Innovative Surgery Helping Young Mom Beat Rectal Cancer

Podcast Transcript

Kyle: Hey everybody welcome to The Comeback, I'm your host Kyle Michael Miller. During this episode we're talking with Annie Schreiber, a young mom who's part of an alarming trend adults under the age of 50 being diagnosed with colorectal cancer. We're also joined by Annie’s surgeon chairman of colorectal surgery at Cleveland Clinic, Dr. Scott Steele but first here's Annie in her own words. 

Annie: My name is Annie Schreiber. I'm 36 years old and I am currently living in West Lafayette, Indiana. So, I'm married to my husband, Sven. So we've been married 12 years just this past March 18th and we have three kids, one son Calvin and two daughters Evelyn and Sylvia. It was in late July, I think, or maybe early July that I first went to my family doctor, last July, and really talked about some symptoms I was having that were indicative of hemorrhoids and something that seemed much more benign than it turned out to be. The doctor told me to increase fiber intake and make sure I was getting plenty of water and to wait a month to assess whether the symptoms went away by themselves. I was ultimately diagnosed with rectal cancer so I had adenocarcinoma of the rectum. I was treated initially with a local excision surgery and then I came to the Cleveland Clinic for more extensive surgery and that removed more of the tissue and lymph nodes. My ultimate goal is to live a long time. So, I have young children that I would love to raise. I'd like to be here another 50 years if possible but certainly, certainly in the short term my goal is to survive. 

Kyle: Annie is joining us on the phone from her home in Indiana. Annie thanks for calling in today.

Annie: You're welcome.

Kyle: And Dr. Steele thank you for being with us here in studio. Annie, I know that you are young, you have three kids and you're beating rectal cancer. Is that correct?

Annie: Yes.

Kyle: Tell me a little bit about your kids.

Annie: So I have three kids, a son who's eight, and two daughters who are six and three and, you know, they're just typical kids, they're in third grade, kindergarten, and preschool. Working on things like potty training, and doing our best work at school, learning how to raise a boy which is interesting since I grew up in a family of all girls.

Kyle: So they keep you pretty busy I bet.

Annie: very busy. Yes.

Kyle: Annie when did you first learn that younger people were at risk for colorectal cancer?

Annie: So, I read an article about that back in July or August of 2017 and it is an online article and it really, the first, that was the first time I had heard that her peculiar piece of data.

Kyle: Annie when you read that CNN article did it surprise you that the two other patients that were in that story were the same age as you?

Annie: Yes, it was surprising and shocking. It was scary honestly.

Kyle: How soon after you read that article did you go and get a colonoscopy?

Annie: I think it was about a week later. So, pretty quickly.

Kyle: Dr. Steele Annie isn't alone. There's, there's a trend of younger people being diagnosed with colorectal cancer at a really young age. Can you talk a little about that trend and why you think we're seeing it?

Steele: Yeah it's a great question. It's also the question that I don't think we have a really great answer for right now. What I would tell you is that cancer is multifactorial, you know, whether it's environmental issues, whether it's, you know, exposure type issues, things you eat, and then also the genetic component that certain people are just at risk and this may be aside from the people who have a very strong family history and so there's no question that we're seeing kind of a push towards the left, towards younger ages or what it is. I think the thing that Annie highlighted a couple of very important points in her, in her answers there and the first one is is that she mentioned that I could have symptoms that are either A- hemorrhoids or they’re cancer and what I would say is that, still to this day, it's important that people know two major things. Number one, that the majority of patients, obviously Annie excluded, have benign diseases and they tend to be something that is generally something in the anal-rectal region such as hemorrhoids or, or the like but more importantly is that it could be something else and so, don't ignore your symptoms and she did the right thing, she didn't ignore those symptoms and went in and got evaluated and it did lead to something that, you know, could be treated and cured and taken care of at an early stage.

Kyle: And I just think what if she hadn't read that CNN article that day?

Steele: Yeah, exactly right.

Kyle: Yeah I know that you performed a new procedure or a newer procedure on Annie, T-A-T-M-E. How is that different from some of the other ways you can treat colorectal cancer?

