Colorectal Cancer Archives - Granite Peaks Gastroenterology of Utah

Headlines are misleading. Colorectal cancer screening saves lives!

Posted on October 27, 2022October 26, 2022 by fuelmarketing

You may have recently read or heard that a study published in The New England Journal of Medicine showed that colonoscopy does not reduce colorectal cancer very much and does not reduce death from colorectal cancer.

Not exactly.

As with many things, the details matter. Those details show a very different picture than the headlines suggest.

THE STUDY:

85,000 people living in four countries in Europe
One-third received a letter inviting them to have a colonoscopy, the others received no colorectal cancer screening
Ten years later, colon cancer risk was 18% less in the invited group and there was no difference in colorectal cancer deaths between the groups. This is the typical headline
But… many important details were left out

THE DETAILS:

Less than half (42%) of those invited to have a colonoscopy actually had one
In those who actually had a colonoscopy:
- The risk of developing colorectal cancer decreased by 31%
- The risk of dying from colorectal cancer decreased by 50%

THE BOTTOM LINE:

This study, along with prior studies, shows that colonoscopy decreases your chances of getting and dying from colorectal cancer. Getting sick and dying from colorectal cancer – especially due to delayed screening – is real. Screening with colonoscopy saves lives.

For more information, check out the topics on Colonoscopy and Colorectal Cancer:

gi.org/topics/colorectal-cancer

What is Lynch Syndrome?

Posted on April 2, 2019March 28, 2022 by J. David Schmidt

By J. David Schmidt, MD

Lynch Syndrome is also known as hereditary non-polyposis colorectal cancer. It is the most common cause of inherited colorectal cancer accounting for 3% of all newly diagnosed cases of colorectal cancer and 3% of endometrial cancer. Colorectal cancer is the 2nd leading cause of cancer-related death in the United States.

Lynch Syndrome refers to patients and families with a genetic mutation in one of the DNA mismatch repair (MMR) genes. It is seen in approximately 1 in 279 people in the population. As we age, errors in DNA replication tend to occur more frequently resulting in abnormal genes being produced which produce abnormal function in the body. The role of the DNA mismatch repair system is to maintain correct DNA base pairs and prevent abnormal gene expression that leads to conditions such as cancer. Microsatellite Instability (MSI) is when regions of repetitive DNA sequences fail to be repaired correctly. This is a characteristic of tumors in Lynch Syndrome. However, 15% of sporadic (non-inherited) colorectal cancers demonstrate MSI.

The major clinical manifestation of Lynch Syndrome is colorectal cancer (CRC). Patients with this condition may be asymptomatic or may have worrisome symptoms such as abdominal pain, blood in their stool, or a change in the pattern of their bowel habits. The lifetime risk of colorectal cancer for Lynch Syndrome varies but can be as high as 47%. Colorectal cancer in Lynch syndrome tends to occur at a younger age (45-60 years) compared to sporadic colon cancer (69 years). Patients with Lynch Syndrome are at risk for more than one location of colon cancer developing at the same time (synchronous) and developing colon cancer again after the initial cancer is found and treated (metachronous). Seven percent of patients have more than one cancer at the time of diagnosis. The cancers that develop in Lynch Syndrome tend to occur in a different location in the colon compared to sporadic CRC, the right side of the colon also known as the proximal colon. These polyps tend to be large, flat and more aggressive. In Lynch Syndrome, the time it takes a polyp to develop into cancer is relatively short (35 months) compared to sporadic CRC (10-15 years).

Other Cancer Types Associated with Lynch Syndrome

Lynch Syndrome is also associated with diseases outside of the colon; the most common is endometrial (uterine) cancer. Other cancers that are associated with Lynch Syndrome include ovarian, stomach, small bowel, bile duct, ureter, brain (gliomas) and sweat gland tumors (sebaceous neoplasms). A rare condition called Muir-Torre syndrome is a variant of Lynch Syndrome and is characterized by sebaceous tumors.

