decide if a test like this is right for them?
Dr. Baldwin Young: So for those in the audience who don't know what the at-home tests
are, they are tests that detects certain DNA markers and blood in the
stool, which could be a sign that there may be polyps or cancer in the
colon or rectum.
These are not the standard or gold standard tests. These aren’t the
tests that we recommend for everyone to do first. The colonoscopy is still
the standard test. That's the test that we recommend first, and this
is mainly because the at-home tests do not detect adenomas which are precancerous
polyps as well as colonoscopies. Additionally, as I mentioned before,
when a colonoscopy is done, abnormalities can be biopsied or removed.
These at-home tests cannot do that, so one because the at-home tests aren't
as good as colonoscopies, they have to be done more often.
So a colonoscopy typically can be done every 10 years if no abnormalities
are found, and more often, depending on what abnormalities are found.
Whereas these at-home tests routinely have to be done every year or every
three years, depending on which test was used.
In addition to that, if an abnormality is found on one of these tests,
you still need to get a colonoscopy to find out exactly where is that
abnormality, to get a biopsy to know what the abnormality is, and then
also to potentially treat that abnormality.
So, again colonoscopies are the go-to tests. However, screening can save
lives. We mentioned before how finding cancer early can save lives and
increase the cure rate or a five-year survival rate. So whatever test
you decide to use to get screened, do that. Don't let the bowel prep
scare you. Don't let your medical problems, which may prevent you
from getting a colonoscopy scare you. Don't let the idea of a tube
going into your digestive tract scare you. There are other options.
If you meet the indications for screening or, if you have symptoms, find
a gastroenterologist, find a colorectal surgeon and discuss your options
with them. Don't just ignore it.
Emily Thurston: Great advice, thank you. Dr. Geisler just to kind of dovetail off some
of the things that Dr. Baldwin Young just mentioned and we’ve talked
about colonoscopies pretty frequently tonight, there is some stigma around
the test, from the prep that Dr. Baldwin Young mentioned to the actual
procedure. So what other words of wisdom or encouragement might you offer
to help nudge someone in the right direction to schedule their colonoscopy?
Dr. Geisler: I try to stress to my patients that it's actually a very easy test.
The knock against it had been the big gallon jug of awfulness that most
of us don't even use anymore. We have various different preps and
they're very easy and do not taste awful, that are not large volume.
We can really tailor preps accordingly to the patient. That had been the
knock against it. Some patients will get a little “ewww” by
the colonoscopy. Many out there may remember when Katie Couric had hers
done on live TV. It did wonders with helping the screening process.
I personally would say there's no better time to get screened than
right now. If you need screening get checked now. If you have advanced
symptoms and you're concerned about things, again no better reasonable
time to get checked than right now.
The procedure itself, you come in that morning, again, I think we have
wonderful, wonderful, wonderful team that assures your comfort, assures
that you're in an area that you're not feeling imposed or anything.
The check in process, the checkout process is very easy.
Most of my patients, if I hear anything afterwards they say, “But
that's it? We're done?”, not knowing we did the procedure.
So it's a very well tolerated procedure with very, very minimal risks.
And again, it is the really gold standard treatment for screening for colorectal
cancer, as well as surveillance and even the treatment and avoiding getting
cancers, by removing polyps.
Emily Thurston: Thank you, I feel very encouraged by that. I might just go sign up for
mine today too. Juanita and Tiffany, I’d like to spend a little
bit of time addressing some questions about how friends and family can
help support someone with colorectal cancer. Juanita, do you have some
quick tips to share with our audience?
Juanita Thompson: Absolutely. When you're able to go on to our website cancer.org, there's
a myriad of information around caregivers. We actually have an exclusive
portfolio, known as the caregiver’s resource guide. In there are
pointers on how to take care for a loved one undergoing treatment or in
We also have great information about where to turn when you're diagnosed
with cancer. There's a lot of great information and pages—loads
of pages—on our cancer.org site, or you can also call and get a
live voice at 800.227.2345 to speak to someone on hand who can help answer
questions, not only for the patient, but also for the caregiver.
