March 16, 2026 • 38 mins
In this episode, Debra talks with MedStar Health colorectal surgeon Dr. Sherief Shawki about survey results which reveal many Americans are confused about when to have a colonoscopy. This discussion covers the rise in colorectal cancer diagnoses in younger adults and the impact that’s had on the guidelines for routine screenings. Dr. Shawki explains how colorectal cancer develops, and how colonoscopy can actually prevent cancer by identifying and removing these growths early.
The conversation also covers how genetics and family history can affect screening timelines, and what symptoms should never be ignored. Dr. Shawki walks listeners through what happens during a colonoscopy, from the preparation process to the procedure itself, and addresses common concerns that often cause people to delay screening.
MedStar Health DocTalk aims to make complex medical topics easier to understand by bringing together experienced physicians who share their expertise in a clear, conversational way. Whether you’re interested in learning about cancer prevention, new medical technologies, or advances in treatment and surgery, this podcast offers reliable information from trusted experts.
Learn more about colorectal surgery at MedStar Health:
https://www.medstarhealth.org/services/colorectal-surgery
To make an appointment:
443-777-2475
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Email: DocTalk@medstar.net
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
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Episode Transcript
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(00:04):
Comprehensive, relevant,and insightful conversations about health
and medicine happen here when MedStarHealth, dog talk.
These are real conversations withphysician experts from around the largest
healthcare system in theMaryland, DC region. Sadly,
it seems most of us have been impactedby a diagnosis of colorectal cancer.
(00:27):
It has touched my own family. Recently,the conversation has grown louder as
several well-known actors have died fromcolorectal cancer, including
Chadwick Bozeman who died at just 43,and Dawson's Creek star James
Vanderbeek, who died at 48.
Earlier this year,actress Katherine O'Hara,
known to many as the beloved mom andhome alone also died from complications
(00:50):
related to colorectal cancer.
It used to be considered an olderperson's disease when routine screenings
weren't even covered by insurance beforethe age of 50, but that's changed.
A national survey commissioned by MedStarHealth found that more than 75% of
Americans are unsure when orhow often to get a colonoscopy
(01:10):
screening.
Even more concerning,more than a third of eligible adults say
they've skipped screening altogether.
And this comes on the heelsof the American Cancer
that colon cancer is now the leadingcause of cancer deaths among people under
50. The facts are clear.
Colorectal cancer is the third mostcommonly diagnosed cancer in the US,
(01:34):
and the incidence of diagnosis in peopleunder 50 has roughly doubled in the
last 30 years.
It's never been more important toremove all doubt about who should get a
colonoscopy and when.
Joining us to clear up the confusionis MedStar Health colorectal surgeon,
Dr. Sharif Shawke, and I'm yourhost, Deborah Schindler. Dr. Shalke,
(01:56):
thank you for being here today.
Thank you very much,Deborah, for hosting me.
I'm looking forward for a good sessiontrying to answer some of the questions,
clarify some of the misconceptions,and hopefully we'll deliver a
good information for the audience.
Let's start with the big picture.
What is colorectal cancer?
That's a very good question to startwith so people can understand ultimately
(02:19):
what we want to achieve.
So I'm going to even back up one step.
Let's just say in the human body,there are three types of cells,
labile cell, stable cell, and permanentcell. So permanent cell, for example,
like the nerve cells, they don'treplicate what you are born with,
you stay with. The stable cellyou are born with, you stay with,
(02:43):
the only regenerate when isneeded. When there is injury,
when there is something happened,and they need to regenerate.
Now this will lead us to the labile cell,which are cells who are continuously
replicating like your skin,like your hair, like your GI tract.
If something that'sreplicating continuously,
(03:05):
this means that duringreplication, things may go wrong.
In our colon example,the continuous replication
may result into an overgrowth,also known as a polyp.
That overgrowth is notcancer yet, but if it is left to grow,
(03:27):
it will eventually become cancer.
So a colon cancer is atransformation in the normal
lining of the colon that usually starts asprecancerous growth that is left in place,
unremoved or untreated.
It will become cancer.
(03:49):
Do all colorectal cancers startas that precancerous polyp or this
growth? Can they come about another way?
For the most extent, yes. Theystart as precancerous lesions,
polyps, and then they becomemalignancy or cancerous.
Now, the difference in types of cancers,if it's sporadic versus genetic and
(04:10):
even the type of genetic itself is theduration, how fast or how
slow the precancer growth,AKA polyp, would become
malignant. For example,a genetic syndrome will have this
adenoma, the polyp, another name for it,adenoma to carcinoma
transformation polyp to malignancyin one to two years. The other
(04:35):
extreme in this sporadic,which it can happen to anybody,
not people who have geneticpredisposition to cancer,
it can take up to seven,eight, or even 10 years.
So in theory,the process that takes years gives
us plenty of time to interrupt thatcycle process, stop the
(04:55):
growth with screenings.
Excellent question. Based on knowingthe background of the person,
this will enable us to provide theright guidelines and the right guidance
to how to prevent polyps frombecoming cancerous because the
good news here,if you can stop the cycle of
transforming the polyp to acancer malignant growth,
(05:23):
then you will not have that cancer.
And that's the positive message weare trying to deliver to the people
that with one test,you can prevent cancer.
And that's where the colonoscopy becomesso powerful because if it's found early
enough, it could be removed before ithas a chance to develop into cancer,
(05:45):
and that's clear and understood.
But I think where the confusion sometimeshappens is maybe they don't know
they're predisposed to thiscancer because of genetics.
Maybe they don't know that they had afamily member who had it. If they do know,
what's your recommendation?
Another good point, Deborah.
So let's talk in general about howwe look at screening colonoscopy in
(06:05):
relation to family historyversus no family history. Okay.
So in the old times, itused to be, as you said,
an old age disease. Therefore,people would start screening
colonoscopy everybody at age of 50without genetic predisposition,
without family history,just a person who had no family history.
(06:28):
But we have realizedthat a younger age had
been getting colon cancer morefrequently compared to the last
millennia, and it's almost doubledand it's going to triple. Therefore,
the screening age haddropped down to 45. Now,
let's say somebody has a first degreefamily member with colon cancer
(06:52):
that was picked at age of 54.
If you look at what we were saying,this means that this person had been
having a polyp for eight years ago,at least,
and has been growing silentlyuntil it was detected on a
colonoscopy when the patient startedhaving blood in the stool or bleeding per
(07:12):
ectum. Therefore, that promptedcolonoscopy and it found a malignancy.
If that colonoscopy wasdone eight years ago,
it could have basically prevented thatsituation from happening. Therefore,
the guidelines dropped the age ofscreening colonoscopy from 50 to 45. Now,
that person who had cancer at 54,now their kids should start
(07:33):
having screening colonoscopy10 years before the age of
diagnosis, which means 44.
What about siblings?
Siblings, if it's notgenetic predisposition,
So right now, everybody will go at45. If there is any alarming signs,
(07:55):
bowel habit changes, bleeding, straining,the sense of defecation that doesn't
translate into a real bowel movement,all of these are signs of space occupying
lesion and there is something wrong,which should prompt going to your primary
care physician and should prompt doingscreening colonoscopy. In people
with genetic predispositions,we know that these genes,
(08:18):
what do they mean in termsof the genetic anomaly?
And what does this translateto the age at which screening
colonoscopy would becomeright? For example,
familiar adenomatous polyposis,people would start screening
at the age of 11 years.
