Shanna M 00:00
Hi listeners. Just a little note about the upcoming podcast. We were having some audio difficulties so we apologize, there is some great information. So please stay with it and thank you for listening.

Shanna M 00:22
Hello, welcome to the Adventist HealthCare & You podcast. I'm really excited today to be joined by Dr. Vinni Juneja. He's a medical oncologist, has been practicing for 16 years with Maryland Oncology Hematology, and he's also located at the White Oak Cancer Center, which is right next door to the Adventist HealthCare White Oak Medical Center. So welcome, Dr. Juneja. Thank you for joining.

Vinni Juneja, MD 00:42
Thank you very much for having me over.

Shanna M 00:44
Yes, thank you. So it's Colorectal month, which is always in March. And we wanted you to come on today and share a little information about this topic because you have some personal experience with it.

Vinni Juneja, MD 00:54
Yes, again, thank you for hosting the podcast. This topic is personally important to me, it's also professionally important to me from the standpoint of being a doctor who treats cancer patients all day long. And too often in the cancer world, we see people who come in with advanced cancer, or the dreaded stage four diagnosis, which means that the cancer has spread beyond the local area. And one of the most effective ways we have of avoiding that dreaded situation is with screening. And we're talking about colon and rectal cancer here. So there is effective screening for that, which is a colonoscopy as sort of the best test, and stool based testing such as cologuard, as the quote, second best test, and so colon and rectal cancers are avoidable, with proper screening. And when we see a patient with stage four disease, for example, colon cancer that has spread to the liver, who hasn't had any previous screening with a colonoscopy or stool based test, honestly, it just makes me very sad to know that this particular situation may have been avoidable. And we may have been able to do surgery to cure this patient 1,2,3,4,5 years ago, had the patient been able to get screening, and very often I hear from patients who either have an early stage colon cancer or later stage one, that the screening worries them, they're afraid of it, they're afraid of a colonoscopy. People make jokes about it, it's something you really don't want to do. And there is not always awareness of how a colonoscopy is done, how it has become easier over the years, or how there is stool based testing now for people who can't tolerate a colonoscopy, for whatever reason don't have access to one or just simply don't want to do one.

Vinni Juneja, MD 00:54
when should people begin their screening for colorectal cancer?

Vinni Juneja, MD 03:04
So this is a great question. I'm going to date myself and say that i'm definitely middle age and mid career now. When I started medical school in 1996, we were still doing flexible sigmoidoscopy risk screening. And what that is, is it's an oftentimes unsedated procedure where a scope is inserted up the colon and looks at the basically the bottom of approximately one third of the colon. Not a very comfortable test, because a lot of times it would be unsedated, It's still done in much of the developing world as the screening tests for colon cancer. In just about in the year 2000 or so, a screening colonoscopy was proven to be the most effective way to screen for colon cancer. And the difference between a colonoscopy and a flexible sigmoidoscopy, is the colonoscopy is better because it looks at the entire colon. And it's also done most times under sedation. So you're blissfully unaware of the procedure. You literally sleep for somewhere between 15 minutes to half an hour, and you wake up and it's over. So a screening colonoscopy really started to gain traction, It's about 22 years ago in year 2000. And since then, it has become the gold standard test they screened for colon cancer and our old thought was to do colonoscopies at the age of 50. And for most people perform it only every 10 years. More recently, in the past decade. We've been seeing colon cancer more and more in patients under 50. And the reason that we're seeing more and more colon cancer is still a little enigmatic, it's still a little mysterious. But what we think is the reason is essentially environmental, weather it's the food we eat, the water we drink, the air we breathe, something is causing more colon cancer and more rectal cancers in younger people under 50. So, more recently, the World Health Organization lowered the recommended screening age down from 50, down to 45. For colon and rectal cancers.

Shanna M 05:35
Thank you. So people should now start at age 45. They're not as bad as they used to be. And it's a relative, and it's relatively easier procedure than it used to be as well. So definitely talk to your doctor about when to start. I'll share my husband is under 45, and he's high risk, he has a family history of polyps and is immune suppressed. So he needed to have a baseline one. So there are instances where if you are considered high risk, you may need to start even earlier. So are there factors that people need to think about that could make them higher risk?