Emily Thurston: Thank you, Juanita. Tiffany, from your experience, do you have any other
advice to offer to our community, people who might have friends or family
members going through cancer treatment?
Tiffany Farrell: I would say, send them our way. I talked about all the different resources
that we have, but a big thing would be our support groups, and then we
also have an ostomy resource called
Kenny's Closet that we can tap into to get extra resources for patients.
Emily Thurston: Thanks, Tiffany. Dr. Geisler, for folks who are looking at having colorectal
surgery. For some there's a preconceived notion that they will end
up needing a colostomy. Cn you talk a little bit about that part of treatment
and if a colostomy is something that just happens every time, or are patients
able to mitigate that?
Dr. Geisler: A colostomy is rarely needed, and there's a very, in my mind, a very
select group that needs one. Most cancers can be treated without a colostomy.
For the right side, what I tell my patients is, we take the cancer out,
we put the intestines together, we check to be sure it's air tight.
And if it is, 99% of the time it stays that way, meaning less than 1%
chance it may leak, and they might need a temporary stoma, not a permanent
one, but a temporary one that may be three months or so. For the left
side that goes up to 3%.
Again we're not talking about a permanent stoma. We're talking
about a pretty small percentage. The thing I find very interesting is
the rectal cancer and having spent better part of my career at Cleveland
Clinic, I studied some of their rectal cancer numbers and was pretty surprised
by use of radiation and the chance of needing a permanent colostomy for
rectal cancers. And what we found is a program that I like to use stressing
adjuvant therapy, meaning radiation chemotherapy.
Prior to surgery for rectal cancer, we can have a 93% rate of sphincter
preservation meaning 93% of patients, for these low and challenging rectal
cancers do not need a permanent bag.
The numbers in Cleveland when I was at the clinic were upwards of 40% needed
a permanent bag. It’s quite alarming to see the difference between
seven and 40%. Again that stresses that teamwork, of having the radiation
oncologist, the medical oncologist, and doing everything you can, not
just to treat the patient, but to hopefully beat the cancer and a very
second goal of maintaining a normal quality of life.
Emily Thurston: Thank you for that clarification, Dr. Geisler. Tiffany, you had mentioned
Kenny’s Closet previously and that ties in really well with the
colostomy conversation. Can you talk a little bit about Kenny’s
Closet and and how can Kenny’s Closet supports ostomy patients?
Tiffany Farrell: It's run by volunteers and the supplies are gotten by donations from
the community, supplies that they don't need anymore. And patients
can come here to the Cancer Center once a week. There's a set time
that they can come here and get them, but if that time doesn't work,
we can absolutely get them their supplies at any time.
Emily Thurston: What a what a valuable resource for our community, anybody who has supplies
to give or needs supplies.
We have a lot more questions from our community so let's just keep
right on going. We do have a few people who joined late and are wondering
about the recommended age to start colonoscopies for screening. So we'll
say it again, extra loud for the people in the back, Dr. Baldwin Young,
can you tell us again the recommended age to start screening?
Dr. Baldwin Young: 45! I mentioned earlier that previously, we recommended starting screening
at the age of 50 because the majority of people with colorectal cancers
and polyps were over that age. We're seeing younger and younger people
being diagnosed with colorectal cancer and polyps, so the recommendation
by most of the national societies is 45 now.
I did mention that some insurance companies have not caught on and started
covering the cost of screening colonoscopies at the age of 45, but some
gastroenterologist and colorectal surgeons can push for coverage. So just
go for your appointment to see if you could get a screening colonoscopy
if you are 45 and hopefully we can get you taken care of.
Emily Thurston: Thanks, Dr. Baldwin Young. One more question for you: how does someone
get to the point of having a colonoscopy? Do they need to just call up
their local GI and make an appointment, do they need a referral is the
process difference between someone who is getting a routine screening
versus someone who is maybe getting a diagnostic screening?