So the kids of a person with familiaradenomatospoliposis known as FAP,
(08:41):
they would start at age of 10 or 11.
A person with somethingcalled Lynch syndrome,
they would start between age of 20 and 25.
The former will do thiscolonoscopy every year.
The latter will doevery year to two years,
depending on how muchburden of polyps are there.
So we know the genetic syndromes,we know how to deal with them.
(09:03):
We take care of thosefamilies, we educate them,
we take care of theiroffsprings and their kids,
and they are usually moreengaged and more involved.
Are they usually a faster growing cancer.
When.
They're younger like that?
Yes. Or.
Genetically predisposed?
They are genetically disposed.
We know for FAP that by the age of 40,they will get colon cancer.
(09:28):
That's why they will have somethingcalled prophylactic colectomy.
So at some point we prophylacticallyremove their colon and rectum to
avoid having cancer.
Wow.
And for Lynch syndrome, theyhave, as we talked before,
the adenoma to carcinoma progression,the polyp to cancer transformation.
(09:49):
They have a very fast adenomato carcinoma duration.
Despite what I've told youabout the genetic syndromes,
they occupy about five to6% of all colon cancer.
So not every young onsetcolorectal cancer is considered
genetically predisposed.
And it is what makes coloncancer different from many
(10:11):
is possibly prevented.
With.
The screenings.
Exactly. Because in orderfor someone, as I said,
in order for someone to developcancer, they have to have growth.
Now, that growth could be treated if itis picked up early and could be removed
and we can stop thecycle there. Therefore,
(10:33):
the colonoscopy is a veryimportant tool to identify,
diagnose, and to treat byremoving the precancerous growth,
blocking this cycle. Now,there is something I must say
to explain for the audience,why do we do colonoscopy every 10 years?
(10:54):
So you will hear somebody saying, "Oh,I get myicolonoscopy
every five years," or,"I get micolonoscopy
every one to two years,or I get macolonoscopy
every three," and so forth.
So that was the importance ofthe introduction I gave earlier,
because as we said, here are thefacts to conclude an information.
It takes time for the polyp,the precancerous growth to become
malignant. That time could be eight to 10years in the sporadic normal human being.
(11:21):
It could be shorter in somebody whohas a first degree relative with colon
cancer, because we know thesepeople are at higher risk.
It could be even shorter ifsomebody who just has colon or their
colon is a polyp former.
It could be even shorter in somebodywho is genetically predisposed,
(11:42):
and it could be as short asin someone who has chronic
longstanding inflammation likeinflammatory bowel disease.
What does this mean for theaudience, simply speaking?
So if somebody gets acolonoscopy, they are clear,
which means they have no polyps.
They are good to be seen in eightto 10 years. Why did we say this?
(12:06):
Remember, polyps can form continuously.
The colon has labile cells.
They replicate continuously,therefore they can grow
abnormally at any point.
All the information I provided is layered.
Therefore, if you are clear now,this doesn't mean that you're clear
forever. This means you're clear now,but tomorrow you may start
(12:27):
having another polyp.
How long this polyp will take tobecome cancer? About eight to 10 years.
Therefore, you are due foranother screening colonoscopy
If you have polyps, dependingon the type of the polyp,
if that type of polyp israpidly growing to malignancy,
then you cannot do it in eight yearsbecause you can have cancer that
(12:51):
will grow in five years.
Therefore, we tell you, no,you have to come in five years because
you have that type of polyp that is riskyto become cancer sooner than later. Okay.
What if I have a genetic syndrome? Well,depending on the genetic syndrome,
the adenoma to carcinomasequence is very fast. Therefore,
you're going to come every year.
What if I have a chronic longstandinginflammatory process condition such
(13:15):
as inflammatory bowel disease? Well,we know after 10 years of inflammation,
people tend to have an extrapercentage of risk to develop
cancer.
So if somebody with chronic ulcerativecolitis and these patients know that very
well, after 10 to 15 years of the disease,they will start having colonoscopy
(13:35):
every one to two years,because their longstanding
inflammation results into provokingmalignant transformation
as another external factor.
So for each person and eachsituation, there are guidelines.
The bottom line for the audienceis don't get noises from
(13:59):
what other people are telling you.
You just need to focus on your own health.
Do your first colonoscopy and let yourhealthcare provider take care of the
rest.
Get a GI specialist, right?
A gastroenterologist.
And if they haveinflammatory bowel disease,
you'd think they were alreadybeing treated by someone.
(14:21):
Absolutely. That's whyI said- You would be.
Making these recommendations.
That's why I said thesepeople already know.
I'm just trying to explain forthe audience who don't know this.
Why would you hear different durationsand different frequency of colonoscopy
because people conditions are different?
They are different. Well,look, since the mid 1990s,
(14:43):
diagnosis in people under 50 have beenrising from about one to 2% every year,
and the number of youngerpatients has just about doubled.
We've established that. Soamong adults ages 20 to 39,
the incidence has been risingabout 2% a year. That, of course,
created the need to change whenthe colonoscopy is a standard
(15:04):
screening from age 50 to age 45.
I want to be clear aboutthat and underscore that
not seeing a gastroenterologistand they're not already
maybe they're still thinking,"I have until I'm 50." I just want to
underscore that going into this podcast,that routine screenings start at 45. Now,
(15:26):
to think of someone being 20 and gettinga diagnosis of colorectal cancer is
inconceivable. What's the youngest agethat you've treated, would you say?
It's sad story. The patientwas not even 20 years old.
Oh my goodness.
And it was delayedpresentation and it was already
metastasized. Unfortunately,they didn't make it.
(15:48):
And I have been seeingmore often in 30s and in
20s, over the last few years.
So sidestepping the issueof genetics for a moment,
is there anything maybe research wisethat supports why that's happening?
And is there anything that we can do toprevent colorectal cancer such as our
(16:09):
diet or minimize the risk for it?
That's a very good questionand a slowed question.
So on the scientific side,there are many studies
underway trying to identify whyis it happening in the younger population?
What led to that shift or what ledto that rising incidence in the
(16:31):
younger population? But Ihave a very simple opinion,
and this is my humble opinion. Usuallyhuman beings starts to do new things,
and then you see the impact of thisin two, three decades down the road.
So something must have happened. 20, 30,40 years ago, we changed
(16:51):
something in the diet.
We consumed something in a processed diet.
Something happened that itseffect on the human genome is
basically had been showing overthe past decade when we have been
noticing the increase in youngonset colon and rectal cancer.
As for how to preventit, as much as I can say,
(17:15):
there are known factors that areunhealthy and they lead to diseases.
Therefore, moderation ingeneral is a key. For example,
you will find smoking involved incardiac disease, in lung cancer,
and with other type of cancers as well.
You will find the red meatinvolved in obesity or fat
related diseases, blood vesseldiseases, as well as colon cancer.
(17:40):
Therefore, my advice to the audienceis this. Adopt healthy lifestyle.
You don't have to cut offanything, but moderation is a key.
Not too many potato chips or ...
I have to tell you, I like potato chips,but I stopped binging
on them long time ago.
I like them too. What aboutthis idea of an aspirin a day?
(18:03):
I read that as an anti-inflammatory thatsome people believe in aspirin a day
keeps the GI away. Isthere any truth to that?
It's unconfirmed. In mymind, it's unconfirmed yet.
So back to the MedStar Health Survey,which resulted from
questioning 1,000 people.
