Online Health Chat with Dr. Carol Burke, Dr. Robert Pelley and Dr. Scott Strong
March 22, 2010
Cleveland_Clinic_Host: With March being National Colon Cancer Awareness Month, Cleveland Clinic is committed to educating the public on prevention, diagnosis, and treatment of this disease. Some important risk factors include age, African American race, personal and family history of colon cancer and polyps; ulcerative colitis or Crohn’s disease; smoking and being overweight or obese.
Colon cancer is the third leading cause of cancer deaths among men and women in the United States, 1 out of 22 Americans. 91 percent of new cases occur in patients 50 or older. But, the good news is, according to the National Cancer Institute, deaths from colorectal cancer are declining due to increased use of screening.
In fact, colorectal cancer is one of the most preventable cancers. Almost always it starts in a non-cancerous growth called a polyp that forms on the lining of the colon and rectum. Colonoscopies detect and remove polyps. So if precancerous polyps are found and removed cancer can be prevented before it gets started. Up to 85 percent of colorectal cancers could be prevented if everyone who was eligible for screening actually got screened. If cancer develops and is detected early, it can be cured by surgery. If it is more advanced, the additional use of chemotherapy or radiation therapy may be life saving.
Did you know?
- Removal of precancerous polyps by colonoscopy may reduce your chance of getting colon cancer by up to 70 percent.
- Having a personal or family history of pre-cancerous polyps or colorectal cancer can increase your risk of colorectal cancer by two to three times.
- Being overweight or obese increases your risk of colon cancer twofold.
- Having Crohn’s colitis or ulcerative colitis significantly increases your colon cancer risk.
- Heavy smoking (pack of cigarettes for 20 years or its equivalent) increases your risk of colon cancer by 30 percent.
- African Americans more often have advanced-stage colon cancer and more often die from the disease than other racial groups in America.
- Polyps and colon cancer don’t always cause symptoms, so getting screened before symptoms develop is critical.
Through a multidisciplinary approach, Cleveland Clinic specialists in the Digestive Disease Institute and Taussig Cancer Institute explore all medical and surgical options to ensure that our colon and rectal cancer treatment program will result in a successful outcome for each patient. Treatment plans are tailored to their patients’ needs, taking into account how advanced the cancer is, the age of the patient, and the degree to which the cancer has spread.
The Digestive Disease Institute is a globally recognized leader in colon cancer prevention, treatment and surgical innovation, attracts patients from all 50 states and beyond. Our gastroenterologists and hepatologists receive worldwide referrals, particularly for complex cases and severely affected patients. Our surgeons offer traditional approaches, and lead with numerous minimally invasive firsts. Cleveland Clinic receives increasing worldwide referrals, particularly for complex hereditary colon cancer syndromes, whether for an expert opinion on medical therapies, access to clinical trials or for surgical expertise that consistently reports excellent outcomes.
The Taussig Cancer Institute provides outstanding multidisciplinary care to patients with solid tumors and hematological malignancies. Our exceptional clinical experience and extensive translational research programs allows us to offer patients individualized treatment plans based on the best standard of care and access to new and emerging treatment options. We also offer an extensive range of support services to patients with cancer and their family members.
Cleveland Clinic is ranked #1 in Ohio for both digestive diseases and cancer care by U.S. News&World Report.
Would you like to know why the preparation for a colonoscopy is easier than ever? Or what are the latest advancements in surgical and medical treatment options for colorectal cancer? Take advantage of this rare opportunity to chat live with medical and surgical experts in the treatment and management of colorectal polyps and cancer. Cleveland Clinic gastroenterologist Dr. Carol Burke, colorectal surgeon Dr. Scott Strong and oncologist Dr. Robert Pelley are here to answer your questions about colorectal polyps and cancer.
pearlywhites: What is colon cancer? Are colon and colorectal cancer the same thing?
Dr__Robert_Pelley: Colon cancer starts out from a premalignant condition called a colon polyp. These are wart-like structures that can grow on the inside lining of the colon. Many grow for years and some will not turn into cancer. However, with time (years), some polyps will eventually become invasive and malignant- behaving and start to grow into the deeper layers of the colon and can possibly spread. This process is caused by mutations in the chemical called DNA, which is the blueprint for life. It is not exactly known why these mutations occur, but we know that diet and family history have a lot to do with it.
