rectal cancer awareness month

[marci dodson] welcome to the uc irvine healthlive streaming of a colonoscopy. we're live streaming this procedure today as part of colorectal cancer awareness month. to spread awareness of how colonoscopy is an important, painless procedure that actually can prevent colon cancer. we wantto demystify the procedure and answer your questions about colonoscopy and about colon and rectal cancers. you're joining us in the uc irvine health h.h. chao comprehensive digestive disease center, or cddc for short. we're in one of ouroutpatient procedure rooms. let me introduce you to the two doctors who areinvolved in today's procedure. first we have dr. kenneth chang, a renownedgastroenterologist and director of the

cddc. he's going to be performing thecolonoscopy. and on the table here we have dr. c. gregory albers, also a renownedgastroenterologist, who has lectured extensively on colon cancer andcolonoscopy. but today the tables are turned and dr. albers is the patient andhas agreed to have his colonoscopy livestreamed without any sedation so thathe can participate in the conversation and answer your questions about colonoscopyand colon cancer prevention. and dr. chang do you want to introduce the rest of theteam? [dr. kenneth chang] yes, to my right is tony, he's our gi tech, and eliza next to him is our gi nurse, and we're here to do thisprocedure for dr. albers. about 10 years

ago, dr. albers had a small precancerouspolyp, which i removed and so he's now here for his regularly scheduled follow-upsurveillance colonoscopy. [marci] anyone watching this live canparticipate in this conversation, get on twitter and send us your questions andcomments, #ucihealthchat. we'll convey them to dr. albers and to dr. chang. dr.chang are we ready to begin? [dr. chang] yes, first i want to ...marci, do you want to introduce the audience to a little bit of theinstrumentation. part of the demystifying of colonoscopy is the instrumentsthemselves, people think that they may be larger than they truly are. so thecolonoscope is a thin, flexible tube with

essentially a video camera at the end ofit. let me show you what the scope looks like. so as you can see it's quite thin,it's about a centimeter in thickness and very flexible, there is a ccd video cameraright at the tip, which allows us to see in high definition. which you'll bewatching in a short while. now there are various instruments that we can putthrough the scope for removal of polyps and so on, we can wash, there's awindshield wiper, it's quite a sophisticated instrument. in addition, ourgroup here at uc irvine has been involved in various research to see if we can evenincrease the polyp protection rate, and one of the instrumentations that we haveis this endocuff, it's a simple little

cuff and it has these little soft prongsand these help to push folds, so we can see around folds, sometimes polyps canhide behind the folds as you'll see so we simply slip that on. and that helps to aswe come back, helps to push the folds so that we can see behind them. so that's anintroduction to the instrumentation. very slim and comfortable. so now we'll goahead and start the procedure, we first place the scope through the anal canal andinto the rectum, and right now we are...we're in the rectum now, and i'mgoing to put some nice lube. now there's several ways of performing thecolonoscopy, now we're in the rectum, the colon is five to six feet in length, andwe're going to journey through the entire

colon, we're going to go upstream, so tospeak, starting from the rectum and through the splenic flexure, hepaticflexure and cecum, these are the four parts of the colon that are attached, thecolon is a floppy tube, and we're putting a scope through a floppy tube to inspectevery square inch of the colon looking for either cancer or precancerous polyps. soone of the ways we do that is ... now the colon normally is collapsed or flat, so wecan either put air, now we don't use air anymore here, we use co2, because co2dissipates very quickly so patients are much more comfortable and when they wakeup there's much less recovery and bloating so there's practically no bloating whenthey wake up. the newest method is called

underwater colonoscopy where we simplyinfuse sterile warm water, which helps to open the bowel, and because it's warm,it's very soothing and it cuts down on the spasms and it cuts down on the patient'ssense of discomfort, so it's the most comfortable way of doing a colonoscopy,using a warm sterile water immersion. so here we go, we're infusing some warm waterand what we're doing is looking for the lumen, which is the central part, so that wecan safely move the scope and advance it up throughout the colon. and what you'reseeing here is just a normal lining of the colon, it's called the mucosa. and thecolon has these what we call haustra or these muscular rings that propel the stoolsouthbound, and from time to time you'll

