Shanna M 00:11
Hello, welcome to the Adventist HealthCare & You podcast. I'm Shanna.

Nimeet K 00:14
And I'm Nimeet.

Shanna M 00:15
Hello Nimeet, how are you?

Nimeet K 00:16
Good, How are you?

Shanna M 00:17
Good! and welcome to all of our listeners. We are excited to welcome a new guest today, Dr. Jatinder Sekhon, who's the Chief of Gastroenterology Department at Adventist HealthCare Shady Grove Medical Center. Welcome Dr. Sekhon.

Jatinder Sekhon, MD 00:20
Thank you for having me.

Shanna M 00:32
You're bringing some really great information today, all about colorectal cancer screenings.

Jatinder Sekhon, MD 00:37
Yes, I am. And this is the month for colorectal cancer awareness. And as you know, this is one of the hot topics in the country, one of the leading causes of death from cancer.

Shanna M 00:47
Yes, and more and more younger people, younger adults are being diagnosed with colorectal cancer.

Jatinder Sekhon, MD 00:54
That's very true.

Shanna M 00:55
So maybe we can just start right there. Is there any scientific evidence or anything that might be pointing to the fact that younger adults are being diagnosed with colorectal cancer.

Jatinder Sekhon, MD 01:07
So as you know, colon cancer is 153,000 people are diagnosed every year with colon cancer, colorectal cancer, and out of which about 53,000 people die from it. And so it's one of the leading causes of cancer death here in this country. And that's why this is so important now. And for many years, we were aware of seeing sporadic, younger people coming in less than 50 years, with sometimes quite advanced cancer, and the data started getting collected. And then, about a year ago, the US Preventive Task Force, they made the recommendation that instead of 50 years of being the limit at the lower limit of doing colorectal cancer screening, we should start at 45, for healthy people with no family history or other comorbidities, you know.

Nimeet K 01:57
At last it went from 50 to 45, it went five years younger.

Jatinder Sekhon, MD 02:00
That is very true. And we are seeing way more polyps and awareness in the population. And we are seeing a few cancer pickups in my practice and several other practices whom I'm talking with you know.

Shanna M 02:13
Okay

Nimeet K 02:13
Wow

Nimeet K 02:13
So tell us what you do at Adventist HealthCare. And like, you know, how does it help our patients and our community?

Jatinder Sekhon, MD 02:19
The, first and foremost is the patient awareness, you know, first they have to be aware of the many modalities available to them to prevent this cancer, and it's a totally preventable cancer. It starts from patient awareness, it starts from the primary care making them aware of the different options, which they can avail of, and all of them are covered by insurance. Marylanders, we are fortunate that this is 100% covered in the state. And once they have had that conversation with the primary cares, and they are aware of and they have done a little more research on their own, then they come to people like us, and from our standpoint, they have different things which can be done. And first and foremost is a colonoscopy, which is a gold standard, or detection for prevention, surveillance of cancer.

Shanna M 03:10
What are some of the different options, you mentioned that there are some options, obviously, the colonoscopy is the gold standard, what are some other options?

Jatinder Sekhon, MD 03:18
So the whole idea is that the patient or the normal population should get some sort of test to help detect and prevent colon cancer. And it started about thirty years ago when initially the thought was that you start with a sigmoidoscopy. Because the data available said that, well, if you do a sigmoidoscopy, which is looking at the left colon, it saves lives. And slowly it evolved over time. And the initially it was stool hemoccults, anybody would give a little sample of stool and they tested for blood. And then it evolved into one of the options is now cologuard, which is a little more advanced than simple stool tests. Of all the options that two options which are considered class one, which is a colonoscopy and stool hemoccult on a yearly basis. Cologuard is the one which we generally encourage people who can't get a colonoscopy, because of age, you know, frailty and all that stuff, are some people who don't want a colonoscopy. And that's one of the things which is, as you can see, and hear on TV being promoted also by a lot of interested parties, that entails sending a sample to outside lab, and then they test it and then to send the results to your physician, you got to understand that's not the best test. That is one of the tests, which is better than doing nothing, but on the other hand, it while it can detect 92% of cancers, but that means you already have a colon cancer. The problem with that test is only detects what 42 or 43% of people with advanced polyps and they don't even detect this smaller polyps, but from our standpoint, as you asked, what are the other options? This is one of the options, which is well, if you're not going to do a colonoscopy do something. So this is one of those some things we do, you know.

