Bowell Cancer Symptoms

>> funding for "confrontingcolon cancer" comes from the dr. donald j. goodman and ruthwebber goodman philanthropic fund of the cleveland foundation, providing medical information programming for individuals andfamilies on ideastream's broadcast and educationalchannels. and by the margaret clark morganfoundation, the woodruff foundation, the mcgregorfoundation, and the community foundation of lorain county. >> cancer is a very scary word.

>> the fear of colon cancer. >> when it presents in a latestage, it's definitely. >> the key is prevention. follow patients inside insideand out. and discover hope. next on confronting "coloncancer." >> welcome to "confronting coloncancer." i am standing in a clevelandicon, brown stadium. on game days, more than 70,000people packed this place.

imagine 70,000 people and allthe sounds of -- all the seats around me. now i want you to imagine 50,000of them gone. why that number? because this year, across theunited states, nearly 50,000 people will die of colorectalcancers. cancers of the colon and rectumare collect of lee called color rectal cancer. we are going to begin to look atthis treatable cancer and take a

step back and understand whatthe colon does and how cancer starts. here is ideastream producer kencolby. >> while there are many types ofcancer, all have one thing in common -- cells growing out ofcontrol. normal cells played by strictrules and act in an orderly fashion. >> they grow up. they mature.

they have a certain lifespan andthen they die and they are replaced by other normal cells. >> in contrast, cancer cellsbreak all the rules. they don't die when they aresupposed to. and they keep forming newabnormal cells. the rules governing a cell'sbehavior for making copies of itself and dying onto ourcontained in the cell's genetic material known as dna. dna is referred to as a doublehelix.

two strands of genes, one fromeach of our parents, our interlocked and wrapped asdepicted as the arms of these modern dancers. cancer occurs when the dna getsdamaged. >> here is the math. here is the cancer mass cominginto view right here. >> to understand how this cancerformed, it first helps to understand what the colon does. the colon, or large intestine,is the last of what is a giant

hose wrapped inside herabdomen. the colon stretches around theabdominal cavity. the last six inches of the coloncomprise the rectum. the primary function of thecolon is to take food that travels from the stomach intothe small intestine and absorb the water out of it so it can bepassed out on the body. under the microscope, normaltissue in the colon looks like this. cells organized in crypt thatresemble rows of test tubes.

in contrast, cancerous tissuelooks like this. >> so this whole thing is atumor? >> this is a picture of a coloncancer. this is an architectural mass ofthe cells that are normally found in the colon but haveundergone change to cancer. >> colon cancer starts off witha pile of cells with damaged dna forming a free cancerous polyp. >> the thought is that smallpolyps can be left to there for a few years and they are notgoing to cause any problems.

but certainly, within 10 years,a polyp has the potential to become big and form a cancer. >> a polyp turns cancerous whenthe cells infiltrate surrounding tissues and can get into thebloodstream. >> right here, you can see thatthis tumor has spread through the wall of the bowel. into the adjacent fat around thebowel. >> cancerous tumors are theresult of many different changes or mutations to the dna of cellsinteracting over a long period

of time. a tumor measuring fourcentimeters takes at least 15 years to grow into a polyp andturn into cancer. some people are born withcertain mutations that make them susceptible to cancer. but in colon cancer, themajority of changes occur in the dna of cells as people age andare associated with certain lifestyle habits such as diet. >> we know that lack of physicalactivity and obesity, diets high

in red meat, low on fruits andvegetables are associated with colorectal cancer. >> people who have the mostcommon type of diabetes also face an increased risk of coloncancer. other risk factors include beingage 50 or over, having a parent or sibling with colon cancer,and being from certain racial or ethnic groups, includingafrican-american. colon symptoms of cancer includeblood in the stools, chronic diarrhea, persistent changes inthere frequency about movements

and or the shape of stools, andanemia. by the time cancer causessymptoms, it may already be advanced. the goal is to catch coloncancer early or better yet stop it before it starts. >> one important think aboutcolor rectal cancer is that sometimes it can be preventedwith a procedure called colonoscopy. a lot of people don't like totalk about it because it