see us just gently advancing the scopethrough these muscular rings. [marci] so how are you doing dr. albers? [dr. gregory albers] i'm doing great, i can feel the warm water, no pain, no discomfort, maybe just a little rectal pressure butnot at all, not a problem, a really very interesting experience and i'm really gladi'm here. [dr. chang] this is like a colon spa. [marci] most patients, the vast majority ofpatients, are sedated when they have a colonoscopy. but you're not havingsedation today. can you tell me why you volunteered to have this done?

[dr. albers] well, march is colon cancer awareness month, and what better way to celebrate the month than to have a colonoscopy? prettysimple. i really wanted to respect the patients who have come before me, i'vedone many colonoscopies on them, about thirty thousand. i try to inspire thosethat are on the edge maybe considering colonoscopy and just try to demystify itand show them that this is something that everyone can and probably should get done. [marci] if a patient is sedated, what is it likefor them, dr. albers? [dr. albers] well, the patient if under sedation, there's different levels of sedation, one is moderate sedation, we use intravenousmedications to keep them comfortable in a

twilight sleep and then there's anotherwhere we use an anesthesiologist where the patient has a deeper level of sedation.generally, patients wake up and they don't even recall the procedure. quite oftenpeople want to see the pictures to even say that i did a procedure on them, soit's that much of an easy procedure for the patient under sedation. [dr. chang] patients are very comfortable. it's an outpatient procedure. and those who elect to go under twilight sedation are verycomfortable, we give them the option, patients the option of being more alertand watching on the screen like we're doing right now, or some patients say,"hey, you know what, just i'd like to take

a nice nap and wake me when it's over,"and that's perfectly fine as well. [dr. albers] we're seeing more and more people actually electing to do it without sedation at all and it's not for everyoneby any means but for those patients who are so motivated, it's a very, i think avery rewarding procedure to see your colon on tv, this is the first time i've done itun-sedated and it's quite fascinating. [dr. chang] you've never seen your colon before? [dr. albers] not on tv, not like this, it's prettyamazing. [marci] so what's the age that someone should undergo a colonoscopy for the first time? [dr. chang] so colon cancer, marci, is the second leading cause of cancer death in the

united states, this year approximately onehundred and fifty thousand patients will get diagnosed with colon cancer so it is anational killer. sadly, colon cancer could essentially be preventable because almostevery colon cancer arrives from colon polyps, and that's what we're doing today.now, studies have shown that 90 plus percent of patients who are diagnosed with colon cancer are already beyond the age of 50, so the recommendation according to all of oursocieties is that patients who have no increased risk of colon cancer, this isthe average anybody at the age of 50, should get a screening colonoscopy. that'swhy 50 is chosen. now, if you're african american, they have a higher colon cancerrisk so the recommendation is at age 45.

and then obviously if you have a familialrisk, one degree, first degree relative, or two first degree relatives with coloncancer, then you want to get your colonoscopy 10 years before that relativewas diagnosed with colon cancer. so if they were diagnosed at age 50, you wantto get your colonoscopy at age 40. so essentially for most people it's once youhit the age of 50, happy birthday, come get your colonoscopy. [marci] and then afterwards to have it redone again. [dr. chang] yeah, so if your colonoscopy is clean, as we're hoping to see with dr. albers here, then you are scheduled to come back in 10 years. so it's a once in 10 year

screening procedure. if however, we findpolyps, depending on how many and the size, up to three small polyps we say comeback in five years, if we see greater than three polyps or a large polyp, then wesay come back in three years. so ... [marci] where are we now? [dr. chang] we're at the very top of our colon. what we're seeing in the middle of the screen is what we call the appendiceal orifice. that's where the appendix comes out of the colon, and that happens at the very, verytop of the colon, at the beginning of the colon. so that's one of the landmarks thattells us we've actually seen all of the colon that we need to see and we'vereached our destination, so to speak. so at this point the prep has been very verygood, i don't know what you ate last night

