October 26, 2025 • 36 mins
10/26/25
The Healthy Matters Podcast
S05_E02 - Gut Check: Colon Cancer 101
With Special Guest: Dr. Jake Matlock, MD
Colon cancer isn't exactly dinner-table conversation, but maybe it should be. Behind the awkward jokes and uncomfortable colonoscopy prep lies one of the most preventable forms of cancer out there. But how does colon cancer develop? Who's most at risk? And can screening and early detection really save your behind?
On Episode 2 of our show, Dr. Hilden sits down with gastroenterologist, Dr. Jake Matlock to go through everything from prevention to treatment. We'll cover the basics of the condition, weigh the merits of available screening options and discuss the best practices for staying healthy. When it comes to colon health, a little knowledge (and a little humor) goes a long way. We hope you'll join us.
Got healthcare questions or ideas for future shows?
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_03 (00:18):
Hey everybody, and welcome to episode two of season
five of the podcast.
I am David Hilden, your host,and you know there are plenty of
things that we'd probably allrather talk about than our
intestines and our colon.
Like literally anything.
But here's a sobering fact: colon cancer is one of the most (00:33):
undefined
common cancers in the UnitedStates.
There's a hopeful part though.
It's also one of the mostpreventable.
I get it that people want to putit off, but the truth is a
little screening can go a longway and it's not nearly as bad
as you might think.
Catching colon cancer early canliterally save your life.
So today we're gonna sit downonce again with my colleague at
(00:54):
Hennepin Healthcare, Dr.
Jake Matlock.
He is a gastroenerologist andknows a thing or two about colon
cancer.
Jake, welcome back to thepodcast.
Thanks, David.
It's great to be here.
Start us off.
Can you just explain what coloncancer is?
How does it arise in people?
SPEAKER_02 (01:09):
Sure.
Colon cancer is uh a an abnormalgrowth that occurs within the
lumen or within the tube of theintestinal tract in the portion
of the intestine called thecolon, which is the last roughly
five to six feet of yourintestinal tract.
It's the part of your intestinaltract that's responsible for
waste processing.
So it's not one that we thinkabout uh very often or like to
(01:32):
talk about in politeconversation, but it is one of
the most common cancers in bothmen and women in this country.
And so it's an important topicfor everyone to be aware of.
SPEAKER_03 (01:42):
So your colon being your large intestine, the last
five feet.
Say more about that if youcould.
What does your colon do exceptmove yucky stuff through it?
SPEAKER_02 (01:49):
Trevor Burrus So if you can imagine the intestinal
tract as a whole is responsiblefor absorbing nutrients from the
food that we eat, but there's alot of waste that runs through
us that is not useful to ourbodies, not useful for our
nutrition.
And so as a result of that,about three liters of liquid
waste is delivered to the colonevery day, and the colon is
(02:11):
responsible for processing thatliquid waste, reabsorbing the
water from it, and turning itinto solid stool.
SPEAKER_03 (02:17):
Aaron Ross Powell You said liquid waste, though.
I ate a steak the other night.
That wasn't very liquid.
It wasn't how did it get to beliquid?
SPEAKER_02 (02:23):
Uh so the digestive process uh starts actually uh as
soon as you put food in yourmouth.
Uh the salivary enzymes startthe digestive process and and
through the actions of yourupper intestinal tract, from
your mouth through your uhstomach and the upper part of
your small intestine, food isbroken down from solids uh first
(02:43):
into smaller pieces of of solidmaterial and then ultimately
down into liquid, occasionallywith some solid chunks uh
without getting too graphic.
You know, some people areputting together while they're
listening to this.
But but by and large, what isdelivered to the colon is is
kind of a pea soup consistencymixture.
Trevor Burrus, Jr.
SPEAKER_03 (03:02):
Well, that's actually a good consistency uh
um thing, pea soup, becausethat's roughly what it is.
It's not water.
It's not water.
But it's not what it's not yourstool yet.
It's not the solid stuff.
Correct.
And so your intestines then getrid of all the water?
SPEAKER_02 (03:14):
Aaron Powell, so your colon is responsible for
reabsorbing the water from thatstool stream, and that's useful
because if you know if you canimagine three liters of liquid
waste coming through every day,if you couldn't reclaim that
water, number one, you'd bespending most of the day in the
bathroom.
And number two, if you weren'tin the bathroom, you'd probably
be trying to replace all thefluids that you were losing.
So really your colon allows youto function in the world.
SPEAKER_03 (03:36):
Yeah, and and I know uh you know, occasionally during
this podcast, we'll we'll make acouple jokes here and there, but
people who have loose stools,who have chronic diarrhea or any
diarrhea know, know that itchanges your day, it changes
your week, it changes your life.
So you know, when your colon'snot working, that comes into
dramatic focus then.
So is there a connection betweencolon cancer and rectal cancer?
(03:58):
Rect your rectum being the lastfew inches of your colon?
SPEAKER_02 (04:01):
That's correct.
Your rectum is the last fewinches of your colon.
It's anatomically distinct in afew ways.
For one, it has a differentinnervation that allows you to
sense when you need to have abowel movement.
Uh, that's that's where thatsensation comes from.
The rectum is also anatomicallydifferent from the colon just
because of its location down lowuh within the bowl of the human
(04:23):
pelvis.
But from a physiologicstandpoint and and more from the
standpoint of cancer, uh thedistinction is not terribly
important.
I hesitate a little bit therebecause the distinction is
important when it comes totreatment, which is a little
farther down the line, but butuh but beyond that, I think we
you can kind of lump themtogether.
SPEAKER_03 (04:43):
So we use the word colorectal cancer in that case.
Correct.
Okay, so how do these cancersstart?
And something about polyps.
Why don't you talk about polypsif you could?
SPEAKER_02 (04:51):
Aaron Powell Yeah.
So the the the overwhelming mostcommon pathway for the
development of colon cancer isthrough these small growths in
the colon called polyps.
Now, polyps uh can take avariety of forms, not all of
them are associated with thedevelopment of colon cancer, but
the kind that that people mostcommonly think of, which are
called adenomatous polyps oradenomas, are associated with
(05:13):
growth and ultimatelytransformation into colon
cancer.
For all intents and purposes,you can think of this as the as
a sole common pathway for thedevelopment of colon cancer.
There are some very rareexceptions, but that's that's
really the the major pathway.
SPEAKER_03 (05:27):
So why do why do we grow polyps?
Or why do some people growpolyps?
SPEAKER_02 (05:31):
Aaron Powell It's a great question.
Uh you know, if you lookstatistically speaking,
somewhere around a third ofadults will have polyps.
And so it's a very common thingfor adult humans to have.
A third.
A third.
Yeah.
And and some people wouldsuggest that's even an
underestimate of the prevalence.
There are risk factors that canincrease a person's uh
(05:53):
likelihood of developing polyps.
Some of them are genetic orfamilial risk factors, some of
them environmental.
But even in the absence of anyidentifiable risk factors, we
still find polyps quite commonlyin asymptomatic people.
SPEAKER_03 (06:06):
So one of the perks of being a doctor and working at
a major metropolitan center likeI do is that you have friends
and colleagues who will let youlike look in on what they do.
So I have been there when youhave done a colonoscopy.
It's fascinating.
But could you talk listenersthrough when you're doing a
colonoscopy?
And we'll talk more about whoshould get a colonoscopy later,
but talk us through when you arelooking in someone's intestines,
(06:26):
what does a polyp look like?
SPEAKER_02 (06:28):
So uh a polyp looks uh like a small break in the
contour or texture of the liningof the colon.
So normally your colon is is asmooth, moist lined structure.
It looks a little bit like theinside of your cheek, honestly.
And if you can imagine uhsomething growing uh on that
lining that looks almost like amole on the skin.
(06:50):
So it breaks the contour, it's alittle bump.
Uh over time, uh those bumpswill get bigger and and more
geographically interesting.
They get uh ridges and bumpswithin them.
Occasionally they'll even grow astalk and look almost like a
mushroom coming up off thelining of the colon.
SPEAKER_03 (07:06):
And they're little, right?
These aren't big.
They look huge on your screen,because you're looking at them
on a screen, but they're nothuge.
They do.
SPEAKER_02 (07:12):
I mean, we have we have uh thankfully through the
improved technology, throughhigh-definition cameras and
better lighting, we have beenable to detect much smaller
polyps than we used to.
So now the limits of ourdetection are probably on the
order of one to two millimetersin size.
Uh they can get quite large.
Uh, you know, some of them areuh uh uh five centimeters even,
(07:34):
so uh so fifty millimeters insize, so that's about two inches
in diameter.
Whoa.
Uh so that's that would beconsidered a giant polyp, but uh
but from a certain perspective,that's still not very big.
It's a couple of inches.
SPEAKER_03 (07:45):
From a from a sesame seed to a big grape or a small
golf ball, even.
Yeah.
Yeah.
Yeah.
Wow.
Okay.
So how long does it take for oneof these polyps, those that
might turn into colon cancer,how long does that take?
SPEAKER_02 (07:58):
So to go from no polyp through the process of
forming a polyp, having it grow,and ultimately transform into a
colon cancer is probablysomewhere on the order of 10
years.
So there's a window there, along time.
There is a pretty good window.
And that's really the onlyreason that colon cancer
screening works, is because weknow what the precursor thing
is, what it looks like before itbecomes cancer, and we have an
(08:21):
adequate time lag to be able toget in there and do something
about it.
