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Colorectal Cancer #2: Endoscopic Diagnosis And Treatment
00:03
Hello and welcome to Doctor's Insight.
00:06
This is an endoscope used for diagnosing and treating colorectal cancer.
00:12
Roughly 90% of colonoscopes used throughout the world are made in Japan, and Japan is said to be a pioneer in the endoscopic treatment of colorectal cancer.
00:24
Diagnostic methods are also advancing.
00:27
In 2021, an AI system became available in Japan which instantly analyzes the images of the colorectum.
00:36
It is used to support the doctor with diagnosis and is gradually being adopted throughout the country.
00:43
However, some 30% of Japanese people who should be getting tested, do not undergo the endoscopic procedure.
00:51
What is the reason behind it?
00:53
And what is being done to address this issue?
00:56
Today, we'll look at the latest on endoscopic diagnosis and treatment.
01:09
Today's expert is Dr. Yoshino Takayuki, Deputy Director of the National Cancer Center Hospital East.
01:19
He is one of the world's leading physicians in colorectal cancer and has been involved in the development of numerous drugs.
01:30
Dr. Yoshino, thank you for joining us again today.
01:33
Thank you for having me.
01:35
Now, as it was mentioned, why is it that 30% of people in Japan who tested positive for blood in their stools do not undergo endoscopy?
01:44
The reasons vary, but common responses would be: They are embarrassed because the tube is inserted into the anus.
01:54
The procedure sounds painful.
01:57
They previously had an unpleasant experience using laxatives for an endoscopy.
02:04
However, improvements are being made to address such issues.
02:10
As you said, the endoscope is inserted through the anus, but is it safe?
02:16
Yes, the procedure is safe.
02:20
Today, I have with me a colonoscope.
02:23
Improvements have been made, and the ones being used currently are 11 to 13 millimeters in diameter.
02:32
As you can see, there's a camera at the tip.
02:36
And we can move it like this.
02:41
For patients who are truly afraid, many hospitals provide anesthesia, letting them to sleep through the procedure.
02:47
So let the doctor know in advance, if that's the case.
02:52
What does the inside of a colorectum look like?
02:56
The images of the rectum and colon are projected on a monitor.
03:01
This is a picture of an early-stage colon cancer.
03:03
The shape is more deformed compared to a polyp.
03:06
This one is about 8 mm in diameter.
03:11
I can understand that some people may feel embarrassed or maybe find it uneasy to use laxatives.
03:18
How are these issues being addressed?
03:21
During the endoscopy, your bottom will not be fully exposed.
03:24
You'll put on a trouser-type patient wear, which has a flap on the back that is opened only when inserting the endoscope.
03:32
Laxatives were unpopular, as people had to drink two liters of bad-tasting solution.
03:37
However, now, there are different flavors available.
03:42
Patients also drink less now;one liter of laxative, followed by 500 milliliters of water.
03:48
There is also a system using AI to detect cancer.
03:52
Can you tell us more about it?
03:55
To be precise, it is called the "AI-assisted Endoscopic Diagnosis System."
04:00
AI instantaneously analyzes the images and shows where lesions, or polyps, that could become cancerous are located.
04:09
Here is a video where the system is being used.
04:12
It shows the endoscope passing through the rectum and colon and projecting the inner walls.
04:18
Notice that a section of the wall is instantly marked by lines.
04:22
This is how AI identifies the presence of a polyp.
04:26
And the numbers indicate the probability of it being a polyp.
04:31
So the AI does the job instead of the doctor?
04:35
No, it is only used to assist doctors with diagnosis.
04:38
The doctor makes the diagnosis with what the AI detects.
04:42
As doctors are human, it's possible that they miss a lesion due to fatigue or differences in their skills.
04:48
It is hoped that such occurrences will be minimized.
04:53
According to the developer, the system is able to detect raised polyps about 95% of the time, and flat polyps about 78% of the time.
05:04
As artificial intelligence enhances its ability through learning, its accuracy will continue to improve in the future.
05:13
If polyps or cancer are found during an endoscopy, how are they treated?
05:19
We remove polyps and early-stage cancer with the endoscope.
05:23
In many cases, treatment can be performed as part of the exam.
05:27
What does an early-stage cancer look like?
05:33
Colorectal cancer originates from inside the wall of the colon or rectum and penetrates deeper into the wall as it progresses.
05:46
Cancer is considered "early-stage" when it remains in the "mucosal layer" or in the "submucosal layer" just below.
05:53
In the early-stage, there is very little chance that the cancer has spread to other parts of the body.
06:00
It can be treated using an endoscope since the treatment only requires a small resection of the cancer and its surrounding area.
06:09
How do you treat early-stage cancer and polyps with an endoscope?
06:14
The tip of the endoscope has a camera plus a tiny hole.
06:18
A special instrument to remove the cancer comes out through here.