[dr. albers] that is gold specks, i think. [dr. chang] but now our job is just to slowly come back and we get two looks at least of every square inch of the colon, one on theway in and one on the way back, the way back is a more careful inspection, and inthe right side of the colon, which is where we are now, we want to inspect thisarea at least two times if not three, because the miss rate is highest on theright side of the colon. now, up on the left side of the screen ... let me see if ican show that to you. here, at around 10 or 11 o'clock, i'm going to change thefilter on the imaging. can you see the little nubby things on the left side?that's the small bowel.

the small bowel mucosa have villi, and these villi increase the absorptive surface area of the small intestine. the colon we said is5 feet long, the small intestine is 20 feet long. but with the presence of thevilli, the surface area is the size of a football field. so the small bowel is justa crazy surface area, it has a crazy surface area to absorb all the nutrientsthat we take in. we're going to go back and take a second look through that rightcolon. again, we come up to the appendix here. we can wash and move any smalldebris. we just don't want to miss a polyp that may be hiding behind stool. [marci] what would a polyp look like? [dr. chang] a polyp would look like

a growth. there's two versions. one is more of like a cauliflower with a stem and a head, andthe others, which are now known to be harder to find and more risky, are the flatsessile serrated adenomas, those polyps are like dropping the pancake on thekitchen floor and the kitchen floor is yellow. so harder to find and harder toremove. but we have a very high rate of detecting even these difficult polypswithin our faculty. which gets to the whole concept of adenoma detection rate.we now have report cards or quality measurements for what determines a goodcolonoscopy. so it's not just the fact that you did it, but over time that youwere able to find a certain percentage of

polyps which statistically should be whatyou find. and nationally, the criteria is you need to find at least 25 percent of yourpatients in this screening venue, you should be able to find an adenoma polyp ora precancerous polyp. so amongst our faculty we're between 30 and 55 percent. dr. albers has one of the highest adenoma detection rates, i think, in the country. what is your adr? [dr. albers] 49 percent. [dr. chang] so we take care in really trying to look for these polyps. again, over to the left that's the small bowel, and sometimes wecan just take a peek into the small bowel. all right, so this is the small bowel, andif i turn on the narrow band imaging,

that's just a button i push to change thefilter and you can see how it can highlight the contrast and that's how wedetect these difficult to detect polyps. we have high-definition imaging, we havenarrow-band imaging, we have underwater magnification. these are all techniquesthat improve the detection rate. so the things that factor into finding polypsis a good prep, and dr. albers has a beautiful prep, the time, studies haveshown that if i take less than six minutes coming back and looking, i'm going to findless polyps which makes sense. if i take six minutes or more, then i'm going tofind more polyps, so time is important. [twitter] we have a twitter question here that's right on that subject. from twitter, if

benign polyps are found, does that meanyou're at risk for colon cancer or is it normal to find polyps? [dr. chang] by normal, typically about 30 percent of men and 20 percent of women on a screening colonoscopy will have polyps. now theydon't belong there so they're not normal but that's the typical statistics. once wefind these polyps, we remove them completely. so a colonoscopy is not only adiagnostic test, it's a therapeutic test. we detect and we remove the polyp on thesame procedure. so not only do we know that these are precancerous polyps, butthe risk is gone once they're removed. [marci] and we may not find any here today but can you describe how you remove a polyp?