Dr. Baldwin Young: So the process can vary. It may start with your primary care doctor. Good
primary care doctors, a lot of primary care doctors will go ahead and
start recommending the screening test when you hit the appropriate age.
As far as being referred for a colonoscopy it doesn't matter if it's
for screening or symptoms, most people will start discussing their symptoms
with their primary care doctor. So again, their primary care doctor could
be the one to refer someone for a diagnostic colonoscopy as well. From
there, if you don't have a primary care doctor or they haven't
mentioned it, and you know you either meet the indications for screening,
whether you’re average risk, age of 45, or high risk—the other
factors that we talked about where you may need a colonoscopy earlier
than 45—or you're having symptoms, if your insurance allows
it just go ahead and make an appointment for a gastroenterologist or colorectal
surgeon, to discuss how you would proceed with a colonoscopy.
And in fact I’ve had plenty of patients come to me if they've
had issues, just to discuss it, even if they're not ready to proceed
with it, and a lot of people understand how important is, so they'll
even pay out of pocket for those visits sometimes if their insurance companies
don't cover it
Emily Thurston: Thank you for that clarification. We do have a question from a member of
our audience who it sounds like they’re going through a rough time.
The question that states that they've been through radiation and chemo
and are in remission, which is good news, but there's constant pain,
including painful urination. So when a patient is experiencing symptoms
like that, who should be their first call?
Dr. Baldwin Young or Dr. Geisler, what feedback might you have for that patient?
Dr. Geisler: So if it's a surgical patient than I think, obviously the surgeon helps
drive the ship in that situation to talk to them about it. In patients
that have received radiation and chemotherapy, it's more often than
not rectal cancer, and we know that radiation does come with a price which
is it can injure some other organs. But oftentimes there are a lot of
things that can be done with that.
As far as any kind of chronic pain, I try to stress to my patients and
their families, no that should not be a new norm, that you need to seek
out people. If you talk with someone who doesn't have the answers,
then find someone else, because there's always something that can
be done to help alleviate the problem.
If they haven't been seen by a surgeon, I’d say that would be
another obvious next step, but also to speak with their oncologist about
different things. An unresectable tumor is one of the worst things we
see, a tumor that's just been left way too long, that can’t
shrink with radiation and chemo.
Again that's where, unfortunately, we have move to pain management
and other people, but there's always something that can be done to
help those patients.
Emily Thurston: Thank you, Dr. Geisler.
Dr. Baldwin Young: And just to add to that, radiation can be quite debilitating at times as
well. This is not the norm for everyone. Like Dr. Geisler mentioned earlier,
every cancer is different, every person is different. But if you have
symptoms from the radiation, reach out to your radiation oncologist. And
sometimes they will refer people to colorectal surgeons, because there
are things that we can offer that the radiation oncologist may not be
able to offer as far as comfort.
Emily Thurston: Thank you. Dr. Baldwin Young we actually have a question coming in that
goes back to some of the signs and symptoms that you were talking about
earlier in our discussion this evening, so the audience member is having
a colonoscopy because they've been suffering from diarrhea for about
a year and they're wondering if they should be overly concerned about
Dr. Baldwin Young: One of my mottos is “Life is hard enough—try not to stress,
if you don't have to.” This is why we do diagnostic tests, so
we can figure out what's going on. There are so many things that can
cause diarrhea: allergies, infections, change in the bacteria in your
colon. So there are a lot of different things that can be causing diarrhea.
Any one of the symptoms that I mentioned does not mean if you have that
symptom, you have cancer. So don't be overly concerned right now.
Get your diagnostic test and hopefully all will be fine and if not, if
you're in the area, at least, you know that you're in a good area
to find care.
Emily Thurston: That's great advice, thank you. Dr. Geisler, we have a question coming
in that again kind of goes back to some of the things you were talking
about earlier about colonoscopies and especially the prep about for colonoscopy.