SPEAKER_03 (08:25):
Which is what a screening test needs.
If there's if you don't knowwhat the precursor looks like
and you can't catch it in timeearly enough and there's nothing
to be done about it, then ascreening test doesn't work.
This checks all the boxes.
Exactly.
Okay, so before we get into howyou get screened, let's talk a
little bit about colon canceritself in the population.
How common is it?
SPEAKER_02 (08:44):
Well, colon cancer is currently the third most
common cancer in both men andwomen in the United States.
So if you think about the actualnumbers, uh in this country
every year, approximately twomillion people are diagnosed
with some form of cancer.
Colon cancer accounts for150,000 of those.
So that's just under 10 percentof uh the cancers diagnosed in
(09:06):
this country each year.
If you look at how many peopledie from cancer, roughly 600,000
people die each year from someform of cancers.
And roughly 55,000 of those arecolorectal cancers.
And so colorectal cancers dotake up a larger s share of the
deaths from cancer than they doof cancers themselves.
(09:28):
And and when you consider thefact that, again, it is the
third most common cancer in bothmen and women, it's a
substantial public healthproblem.
Trevor Burrus, Jr.
SPEAKER_03 (09:36):
It totally is.
And many people think of, well,I'm not old enough for that.
We used to think of it it'speople over age 50, and in fact,
that's who we used to screen.
Everybody over 50 should getsome kind of screening done.
But everybody knows somebody orhas heard about somebody younger
getting colon cancer.
Do we know why that might be?
SPEAKER_02 (09:53):
I don't think we have the full answer yet.
Uh certainly there's a lot ofspeculation about uh
environmental factors, changesin our food stream, changes in
our uh health habits that areprobably playing a role.
Currently, the guidelinesuggests that we should be
screening everyone at age 45,which is, as you pointed out,
(10:13):
younger than what uh was thecase when you and I did our
training.
There is not, as of yet, aguideline for screening people
younger than 45, unless theperson has identifiable specific
risk factors or symptoms relatedto their colon.
But as you pointed out, theincidence in younger people is
rising.
(10:33):
It is still an order ofmagnitude lower than in older
individuals, but uh but it it isa cause for concern and
attention, I think.
SPEAKER_03 (10:40):
Aaron Powell What are those risk factors?
You mentioned risk factors.
Is it genetic?
Is it the steak I ate the otherday?
What is it?
It might be the steak I ate.
SPEAKER_02 (10:48):
It's unfortunately the same litany of risk factors
that doctors seem to uh harp onfor just about everything.
SPEAKER_03 (10:55):
So are you gonna tell me to eat right, don't
drink, and like exercise?
SPEAKER_02 (10:59):
Aaron Powell I'm afraid so.
Uh, Dr.
Pottskill.
Yeah.
So from a dietary perspective,uh uh alcohol, tobacco, and uh a
diet high in red meat uh placepeople at substantially
increased risk for colorectalcancer.
Uh and I love the roller grillat the gas station as much as
anybody, but that hot dog is notdoing you any favors uh from the
(11:22):
standpoint of colon cancer risk.
SPEAKER_03 (11:24):
Aaron Powell Yeah, that's a questionable life
choice on many levels to get thehot dog at the gas station,
Jake.
SPEAKER_02 (11:29):
I think we've both been there, though.
SPEAKER_03 (11:33):
Yep.
SPEAKER_02 (11:34):
Looking uh away from specific uh environmental
exposures, uh obesity is also arisk factor uh for colorectal
cancer.
And then there's there's thefamilial risk factor.
If you have relatives uh whohave colon polyps or colon
cancer, particularly if it is atan early age, and here I'm
talking about under the age of60, uh, then you are at
(11:55):
increased risk and you shouldlet your your healthcare
provider know that.
SPEAKER_03 (11:59):
Let's pivot to that then.
Let's talk about the nuts andbolts of screening.
So you already touched on whoshould get screened by age.
Is there anything more we needto say about age?
It's 45 for everybody, and somepeople younger.
Who are the younger ones?
SPEAKER_02 (12:18):
And I think that uh without getting too much into
the weeds, it's important to tomake note of first degree
relatives with colon cancer orpolyps.
And by first degree relatives Imean parents, siblings, or
children.
If you have second degreerelatives, so grandparents,
aunts, uncles, cousins who havecolon erectal cancer, that may
(12:41):
be important uh depending ontheir age and the number of uh
second-degree relatives that areuh involved.
Uh, but that gets a little bitmore complicated and it's
probably worth a focuseddiscussion with your healthcare
provider.
Aaron Ross Powell, Jr.
SPEAKER_03 (12:54):
Let's talk about the types of screenings you can do.
We're going to talk a little bitabout, or a lot of bit, about
colonoscopy, but it's not theonly kind.
So if you could talk us throughabout what the options are for
people.
SPEAKER_02 (13:04):
Sure.
There are there are a lot ofoptions now, and I think as you
and I have discussed on multipleoccasions in the past, the most
important factor is choosing atest that you are actually
willing to do.
So getting screened uh in oneway or another is more important
than how you do it.
I think that the modes ofscreening can be broken down
(13:25):
into endoscopic tests, of whichcolonoscopy is the most common
and the most widely available,and then stool-based tests,
which are tests that use samplesof a person's stool collected
usually at home to look foreither blood or certain uh
changes in the DNA in shed cellsin the stool to look for signs
(13:48):
of uh potential cancer orprecancerous changes.
The other modalities that areout there, and here I'm thinking
mainly about imaging modalitieslike CT colonography have not
really panned out uh as well uhuh in in their actual prevention
of colon cancer, and so areprobably best reserved for
people who are unable to do oneof the other tests.
SPEAKER_03 (14:10):
Aaron Powell So talk us through stool-based testing
just briefly.
SPEAKER_02 (14:14):
Sure.
So the the uh tried and true uhstool-based tests uh uh rely on
the detection of blood or bloodproducts in the stool.
So here you may be familiar withwhat are called hemacult cards.
These are small cardboard cardsthat you put a little bit of
stool on, you mail it in, andsome of the things that you're
doing.
SPEAKER_03 (14:34):
That means you don't need a big amount of stool on
there.
Trevor Burrus, Jr.
SPEAKER_02 (14:38):
Please no.
Please no.
Uh the uh cards then have adeveloper that's placed on them
and they they uh uh change coloruh with the presence of blood.
Kind of old school that one.
Aaron Ross Powell That's veryold school.
And I would say that most placesare no longer using straight
hemocults, but uh the hemaculthas been, has evolved to include
(14:59):
uh testing for DNA markers.
So now we have the FIT test andthe IFOB test, both of which,
again, are looking for changesto the uh the shed cellular
material in stool.
More recently, we've uh had theability to do something called a
cola guard test.
Uh this is a more extensivestool-based test.
(15:21):
It involves the collection of alarger volume of stools, so it's
not just a little bit on a card,but actually a whole collection
kit that gets mailed to apatient uh for collection at
home.
Uh this has a a wider uh arrayof markers that it is looking at
within the shed stool and doesprovide some uh longer duration
(15:41):
of protection.
So the the downside of the stooltests has always been that you
have to repeat them every year.
Uh, but with the cola guard,that uh interval is extended to
three years.
Aaron Ross Powell And then youhave to do something if it's
positive.
Aaron Ross Powell That'scorrect.
If if any of the stool-basedtests show a positive result,
then the recommendation is tohave a direct optical
(16:02):
examination of the colon with acolonoscopy.
That's when a guy like you stepsin.
That's when a guy like me stepsin.
SPEAKER_03 (16:07):
So we have been talking with uh Dr.
Jake Mattlock, he's agastroenterologist, and we're
talking about colon cancer.
When we come back from a shortbreak, we are going to talk
about how it's diagnosed, whatthe experience of a colonoscopy
is like from the guy who'sactually doing it.
So stay with us, we'll be rightback.
SPEAKER_00 (16:25):
When Hennepin Healthcare says we're here for
life, they mean here for you,your life, and all that it
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They provide all of the primaryand specialty care you'd expect
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(16:48):
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Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (17:02):
And we're back.
Okay, so colonoscopy sort ofgets a bad rap with some people.
It's like, oh my gosh, this isgonna be horrible.
Can you talk us through theprocess of colonoscopy from PrEP
to what you do?
SPEAKER_02 (17:12):
Sure.
So the the PrEP is the part ofthe colonoscopy experience that
most people find mostdistasteful.
Uh in order to look at aperson's colon, we have to clean
it out.
I have to be able to see thewalls of your colon clearly in
order to detect these very smallabnormalities.
As such, we have people drink alarge volume of liquid that the
(17:36):
body can't absorb and can't use.
And so, as such, that liquidjust runs through you.
It creates a tidal wave throughyour intestinal tract.
SPEAKER_03 (17:44):
Like a radiator flush.
SPEAKER_02 (17:45):
It overwhelms the colon's ability to reabsorb
water, and so it it literallyjust flushes everything out.
The volume that people have todrink varies depending on the
type of preparation that isprescribed, but is typically
between a half gallon and gallonof liquid.
I wish I could say that ittastes really good.
It doesn't.
Chill it, drink it a littleslower, and maybe throw a straw.
(18:08):
That's what I heard.
Trevor Burrus, Jr. (18:09):
There are any number of tricks.