[dr. chang] sure we have different instrumentations that we put through the working channel to the small little channel we can put theseforceps, biopsy forceps, or these snares that loop around. we can actually show you a biopsy forcep. so this is the third time now i'm coming back through that sameright colon. taking a very careful look. and i'm switching between high-definitionwhite light and now narrow-band imaging, and now high-definition white light. sothis is what a biopsy forcep looks like, if you can open that, see it opens andcloses, opens, closes, and we can just advance that through the working channelof the scope, and it goes through the entire length of the scope and pulls outthe polyp and removes it. we also have the

snares, the loops that likewise gothrough, and just cut the polyp. when the polyps are removed the patient does notfeel it at all, which is a good thing. the only pain that the colon feels is stretch. that's why we take a lot of care in not using room air. we use co2. we use water,warm water, so that the patient doesn't feel uncomfortable with the stretch. areyou feeling uncomfortable? [dr. albers] no, i feel perfect, it's amazing. [dr. chang] now the other thing you see over on the right side of the screen, here and there you'll see these little blue hands,and that was the endocuff we talked about that we put on the tip of the scope so aswe ... let me see if i can demonstrate that

for you. as we slide by these large folds,you see the purple hands there? the right side? see how they're pushing thefolds aside and allowing me to see behind the folds so that the polyps that are onthe other side will be revealed. so we have some helping hands inside the colon. [dr. albers] we're doing a lot of research here at uc irvine using these adjunctive tools including the endocuff and it has shownsignificant improvement in detection of polyps in men and women and especially inthe right colon we have the folds that are deeper and the flatter polyps tend to hidebehind folds. [dr. chang] i think we have a polyp here.

[dr. albers] we got lucky. everything is relative, i guess, but ... [dr. chang] so this is a small, flat polyp. it'smaybe two to three millimeters. and let's pinch using the biopsy forceps. it's asmall polyp so this should, with one of two bites we should be able to remove thatsafely. [dr. albers] there are no pain receptors on the inner parts of the colon so i'm not even feeling anything when dr. chang takes that off. [dr. chang] so it slid back a little bit just byperistalsis. [marci] where are you roughly in the colon? [dr. chang] we're near the hepatic flexure, so it's the right side of the colon just under the

liver. so again, it was a smalltwo-millimeter polyp, we just need to re-localize it since with a littleperistalsis, the scope got pushed further downstream. [marci] after we catch this polyp, we're going to talk about how you prepare for a colonoscopy okay? [dr. albers] sounds great. [marci] let's get this first. [dr. chang] great. you took some ... what did you take last night? [dr. albers] well i took ... i actually donated one of my kidneys to my wife a few years ago i only have one kidney, and because of that,i wanted to be extra safe so i took four

liters of the bowel prep, the jug prep soto speak, called golytely, probably the most misnamed medication in history. butthat being said, i took half last night and then half at around three or four thismorning, and the splitting of the dose really makes a big difference. i knowthere's some specs of gold in there and i'm not sure what that is, to be honestwith you, but, for the most part it really makes a much, much better difference ifyou split dose the bowel prep. so i did use about four liters of golytely bowelprep but there are other options for patients. anything including a lowervolume bowel prep. one called suprep, to moviprep. somepeople a lot of patients like a miralax prep

where it's mixed with gatorade. but iwanted to take the safest one possible for my kidneys. [marci] and the idea is to induce a lot ofdiarrhea? [dr. albers] right. all about prep. got to get rid of all the stool, so i go on a clinical diet the day before the procedure, althoughwe're doing research here at uc irvine with dr. samarasena as a leadresearcher, actually one of my colleagues, showing that actually a low residual bowelprep can lead to just as good a cleansing. thus, i think in the future, we may be ableto even forego the clinical diet the day before. [marci] and eat what? some low-residue ... [dr. albers] low-residual diet, right.