Lynch Syndrome Diagnosis

The diagnosis of Lynch Syndrome can be challenging and is therefore often overlooked. Different strategies for identifying individuals at risk for the condition consider family history, prediction models, tumor-based testing (which includes MSI testing), and genetic analysis. The Amsterdam I criteria are frequently used and can be simplified by using the “3-2-1 rule.” Patients at risk for Lynch Syndrome will have 3 or more relatives with Lynch Syndrome-related cancers including a first degree relative, 2 generations are affected by Lynch Syndrome related cancers, and 1 or more cancers were diagnosed before age 50 years. Other systems have been proposed for identifying patients at risk; one is known as the Bethesda guidelines.

Lynch Syndrome should be suspected when a patient meets certain criteria. Those criteria include identifying more than one CRC at the time of diagnosis, identifying a second CRC in the same individual over time, diagnosing CRC at an age less than 50 years, or identifying multiple Lynch Syndrome-related cancers (see above). In order to reach a definitive diagnosis of Lynch Syndrome, an abnormal genetic mutation in the mismatch repair gene (MMR) must be identified.

Individuals who may be candidates for genetic testing include the following:

– All newly diagnosed CRC

– Endometrial (uterine) cancer diagnosed before age 60 years

– First degree relative with known MMR/EPCAM genetic mutation

– Newly diagnosed CRC and an elevated risk based on prediction models

– Family history meeting above Amsterdam-type criteria

This overview of the Lynch Syndrome focuses on what defines the syndrome and who should be considered for additional testing.

If you have questions about your GI health or how hereditary gastrointestinal conditions may play a part in your overall health picture, contact the gastroenterologists at Granite Peaks Gastroenterology in Sandy or Lehi for answers.

Understanding Colon Polyps and Treatment

Posted on March 28, 2017February 14, 2019 by fuelmarketing

By American Society for Gastrointestinal Endoscopy

What Is a Colon Polyp?
Polyps are benign growths (noncancerous tumors or neoplasms) involving the lining of the bowel. They can occur in several locations in the gastrointestinal tract but are most common in the colon. They vary in size from less than a quarter of an inch to several inches in diameter. They look like small bumps growing from the lining of the bowel and protruding into the lumen (bowel cavity). They sometimes grow on a “stalk” and look like mushrooms. Some polyps can also be flat. Many patients have several polyps scattered in different parts of the colon. Some polyps can contain small areas of cancer, although the vast majority of polyps do not.

How Common Are Colon Polyps? What Causes Them?
Polyps are very common in adults, who have an increased chance of acquiring them, especially as we get older. While quite rare in 20-year-olds, it’s estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp. We don’t know what causes polyps. Some experts believe a high-fat, low-fiber diet can be a predisposition to polyp formation. There may be a genetic risk to develop polyps as well.

What Are Known Risks for Developing Polyps?
The biggest risk factor for developing polyps is being older than 50. A family history of colon polyps or colon cancer increases the risk of polyps. Also, patients with a personal history of polyps or colon cancer are at risk of developing new polyps. In addition, there are some rare polyp or cancer syndromes that run in families and increase the risk of polyps occurring at younger ages.

There are two common types: hyperplastic polyp and adenoma. The hyperplastic polyp is not at risk for cancer. The adenoma, however, is thought to be the precursor (origin) for almost all colon cancers, although most adenomas never become cancers. Histology examination of tissue under a microscope) is the best way to differentiate between hyperplastic and adenomatous polyps.

Although it’s impossible to tell which adenomatous polyps will become cancers, larger polyps are more likely to become cancers and some of the largest ones (those larger than 1 inch) can already contain small areas of cancer. Because your doctor cannot be certain of the tissue type by the polyp’s appearance, doctors generally recommend removing all polyps found during a colonoscopy.

How Are Polyps Found?
Most polyps cause no symptoms. Larger ones can cause blood in the stools, but even they are usually asymptomatic. Therefore, the best way to detect polyps is by screening individuals with no symptoms. Several other screening techniques are available: testing stool specimens for traces of blood, performing sigmoidoscopy to look into the lower third of the colon, or using a radiology test such as a barium enema or CT colonography. If one of these tests finds or suspects polyps, your doctor will generally recommend colonoscopy to remove them. Because colonoscopy is the most accurate way to detect polyps, many experts now recommend colonoscopy as a screening method so that any polyps found or suspected can be removed during the same procedure.

