Colon Polyps and Colon Cancer:

Colon cancer is the 2^nd most common cause of death form cancer in the U.S.  Approximately 50,000 people die each year due to the disease, and about 150,000 people are diagnosed each year.  Colon cancer tends to affect people in their fifties and older, although we do see patients much younger.  Symptoms from colon cancer may be very non-specific, such as vague abdominal pain or weight loss.  Many people will experience bleeding or a change in bowel pattern.  Sometimes, people have minimal symptoms, but are found to be anemic on yearly blood work.  Once symptoms have developed, it is likely that the disease has been present for some time.  The usual method of diagnosing colon cancer is Colonoscopy, an examination of the colon (large bowel) with a flexible scope while sedated.  Treatment of colon cancer may involve surgery, chemotherapy, or a combination of therapies, depending on the type, size, location, and extent of disease.

People with family members with colon cancer are themselves at increased risk for developing the disease.  The closer the family member, the younger the family member’s age at diagnosis, the greater the number of family members with the disease all increases the risk of the individual.  Sometimes, other cancers in the family may impart a relative risk as well, such as other types of GI malignancies, uterine cancer, and breast cancer.  People with a family history should be screened for colon cancer at an age and frequency determined by their risks.

Colon cancer, for the most part, grows from benign polyps or growths on the lining of the large bowel. These are usually present without any symptoms at all. Not all polyps will turn malignant, but the larger the polyp the greater the risk.  Not all people have polyps.  (About 30% of our screening patients will have polyps.) The process of a benign polyp turning into a cancer seems to be rather long, leading to plenty of time for screening and removal of polyps before that occurs.  Several years ago protocols were developed to screen higher risk patients (those with a family history of colon cancer).  In the recent few years, it has become an accepted practice to screen “average risk” individuals as well, beginning at age 50.  The idea is to find and remove polyps, thus preventing them from progressing to cancer, or find cancers as early as possible to get the best outcome from treatment as possible.

Chronic Gastroesophageal Reflux Disease (GERD)

Chronic reflux of stomach acid into the esophagus may lead to symptoms of GERD.  Most commonly people with GERD would experience heartburn.  But even a simple and common symptom such as heartburn may be described in many different ways among patients.  When discussing your symptoms with your physician, be as specific as possible.  Try to characterize when it occurs, how long it lasts, what is associated with its onset or improvement, and how long you’ve been experiencing symptoms.

Episodes of reflux are common and occur in everyone to a small extent.  Such episodes are called physiologic.  The body has defense mechanisms which help clear the acid from the esophagus before injury occurs.  Pathologic reflux occurs when these episodes happen much more frequently or are prolonged, allowing symptoms or even injury to develop (GERD).  It is estimated that 40 million Americans experience reflux symptoms at least twice a week, to the point that they medicate themselves. 

The Lower Esophageal Sphincter (LES) is a muscular ring at the distal end of the esophagus.  This relaxes to allow for passage of food and liquids into the esophagus, then tightens again to keep the food in the stomach for digestion.  Gastroesophageal reflux occurs when the LES relaxes inappropriately, or when pressures in the stomach overcome the pressure of the LES.  Some substances may encourage relaxation of the LES, such as nicotine, caffeine, and alcohol.  Also, some foods such as chocolate, onion, and peppermint may contribute to relaxation of the LES.   Obesity, tight clothing, exercising after eating may result with increased abdominal pressures that overcome the LES and result with reflux.  Patients that are prone to reflux should avoid reclining just after eating, as this will also increase their chances of reflux due to their positioning.

Most people self-treat their reflux with over the counter medications.  There are many antacid preparations to choose from. Also, many acid suppression medications are now available.  The antacids work quickly and can be used “on the spot” for quick relief by patients who infrequently have heartburn.  Acid suppression medications such as the H2 receptor blockers (Zantac, Tagamet) and the proton pump inhibitors (Prilosec) work effectively to prevent acid secretion by the stomach cells, and prevent reflux and heartburn in patients that frequently experience symptoms.

Patients that have heartburn or reflux symptoms of a chronic nature, frequently recurring, or difficult to control with over the counter medications should discuss their symptoms with their physician.  They probably would benefit from prescription medications.  Also, patients with “Alarm” symptoms such as nocturnal heartburn, and difficult or painful swallowing, should certainly be further evaluated.

Many patients with reflux simply have symptoms.  Some patients may actually have injury occurring due to the acid exposure of the esophagus.  This may be mild (with minimal inflammation) to severe (with ulceration and strictures).  A severe complication of reflux is Barrett’s esophagitis, where the acid exposure has caused a change in the lining of the esophagus.  This condition is associated with an increased risk of developing esophageal cancer.  Patients with Barrett’s esophagitis generally have experienced significant reflux symptoms for a considerable period of time. 