[marci] which would be like white bread [dr. albers] bread, bagels. so things like that, yeah. [marci] so it's not quite the deprivation the day before, making the patient a little bit more comfortable and and maybe a little less reluctant to undergo the colonoscopy. and the bowel prep is really important because ... what happens if you don't have a good bowel prep? [dr. albers] yeah, if you don't have a good bowel prep, you obviously can't see around. you can't see well. polyps may be hidden by stool. we can actually clean the bowel as we can see here, so if there's some small littleresidual parts, we can actually clean very easily. but if it's coated with a largeamount of stool, it's very difficult to see so it really is important for thepatient to do a really good job of the

bowel prep. i did my very best, and i thinki would actually grade myself as having a grade ... we use a boston bowel prep score and i would give myself 'three.' not that i'm biased, but ... [marci] and what's the highest score? [dr. albers] three. [marci] and are we back to the polyp? [dr. chang] yeah, so we went all the way back up so as i come back the second time, i don't want to miss it. it's a bit of a needle in thehaystack. it's only two millimeters in size, so we're going to carefully all eyes,we have eight pairs of eyes here we're going to find that little two-millimeterpolyp. so on the first time that we saw it

was ... oh here it is. [dr. albers] there it is. and you can see how the endocuff makes a big difference in how it helps to hold back those folds. [dr. chang] alright, open. [dr. albers] beautiful. [dr. chang] close. we just glanced it. but that helps to mark it as well. [marci] you didn't feel anything then? [dr. albers] no, not at all. [dr. chang] close. so everything is magnified so you see a little bit of bleeding there, but with a little bit of lavage and time, thebleeding spontaneously stops. and dr. albers did not feel this at all.

[marci] and now what happens to that tissue that you just removed? [dr. chang] so that polyp that was safely removed goes to pathology. they then create a pathology slide and it's a two tothree-day process to create a slide and look under the microscope, look at thecells to determine what kind of polyp this may be. there are three kinds of polyps. ahyperplastic polyp, which is benign and not pre-cancerous, the adenomas polypwhich is benign and precancerous, and then there's the sessile serrated adenoma,which is benign but revved up towards cancerous. [marci] and how long does it take for each type of those polyps to develop into a cancer? [dr. chang] into a cancer? so a polyp of this size, if we had not removed it, 10 to 15 years

could become a cancer. not all polyps become cancers, but almost all cancers came from polyps. [dr. albers] the so-called flatter, sessile serratedpolyps typically can have a timeline of two to five years to develop into cancer, sothey're really important. [dr. chang] here you can see that the bleeding has stopped and then i can safely come back. i don't need to suture it, i don't need toclose it. only very, very large polyps do we need to actually close the wound, andthis is a simple biopsy so we're safe. [marci] we have some more twitter questions here. dr. albers, will you feel any discomfort after this colonoscopy? [dr. albers] i anticipate none at all. with the co2, i'm probably not going to pass much gas at

all and i anticipate going about my dayregularly. i drove myself here and i'm going to drive myself home, and do a little bit of workafterwards, but i anticipate no discomfort, no problems, no issueswhatsoever. [dr. albers] now if you were under sedation, things would be a little different for you today. [dr. albers] yeah. if i was under sedation i would actually be getting a ride home and i would have a recovery time of at least ahalf hour, just to make sure everything is looking good and my vital signs are stablebefore going home with a driver. and we also tell patients not to drive for atleast 24 hours after the procedure and not to make any important decisions likebuying a house or something like that just

in case of the sedation. [marci] i have another question here. why don't you take this one, dr. chang. i hope i pronounce this right. i had a erythematousmucosa in the rectum, what does this mean and how is it treated? [dr. chang] erythematous mucosa is non-specific. it just means a little bit red on endoscopy, and sometimes a little bit red could beinflammation or it could be something of concern, so we would typically biopsy that,and if the biopsy is reassuring that there's no concern for polyp tissue and nodiagnosis of inflammatory bowel disease, then it could be some irritation. sometimeseven the prep itself could irritate.

