Colon Cancer Rates Are Rising for Young People – Am I At Risk? with Dr. Beatrice Dionigi

Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

Rates of colorectal cancer among people under fifty have risen nine percent in the past three years. Not only is colon cancer on the rise, it is the deadliest cancer for men under age fifty and the second deadliest cancer among women in the same age group. It is increasingly important we educate ourselves about how to spot this illness because detecting it early drastically improves the chances of survival.

This week, Dr. Beatrice Dionigi joined me to talk about the signs and symptoms of colorectal cancer and the important steps you can take to protect yourself from this deadly disease.

Faith: Dr. Beatrice Dionigi, thank you so much for joining us.

Dr. Dionigi: Thank you so much for having me. It’s an honor.

Faith: Let’s start out by getting a basic idea of what colorectal or colon cancer is. So what is happening inside the body when someone has colon cancer?

Dr. Dionigi: So first of all, what is cancer, right? So cancer means that there are cells inside your body that are growing without control. And specifically for colon cancer, that means that the cells that are part of the internal lining of the colon, or the rectum, are going to start developing and grow without control. That will cause the formation of a polyp, which is a small growth. If you don’t remove the polyp, the polyp can continue to grow and become a cancer. So, polyps are precancerous lesions that left alone can develop into colorectal cancer. And then of course, if you don’t treat the cancer mass, then that can also evolve and spread.

Faith: All polyps become cancer if left unremoved?

Dr. Dionigi: Yes, most of them will. The timing of evolution from polyp to cancer depends on many factors. Some of them we don’t even know, know them yet. There are very specific polyps called hyperplastic polyps that are very benign, just growth. So those usually don’t translate into cancer, but what we call adenomatous polyp: yes, they will continue to grow into possibly cancer.

Faith: What are some of the symptoms people should watch out for that indicate that they have colon cancer?

Dr. Dionigi: So there are four red flags, sign and symptoms that have been associated to colorectal cancer. First and foremost rectal bleeding, then abdominal pain, diarrhea, constipation, and iron deficiency anemia. Rectal bleeding in particular has been shown to have strongest association to colorectal cancer. So patients that have rectal bleeding, which can be bright red blood or even dark blood, so dark stool, should raise that concern to their provider.

Faith: So, if, if you’re exhibiting some of these symptoms, some of them seem pretty run of the mill benign. Like, we all get gas sometimes, right? We all have a stomachache, maybe diarrhea, right? So when do you know it’s time to see a doctor?

Dr. Dionigi: I think it’s when it’s persistent, if you have the symptoms more than a month or two and you tried remedies, you can have changed your diet, you can have taken stool softeners if you’re constipated and you feel that it’s not going away and it’s persistent, then I would suggest strongly to be seen, because in the office, for example, if a patient comes to my office and has rectal bleeding and we think it could be related to hemorrhoids, I can do a rectal exam.

Again, it’s not very fun, but we make the patient, uh, comfortable. I walk the patient through the exam and I can not only examine the outside of the anal area, but I can also do what we call anoscopy, which is a small scope that goes inside the rectum and can check the hemorrhoids and the lower part of the rectum.

So if in that case the hemorrhoids look normal and there’s no active bleeding at that time, then the patient should be upgraded to colonoscopy.

Faith: What factors put someone at risk for getting colon cancer?

Dr. Dionigi: So, colorectal cancer is, uh, what we define a multifactorial disease process. So, there are different factors. There are genetic factors, there is environmental exposures, and then there are inflammatory condition of the GI tract. All of them can contribute in, uh, increasing the risk of developing colon cancer.

So from a genetical standpoint, um, again, colon rectal cancer is a very complex disease and, uh, there are different genetic alteration that can occur. There are families that are predisposed genetically to develop colorectal cancer earlier in life. And so patients that have that type of family history should be screened early and genetic testing should be part of their workup. From an environmental standpoint, tere are many studies that shows that there is increased risk of developing colon cancer, uh, linked to dietary factors, you know, red meat, low fibers diet, low overall intake of fruits and vegetables. Uh, obesity is another risk factor as well as smoking and increased alcohol consumption.

Faith: And does colon cancer occur in more people as they get older? Is age a factor?

Dr. Dionigi: Yes. So age, it’s a well known risk factor for colorectal cancer, as well as for many other solid tumors. The time progression from an early premalignant lesion to malignant cancer ranges from 10 to 20 years, and the median age of diagnosis is around 66 years old, but we, especially in the last several years, we’ve seen an increased number of young patients affected with colorectal cancer and a slight decrease in the older population having colorectal cancer.

Faith: Dr. Dionigi, I’m going to back you up there with, with some eyebrow raising statistics. According to the American Cancer Society, there’s been a 9 percent increase in people under 50 since 2020. And another way of putting that, if 9 percent doesn’t sound like a big number, millennials have twice the risk of colorectal cancer compared to those born in 1950. So that puts a lot of urgency on this prescription to get a colonoscopy at age 45. Is that right?