involves going to the bathroomand having a scope instrument inserted in the rectum. there are several methods forscreening for color rectal cancers, but the colonoscopyremains the gold standard. in our next story, gretchenfollows a 66-year-old man through a colonoscopy to findout how colon cancers can be stopped before they start. >> there are all kinds ofbicycles there. >> he wants to be around formany years to enjoy his

granddaughter and the rest ofhis family. that's why this retired autoworker from talmage doesn't mind having another colonoscopy. >> is better than going to adentist. i'll tell you that. >> bert repairs for hisprocedure the day before. >> i don't use the lemon flavorpackage. i drag it straight. >> is dr. prescribed a colonflush which mixes and -- which

bert mixes and refrigerate. burt has to drink about 17glasses of the liquid which he describes as bland, salty water. >> yucky. yes, it does. it tastes yucky. >> he sits back in his favoritechair, sets the timer and, every 10 minutes, downs another glass. doctors need the colon clearedout before the exam.

over the course of the evening,he will go to the bathroom four times. about halfway through the job,the mixture starts working its magic. >> oh, what a relief that is. >> bird has one main reason forletting our camera follow him through these private momentsand his colonoscopy. >> black america is in thehighest group that gets colon cancer.

you know you have these guys whowant to have that macho image that somebody going up intothere reran is not -- they're rear end is not cool, so tospeak. i think we need to be educatedmore to understand that this is a procedure that needs to bedone because we died more than any other group in america. >> the next day, he is ready togo. >> can you say break a leg? >> it's been since may?

>> yes, sir. >> all right, things have beengoing alright for you? >> pretty good. >> dr. james church will inserta flexible scope with a tiny camera on the end through therectum. >> and here comes the scope. >> images projected on thescreen will allow dr. church to take a virtual tour of theentire colon, which is almost six feet long.

>> you see the colon has lots oflittle nuts and crannies and shelves. >> it doesn't take long to spotpollack number one. -- spot polyp number one. dr. church and his team use aninstrument called a snare to cut off the polyp. the polyp is sucked up throughthe scope and removed. >> it is kind of a quarter of aninch. we will send this to pathology.

>> you ok? doing all right? >> burke has been given asedative so he likely won't remember anything aboutthis procedure. although he remains away, otherpatients are given stronger painkillers and prefer to sleep. doctors recommend everyone aged50 and over the screen for while there are various methodsfor screening, the colonoscopy remains the only way to find andremove polyps all at once.

>> colonoscopy, all of thescreening tests for colon cancer, is the only one that youcan treat at the same time as you can find. because every colon cancerstarts off as a polyp, if you take off all the lips, you aregoing to prevent colon cancer. it is very frustrating for mewhen i see patients come in with colon cancer knowing that theycould have been prevented if they had had a colonoscopy. >> people with a family historyof colon cancer need to start

screening earlier than age 50. but since the majority of allcolon cancers are found in people without a family historyof the disease, everyone needs to be checked, including women. >> all right. you did very well. >> so how are you doing? >> doing fine. >> all right, was it ok?

>> done very well. no pain. >> how is he going to feel inthe next few hours or a few days? is he going to have pain lateron and a little discomfort? >> to the extent that he stillhas some gas in his colon, he is going to be a little bloated. over the course of the next 20or 30 minutes, he is going to get rid of most of that gas.

>> dr. church removed a total ofseven polyps, which is a lot. because he has a high-risk colon, he will return for another colonoscopy in six months. byrd has one thing to say abouthis dock your. -- his doctor. >> if you want to get saved, goto church. [laughter]>> i am very much relieved that dr. church got the polyps outand he is safe for another six months.