Four in 10 people believed screeningafter the age of 45 is only necessary if
(18:25):
there's a family history of colon cancer.
I think we've already addressed that,but true or false?
False.
Right. Why should someone with nofamily history still get screened?
And how often?
Perfect.
So this is a good question now to examinethe audience for what we have been
talking about. Someone withoutfamily history, number one,
(18:46):
do they need screeningcolonoscopy or no? Remember,
the GI tract has a type of cell thatreplicates continuously. Therefore,
an overgrowth can happen anytime andthat overgrowth can transform to cancer.
So the answer is yes, they should getscreened colonoscopy. At what age?
Right now, at 45.
And it could be younger if there arealarming signs such as blood in the stool,
(19:10):
bleeding per rectum, constipationthat is just not explained.
Change in bowel habits,feeling the urge to defecate,
but really nothing come out. All theseare signs of space occupying mass,
like a tumor or a large polyp.
A large polyp can harborpre-malignant cancer and it's not
(19:31):
considered cancer yet, and therefore itcan be basically removed by colonoscopy.
Well,that's interesting too that another
concern that was revealed in the survey isthat only 13% of respondents couldn't
identify all the symptoms of colorectalcancer. And you just went
through a full list of them,but we know that people who show up with
colon cancer or colorectal cancer whohad no symptoms.
(19:53):
Thank you for saying that, Deborah,because it's a slow growing tumor.
So there is a time that it will be silent.
I have many of my patients who come andthey are curious and they say, "Doc,
how long have I been carryingthis tumor?" And I say,
"At least eight to 10 years." And youshould see the shock look on their face,
(20:14):
and I feel sorry to tell themthat, but they can't believe it.
They are in denial. I have been livingwith cancer for that time. Yes, you are.
When you find a polyp or acancerous tumor while performing a
colonoscopy, is it usually one?
This is a very good question. I'mgoing to answer this in two dimensions.
(20:36):
Number one, which is a direct one, yes,you can find one or you can find as
many as two, three, four, five. Now,if you find more than 10, then we
start thinking of polyposis syndromes,something genetically predisposed
to result into that colon to formway larger numbers of polyps. Okay?
(20:58):
The other thing that Iwant to tackle is this.
We are all perfectly imperfect.
So colonoscopy is very sensitivewhen it's done by the specialist.
That's why you said,Deborah, in the beginning,
you need a gastroenterologist to do withsomebody who knows what they are doing
and how they do it and they do it up toquality indicators and metrics. However,
(21:18):
we know there is something calledmisrate. What does this mean?
This means that I can docolonoscopy in a patient and I can
detect three polyps.
Now you are better than me.
You can do a colonoscopy for the samepatient and you can detect five polyps,
which means I miss two.
So we know that we havean acceptable miss rate.
(21:42):
I can do colonoscopyand I can miss a polyp.
That's a forgivable miss.
But if I miss three or four,that's unforgivable miss
and it should not happen.
So if somebody has colonoscopyor their colonoscopy is normal,
that's very good, up to90%, 90 plus percent.
(22:04):
And that's why we say you haveto come back in eight years,
because if there is something missed,it will take that duration to
be discovered early at least.
And that's why with somebody withlongstanding inflammatory conditions or
genetic predisposition,we do that colonoscopy every one to
two year because we know that durationfrom adenoma to carcinoma is shorter,
(22:28):
but factoring also the miss rate.
Let's say what if we missed one?
And that's why we do it every one totwo years to detect the lesion early and
to compensate for any missedpolyps from the prior colonoscopy.
Would you repeat the name of thatcondition that you just identified where
someone has a lot of polyps?
(22:49):
It's called polyposis syndrome.
And does that significantly predisposesomeone who has that to getting colon
cancer?
Yes. So going back to the geneticdisease I told you about, for example,
familial adenomatous polyposis,juvenile polyposis syndromes.
As we said before, it startsby growth that's called polyp.
(23:11):
The term osis in medicineindicates the presence of numerous
polyps.
So polyposis means there are so manypolyps that are existing in the colon.
So many polyps, meaning so manygrowth where therefore there are one,
it takes only one of thosepolyps to become cancer.
And you cannot really detect it justby looking at it- Not by the size.
(23:34):
In the colonoscopy.
A bigger polyp means closerto being a cancer? No?
So very smart question, Deborah. So thereare something called advanced polyps.
Advanced polyps, meaning it's a polypthat's closer to become a cancer.
And the advanced features are size, shape,configuration, and
(23:56):
histology, the type of cells.
So size above two is advanced. Shapeand configuration, flat polyps,
the polyp could have a neckcalled pedunculated polyps,
or could be just stunt flat on thecolon wall. They call systele polyps.
So these are more risky. Andthen the type of histology.
(24:17):
If they have more abnormal cells,this means they are more
closer to become cancer.
But you can't just lance at that. I mean,I assume that you're able to
identify them during the colonoscopy.
Maybe without the biopsy, doyou come out and say, "Yeah,
I think that's likely to be cancer.
We haven't done the biopsy yet,but I'm pretty sure that
that's going to come back.
(24:38):
As.
Cancer.".
Yes.
An experienced gastroenterologistor colorectal surgeons
routinely,they have enough experience
to suspect a malignant lesionin colonic growth.
There are also other criteria andfeatures that they can apply on
the lesion that they can know bywhich they can know if the tumor is
(25:01):
high risk to harbor malignant cells or no.
The gastroenterologists nowhave more advanced techniques.
So I want to assure the audience ifthere is a polyp or even a larger polyp
that had been found,we now do organ preservation
endoscopic advancedtechniques where the advanced
endoscopist can go inand shave that large
(25:24):
polyp from the colonicwall, take it out, and the person
does not need to have their colon out.
If it was pre-malignant, but big polyp.
Okay. But if it is malignant,there's a resection of the colon.
Then the best course of actionis to resect segment of the colon
(25:48):
and put the colon back together allin one surgery and no bag is needed.
Okay.
So many people do feel nervous aboutgetting a colonoscopy and in spite of the
screening itself, it's really theprep that people most complain about.
Let's go through the PrEP process.
Is there anything that you can sharethat suggests that the PrEP process has
improved from maybe when thelast time someone did one?
(26:11):
Well, PrEP is PrEP. The concept isif you're going to do a colonoscopy,
you want to do it successfully andyou want to do the bowel prep once.
You don't want to do a half job ingetting your colon cleaned and cleansed,
and then the colonoscopist or theendoscopist cannot see clearly the
colonic mucosa due to fecalmaterial residue in your colon.
(26:35):
So therefore I say, if you'regoing to do the colonoscopy,
take the bowel prep seriously. Now,the concept of the bowel prep is you're
giving a material that it will resultinto water and fluid
being in the colon to washall the stool out. Therefore,
it is taken with lots of fluidintake to avoid dehydration and to
(26:58):
avoid electrolyte imbalance. Regardlessof the type of prep you are using,
this is the concept.
You want to put lots of water in yourcolon to remove any fecal material
residue so the endoscopy can havea clear picture and minimize the
misrate we talked about before.
This could be in form of highsalt compounds,
(27:21):
which is going to drawwater in your colon,
or it could be high sugar basedcompound like the polyethylene lycol,
which is also going to drawwater, but you take it with water.
So the bowel prep, Deborah,unfortunately, is the wishful thinking.