Dr. Dionigi: Is that totally right. And the statistics are scary. If you think about it that approximately 10 percent of all the new diagnosis of colorectal cancer in the United States are what we call early onset colorectal cancer—so patients are less than 45 years old—I think it’s, it’s talking to us about the importance of catching the symptoms early and intervene.

Faith: The rising rates of colon cancer in younger people: what does it mean for how we should be approaching colon and colorectal cancer prevention?

Dr. Dionigi: I think patients should be their own advocate. I cannot stress more about this topic. Uh, I think if you have a rectal bleeding, abdominal pain and all the symptoms we discussed before, uh, if they don’t go away, you should be seen and you should be seen by a GI provider or colorectal surgeon. And if the colonoscopy shows a mass, uh, that is suspicious or biopsy confirm, uh, colon cancer, then there are other things that we are going to do to understand more about what’s going on. But the most important thing is to talk about it, to not be shy, not be shy to go for a colonoscopy, but not be shy even to talk with your provider about your symptoms, because that can start the process of getting a diagnosis and save a life.

Faith: What is involved in a standard screening? So, okay, we all now know that we need to do it at 45, if our doctor hasn’t already told us to do it before 45. What does it involve?

Dr. Dionigi: So the gold standard is colonoscopy, which can be at the same time diagnostic and therapeutic. So what does it mean? That diagnostic: it means that if we do the colonoscopy and we see a growth like a polyp, that can be identified. And therapeutic means that we can intervene right away.

So the gastroenterologist or the colorectal surgeon can remove the polyp during the colonoscopy during that session. There are different techniques that can be used, but the polyp can be fully removed and sent to pathology. If the polyp is too large, then the provider can take a biopsy, meaning a small bite that will be sent to pathology and be analyzed.

And then based on the results, then we can decide what will be the next step in management. There are other modalities, like stool studies, as well as CT scans. We call it CT colonography. That can be used, but if any of these modalities shows abnormal results, then the next step will be colonoscopy.

Faith: I don’t think we need to go into great detail here about what a colonoscopy entails. It’s not always fun. Most people who experience them, and it gets to be just about all of us, I hope, feel actually like it’s, it’s a very cathartic experience. And, you know it’s necessary. And, you know, if there’s no news, that’s good news. If there’s news, that’s good news, because you are keeping yourself alive.

Dr. Dionigi: Exactly. So I think the part that is not fun, as I usually define it with my patients, when we talk about it before the procedure is the bowel prep. Nobody really wants to take the bowel prep and cleanse, but the better you cleanse, the better chances the provider has to find even small polyps. So that is the important steps to be done the day before. The day of the procedure, unless you are like me who wanted to have her own colonoscopy without sedation, usually patients have it with, with sedation. So you have a nice nap throughout and you just wake up when everything is over.

Faith: Okay, as someone who chose to give birth without any, any pain drugs, I say namaste, but I do like my colonoscopy under sedation.

Dr. Dionigi: Many of my patients do.

Faith: What a wonderfully curious doctor you are. So, the headlines around colon cancer can feel very scary, but what I find comforting, uh, about this conversation with you and about the facts is that while colon cancer is not necessarily preventable, it is very, very treatable.

Dr. Dionigi: Exactly. So as a colorectal surgeon, so someone that received the patient after being diagnosed with a colorectal cancer or being the one diagnosing it on colonoscopy sometimes, I think it’s having a diagnosis of cancer is very scary for everybody. It, it can change your life in just one second. But I start, usually, the discussion of my patient reassuring them, reassuring them that in the majority of cases, we can treat and cure and we can have good results.

Faith: You had a very important edit to what I said. I said it’s colon cancer may not be preventable, but it’s very, very treatable. And you added most often curable.

Dr. Dionigi: Yes. Especially if it’s found early, we can achieve cure.

Faith: So this is what I’m taking away from, from this illuminating conversation with you. Stay vigilant, stay informed, take care of yourself. Don’t be shy and make sure you schedule your colonoscopy for a 45th birthday present.

Dr. Dionigi: Exactly. I think you are right on top of everything.

Faith: Dr. Dionigi, thank you so much for shedding light on, on this topic that maybe people don’t talk enough about.

Dr. Dionigi: Thank you, Faith! I’m very honored to be here and I hope this, uh, will help someone out there to speak up and get screened.

Our many thanks to Dr. Beatrice Dionigi. I’m Faith Salie. Health Matters is a production of New York Presbyterian.

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Faith: Why didn’t you want sedation, Dr. Dionigi?

Dr. Dionigi: Because I think I was curious to see the inside and just see if I had polyps and make sure that I had a good bowel prep, which was excellent, thankfully.

Faith: Congratulations.

Dr. Dionigi: And—thank you. And I think was more to have the experience and also being able to be an advocate for my patients. Some of them cannot have it with a sedation for medical reason. And so I just want to be, you know, a voice. For them and say, listen, if I did it, you can do it. The provider can be very gentle. There are different ways where you can participate during the procedure and make it even less painful. And to be honest, it wasn’t painful at all. So if I, when I have to do it again, we’ll do it without, I think it will be fine.