Shanna M 05:04
Okay, but if it does detect something, you still need to go in for a for a colonoscopy to actually see what's going on. Right?

Jatinder Sekhon, MD 05:11
So if any of the other tests that, many of those you know, including, you know, capsule, including a CT Cholangiography, CT colonography, and if any of those tests are abnormal, then you have to go and get a colonoscopy, which is a diagnostic and therapeutic test. If you detect anything at the time, you can remove it, you know?

Shanna M 05:32
So let's, well, let's talk about colonoscopies a little bit. They're not the most pleasant thing, but they're so important. So what is what's the typical process for a colonoscopy? How can we encourage people to get it? They're not as bad as they used to be!

Jatinder Sekhon, MD 05:44
So the biggest inhibiting factor, I would say they're two. The biggest inhibiting factor is fear of the unknown. People think there's hearsay going around, no, it's terrible, it's tough. Relatively, it's a fairly straightforward process, you know, you do have to have a liquid diet the day before, and then you drink this prep, which, by the way, these preps have gotten much better from several years ago, they taste better, and they can be tolerated better, and you drink that which basically cleans you up. And once you're clean, you go to the surgery center to the hospital where they do the procedure. And the procedure takes typically about 15/20 minutes, longer if there polyps to be removed, or there are growths to be removed. All this is done under sedation. So the process is totally painless. People generally at the end of the procedure is extremely happy and say, Well, if that's what it is, I'm going to tell our neighbors and friends.

Shanna M 06:36
My husband had to have an early one, he has a family history, and he's is at high risk for polyps. And so he said the same thing after, he's like, it wasn't as bad. He's like, I went to sleep and I woke up, I felt great.

Nimeet K 06:51
I'm also glad those preps tasting got better. When I first became a nurse. That was the number one complaint patients used to have is that just didn't taste the best. So I'm glad over the years.

Shanna M 06:59
Yeah, yup, yup. Yeah, my spouse said the same. He's like, I thought it was gonna, everybody told me it tasted terrible, didn't think it was that bad. He's not that, he's not that hard to please. Though, so

Jatinder Sekhon, MD 07:09
There you go, there's a straight testament, right?

Shanna M 07:11
Yup, yup.

Jatinder Sekhon, MD 07:12
It used to be a high volume. And now it's a low volume. Also, they have tried changing the tastes and all, the only problem is that you can't change too many of the ingredients because we got to be careful that they don't affect the kidneys, the liver or other, the blood pressure and diabetes, and also. So they have to play within certain parameters to make these preps also.

Nimeet K 07:34
So you mentioned polyps, you know, multiple times. So what happens if you find polyps in a colonoscopy? Like, what is the next step? Like, does that mean they have cancer? Or, you know, what are some of the things around them?

Shanna M 07:44
Well, I was, that's what I was going to ask to and say, it's so interesting, you can actually remove them right there and begin to take action.

Jatinder Sekhon, MD 07:52
So all up in a generic term is a little growth, which you see in the colon, and we call it a polyp. And we know by history of progression, that this, these are the things which lead on to as they slowly grow bigger, they turn into cancer. So the whole hypothesis is that if you go and you find these growths and you remove them, you're basically prevented cancer. Chances of finding polyps in normal population about 30% or more, plus minus depending on male, female, ethnicity and all that stuff, you know. These growths happen in the colon, and so when you go in, during colonoscopy, you have various instruments you can use to sort of cut them out, burn them, remove them. And basically, at the end of the procedure, when the patient wakes up is basically got a normal looking colon after the procedure, you know.

Shanna M 08:40
Okay.

Nimeet K 08:41
Do you typically test those polyps for cancer cells?

Jatinder Sekhon, MD 08:45
Polyps can be benign, and they can be precancerous, and some of the polyps can have cancer cells. So depending on what we see at the time of removal, in fact, all of the polyps are central pathology, sometimes we can detect, see and say, well, these are dangerous looking polyps and they need a little bit of care this that and you go in and you remove the tissue around it at the time of the procedure also, but typically, like you asked, all of them are tested, depending on the test, what sort of polyps they are and the further surveillance intervals are determined.

Shanna M 09:16
So not every polyp is cancerous. It has the potential but not everyone.

Jatinder Sekhon, MD 09:21
Some of the polyps are benign, and the vast majority of the polyps are about 70%, I would say, are precancerous.

Shanna M 09:28
So really important to catch them.