The bowel prep is a bowel prep and weare basically inducing diarrhea for a
short period of time to clean anyfecal material residue of the cone.
(27:45):
But I have heard people describetheir experiences differently.
Some of them are using pills and nothaving to drink a gallon of water.
Some of them are usingGatorade. They're all different.
Is there something that you can sharewith us that would suggest this might be
an easier way to go, that yourpatients come back and they say,
(28:06):
"This wasn't so bad. I didn't havea problem getting all that down.".
It's a good point. As I said,there are different types of
compounds used for bowel prep.
There is the one that youdrink a gallon of water with,
and the pills and theother stuff is basically,
it has more concentratedmaterial like salts,
but this also may impactyour kidney function and it
(28:29):
imbalance and dehydration.
The concept of reducing the amountof fluid to be drank with the
colonoscopy doesn't gounpunished too. As we said,
there is a concept to remove the stoolfrom the colon. We just need fluid to ...
That's common sense.
You need fluid to wash off thestool residue of the colonic wall.
(28:50):
You can help your body by drinkingwater that can go into your GI
tract and wash off thatstool or alternatively,
you can take the pill,which is basically a concentrate of salt
that will use your own body fluid toget inside the GI tract with
less oral intake compared tothe gallon,
(29:12):
and it's going to wash off the stool.
So if you look at the second situation,yes, you are drinking less water,
but that's on the expense ofyour own body water. Therefore,
you are more susceptible to waterimbalance or water shifts in your body
and electrolyte imbalance in your body.
I would not recommendsomebody who is old age.
(29:33):
I don't recommend somebody withkidney related diseases that would do
that.
So maybe that's why-.
That type of bowel prep.
And last but not least,when I had my two colonoscopies,
I used the gallon and I will sharewith the audience, I just friended,
meaning I did not look atit as a challenge, I looked
(29:57):
I learned to look at asI'm going to, "Oh my God,
I'm going to drink all All of this, no,I looked at it as I'm going to get good
news tomorrow when my colonoscopy comeback normal or when they found
a polyp and they take it out.
And indeed they found advanced polypin me and they took it out. Therefore,
I have to make my colonoscopyin three years from now.
(30:18):
Another good thing I'm goingto share with the audience,
when you do your bowel prep and you drinkthat fluid and you empty your colon,
you will have the best feeling of yourGI tract because you have got rid of so
much weight that was causinginflammation in your GI tract
and you will feel really good.
(30:38):
I know. I need that. Yeah. A lot of thesequestions are coming from the heart.
If this answer would be really good,I'll leave it up to you to say it or not
say it, but this is really how I feel.
Okay. So the prep is done andthe person, the patient comes in.
Walk us through what happens next whenthey have to come in for the colonoscopy.
(31:01):
Take us through it step by step.
Excellent. So the daybefore the colonoscopy, they
but they were also not allowed toeat. They were allowed to drink.
So they don't clean the colon and thenthere's another material coming on its
way to becomes tool for the followingday. So they are not allowed to eat.
They only drink clear stuff.
So the day of colonoscopy,the people go to the endoscopy suite.
(31:23):
They are met with very friendly nurses.
They know that this is theirfirst time most likely.
If it is the second or third time,then they usually know the drill.
For the first timers, they meet them,they comfort them and they take them to
the process. First, after they check in,they go to a room so they can
change their clothes. After that,you will go into the endoscopy room where
(31:45):
you meet the technician endoscopist.
You will meet the techniciannurse and the circulating nurse.
The doctor will explain for you whatthey will do and how they will do it,
and they will also explain foryou that you will get sedation.
Depending on the policyof that endoscopic suite,
you can fall asleep or you can bein a twilight don't have a sleep.
(32:08):
It doesn't really matter. Youwill be comfortable anyway.
And that sedation is through an IV?
Yes. Through an IV access,therefore you will get an IV
line placed before the procedure.
Once you sign the consent and you getyour medication and you start falling
asleep,they are lying on the left
side and their both knees arebent upwards or the right
(32:31):
knee is bent toward the chestand the left knee is not bent.
It's in a position that allow theendoscopist to perform the procedure
comfortably and also allow theperson themselves to be lying
comfortably.
Usually the procedure starts witha gentle digital exam to make
(32:54):
sure there is no tumor in theinterrectal area, interrectal junction.
And then the tip of the colonoscopy isintroduced gently with good amount of
lubrication to avoid any discomfort.
Endoscopists navigate thecolonoscopy through the colon until
they meet their final destination,which is the junction between
the small bowel and the colon,an area called the cecum.
(33:16):
Once the endoscopist get the finaldestination there, the exam starts.
The colon is examined whilethe colonoscopy or the outwards.
While the endoscopist is retractingthe colonoscope outwards,
they start looking all aroundcircumferentially in the colon
(33:40):
surveying it. There are folds inthe colon that acts like curtains.
There could be hidden growth.
So the endoscopist has to go throughthat, look to the right, look to the left,
look up and look down to make surethere is nothing behind those walls.
We call them like curtainsbecause they look like a curtain.
And when the endoscopist is retractingor retrieving the colonoscope outside,
(34:05):
they have to go and look behind thosecurtains on each side to make sure there's
no residual lesions there.
And that's the concept behindthe mist rate we talked about,
because sometimes the polyp is so tinyand it's just growing that even with a
head-on look at it,it may still not be visible for the
endoscopist. Until they come backall the way to the rectum, in the rectum,
(34:30):
they need to look upside down orlook backwards on themselves to see
the area is calledretroflection. So the colon,
instead of basically the scope,instead of basically looking forward,
the endoscopist make thecolon tube like a letter of J.
So it looks on itself like a candycane tip on the interrectal junction
(34:53):
because it's one of the hidden areas.
Once that is done and it's clear,the endoscopists adjust the
position of the scope again,suction all the air out, and
then they take the scope out.
And the best part after that,that the patient or the person can go
eat because they're usually hungry.
So it's not an easy processto go through a colonoscopy.
There's a lot of things that maybepeople feel indignified about,
(35:16):
or maybe they're just not comfortablewith the whole idea of having to go
through a prep.
So what do you say to your patients whoare really hesitant to schedule their
first screening?
What can other people say to theirloved ones to ensure that they go and
have that screening.
Done?That's a very goodpoint. I would say this,
(35:38):
and I apologize if thiswould hurt some people,
but I would say let's all close our eyes
and imagine it's 20 (35:47):
30 and you are seeing me in the
clinic and I'm telling you,I am so sorry to let you know
that you have colon cancer,you'll have to get part of your
colon out and you may need abag. And unfortunately,
(36:07):
there is nothing you can do about itto reverse the clock and to undo the
cancer.
We also need to make imaging studiesto make sure the cancer did not
spread to other organs in yourbody. How do you feel now?
And imagine now I'm tellingyou, okay, open your eyes.
Now we are back in 2026 andyou can avoid that situation
(36:31):
by doing your colonoscopy.
Avoid the trauma andthe burden to yourself,
to your significantothers, to your family,
and to your beloved ones if youcan only do the colonoscopy.
I have to say that is powerful.
That is a powerful message.
(36:51):
I thank you for that.
And thank you for helping us clear upthe confusion around colorectal cancer
screenings and why it'sso important not to delay.
The bottom line is simple.
Colon cancer is one of themost preventable cancers
Talk with your doctor aboutwhen you should begin your
is right for you.