06:24
There are several types of instruments and methods.
06:26
And this here is called a snare.
06:28
The doctor loops the wire around the polyp or cancer.
06:33
Here is a video of a real procedure.
06:36
The snare tightens around the base of the cancer.
06:39
Next, high-voltage current is applied to the area to burn it off.
06:45
When the cancer is flat, the doctor injects saline solution to raise the tumor.
06:49
It is then burned with a snare or removed with an electric scalpel.
06:55
Early-stage cancer can be cured almost 100% with such treatments.
07:00
However, in some cases, a section of the colon may be adhered, making it difficult for the tube to pass through.
07:08
In such cases, there are mainly two testing options.
07:14
One is the "capsule endoscopy," which is a procedure using an 11 mm-diameter capsule with a built-in camera.
07:23
After swallowing the capsule, it passes through the colon and rectum while taking pictures.
07:29
The images are transmitted to a receiver and the capsule is excreted during a bowel movement.
07:36
This is an image taken with the capsule camera.
07:39
It has lower resolution compared to the images of a regular endoscopy.
07:45
The other method is called CT Colonography.
07:49
It uses CT scanning to produce a three-dimensional image of the colon as shown here.
07:55
The bulging area is the cancer.
08:03
This is a comparison of a regular endoscopic image and a CT Colonography image of the same cancer.
08:10
The image of cancer is reproduced very realistically through computer graphics.
08:16
If in case polyps or suspicious tumors are detected, patients will have to be examined with the conventional endoscopy procedure for definitive diagnosis.
08:26
You mentioned that endoscopic treatment can be performed for early-stage cancer, but how about for cancer that is more advanced?
08:35
For cancer that's found deeper than the layer of early-stage cancer, there is a chance that it has spread, even if the tumor is removed.
08:42
In that case, the patient will need to undergo surgery to remove a large area of the colon instead of an endoscopic treatment.
08:49
There is open surgery as well as laparoscopic surgery, in which the procedure is conducted through several small incisions.
08:57
And recently, robot-assisted laparoscopic surgery is also becoming available.
09:03
If no cancer is found away from the colorectum, there is a good chance that it can be cured with surgery.
09:13
However, it's still possible that cancer cells had already spread, leading to recurrence even after surgery.
09:20
Furthermore, with surgery, there are often side effects such as bowel and bladder problems and sexual dysfunction.
09:28
The most important thing is to undergo regular colorectal cancer screening, and if an endoscopy is recommended, be sure to get one.
09:38
Doing so will help detect and cure cancer in its early stages almost 100% of the time.
09:48
That's good to know.
09:50
Dr. Yoshino, thank you for being with us today.
09:53
My pleasure. Thank you for having me.
Symptoms That May Signal Early Colon Cancer
Not Everyone Is Symptomatic in the Beginning
Medically reviewed by Robert Burakoff, MD
Diagnosing colon cancer early is important so that it can be treated most effectively. Paying attention to any possible symptoms is key. While there may be symptoms of early colon cancer, sometimes there aren't.
Early symptoms can be vague and nonspecific, such as changes in bowel habits (frequency, volume, consistency, color, control of defecation) or blood in the stool.
See a healthcare provider if you notice any changes in your bowel habits or any symptoms that don't feel right. These can be symptoms of various ailments, and getting an appropriate diagnosis and subsequent treatment as soon as possible helps with the likelihood of positive outcomes.
Photo composite by Tara Anand for Verywell Health; Getty Images
Early Colon Cancer: Symptoms to KnowPeople tend to use the terms symptoms and signs interchangeably, but they have different medical definitions. Symptoms are things you feel in your body, and signs are changes that can be measured, like blood work numbers or blood pressure.
Very early colon cancer is typically asymptomatic (doesn't have any symptoms), which makes regular screening extra important.
Colon cancer usually arises from a polyp—a clump of cells. Many polyps are not cancerous, but even for cancerous polyps, they can take 10 to 15 years to turn into cancer. It then takes time to grow and spread, causing symptoms.
However, symptoms can occur, and it's important to be aware of them. These symptoms might also indicate other conditions. If you have any symptoms, see a healthcare provider.
Colon Cancer and Young AdultsThe incidence of colon cancer is rising in young adults. They're more likely to ignore symptoms that may indicate disease, which leads to later diagnosis and treatment. Don't put off seeing a healthcare provider if you notice any symptoms. Early diagnosis and treatment are key for optimal results and a greater chance of survival.
Common in Early Colon CancerSymptoms that can occur, especially in the earlier stages of colon cancer, include:
Changes in your bowel habits, such as having more diarrhea or constipation than usual
A feeling that you haven't emptied your bowels completely after a bowel movement
Bleeding from the rectum or blood in your stool
Thinner or narrow stool
Cramping or stomach pain
Unintentional weight loss
While fatigue may be present in early colon cancer, it's more likely to show up as time goes on. This is because colon cancer causes bleeding from the rectum or digestive tract. Over time, this blood loss becomes more significant, causing a low red blood cell count (anemia), which causes fatigue.
