Reducing Your Risk of Colorectal Cancer

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi again, everyone, and welcome to another episode of Butts and Guts. I'm your host Scott Steele, the president of main campus and colorectal surgeon here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, I'm absolutely pleased always to have one of my colleagues and companions and friends, Dr. Joseph Trunzo, who is a colorectal surgeon within the Cleveland Clinic Digestive Disease Institute and program director for our general surgery residency.

Joe, welcome to Butts & Guts.

Dr. Joseph Trunzo: Thank you for having me. I'm really happy to be part of this. Thank you.

Dr. Scott Steele: So today, we're going to talk a little bit about preventing or reducing your risk of colorectal cancer. But before we jump into that, give the listeners a little bit about your background. Where are you from, where'd you train, and how did it come to the point that you're here at the Cleveland Clinic?

Dr. Joseph Trunzo: So I'm actually originally from the Cleveland area. I did grow up in this area. I went elsewhere for my education, medical school at Wright State University, and then came back to the Cleveland area for my residency. And ultimately, finished my fellowship at the Cleveland Clinic and then stayed in the community here as a colorectal surgeon. And then joined the Cleveland Clinic back in 2017, I've been here in my position since 2017.

Dr. Scott Steele: Well, we are super excited to have you here. So we're going to talk about colorectal cancer today, something, the subject that's near-and-dear to your heart. So at a very high level, can you walk us through what is colorectal cancer and how common is it?

Dr. Joseph Trunzo: Colorectal cancer is a growth of the colon or rectum. It is the third most common cancer that we see presenting in men and women. Breast, and lung and prostate being the others. We see it an increasing amount in this country. There's about 150,000 new diagnoses a year to date according to the American Cancer Society, the most recent literature.

Dr. Scott Steele: So Joe, we've obviously been hearing some alarming news about colorectal cancer rates, especially in younger adults. Can you walk us through a little bit about what we know, what's happening? And obviously, why are we so concerned about this trend?

Dr. Joseph Trunzo: It is a troubling trend that we continue to see in increasing numbers in the younger population. A number of years ago, we had reduced the screening age from 50 to 45 because of this trend. Since the '90s, we've actually seen a two to three percent increase in the age 20 to 40-year-old group increasing diagnosis of colorectal cancer. The concern is that we were doing such a good job with screening in the older age population and missing some of these younger folks. The problem is is there are some environmental or personal exposures that have changed in our environment and how that has changed why we're seeing younger folks presenting with new diagnosis of cancer.

Dr. Scott Steele: Joe, our GI health isn't something we sit around the table and talk a whole lot about, but can you give us some warning signs or symptoms that might make someone think that they should see a doctor potentially about colorectal cancer or benign disease?

Dr. Joseph Trunzo: Yeah, certainly. One of the most common things we always talk about is are people seeing blood in their stool or when they go to the bathroom and that's probably one of the first signs there could be something going on. Now, there are many things that can be benign causes of why someone might see blood, but in the situation where that is a new finding for yourself, we would always encourage you to talk to your medical doctor about that finding and see if you need to be evaluated for or screened for colon cancer and things like that.

Other things to consider are changing bowel habits. Sometimes we don't see blood when there's cancer, but there could be some other GI-related changes that might be some indicator that something else is going on. Abdominal pain being a third very general one and there's a lot of things that can cause some abdominal pain. But again, new changes in your day-to-day life that don't seem to resolve in what we say is the short term, probably something to be looked at.

Dr. Scott Steele: And Joe, certainly we're not saying that if you have any of those symptoms, you for sure have colorectal cancer. But as you said, it's important to be able to go in and get evaluated. So can you have colorectal cancer and be asymptomatic, have no symptoms at all?

Dr. Joseph Trunzo: Yeah, certainly. That's one of the more difficult things for us to hone in on. There can be a period of time where you have zero symptoms and then many times, when the symptoms do present, it's further down the line. So yes, it's possible and that's why if there are some other family-related history or if you're of age to be screened, you should do that. Because just because there's no symptoms does not mean that you could be either in the early stages of such a thing or the possibility that it could happen for you.

