By Karen Gorby
Chief Executive Officer/Chief Nursing Officer, Angel Medical Center
Even though March is Colorectal Cancer Awareness Month, it’s important to be aware of this disease all year round. It’s the third leading cause of deaths related to cancer in the United States and sadly, according to the American Cancer Society, the disease is expected to cause more than 51,000 deaths this year. Locally, it’s estimated that 138 new colorectal cancer cases will be diagnosed in Buncombe County for 2019 and 24 for Macon County. Macon County’s rates were historically similar to North Carolina’s, but as of 2017, its numbers eclipsed those of the state.
I had a recent conversation with one of our talented clinicians about how important it is to get the word out about colorectal cancer. Lawson Hunley, MD, practices at Mission Primary Care here in Franklin and shares the ways we screen for colorectal cancer, how to lower your risk factors for the disease and why you should get a colonoscopy if your doctor recommends it, or if you’re older than 50.
“Though colonoscopy is the best thing we’ve got for detecting cancer, there are other ways to screen for it,” explains Dr. Hunley. “If you’re at average risk, fecal occult blood testing is an appropriate option. This test looks for blood in the stool; if it’s not present, those older than 50 are advised to perform the test yearly, but if blood is detected, we move on to colonoscopy.”
Cologuard® is another test for people older than 50 with average risk factors. It’s different because it looks for altered DNA related to colon cancer or polyps, as well as blood in the stool. If prescribed, one receives the test by mail, performs it at home and mails it back to the company for analysis. “One drawback with Cologard® is that its cost can be prohibitive,” says Dr. Hunley. If test results are negative, a person doesn’t have to get it again for three years.
Dr. Hunley shares that while these two screening options are convenient, the limitation is that they can’t provide the visual advantage that a colonoscopy screening does. “The in-office colonoscopy is really the gold standard screening – especially for high-risk patients – and the only one of these options where we can see a precancer,” Dr. Hunley states. “It’s both a screening test and, if necessary, a treatment; if we detect a polyp, we can remove it at the same time.”
Dr. Hunley admits that what most patients dread about colonoscopy – the preparatory step of fasting and drinking a not-very-appetizing liquid – is nevertheless important. “The colonoscopy itself isn’t bad and it’s brief, but the screening is only as good as the prep. To get the best view of the colon, it must be completely clean. If any stool remains, it could hide a polyp,” he says. His tips for successful prep are following the prep instructions closely, staying hydrated throughout the process, and devoting a full day to it.
As for lowering the risk factors for colorectal cancer, Dr. Hunley explains that there are two types: Nonmodifiable and modifiable. “Nonmodifiable factors are ones that can’t be changed, like your age or a family history of ulcerative colitis, Crohn’s Disease or colon cancer. Ethnicity is another, as African Americans and Ashkenazi Jews are at higher risk for colorectal cancer,” he says. Modifiable factors, he relates, are ones we have control over, like choosing a healthy, mostly plant-based diet, daily moderate exercise like walking, not smoking and keeping an eye on alcohol consumption.
A troubling recent trend is people younger than 50 getting diagnosed with colorectal cancer and it’s also known that those with Type 2 diabetes are also at higher risk. Though answers are still being sought, Dr. Hunley notes that again, obesity is one of the most significant links to colorectal cancer.
Dr. Hunley emphasize that early detection is critical. “If cancer is localized (just in the colon), the average five-year survival rate is 90 percent, if it spreads to an area or lymph nodes near the colon, the five-year survival statistic is 71 percent. If it spreads to distant places on the body like the liver, the figure drops to 14 percent,” he says.
Part of partnering with your physician in taking care of yourself is having a conversation about colorectal cancer risk and screening options. Take the time to have this talk at your next appointment. It could end up saving your life.
On another topic, with the resignation of Mark Moriarty, MD, who is leaving the area to pursue a new position in New York, we are actively recruiting an orthopedic surgeon to replace him. During the interim, Pam Meliski, MD, who has been serving orthopedic patients at Angel Medical Center over the past year, will continue to perform surgeries and see patients in the clinic on a weekly basis. We have also welcomed a new Sports Medicine fellowship trained physician, JD Hales, MD, to Franklin and he is seeing patients in the clinic 5 days a week.
Karen S. Gorby, RN, MSN, MBA, CENP, FACHE, is Chief Executive Officer and Chief Nursing Officer of Angel Medical Center. Gorby is a Fellow of the American College of Healthcare Executives (ACHE). For nearly three decades, she has served hospitals and health systems in Ohio before assuming her role at Angel Medical Center. Gorby received her MSN from Saint Joseph’s College in Standish, Maine, and her MBA from Wright State University in Fairborn, Ohio.