Use of a straw, use of cold,walking and moving around to try
to try to keep stuff movingthrough you so it's not coming
in.
SPEAKER_03 (18:19):
And can't you make your life a little better by not
eating heavily in those days,leading up to it?
SPEAKER_02 (18:24):
Aaron Ross Powell, we do recommend modifying uh the
diet in the the three to fivedays leading up to the PrEP.
And the goal of the dietarymodifications are to try to
reduce the volume of uh wastethat's in the intestinal tract.
It's a little counterintuitivebecause normally we are telling
people to eat a lot of fiber,it's good for your health and so
forth.
But in order to really reducethe volume of stool that needs
(18:46):
to be cleared out, we do we dotypically suggest a low fiber
diet just for that few daysprior to the preparation.
SPEAKER_03 (18:52):
Aaron Powell What about preps that don't involve
uh all that drinking of fluids?
People talk about the little,isn't there one that's just uh
64 ounces?
And isn't there even one in pillform or something?
What about all of those?
SPEAKER_02 (19:03):
Aaron Powell There are low volume preps, and um
those are still creating a tidalwave that runs through the gut.
I mean, it you cannot get aroundthe fact that you have to flush
everything out in order to see.
But for the low volume preps,they are relying on taking fluid
from a person's body and suckingit into the intestinal tract to
(19:24):
create the volume for the flushrather than having the person
consume it.
SPEAKER_03 (19:28):
Okay.
SPEAKER_02 (19:28):
Uh that's more palatable uh for many people.
It also does run the risk ofcreating some electrolyte
imbalances because you arestealing, you got to steal the
liquid from somewhere.
And so if you're not uhconsuming the liquid, uh then
your your body has to has tosacrifice that liquid.
The nice thing about the highervolume preps, as as challenging
(19:50):
as they can be, is that theyare, by and large, volume and
electrolyte neutral.
So that makes them much more ownbody.
Yeah, it makes them much saferfor for people to consume again
with the caveat that it can besomewhat challenging because of
the volume.
SPEAKER_03 (20:03):
Okay.
So I'm all prepped up.
I've been on the toilet allnight long.
My colon is pristine.
And I come into your office inthe GI lab, and what happens?
SPEAKER_02 (20:14):
Well, first of all, we're gonna make every effort to
make you comfortable whileyou're there.
Uh, we recognize that it's anuncomfortable situation to be
in.
It can be kind of awkward ifyou've never been there before.
And so we want to make you feelwelcome.
We're gonna bring you in, we'regonna introduce you to our team.
Uh so you're gonna meet thenurse, the tech, and the doctor
who's gonna be involved in yourprocedure.
(20:34):
We'll put an IV in one of theveins in your arm, and that is
to allow us to administermedication to keep you
comfortable during the test, andthen we'll bring you into the
procedure room.
Once we're in the procedureroom, we'll administer small
doses of sedating medications,and those are again just to keep
you comfortable and relaxedduring the test.
Uh, it's uh certainly morepleasant for you.
(20:56):
It's also better for me as theperson performing the test if
you're relaxed and not movingaround so that I can get a good
look.
Yeah.
The better look I get.
Aaron Powell, Jr.
SPEAKER_03 (21:06):
Are most people out sleeping?
SPEAKER_02 (21:09):
I would say the majority of people are somewhat
awake during their colonoscopy,although it is also the case
that most of them do not havemuch, if any, recollection of
the event.
And so uh whether or not aperson is awake kind of depends
on who you ask.
If you ask the person, they'llusually tell you they slept
through it.
But if you ask the operator,they'll typically tell you no,
(21:30):
they didn't.
SPEAKER_03 (21:30):
Really?
So, because here's the deal.
In all full disclosure, I had mycolonoscopy here and I know
everybody.
I knew the doctor doing thetest, I knew the nurse, and I
go, hey, I'm gonna watch thisthing.
I'm really, I'm good.
This is gonna be interesting.
I'm gonna watch my colon on thatscreen.
I don't remember 10 seconds ofit.
I was probably pretty sedated,but kind of maybe I wasn't as
squirmy as I would have been hadI not been.
SPEAKER_02 (21:51):
Yeah, I I had mine here as well.
I had mine without any sedation,and uh it's not as it's not as
difficult a an experience as Ithink most people expect it to
be.
It's really just not thatdifficult.
Yeah, that's you're kind of ahero there.
I can't believe that I think thehero is the person who did the I
think so okay.
SPEAKER_03 (22:10):
So you're on this thing.
Just real briefly, talk usthrough what you put the scope
all the way as far as it'll goin, and then you'll look on the
way out.
Is that is that fair to say?
SPEAKER_02 (22:18):
That's correct.
So the the part of the test thatcan be uncomfortable is is
inserting the scope all the wayto the top of the colon.
Again, that's about five or sixfeet uh of intestinal tract.
And so getting in there aroundall the different twists and
turns that the colon takesthrough your abdominal cavity
can be a little bit challenging.
SPEAKER_03 (22:34):
Be honest with me.
Is it like playing a video game?
A little bit.
I mean, I'm not gonna do that.
I'm seeing your hands on this.
You've got all these things,you're looking at a video
screen, you're turning, youknow, you're you know, there
there are there are a lot of funthings in medicine.
SPEAKER_02 (22:45):
This is definitely one of them.
SPEAKER_03 (22:46):
Um people say, why do you go in to being a
gastroenterologist?
You're looking at all the netherregions of people, and here you
are saying it's kind of fun.
It is kind of fun.
SPEAKER_02 (22:56):
And uh, you know, typically to get to the top of
somebody's colon takes one totwo minutes.
Uh and then really it's on theway back out, as you as you
said, that we're doing theexamining part of the uh uh of
the test.
And on the way back out, whatwe're doing is we're trying to
make sure that we get a look atevery surface of the colon.
Your colon is not a longstraight tube, it's got twists,
(23:18):
turns, folds.
It's kind of shaped like aquestion mark, I always thought.
So it's shaped like a questionmark, and the structure is
somewhat like an accordion.
So it's got it's got rings ofmuscle and and somewhat
ballooned out areas in betweenthose rings of muscle.
And so we really need to takeour time to look behind each
fold, around every turn, uh, sothat we can detect as uh as many
polyps as And do puff it up,puff it up with air.
(23:39):
Aaron Powell We do.
Uh typically we'll use eitherair or carbon dioxide to inflate
the colon uh to allow us to seea little better.
We try to take as much of thatgas back out as possible.
SPEAKER_03 (23:49):
Because it's coming out somehow.
It's coming out somehow.
So don't go back to work.
Yeah.
SPEAKER_02 (23:54):
Well, and if you do, you can blame me for the whole
day.
SPEAKER_03 (23:57):
Uh okay.
The colonoscopy is done.
How do you diagnoseabnormalities?
SPEAKER_02 (24:02):
Aaron Powell So as we talked about earlier, uh, the
main thing that we're lookingfor during a colonoscopy are
these small growths calledpolyps.
Those are diagnosed based onvisual inspection.
So I have to be able torecognize a polyp and and uh and
and see it when it's present.
If we see polyps, our job is totake them out, which we do
during the colonoscopy.
(24:23):
It all happens in one fellswoop.
How do you do that?
Typically, we'll use either uh asmall lasso of wire called a
snare, or on occasion, withreally small polyps, we can use
a biopsy forceps to just pluckthem out.
But I think that that mostpolyps are removed with a a
small snare.
The scope has a channel thatruns through it that we can
(24:44):
insert a variety of instrumentsthrough, and uh one of those is
is this small snare and then onthe end of like a five-foot-long
wire?
Yeah, yeah.
I mean it's it's a it's acatheter and it has a uh a
handle at one end that a techwill open and close the snare
with, and and we open the snare,place it around the polyp, and
then close the snare, eitherjust using it as a a knife to
(25:06):
cut through the polyp, or onoccasion, if uh if the polyp is
larger and we're worried aboutbleeding, we'll pass an
electrical current through thatsnare to to cauterize as we cut
the polyp off.
SPEAKER_03 (25:17):
Okay, so you've cut this thing off or you you have
cauterized it off.
It's sitting there in the colon.
How do you get it out?
SPEAKER_02 (25:22):
Depends on the size.
Uh for smaller polyps, we canapply suction and suck them up
through the same channel thatthe uh the instruments run
through.
For larger polyps, we'll put adifferent instrument through the
channel that looks like afishing net and and simply put
the polyp in the net, pull thepull the scope all the way out,
dump the polyp out uh of the netand go back into where we were
(25:44):
and keep moving.
SPEAKER_03 (25:45):
Okay, so you get this thing out, you've got a
little piece of tissue, Isuppose you put it in a specimen
container.
How is colon cancer thendiagnosed?
What happens to that polyp next?
SPEAKER_02 (25:52):
Aaron Powell So everything that we take out,
whether it's a polyp or simply asample from a larger lesion that
we actually are concerned is acancer, gets sent down to the
pathology lab where uh the thespecimen is fixed, sliced, and
stained to be examined by one ofour pathologists.
Uh so when I take a polyp out ofsomebody, I put it in a jar, I
(26:14):
wave goodbye to it, and then Iwait.
And I uh typically 24 to 48hours later, I will get a result
from the pathologist saying,this is a polyp, this is not a
polyp, this is a cancer, this isnot a cancer.
SPEAKER_03 (26:26):
And the majority of the lesions you take out are
some type of polyp, right?