The difference between colon cancer and rectal cancer is simply location. The rectum is the part of the large bowel located in the pelvis and the colon is the part of the large bowel located above this, in the abdomen. Together they make an organ that looks like a question mark. There may be slight biologic differences between the two cancers, but at present they are treated the same, both with surgery first and then possibly chemotherapy and/or radiation therapy.
Harley: How important is a family history of colorectal polyps or cancer?
Speaker_-_Dr__Carol_Burke: A family history of a first degree relative (parent, sibling, child) with precancerous, adenomatous polyps or cancer can increase your risk 2-3 fold. The risk can be higher if there are more numerous relatives affected. WHEN, successive generations are involved, especially if colon cancer develops in individuals under 50 years old or individuals have numerous cancers. This may imply a hereditary colon cancer syndrome which can be associated with a risk of cancer of nearly 80-100%.
Colon Cancer Risk
jackB: How can I determine my colon cancer risk?
Speaker_-_Dr__Carol_Burke: You can visit clevelandclinic.org/score to take a free, quick and easy risk assessment to determine your personal risk for colon cancer. You’ll receive personalized recommendations for screening guidelines and lifestyle choice improvements. You’ll also find valuable information on digestive health and colon cancer prevention as well as clinical trials available for colon cancer.
josephP: What are the risk factors for colon cancer?
Speaker_-_Dr__Carol_Burke: Nearly 150,000 Americans will get colorectal cancer this year. 75% of people who get it don't have any obvious risk factors. The strongest risk factors would be a personal or family history of colorectal polyps or cancer. This risk factor alone can increase your risk 2-3 fold. The greater the number of relatives affected, especially the younger the age of the relative when diagnosed increases your risk.
Additionally, a personal history of chronic inflammation in the colon with ulcerative colitis or Crohn’s increases the risk. The risk is based on the length of colon inflamed and the years the disease has been present.
There are rare hereditary colon cancer syndromes where a genetic mutation is present in all cells in the body, like familial adenomatous polyposis, MYH associated polyposis or hereditary non polyposis colorectal cancer, that leads to the highest risk of colon cancer (up to 100%).
African Americans have the highest risk of getting and dying from colorectal cancer and the exact reasons are not known. They are recommended to undergo colorectal cancer screening at age 45 rather than 50.
Most of these previous risk factors you cannot change. There are some other factors within your control that you can modify to decrease your risk of polyps or cancer. These include being overweight or obese (which more than 30% of the adult American population is); being physical inactive; smoking; eating a diet high in fat- processed and red meats, low in fruit/vegetables, fiber and grains.
Surely: Is there anything I can do to decrease my risk of colon polyps or cancer?
Speaker_-_Dr__Carol_Burke: Avoid smoking, being overweight or obese, a poor diet, physical inactivity and avoid Vitamin D deficiency. If you have had polyps consider using caltrate 1200 mg daily.
traines2332: I am a 27 year old white male. Last month, a colonoscopy found that I have an 8mm flat polyp in my ascending colon. A biopsy was taken and it was determined to be serrated adenoma. What is the likelihood that this will become cancerous and what course of treatment should I seek?
Speaker_-_Dr__Carol_Burke: Traditionally it was thought that the only precancerous type of polyp or pathway to cancer was from the progression of an adenomatous polyp to a cancer. Recently we learned that there is another pathway to colon cancer through the serrated polyp pathway. Serrated adenomas and other serrated polyps which are at risk of progression to cancer are much less common than traditional adenomas. A serrated adenoma is the rarest of the serrated polyps, is usually located in the left colon and should be managed the same as a benign, precancerous adenomatous polyp. The polyp should be totally removed and the usual follow up colonoscopy is in 3-5 years unless there are other risk factors. The other more common serrated polyps; often on the right side are sessile serrated adenomas also known as a sessile serrated polyp which is distinct from the serrated adenoma.
cutty: My father had IBS and Diverticulitis and had his colon removed. I think his mother had it too. I have diverticulitis and IB. I also have a slight problem with Celiac. Am I at risk?
Dr__Scott_Strong: Irritable bowel syndrome (IBS), celiac disease, and diverticulitis do not increase a person's risk for colorectal cancer. Celiac disease does slightly increase the risk for small bowel cancer, but currently screening of the small bowel is not recommended.
goodtimes: I read an article which said that taking proton-pump inhibitors (I take Protonix®) long term causes over-production of gastrin which could increase our risk of lethal cancers. Please comment! Is this true?