Dr. Scott Steele: So let's dig in a little bit more there and I know you briefly mentioned it. So what are the current screening recommendations for colorectal cancer? And at what age should most people start getting screened?

Dr. Joseph Trunzo: Yeah. For a low risk group across our entire country, everyone is recommended to be screened at age 45. There are other factors that would drive them down. If you have a family history, and certainly if you've had a first-degree relative, mother, father, sibling that has had colorectal cancer would potentially tell you to screen earlier at age 40 or at least 10 years prior to their diagnosis.

Dr. Scott Steele: Joe, you mentioned this right there. Why is knowing your family history such an important risk factor when it comes to colorectal cancer?

Dr. Joseph Trunzo: Well, we know that once you have a family history, it does increase your overall risk of developing colon cancer. And then there are some small subsets of genetic component where you could have a genetic disorder throughout your family that would put you at a higher risk category than the general population.

Dr. Scott Steele: So Joe, is colonoscopy the only way to screen for colorectal cancer? Are there other options available? And then what's the difference, if you will, between colonoscopy and these other options?

Dr. Joseph Trunzo: So the other options that you have are fecal occult test, which you do at home. It's a stool swab test to look for any blood that's mixed in your stool. It's something that's been around for quite some time, but it does have some inaccurate or false positives at times, or false negatives, so it's not as sensitive or specific as a test.

Beyond that, there's another stool swab test that you take at home, a card test. It's called a FIT test. It's a little more sensitive looking at the tissue and is less likely to give you some misinformation. Again, this is something that's done at your home.

Something more beyond that and you may have heard about that is a stool DNA test where you mail a specimen into the provider and they, looking for DNA in your stool that potentially shows that there's some abnormality, whether it's cancer or polyps, or something else that could be going on that needs to have a further investigation.

The main difference between these tests and a colonoscopy is with a colonoscopy, we're looking for these little growths called polyps. If we see something, we can potentially treat it by removing it or biopsying it. So that we have the ability to not only screen, but also treat during that intervention with a colonoscopy, which the other tests are just for screening alone. If one of those tests does come back positive, you ultimately will need to go onto a colonoscopy so we can better discern what exactly was causing that abnormal test.

So again, the gold standard is a colonoscopy because of the reasons I described, that we can actually do something or treat and have a better assessment of what's going on throughout the colon.

Dr. Scott Steele: So Joe, we're talking not only about screening, but also about potential other options for reducing your risk of colorectal cancer beyond screening. So let's look at a few things that people can do in their daily lives to reduce that risk of colorectal cancer. Let's talk a little bit first about diet and nutrition.

We hear a lot about red meat, processed foods, sedentary lifestyles that potentially increase the risk of cancer. What does science actually tell us about our food choices and/or physical activity and how does it affect colorectal cancer risk?

Dr. Joseph Trunzo: It is one of those, when we try to look at risk factors among people, family history we talk a lot about, but one of the things that sometimes gets left behind is the things that we put into our bodies, dietary, making poor choices, lifestyle, having a sedentary lifestyle. These have been contributors to people that have increased risk than the general population. So how it affects our makeup within our colon and these processed foods, heavy amounts of red meat seems to have some effect on the way we are able to prevent development of colorectal cancer. And certainly, in those situations, if you don't live a healthier lifestyle, it does put you in a higher risk category.

Dr. Scott Steele: What about alcohol and smoking, Joe? Do they play a role in colorectal cancer?

Dr. Joseph Trunzo: They can and actually, they do. And unfortunately, alcohol and smoking can contribute to a lot of different types of cancer. We know about lung, pancreatic cancer, liver cancers. Colorectal cancer is no different. The carcinogens or the negative effects of these addictive habits can put you, again, in another risk category for colorectal cancer as it does in those other cancers.

Dr. Scott Steele: So we talked about some of the major ones. Are there other maybe lesser known risk factors that people might not commonly associate with an increased chance of developing colorectal cancer?

Dr. Joseph Trunzo: There are a couple. Diabetes, type two diabetes with increasing insulin also has shown some. So poorly-controlled diabetic type twos can have some increased risk. Patients that have had a history of inflammatory bowel disease, ulcerative colitis or Crohn's disease being in those two categories, they are another increased risk of developing colon cancer over the general population.