It's it isn't that you'reusually taking out and sending
to the lab and they say thisthing's already cancer.
SPEAKER_02 (26:36):
That's correct.
I think it's a good idea.
You know, we do, as I said, findpolyps in roughly a third of
people who come in for for thisexam.
So that's a very common finding.
To find an actual colon canceron a routine screening exam is
much less common.
Uh I would say that that, youknow, if I'm in the endoscopy
lab and and doing colonoscopyall day, every day, uh, Monday
(26:59):
through Friday, I'll probablyfind one cancer in a week.
SPEAKER_03 (27:02):
And a lot of polyps.
SPEAKER_02 (27:03):
And a lot of polyps.
SPEAKER_03 (27:05):
Which is the reason we're doing these.
You want to find those polypsbecause you're in that 10-year
window and you got rid of it.
Exactly.
And comment on this if youcould.
The one advantage tocolonoscopy.
Well, there's many.
There's some advantages tocolonoscopy about other
screening methods.
But one of them is that when yousee one of these polyps, you
actually removed the problem inreal time.
SPEAKER_02 (27:24):
Aaron Powell That's correct.
I mean, colonoscopy is is nicebecause it is both a screening
exam and a therapeutic uhmaneuver.
Because that polyp is not goingto bother you in the future,
assuming you got it.
Correct.
Once it's gone, it's gone.
And uh, you know, we when weidentify somebody as a as a
person who is a polyp former, wewill typically advise them to
(27:44):
come in on a somewhat morefrequent basis.
But the the individual polypthat we have removed is no
longer a threat to them.
It's gone.
Currently, for people with smallpolyps, the recommendation is to
come back in seven to ten years,uh, which is a change from just
even five years ago.
Uh, and that is uh a reflectionof the fact that uh number one,
(28:05):
we now understand that polypgrowth is slow.
And number two, the detection ofpolyps has gotten better, and so
the ones that we're finding aresmaller than they used to be.
Aaron Powell Okay.
SPEAKER_03 (28:15):
Uh we're not going to get in a lot of detail about
colon cancer treatments, but ata higher level, somebody is
diagnosed with an actual cancer.
How are what are the treatmentoptions that they might at least
have to consider?
SPEAKER_02 (28:27):
The most important treatment for colorectal cancer
is resection.
And for early stage coloncancers, uh, resection can be
curative.
Cut it out.
Cut it out.
And often resection isrecommended even for more
advanced colon cancers, which isdifferent from a lot of types of
cancer.
And the reason for that is thatyou don't want the primary
(28:50):
cancer getting so big that itblocks off the intestinal tract.
And so, really, resection issomething that should be
considered and on the table asan option for any colon cancer.
It's not always the right thingto do, but it should always be
under discussion.
SPEAKER_03 (29:04):
And when you're talking about resection, you
refer to one of our colorectalsurgeons who isn't cutting out
the tumor, right?
They're cutting out a segment ofyour intestine.
Is that a fair statement?
SPEAKER_02 (29:15):
They're cutting out the segment of the intestine
that contains the tumor, and andthey want to get several
centimeters of normal, healthycolon on either side, as well as
the lymph nodes that drain thatsegment of colon, because the
lymph nodes are going to be thefirst place that the cancer
spreads out if it has left thecolon.
And so getting those lymph nodesthat drain that particular area
(29:37):
is important so that thepathologists can again look at
those lymph nodes to see ifthere is any sign of spread.
And that helps us to determineif the resection was adequate to
treat the cancer or if more uhtreatment would be recommended.
And then they just hook up thetwo ends?
That's correct.
Usually uh they are able to dowhat's called a one stage
(29:59):
operation.
Which means that they take outthe section of colon that has
the cancer and then hook the twoends back together.
There are some circumstances,thankfully not very common,
where uh they have to do atwo-stage operation where they
take the section out with thetumor in it and then bring the
intestinal tract out to the skinfor uh a short period of time,
usually a matter of a few weeksto a few months.
(30:21):
Um you have a bag in a couple ofthings.
You have a bag that a person hasto wear and then only later go
back and hook things backtogether.
SPEAKER_03 (30:28):
Aaron Ross Powell So resection is the primary thing
for many or if or even mostcancers.
What about chemotherapy andradiation?
That's on people's minds a lot.
SPEAKER_02 (30:35):
Aaron Powell Yeah.
So chemotherapy is one somethingthat is used frequently in uh
colon cancer if it has spreadbeyond the colon and
occasionally, depending on thethe uh microscopic appearance of
the cancer, even if it has notspread beyond the colon.
The use of radiation isprincipally limited to rectal
cancers, and uh without gettingtoo much into the weeds, that
(30:58):
has to do with the fact that therectum is, as we alluded to
earlier, in the pelvis andtherefore in a relatively fixed,
non-moving location.
The rest of your intestines kindof move around in your abdominal
cavities, it makes them veryhard to target with radiation.
But the fixed location of therectum makes it a good candidate
for radiation therapy.
SPEAKER_03 (31:18):
Aaron Ross Powell So what's the prognosis in general
terms, obviously, for someonewho has their cancer caught
early?
And then obviously, what's theprognosis if it's caught late?
SPEAKER_02 (31:30):
So with an early stage colon cancer, the
prognosis is actually quitegood.
It is one of the cancers that wecan reasonably talk about curing
rather than we don't use thatword much in cancer, but we
still can't, yeah.
Very rarely use that word.
But but with early stage coloncancers, I think it's a
reasonable label.
With later stage colon cancers,uh, particularly those that have
(31:51):
spread even beyond lymph nodesand to other organs within the
abdominal cavity or chest, theprognosis is not as good.
Uh it it it becomes unrealisticto talk about cure.
Uh, and rather we are talkingabout uh slowing the progress of
the disease, slowing theadvancement of the disease.
SPEAKER_03 (32:10):
Which explains the the high numbers that you gave
at the top of the episode.
Before I let you go, Jake,you've mentioned um how
preventable this cancer is andthe importance of screening.
So what what's on the horizonthat that's given you hope um
about treatments or diagnosis orwhat's the future look like?
SPEAKER_02 (32:27):
Aaron Powell Well, I think that that the thing that
has become clear to me over thecourse of my career is that the
best um uh treatment for coloncancer is to prevent it from
occurring in the first place.
And so screening uh uh issomething that I would encourage
everybody to think about anddiscuss with their healthcare
provider.
Obviously, with colon cancer,there is a barrier to screening.
(32:48):
It involves either havingsomebody look in your colon with
a colonoscopy or handling yourown bowel movements, which most
people don't really want to do.
There are blood tests uh thatare on the horizon that are
showing a lot of promise.
I would anticipate that probablywithin the next few years, we're
going to have a blood test tolook for early signs of colon
cancer.
And I think that has the promiseto revolutionize colon cancer
(33:11):
screening.
Uh getting a blood draw ispretty routine for most people
who who are engaged with thehealthcare system.
And I think that if we can getto the point where where blood
testing uh becomes a viableoption, I think it will really
change the game for colon cancerscreening.
SPEAKER_03 (33:26):
Trevor Burrus, Jr.
Could you address theembarrassment factor of
colonoscopy?
People are coming in to see you.
They don't know who you are,they don't know who any of these
folks are.
They've been uncomfortably onthe toilet all night long, and
then they and then they have toput their tukas out there in the
world, and and and it's uh it'sembarrassing.
How do you help people get overthat?
SPEAKER_02 (33:45):
It's it's actually one of the biggest challenges, I
think, with with my practice,and it's one of the most
difficult things to teach thefellows and trainees that we
have uh here at Hennepin, whichis that you're you're meeting
someone usually for the firsttime, and within about five
minutes, you have to convincethem that they can trust you to
put something up their bottom.
(34:07):
That's not a situation thatyou're likely to be in any other
time in your life.
SPEAKER_03 (34:11):
I'm so glad that you're teaching the next
generation of doctors that howimportant that point is.
SPEAKER_02 (34:16):
Aaron Powell It's it it is a very um challenging art
to build that trust in a veryshort period of time.
And the reason for the timepressure is is you want to
devote as much time to theactual exam as possible.
Uh, you know, so there the theestablishment of trust, the
establishment of that rapportbeforehand is certainly
important, uh, but you don'twant to spend so much time that
(34:37):
you're limiting the time thatyou can spend on the exam, which
is where the actual protectioncomes in.
SPEAKER_03 (34:42):
Okay.
SPEAKER_02 (34:43):
If you could leave us with one thought, what would
it be?
Get screened for colon cancer.
Um and again, I I as agastroneurologist, I am
tremendously biased towardscolonoscopy as a preferred
screening modality, but that isreally not the most important
thing.
The most important thing is thatyou get screened.
I guess the other thing I wouldoffer you is that if you do get
(35:04):
screened and you do find thatyou have polyps, or hopefully
not, but if you do find you havea colon cancer, consider telling
your relatives.
Uh you know, as we discussed,family history uh is an
important uh risk factor incolorectal cancer.
And so if you care about thepeople that you're related to,
letting them know uh so thatthey can adjust their their
(35:25):
needs uh appropriately would bewould be the kind thing to do.
SPEAKER_03 (35:30):
Such important information.
Jake, you've been a guest withme on a number of my media
appearances, including thispodcast more than once.
Thanks so much for being hereonce again.
SPEAKER_02 (35:38):
It's great fun, David.