>> should be good. >> thanks a lot, sir. appreciate it. >> let's say you have acolonoscopy. but instead of finding andremoving precancerous polyps, doctors find full-blown cancer. what happens next? you wind up here. surgery is the main treatmentfor: cancer -- for colon.

they take surrounding tissue forpathologists to analyze. in our next segment, producerkay follows one patient's case from the operating room topathology lab to see what doctors can learn from thetissue and what it means for the patient. and i must advise you thefootage you are about to see is graphic. >> i think everything is goingto be ok. i mean, we keep tellingourselves that.

>> sylvia, a retiredschoolteacher, will have surgery for colon cancer. it is something that we hopewill never happen to us, that this is something for otherpeople. but not really for us. >> hi, mrs. heller. how are you? >> i'm fine, thank you. >> good.

do you understand what we aregoing to be doing today? when you are asleep, we aregoing to put the little keyhole forks into your timing. and then we will be able to putthese little surgical instruments in to take out thediseased part of your colon. ok? >> ok. >> you will probably be inhospital for about three or four days.

you will have medicines for painand it should run very smoothly. so don't worry. you should be fine. all right? >> thank you. >> i'll see you in a littlewhile. >> ok, have fun. behave. >> i'll try.

>> go ahead and lay there. there you go, perfect. >> surgeon conor delaney has twodeauville main goals. wexner one is getting local -->> one is getting local control. anything that might be inventedby the tumor. number two, we are also taking aspecimen that the pathologist can evaluate. >> this is a laparoscopicprocedure that involves inserting scopes through a tinyincision.

a tiny video camera is insertedat the opening at the bellybutton. >> if you want to look up at thescreen for a moment, you will see a metal cylinder throughwhich the camera is traveling into the abdominal cavity. >> so that becomes your eyesinto the body. >> that becomes your eyes insidethe body. >> tiny tools inserted throughother scopes the come dr. don delaney's hands, allowing him tosift and cut through tissue.

>> and here you can see thetissues are a little bit firmer. so we actually need to dissectit. i am using the scissors todissect. and so we are separating thestructures that we want to leave behind. >> the next part of the surgerytakes place outside the body. extending the incision at thebellybutton, dr. delaney removes all the parts he has freed up onthe inside. >> then we are going to drawthis out of her abdomen.

>> so it all comes out in onepiece? >> absolutely. we are going to move the segmentwith the cancer in it. we are going to divide below thecancer and above the cancer. and then we are going to takeaway that piece and join the ends together so the diseasedportion is gone. then we have to join the healthyends back together that we want to keep in the abdomen. >> with the entire right side ofthe colon gone, the small

intestine is reconnected to theremaining colon and returned back into the abdomen. you basically took out herintestine. refigure them and then put themback in. how do you know they are goingto work right again? >> so what happens after surgeryis that your bowel is almost paralyzed. it goes to sleep for a period ofa couple of days. so as your bowel starts torecover its function and starts

to squeeze and push the foodthat you digest through, it pushes it through that channel. >> as opposed to a traditionalopen operation, heller's procedure is minimally invasive. >> instead of an incision thatmight run from here to here, she's got a couple of smallincisions and the short size of these incisions means that shedoesn't get too much rain after surgery and she is able torecover more quickly. she will go into recovery.

and then we get her up to thenursing four. so this is the section of colonwe removed. >> so that is the cancer. the tumor and surrounding tissueare prepared for pathology and dr. delaney updates heller'sfamily. >> ok, so it went perfectly. we took out the section with thetumor and we took out the lymph glands around that. she is now awake.

we just brought her back to therecovery room. she will probably be there forabout an hour, maybe two hours. >> i just feel like i'm a coupleof inches off the ground right now. i just can't think of a greatenough answer to explain. >> i am very relieved, ofcourse. but you know, we want to waitand see what the results are when they get the pathologyback. >> less than 24 hours aftersurgery, heller is sitting up in

a chair visiting with herfamily. and the pathologists are at workon the surgical specimen. heller's tumor measures aboutone and a half centimeters. >> yesterday in the operatingroom, it was like a more red. why is it brown now? >> we have fixed this specimenovernight in a substance called formalin which allows it topreserve and allows us to take sections in pathology. >> dr. joseph willis cuts out amiddle section of the tumor that

