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Colon Screening Can Be A Lifesaver & Taking Control of IBD

Dr. Eugene Yen March 12, 2009 12:00 PM This chat has ended. Thank you for participating.
Kristin Philbin (Moderator) - 11:58 AM:
Welcome! Today’s chat: Colon Screening Can Be A Lifesaver & Taking Control of IBD will begin shortly. Please start submitting your questions and Dr. Eugene Yen will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Colon Cancer department to obtain more information about colon cancer.

Dr. Eugene Yen (NorthShore) - 11:58 AM:
Hello, my name is Dr. Eugene Yen. I am a gastroenterologist who has been practicing with the NorthShore System for 2 years, and I am excited to join today’s online chat. My area of research and expertise is in Inflammatory Bowel Disease (IBD), a medical condition that includes ulcerative colitis, Crohn’s disease, and microscopic colitis. In addition, I am interested in the early detection of colon cancer. I’m available for any questions.

Gary C. Gerstein (Evanston, Illinois) - 11:59 AM:
What is the exact difference between Inflammatory Bowel Disease and Irritable Bowel Syndrome, which I've been diagnosed with. Also, are there any new medications or treatments for IBS? I'm 55 years old and my IBS seems to be getting progressively worse.

Dr. Eugene Yen (NorthShore):
The symptoms are often the same in IBD and IBS: abdominal pain, abnormal bowel movements, cramping, etc. However, IBD is diagnosed with by endoscopy and colonoscopy with findings of inflammation, whereas, IBS has normal findings. Yes, there are some new medications for IBS, but if your symptoms are worse, you should consider seeing a gastroenterologist again.

Ethan (Lincolnwood) - 12:01 PM:
What are the most common symptoms of colon cancer?

Dr. Eugene Yen (NorthShore):
The most common symptom is NO symptoms, which is why colon cancer is called the "silent killer." While no one likes to talk to ther doctors about their bowels, if you are experiencing blood in your stool, pain, a change in your bowel habits, or weight loss, this may be an indication to investigate further. Talk to your doctors. We want to hear about your bowel movements!

Gene Meyers (Morton Grove, IL) - 12:06 PM:
I’m 39 years old and have experienced constipation and rectal bleeding over the past year. I’ve dismissed the notion that anything is wrong because I have no family history of colon cancer and also that the bleeding is usually a light red color. But now I’m having second thoughts. Should I have cause for concern?

Dr. Eugene Yen (NorthShore):
Often, this is a harmless problem from hemorrhoids. This is treated with high fiber and stool softeners. So, if you're constipated, I would fix that with the above, and laxatives if needed. If you are having soft stool, and your blood is continuing, I would consider seeing a doctor for a colonoscopy. Remember, the most common form of colon cancer is the type that is NOT inherited. See your doctor, make sure that you have had at least some preliminary lab work like a blood count.

Ethan (Lincolnwood) - 12:08 PM:
At what age should you start getting regular screenings for colon cancer?

Dr. Eugene Yen (NorthShore):
Without symptoms and without a family history, start at age 50. If you have a family history, start at age 40, or 10 years prior to your affected relative (ex. if your mother had it at age 40, then you should get it at age 30). Often, we will also do colonoscopy in patients who are having rectal bleeding.

Katie (Glenview, Illinois) - 12:09 PM:
My father died of colon cancer at the age of 61. I am 35 and have yet to have a screening test. Two questions: Should I get one? And is there a high risk that my children, ages 2 and 6, might be predisposed to colon cancer?

Dr. Eugene Yen (NorthShore):
If there are no other family members in your family, you are at slightly increased risk of colon cancer. I would recommend starting at age 40, unless you have been having bowel symptoms (change in the bowel habits, constipation, diarrhea) or blood in the stools. If that's the case, then see your doctor. Your children may be at slightly increaesd risk, but less than you. There's very little risk when they are young.

Bill L. (Highland Park) - 12:11 PM:
My immediate family does not have a history of colon cancer but extended relatives – my grandmother and two uncles – died of the disease. Am I still considered at higher risk for getting colon cancer even though my immediate family has not had the disease?

Dr. Eugene Yen (NorthShore):
Yes, if you have 2 or more 2nd degree relatives with colon cancer, then you are at slightly increased risk. I would recommend that you start screening at age 40. This is also a good time for you to get your family that is of age to be screened as well, especially if you have already had a colonoscopy. So, talk to your family and siblings, if you have a family history.

Mark (Wilmette) - 12:13 PM:
What are the common risk factors of colon cancer?

Dr. Eugene Yen (NorthShore):
Age is probably the biggest.Smoking, family history of colon, or other cancers, obesity,inflammatory bowel disease and having other cancers. While there have been other possible connections, these are the most widely discussed. Diet is thought to play a role, since 3rd world countries tend to have a much lower rate of colon cancer. I'm sure that our American diets play a role.

