Published on March 24, 2022

45 Is the New 50

A look at colorectal health

Colorectal cancer is the third-leading cause of cancer-related deaths in men and women in the United States, and experts now recommend getting screened starting at age 45. 

Daniela Contreras, host: When it comes to colorectal cancer, 45 is the new 50. Colorectal cancer is the third-leading cause of cancer-related deaths in men and women in the United States, and experts now recommend getting screened starting at age 45. Why? Because this common cancer is being seen in younger adults more often.

Hello, everyone, I’m Daniela Contreras. I’m here with gastroenterologist Frank Cheng to talk about this topic in honor of National Colorectal Cancer Awareness Month.

Dr. Cheng, thank you so much for being here today.

Frank Cheng, Gastroenterologist: Thank you for inviting me.

DC: Dr. Cheng, what is colorectal cancer and how common is it?

FC: Colorectal cancer is when the cells in your colon or rectum grow abnormally and out of control. Colorectal cancer is the third-most common cancer in the United States in both men and women.

There’s a new study in 2020 that estimates about 147,950 new cases that have been diagnosed and 53,200 individuals that would have died from this disease.

DC: So it’s very common. And what are some of the risk factors?

FC: The most common risk factor will be having a personal history of polyps or colon cancer, family history of polyps and colon cancer, having inflammatory bowel disease — which is a chronic inflammatory bowel disease of your colon or your small intestine — and finally, having a familial genetic cancer syndrome that can happen from generation to generation of having cancers in your family.

Now, in terms of lifestyle risk factors, those are not as directly impactful. But there’s some association with colon cancer and that includes eating red processed meats, drinking excessive alcohol, smoking excessively, and finally having obesity and leading an unhealthy lifestyle.

DC: Can you explain to us what are polyps?

FC: Polyps are growth in your colon or rectum. That is when the cells have grown abnormally and are growing uncontrollably.

DC: Do they hurt?

FC: No, they don’t. They don’t hurt. They are a precursor to colon cancer. So polyps are what we detect during the colonoscopy to remove. And that way we prevent the polyps to grow into cancer.

DC: What are some of the symptoms that people experience when they have colon cancer?

FC: Some of the symptoms that patients can experience include having blood in their stools, blood in the toilet paper or blood on the toilet bowl, a change in their bowel habits and having unintentional weight loss, having anemia.

DC: Are there any instances where there are no symptoms?

FC: Most often there are symptoms. But those are the most common symptoms to be looking out for.

DC: And what can people do to prevent having colorectal cancer or getting colorectal cancer?

FC: First and foremost, patients and people need to screen, go through the screening process. There are also those risk factors we talked about earlier: eating more healthy, eating vegetables and fruits, avoiding red processed meat, avoiding drinking and smoking excessively, and finally needing to exercise at least 30 to 45 minutes a day.

DC: And what are some of the screening options that people have?

FC: The gold standard for screening currently is going to be the colonoscopy, where it not only detects the polyps, but we’re able to remove the polyps at the same time during the procedure. There’s also stool-based studies to include a co-fecal blood test, fecal immunochemical tests, the Cologuard, the virtual colonoscopy CT scan and finally a shortened version of the colonoscopy, where we look at the left colon with a flexible sigmoidoscopy.

DC: Dr. Cheng, some people might be afraid of a colonoscopy. Can you tell us, what’s the process like and what is the prep like?

FC: Well, there are quite a few different bowel preps. The most common bowel prep that we have is called the Golytely. It’s a gallon, and the patient would take it early in the evening, half of it, and the other half 4 hours before the procedure.

They show up to the procedure after their Golytely bowel prep, and they are accompanied by an escort, a loved one, a sibling. And from there, we discuss the risk factors, and I’ll tell them the benefits of a colonoscopy. It typically takes me 30 minutes, but oftentimes my patients tell me, “Have we started this procedure yet?” And I would have said, “We’ve already finished already.”

DC: Wow, so it’s very fast.

FC: It’s a very fast exam. The hardest part is just drinking the bowel prep and making sure you’re clear.

DC: Some people might be embarrassed to come to the doctor. What advice do you give them?

FC: I would advise that talk to someone that you feel comfortable with: your family, your sibling, a friend, a health care provider that you trust or come into our office in the gastrointestinal department, and we can go over the screening options.

There’s nothing to lose for you to come in to talk to us and try to prevent this disease early on so we can detect it and treat it.

DC: Is 45 the new age recommended for getting screened or what is the recommended age?

FC: Yes, over the past two decades, colorectal cancer has increased, and we have been able to detect them before the age of 50.

So the American Cancer Society has recommended the new diagnosis age to be 45, which is the new 50 to start screening.

DC: Once someone is diagnosed with colorectal cancer, what are some of their treatment options?

FC: So before we’re able to talk about treatment options, we want to make sure that the diagnosis is a correct one. We need to do the colonoscopy, do the biopsies and send it to the pathology, confirm it.

And then we go into the staging process, where typically we would do imaging, CT scan to see if there’s any involvement in other organs. And then finally, once that happens, we defer to a multidisciplinary cancer team, which includes a medical oncologist, a surgical oncologist, as well as a colorectal surgeon, and depending on the staging of the cancer, that’s when they go ahead and decide whether surgery alone is enough to treat the cancer or chemo radiation needs to be added to the treatment plan.

And once the cancer gets taken care of, then they come back to us where we do surveillance of the cancer to make sure it doesn’t come back via colonoscopy.

DC: Dr. Cheng, is there anything else that you would like to add or tell our viewers that I didn’t ask you?

FC: Yes, out of 4,500 hospitals, Enloe has been ranked the top 100, according to Healthgrades in the last three years.

In addition, we’ve also been recognized by the American Society for Gastrointestinal Endoscopy as a unit for excelling. All our providers have been batting at the national rate or higher in detecting and removing polyps for patients during a colonoscopy. Colorectal cancer is a very preventable and beatable disease.

So I would advise patients don’t be embarrassed. Come in, come and see us, so we can talk about all the screening options and tailor the treatment accordingly.

DC: Thanks again for being here, Dr. Cheng, and thank you so much for watching. If you want to learn more about colorectal cancer and hear the inspiring story of an Enloe patient who faced this condition and is thriving today, check out Enloe’s podcast, Health Matters. We’ve placed a link to it in the comments field. Goodbye for now.