So our audience is wondering if the pills are as effective as the liquid prep.
Dr. Geisler: The pills work rather well. You do have to drink a pretty large volume
of water with them. I personally use the MiraLAX prep more than anything
else and that's just kind of a tasteless, odorless powder that you
mix into one quart of Gatorade. And honestly, I’ve only had one
problem with that and that's usually in the patients who had the gallon jug.
And they're thinking yuck this is going to taste awful and they start
drinking it, and hey this isn't bad and chug chug chug. So we warn
them, hey take it slow, it's a small amount, you can have other liquids
with it. Spread it out don't drink it too quick but otherwise the
taste is not bad it's small it's one quart.
Dr. Geisler: But yeah I’m fine using the pill prep, I’m fine using most
any prep that a patient has had before. Obviously if they've used
one that they liked and it worked well, no reason not to use that again.
Emily Thurston: Thank you, Dr. Geisler. Another question for you, Dr. Geisler, coming in:
someone is wondering if colorectal cancer is more common in men than women.
Dr. Geisler: Yes, it is slightly more and there's differences across races as well,
and some of that hopefully starting to level off. But we do see a little
higher incidence there, and there's other risk factors obviously between
colon and rectal cancer.
One thing I’d like to comment on, hopefully the stigma of colonoscopy
is gone. I love my patients. I think I’ve learned something from
each and every patient. While being here in Fredericksburg, I had a very
lovely 30-something year old female come in with change in bowel habits.
So you know, we should consider colonoscopy, and we found a golf ball
sized polyp in her. It was pre-cancerous and we removed it, and it came
back with dysplasia. The colonoscopy took care of it.
She in turn talked with her sister, who is in the Denver area, and her
mom, and said listen, you have to go get screened. All three of them had
polyps in the same area that were all dysplastic, so the colonoscopy itself
took care of them.
So, again, I think it underscoring the importance, even if you're having
symptoms, whatever. Back to the question, yes there's changes in incidence
along race and along sexes. There's select patients, and I usually
say I’ve done colonoscopies from the age of eight to the age of
And we see patients with familial polyposis that we know one hundred percent
chance they're going to get cancer early in life and metastatic cancer
unless they get checked and unless they get treated accordingly. So again,
a lot of other factors come into play as well, not just sex and race.
Emily Thurston: Thanks, Dr. Geisler. Along those same lines, Dr. Baldwin Young someone
is wondering if colon and rectal cancers are more prominent in people
who are older.
Dr. Baldwin Young: Absolutely, the older someone is that increases their risk of developing
colorectal cancer. And we start at the age of 45 because the majority
of people are over that age, but as you increase in age, you see an increasing
number of people with colorectal cancer. Another way to put that is of
the people who have colorectal cancer and polyps, most of them are going
to be of older age.
Emily Thurston: Thank you. We do have a question about what exactly is entailed within the
colonoscopy procedure. Dr. Baldwin Young is that something that you can
speak to and then Dr. Geisler, feel free to jump in.
Dr. Baldwin Young: So most often you do a prep the day before the procedure. After a certain
amount of time you can't eat or drink anything, because most often
colonoscopies are done under anesthesia. You come in the day of the procedure,
you meet your team, the nurses, the doctor that's going to be performing
And then, when they bring you into the room, your anesthesiologist will
give you a light anesthesia so that you don't remember anything or
feel anything and then you wake up in the recovery room and are told that
it's done. And then your doctor usually comes in and fills you in
about the findings. While you're asleep the colonoscopy has performed,
and like I mentioned, a long flexible tube with a camera and a light in
it is used to look throughout the large intestine and if any abnormalities
are found, then they're either biopsied or removed.
Emily Thurston: Thank you. Dr. Geisler, do you have anything to add?
Dr. Geisler: Sure yeah, it is a very easy procedure most patients do opt for sedation.