(37:13):
And if you notice symptoms like bloodin the stool or changes in your bowel
habits or unexplained abdominalpain, don't ignore them, get checked.
Early detection saves lives.
Dr. Shawki, thank you so much.
Thank.
You Debra.
It's been a pleasure and I'm lookingforward for more educational podcasts for
our patient and community.
(37:34):
As am I.
To make an appointment with Dr. Shawkior another colorectal surgeon in Central
Maryland, call 443-77-2475.
To learn more about our MedStar HealthColorectal Surgery Program or to find a
colorectal surgeon in theWashington DC region, visit
(37:58):
medstarhealth.org/services/colorectal-surgery.
Comprehensive, relevant,and insightful conversations about health
and medicine happen here when MedStarHealth, dog talk.
These are real conversations withphysician experts from around the largest
healthcare system in theMaryland, DC region. Sadly,
it seems most of us have been impactedby a diagnosis of colorectal cancer.
(00:27):
It has touched my own family. Recently,the conversation has grown louder as
several well-known actors have died fromcolorectal cancer, including
Chadwick Bozeman who died at just 43,and Dawson's Creek star James
Vanderbeek, who died at 48.
Earlier this year,actress Katherine O'Hara,
known to many as the beloved mom andhome alone also died from complications
(00:50):
related to colorectal cancer.
It used to be considered an olderperson's disease when routine screenings
weren't even covered by insurance beforethe age of 50, but that's changed.
A national survey commissioned by MedStarHealth found that more than 75% of
Americans are unsure when orhow often to get a colonoscopy
(01:10):
screening.
Even more concerning,more than a third of eligible adults say
they've skipped screening altogether.
And this comes on the heelsof the American Cancer
that colon cancer is now the leadingcause of cancer deaths among people under
50. The facts are clear.
Colorectal cancer is the third mostcommonly diagnosed cancer in the US,
(01:34):
and the incidence of diagnosis in peopleunder 50 has roughly doubled in the
last 30 years.
It's never been more important toremove all doubt about who should get a
colonoscopy and when.
Joining us to clear up the confusionis MedStar Health colorectal surgeon,
Dr. Sharif Shawke, and I'm yourhost, Deborah Schindler. Dr. Shalke,
(01:56):
thank you for being here today.
Thank you very much,Deborah, for hosting me.
I'm looking forward for a good sessiontrying to answer some of the questions,
clarify some of the misconceptions,and hopefully we'll deliver a
good information for the audience.
Let's start with the big picture.
What is colorectal cancer?
That's a very good question to startwith so people can understand ultimately
(02:19):
what we want to achieve.
So I'm going to even back up one step.
Let's just say in the human body,there are three types of cells,
labile cell, stable cell, and permanentcell. So permanent cell, for example,
like the nerve cells, they don'treplicate what you are born with,
you stay with. The stable cellyou are born with, you stay with,
(02:43):
the only regenerate when isneeded. When there is injury,
when there is something happened,and they need to regenerate.
Now this will lead us to the labile cell,which are cells who are continuously
replicating like your skin,like your hair, like your GI tract.
If something that'sreplicating continuously,
(03:05):
this means that duringreplication, things may go wrong.
In our colon example,the continuous replication
may result into an overgrowth,also known as a polyp.
That overgrowth is notcancer yet, but if it is left to grow,
(03:27):
it will eventually become cancer.
So a colon cancer is atransformation in the normal
lining of the colon that usually starts asprecancerous growth that is left in place,
unremoved or untreated.
It will become cancer.
(03:49):
Do all colorectal cancers startas that precancerous polyp or this
growth? Can they come about another way?
For the most extent, yes. Theystart as precancerous lesions,
polyps, and then they becomemalignancy or cancerous.
Now, the difference in types of cancers,if it's sporadic versus genetic and
(04:10):
even the type of genetic itself is theduration, how fast or how
slow the precancer growth,AKA polyp, would become
malignant. For example,a genetic syndrome will have this
adenoma, the polyp, another name for it,adenoma to carcinoma
transformation polyp to malignancyin one to two years. The other
(04:35):
extreme in this sporadic,which it can happen to anybody,
not people who have geneticpredisposition to cancer,
it can take up to seven,eight, or even 10 years.
So in theory,the process that takes years gives
us plenty of time to interrupt thatcycle process, stop the
(04:55):
growth with screenings.
Excellent question. Based on knowingthe background of the person,
this will enable us to provide theright guidelines and the right guidance
to how to prevent polyps frombecoming cancerous because the
good news here,if you can stop the cycle of
transforming the polyp to acancer malignant growth,
(05:23):
then you will not have that cancer.
And that's the positive message weare trying to deliver to the people
that with one test,you can prevent cancer.
And that's where the colonoscopy becomesso powerful because if it's found early
enough, it could be removed before ithas a chance to develop into cancer,
(05:45):
and that's clear and understood.
But I think where the confusion sometimeshappens is maybe they don't know
they're predisposed to thiscancer because of genetics.
Maybe they don't know that they had afamily member who had it. If they do know,
what's your recommendation?
Another good point, Deborah.
So let's talk in general about howwe look at screening colonoscopy in
(06:05):
relation to family historyversus no family history. Okay.
So in the old times, itused to be, as you said,
an old age disease. Therefore,people would start screening
colonoscopy everybody at age of 50without genetic predisposition,
without family history,just a person who had no family history.
(06:28):
But we have realizedthat a younger age had
been getting colon cancer morefrequently compared to the last
millennia, and it's almost doubledand it's going to triple. Therefore,
the screening age haddropped down to 45. Now,
let's say somebody has a first degreefamily member with colon cancer
(06:52):
that was picked at age of 54.
If you look at what we were saying,this means that this person had been
having a polyp for eight years ago,at least,
and has been growing silentlyuntil it was detected on a
colonoscopy when the patient startedhaving blood in the stool or bleeding per
(07:12):
ectum. Therefore, that promptedcolonoscopy and it found a malignancy.
If that colonoscopy wasdone eight years ago,
it could have basically prevented thatsituation from happening. Therefore,
the guidelines dropped the age ofscreening colonoscopy from 50 to 45. Now,
that person who had cancer at 54,now their kids should start
(07:33):
having screening colonoscopy10 years before the age of
diagnosis, which means 44.
What about siblings?
Siblings, if it's notgenetic predisposition,
So right now, everybody will go at45. If there is any alarming signs,
(07:55):
bowel habit changes, bleeding, straining,the sense of defecation that doesn't
translate into a real bowel movement,all of these are signs of space occupying
lesion and there is something wrong,which should prompt going to your primary
care physician and should prompt doingscreening colonoscopy. In people
with genetic predispositions,we know that these genes,
(08:18):
what do they mean in termsof the genetic anomaly?
And what does this translateto the age at which screening
colonoscopy would becomeright? For example,
familiar adenomatous polyposis,people would start screening
at the age of 11 years.
So the kids of a person with familiaradenomatospoliposis known as FAP,
(08:41):
they would start at age of 10 or 11.
A person with somethingcalled Lynch syndrome,
they would start between age of 20 and 25.
The former will do thiscolonoscopy every year.
The latter will doevery year to two years,
depending on how muchburden of polyps are there.
So we know the genetic syndromes,we know how to deal with them.
(09:03):
We take care of thosefamilies, we educate them,
we take care of theiroffsprings and their kids,
and they are usually moreengaged and more involved.
Are they usually a faster growing cancer.
When.