Steele: So, it's important to understand with any cancer, but specifically with rectal cancer there's kind of three different main ways of therapy; radiation therapy, chemotherapy, and surgery and still within rectal cancer surgery is still a mainstay. So, it's also important that people understand that you may be somebody that for whatever reason, whether it's the type of tumor that you have, or the location specifically that it is in, that you may need one or all three and so the surgery for many times of very early rectal cancers might just be involved, just removing the cancer itself but in general we need to not only remove the cancer, but also the lymph nodes that are behind it and so in Annie’s case it's important to understand that rectal cancer in general, also we’re one long garden hose from our mouths to our bottoms, and you have to understand that in order to cut out a rectal cancer you have to not only take out the cancer itself but take out the margins around it and as the tumor gets a little bit lower the margins around that tumor, meaning the good tissue, that there's no cancer at the edges of where we cut out, can encroach upon the muscles what we call the sphincters right down at your bottom which is called your anus, and so those muscles are important so that when you want to hold in gas, or liquid, or stool or anything like that, that you are able to do that and so the trans anal approach really takes the hardest part of the procedure, especially for people who have very low tumors and makes sure,  number one, that you're looking right at that tumor, that you get great margins on it, and you kind of do a bottoms up approach combined with a minimally invasive procedure on the belly and you kind of connect in the middle to take out not only the tumor with good margins around it, but also take out that lymph node package and allow you the ability to basically still keep the all the benefits of having a minimally invasive procedure.

Kyle: You said all of that so eloquently, I don't think anybody could have said it as well as you just did.

Annie, I know there was a critical moment for you when you woke up from surgery and it had to do with the right or left. Can you tell us about that?

Annie: Yes, so when we talked to Dr. Steele we, we understood that we were going to try the trans anal TME approach and go with a temporary ileostomy that could be reversed later so that the coloanal anastomosis would allow me to basically poop in the normal way and that the other option would have been a permanent colostomy and we weren't 100 percent sure going into the procedure which one would be appropriate. So, it was really just trying to figure out where the ostomy was, whether it was on the right or the left, and so it was on the right which was encouraging. I was pretty out of it when I woke up obviously but it was so good to find it on the right side.

Kyle: Dr. Steele but for some patients that's, that's the only option is to have a colostomy bag. Absolutely but for other patients like Annie this improves her quality of life.

Steele: You know I’ve heard Annie say that before as a matter of fact, I may have actually the first time I read that, and it's funny because sometimes as a physician you know the things that come out of your mouth you don't, you don't always know, even though I’ve been a patient myself, the things we hang on and so I'm always struck by that was one of her initial thoughts. It was a very powerful image for me it's a very, kind of almost chokes me up when I think about her waking up from surgery because I was there, she was a little out of it as she said, but you know she was there and I would tell you that the point you bring up is very eloquent in many ways because you're right, in some cases having a permanent bag is the absolute right thing. There's two important things to think about with rectal cancer. First and foremost, is making sure we get an adequate cancer operation. Function is the second thing so, we want everybody to not have a bag, you know, that would be great if we can you know restore so that is and he said people can poop in a normal way. Right? That's, that's the way that most people were born you know, not everybody, but almost everybody was born in that way. And so if we can restore that ability that's great, but function comes along with the fact that if you have an inability to control, then that's not necessarily going to be the greatest quality of life ever. If you have leakage, and you can't really go anywhere because you're scared about the ability that you can't hold anything in and that's very, very difficult. So sometimes colostomy is the right reason for first that she did the right cancer operation with good margins which has to take all of the sphincter and then number two, that your function is still there so that you can have the quality of life that you need to and not be hampered by your bowel movements, or inability to control them.

Kyle: Annie, where are you at in the treatment process right now?

Annie: I'm on chemotherapy which I have about another month to go with that and I think I'm done with surgeries for now at least.

Kyle: That's a good thing. Yeah, and how are you balancing going back to work, raising those three kids, you're married. How is that all going?

Annie: So, it has its challenges. I needed to move my office closer to the restroom so, I did that. Fortunately, my workplace is pretty supportive of that. It's been, it's been good to work at a company that I’ve been at for about 13 years so, it's been nice to have some of that flexibility in terms of days where I'm not well and that kind of thing so, work has been easier to balance than some things. I think the hardest part for me right now with some of the symptoms that chemotherapy brings on is just being able to go out and do things and take my kids places right now that's, that's still a challenge.

Kyle: Right. And Doctor Steele that that will get easier for her, correct?

Steele: Yeah, typically that as time goes on that a lot of the symptoms unfortunately with any treatment there is whether it be chemotherapy, or whether the medications we take, or whether it be surgery is that you do have a plus side and a downside of everything and one of the downsides specifically to having any low surgery is that you're gonna, there is a new you for sure in terms of having bowel movements but you know, you're hearing the raw, of any rate, in the middle of chemotherapy and some some, some of the side effects that you get from chemotherapy exacerbate those bowel symptoms and that can make it even a little more hard than it would normally be. So, I'm excited to have her be done and through with chemotherapy and have things settle out a little bit more.