Alyssa Lawson (Chicago) - 12:16 PM:
If colon cancer begins with the formation of a polyp, what causes the polyp to form in the first place?

Dr. Eugene Yen (NorthShore):
Your colon tissue, like your skin, is a gland that is constantly reproducing cells and tissue. There is a lot of room for error. The good news is that polyps take a few years to become a cancer, so by removing your polyps, we are preventing many colon cancers. We see this in the GI lab every day. As a physician, I chose this job in part because I know that I make a difference every day if I remove just one polyp.

J.K. (Chicago) - 12:18 PM:
Does the length of my colon put me at greater risk for developing colon cancer?

Dr. Eugene Yen (NorthShore):
No.

Mark (Wilmette) - 12:19 PM:
Are screening tests performed by your general practitioner or do I see a specialist?

Dr. Eugene Yen (NorthShore):
There are certain stool tests that your GP can order which check for the presence of blood or mutated colon DNA. If these are abnormal, you need to see a specialist for a colonoscopy. In some parts of the country, GPs can do sigmoidoscopy for screening, which is another choice. Studies from Canada have approx 1/3 of procedures being done by non-specialists. I know that this is my field, and I am biased, but if you are going to go through the trouble of getting screened for colon cancer, have someone do it where it's their ONLY job. As a gastroenterologist, I do this every day.

Julia (Niles, IL) - 12:21 PM:
What should a person with IBD do in order to decrease chances of developing colon cancer? Whould you suggest any vitamins?

Dr. Eugene Yen (NorthShore):
Folate and calcium have been widely studied, and may provide some benefit, so I check my patient's Vit D status and recommend a multivitamin. The more important thing is to control your IBD. Having active inflammation, or flaring disease, puts you at increased risk for cancer later. I usually ask my patients who are doing well to see me at least 1-2x per year, as regular doctor visits also seem to correlate with less cancer, since I'm always asking about your symptoms.

Tim (Glenview) - 12:24 PM:
My doctor has instructed me to get a colonoscopy. But I’m a bit apprehensive about the actual procedure. I know there are other types of tests available like a virtual scan or blood test. Are they adequate alternatives?

Dr. Eugene Yen (NorthShore):
There are no adequate blood tests. The virtual scan is available, but your insurance may not pay for it. Most don't. Keep in mind, though, that you still have to go through the prep the night before, which most say is the worst part. Also, if there are any abnormalities, you have to repeat the steps and get a colonoscopy anyway. However, we do think that this is an adequate test. About 90% of my patients are scared to death prior to their procedure, and most don't remember anything and are reassured that they had a full exam. These days, our technology is better, the training of doctors is better, and complications are much lower than they were even 10 years ago.

Ethan (Lincolnwood) - 12:27 PM:
If detected early, how curable is colon cancer?

Dr. Eugene Yen (NorthShore):
Completely curable if caught in the early stage, which is why your doctors should be encouraging you to get some form of colon cancer screening. Colon cancer is the 2nd most common killer of cancer in the USA, and the fact that it is potentially preventable should convince you to get screened. Most of the time, polyps and early cancers start in the superficial layers of the colon. I remove them routinely in the GI lab. If cancer has gone through the wall of the colon, surgery and chemotherapy has also improved significantly.

Mark (Wilmette) - 12:30 PM:
If one of my parents had colon cancer, how likely am I to have it?

Dr. Eugene Yen (NorthShore):
Your risk is slightly higher, but it depends on when your parent was diagnosed. If they were diagnosed after age 60, your risk may be only marginally higher than the normal population. Regardless, you should have a colonoscopy at age 40, or sooner if your parent was young when he/she got cancer.

Farrah (Lake Forest, IL) - 12:32 PM:
My father is 57 and has not had a colonoscopy. When I try to talk to him about it, he refuses to discuss it. Any recommendations on how I can get my father to have this lifesaving test done?

Dr. Eugene Yen (NorthShore):
If you trust his primary care doctor, have him or her continue to remind him about it. If he allows you, ask him what his hesitation is for the test. For how common this occurs in men, I also have a hard time with this. I'm happy to talk to him in my office before his procedure. I think we need to continue educating people. It's amazing how far we have come, from never discussing these issues, to celebrities getting their colonoscopy on live TV. There's still hope for your dad.

Ethan (Lincolnwood) - 12:37 PM:
Are there certain foods that I can avoid to lower my risk factor for colon cancer?

Dr. Eugene Yen (NorthShore):
This is unclear. Certainly, those who eat a high fiber and heart-healthy diet seem to do much better, but there haven't been any foods shown to reduce the risk. As we discussed earlier, people from poor developing countries have much much lower rates of colon cancer than us. I'm convinced that it's our overall unhealthy lifestyle.