SPEAKER_03 (35:39):
I'm glad to do it.
Okay, listeners, that's theadvice from the show.
Make sure you get screened.
And if you do have anabnormality, consider telling
your relatives so they too canget screened.
Thank you for listening.
I hope you picked up some goodinformation.
We'll be back in two weeks' timefor another episode.
And in the meantime, be healthyand be well.
SPEAKER_01 (35:58):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(36:19):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanCamito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program, and every case isunique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(36:40):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_03 (00:18):
Hey everybody, and welcome to episode two of season
five of the podcast.
I am David Hilden, your host,and you know there are plenty of
things that we'd probably allrather talk about than our
intestines and our colon.
Like literally anything.
But here's a sobering fact: colon cancer is one of the most (00:33):
undefined
common cancers in the UnitedStates.
There's a hopeful part though.
It's also one of the mostpreventable.
I get it that people want to putit off, but the truth is a
little screening can go a longway and it's not nearly as bad
as you might think.
Catching colon cancer early canliterally save your life.
So today we're gonna sit downonce again with my colleague at
(00:54):
Hennepin Healthcare, Dr.
Jake Matlock.
He is a gastroenerologist andknows a thing or two about colon
cancer.
Jake, welcome back to thepodcast.
Thanks, David.
It's great to be here.
Start us off.
Can you just explain what coloncancer is?
How does it arise in people?
SPEAKER_02 (01:09):
Sure.
Colon cancer is uh a an abnormalgrowth that occurs within the
lumen or within the tube of theintestinal tract in the portion
of the intestine called thecolon, which is the last roughly
five to six feet of yourintestinal tract.
It's the part of your intestinaltract that's responsible for
waste processing.
So it's not one that we thinkabout uh very often or like to
(01:32):
talk about in politeconversation, but it is one of
the most common cancers in bothmen and women in this country.
And so it's an important topicfor everyone to be aware of.
SPEAKER_03 (01:42):
So your colon being your large intestine, the last
five feet.
Say more about that if youcould.
What does your colon do exceptmove yucky stuff through it?
SPEAKER_02 (01:49):
Trevor Burrus So if you can imagine the intestinal
tract as a whole is responsiblefor absorbing nutrients from the
food that we eat, but there's alot of waste that runs through
us that is not useful to ourbodies, not useful for our
nutrition.
And so as a result of that,about three liters of liquid
waste is delivered to the colonevery day, and the colon is
(02:11):
responsible for processing thatliquid waste, reabsorbing the
water from it, and turning itinto solid stool.
SPEAKER_03 (02:17):
Aaron Ross Powell You said liquid waste, though.
I ate a steak the other night.
That wasn't very liquid.
It wasn't how did it get to beliquid?
SPEAKER_02 (02:23):
Uh so the digestive process uh starts actually uh as
soon as you put food in yourmouth.
Uh the salivary enzymes startthe digestive process and and
through the actions of yourupper intestinal tract, from
your mouth through your uhstomach and the upper part of
your small intestine, food isbroken down from solids uh first
(02:43):
into smaller pieces of of solidmaterial and then ultimately
down into liquid, occasionallywith some solid chunks uh
without getting too graphic.
You know, some people areputting together while they're
listening to this.
But but by and large, what isdelivered to the colon is is
kind of a pea soup consistencymixture.
Trevor Burrus, Jr.
SPEAKER_03 (03:02):
Well, that's actually a good consistency uh
um thing, pea soup, becausethat's roughly what it is.
It's not water.
It's not water.
But it's not what it's not yourstool yet.
It's not the solid stuff.
Correct.
And so your intestines then getrid of all the water?
SPEAKER_02 (03:14):
Aaron Powell, so your colon is responsible for
reabsorbing the water from thatstool stream, and that's useful
because if you know if you canimagine three liters of liquid
waste coming through every day,if you couldn't reclaim that
water, number one, you'd bespending most of the day in the
bathroom.
And number two, if you weren'tin the bathroom, you'd probably
be trying to replace all thefluids that you were losing.
So really your colon allows youto function in the world.
SPEAKER_03 (03:36):
Yeah, and and I know uh you know, occasionally during
this podcast, we'll we'll make acouple jokes here and there, but
people who have loose stools,who have chronic diarrhea or any
diarrhea know, know that itchanges your day, it changes
your week, it changes your life.
So you know, when your colon'snot working, that comes into
dramatic focus then.
So is there a connection betweencolon cancer and rectal cancer?
(03:58):
Rect your rectum being the lastfew inches of your colon?
SPEAKER_02 (04:01):
That's correct.
Your rectum is the last fewinches of your colon.
It's anatomically distinct in afew ways.
For one, it has a differentinnervation that allows you to
sense when you need to have abowel movement.
Uh, that's that's where thatsensation comes from.
The rectum is also anatomicallydifferent from the colon just
because of its location down lowuh within the bowl of the human
(04:23):
pelvis.
But from a physiologicstandpoint and and more from the
standpoint of cancer, uh thedistinction is not terribly
important.
I hesitate a little bit therebecause the distinction is
important when it comes totreatment, which is a little
farther down the line, but butuh but beyond that, I think we
you can kind of lump themtogether.
SPEAKER_03 (04:43):
So we use the word colorectal cancer in that case.
Correct.
Okay, so how do these cancersstart?
And something about polyps.
Why don't you talk about polypsif you could?
SPEAKER_02 (04:51):
Aaron Powell Yeah.
So the the the overwhelming mostcommon pathway for the
development of colon cancer isthrough these small growths in
the colon called polyps.
Now, polyps uh can take avariety of forms, not all of
them are associated with thedevelopment of colon cancer, but
the kind that that people mostcommonly think of, which are
called adenomatous polyps oradenomas, are associated with
(05:13):
growth and ultimatelytransformation into colon
cancer.
For all intents and purposes,you can think of this as the as
a sole common pathway for thedevelopment of colon cancer.
There are some very rareexceptions, but that's that's
really the the major pathway.
SPEAKER_03 (05:27):
So why do why do we grow polyps?
Or why do some people growpolyps?
SPEAKER_02 (05:31):
Aaron Powell It's a great question.
Uh you know, if you lookstatistically speaking,
somewhere around a third ofadults will have polyps.
And so it's a very common thingfor adult humans to have.
A third.
A third.
Yeah.
And and some people wouldsuggest that's even an
underestimate of the prevalence.
There are risk factors that canincrease a person's uh
(05:53):
likelihood of developing polyps.
Some of them are genetic orfamilial risk factors, some of
them environmental.
But even in the absence of anyidentifiable risk factors, we
still find polyps quite commonlyin asymptomatic people.
SPEAKER_03 (06:06):
So one of the perks of being a doctor and working at
a major metropolitan center likeI do is that you have friends
and colleagues who will let youlike look in on what they do.
So I have been there when youhave done a colonoscopy.
It's fascinating.
But could you talk listenersthrough when you're doing a
colonoscopy?
And we'll talk more about whoshould get a colonoscopy later,
but talk us through when you arelooking in someone's intestines,
(06:26):
what does a polyp look like?
SPEAKER_02 (06:28):
So uh a polyp looks uh like a small break in the
contour or texture of the liningof the colon.
So normally your colon is is asmooth, moist lined structure.
It looks a little bit like theinside of your cheek, honestly.
And if you can imagine uhsomething growing uh on that
lining that looks almost like amole on the skin.
(06:50):
So it breaks the contour, it's alittle bump.
Uh over time, uh those bumpswill get bigger and and more
geographically interesting.
They get uh ridges and bumpswithin them.
Occasionally they'll even grow astalk and look almost like a
mushroom coming up off thelining of the colon.
SPEAKER_03 (07:06):
And they're little, right?
These aren't big.
They look huge on your screen,because you're looking at them
on a screen, but they're nothuge.
They do.
SPEAKER_02 (07:12):
I mean, we have we have uh thankfully through the
improved technology, throughhigh-definition cameras and
better lighting, we have beenable to detect much smaller
polyps than we used to.
So now the limits of ourdetection are probably on the
order of one to two millimetersin size.
Uh they can get quite large.
Uh, you know, some of them areuh uh uh five centimeters even,
(07:34):
so uh so fifty millimeters insize, so that's about two inches
in diameter.
Whoa.
Uh so that's that would beconsidered a giant polyp, but uh
but from a certain perspective,that's still not very big.
It's a couple of inches.
SPEAKER_03 (07:45):
From a from a sesame seed to a big grape or a small
golf ball, even.
Yeah.
Yeah.
Yeah.
Wow.
Okay.
So how long does it take for oneof these polyps, those that
might turn into colon cancer,how long does that take?
SPEAKER_02 (07:58):
So to go from no polyp through the process of
forming a polyp, having it grow,and ultimately transform into a
colon cancer is probablysomewhere on the order of 10
years.
So there's a window there, along time.
There is a pretty good window.
And that's really the onlyreason that colon cancer
screening works, is because weknow what the precursor thing
is, what it looks like before itbecomes cancer, and we have an
(08:21):
adequate time lag to be able toget in there and do something
about it.
SPEAKER_03 (08:25):
Which is what a screening test needs.
If there's if you don't knowwhat the precursor looks like
and you can't catch it in timeearly enough and there's nothing
to be done about it, then ascreening test doesn't work.
This checks all the boxes.
Exactly.
Okay, so before we get into howyou get screened, let's talk a
little bit about colon canceritself in the population.