Jatinder Sekhon, MD 09:30
Very true.

Shanna M 09:31
How often does someone need a colonoscopy?

Jatinder Sekhon, MD 09:34
So if you have a colonoscopy, and that's all clean, and there's nothing wrong, at the end of the day, the doctor and you're both happy. You say, well, I'll shake your hand and I'll come back after 10 years. So it's a long interval. This is one of the class one cancer prevention strategies. 10 years is a long interval and the amount of lives it can save is tremendous.

Shanna M 09:57
Yeah, so if you can catch it on that first one, and then you're you can be good for almost 10 years. Yeah, that's great. Yeah.

Nimeet K 10:05
So if you know, if somebody had detected cancer, if they do have colon cancer, what are some of the available treatments now?

Jatinder Sekhon, MD 10:11
So if the patient is lucky, if the cancer is in a polyp, and we remove the polyp, and there's no cancer cells at the margin, and it hasn't invaded to a certain depth, and you basically have cured a cancer, it happens. And I wouldn't say the majority of the minority are the cases. On the other hand, if there is already cancer there, you can stage the cancer, to some extent, how long it is, where it is, you can tattoo it for the surgeons to come in later on. You can get pathology from there, you can get some time these cancers also have lesions in the rest of the colon, you can remove those at the same time. So there are many things you can do at the time of the colonoscopy. Later on, depending on again, the size, the depth, the further staging of the cancer, if it's spreading from the colon, or if it's confined to that the first option is always to completely remove it surgically.

Shanna M 11:08
I like what you said, though, that there's options when you can catch it early. There's options.

Jatinder Sekhon, MD 11:14
Very true! Early detection and early prevention, a cure is should be always taught often and hoped for you know.

Shanna M 11:22
Yeah, encourage everybody listening, if you are 45 years and older, at average risk, talk to your primary care doctor, get your colonoscopy scheduled. And if you are at higher risk, what are some high risk factors that may indicate that you would need an earlier screening?

Jatinder Sekhon, MD 11:38
So if you have a family history of colon cancer, or if you have a family history of advanced polyps, then the typical age is starting at age 40 or 10 years before the index case. Say for example, if somebody's father had cancer to 45, then children and siblings should start at age 35, 10 years before the index case.

Shanna M 12:00
Okay, thank you. Is there anything else that you want to let our listeners know about colorectal health, their digestive health?

Jatinder Sekhon, MD 12:06
Like I said before, this is one of the most common cancer killers, and it's a totally preventable cancer. I think awareness and the is more important. Talking with your primary care doctor is very important. So you know, the options, and coming at the right time, as you know, having a procedure every 10 years is should not be a big deal, because it saves your life.

Nimeet K 12:31
Not at all, every 10 years.

Shanna M 12:33
Yeah. I like what you said earlier, you know, you're curing the cancer, right there. Taking care of it. So that's important to remember too, that that's a, that you're taking a step like that.

Jatinder Sekhon, MD 12:44
Very True.

Shanna M 12:44
Yeah. So well, we always like to end our episodes by asking our physician experts, what advice do you have for someone to live a happy, healthy life?

Jatinder Sekhon, MD 12:57
Well balanced life, including a well balanced diet and sense of inner peace.

Shanna M 13:04
I like that. Yeah.

Nimeet K 13:06
Inner Peace.

Shanna M 13:07
Yes. I like that. Everybody search for that. That's, that's so important. So well, thank you, Dr. Sekhon. We really appreciate your time today. And all this wonderful information that you have that you brought us today. Nimeet, anything before we close out?

Nimeet K 13:21
No, I think we got great valuable information.

Shanna M 13:23
I think we got it, I agree. So don't forget, talk to your primary care doctor about colorectal cancer screenings at your next visit or schedule your visit and talk about all the screenings that you might need. Thank you, Dr. Sekhon, we hope you'll come back again and talk to us again about maybe another topic.

Jatinder Sekhon, MD 13:37
Thank you. Thank you for having me.

Shanna M 13:38
Thank you, to find information about Dr. Sekhon, visit AdventistHealthCare.com, click on Find a Doctor. information will also be available in today's show notes. And we'd love to hear from you. You can let us know if you liked the podcast by leaving a review or you can email Podcast@AdventistHealthCare.com, and let us know what healthcare topics you want to know more about. Don't forget to subscribe so you can get all of our new episodes. Thank you and be well