Rachel (Winnetka) - 12:39 PM:
My father had colon cancer 13 yrs ago & survived it. He is the first in the family to get the disease. Would it still be considered genetic since he is the only one to have it? At the time he was 62.

Dr. Eugene Yen (NorthShore):
Most cancers are NOT genetic. However, if he had cancer, then family member are at slightly increased risk. His siblings, and your siblings should all have colonoscopy at age 40.

Ethan (Lincolnwood) - 12:41 PM:
Are males and females equally susceptible to colon cancer? What about different ethnicities?

Dr. Eugene Yen (NorthShore):
Males tend to get colon cancer more. A colleague and I recently did a study at Evanston Hospital that confirmed that. However, colon cancer is still the 3rd most common cancer among women (behind lung and breast), so this does not change anyone's recommendations to be less aggresive with screening between men or women. African Americans tend to get colon cancer at an earlier age and often more aggresively. Most recommend starting screening at age 45.

Louis (Buffalo Grove, Il) - 12:44 PM:
I've been experiencing pain in the lower part of my left ribcage and also constipation. When I eat, I also feel pain in the affected area. This situation has become more presistent in recent weeks. I have not sought out a doctor yet. Could I be dealing with an inflamatory bowel issue?

Dr. Eugene Yen (NorthShore):
Most likely not, but I would seek out the care from your doctor, as these symptoms can mean a whole myraid of things, mostly minor. I'm happy to see you if you don't have a doctor.

Peter S. (Chicago) - 12:47 PM:
This is not so much a medical question… But my best friend suffers from colitis and feels miserable all the time. I’ve encouraged him to seek some counseling or reach out to talk to others who have the same thing. I want to help him feel better about himself. Can you provide some direction?

Dr. Eugene Yen (NorthShore):
Yes, please feel free to have him see me. My expectation from my colitis patients is that, with treatment, they feel normal. Colitis is a chronic illness, but people shouldn't feel chronicially ill. All of you should be happy with your doctors. There's a lot of us out there, and you should have your questions answered to your satisfaction.

Ethan (Lincolnwood) - 12:51 PM:
Is a family history of colon cancer due to shared risk factors, or is colon cancer genetic?

Dr. Eugene Yen (NorthShore):
The most common scenario of colon cancer is when it is NOT inherited. However, if you have a family history, you are at increased risk. Genetics certainly play a role, but it is due to a host of shared factors.

Julia (Niles, IL) - 12:52 PM:
Do occasional abdominal pains and occasional loose stools indicate a flare-up in a person with UC?

Dr. Eugene Yen (NorthShore):
Not always. Most of my UC patients know when they are flaring, but stress and illness and infection can be non-UC related reasons when you may get pains and loose stool. You should make your doctor aware of this, however. The more I hear from my patients, the easier it is for me to predict when to be worried about a flare or not.

Kristin Philbin (Moderator) - 12:52 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Mark (Wilmette) - 12:54 PM:
What effect does diabetes have on colon cancer?

Dr. Eugene Yen (NorthShore):
There is a slightly increased risk of cancer in diabetics, but I think that it's mostly because obesity is a risk factor for colon cancer. i would still encourage diabetics to get routine screening.

Alyssa Lawson (Chicago) - 12:55 PM:
Thank you for answering my earlier question about polyps.Can polyps fall off the colon wall or pass through your system on their own, or do they always need to be surgically removed?

Dr. Eugene Yen (NorthShore):
They need to be removed, but we mostly do them all during colonoscopy.

Mark (Wilmette) - 12:56 PM:
Can a PET scan be used instead of a colonoscopy to detect colon cancer?

Dr. Eugene Yen (NorthShore):
Currently, no. PETs are used in the staging of cancer, and are a horrible screening test for colon cancer. Colonoscopy is still considered the gold standard for screening.

Jim (Northfield, Ill.) - 12:57 PM:
I like to play basketball and raquetball regularly. But I'm less disciplined about what I eat. Are there certain foods or food groups that might help fight in the development of polyps or colon cancer?

Dr. Eugene Yen (NorthShore):
We don't think so, although we tend to see less cancer in those who stay in shape and eat healthy. So, as long as you have a diet that is low in cholesterol and high in fiber, that is a good start.

Kristin Philbin (Moderator) - 1:00 PM:
Thank you again for participating in our chat today. For more information please visit our Screening pages.

Also, a transcript of this chat will be available shortly.

Dr. Eugene Yen (NorthShore) - 1:01 PM:
Thank you so much for having me. I really enjoyed this, my first online chat! If you have any questions or would like to schedule an appointment to see me, please feel free to call my office at 847-657-1900.
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