Guest: Jerald D. Wishner, MD, FACS
Presenter: Neal Howard
Guest Bio: Dr. Jerald Wishner is the Co-Director for The Institute for Robotic and Minimally Invasive Surgery and the Medical Director for the Colorectal Surgery Program at Northern Westchester Hospital. Dr. Wishner is Fellowship trained in both colorectal and minimally invasive surgery, has received advanced training in robotic laparoscopic surgery, and has been designated as a trainer for robotic general and colorectal surgery by Intuitive Surgical.
Segment overview: March is Colon Cancer Awareness Month and Dr. Jerald Wishner discusses a new report from the American Cancer Society that suggests colorectal cancer rates are rising sharply among younger people (both millennials and Gen X).
Transcription – Colorectal Cancer Awareness Month
Neal Howard: Welcome to the program. I’m your host Neal Howard, thank you for joining us here on Health Professional Radio. Our guest today is Dr. Jerald Wishner, Director of the Minimally Invasive and Colorectal Surgery Program at Northern Westchester Hospital. He’s here today to talk with us about a new report from the American Cancer Society that suggests that colorectal cancer rates are rising sharply among younger people. Welcome to the program Dr. Wishner.
Dr. Jerald Wishner: Thank you very much for having me today.
N: Thanks for coming in. When I hear colorectal cancer, I immediately get a middle-age guy who neglected to get rectal exams his entire life. Now, anybody is a prime candidate for colorectal cancer?
W: Sure. I wouldn’t say anybody is a prime candidate for it because as you kind of eluded to, it’s still a disease for the most part down in older individuals, patients in their 60s and 70s. But I think all physicians who treat patients with colorectal cancer have noted over the past decade or 20 years that we’re seeing an increased frequency in the number of 30 year olds and even occasionally someone in their 20s will be showing up colorectal cancer. The younger patients still make up for relatively a small fraction of the patients we see. The study you elude too is kind of validates what I think a lot of doctors have been saying is that we are absolutely seeing a rise particularly in younger patients which is obviously very concerning.
N: Now even though we’ve only got a few days of this month left, it is Colon Cancer Awareness Month. As far as the study is concerned, what is it that is causing this sharp rise, not just a rise but a sharp rise among millennials and gen X-ers even?
W: Right, to understand the background a bit so approximately, 90,000 – 100,000 patients in the United States are diagnosed with colon cancer each year and maybe another 30,000 or 40,000 with rectal cancer. Again, most of those are older patients and through early surveillance and screening mainly colonoscopy, we’re able to detect cancers at the very early stage and in fact, we’re able to identify polyps in the colon which are precursors of the cancer where are the polyps are removed through the colonoscopy, they don’t have the chance to develop into a cancer. We’re very good at preventing this cancer which is why pretty much across the board, the rates of colon and rectal cancer have been steadily dropping in the United States. Now the only change and what really shocked everyone when the study came out is that all the rates are dropping in the older patients, we see an increase almost two pole plus in the younger patients, the millennials, and the gen X-ers as you say. It’s a little bit unclear at this point to say exactly why that is happening. We don’t have an answer for that quite yet, one of the things that we do note is that the rise in colon and rectal cancer in the younger patients parallels the rise in obesity that we see. That’s not to say that obesity causes colorectal cancer but we do think that the same issues, the lifestyle issues, the sedentary lifestyle, the dietary habits that go along with obesity are probably playing a role in the development of colorectal cancer as well and that’s why we see then in that younger group of patients. But again, it’s little unclear right now exactly what specifically is causing that rise.
N: As far as symptoms and early warning signs, do they vary greatly in the older patient and the younger patient? Should we be looking for different things in our younger population when it comes to colorectal cancer warning signs?
W: I think that it’s important to understand that the most part there are not a lot of early warning signs and symptoms for colorectal cancer which can be one of the most concerning things obviously just like with any cancer, the early you find it that better off it is. The symptoms that we normally talk about, change in your bowel habits. Some of us normally bowel regular it hasn’t changed. Things some blood in their stool, blood in the stool is almost always going to be for something like hemorrhoids or some other benign condition but it can be a sign of colorectal cancer. A change in the caliber of the stool, bloating and crampy abdominal pain. I don’t want to set people off and have everybody kind of run to their doctor, the second they see a little drop of blood or they get a symptom, I think it’s important to point out that with this type of cancer, there is no urgency to the point that if you waited a couple of weeks, if you waited a month to see how the symptoms play out, you’re not impacting your outcome even in the rare case it turns out to be colon cancer. So if you have a little blood one day and you never see it again, you don’t have to necessarily go in. But if you have any of these symptoms that are lasting for days and weeks, it’s certainly want to bring that to your attention to your health care provider, to your physician, and have some simple testing just to get a better sense of what might be going on.
N: Was this the aim of this study done by the American Cancer Society? Was that the aim to find out a little bit about the younger population as relates to cancer? Or was this something that was surprising and there was another goal of the study in the first place, another purpose?
W: I … of the study and from time to time when we do look at incidence of cancers and colorectal cancer mean one of the most common cancers we see in the United States. I think the aim of the study was more to just get a better sense on how are we doing in terms of our screening and surveillance. I think approximately 40% of Americans who should be screened, who meet the criteria, are still not going in for screening. There’s obviously room for improvement whereas this is just looking at the broader picture of colorectal cancer as a whole, then when you break it down and you look at it for example just in men or just in women, or geographically, or just in older and younger folks to see what you’re doing, that’s where this kind of popped up and I think this was a bit unexpected in terms of the outcome.