What If You're Asymptomatic?As colon cancer progresses, symptoms will eventually show up. But in the earlier stages, there is the chance of being asymptomatic.
If you are at elevated risk for colon cancer because of family history, genetics, or lifestyle factors, talk with a healthcare provider about your concerns. Sometimes, you may be able to be screened for colon cancer based on established risk, but this is not always the case.
Colon Cancer and Overlapping Symptoms in Other ConditionsMany symptoms of colon cancer are similar to symptoms of other conditions, which is why it's so important to see a healthcare provider if you notice any symptoms. They can do an exam, get a thorough medical history, and order any screening or diagnostic tests that can help with an accurate diagnosis.
Other conditions that have overlapping or similar symptoms can include:
Screening to Detect Early Colon CancerEarly colon cancer can often be found or prevented through screenings, which can find and remove polyps before they become cancerous or when they start to become cancerous. Your provider should discuss with you when screening starts based on your age, family history, medical history, and lifestyle.
Certain risk factors indicate that you should start screening at an earlier age and/or have screening more often, and these include:
A personal history of colon cancer
Strong family history of colon cancer or polyps (i.E., in a first-degree relative such as a parent or sibling younger than 60 or two first-degree relatives of any age)
Personal history of inflammatory bowel disease
Family history of any hereditary colon cancer syndrome, including familial adenomatous polyposis (FAP) or Lynch syndrome
The United States Preventive Services Task Force (USPSTF) recommends that people between the ages of 45 and 75 get regular screening. However, they don't recommend a specific test. For most people of average risk, insurance will cover a colonoscopy every 10 years.
Tests that can be used for screening include:
Colonoscopy: Uses a thin tube with a camera and tools on it inserted through the rectum to examine the entire rectum and colon and also remove polyps
Computed tomography (CT) colonography: Also called "virtual" colonoscopy, it uses CT to produce detailed images of the colon and rectum.
Sigmoidoscopy: This procedure is similar to colonoscopy, but it cannot check the upper part of the colon.
Fecal occult blood test (FOBT) and fecal immunochemical test (FIT): These are tests to find blood in the stool.
Stool DNA test: This test checks the stool for signs of tumor genetic material.
Localized colon cancer, or cancer that has not spread beyond any local tissues to lymph nodes or any distant organs or tissues, has a five-year survival rate of 91%. Localized colon cancer typically refers to stages 0 through 2A.
When to Get a Provider OpinionSo when should you see a healthcare provider?
If you have any chronic bowel issues and notice a change in your bowel habits, blood in your stool, or unexplained bloating or fatigue, it's worth calling a healthcare provider to see if there's something that needs addressing.
If you have a family history of colon cancer, polyps, or any hereditary colorectal cancer syndrome, your screening guidelines are likely different than the general population. You should speak with a healthcare provider about when you should get screened, and any signs or symptoms to watch for.
Tell a healthcare provider about your concerns or anxiety about symptoms getting worse or your risk factors. They may be able to provide you with concrete information that may help ease your fears or help mitigate your anxiety.
Can You Lower Your Colon Cancer Risk?Anyone can get colon cancer, but certain risk factors can increase the likelihood of the cancer developing. However, it's important to remember that risk factors don't necessarily mean you will develop cancer; they increase your risk. It's also possible to develop colon cancer with no risk factors.
Some risk factors that are out of your control include things like:
Older age: Your risk of colon cancer increases as you get older.
Having inflammatory bowel disease (IBD) like Crohn's disease or ulcerative colitis
Genetic syndromes like familial adenomatous polyposis (FAP) or Lynch syndrome
Talk with a healthcare provider about these risk factors and how they may impact screening for you.
Some other risk factors relate to behavior or lifestyle and can be modified. High-risk lifestyle factors include:
Using alcohol and tobacco
A diet low in fiber and high in fat or a diet high in processed meats
Lack of fruits and vegetables in your diet
Minimal physical activity
Overweight or obesity
If you have one or more modifiable risk factors, talk with a healthcare provider about steps you can take to address your risk and reduce it. Sometimes, you may want additional help, like a nutritionist or a counselor, to help change behaviors and choices.
SummaryEarly colon cancer doesn't always have symptoms, but when they do arise, they are often general and nonspecific, like bloating, gas, or changes in bowel habits. Sometimes, more serious symptoms like bloody stools, significant weight loss, or fatigue may occur.
It's important to note any changes in bowel habits and see a healthcare provider if you notice anything different about your body or how you feel. Talk with them about when you should start screening for colon cancer, depending on your family and medical history, and what steps you can take to help reduce your risk of developing colon cancer.
Read the original article on Verywell Health.
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