The usual method of examining the esophagus is Upper Endoscopy.  (See Upper Endoscopy on the procedure information list.) This allows us to visualize the esophagus for signs of injury or Barrett’s changes, as well as determine the effectiveness of therapy in healing injury caused by reflux.

Most patients can be controlled with once daily medications.  It is still advisable that they follow an anti-reflux routine.  This includes avoidance of those substances and behavior that aggravate reflux. Some patients may require combination therapy for their symptoms with multiple medications.

Most of our patients present with common heartburn symptoms, but a few patients experience “atypical” symptoms.  These may include pharyngitis or hoarseness, asthma or chest pain.  It is important that you discuss such symptoms with your physician, to determine if they warrant referral to a gastroenterologist for evaluation.

Hepatitis C

Hepatitis C is a chronic viral infecting approximately 20 million Americans.  Despite being identified for several decades, it was only in 1990 that tests became available for specifically diagnosing the infection.  Since that time many patients previously identified as non-A, non-B hepatitis, have been more accurately diagnosed as chronic hepatitis C.

The well known risk factors for chronic hepatitis C are a history of intravenous drug use (even remote), blood transfusions before 1990, and other lifestyles or conditions which put the patient at risk for blood to blood contact with others who carry the virus (including health care workers).  Some other risks that have been suggested include tattoos and the sharing of razors and toothbrushes.  Still, many patients present with the infection without an obvious risk identified.  Although possible, the risk of sexual transmission appears to be low, unlike that of hepatitis B.

The virus resides in the liver for long periods of time, insidiously causing disease over several decades for most patients.  Many are totally unaware of any problem, until routine blood-work for insurance screening or that obtained as part of a yearly physical identifies an elevation in routine liver tests. Many are also screened positive for the virus when donating blood to the Red Cross. 

Few patients develop an acute infection resulting in jaundice and other symptoms.  Some patients may later develop more chronic symptoms of viral infections, such as fatigue and arthritis.  As stated above, many have no symptoms at all.

Most patients will eventually develop some degree of liver injury, although for many this consists of mild inflammation that causes no discernable alteration of liver function.  Some affected patients, however will proceed to cirrhosis and symptoms of liver failure over many years.  This may include problems with blood clotting (coagulopathy), alteration in the blood counts (anemia, thrombocytopenia, leucopenia), mental status (hepatic encephalopathy), accumulation of abdominal fluid (ascites), and bleeding risks due to increase portal pressures (esophageal and gastric varices due to portal hypertension).  The liver is able to continue its needed functions early on, but begins to decompensate later in the course of the infection leading to these signs and symptoms at some point in many patients.

Hepatitis C

Hepatitis C is a chronic viral infecting approximately 20 million Americans.  Despite being identified for several decades, it was only in 1990 that tests became available for specifically diagnosing the infection.  Since that time many patients previously identified as non-A, non-B hepatitis, have been more accurately diagnosed as chronic hepatitis C.

The well known risk factors for chronic hepatitis C are a history of intravenous drug use (even remote), blood transfusions before 1990, and other lifestyles or conditions which put the patient at risk for blood to blood contact with others who carry the virus (including health care workers).  Some other risks that have been suggested include tattoos and the sharing of razors and toothbrushes.  Still, many patients present with the infection without an obvious risk identified.  Although possible, the risk of sexual transmission appears to be low, unlike that of hepatitis B.

The virus resides in the liver for long periods of time, insidiously causing disease over several decades for most patients.  Many are totally unaware of any problem, until routine blood-work for insurance screening or that obtained as part of a yearly physical identifies an elevation in routine liver tests. Many are also screened positive for the virus when donating blood to the Red Cross. 

Few patients develop an acute infection resulting in jaundice and other symptoms.  Some patients may later develop more chronic symptoms of viral infections, such as fatigue and arthritis.  As stated above, many have no symptoms at all.

Most patients will eventually develop some degree of liver injury, although for many this consists of mild inflammation that causes no discernable alteration of liver function.  Some affected patients, however will proceed to cirrhosis and symptoms of liver failure over many years.  This may include problems with blood clotting (coagulopathy), alteration in the blood counts (anemia, thrombocytopenia, leucopenia), mental status (hepatic encephalopathy), accumulation of abdominal fluid (ascites), and bleeding risks due to increase portal pressures (esophageal and gastric varices due to portal hypertension).  The liver is able to continue its needed functions early on, but begins to decompensate later in the course of the infection leading to these signs and symptoms at some point in many patients.