will be turned into slides foranalysis. his next task is to search forlymph nodes, tiny, often microscopic nodules in the factthat contains clues to heller's >> what happens next in terms oftreating this patient is very much dependent on whether or notwe find cancer in these lymph nodes or not. >> patients are recommended forchemotherapy if cancer is found in there lymph nodes. the medical turn ismetastasized, which means cells

from the original tumor have setup shop in another location. that puts it at higher risk ofturning up elsewhere in the body , like liver and lung or distantlymph nodes. so it's a more aggressive tumor. that's what we call stage threein colorectal cancer, when it has gone to the local lymphnodes. within minutes of beginning thedissection, dr. willis finds the first of 13 lymph nodes neededfor analysis. pieces are sliced into tinyslivers and mounted on slides.

the tissue yields good news. all 13 nodes are cancer free. one week after surgery, dr. delaney presents heller's caseto the tumor board, a group of doctors literally sitting in aboardroom setting discussed saying pathological findings andtreatment recommendations for every patient. >> so we scheduled her for alaparoscopic right hemi colectomy.

which she had done last week. >> and the tumor extended intothe muscle layer and did not go through the muscle layer. >> she is stage one disease andthere has been no role for attitude chemotherapy becauseher prognosis should be quite good. >> while heller will not needchemotherapy, she will need intermittent checkups and testsfor the next five years. >> obviously, we have to waituntil five years after surgery

to know that she is cured and noshe doesn't have any disease back. but she is very likely to becured by this operation. this is very much a cancer storywith a happy ending. >> i hope to be around for a fewmore years. and be able to maybe have agreat grandchild. >> take care. >> the patient in the story wejust saw was lucky. her cancer was caught early.

unfortunately, the majority ofcolon cancers are caught at a later stage, which meanspatients must undergo surgery and chemotherapy. traditional chemotherapy drugssend powerful toxins throughout the body to kill fast-growingcancer cells. in the process of killing offcancer cells, they also take out lots of other kinds offast-growing cells, causing side effects like hair loss and mouthsores. but new rugs to treat coloncancer target specific things

only going on in the dna ofcancer cells, causing them to die while leaving other normalcells alone. these days, doctors usuallyprescribe a combination of targeted therapy drugs withtraditional chemotherapy. >> advancements in treating:colon cancer stem from dna. scientists are learning a lotabout colon cancer by studying the dna of people from familieswho face an increased risk of colon cancer. >> to better understand whathappens in cancer, think back to

our initial discussion of dna. cancer occurs when the dna ofcells becomes damaged, causing cells to grow out of control. >> each and every cancer is dueto genetic change in that cancer cell. it causes the cell to growabnormally. >> damage to dna happens in oneof three ways. it is inherited, meaning it ispassed on from parent to child at birth.

it is altered by the things wecome in contact with in our daily lives. or it becomes damaged duringnormal cell division as part of the natural aging process. most of us aren't born withdamaged dna but instead gather errors as we age. as we grow older, the number oferrors increases and with it the likelihood of developing cancer. in order for a cell to becomecancerous, it typically has to

acquire more than a dozendifferent errors in its dna. the goal of dna research isfirst to find as many of these errors as possible and, second,to understand the different ways they lead cells to grow out ofcontrol and develop tests to did act cancer early -- to detectcancer early and block cancer cells from growing early. researchers have already foundmore than 100 different changes in dna that can lead to cancer. they believe there are manymore.

but with over 3 billion lettersin the genetic code to search through, they need a way to honein on a likely target. >> finding genes is a little bitlike looking for a needle in a haystack. what we use is family to help usnarrow our search and identify those genes in families thathave more than one colon cancer. >> dr. georgia wheezed ourstudies colon cancer that runs in families. >> this is an individual coloncancer, colon cancer, and then

colon cancer here. they have another person who hashad stomach cancer. >> she takes blood from familieswhere more than one sibling has colon cancer and compares thedna. she says that because relatives,brothers and sisters or parents and children, share more ofthere dna than unrelated people, the damaged genes are easier topinpoint. what is more important here isthat the discoveries help everyone, not just people whohave cancer in the family.