How common is it?
SPEAKER_02 (08:44):
Well, colon cancer is currently the third most
common cancer in both men andwomen in the United States.
So if you think about the actualnumbers, uh in this country
every year, approximately twomillion people are diagnosed
with some form of cancer.
Colon cancer accounts for150,000 of those.
So that's just under 10 percentof uh the cancers diagnosed in
(09:06):
this country each year.
If you look at how many peopledie from cancer, roughly 600,000
people die each year from someform of cancers.
And roughly 55,000 of those arecolorectal cancers.
And so colorectal cancers dotake up a larger s share of the
deaths from cancer than they doof cancers themselves.
(09:28):
And and when you consider thefact that, again, it is the
third most common cancer in bothmen and women, it's a
substantial public healthproblem.
Trevor Burrus, Jr.
SPEAKER_03 (09:36):
It totally is.
And many people think of, well,I'm not old enough for that.
We used to think of it it'speople over age 50, and in fact,
that's who we used to screen.
Everybody over 50 should getsome kind of screening done.
But everybody knows somebody orhas heard about somebody younger
getting colon cancer.
Do we know why that might be?
SPEAKER_02 (09:53):
I don't think we have the full answer yet.
Uh certainly there's a lot ofspeculation about uh
environmental factors, changesin our food stream, changes in
our uh health habits that areprobably playing a role.
Currently, the guidelinesuggests that we should be
screening everyone at age 45,which is, as you pointed out,
(10:13):
younger than what uh was thecase when you and I did our
training.
There is not, as of yet, aguideline for screening people
younger than 45, unless theperson has identifiable specific
risk factors or symptoms relatedto their colon.
But as you pointed out, theincidence in younger people is
rising.
(10:33):
It is still an order ofmagnitude lower than in older
individuals, but uh but it it isa cause for concern and
attention, I think.
SPEAKER_03 (10:40):
Aaron Powell What are those risk factors?
You mentioned risk factors.
Is it genetic?
Is it the steak I ate the otherday?
What is it?
It might be the steak I ate.
SPEAKER_02 (10:48):
It's unfortunately the same litany of risk factors
that doctors seem to uh harp onfor just about everything.
SPEAKER_03 (10:55):
So are you gonna tell me to eat right, don't
drink, and like exercise?
SPEAKER_02 (10:59):
Aaron Powell I'm afraid so.
Uh, Dr.
Pottskill.
Yeah.
So from a dietary perspective,uh uh alcohol, tobacco, and uh a
diet high in red meat uh placepeople at substantially
increased risk for colorectalcancer.
Uh and I love the roller grillat the gas station as much as
anybody, but that hot dog is notdoing you any favors uh from the
(11:22):
standpoint of colon cancer risk.
SPEAKER_03 (11:24):
Aaron Powell Yeah, that's a questionable life
choice on many levels to get thehot dog at the gas station,
Jake.
SPEAKER_02 (11:29):
I think we've both been there, though.
SPEAKER_03 (11:33):
Yep.
SPEAKER_02 (11:34):
Looking uh away from specific uh environmental
exposures, uh obesity is also arisk factor uh for colorectal
cancer.
And then there's there's thefamilial risk factor.
If you have relatives uh whohave colon polyps or colon
cancer, particularly if it is atan early age, and here I'm
talking about under the age of60, uh, then you are at
(11:55):
increased risk and you shouldlet your your healthcare
provider know that.
SPEAKER_03 (11:59):
Let's pivot to that then.
Let's talk about the nuts andbolts of screening.
So you already touched on whoshould get screened by age.
Is there anything more we needto say about age?
It's 45 for everybody, and somepeople younger.
Who are the younger ones?
SPEAKER_02 (12:18):
And I think that uh without getting too much into
the weeds, it's important to tomake note of first degree
relatives with colon cancer orpolyps.
And by first degree relatives Imean parents, siblings, or
children.
If you have second degreerelatives, so grandparents,
aunts, uncles, cousins who havecolon erectal cancer, that may
(12:41):
be important uh depending ontheir age and the number of uh
second-degree relatives that areuh involved.
Uh, but that gets a little bitmore complicated and it's
probably worth a focuseddiscussion with your healthcare
provider.
Aaron Ross Powell, Jr.
SPEAKER_03 (12:54):
Let's talk about the types of screenings you can do.
We're going to talk a little bitabout, or a lot of bit, about
colonoscopy, but it's not theonly kind.
So if you could talk us throughabout what the options are for
people.
SPEAKER_02 (13:04):
Sure.
There are there are a lot ofoptions now, and I think as you
and I have discussed on multipleoccasions in the past, the most
important factor is choosing atest that you are actually
willing to do.
So getting screened uh in oneway or another is more important
than how you do it.
I think that the modes ofscreening can be broken down
(13:25):
into endoscopic tests, of whichcolonoscopy is the most common
and the most widely available,and then stool-based tests,
which are tests that use samplesof a person's stool collected
usually at home to look foreither blood or certain uh
changes in the DNA in shed cellsin the stool to look for signs
(13:48):
of uh potential cancer orprecancerous changes.
The other modalities that areout there, and here I'm thinking
mainly about imaging modalitieslike CT colonography have not
really panned out uh as well uhuh in in their actual prevention
of colon cancer, and so areprobably best reserved for
people who are unable to do oneof the other tests.
SPEAKER_03 (14:10):
Aaron Powell So talk us through stool-based testing
just briefly.
SPEAKER_02 (14:14):
Sure.
So the the uh tried and true uhstool-based tests uh uh rely on
the detection of blood or bloodproducts in the stool.
So here you may be familiar withwhat are called hemacult cards.
These are small cardboard cardsthat you put a little bit of
stool on, you mail it in, andsome of the things that you're
doing.
SPEAKER_03 (14:34):
That means you don't need a big amount of stool on
there.
Trevor Burrus, Jr.
SPEAKER_02 (14:38):
Please no.
Please no.
Uh the uh cards then have adeveloper that's placed on them
and they they uh uh change coloruh with the presence of blood.
Kind of old school that one.
Aaron Ross Powell That's veryold school.
And I would say that most placesare no longer using straight
hemocults, but uh the hemaculthas been, has evolved to include
(14:59):
uh testing for DNA markers.
So now we have the FIT test andthe IFOB test, both of which,
again, are looking for changesto the uh the shed cellular
material in stool.
More recently, we've uh had theability to do something called a
cola guard test.
Uh this is a more extensivestool-based test.
(15:21):
It involves the collection of alarger volume of stools, so it's
not just a little bit on a card,but actually a whole collection
kit that gets mailed to apatient uh for collection at
home.
Uh this has a a wider uh arrayof markers that it is looking at
within the shed stool and doesprovide some uh longer duration
(15:41):
of protection.
So the the downside of the stooltests has always been that you
have to repeat them every year.
Uh, but with the cola guard,that uh interval is extended to
three years.
Aaron Ross Powell And then youhave to do something if it's
positive.
Aaron Ross Powell That'scorrect.
If if any of the stool-basedtests show a positive result,
then the recommendation is tohave a direct optical
(16:02):
examination of the colon with acolonoscopy.
That's when a guy like you stepsin.
That's when a guy like me stepsin.
SPEAKER_03 (16:07):
So we have been talking with uh Dr.
Jake Mattlock, he's agastroenterologist, and we're
talking about colon cancer.
When we come back from a shortbreak, we are going to talk
about how it's diagnosed, whatthe experience of a colonoscopy
is like from the guy who'sactually doing it.
So stay with us, we'll be rightback.
SPEAKER_00 (16:25):
When Hennepin Healthcare says we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(16:48):
chiropractic care.
Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (17:02):
And we're back.
Okay, so colonoscopy sort ofgets a bad rap with some people.
It's like, oh my gosh, this isgonna be horrible.
Can you talk us through theprocess of colonoscopy from PrEP
to what you do?
SPEAKER_02 (17:12):
Sure.
So the the PrEP is the part ofthe colonoscopy experience that
most people find mostdistasteful.
Uh in order to look at aperson's colon, we have to clean
it out.
I have to be able to see thewalls of your colon clearly in
order to detect these very smallabnormalities.
As such, we have people drink alarge volume of liquid that the
(17:36):
body can't absorb and can't use.
And so, as such, that liquidjust runs through you.
It creates a tidal wave throughyour intestinal tract.
SPEAKER_03 (17:44):
Like a radiator flush.
SPEAKER_02 (17:45):
It overwhelms the colon's ability to reabsorb
water, and so it it literallyjust flushes everything out.
The volume that people have todrink varies depending on the
type of preparation that isprescribed, but is typically
between a half gallon and gallonof liquid.
I wish I could say that ittastes really good.
It doesn't.
Chill it, drink it a littleslower, and maybe throw a straw.
(18:08):
That's what I heard.
Trevor Burrus, Jr. (18:09):
There are any number of tricks.
Use of a straw, use of cold,walking and moving around to try
to try to keep stuff movingthrough you so it's not coming
in.
SPEAKER_03 (18:19):
And can't you make your life a little better by not
eating heavily in those days,leading up to it?
SPEAKER_02 (18:24):
Aaron Ross Powell, we do recommend modifying uh the
diet in the the three to fivedays leading up to the PrEP.
And the goal of the dietarymodifications are to try to
reduce the volume of uh wastethat's in the intestinal tract.
