Colorectal cancer awareness: When to get screened and preventative steps

AUGUSTA, Ga. (WJBF) – Colon screenings and bathroom habits aren’t things most of us want to talk about. When it comes to colorectal cancer, though, it is important to do just that. With Colorectal Cancer Awareness month upon us, we sat down to a frank conversation with Dr. Kenneth Vega – a gastroenterologist and hepatologist at the Medical College of Georgia – about when you need to be screened, what signs to look for, and what you should be monitoring when you go to the bathroom.

Brad Means: Dr. Vaega, thanks for what you do for everyone, and thanks for being here.

Dr. Kenneth Vega: Thank you, Brad, I welcome the privilege to talk.

Brad Means: Well, it’s a privilege for us too, doctor. And I was thinking of questions to ask you last night, and the very first one was when should we get a colonoscopy? It feels like almost with, as with mammograms, maybe that age has changed, and I don’t really know when it is anymore.

Dr. Kenneth Vega: You’re right, it has changed recently. It used to be at age 50 for people that are average risk. Average risk means you don’t have a family history of colon cancer or polyps. But in the recent past, the American Cancer Society, as well as other both clinical and health foundations, have decided that it should be 45.

Brad Means: 45?

Dr. Kenneth Vega: Correct?

Brad Means: Men and women.

Dr. Kenneth Vega: Yes.

Brad Means: Why did they change it?

Dr. Kenneth Vega: Because there’s a worrisome increase in young individuals with colon cancer before the age of 40, before the age of 50. And this is a way to capture those people and make sure they don’t develop it.

Brad Means: All right, so you talked about family history. What other factors might sort of make a bell go off in our heads to think, okay, I might be at risk.

Dr. Kenneth Vega: Well, any person who has a family history of colon cancer, that means a mother, father, brother, sister. Or if you happen to have two second degree relatives, like a grandparent, or multiple grandparents, multiple aunts and uncles with colon cancer or polyps, both of those put you at risk.

Brad Means: Let’s sorta go back to the colonoscopy for a moment, if we may walk through that. Does it hurt?

Dr. Kenneth Vega: No, we actually sedate people, unless they actually want to not be sedated. But for the vast majority of people that I’ve done in 30 years of doing endoscopy, most all want to get sedated for the procedure.

Brad Means: And it’s just like having surgery. You go to sleep, you wake up, it’s over.

Dr. Kenneth Vega: Correct. It’s very similar to surgery. We use anesthesia that is done many times in the OR. We can also use something called conscious sedation. It depends on the patient preference for their sedation.

Brad Means: Listen, I know that you’re not here today to scare people, nor am I. We wanna encourage people to get screened. But people have told me the worst part of it is the night before. Is that accurate, and what happens the night before?

Dr. Kenneth Vega: Well, it used to be accurate, but now that preparation has changed. I’ve had three colonoscopies previously, and drank the prep that most people complain about. And so now we’ve changed to using MiraLAX, which is a solution that you mix in Gatorade instead of drinking that gallon that people have heard about before, that has a taste that resembles seawater when you’re swimming out in the ocean. So no, we don’t do that anymore. The preps are much more tolerable. And also doing a clear liquid diet for a day or two beforehand makes it easier for us to see. The easier we see, the better it is for both myself and the patient.

Brad Means: How long does it take for that MiraLAX to kick in?

Dr. Kenneth Vega: Usually when you, you’ll start the night before at 5:00, you’ll drink one bottle. Finish that by about 7:00. You’ll start going probably thereafter. Drink the second bottle at around 8:00, finish by 10:00, and then stop going to the bathroom before midnight.

Brad Means: Okay, so you’re not stuck in the bathroom overnight?

Dr. Kenneth Vega: No, that’s my goal, not to keep you in there overnight. Nobody wants a bad night’s sleep before a procedure.

Brad Means: And then when are we back to normal? What I mean by that is the effects of the MiraLAX are gone, the impact of the anesthesia, and the procedure itself, when do we say, okay, I’m myself again.