Dr__Robert_Pelley: The use of pump inhibitors is associated with a slight rise in the GI hormone gastrin, but this is not associated with development of human cancers.
Conoscopy iagnosis and Screening
qpr: What are the options for colorectal cancer screening?
Speaker_-_Dr__Carol_Burke: Colorectal cancer screening is the use of a cancer prevention or detection test in asymptomatic people without any risk factors for the disease.
Colorectal cancer screening is recommended in average risk Americans at or above the age of 50 years in order to prevent death from colorectal cancer.
Colonoscopy every 10 years is the preferred colorectal cancer screening method because it is able to detect and remove polyps which are the precursor to the development of cancer. A shorter scope called flex sig, or an x-ray test called barium enema or CT colonography have also been included as screening options every 5 years. They all have advantages and disadvantages.
The last option is checking the stool annually for evidence of intestinal bleeding with a fecal occult blood test or fecal immunochemical test.
house: Patient with polyps on a colonoscopy test is advised to take the test every year, is this necessary?
Speaker_-_Dr__Carol_Burke: The interval for post polypectomy colonoscopy depends on the size, number and microscopic features of the polyps, in addition to any other risk factors like family history of polyps or cancer or adequacy of bowel prep. Generally if only 1-2, < 10 mm tubular adenomas are detected, the next exam is in 5-10 years. If 3 or more, or > 9 mm polyps or polyps with any villous component, the exam is done in 3 years.
pumpkinpatch: I’ve heard the prep is the hardest part of the colonoscopy. What can I expect from it?
Speaker_-_Dr__Carol_Burke: The prep is usually the most difficult to tolerate but rest assured it has gotten much better. It used to be that the only prep option available was a gallon of solution. Now there are half gallon options. One of the half gallon preps is also split in half so the volume is much less. Split dosing prep is very important where at least half the prep is given on the day of the procedure. It cleans the colon best and allows doctors to see polyps more clearly.
horse3: How could colonoscopy prep be accomplished for someone with a swallowing problem (can only swallow puree-consistency food and cannot swallow liquids)?
Speaker_-_Dr__Carol_Burke: We often use a 3 day liquid diet if someone cannot tolerate large volume of liquids. However alternative preps with tablets may be an option.
signs: What is the cost of colonoscopy not covered by insurance?
Speaker_-_Dr__Carol_Burke: The cost of colonoscopy is dependant on the facility it is done in (ambulatory surgery center, hospital outpatient department), area of the country, reason for the exam and what is done during the procedure. Most insurance companies cover colonoscopy for colon cancer screening and all of them do if people have symptoms. If people do not have insurance most hospitals will work at a financially feasible program.
Patterson_089: I’ve heard of the taking pills for the colonoscopy prep? Do you offer those?
Speaker_-_Dr__Carol_Burke: The pill preps are made of sodium phosphate. Since this prep is not safe for everyone, it is not a standard preparation in most colonoscopy practices. Cleveland Clinic physicians will offer the pill prep on a case by case basis. It includes 32 pills.
bernards23: Can you talk about virtual colonoscopy?
Speaker_-_Dr__Carol_Burke: Virtual colonoscopy is the use of CT scanner or x-ray equipment in a specialized technique to image the colon. The way in which it is done is that the colon must first be cleansed with a bowel preparation and then the patient drinks another liquid to tag bowel movement that may be left in the colon, so they can be picked up on the CT. When you come to the radiology area, a catheter is inserted through your anus and air is instilled to inflate the colon. The scan is performed and the radiologist reads the films. The advantage is that you do not need a driver but the accuracy for polyps greater than 5 mm is only 65% compared to colonoscopy and if a polyp is found, a colonoscopy is still needed. Additionally, this test is not covered for colorectal cancer screening by Medicare.
daddy: Having had diverticulitis surgery plus colonoscopy in Oct. 2007, why should I wait for 10 years for the next colonoscopy?
Dr__Scott_Strong: If you have no other risk factors for colorectal cancer such as family or personal history of colorectal cancer or polyps, you do not need a colonoscopy performed any more frequently than every 10 years. Diverticulitis does not increase your risk for colorectal cancer or polyps.
cleanedup: Is it serious to give a (colonoscopy) to a person between 85-90 years? When is screening not recommended?