It's a little counterintuitivebecause normally we are telling
people to eat a lot of fiber,it's good for your health and so
forth.
But in order to really reducethe volume of stool that needs
(18:46):
to be cleared out, we do we dotypically suggest a low fiber
diet just for that few daysprior to the preparation.
SPEAKER_03 (18:52):
Aaron Powell What about preps that don't involve
uh all that drinking of fluids?
People talk about the little,isn't there one that's just uh
64 ounces?
And isn't there even one in pillform or something?
What about all of those?
SPEAKER_02 (19:03):
Aaron Powell There are low volume preps, and um
those are still creating a tidalwave that runs through the gut.
I mean, it you cannot get aroundthe fact that you have to flush
everything out in order to see.
But for the low volume preps,they are relying on taking fluid
from a person's body and suckingit into the intestinal tract to
(19:24):
create the volume for the flushrather than having the person
consume it.
SPEAKER_03 (19:28):
Okay.
SPEAKER_02 (19:28):
Uh that's more palatable uh for many people.
It also does run the risk ofcreating some electrolyte
imbalances because you arestealing, you got to steal the
liquid from somewhere.
And so if you're not uhconsuming the liquid, uh then
your your body has to has tosacrifice that liquid.
The nice thing about the highervolume preps, as as challenging
(19:50):
as they can be, is that theyare, by and large, volume and
electrolyte neutral.
So that makes them much more ownbody.
Yeah, it makes them much saferfor for people to consume again
with the caveat that it can besomewhat challenging because of
the volume.
SPEAKER_03 (20:03):
Okay.
So I'm all prepped up.
I've been on the toilet allnight long.
My colon is pristine.
And I come into your office inthe GI lab, and what happens?
SPEAKER_02 (20:14):
Well, first of all, we're gonna make every effort to
make you comfortable whileyou're there.
Uh, we recognize that it's anuncomfortable situation to be
in.
It can be kind of awkward ifyou've never been there before.
And so we want to make you feelwelcome.
We're gonna bring you in, we'regonna introduce you to our team.
Uh so you're gonna meet thenurse, the tech, and the doctor
who's gonna be involved in yourprocedure.
(20:34):
We'll put an IV in one of theveins in your arm, and that is
to allow us to administermedication to keep you
comfortable during the test, andthen we'll bring you into the
procedure room.
Once we're in the procedureroom, we'll administer small
doses of sedating medications,and those are again just to keep
you comfortable and relaxedduring the test.
Uh, it's uh certainly morepleasant for you.
(20:56):
It's also better for me as theperson performing the test if
you're relaxed and not movingaround so that I can get a good
look.
Yeah.
The better look I get.
Aaron Powell, Jr.
SPEAKER_03 (21:06):
Are most people out sleeping?
SPEAKER_02 (21:09):
I would say the majority of people are somewhat
awake during their colonoscopy,although it is also the case
that most of them do not havemuch, if any, recollection of
the event.
And so uh whether or not aperson is awake kind of depends
on who you ask.
If you ask the person, they'llusually tell you they slept
through it.
But if you ask the operator,they'll typically tell you no,
(21:30):
they didn't.
SPEAKER_03 (21:30):
Really?
So, because here's the deal.
In all full disclosure, I had mycolonoscopy here and I know
everybody.
I knew the doctor doing thetest, I knew the nurse, and I
go, hey, I'm gonna watch thisthing.
I'm really, I'm good.
This is gonna be interesting.
I'm gonna watch my colon on thatscreen.
I don't remember 10 seconds ofit.
I was probably pretty sedated,but kind of maybe I wasn't as
squirmy as I would have been hadI not been.
SPEAKER_02 (21:51):
Yeah, I I had mine here as well.
I had mine without any sedation,and uh it's not as it's not as
difficult a an experience as Ithink most people expect it to
be.
It's really just not thatdifficult.
Yeah, that's you're kind of ahero there.
I can't believe that I think thehero is the person who did the I
think so okay.
SPEAKER_03 (22:10):
So you're on this thing.
Just real briefly, talk usthrough what you put the scope
all the way as far as it'll goin, and then you'll look on the
way out.
Is that is that fair to say?
SPEAKER_02 (22:18):
That's correct.
So the the part of the test thatcan be uncomfortable is is
inserting the scope all the wayto the top of the colon.
Again, that's about five or sixfeet uh of intestinal tract.
And so getting in there aroundall the different twists and
turns that the colon takesthrough your abdominal cavity
can be a little bit challenging.
SPEAKER_03 (22:34):
Be honest with me.
Is it like playing a video game?
A little bit.
I mean, I'm not gonna do that.
I'm seeing your hands on this.
You've got all these things,you're looking at a video
screen, you're turning, youknow, you're you know, there
there are there are a lot of funthings in medicine.
SPEAKER_02 (22:45):
This is definitely one of them.
SPEAKER_03 (22:46):
Um people say, why do you go in to being a
gastroenterologist?
You're looking at all the netherregions of people, and here you
are saying it's kind of fun.
It is kind of fun.
SPEAKER_02 (22:56):
And uh, you know, typically to get to the top of
somebody's colon takes one totwo minutes.
Uh and then really it's on theway back out, as you as you
said, that we're doing theexamining part of the uh uh of
the test.
And on the way back out, whatwe're doing is we're trying to
make sure that we get a look atevery surface of the colon.
Your colon is not a longstraight tube, it's got twists,
(23:18):
turns, folds.
It's kind of shaped like aquestion mark, I always thought.
So it's shaped like a questionmark, and the structure is
somewhat like an accordion.
So it's got it's got rings ofmuscle and and somewhat
ballooned out areas in betweenthose rings of muscle.
And so we really need to takeour time to look behind each
fold, around every turn, uh, sothat we can detect as uh as many
polyps as And do puff it up,puff it up with air.
(23:39):
Aaron Powell We do.
Uh typically we'll use eitherair or carbon dioxide to inflate
the colon uh to allow us to seea little better.
We try to take as much of thatgas back out as possible.
SPEAKER_03 (23:49):
Because it's coming out somehow.
It's coming out somehow.
So don't go back to work.
Yeah.
SPEAKER_02 (23:54):
Well, and if you do, you can blame me for the whole
day.
SPEAKER_03 (23:57):
Uh okay.
The colonoscopy is done.
How do you diagnoseabnormalities?
SPEAKER_02 (24:02):
Aaron Powell So as we talked about earlier, uh, the
main thing that we're lookingfor during a colonoscopy are
these small growths calledpolyps.
Those are diagnosed based onvisual inspection.
So I have to be able torecognize a polyp and and uh and
and see it when it's present.
If we see polyps, our job is totake them out, which we do
during the colonoscopy.
(24:23):
It all happens in one fellswoop.
How do you do that?
Typically, we'll use either uh asmall lasso of wire called a
snare, or on occasion, withreally small polyps, we can use
a biopsy forceps to just pluckthem out.
But I think that that mostpolyps are removed with a a
small snare.
The scope has a channel thatruns through it that we can
(24:44):
insert a variety of instrumentsthrough, and uh one of those is
is this small snare and then onthe end of like a five-foot-long
wire?
Yeah, yeah.
I mean it's it's a it's acatheter and it has a uh a
handle at one end that a techwill open and close the snare
with, and and we open the snare,place it around the polyp, and
then close the snare, eitherjust using it as a a knife to
(25:06):
cut through the polyp, or onoccasion, if uh if the polyp is
larger and we're worried aboutbleeding, we'll pass an
electrical current through thatsnare to to cauterize as we cut
the polyp off.
SPEAKER_03 (25:17):
Okay, so you've cut this thing off or you you have
cauterized it off.
It's sitting there in the colon.
How do you get it out?
SPEAKER_02 (25:22):
Depends on the size.
Uh for smaller polyps, we canapply suction and suck them up
through the same channel thatthe uh the instruments run
through.
For larger polyps, we'll put adifferent instrument through the
channel that looks like afishing net and and simply put
the polyp in the net, pull thepull the scope all the way out,
dump the polyp out uh of the netand go back into where we were
(25:44):
and keep moving.
SPEAKER_03 (25:45):
Okay, so you get this thing out, you've got a
little piece of tissue, Isuppose you put it in a specimen
container.
How is colon cancer thendiagnosed?
What happens to that polyp next?
SPEAKER_02 (25:52):
Aaron Powell So everything that we take out,
whether it's a polyp or simply asample from a larger lesion that
we actually are concerned is acancer, gets sent down to the
pathology lab where uh the thespecimen is fixed, sliced, and
stained to be examined by one ofour pathologists.
Uh so when I take a polyp out ofsomebody, I put it in a jar, I
(26:14):
wave goodbye to it, and then Iwait.
And I uh typically 24 to 48hours later, I will get a result
from the pathologist saying,this is a polyp, this is not a
polyp, this is a cancer, this isnot a cancer.
SPEAKER_03 (26:26):
And the majority of the lesions you take out are
some type of polyp, right?
It's it isn't that you'reusually taking out and sending
to the lab and they say thisthing's already cancer.
SPEAKER_02 (26:36):
That's correct.
I think it's a good idea.
You know, we do, as I said, findpolyps in roughly a third of
people who come in for for thisexam.
So that's a very common finding.
To find an actual colon canceron a routine screening exam is
much less common.
Uh I would say that that, youknow, if I'm in the endoscopy
lab and and doing colonoscopyall day, every day, uh, Monday
(26:59):
through Friday, I'll probablyfind one cancer in a week.