And then certainly, if you do know or have a family history of one of these genetic disorders, such as Lynch syndrome or familial adenomatous polyposis syndrome, FAP, and there are some other lesser known genetic disorders, those will also increase your risk. So this, again, goes back to the family history component, but there are some that actually have a linear genetic history.

Dr. Scott Steele: So Joe, are there any exciting new advances, anything on the horizon in terms of colorectal cancer research, treatment, prevention that you think that our listeners should know more about?

Dr. Joseph Trunzo: Yeah. Fortunately, we have been making some new advances in immunotherapy. There are certain cancers that have some genetic changes that make them very sensitive to immunotherapy and we've seen such large success in treatment of specifically rectal cancer and certainly colon cancer, depending on some of the biochemical makeup of the tumors. So the chemotherapy treatments have been altered and we have found some huge success with some of these other discoveries in science.

Dr. Scott Steele: Okay. So I'm a listener out there and you got me thinking here, and I want to go towards having a colonoscopy. What should their first steps be? How can they advocate for themselves?

Dr. Joseph Trunzo: That's a great question. I think by-and-large, if you're coming up on the age of 45 and even though you have no symptoms, I think it's doing your due diligence and bringing it up to your primary care doctor. Hopefully, they're bringing it up to you about your normal screenings. For women, breast cancer, for men, prostate cancer, and additionally colorectal cancer. Bringing that up to them is important.

Certainly, if you have symptoms or have questionable symptoms, bringing it to your primary care doctor. Or if you're in contact with a gastroenterologist, which is the medical specialist of a GI disorder, or someone like myself or Dr. Steele, colorectal surgeons that would be happy to help you navigate so that you can make sure that you're getting screened properly during your age group.

Dr. Scott Steele: Yeah, absolutely. So now it's time for our quick hitters, a chance to get to know our guest a little bit better. So first of all, Joe, salt or sweet?

Dr. Joseph Trunzo: Sweet.

Dr. Scott Steele: What was your first car?

Dr. Joseph Trunzo: A 1985 Mustang beater four-speed stick. Four-gear stick.

Dr. Scott Steele: Fantastic. So if you could have a superhero power, what would it be?

Dr. Joseph Trunzo: Ooh, to walk through walls.

Dr. Scott Steele: Fantastic. And finally, if you could go back maybe to time just before medical school and give yourself a piece of advice, what would that piece of advice be?

Dr. Joseph Trunzo: If I'm back to medical school, let's see. I would say take care of myself physically health-wise. I got out of running, I got back into running. I wish I would have done it all throughout because I think I feel better when I'm staying more active and it goes along with our theme for keeping up a good healthy lifestyle. It's very easy to put yourself on the back-burner when you spend all the time in the library and studying.

Dr. Scott Steele: Fantastic. As a fellow runner, all you need is a pair of shoes and a road. So give us a final take home message to our listeners regarding preventing or reducing your risk of colorectal cancer?

Dr. Joseph Trunzo: Yeah. I think it is, you already touched on it, being your own advocate. Hopefully, we try to get the message out that you should be seeking screening once you turn age 45, but certainly if there are symptoms. Don't sit on those symptoms, don't wait around on those symptoms because one of the things about colorectal cancer is it is a very preventable and treatable-type cancer. And if we do find it early on, you can be cured of that disorder with a number of medical treatments, surgery sometimes, sometimes also medical therapy. But ignoring symptoms for long periods of time will make it more challenging for us to treat you, but we do have a great team here and across the country that can help you with colon cancer. And that's one of the things that we are fortunate that it is a treatable cancer.

Dr. Scott Steele: Fantastic. So to learn more about Cleveland Clinic's accredited colorectal cancer program or to schedule an appointment for treatment, call 866.223.8100. That's 866.223.8100. You can also visit clevelandclinic.org/colonoscopy for more information on screening options. That's clevelandclinic.org/colonoscopy.

Dr. Trunzo, thanks for joining us on Butts & Guts.

Dr. Joseph Trunzo: Thanks a lot for having me. Appreciate it.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.