They're younger like that?
Yes. Or.
Genetically predisposed?
They are genetically disposed.
We know for FAP that by the age of 40,they will get colon cancer.
(09:28):
That's why they will have somethingcalled prophylactic colectomy.
So at some point we prophylacticallyremove their colon and rectum to
avoid having cancer.
Wow.
And for Lynch syndrome, theyhave, as we talked before,
the adenoma to carcinoma progression,the polyp to cancer transformation.
(09:49):
They have a very fast adenomato carcinoma duration.
Despite what I've told youabout the genetic syndromes,
they occupy about five to6% of all colon cancer.
So not every young onsetcolorectal cancer is considered
genetically predisposed.
And it is what makes coloncancer different from many
(10:11):
is possibly prevented.
With.
The screenings.
Exactly. Because in orderfor someone, as I said,
in order for someone to developcancer, they have to have growth.
Now, that growth could be treated if itis picked up early and could be removed
and we can stop thecycle there. Therefore,
(10:33):
the colonoscopy is a veryimportant tool to identify,
diagnose, and to treat byremoving the precancerous growth,
blocking this cycle. Now,there is something I must say
to explain for the audience,why do we do colonoscopy every 10 years?
(10:54):
So you will hear somebody saying, "Oh,I get myicolonoscopy
every five years," or,"I get micolonoscopy
every one to two years,or I get macolonoscopy
every three," and so forth.
So that was the importance ofthe introduction I gave earlier,
because as we said, here are thefacts to conclude an information.
It takes time for the polyp,the precancerous growth to become
malignant. That time could be eight to 10years in the sporadic normal human being.
(11:21):
It could be shorter in somebody whohas a first degree relative with colon
cancer, because we know thesepeople are at higher risk.
It could be even shorter ifsomebody who just has colon or their
colon is a polyp former.
It could be even shorter in somebodywho is genetically predisposed,
(11:42):
and it could be as short asin someone who has chronic
longstanding inflammation likeinflammatory bowel disease.
What does this mean for theaudience, simply speaking?
So if somebody gets acolonoscopy, they are clear,
which means they have no polyps.
They are good to be seen in eightto 10 years. Why did we say this?
(12:06):
Remember, polyps can form continuously.
The colon has labile cells.
They replicate continuously,therefore they can grow
abnormally at any point.
All the information I provided is layered.
Therefore, if you are clear now,this doesn't mean that you're clear
forever. This means you're clear now,but tomorrow you may start
(12:27):
having another polyp.
How long this polyp will take tobecome cancer? About eight to 10 years.
Therefore, you are due foranother screening colonoscopy
If you have polyps, dependingon the type of the polyp,
if that type of polyp israpidly growing to malignancy,
then you cannot do it in eight yearsbecause you can have cancer that
(12:51):
will grow in five years.
Therefore, we tell you, no,you have to come in five years because
you have that type of polyp that is riskyto become cancer sooner than later. Okay.
What if I have a genetic syndrome? Well,depending on the genetic syndrome,
the adenoma to carcinomasequence is very fast. Therefore,
you're going to come every year.
What if I have a chronic longstandinginflammatory process condition such
(13:15):
as inflammatory bowel disease? Well,we know after 10 years of inflammation,
people tend to have an extrapercentage of risk to develop
cancer.
So if somebody with chronic ulcerativecolitis and these patients know that very
well, after 10 to 15 years of the disease,they will start having colonoscopy
(13:35):
every one to two years,because their longstanding
inflammation results into provokingmalignant transformation
as another external factor.
So for each person and eachsituation, there are guidelines.
The bottom line for the audienceis don't get noises from
(13:59):
what other people are telling you.
You just need to focus on your own health.
Do your first colonoscopy and let yourhealthcare provider take care of the
rest.
Get a GI specialist, right?
A gastroenterologist.
And if they haveinflammatory bowel disease,
you'd think they were alreadybeing treated by someone.
(14:21):
Absolutely. That's whyI said- You would be.
Making these recommendations.
That's why I said thesepeople already know.
I'm just trying to explain forthe audience who don't know this.
Why would you hear different durationsand different frequency of colonoscopy
because people conditions are different?
They are different. Well,look, since the mid 1990s,
(14:43):
diagnosis in people under 50 have beenrising from about one to 2% every year,
and the number of youngerpatients has just about doubled.
We've established that. Soamong adults ages 20 to 39,
the incidence has been risingabout 2% a year. That, of course,
created the need to change whenthe colonoscopy is a standard
(15:04):
screening from age 50 to age 45.
I want to be clear aboutthat and underscore that
not seeing a gastroenterologistand they're not already
maybe they're still thinking,"I have until I'm 50." I just want to
underscore that going into this podcast,that routine screenings start at 45. Now,
(15:26):
to think of someone being 20 and gettinga diagnosis of colorectal cancer is
inconceivable. What's the youngest agethat you've treated, would you say?
It's sad story. The patientwas not even 20 years old.
Oh my goodness.
And it was delayedpresentation and it was already
metastasized. Unfortunately,they didn't make it.
(15:48):
And I have been seeingmore often in 30s and in
20s, over the last few years.
So sidestepping the issueof genetics for a moment,
is there anything maybe research wisethat supports why that's happening?
And is there anything that we can do toprevent colorectal cancer such as our
(16:09):
diet or minimize the risk for it?
That's a very good questionand a slowed question.
So on the scientific side,there are many studies
underway trying to identify whyis it happening in the younger population?
What led to that shift or what ledto that rising incidence in the
(16:31):
younger population? But Ihave a very simple opinion,
and this is my humble opinion. Usuallyhuman beings starts to do new things,
and then you see the impact of thisin two, three decades down the road.
So something must have happened. 20, 30,40 years ago, we changed
(16:51):
something in the diet.
We consumed something in a processed diet.
Something happened that itseffect on the human genome is
basically had been showing overthe past decade when we have been
noticing the increase in youngonset colon and rectal cancer.
As for how to preventit, as much as I can say,
(17:15):
there are known factors that areunhealthy and they lead to diseases.
Therefore, moderation ingeneral is a key. For example,
you will find smoking involved incardiac disease, in lung cancer,
and with other type of cancers as well.
You will find the red meatinvolved in obesity or fat
related diseases, blood vesseldiseases, as well as colon cancer.
(17:40):
Therefore, my advice to the audienceis this. Adopt healthy lifestyle.
You don't have to cut offanything, but moderation is a key.
Not too many potato chips or ...
I have to tell you, I like potato chips,but I stopped binging
on them long time ago.
I like them too. What aboutthis idea of an aspirin a day?
(18:03):
I read that as an anti-inflammatory thatsome people believe in aspirin a day
keeps the GI away. Isthere any truth to that?
It's unconfirmed. In mymind, it's unconfirmed yet.
So back to the MedStar Health Survey,which resulted from
questioning 1,000 people.
Four in 10 people believed screeningafter the age of 45 is only necessary if
(18:25):
there's a family history of colon cancer.
I think we've already addressed that,but true or false?
False.
Right. Why should someone with nofamily history still get screened?
And how often?
Perfect.
So this is a good question now to examinethe audience for what we have been
talking about. Someone withoutfamily history, number one,
(18:46):
do they need screeningcolonoscopy or no? Remember,
the GI tract has a type of cell thatreplicates continuously. Therefore,
an overgrowth can happen anytime andthat overgrowth can transform to cancer.