Vinni Juneja, MD 06:04
Yes, for sure. One factor would be as you were touching upon, if someone is immunosuppressed with certain drug for other conditions such as rheumatoid arthritis, a huge factor would be if you have a family history of colon cancer, but not just colon cancer, if you have a family history of other cancers, such as uterus cancer, these cancers can run in the family because they run in the human genome. And if you do have that kind of history, we do start colonoscopies, sometimes younger, sometimes more frequently. And you're completely correct about the colonoscopy becoming easier over time. I myself, am a lucky veteran of colonoscopies every two to three years. I'm 47 right now. And I can tell you having received colonoscopies since the year 2008, that it has become easier. It's certainly not easy. And there's a prep, it's like bad food poisoning without the belly pain. And the prep is not easy for older people. But for most younger people, you can tolerate the prep, it's rather something that's rather quick. And the procedure itself is blissfully simple. You essentially go in for the procedure, you have an IV plugged in, and after you're all set up, you essentially sleep, the lights go out very quickly, and when you wake up, it's all done. And a lot of people feel that they have had a full night's sleep after. So it has certainly become easier over the years with very, very few minimal complications.

Shanna M 07:40
And how often should people have them now?

Vinni Juneja, MD 07:42
So your average risk patient? Should receive it every 10 years?

Shanna M 07:46
That's actuallynews to me? I thought you needed one every year.

Vinni Juneja, MD 07:49
Yeah, I mean, if you think about it, you know, you're taking out probably a day or two out of your life every 10 years to ensure that you don't get this particular type of cancer. And if you do get this particular type of cancer, and it's found on screening colonoscopy, it's very often curable with surgery to remove the tumor. And the other important thing to remember about screening is colon cancer doesn't suddenly appear, it evolves over several months to years. For the average risk person, it takes many years to evolve. And it evolves out of these little polyps and polyps can sometimes look like tiny little mushrooms in your colon. Sometimes it can look like a tiny little half dome and the cancers evolve out of these polyps slowly over time, so on a colonoscopy, you can see these little polyps, the gastroenterologist can essentially pluck them out as if you are plucking a mushroom out. And that in itself, if you pluck out a precancerous polyp, you have saved yourself the aggravation of going to surgery someday to remove this cancer when it can be taken out by simply doing a colonoscopy.

Shanna M 09:00
That's interesting thinking back to when my husband had one last summer, I remember from his report, they had found a little small polyp or something and then ended up taking it out and I didn't realize they did that. So that's good to know.

Vinni Juneja, MD 09:11
The colonoscopy. Again, the thing to remember is not just for screening of colon cancer, it's also to remove pre cancerous polyps, which in itself can save you the aggravation of going through a lot of surgery later on.

Shanna M 09:25
Dr. Juneja. Would you mind sharing a little of your personal journey? You've mentioned a little bit, but you have some personal experience with this, and not only your speaking as a physician, but also as having experience with this cancer?

Vinni Juneja, MD 09:37
Sure, sure. I'll start with a preamble that again, because I see cancer patients all day long. One of the biggest questions to a patient when they first hear the news that they have any type of cancer is why me? What did I do to deserve it, all too often wr're seeing people who don't have risk factors, they didn't drink, they didn't smoke, they don't have family history of cancer, they're in shape, they really didn't do anything to, quote unquote deserve getting cancer and colon cancer is very much the same way. So me myself, I am again, the guy who wasn't supposed to get cancer. I was 34 years old, in terrific shape, no family history of cancer, vegetarian, to top it all off. And I had to do just regular screening labs and I was feeling fine. So it's amazing what you can catch on labs with any patient. So my particular case, I found that I had iron deficiency anemia, and that is something certainly abnormal to have. So further workup showed that I had microscopic blood in my stool, I couldn't see it. And a lot of people can't see it. When you go to the bathroom, sometimes you look, sometimes you don't, try not to look, but oftentimes it looks normal. But when you do a what's called a stool hemoccult in your primary care doctor's office or any office. Sometimes it can lead to surprises. And my particular case did lead to a surprise where there was blood in the stool. And then that led to an endoscopy and colonoscopy. And again, what I want to remind people is sometimes what you hear is, Well, you're a young person, you've got plenty of stools, it's hemorrhoids, so just blow it off. I am not sure you should always assume it's hemorrhoids, unless you know you have a history of hemorrhoids. So in my case, I got an endoscopy, which is a camera to look in the stomach, and a colonoscopy. And there it was, we had an eight centimeter enormous tumor on the right side of my colon with no symptoms other than iron deficiency anemia, it certainly a quite a surprising unpleasant way to see this happen. So after digesting everything and wrapping my head around it, what followed was a pretty nerve wracking scan to see if it had spread anywhere. And that is probably one of the more nerve racking thing that any patient goes through, you go to a scan, and you already know you have cancer, has it spread, has it not spread, a million thoughts go into your head. In my case, I got lucky, it had not spread anywhere that we could see. And then I went to surgery. Now surgery is also something that's come a long way. Surgery used to be a thing where you'd have to make a cut down the belly, cross the belly button down to the pelvis and open up a patient's belly completely and take the tumor out. The technology has evolved to the point where one of two things can now often happen for people with colon cancer or rectal cancer, is laparoscopic surgery, or robotic surgery, where you have tiny little scars instead of a giant cut down the middle. And so in my case, I had four tiny little scars on my belly, the tumor was taken out. And then I took about three or four days to recover, which is about average for most people going through this kind of surgery. And then luckily, since then it never come back, I do have to do colonoscopies every two to three years. So that's why I'm a veteran. Sometimes I get accused by the anesthesiologist that i'm drunk seeking, that I love the drug that they give for sedation. That's why I keep coming back. But in actuality,