My parents I pushed for years to get their colonoscopies. They both went
together and my dad, of course, asked whose colon was cleaner and the
endoscopist said, well they both were, but your wife didn't use sedative.
That's my crazy mom who, I think, is listening from Dallas, Texas
right now, did her colonoscopy without any sedative. Telling you that,
yes, it is a simple procedure. With that said, most people say yes, I
want the sedative.
With the anesthesia group that we use, they're phenomenal and that
the bounce back is very quick. I have not—knock on wood—had
any complaints from my colonoscopy patients, because it really is a pleasant
procedure. It's very discreet; they have separate rooms for everyone.
And there's usually light-hearted feelings of they see the screen where
the colonoscopy is going to be, and we kid well it's the same TV screen
that's out front for all the viewers out front, which obviously it's
not, but it's just a very easy going and nice, friendly process for
Emily Thurston: Thank you. And we do have a comment from someone in our audience, who was
diagnosed with colorectal cancer at 34 and wants to encourage everybody
within the sound of our voices to be aware of their risk and to not wait
to get screened. So that's great advice all around from not only our
panel of experts here, but also our live audience.
We are coming up at the top of our time this evening, so before we say
goodbye, I just want to invite our panel to share any closing comments
that they may have, Dr. Baldwin Young, we'll start with you.
Dr. Baldwin Young: Get screened, get screened, get screened, number one. Number two, all rectal
bleeding does not come from hemorrhoids. Please come see us if you notice
a change. Or even if you think your bleeding is coming from hemorrhoids
come see us, so we can help you stop it. If you're always bleeding
from hemorrhoids then you will never know if there's something else
that's contributing to the to the bleeding as well. And don't
be afraid of surgery as Dr. Geisler said, we try to make things as smooth,
as easy, as quick, and as safe as possible for our patients.
Emily Thurston: Thank you, Dr. Baldwin Young and Dr. Geisler, we'll head over to you
any closing thoughts for our audience this evening.
Dr. Geisler: I would echo the screening. There's no better time than now, and even
if you're having symptoms and you're thinking oh it's too
late, it's never too late, and there is always something that can
be done. Even for the most advanced cases there's always something
that can be done to make your quality of life tremendously better.
With said and with earlier screening, yes, no one wants to hear that cancer
word, but it is very treatable and most often people do well.
Emily Thurston: Tiffany, do you have some closing thoughts to share with our audience?
Tiffany Farrell: Sure, so you know, obviously [cancer] no one wants to hear that word, but
if you do get diagnosed, we have a great team of navigators here to help
guide you through the process and be here to hold your hand and get you
whatever you need.
Emily Thurston: Thanks Tiffany, and Juanita, any final thoughts to share?
Juanita Thompson: Absolutely, as a proud partner community partner of Mary Washington Healthcare,
the American Cancer Society is here for you. If you are looking for more
information about what has been shared today, especially the wonderful
mantra of get screened, get screened, get screened, we do have information
on cancer.org around the importance of being screened, because now is the time.
I also wanted to share that there are some new guidelines that have been
updated from the United States Preventive Services Taskforce, USPSTF that
echoes a lot of the sentiments that were shared here today around the
age of 45 at average risk, but as has been said today, it is important
that we take control of our health and the American Cancer Society is
here to help.
Emily Thurston: Awesome. That's a solid way to end our program. Thank you so much,
Juanita, and to all of our panelists for sharing your time and expertise.
And of course we send a huge “thank you” to you our viewers
for tuning in to ask the experts.
If you have questions about colorectal cancer or want to learn more about
Mary Washington Healthcare services, we invite you to visit our website
for additional resources. You can find us online at cancer.mwhc.com. And
if you need ostomy supplies, or would like to donate to Kenny's Closet
you'll find those details on your screen and be sure to watch the
Mary Washington Healthcare Facebook page and other social media channels
to stay informed of the latest health and wellness information for our
community. Again, many thanks to you for joining us this evening, please
stay safe and healthy and have a great night.