So the answer is yes, they should getscreened colonoscopy. At what age?
Right now, at 45.
And it could be younger if there arealarming signs such as blood in the stool,
(19:10):
bleeding per rectum, constipationthat is just not explained.
Change in bowel habits,feeling the urge to defecate,
but really nothing come out. All theseare signs of space occupying mass,
like a tumor or a large polyp.
A large polyp can harborpre-malignant cancer and it's not
(19:31):
considered cancer yet, and therefore itcan be basically removed by colonoscopy.
Well,that's interesting too that another
concern that was revealed in the survey isthat only 13% of respondents couldn't
identify all the symptoms of colorectalcancer. And you just went
through a full list of them,but we know that people who show up with
colon cancer or colorectal cancer whohad no symptoms.
(19:53):
Thank you for saying that, Deborah,because it's a slow growing tumor.
So there is a time that it will be silent.
I have many of my patients who come andthey are curious and they say, "Doc,
how long have I been carryingthis tumor?" And I say,
"At least eight to 10 years." And youshould see the shock look on their face,
(20:14):
and I feel sorry to tell themthat, but they can't believe it.
They are in denial. I have been livingwith cancer for that time. Yes, you are.
When you find a polyp or acancerous tumor while performing a
colonoscopy, is it usually one?
This is a very good question. I'mgoing to answer this in two dimensions.
(20:36):
Number one, which is a direct one, yes,you can find one or you can find as
many as two, three, four, five. Now,if you find more than 10, then we
start thinking of polyposis syndromes,something genetically predisposed
to result into that colon to formway larger numbers of polyps. Okay?
(20:58):
The other thing that Iwant to tackle is this.
We are all perfectly imperfect.
So colonoscopy is very sensitivewhen it's done by the specialist.
That's why you said,Deborah, in the beginning,
you need a gastroenterologist to do withsomebody who knows what they are doing
and how they do it and they do it up toquality indicators and metrics. However,
(21:18):
we know there is something calledmisrate. What does this mean?
This means that I can docolonoscopy in a patient and I can
detect three polyps.
Now you are better than me.
You can do a colonoscopy for the samepatient and you can detect five polyps,
which means I miss two.
So we know that we havean acceptable miss rate.
(21:42):
I can do colonoscopyand I can miss a polyp.
That's a forgivable miss.
But if I miss three or four,that's unforgivable miss
and it should not happen.
So if somebody has colonoscopyor their colonoscopy is normal,
that's very good, up to90%, 90 plus percent.
(22:04):
And that's why we say you haveto come back in eight years,
because if there is something missed,it will take that duration to
be discovered early at least.
And that's why with somebody withlongstanding inflammatory conditions or
genetic predisposition,we do that colonoscopy every one to
two year because we know that durationfrom adenoma to carcinoma is shorter,
(22:28):
but factoring also the miss rate.
Let's say what if we missed one?
And that's why we do it every one totwo years to detect the lesion early and
to compensate for any missedpolyps from the prior colonoscopy.
Would you repeat the name of thatcondition that you just identified where
someone has a lot of polyps?
(22:49):
It's called polyposis syndrome.
And does that significantly predisposesomeone who has that to getting colon
cancer?
Yes. So going back to the geneticdisease I told you about, for example,
familial adenomatous polyposis,juvenile polyposis syndromes.
As we said before, it startsby growth that's called polyp.
(23:11):
The term osis in medicineindicates the presence of numerous
polyps.
So polyposis means there are so manypolyps that are existing in the colon.
So many polyps, meaning so manygrowth where therefore there are one,
it takes only one of thosepolyps to become cancer.
And you cannot really detect it justby looking at it- Not by the size.
(23:34):
In the colonoscopy.
A bigger polyp means closerto being a cancer? No?
So very smart question, Deborah. So thereare something called advanced polyps.
Advanced polyps, meaning it's a polypthat's closer to become a cancer.
And the advanced features are size, shape,configuration, and
(23:56):
histology, the type of cells.
So size above two is advanced. Shapeand configuration, flat polyps,
the polyp could have a neckcalled pedunculated polyps,
or could be just stunt flat on thecolon wall. They call systele polyps.
So these are more risky. Andthen the type of histology.
(24:17):
If they have more abnormal cells,this means they are more
closer to become cancer.
But you can't just lance at that. I mean,I assume that you're able to
identify them during the colonoscopy.
Maybe without the biopsy, doyou come out and say, "Yeah,
I think that's likely to be cancer.
We haven't done the biopsy yet,but I'm pretty sure that
that's going to come back.
(24:38):
As.
Cancer.".
Yes.
An experienced gastroenterologistor colorectal surgeons
routinely,they have enough experience
to suspect a malignant lesionin colonic growth.
There are also other criteria andfeatures that they can apply on
the lesion that they can know bywhich they can know if the tumor is
(25:01):
high risk to harbor malignant cells or no.
The gastroenterologists nowhave more advanced techniques.
So I want to assure the audience ifthere is a polyp or even a larger polyp
that had been found,we now do organ preservation
endoscopic advancedtechniques where the advanced
endoscopist can go inand shave that large
(25:24):
polyp from the colonicwall, take it out, and the person
does not need to have their colon out.
If it was pre-malignant, but big polyp.
Okay. But if it is malignant,there's a resection of the colon.
Then the best course of actionis to resect segment of the colon
(25:48):
and put the colon back together allin one surgery and no bag is needed.
Okay.
So many people do feel nervous aboutgetting a colonoscopy and in spite of the
screening itself, it's really theprep that people most complain about.
Let's go through the PrEP process.
Is there anything that you can sharethat suggests that the PrEP process has
improved from maybe when thelast time someone did one?
(26:11):
Well, PrEP is PrEP. The concept isif you're going to do a colonoscopy,
you want to do it successfully andyou want to do the bowel prep once.
You don't want to do a half job ingetting your colon cleaned and cleansed,
and then the colonoscopist or theendoscopist cannot see clearly the
colonic mucosa due to fecalmaterial residue in your colon.
(26:35):
So therefore I say, if you'regoing to do the colonoscopy,
take the bowel prep seriously. Now,the concept of the bowel prep is you're
giving a material that it will resultinto water and fluid
being in the colon to washall the stool out. Therefore,
it is taken with lots of fluidintake to avoid dehydration and to
(26:58):
avoid electrolyte imbalance. Regardlessof the type of prep you are using,
this is the concept.
You want to put lots of water in yourcolon to remove any fecal material
residue so the endoscopy can havea clear picture and minimize the
misrate we talked about before.
This could be in form of highsalt compounds,
(27:21):
which is going to drawwater in your colon,
or it could be high sugar basedcompound like the polyethylene lycol,
which is also going to drawwater, but you take it with water.
So the bowel prep, Deborah,unfortunately, is the wishful thinking.
The bowel prep is a bowel prep and weare basically inducing diarrhea for a
short period of time to clean anyfecal material residue of the cone.
(27:45):
But I have heard people describetheir experiences differently.
Some of them are using pills and nothaving to drink a gallon of water.
Some of them are usingGatorade. They're all different.
Is there something that you can sharewith us that would suggest this might be
an easier way to go, that yourpatients come back and they say,
(28:06):
"This wasn't so bad. I didn't havea problem getting all that down.".
It's a good point. As I said,there are different types of
compounds used for bowel prep.