Shanna M 09:48
you'd have to

Vinni Juneja, MD 12:25
In all seriousness, I was discovered to have a potential familial syndrome on genetic tests,

Shanna M 13:31
okay

Vinni Juneja, MD 13:32
That means I need to come back every two to three years to make sure that the cancer doesn't come back. And along the way, there have been, I think, a total of two polyps found in since 2008 in my colon that were plucked out just like little mushrooms. And here I am, I'm very lucky to have survived this. And I want to ensure that other people have the full information and access that they need to make sure they get screening and don't have to deal with a more advanced cancer someday.

Shanna M 14:02
Well, thank you for sharing that with me. And it actually touched on a couple of things that we've talked about in past podcasts and just in general that talking to your doctor, don't put off your screenings. There's a lot of screenings out there. If you're over 40. You need your mammogram, if you're over 45, your colonoscopy. That's why it's so important to see your doctor yearly for your annual checkup and also advocate for yourself. You've mentioned that a little bit as well.

Vinni Juneja, MD 14:24
Right, exactly. And I think, you know, with the internet, there's so much knowledge available. Again, I don't want to scare people, all bleeding from the rectum, blood in your school in colon cancer or rectal cancer, I don't want to scare people that all iron deficiency anemia is colon or rectal cancer. But if you have something wrong, definitely investigate it. And one of the keys is just going to the doctor, going to the lab in the first place, and just seeing someone especially for young people who are feeling fine, who have no medical issue. Oftentimes people say oh, why do I need to go to the doctor? I have a question, well, then why do you need an oil change, if you're going to take better care of your car than you do of yourself, that doesn't make a lot of sense.

Shanna M 15:07
I like that. That's a great analogy there.

Vinni Juneja, MD 15:09
And this is again, for colon cancer, we want to emphasize right now we have stool based testing, which is very accurate to detect the presence of cancer, it's somewhat accurate to detect the presence of precancerous polyps. And then we have colonoscopy, which is the gold standard for detection. And I strongly believe in the near future, we're going to have blood based testing that can detect circulating fragments of tumor DNA in the blood in tiny quantities. And I do think that this decade, we will be seeing that and that should hopefully lead to a huge uptake in screening for all types of cancer.

Shanna M 15:47
That's exciting. It's good to hear that there are exciting things happening in the future for cancer.

Vinni Juneja, MD 15:51
Cancer is best caught early, it is most curable early. And that is really one of our missions in the cancer field is early detection and early treatment and a higher cure rate. And we have come a long way since I started in this field in 2006. And I think we'll just keep getting better.

Shanna M 16:10
Well, thank you. Thank you for sharing your story and all this great information. For our listeners, you can find Dr. Juneja at AdventistHealthCare.com, and also MarylandOncology.com. Please don't forget to follow us wherever you get your podcasts so you can listen to our new shows and catch any past topics you're interested in. Thank you again, Dr. Juneja. Hopefully, maybe you'll come back again and talk to us on another topic.

Vinni Juneja, MD 16:31
Happy to, for whatever topic you feel like.

Shanna M 16:34
We really appreciate you coming in and thank you to our listeners and be well!