Kyle: Dr. Steele what are the current recommendations for colonoscopies and do you think they should be changed given the current trend? 

Steele: Yes, so it's important I understand that when you talk about colonoscopy you mix it into both screening and then kind of a diagnostic one so, the easiest part is the diagnosis, here's you're somebody you're having symptoms, you’re having blood or whatever. All bets are off, you don't go by age, or go by anything else if you're having symptoms it's important to talk to your doctor and if they don't see an obvious source of that, they may need to have a colonoscopy as a part of that, so that's, that's a totally different scenario. What you're talking about is screening and for the average age individual what we're talking about is screening is at the average of 50 years old. Now, there's a couple of caveats to that. More recently, for African-Americans specifically, you know, the screening moved to 45 and there's some push for those people who have what we call metabolic syndrome that, you know, is associated with higher BMI that that might be the next thing to push to 45. You should know your family history so if you have a first degree relative or several second degree relatives that have colon or rectal cancer, or maybe a different type of cancer that's associated with it such as some gynecological cancers that you might be somebody who needs to be screened a little bit earlier than age 50 and then there's other types of components that you would say that, such as, people who have inflammatory bowel disease that we may want to look at a little bit earlier. I wouldn't be surprised if in the next few years, or maybe even sooner to that, that the national guidelines would recommend that we're going to see potentially a push to the left or almost everybody is being asked to be screened at age 45. We try to balance between, you know, number one, your bang for your buck. Right? So, there's a lot of different tests that we could get but the vast majority of cases that you're not going to have colorectal cancer, you know, at age 30 or 36 in Annie’s case, I mean she is the exception, there's no question but something is going on. We're seeing a trend and we want to make sure that the take home message for everybody listening to this podcast is don't ignore the symptoms that you have. Be able to understand that your body is telling you something and in the majority of cases it's probably benign but that doesn't mean that you don't need to go in to get those checked out too.

Kyle: So, we're going to play a little game now. Called, it's called Go Fish. Annie we have a fishbowl here in studio. I know that you can't see it. Usually we have our patients will go in and go fishing for a few questions. I’m going to ask Dr. Steele to do that. So he's reaching into the fishbowl right now. He's going to pull out a question, Dr. Steele will you ask it to Annie? And then Annie you give us your answer.

Steele: Here we go Annie. So what song would you use to describe your journey? 

Annie: So when I was diagnosed, I'm really, I like all kinds of eclectic music, but when I was diagnosed, my sister, who has a background in marketing, decided that our family marketing campaign was going to be Beat It by Michael Jackson, so she made me a T-shirt and she gave me a bracelet and so that's, that's been our song and the kids really like it. They love to dance it.

Kyle: That's awesome, it's a great song right?

Steele: Number two here we go. What's one thing you took for granted before that you cherish now?

Annie: Putting my kids to bed. So, you know, you're tired at the end of the day, at least I am tired at the end of the day, and oftentimes I would sort of rush that process and try to sort of read a quicker book, pick a smaller book please, or you know, no I do not want to sing you all three songs, and you know, that's, that's just different now and I just look at that differently and it's just, you know, not that I'm not still tired it's just that it's, that time is more meaningful.

Kyle: Let's do one more question.

Steele: What advice do you have for others?

Annie: Pay attention and be your own advocate. You know, pay attention to the symptoms, that's number one but if it is something, like cancer, is the diagnosis, one of the most important things that we did was really shop for the right doctor and the right clinic and I can't say enough about how important that was in this case. So, you know, I have nothing against the medical systems in my local community but when you're facing something that's unusual because I'm young, and it's in a low spot, and the surgery is somewhat complex, it was really important to make sure that we went to a top notch facility and found a top notch physician.

Kyle: Dr. Steele is really humble, he’s not even smiling.

Steele: I was going to say, who was that person you went to Annie? We are absolutely proud to be here and you know I can't say enough, I guess, I would say very generically that it's, it's, it's stories like Annie's that, you know, on long days and hard days when my wife says you know, are you coming home? And I'm like, I got a few more hours I got to go there, it's, it's the ability to meet patients like Annie, and more importantly people like Annie that make my job, I always say the best job in the world.

Kyle: That's great. Guys, we are just about out of time today, Annie do you have any, any parting words anything you like to say to end our podcast?

Annie: No, just thank you for, thank you for the time and I hope the listeners, you know, get some value out of this and really are aware that this is a disease that can be, you know, beaten and cured.

Kyle: Well, Annie thanks for calling in and Dr. Steele thank you so much for joining us here in studio and thank you everybody for listening, you can find additional podcast episodes on our website clevelandclinic.org/podcasts, on iTunes and Google Play.