Speaker_-_Dr__Carol_Burke: Colonoscopy, as any procedure is a serious, but routine procedure for anyone. It is serious because it requires a bowel preparation which may result in dehydration or changes in electrolyte levels, it also may require adjustments in medications needed for underlying medical problems, requires sedation which can affect oxygen and blood pressure and has a small but real risk of perforation, bleeding, infection.
Routine screening is not recommended at 85-90 years old because the benefit of colonoscopy is not outweighed by the risk, but this is individualized.
diver: What is the difference between a polyp on a stem and the other polyps? What is the risk for each and are flat hard to identify or remove.
Speaker_-_Dr__Carol_Burke: There are a variety of polyp shapes. These include those that look like a broccoli on a stem, called pedunculated, those that look like a hill, called sessile, and those that do not rise above or too far above the colon lining, called flat. The polyp on a stalk started as a sessile or flat polyp but was just pulled on by the colon muscles into a stalk like shape.
In Asia, and less so in North American, flat or depressed adenomatous polyps, which are rare can be associated with a higher rate of being advanced at a smaller size then sessile polyps. More importantly, sessile serrated polyps also known as sessile serrated adenomas are flat and in the right colon. These are much more common in the US than flat advanced adenomas. They must be completely removed.
powderpuff: Why so long - 10 years between colonoscopies? Is intestinal cancer slow growing? If part of colon has been removed (not cancer) does that increase risk?
Speaker_-_Dr__Carol_Burke: It is believed that it takes 10 years for normal colon to develop a polyp and the polyp to turn into cancer. Removing part of the colon does not increase the risk of colorectal cancer.
junebug: What types of questions should I be prepared to ask if the pathology report comes back positive for colon cancer? Would I ask the gastroenterologist or the cancer specialist?
Dr__Robert_Pelley: After colonoscopy and polyp removal, the gastroenterologist will inform the patient as to how things appeared during the exam and will reassure you before leaving the recovery room. Most gastroenterologists know by the look of the large or irregular polyps or masses whether there is anything of concern on the exam even sending the tissue to the lab. When they get the miscroscopic nature of the polyp back from the lab they will advise you of that and the recommendations for follow up. Most polyps are removed in their entirety at the time of colonoscopy. If they were not able to be totally removed, because of the size or number of polyps, additional colonoscopies or surgery may be required. If cancer was detected, the patient will be referred to a surgeon to either perform immediate surgery or consider preoperative radiation therapy, if the polyp was located in the rectum. The surgeon will explain these options.
mothermayi: How common is colorectal cancer? Do people typically have symptoms of colorectal cancer?
Dr__Robert_Pelley: Colon and rectal cancer in the US affects 1 out of 22 Americans at sometime in their life. It affects men slightly more often than women. If a person has a first degree relative with colon and rectal cancer (parents, sibling, children), then their risk increases to approximately 1 out of 15. Overall, 150,000 American men and women will get colon and/or rectum cancer each year.
For the most part, colon and rectal cancer are silent. When the disease is advanced, it will cause visible bleeding in the stool or may produce nonspecific abdominal symptoms such as: bloating, pain, or a change of bowel habits. Since these symptoms are nonspecific and occur with many benign conditions, they are generally very common and cannot identify people with colon or rectal cancer. Therefore, screening colonoscopies are very important to find these diseases early when they can be treated more easily.
happydays: If cancer is detected, what are my treatment options?
Dr__Robert_Pelley: A possible cancer is usually found on a colonoscopy as a larger than average polyp. Determining whether it is cancer or not can only be accomplished by performing a biopsy. Once cancer is established, the cancer must be surgically removed. Efforts at treating cancer with chemotherapy, immunotherapy and radiation therapy alone are not successful at eradicating the cancer. Therefore, surgery must be performed, which also gives information about the cancer, helping doctors to determine the extent or stage of the cancer (whether lymph nodes are involved or not). If lymph nodes are involved, then the tumor has a higher chance of microscopically spreading and those patients may benefit by receiving chemotherapy, which can eradicate microscopic disease.
If the cancer occurs within 6 inches of the anus (rectum), radiation therapy may also be useful.
howcome: What types of medical therapy options do you offer for colon cancer?
Dr__Robert_Pelley: Medical therapy is limited to chemotherapy and radiation therapy. Chemotherapy is used after surgery for high risk colon cancer patients, who may be at risk for recurrence of their tumor. Radiation therapy is used with chemotherapy for high risk rectum cancer patients. Immunotherapy and nutritional therapy have failed to improve survival for patients after surgery and are currently not used.