so we're just going slowly back, our purplehands are moving the folds so that we can see behind them. oh, i think ... no, no see? that was a fake out. that was a mucous ball that pretended to be a polyp but we wereable to move that along with just lavaging it. [dr. albers] dr. chang, can you tell what type of polyps they are by just looking at them? [dr. chang] you know we, with the advancing technology, we're getting closer and closer to about a 90 percent predictive evenwithout removal. we're not quite there yet, not quite ready for prime timeusing imaging only, so currently the standard of practice is to remove thepolyp. but there's a lot of intense research that we're doing here as well sothat we can diagnose these polyps with a

virtual biopsy or by imaging technology. [marci] dr. albers, i know you have a phrasethat you like, pt3 about the marks of a good colonoscopy. can you briefly explain that? [dr. albers] yeah i say pt3 is cancer free, or pt3 is a mark of a good colonoscopy. really right now, we really ... it's quality. because acolonoscopy by itself is good, but we want quality colonoscopy, and that really is kind of a marriage of good bowel prep on the patient's part and then on the physician'spart, it's times. dr. chang talked about, we like at least six to eight minutesduring the withdrawal time, we're way over that for sure so we're fine there, but also it'stechnique of withdrawal, it's using a good

technique to look around, look at all thecorners, look around the folds, maybe double backing on oneself to look at it.so it's not just time, but it's technique. and finally the other t, it's time,technique and technology. and the technology we're using today is theendocuff to help us out to see us around the corner so i think these adjunctivetechnologic advances are going to help us to actually see polyps better and narrow-band imaging. so technique includes double or triple looks in the right colon, sometimes retroflexion in the right colon, use of carbon dioxide and underwater colonoscopy. but also the whole issues of using narrow-band imaging andthe endocuff have really enhanced our

visualization for flat, and especially flatpolyps in the right colon. so pt3, is cancer free. it's kind of a little thing iput together and i think it's one of my fellows so i have to give her credit, buti think it's a very valid marriage of technology and effort, because we have towork as a team. both patients, i guess myself now, and dr. chang as the physicianand the nursing staff. [marci] and when you're doing a colonoscopy you're not just looking for polyps, what else do you look for during a colonoscopy,dr. chang? [dr. chang] yeah so the common findings other than polyps would include diverticulosis. this is the outpouches that are caused by weakening of the muscle. the colon is a

muscular tube, and as we get older, ourmuscles atrophy. so a part of aging is the formation of these diverticulum ordiverticulosis, when we have many of them. so we make note of that. dr. albers doesnot have any diverticulosis, so he's got a young colon. and then we also look forhemorrhoids. hemorrhoids are right at the exit point in the anal canal, so they cancause itching and bleeding and prolapse so we assess the size and presence ofhemorrhoids. and we also look for these, what we call arteriovenous malformations. these are the tufts of blood vessels that can sometimes pop up to the surface. forexample here are some blood vessels and we turn on narrow-band imaging and we can see these blood vessels, but that's normal.

with avms, these blood vessels engorge and pop to the surface and they can bleed so we make a note of that, and if the patienthas a history of bleeding we can simply coagulate them during the colonoscopy. sothere are other things we can detect. also signs of inflammation. patients withdiarrhea may have different forms of inflammatory bowel disease, and we canmake note of that and also take biopsies to confirm that. did i miss anything, greg? [dr. albers] no, well i mean even patients with normal colonoscopies and some patients with diarrhea, we take biopsies looking formicroscopic colitis too. so the scope has the ability to see everything, and it's ourability to interpret what we're finding

and seeing, plus the ability to takebiopsies and take out polyps. so i think the key is that we've seen a decline incolon cancer especially over the past 10 years of almost a half million people, andthat's because of colonoscopy and polyp removal. so what we're really doing is,it's not just cancer protection, we call it colon cancer screening, but it's reallycolon cancer prevention that we're doing right now, and i wanted to emphasize that.this is, you know, yes that polyp may or may not have developed into cancer in the future,but taking it out, it's gone and i'll have to come back at some point in the future,generally in maybe five years, if it comes back as adenoma. but the key is that polypremoval equals cancer prevention and

that's a principle used. [dr. chang] here at uci cddc, we're passionate aboutthis, and one of our stated, we have three stated vision goals, and one is to create acolon cancer free orange county. which is hypothetically possible ... if everyone whoshould be screened is and everyone gets a quality colonoscopy, we can significantlyreduce the deaths related to colon cancer. and a major landmark article in 2012showed that colonoscopy not only decreases colon cancer, which makes sense becauseyou remove the precancerous polyps, but they actually confirmed that it decreasesdeath from colon cancer, so we're actually decreasing death and extending life herein orange county.