There is the one that youdrink a gallon of water with,
and the pills and theother stuff is basically,
it has more concentratedmaterial like salts,
but this also may impactyour kidney function and it
(28:29):
imbalance and dehydration.
The concept of reducing the amountof fluid to be drank with the
colonoscopy doesn't gounpunished too. As we said,
there is a concept to remove the stoolfrom the colon. We just need fluid to ...
That's common sense.
You need fluid to wash off thestool residue of the colonic wall.
(28:50):
You can help your body by drinkingwater that can go into your GI
tract and wash off thatstool or alternatively,
you can take the pill,which is basically a concentrate of salt
that will use your own body fluid toget inside the GI tract with
less oral intake compared tothe gallon,
(29:12):
and it's going to wash off the stool.
So if you look at the second situation,yes, you are drinking less water,
but that's on the expense ofyour own body water. Therefore,
you are more susceptible to waterimbalance or water shifts in your body
and electrolyte imbalance in your body.
I would not recommendsomebody who is old age.
(29:33):
I don't recommend somebody withkidney related diseases that would do
that.
So maybe that's why-.
That type of bowel prep.
And last but not least,when I had my two colonoscopies,
I used the gallon and I will sharewith the audience, I just friended,
meaning I did not look atit as a challenge, I looked
(29:57):
I learned to look at asI'm going to, "Oh my God,
I'm going to drink all All of this, no,I looked at it as I'm going to get good
news tomorrow when my colonoscopy comeback normal or when they found
a polyp and they take it out.
And indeed they found advanced polypin me and they took it out. Therefore,
I have to make my colonoscopyin three years from now.
(30:18):
Another good thing I'm goingto share with the audience,
when you do your bowel prep and you drinkthat fluid and you empty your colon,
you will have the best feeling of yourGI tract because you have got rid of so
much weight that was causinginflammation in your GI tract
and you will feel really good.
(30:38):
I know. I need that. Yeah. A lot of thesequestions are coming from the heart.
If this answer would be really good,I'll leave it up to you to say it or not
say it, but this is really how I feel.
Okay. So the prep is done andthe person, the patient comes in.
Walk us through what happens next whenthey have to come in for the colonoscopy.
(31:01):
Take us through it step by step.
Excellent. So the daybefore the colonoscopy, they
but they were also not allowed toeat. They were allowed to drink.
So they don't clean the colon and thenthere's another material coming on its
way to becomes tool for the followingday. So they are not allowed to eat.
They only drink clear stuff.
So the day of colonoscopy,the people go to the endoscopy suite.
(31:23):
They are met with very friendly nurses.
They know that this is theirfirst time most likely.
If it is the second or third time,then they usually know the drill.
For the first timers, they meet them,they comfort them and they take them to
the process. First, after they check in,they go to a room so they can
change their clothes. After that,you will go into the endoscopy room where
(31:45):
you meet the technician endoscopist.
You will meet the techniciannurse and the circulating nurse.
The doctor will explain for you whatthey will do and how they will do it,
and they will also explain foryou that you will get sedation.
Depending on the policyof that endoscopic suite,
you can fall asleep or you can bein a twilight don't have a sleep.
(32:08):
It doesn't really matter. Youwill be comfortable anyway.
And that sedation is through an IV?
Yes. Through an IV access,therefore you will get an IV
line placed before the procedure.
Once you sign the consent and you getyour medication and you start falling
asleep,they are lying on the left
side and their both knees arebent upwards or the right
(32:31):
knee is bent toward the chestand the left knee is not bent.
It's in a position that allow theendoscopist to perform the procedure
comfortably and also allow theperson themselves to be lying
comfortably.
Usually the procedure starts witha gentle digital exam to make
(32:54):
sure there is no tumor in theinterrectal area, interrectal junction.
And then the tip of the colonoscopy isintroduced gently with good amount of
lubrication to avoid any discomfort.
Endoscopists navigate thecolonoscopy through the colon until
they meet their final destination,which is the junction between
the small bowel and the colon,an area called the cecum.
(33:16):
Once the endoscopist get the finaldestination there, the exam starts.
The colon is examined whilethe colonoscopy or the outwards.
While the endoscopist is retractingthe colonoscope outwards,
they start looking all aroundcircumferentially in the colon
(33:40):
surveying it. There are folds inthe colon that acts like curtains.
There could be hidden growth.
So the endoscopist has to go throughthat, look to the right, look to the left,
look up and look down to make surethere is nothing behind those walls.
We call them like curtainsbecause they look like a curtain.
And when the endoscopist is retractingor retrieving the colonoscope outside,
(34:05):
they have to go and look behind thosecurtains on each side to make sure there's
no residual lesions there.
And that's the concept behindthe mist rate we talked about,
because sometimes the polyp is so tinyand it's just growing that even with a
head-on look at it,it may still not be visible for the
endoscopist. Until they come backall the way to the rectum, in the rectum,
(34:30):
they need to look upside down orlook backwards on themselves to see
the area is calledretroflection. So the colon,
instead of basically the scope,instead of basically looking forward,
the endoscopist make thecolon tube like a letter of J.
So it looks on itself like a candycane tip on the interrectal junction
(34:53):
because it's one of the hidden areas.
Once that is done and it's clear,the endoscopists adjust the
position of the scope again,suction all the air out, and
then they take the scope out.
And the best part after that,that the patient or the person can go
eat because they're usually hungry.
So it's not an easy processto go through a colonoscopy.
There's a lot of things that maybepeople feel indignified about,
(35:16):
or maybe they're just not comfortablewith the whole idea of having to go
through a prep.
So what do you say to your patients whoare really hesitant to schedule their
first screening?
What can other people say to theirloved ones to ensure that they go and
have that screening.
Done?That's a very goodpoint. I would say this,
(35:38):
and I apologize if thiswould hurt some people,
but I would say let's all close our eyes
and imagine it's 20 (35:47):
30 and you are seeing me in the
clinic and I'm telling you,I am so sorry to let you know
that you have colon cancer,you'll have to get part of your
colon out and you may need abag. And unfortunately,
(36:07):
there is nothing you can do about itto reverse the clock and to undo the
cancer.
We also need to make imaging studiesto make sure the cancer did not
spread to other organs in yourbody. How do you feel now?
And imagine now I'm tellingyou, okay, open your eyes.
Now we are back in 2026 andyou can avoid that situation
(36:31):
by doing your colonoscopy.
Avoid the trauma andthe burden to yourself,
to your significantothers, to your family,
and to your beloved ones if youcan only do the colonoscopy.
I have to say that is powerful.
That is a powerful message.
(36:51):
I thank you for that.
And thank you for helping us clear upthe confusion around colorectal cancer
screenings and why it'sso important not to delay.
The bottom line is simple.
Colon cancer is one of themost preventable cancers
Talk with your doctor aboutwhen you should begin your
is right for you.
(37:13):
And if you notice symptoms like bloodin the stool or changes in your bowel
habits or unexplained abdominalpain, don't ignore them, get checked.
Early detection saves lives.
Dr. Shawki, thank you so much.
Thank.
You Debra.
It's been a pleasure and I'm lookingforward for more educational podcasts for
our patient and community.
(37:34):
As am I.
To make an appointment with Dr. Shawkior another colorectal surgeon in Central
Maryland, call 443-77-2475.
To learn more about our MedStar HealthColorectal Surgery Program or to find a
colorectal surgeon in theWashington DC region, visit
(37:58):
medstarhealth.org/services/colorectal-surgery.
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