Q & A: With Dr. Grimes, Colon and Rectal Surgeon

In February, the American Cancer Society released findings of a study showing that new cases of colon cancer and rectal cancer are occurring at an increasing rate among young adults. Adults born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to adults born in 1950. SB Magazine sat down with Dr. W. Reid Grimes, with Colon & Rectal Associates to discuss colon cancer and the recent study.

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SB: What is the difference between colon and rectal cancer?
Dr. Grimes: Often they get lumped together as colorectal cancer or colon and rectal cancer but there are differences in the treatment of colon cancer and rectal cancer. With rectal cancer, we often involve radiation therapy in the treatment, whereas radiation therapy is seldom used in colon cancer. There are occasions we do, but very infrequently. But with rectal cancer, the majority will include radiation as part of the treatment.

SB: Which one is more deadly?
Dr. Grimes: Generally, rectal cancer is felt to be a little bit greater risk.

SB: What are your thoughts on the study by American Cancer Society?
Dr. Grimes: We are seeing it younger. We’ve always seen young patients. My youngest is 11. Thirty plus years ago, as a resident I reviewed 10 patients under 18 years of age with colon cancers, so not very many but not nonexistent either. I’ve had plenty of patients in their twenties and thirties with cancer but our impression in practice and what the numbers are showing is we are seeing more of these young patients. I don’t know why. We’re hoping to get a handle on that some day. Is it going to change our screening? It’s certainly being looked at. It has not changed the screening system yet. It’s certainly something that’s going to have to be considered. Screening systems aren’t designed to prevent every single colon cancer. You just couldn’t do it. If my youngest is age 11, that means we have to start at age four or five doing colonoscopies. That’s not realistic, so you have to figure out your risks and benefits.

SB: Right now, the recommended age for screening of colon cancers is age 50, correct?
Dr. Grimes: For the general population right now, it’s still considered age 50. There is one prominent set of guidelines from the American College of Gastroenterology, that for blacks, they recommend screening to start at age 45. Now the American Cancer Society has not changed their recommendation yet. There is some consideration to screen blacks younger since they are at an earlier risk.

SB: Are there factors that put people at greater risk?
Dr. Grimes: Family history. That’s the biggest, but approximately 80 percent of colon cancers are sporadic, meaning you cannot identify a family history cause or a syndrome cause or anything like that. Still the vast majority is sporadic. That’s why we screen everybody.

SB: What symptoms should people look for?
Dr. Grimes: There are no early signs for colon and rectal cancer. The bleeding might be the earliest, especially maybe for a rectal polyp, but most often not. Usually they’re not going to bleed until you have a cancer. Certainly if a young person has bleeding, if the cause cannot be identified, then they need to be evaluated for the potential of having a colon cancer.

SB: How treatable is colon cancer if caught early?
Dr. Grimes: Very treatable. We should be able to cure the majority of patients even if they have cancer. Staging is the key. The more advanced the stage, the less likely we are to cure it. If we don’t find the polyps to remove in order to prevent the cancer, we at least want to try and find them as early as we can as far as stage goes. With a combination of surgery, chemotherapy in appropriate patients, radiation in appropriate patients with rectal cancer, we offer a good chance of curing the cancer.

SB: What should people expect when having a colonoscopy?
Dr. Grimes: The day before, you consume clear liquids and you have to take a laxative to clean the bowels out because if it’s not clean, we can’t see. Then, you get sedated. There are risks—risk of bowel injury—but it’s a very low risk.