How Are Polyps Removed?
Most polyps found during colonoscopy can be completely removed during the procedure. Various removal techniques are available; most involve removing them with a wire loop biopsy forceps and/or burning the polyp base with an electric current. This is called polyp resection. Because the bowel’s lining isn’t sensitive to cutting or burning, polyp resection doesn’t cause discomfort. Resected polyps are then examined under a microscope by a pathologist to determine the tissue type and to detect any cancer. If a large or unusual looking polyp is removed or left for possible surgical management, the endoscopist may mark the site by injecting small amounts of sterile India ink or carbon black into the bowel wall. this is called endoscopic tattooing.

What Are the Risks of Polyp Removal?
Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure. Possible complications, which are uncommon, include bleeding from the polypectomy site and perforation (a hole or tear) of the colon. Bleeding from the polypectomy site can be immediate or delayed for several days; persistent bleeding can almost always be stopped by treatment during colonoscopy. Perforations rarely occur and may require surgery to repair.

How Often Do I Need Colonoscopy if I Have Polyps Removed?
Your doctor will decide when your next colonoscopy is necessary. The timing depends on several factors, including the numbe and size of polyps removed, the polyps’ tissue type and the quality of the colon cleansing for your previous procedure. The quality of cleansing affects your doctor’s ability to see the surface of the colon.

If the polyps were small and the entire colon was well seen during your colonoscopy, doctors generally recommend a repeat colonoscopy in three to five years. If your repeat colonoscopy doesn’t show any indication of polyps, you might not need another procedure for an additional five years.

However, if the polyps were large and flat, your doctor might recommend an interval of only months before a repeat colonoscopy to assure complete polyp removal. Your doctor will discuss those options with you.

IMPORTANT REMINDER: The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

Cancer Survivor Story: Stacey

Posted on March 23, 2017March 28, 2017 by fuelmarketing

Stacey works as a procedure scheduler at Granite Peaks Gastroenterology. When she was thirty years old and pregnant with her youngest child, she found a lump in her breast. The lump turned out to be cancerous, and it didn’t look good for Stacey. But after going through harsh chemotherapy and treatment, Stacey is a cancer survivor.

Eight years later, Stacey began working at Granite Peaks Gastroenterology. “At the time, I was desperately needing a job,” she says, “but I wasn’t happy about it…all I could think about was how upset I was to be talking to patients about their bowel habits all day.” Little did she know that her new job would be a blessing in disguise. Stacey tells us:

“One morning, I was chatting with a new coworker about my battles with breast cancer. One of our doctors, Dr. Heiner, overheard the conversation and asked me if I had ever had a colonoscopy. Shocked, I sternly replied, ‘I am thirty-eight years old, no I have not had a colonoscopy!’ He told me that breast cancer and colon cancer are very closely related, and the next thing I know, he’s scheduled me for a procedure the very next day.”

“So there I was, about to have a colonoscopy performed by my employer, wondering how I was going to go into work to face him after he’s seen my best side. As the sedation wore off and I woke up, Dr. Heiner was there smiling and proud and said, ‘The colonoscopy just saved your life.’ He went on to explain that he had found precancerous polyps and that I would have never made it to forty if I hadn’t had the procedure.”

“Thirteen years later and I am still here, a cancer survivor, preaching to the choir every single day. I have had five colonoscopies since and have had precancerous polyps each time. I can’t begin to tell people how important [colonoscopy screening] is. That’s why I love my job so much, I love sharing my story to help people understand and spread colon cancer awareness.”

Colorectal cancer is the second most common cause of cancer death in the U.S.. But when colorectal cancer is diagnosed early, the 5 year survival rate is 90%. Screening and early detection saves lives. Schedule a colonoscopy with Granite Peaks Gastroenterology today.