Dr. Kenneth Vega: You should be yourself probably later that afternoon of the procedure. And in fact, the next day you should be able to resume all normal activities. One thing we do recommend for patients, because they get sedated, is not drive on the day of the procedure. So they have to bring someone with them to take them home with after the procedure.

Brad Means: What are you looking for during a colonoscopy? We hear about people who say, and while I was there, he took a couple of polyps out. Are you taking cancer out when you do that?

Dr. Kenneth Vega: Well, sometimes we can, depending on how big the polyp is and what it looks like under the microscope after we remove it. I’ll give you an example. There was a patient that I did a procedure on who waited until his primary care physician had his procedure, and then finally he came to see me. And that individual had 30 polyps total. I took out 21. Four of those were each bigger than a centimeter.

Brad Means: Oh my word.

Dr. Kenneth Vega: Or a half inch. Those four each had cancer at the tip, but not at the base that I took off. That said man is still my friend on Facebook and sends me greetings every year for my birthday.

Brad Means: Can you feel that, when you have a couple dozen polyps inside you?

Dr. Kenneth Vega: No, that’s the problem. many times if you feel issues or have, let’s say, bleeding, that may be too late. You could have had a ulcer, or the polyp could have bled or spread by the time you get to the procedure. So coming in preventatively, finding polyps when they’re small and removing them is the best method.

Brad Means: So, talk about historically throughout your career, when you do spot something that’s of concern. How helpful is that early detection to the patient’s recovery?

Dr. Kenneth Vega: Oh, it’s paramount, it’s paramount. Finding something small, removing it when it’s a quarter inch in size, but knowing that had it stayed, it had the potential to develop into something bad is a very satisfying experience, both for myself and for the patients. When you talk to them after their procedure and say, hey, I took this out, this could have become cancer, you can see the relief in their eyes from having that done.

Brad Means: So, you talked about bleeding, and other issues that one might notice in the restroom. What are some other symptoms that might make you think, even if you’re not 45, maybe you’re 35, where you should go, I need to do something.

Dr. Kenneth Vega: Correct, one is rectal bleeding. So if you have bleeding that either turns the toilet water red, that’s always of concern and you should mention to your doctor. Another one is if a change in how you move your bowels from your usual pattern, that’s also important to let your primary care doctor know, and then they’d send it to us. A third one is if you’re losing weight and you don’t know why you’re losing weight. That’s always something to mention to your primary care physician, because that could be a sign, a very remote sign, that something’s going on that needs to be investigated.

Brad Means: How much weight are you talking about?

Dr. Kenneth Vega: Probably between five and 10% of your body weight.

Brad Means: Really? And no other symptoms?

Dr. Kenneth Vega: No other symptoms.

Brad Means: And then that would be enough to go to the doctor and get it checked out.

Dr. Kenneth Vega: Yes, at least talk to your primary doc and see where to go from there.

Brad Means: What kinda journey do these patients go on if you do find something? All right, if it’s not just clipping polyp, I mean, you clip the polyps, you get ’em biopsied.

Dr. Kenneth Vega: Or take them off, actually, we can remove them.

Brad Means: Remove them, excuse me. And it’s cancer.

Dr. Kenneth Vega: Yes.

Brad Means: What happens then, and is this something that would consume the months or years of this patient’s life going forward?

Dr. Kenneth Vega: Well, I guess in some ways it depends on what I find and how big the problem we find is. For example, if I was to find something that, to me, endoscopically, looked like cancer, I would biopsy it. The next thing I do, once the procedure ends, is call my surgical oncology colleague, saying I have this patient. I think this is big, needs to be removed surgically, at least have you evaluate it, and go from there. We have surgical oncologists at AU that do see patients that I recommend to them within about a week or two. And then if it’s deemed that they need a surgery, they’ll get the surgery at AU as well.

Brad Means: Is insurance good with all of this?

Dr. Kenneth Vega: Oh yes. Insurance is good because finding it out in a proactive way rather than having someone present with more advanced signs, like obstruction or spread somewhere, clearly is something that insurance companies would want to prevent from happening.