[dr. albers] so across the united states, i thinkright now, about 60 to 65 percent of people participate or are up to date in colon cancerscreening in one form or another. maybe about 30 percent of people have not participatedfor one reason or another, and that's one reason why we're here today is todemystify and show people that this is a straightforward procedure that anyone canundergo, and to enter into that screening process. there are opportunities thatreally prevent even more cancers in the future. [dr. chang] does this mean next time you're going to do mine? [dr. albers] i think so, yeah. it's payback. [dr. chang] i've already had two. i'm a little older than that guy over there.

[marci] colonoscopy obviously is a major way to prevent colon cancer, are there other things people should be doing to preventcolon cancer? [dr. albers] well i always kind of, one way to thinkabout it is that colon cancers are related to certain things that we can change andcertain things we can't change. so the age is a factor, family history is a majorcontributing factor. some patients have a family genetic syndrome where there is asingle gene disorder so seeing a geneticist for some high, high riskfamilies is an essential part of it. there are certain things that we can do aspatients and myself, and i usually kind of think of it as what we can do to prevent heartdisease we can do to prevent colon cancer. so

things like maybe a high-fiber diet mightbe a potential benefit, a low red meat diet, exercise, not being sedentary, fruits andvegetables, probably beneficial, fish, omega-3 fatty acids might be beneficialand even red wine might be, have shown in grapes, and there's resveratrol in it. sothere's a number of factors that might be potentially useful. they've done a lot ofresearch here at uc irvine about chemoprevention, and it's ongoing currentlyright now as well too. baby aspirin, of note, does help prevent colon cancer. [dr. chang] i know you're going to be really sad, but our journey is over, we're back in the rectum and we've completed the colonoscopy, but we can certainly continue to talk.

[dr. albers] sure. or get tweets. [marci] let's see. i'm trying to see if we have any other questions here. what about lynch syndrome? i've heard about lynch syndrome, how does that figure into colon cancer? [dr. albers] lynch syndrome accounts for about two to three percent of all cancers and that's a syndrome where patients inherit, if youwill, one hit in a gene that might contribute to the risk of cancer. so overtime, that patient develops another mutation in the same gene on the oppositechromosome and that accelerates the patient developing polyps.those polyps have what's called dna mismatch repair, so they don't repair thedna, and they can develop cancer at a very

rapid age. so those patients and thosefamilies can undergo genetic testing and can actually find the gene for it, andthose patients who have the gene can undergo surveillance colonoscopiesbeginning at the age of 20 or 25, much earlier, and they're also at other risksfor uterine cancer, sometimes kidney cancer, and stomach cancer, small bowelcancer. so those patients need to be a part of a very progressive, comprehensive screening program. [marci] early stages of colon cancer reallydoesn't give the person any symptoms, is that correct? [dr. chang] that's right. so we, in terms of specificsymptoms that would alarm the patient to colon cancer, they're quite nonspecific.one of the most common ways a patient

presents is unexplained anemia,meaning that suddenly their hemoglobin instead of being 13 or 14, which is normal,is now 9 or 10, and their doctors may say, "oh you've got low iron." that is a redflag for colon cancer. my own father's story is just that. he had anemia, he hadiron deficiency, and what did his doctor do on the east coast? gave him iron. so isaid, "dad, here's the airplane ticket, come to california and we'll do yourcolonoscopy." that was 10 years ago, dad is a colon cancer survivor, but he hadadvanced colon cancer, he had surgery and chemotherapy, fortunately, it's a blessingthat he's alive and that's what propelled me to get into this field because there'sa lot of work to be done in preventing the