Chemotherapy and radiation therapy are both used for patients with metastatic cancer. Immunotherapy, using antibodies, have been beneficial in this setting and are routinely used. Again, nutritional therapy has failed to show a major impact with metastatic cancer.
kudaking: How often is radiation or chemotherapy used as a follow-up to colon cancer surgery? What are the factors in determining which is used?
Dr__Robert_Pelley: Follow-up chemotherapy is called adjuvant therapy. It is given after surgery, when the surgery is felt to have gotten all of the cancer out with a significant chance for cure. However, there may still be a significant chance for the tumor to recur because of invisible microscopic disease which might have been left behind and the chemotherapy is intended to kill that microscopic disease.
Risks for the cancer returning include: involvement of the lymph nodes or the tumor penetrating outside the colon and adhering to another organ. This happens about 1/3 of the time. Therapy includes chemotherapy which is given for 6 months.
kudaking: If radiation or chemotherapy is used as a follow up to surgery, how is the choice made between them?
Dr__Robert_Pelley: Radiation therapy is only utilized when the tumor occurs within the pelvis (rectum), and can be given before or after surgical removal. Radiation can also be used for colon cancer if there is tumor left behind after attempted surgery. Otherwise, radiation therapy is almost never used when treating colon cancer.
Chemotherapy is used for either colon or rectum cancer if lymph node involvement is found at the time of surgery.
slayer: What type of problems does radiation cause? For instance, 12 CT scans & 18 chest x-rays in 10 months? Is that too much radiation for a colonoscopy or digestive tract procedure?
Dr__Robert_Pelley: There have recently been studies indicating a risk for excessive CT scans in certain age groups. The patients who received CT scans did not have an increased risk of developing cancer before they had 20 CT scans. In addition, it took over 20 years for the cancer to develop, and the risks were still relatively small.
When a patient has an active cancer, it is much more important that the cancer be staged properly, and this will require some CT scans. Generally, we do not obtain more than 4 per year, unless it is medically necessary.
There is no radiation exposure during most colonoscopies and this should not be an added risk.
Surgery for Colon Cancer
hallie: What are the treatments for colon cancer? Surgery vs. chemotherapy?
Dr__Robert_Pelley: Surgery is a necessary step in curing colon cancers. Chemotherapy may be added to it in high risk patients with lymph node positive disease. Chemotherapy may be given to patients with advanced colon cancer which cannot be removed. In that situation, it may help prolong life and treat symptoms, but it cannot be curative.
kudaking: If cancer is detected in a colonoscopy, how soon is surgery recommended?
Dr__Robert_Pelley: Since colon cancer may take years to develop, there is evidence that delaying surgery by a few weeks to a few months may not be critical to the ultimate outcome or cure rate.
What is more important is the proper staging of the cancer before surgery (CT scans, blood work, etc.) and the choice of a experienced surgeon who is skilled in treating the disease.
lilypad: Is there a minimally invasive surgical option for colon cancer?
Dr__Scott_Strong: Colon cancer can be treated with conventional open surgery or using a minimally invasive approach with laparoscopy. Either approach is acceptable and depends on the surgeon's skills and preference.
Jerry: I’ve heard of a J-pouch as a surgical treatment option for colon cancer. Can you tell me about that procedure?
Dr__Scott_Strong: Selected patients undergoing surgery for low-lying rectal cancers often experience fewer stools if a bowel reservoir is constructed and joined to the muscles that provide control over bowel motions. This reservoir can be configured like a "J", but other configurations are also employed.
JJBonder: If colon cancer is treated, will I have to have an external ‘bag?’
Dr__Scott_Strong: Most patients undergoing surgery for cancer of the colon or rectum do not require any form of external "bag" called a stoma. Only those patients with very low lying cancers of the rectum typically require a permanent stoma while others may need a temporary stoma for 3-6 months.
hearit: Does removing a polyp leave a hole in your colon?
Dr__Scott_Strong: Polyps can generally be removed during a colonoscopy, which might leave a small hole in the bowel lining. The hole rapidly heals over the ensuing 1-2 weeks and does not present any danger except for a 1-2% chance of bleeding that usually stops without treatment. Rarely (0.1-0.2% of instances), a hole through the entire bowel wall can occur when a polyp is removed, which may require an operation to correct.
kudaking: How do I find an experienced surgeon?