Brad Means: It seems like so many medical procedures these days are done remotely with some sort of robotic assistance. Is that what you’re doing in your line of work? What sort of apparatus goes into the person to check their colon?

Dr. Kenneth Vega: Well, the colonoscope is about as wide as my finger, actually.

Brad Means: Colonoscope…

Dr. Kenneth Vega: And it’s got light-in camera and an opening for biopsy material, for biopsy forceps or a snare to remove polyps. And then you also have the ability to use, now, artificial intelligence, which helps us detect things that we don’t necessarily see.

Brad Means: What do you mean by that? What part of the equipment or part of what you do is AI?

Dr. Kenneth Vega: It’s a processor that looks at the image as you’re looking at the image, and tells you, hey, check out this area a little bit better than you would usually. And so it highlights potential areas for concern. And actually here at AU, we’ve started using that within the past two weeks, and are the first place in Georgia to have that type of technology.

Brad Means: What can people do? Lifestyle choices, I guess, dietary choices to lower their risk of colon cancer, to make fewer polyps appear, maybe?

Dr. Kenneth Vega: Sure, of course, the American diet is always notorious for developing or leading to cancer compared to other diets, like the Mediterranean diet, for instance. Also high fiber diets, vegetables, regular vegetables, things of that sort. Salads, broccoli, cauliflower clearly help move things through the colon so that you get rid of the waste that you have appropriately.

Brad Means: How many times should you go to the bathroom every day and consider yourself normal?

Dr. Kenneth Vega: Well, that’s a range actually. It ranges from once every three days to three times a day. It’s more what your individual pattern is that you should recognize. So for example, if a person goes every day and then all of a sudden their bowel habits change, all of a sudden they’re going every third or fourth day, and it stays that way, that’s a concern. Or if they’re going three or four times a day and it stays that way, that’s also the concern. That’s what I mean by change in bowel habits.

Brad Means: Listen, while we’re in this area, lemme just ask you one more question.

Dr. Kenneth Vega: Please.

Brad Means: What should it look like? Float, not float? Anything like that, that might alarm us.

Dr. Kenneth Vega: Well, there’s a scale called a Bristol Stool Scale. You can actually check it online. And it describes seven different types of bowel moments, from the pebbles that you see that people describe, to a more, for lack of a better term, bratwurst type of bowel-

Brad Means: Sure, sure, no, that’s helpful.

Dr. Kenneth Vega: And then to a very liquidy bowel movement. The normal range is three to four. Anything one to two are the pebbles, and more liquid forms go from five and above.

Brad Means: Okay, and you wanna be three to four.

Dr. Kenneth Vega: You wanna be three to four.

Brad Means: No, I’m glad you said it. I mean, it’s sort of awkward for me to talk about it, I’m sure it’s not for you.

Dr. Kenneth Vega: No, no, it’s a occupational thing that we’ve been doing for a long time.

Brad Means: Probably my last question.

Dr. Kenneth Vega: Please.

Brad Means: When you talk to your colleagues around the country and you talk about cases that you’ve worked, do you find that the South Georgia has a higher rate of colorectal cancer, more polyps, if you will, per patient down here, because of our lifestyle?

Dr. Kenneth Vega: Well, I think there’s some contribution to that. Actually Georgia is at about the national average for colon cancer. And actually also at about the national average for screening. In the state, I believe, 13 or 14 patients get diagnosed every day with colon cancer. And I believe it’s seven that die of colon cancer in the state every day. In South Carolina, they actually do a little bit better. They’re a little bit better than the average, despite what you would think with diet, with regard to screening. And actually they actually have a lot in the, two or three people die of cancer and seven get diagnosed every day.

Brad Means: Well, I tell you, you said it at the beginning of the interview, early detection is key. Go get screened. Dr. Kenneth Vega, thank you again for what you do for patients and for being with us.

Dr. Kenneth Vega: Thank you for having me, Brad. I appreciate the time.

Brad Means: Absolutely, Kenneth Vega, MCG at AU.