Meet Colon Cancer Survivor Ben

Posted on March 16, 2017February 14, 2019 by fuelmarketing

At age 59, Ben noticed he had been experiencing subtle changes in his bowel movements for the past nine months. He decided to talk with his internist about his symptoms. Ben’s internal medicine physician mentioned that he was very overdue for his colonoscopy screening. Since Ben didn’t have a family history of colon cancer, he should have had a colonoscopy done at age 50. Knowing he could not put it off any longer, Ben scheduled a colonoscopy with a gastroenterologist.

Ben’s colonoscopy revealed a large cancerous polyp that had gone through the colon wall and spread into his lymph system. Faced with a diagnosis of Stage IVA colon cancer, his chances of survival were lower than he hoped for.

With his gastroenterologist’s support, Ben was optimistic that he could beat colon cancer. He had surgery to remove the section of the colon containing the cancer, along with the lymph nodes. Six months of chemotherapy was the next step in his brave fight against colon cancer. During those hard days of chemo treatment and its challenging side effects, Ben maintained his positive attitude and was determined to be a colon cancer survivor.

Ben is now 75 years old and his follow-up colonoscopies have not shown any recurrence of cancer. Ben IS a colon cancer survivor — and he wants everyone to know just how important colorectal screening is. Colonoscopy screening is vital for those aged 50 and older, having abnormal bowel movements, or with a family history of cancer. Get a colonoscopy. It can save your life, just as it did Ben’s.

Call Granite Peaks GI today to schedule your colonoscopy at (801) 619-9000 or request an appointment online.

March is Colorectal Cancer Awareness Month

Posted on March 7, 2017April 18, 2019 by R. Kyle Barnett

By Dr. R. Kyle Barnett

Granite Peaks Gastroenterology has partnered with the American Cancer Society and the National Colorectal Cancer Roundtable to promote “Eighty By 2018.” The initiative joins force with organizations such as ours that are committed to eliminating colorectal cancer as a major public health problem. Together, we are working toward the goal of reaching 80% of adults aged 50 and older to get screened for colorectal cancer by 2018. If we can achieve 80% screening by 2018, 277,000 cases and 203,000 colorectal cancer deaths could be prevented by 2030. This would be truly remarkable!

Consider the following facts:

• Colorectal cancer ranks #2 among killer cancers in the United States. Around 50,000 people die of colorectal cancer each year in the U.S.

• The likelihood of developing colon cancer in your lifetime is 1 in 20

• There are 136,000 new cases of colorectal cancer each year in the U.S

• 1 in 3 American adults (almost 23 million total) aren’t screened for colorectal cancer as recommended

• There is a 90% reduction in cancer risk following colonoscopy and polypectomy

When adults get screened for colorectal cancer, it can be detected at an early stage when treatment is most likely to be successful. In some cases it can be prevented through the detection and removal of precancerous polyps. Colon cancer arises from precancerous growths (polyps) that grow in the colon. When detected early, these polyps can be removed, stopping their progression to colorectal cancer. Prevention is powerful! Unlike other cancer screenings, which only detect a problem, colonoscopy screening can prevent colorectal cancer by removing these precancerous polyps during the exam.

The risk of colorectal cancer is roughly equal in men and women, and is most common after the age of 50, but it can also strike at younger ages. It is also more likely if you have a family history of colorectal cancer or polyps. Symptoms that may be associated with colorectal cancer might include new onset of abdominal pain, blood in the stool, or a change in your typical bowel habits. However, most colorectal cancers produce NO SYMPTOMS and this is why screening is SO IMPORTANT!

Colonoscopy every 10 years is the preferred colorectal cancer prevention test. For normal risk individuals, the American College of Gastroenterology recommends colonoscopy beginning at age 50 (age 45 for African Americans). Other screening tests are also available. Just remember, the best screening test is the one that gets done!

So please join us here at Granite Peaks Gastroenterology and Endoscopy and make the pledge to reach our “80% by 2018” goal. By scheduling your colonoscopy screening, we can take steps to eliminate this terrible disease that can lead to heartbreak for too many. You (and your family) will be glad you did!

Additional resources:
www.nccrt.org
www.cancer.org
www.gi.org
www.utahcolon.com