Despite remarkable advances in detection and treatment of colorectal cancer, it remains the second-largest cause of cancer mortality in the United States. This statistic looms despite the fact that colorectal cancer is one of the most treatable cancers there is because early detection, thus cure, is entirely possible.
What makes this unique among the other cancers for which we have screening tools is that prevention is also possible. This is because we can identify and remove premalignant lesions before they become cancer. So what accounts for the stark contrast between this grim statistic and our known ability to prevent, detect and cure this cancer? Lack of screening. The most common signs and symptoms of early colon cancer are — nothing at all. That’s why we so strongly recommend screening for colorectal cancer.
Current guidelines recommend colorectal cancer screening for adults between the age of 50 and 75. This may start earlier for those at higher risk (family history of colorectal cancer, chronic inflammatory bowel disease, polyposis syndromes or patients of African-American descent).
After the age of 75, we recommend screening on an individual basis. There are a variety of recommended screening tests. The gold standard is the colonoscopy, which provides both screening and prevention. Not only can it detect early stage cancers, but also precancerous lesions called polyps, can be removed to potentially prevent a cancer from developing.
But their experience with these conditions isn’t just professional: Jenna has ulcerative colitis, and Emily has Crohn’s disease. Both are lifelong, chronic inflammatory disorders of the digestive tract that are treated with medications and often with surgery.
Recently, Jenna and Emily sat down to talk about their unique positions, and how their personal lives inform their work with patients.
Jenna: I’ve been a physician assistant at Rush for almost three years now. My decision to work in this field was strongly influenced by my own diagnosis of ulcerative colitis. After spending many years as an IBD patient, I felt that I could relate to my patients as a provider, and that’s why I decided to work in gastroenterology.
Emily: I had similar reasons for joining our practice as a PA nearly two years ago. While the majority of my patients don’t know that I have Crohn’s disease, I think I bring a unique perspective on topics that can oftentimes be both embarrassing and personal. Having been a patient myself for over a decade, I have learned to be the type of provider who I would want to take care of me.
Food and its impact on health is a common topic of conversation among people. There are television shows, books and countless websites dedicated to the subject. In recent years, one of the most common culprits of concern when it comes to food is gluten.
As a pediatric gastroenterologist at Rush, I often hear questions about gluten. Many of my patients’ parents ask me how a gluten-free diet can affect their child’s health or help improve different symptoms. The answers to their questions are not always simple.
What is gluten?
Let’s start with the basics. Gluten has been an integral part of the human diet for thousands of years. There is currently no scientific evidence that states gluten is intrinsically harmful to healthy children.
I first met Tyler Jankiewicz and his mother, Ann, in August 2013, when he was 15 years old. Tyler had been referred to Rush’s pediatric gastroenterology program seven months earlier and was diagnosed with Crohn’s disease, a chronic autoimmune disease that causes inflammation throughout the intestinal tract. People with Crohn’s experience a variety of symptoms (abdominal pain, diarrhea, vomiting, blood in the stool), as well as weight loss, inflammation in the eyes and skin, fevers and joint pain.
Tyler first started having symptoms in December 2012, and his condition had progressed dramatically. He couldn’t eat and rapidly lost 40 pounds. By the spring of 2013, his weight was down to 115, and he didn’t have the strength or stamina to play volleyball on his high school team. He was anemic, and his condition was worsening.
Tyler Jankiewicz and his mother, Ann, describe the toll of Crohn’s disease, and how doctors at Rush helped him get better.
At first, I was just having stomachaches — maybe one or two a day. They weren’t too bad, and if I went to the bathroom, they went away. This was in the fall of 2012, during basketball season my freshman year of high school. When the symptoms first started, I still felt mostly fine; I was still able to get through practices and games.
But toward the end of the season, around December, the symptoms really started affecting my physical abilities. My coach was very understanding. He said if I needed anything, like in the middle of a game if I needed to use the bathroom, to just give him a signal and he’d take me out. I couldn’t play in the last few games, though, because I would get winded quickly and felt weaker.
I had planned to play volleyball in the spring, but by then I was really sick and had lost so much weight, about 40 pounds. I’d lost all the muscle I had, so I wasn’t in good enough shape to even try out. The coach said, “If you get better, you’ll be able to play.” I sat in the bleachers and watched practice for a few weeks, but after a while I didn’t want to be there because it was too hard to not be on the court.
Last July, an issue with swallowing food caused me to ask why, but I didn’t think twice until it was repeated two more times at three-week intervals. At that time, I moved my annual physical ahead from Oct. 26 to Oct. 6, at which time I insisted to my local doctor of a scope of the area in question. On Oct. 10, it was determined that there was a tumor, and biopsies confirmed a malignant tumor. I was diagnosed with esophageal cancer.
Upon meeting him, I knew he was the surgeon I wanted. He requested two more tests to confirm the diagnosis, after which a port was placed in me. On Oct. 25, I had a consultation with the team of doctors who would be handling my case, including Dr. Chmielewski, a thoracic surgeon; Dr. Sohrab Mobarhan, a gastroenterologist; and Dr. William T. Leslie of hematology/oncology.
Dr. Leslie chose the chemo treatment for my case, and surgery would take place after 12 treatments (depending on results). After eight treatments, the results were impressive, and surgery came sooner then anticipated — on Feb. 27, 2012.
No patient represents the importance of the “mind-body” connection like Jeff Galas.
When I saw Mr. Galas in the fall of 2011 for his newly diagnosed cancer of the esophagus, for all practical purposes on the surface he looked like he would proceed directly to surgical for treatment. On further staging workup, though, he was found to have possible liver metastasis on PET scanning, and at that point surgery was off the table. Chemotherapy would likely be his only option.
When given the dire news, Mr. Galas was his usual positive self and said “Don’t worry, doc, I am going to be the poster child for esophageal cancer. You will be operating on me yet.”
We already had a multidisciplinary team in place consisting of a surgeon, radiation oncologist and a oncologist — so Dr. William Leslie from oncology weighed in on the treatment options. To his credit, instead of recommending the standard agents, he suggested a new regime consisting of FOLFOX that has shown promise in metastatic GI cancers. Mr. Galas sailed through this regime, and when we restaged him, there was no evidence of metastasis.
Being cautiously optimistic, the Coleman Clinic GI team reviewed his case and presented his options of proceeding with radiation treatment or the original option of a minimally invasive esophagectomy if liver biopsy confirmed no disease. Mr. Galas opted for surgery and the minimally invasive approach. At time of laparoscopy, liver biopsy showed no signs of cancer spread to the liver, and a minimally invasive esophagectomy was completed. Mr Galas was home 10 days later, tolerating a diet and resuming many of his normal activities. Because a minimally invasive approach was used, he was able to restart his chemotherapy after only four weeks post-operatively. I am certain Mr. Galas’s positive mindset contributed to his excellent response to date.
My interest in nutrition began when I was 15 years old. As a young athlete, struggling with iron deficiency anemia, I started learning how nutrients affected my body. I learned how to manage my condition with food and was taught to consume foods rich in iron, such as red meat or spinach, with foods high in vitamin C, such as bell peppers or oranges.
I knew I wanted to specialize in nutrition support from the minute I calculated my first tube feeding and parenteral nutrition prescriptions in my dietetic internship here at Rush University. After becoming a registered dietitian (RD), I pursued a specialty in gastrointestinal (GI) and transplant surgery because of my passion for nutrition support. I continue to be amazed by the way nutrition can improve my patients’ outcomes. Continue reading →