SPEAKER_03 (27:02):
And a lot of polyps.
SPEAKER_02 (27:03):
And a lot of polyps.
SPEAKER_03 (27:05):
Which is the reason we're doing these.
You want to find those polypsbecause you're in that 10-year
window and you got rid of it.
Exactly.
And comment on this if youcould.
The one advantage tocolonoscopy.
Well, there's many.
There's some advantages tocolonoscopy about other
screening methods.
But one of them is that when yousee one of these polyps, you
actually removed the problem inreal time.
SPEAKER_02 (27:24):
Aaron Powell That's correct.
I mean, colonoscopy is is nicebecause it is both a screening
exam and a therapeutic uhmaneuver.
Because that polyp is not goingto bother you in the future,
assuming you got it.
Correct.
Once it's gone, it's gone.
And uh, you know, we when weidentify somebody as a as a
person who is a polyp former, wewill typically advise them to
(27:44):
come in on a somewhat morefrequent basis.
But the the individual polypthat we have removed is no
longer a threat to them.
It's gone.
Currently, for people with smallpolyps, the recommendation is to
come back in seven to ten years,uh, which is a change from just
even five years ago.
Uh, and that is uh a reflectionof the fact that uh number one,
(28:05):
we now understand that polypgrowth is slow.
And number two, the detection ofpolyps has gotten better, and so
the ones that we're finding aresmaller than they used to be.
Aaron Powell Okay.
SPEAKER_03 (28:15):
Uh we're not going to get in a lot of detail about
colon cancer treatments, but ata higher level, somebody is
diagnosed with an actual cancer.
How are what are the treatmentoptions that they might at least
have to consider?
SPEAKER_02 (28:27):
The most important treatment for colorectal cancer
is resection.
And for early stage coloncancers, uh, resection can be
curative.
Cut it out.
Cut it out.
And often resection isrecommended even for more
advanced colon cancers, which isdifferent from a lot of types of
cancer.
And the reason for that is thatyou don't want the primary
(28:50):
cancer getting so big that itblocks off the intestinal tract.
And so, really, resection issomething that should be
considered and on the table asan option for any colon cancer.
It's not always the right thingto do, but it should always be
under discussion.
SPEAKER_03 (29:04):
And when you're talking about resection, you
refer to one of our colorectalsurgeons who isn't cutting out
the tumor, right?
They're cutting out a segment ofyour intestine.
Is that a fair statement?
SPEAKER_02 (29:15):
They're cutting out the segment of the intestine
that contains the tumor, and andthey want to get several
centimeters of normal, healthycolon on either side, as well as
the lymph nodes that drain thatsegment of colon, because the
lymph nodes are going to be thefirst place that the cancer
spreads out if it has left thecolon.
And so getting those lymph nodesthat drain that particular area
(29:37):
is important so that thepathologists can again look at
those lymph nodes to see ifthere is any sign of spread.
And that helps us to determineif the resection was adequate to
treat the cancer or if more uhtreatment would be recommended.
And then they just hook up thetwo ends?
That's correct.
Usually uh they are able to dowhat's called a one stage
(29:59):
operation.
Which means that they take outthe section of colon that has
the cancer and then hook the twoends back together.
There are some circumstances,thankfully not very common,
where uh they have to do atwo-stage operation where they
take the section out with thetumor in it and then bring the
intestinal tract out to the skinfor uh a short period of time,
usually a matter of a few weeksto a few months.
(30:21):
Um you have a bag in a couple ofthings.
You have a bag that a person hasto wear and then only later go
back and hook things backtogether.
SPEAKER_03 (30:28):
Aaron Ross Powell So resection is the primary thing
for many or if or even mostcancers.
What about chemotherapy andradiation?
That's on people's minds a lot.
SPEAKER_02 (30:35):
Aaron Powell Yeah.
So chemotherapy is one somethingthat is used frequently in uh
colon cancer if it has spreadbeyond the colon and
occasionally, depending on thethe uh microscopic appearance of
the cancer, even if it has notspread beyond the colon.
The use of radiation isprincipally limited to rectal
cancers, and uh without gettingtoo much into the weeds, that
(30:58):
has to do with the fact that therectum is, as we alluded to
earlier, in the pelvis andtherefore in a relatively fixed,
non-moving location.
The rest of your intestines kindof move around in your abdominal
cavities, it makes them veryhard to target with radiation.
But the fixed location of therectum makes it a good candidate
for radiation therapy.
SPEAKER_03 (31:18):
Aaron Ross Powell So what's the prognosis in general
terms, obviously, for someonewho has their cancer caught
early?
And then obviously, what's theprognosis if it's caught late?
SPEAKER_02 (31:30):
So with an early stage colon cancer, the
prognosis is actually quitegood.
It is one of the cancers that wecan reasonably talk about curing
rather than we don't use thatword much in cancer, but we
still can't, yeah.
Very rarely use that word.
But but with early stage coloncancers, I think it's a
reasonable label.
With later stage colon cancers,uh, particularly those that have
(31:51):
spread even beyond lymph nodesand to other organs within the
abdominal cavity or chest, theprognosis is not as good.
Uh it it it becomes unrealisticto talk about cure.
Uh, and rather we are talkingabout uh slowing the progress of
the disease, slowing theadvancement of the disease.
SPEAKER_03 (32:10):
Which explains the the high numbers that you gave
at the top of the episode.
Before I let you go, Jake,you've mentioned um how
preventable this cancer is andthe importance of screening.
So what what's on the horizonthat that's given you hope um
about treatments or diagnosis orwhat's the future look like?
SPEAKER_02 (32:27):
Aaron Powell Well, I think that that the thing that
has become clear to me over thecourse of my career is that the
best um uh treatment for coloncancer is to prevent it from
occurring in the first place.
And so screening uh uh issomething that I would encourage
everybody to think about anddiscuss with their healthcare
provider.
Obviously, with colon cancer,there is a barrier to screening.
(32:48):
It involves either havingsomebody look in your colon with
a colonoscopy or handling yourown bowel movements, which most
people don't really want to do.
There are blood tests uh thatare on the horizon that are
showing a lot of promise.
I would anticipate that probablywithin the next few years, we're
going to have a blood test tolook for early signs of colon
cancer.
And I think that has the promiseto revolutionize colon cancer
(33:11):
screening.
Uh getting a blood draw ispretty routine for most people
who who are engaged with thehealthcare system.
And I think that if we can getto the point where where blood
testing uh becomes a viableoption, I think it will really
change the game for colon cancerscreening.
SPEAKER_03 (33:26):
Trevor Burrus, Jr.
Could you address theembarrassment factor of
colonoscopy?
People are coming in to see you.
They don't know who you are,they don't know who any of these
folks are.
They've been uncomfortably onthe toilet all night long, and
then they and then they have toput their tukas out there in the
world, and and and it's uh it'sembarrassing.
How do you help people get overthat?
SPEAKER_02 (33:45):
It's it's actually one of the biggest challenges, I
think, with with my practice,and it's one of the most
difficult things to teach thefellows and trainees that we
have uh here at Hennepin, whichis that you're you're meeting
someone usually for the firsttime, and within about five
minutes, you have to convincethem that they can trust you to
put something up their bottom.
(34:07):
That's not a situation thatyou're likely to be in any other
time in your life.
SPEAKER_03 (34:11):
I'm so glad that you're teaching the next
generation of doctors that howimportant that point is.
SPEAKER_02 (34:16):
Aaron Powell It's it it is a very um challenging art
to build that trust in a veryshort period of time.
And the reason for the timepressure is is you want to
devote as much time to theactual exam as possible.
Uh, you know, so there the theestablishment of trust, the
establishment of that rapportbeforehand is certainly
important, uh, but you don'twant to spend so much time that
(34:37):
you're limiting the time thatyou can spend on the exam, which
is where the actual protectioncomes in.
SPEAKER_03 (34:42):
Okay.
SPEAKER_02 (34:43):
If you could leave us with one thought, what would
it be?
Get screened for colon cancer.
Um and again, I I as agastroneurologist, I am
tremendously biased towardscolonoscopy as a preferred
screening modality, but that isreally not the most important
thing.
The most important thing is thatyou get screened.
I guess the other thing I wouldoffer you is that if you do get
(35:04):
screened and you do find thatyou have polyps, or hopefully
not, but if you do find you havea colon cancer, consider telling
your relatives.
Uh you know, as we discussed,family history uh is an
important uh risk factor incolorectal cancer.
And so if you care about thepeople that you're related to,
letting them know uh so thatthey can adjust their their
(35:25):
needs uh appropriately would bewould be the kind thing to do.
SPEAKER_03 (35:30):
Such important information.
Jake, you've been a guest withme on a number of my media
appearances, including thispodcast more than once.
Thanks so much for being hereonce again.
SPEAKER_02 (35:38):
It's great fun, David.
SPEAKER_03 (35:39):
I'm glad to do it.
Okay, listeners, that's theadvice from the show.
Make sure you get screened.
And if you do have anabnormality, consider telling
your relatives so they too canget screened.
Thank you for listening.
I hope you picked up some goodinformation.
We'll be back in two weeks' timefor another episode.
And in the meantime, be healthyand be well.
SPEAKER_01 (35:58):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(36:19):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanCamito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program, and every case isunique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(36:40):
Until next time, be healthy andbe well.
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