N: What steps are you involved in as well as with the American Cancer Society as a Director of the Minimally Invasive Colorectal Surgery Program there at Northern Westchester Hospital?
W: Here at our hospital, I think most centers will tell you the same thing. We look at this as an ongoing educational opportunity and certainly with this being Colorectal Cancer Awareness Month as you pointed out, we are a little bit more aggressive in getting the word out and educating our community whether we do seminars at the hospitals open to the community whether we have a literature available both online resources and at the hospital. Patients coming in and out of the hospital and their families are coming into the hospital, the clients for a wide variety of reasons, so we take it the advantage of that when it’s Colorectal Cancer Awareness Month. At the same token, when a study like this comes out, whenever there’s a high profile event, whether it’s a celebrity or someone in the media gets diagnosed with colon cancer or a study like this comes out that obviously has a tremendous interest to a wide variety of people. We often use that as an opportunity again to go off there and educate because I think the most important take home message of the study is really just awareness and understanding that, ‘Yes, you are at risk as you pointed out.’ You don’t have to be a 65 or 70 years old, you can be 25 and 35 years old and get diagnosed with colorectal cancer. By having some awareness that yes, it can happens to you, you’ll take some of these potential symptoms seriously and often and go on to your physician and be checked out because early evaluation or early diagnosis is actually the key to having a good outcome.
N: There are some very invasive treatment methodologies when it comes to colorectal cancer based on the nature of it. Talk about some of the latest advancements in surgery for colorectal cancer.
W: Absolutely. The vast majority of patients with colorectal cancer will require surgery as part of their treatment and the cure rates are excellent particularly when it’s found early. It involves removing a piece of the colon and putting everything back together. The colon is essential like a pipe and you take a piece out and put it back together. But I think one of the myths that people don’t understand is that once that is done, the vast majority of people will function normally. They will eat normally, they will have normal bowel movements, there will be no real limitation. A lot of people think that they’re going to end up not put together properly or they have a colostomy bag and those are rare, rare occasions. The newer methods to do the surgery, traditionally this will involve the big incision, opening up the abdomen, the very painful recovery, patients would be in the hospital for 7 to 10 days, be out of work for 6 or 8 weeks. Over the years, the technology just like your cellphone, your computer, the internet has gotten better and better so we have surgeons take an advantage of this type of technology, initially doing minimally invasive surgery with a TV camera put in through the belly button. And over the past several years, robotic technology has really advanced dramatically in this area to the point that we’re doing major colon surgery and most of our patients will come in, have a 4 or 5 little holes that are about half an inch in size, tiny little incisions. We do the operation with the robotic assistance and the another patients for the most part of going home the next day, they’re only in the hospital for one day, maybe two, and are back to their normal routine about 10 to 14 days later with the same outcomes, the same results, excellent success rates. So it’s really minimalized the impact on patients in terms of their recovery. The robotic technology has enabled us to do surgical procedures with a level of visualization and a level of precision that was never really possible prior to that development.
N: You mentioned the rarity of complications with traditional surgery. Is this robotic method, does it minimized the risk of complication even further?
W: That’s correct. Very simply put, it enables you to see things much more clearly and much more precisely, it enables you to control the instrument with a much higher level of precision, and the end of the day, seeing having your surgeon see better and having your surgeon be more precise with the instruments can only be a good thing. As a result, what we’re seeing is this minimally invasive approach with the little incisions, is now possible in even more patients. We’re avoiding the need for that big incision and that fix scar, we’re reducing their need for a lengthy hospitals stay and we certainly know that the longer people stay on the hospital increases the risk of other problems, picking up with the infection and other complications like that. Although even before we had this technology, because this is such a common problem, we’ve had time to refine the technique over many, many years and develop a technique that has excellent results next on outcome. This is just fine tuning it even further. The operation we’re doing this to essentially the same. In other words, we still have to remove the same amount of tissue, we still have to put things back together the same way. We’re just using technology to enable us to do that at a just more precise level.
N: Dr. Wishner, where can our listeners go and get more information about this minimally invasive type of surgery and about Northern Westchester Hospital in general?
W: Sure. Certainly, the Institute for Robotic and Minimally Invasive Surgery at Northern Westchester Hospital maintains a fairly robust web presence to talk about not just robotic colon surgery but the other types of robotic surgery. The National Cancer Institute, the American College of Surgeons, there’s ample opportunity to go look and do some research. Northern Westchester Hospital, nwhc.net online and then you can easily link to the minimally invasive and robotic surgery. A subsection in that, and learn more and more about it and it’s something that because the development of it is still so new relatively, we’ve been doing it this way for between 5 and 10 years which still a relatively short period of time in the field of medicine. Many non-specialists, your primary care doctor and things like that may not be aware of it. It’s something you definitely want to talk to your doctor about should you need surgery and you definitely want to seek out a surgeon who can do all the different types of surgery both robotic and non-robotic to determine what is the best approach for a specific patient, the answer is going to be robotic to the vast majority of the time. But everything is not suitable for everybody, you just need to seek out someone who can discuss all the options if you not just one option should you find yourself in a situation where you need surgical intervention.
N: Well I thank you for talking with us today Dr. Jerald Wishner. Thank you so much for coming in.
W: Thank you so much for taking the time to help get the word out and share some of this important information.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. In studio, with Dr. Jerald Wishner. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. And you can listen in and download on SoundCloud, subscribe to this podcast on iTunes.