spread of disease. so anemia that'sunexplained to me is colon cancer until proven otherwise, certainly if there'sblood in the stool, constipation and diarrhea can be symptoms but that's sonon-specific, unexplained weight loss that's also rather non-specific. so reallythe vast, vast majority of folks if you want to prevent colon cancer just come atage 50 to be screened and that should take care of things. [dr. albers] the other thing is know your risk ithink, talk with the doctors if there's a family history, certainly start earlier,african americans start at age 45 and it's also important to recognize some of thesigns of colon cancer. we're seeing a

decline of colon cancer across the board,in patients 50 to 60 to 70, but we're actually seeing a rise in younger patientsunder the age of 50, so we're actually seeing a rise, we're not sure exactly why. so we really have to be alert for symptoms. we can't just say, "oh, i'm 35,i can't get colon cancer," because that's just not true. rectal cancer in men, especially, so we have to be very concerned. [dr. chang] our faculty are really working hard toget this kind of risk information out to orange county community. one of ourfaculty, dr. bill karnes, is heading up the atlas program and that's just about tolaunch. we've been years in preparation with various grant awards and so on. sothe idea is, on a simple ipad in a doctor's

office or on a website, you can justanswer a few simple questions and it will tell you your individualized risk fordeveloping colon cancer. if you were to do that and your risk was 12 percent, i think youwould get yourself in for a colonoscopy. so that community knowledge and awarenessis critically important, and we're passionate about getting that out there. [dr. albers] i think that uc irvine is, i've beenhere for 15 years, and i've really seen the passion and the commitment at all levelsfrom our gi department, my gi colleagues, our researchers in regards to coloncancer, risk assessment, genetics, colon cancer treatment. we have one of the topsurgical colorectal surgical teams in the

world, in my opinion. and the oncologyteam, we work together under dr. chang's leadership under the cddc, so it's acomprehensive approach to colon cancer. what we really want to do is to reach outto community physicians and to get the patients of the community, because we'reall in this together. to be honest with you. i got my polyp taken out, i'm takencare of, but i feel well, i'm perfectly fine now. we really want to get the wordout to other people to participate and get checked. [marci] one more quick twitter question, how long, infeet, is the journey through the colon? [dr. chang] so the colon is five to six feet longand as we talked about, we went in reverse, the journey. so we started downin the rectum and went up the left side,

reached the spleen, right under thespleen, went across the abdomen, went right under the liver and then went downtowards the appendix. so that entire journey is five to six feet in length.typically, it takes about 20, 30 minutes, we took a little bit longer since we werebabbling, and depending on how many polyps we remove and so on, it could take alittle bit longer. but in general it's a very well-tolerated procedure and we'retrying to remove the stigma of "you're going to put what up my what?" [marci] okay, so this concludes our live streamof a colonoscopy from the uc irvine health h.h. chao comprehensive digestive diseasecenter. i want to thank the doctors and

the staff involved. dr. chang, thank youvery much. especially dr. albers, thank you. did you have any other things, lastwords you wanted to say before we signed off here? [dr. chang] get your colonoscopy. [dr. albers] get checked, know your risk. thank you for participating. [dr. chang] and if you're young, think about your parents and your loved ones and just prompt them to get their colon screened.we have fantastic gastroenterologists throughout orange county there's no reason why peopleshouldn't get screened and unfortunately now only half the people who should getscreened are actually getting screened. [dr. albers] and we really want, there's a new dictumfor the united states, it's "80 by 18." so by 2018, we really want to get at least 80 percentof people who are at risk for cancer to be

screened, now we here in orange county, wewant to be 100 percent, we want to be cancer-free here in orange county. united states, wewant to be at least 80 percent. let's be a leader in orange county and work together. [marci] and we invite you to continue thisconversation with your family and friends and on twitter, you can continue to sendyour tweets to #ucihealthchat. this can be viewed again, we're going to put thisup on our youtube channel, and that address is youtube.com/ucirvinehealth.thank you very much for joining us this morning and have a good day. so long. [dr. albers] thank you, everybody. thank you.

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