Dr__Robert_Pelley: You want to look at the volume of surgeries the doctor has performed, their credentialing, including location of training and whether they are board certified. We can provide you with a "checklist" of organizations that help provide this information. Tertiary referral centers will generally provide this information regarding their surgeons, including if they are involved in a multidisciplinary program.
Post Colon Cancer
Howard_O3H: Does it make a difference where I am treated for colon cancer?
Speaker_-_Dr__Carol_Burke: There are a number of studies reported in the medical literature that report better outcomes when patients are seen at referral centers with higher volumes of specific diseases, such as colon or rectum cancer.
dragontails: How is follow up care managed for colon cancer patients?
Dr__Robert_Pelley: Following surgery and completion of any adjuvant chemotherapy or radiation therapy, the routine is for the patient to be seen every three months for two years. Each visit, blood work and a physical examination are performed. Patients also have a yearly CT scan performed. If after 2 years, there is no sign of the cancer recurring, these visits are decreased to every 6 months, until 5 years after surgery. Special tests, such as PET scans, are reserved for situations where CT scans or blood tests are ambiguous.
1234: Do you have anyone I can talk to who is going through the same experience with colon cancer?
Dr__Robert_Pelley: The Cancer Center at the Cleveland Clinic (Taussig Cancer Institute) has a program where former patients mentor active patients, in a program called the Fourth Angel Mentoring Program. There are also a number of support groups for cancer patients in general.
lovingyou: Do my lifestyle choices affect my risk for colon cancer?
Speaker_-_Dr__Carol_Burke: Couch potatoes beware! There are modifiable risk factors that you can work on to decrease your risk of polyps and cancer. Smoking and being overweight or obese (by BMI) increase your risk 2 fold. Increase physical activity to 40 minutes 5 times per week and avoid high fat, red and processed meats, low fruit, and vegetable and grain diets.
Bozo: Are colon cleanse products a good substitute for one or two vegetables a day?
Speaker_-_Dr__Carol_Burke: There is no substitute for eating from Mother Nature. There is also absolutely no data that colon cleanse products offer any health advantage. They are however associated with risks of perforation and colon damage. The best fuel for your colon is a 25 gram daily fiber diet which may require a fiber supplement to get to that dose.
jewels: Would you discuss fiber supplementation such as Metamucil® or Benefiber®?
Speaker_-_Dr__Carol_Burke: A high fiber diet is a healthy diet for the colon and the rest of the body to prevent disease and maintain health. The amount of fiber recommended for colon health is 25 grams per day, which often requires a fiber supplement. The type of supplement to get to that level does not matter. Whatever type works for you, powder, bars, tablets, taste with reasonable cost. Best to try with mostly dietary ways, fruits, veggies, grains and fibers.
playdough: What about probiotics? Are they helpful in bowel health?
Speaker_-_Dr__Carol_Burke: No data to suggest probiotics prevent colon polyps or cancer.
Research and Clinical Trials
how2: Do you offer any clinical trials for colon cancer?
Dr__Robert_Pelley: Yes, Cleveland Clinic offers a number of levels of clinical trials for colon and rectum cancer. We participate in large randomized national trials overseen by the NCI (National Cancer Institute), but we also have trials unique to the Cleveland Clinic, especially for patients with metastatic disease.
Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic gastroenterologist Dr. Carol Burke, colorectal surgeon Dr. Scott Strong and oncologist Dr. Robert Pelley is now over. Thank you again doctors for taking the time to answer our questions about colorectal polyps and cancer.
Speaker_-_Dr__Carol_Burke: Thank you for taking the time to chat with us today.
Speaker_-_Dr__Scott_Strong: I enjoyed being here today.
Speaker_-_Dr__Robert_Pelley: We hope we were able to answer your questions here today.
Cleveland_Clinic_Host: Visit clevelandclinic.org/score to take a free, quick and easy risk assessment to determine your personal risk for colon cancer. You’ll receive personalized recommendations for screening guidelines and lifestyle choice improvements. You’ll also find valuable information on digestive health and colon cancer prevention as well as clinical trials available for colon cancer.
Cleveland Clinic is ranked #1 in Ohio for both digestive diseases and cancer care by U.S. News & World Report.
Cleveland Clinic Digestive Disease Institute (DDI) is the first of its kind to unite all specialists within one unique, fully integrated model of care - aimed at optimizing patient experience. At DDI we offer patients the most advanced, safest and proven medical and surgical treatments primarily focused on the gastrointestinal tract. Our Institute includes:
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