>> when you find a genethat can cause cancer in a family, it is going to be a genethat causes cancer in anybody as well. the only difference between theperson in the family and the person who is not in the familyis when a life did the gene yet damaged. >> how was your day? >> this mother from avon lakecarries a gene that causes lynch syndrome, a rare disorder thatleads to skin, ovarian, and

stomach cancer as well as coloncancer at a young age. she inherited the gene from oneof her parents at birth and two of her five children inherited acopy of the bad gene from her. anthony only found out that shehad the gene until her 19-year-old daughter wasdiagnosed with colon cancer. >> he said, well, it's coloncancer. i looked at him and said she's19. you must have the guy in the bednext to her, not her. this couldn't be her becauseanybody that i have heard, from

the little i knew, had all beenolder people. you don't get tested untilyou're 50. >> anthony is thankful that herdaughter is getting treatment but still remains shocked thatshe got colon cancer so young. remember, it takes more than adozen different errors to cause the cell to become cancerous. for most of us, that can take alifetime or, if we're lucky, never occur at all. the people who inherit geneticdamage at birth get cancer at a

younger age because they hadmore errors to start with. gene. -- they've already got onedamaged gene. whereas if you wait for thedamage to occur, it takes a few more decades and you have peoplein there 50's and 60's instead of there 30's and 40's. >> more than a decade ago, dr. markowitz and other researchersmade significant progress in understanding how a singledamaged gene, known as the spellchecker, causes lynchsyndrome.

>> every time your cells divideand you have two copier dna over, there is aspellchecker that goes over your dna and says, no, you made amistake. fix it. so that is how we've got a geneand it is gatc, gatc. you can't spell that. i can spell that even withoutlooking at the board. but what if it is aaaat. now it's hard.

aaaat? or aat? you stutter. everybody stutters when you haveto say the same thing over and over and over and over again andso does the dna. and this is where we need aspellchecker for. this is where your computerspellchecker helps you out and this is where dna needs aspellchecker. >> so normally, the spellcheckerwill come along and find these

stutters and breaks them. >> normally come i spell checkerwill come along and recognize the stutter and fix it. >> and then, when that doesn'thappen, the error stays. >> then the error stays. and if that error happens to bein a gene you really need, like one that happens to make theantenna that tells you you are just getting the signal to gobye-bye and leave the colon and i, then you've got a problem.

you needed that gene. >> the story of lynch syndromeis one example of how to ena research has led to a betterunderstanding of the way damage to our genes causes cancer. researchers used the sameapproach to develop that are ways to detect and treat thedisease. >> when you know what is causingthe cancer, then you can then say how can i use thisinformation to either develop tests to diagnose these cancers,to detect them early when they

are curable, to maybe developdrugs that will prevent them or develop drugs that will treatthem. >> already, markowitz and hiscolleagues have used dna research to develop a test thatcan detect as much as 75% of: colon cancers just iexamining a person's stool. they have also used to thereresearch to understand why aspirin prevents colon cancer insome people and not others. and drugmakers used dna researchto develop drugs that increase a person's natural defensesagainst cancer and drugs that

target and kill cancer cellswith fewer side effects. >> you are very active and youare maintaining your weight. >> when treating colon cancer,doctors are now at the point that even being able to test thedna of a patient's tumor to see if the specific therapy willwork on a particular individual. the advances in medicine comebecause basic research about dna have shown doctors andpharmaceutical companies where to look. >> these were drugs that weren'tdeveloped by accident.

these were drugs that weredeveloped because there was a specific gene that was known tobe abnormal, that gave researchers a specific targetto shoot at. >> and the more targets theyhave, the better the chance of saving lives. >> while dna research continuesto lead to new and that her methods of the acting andtreating cancer, we already know some important things aboutcolon cancer. getting screened can save yourlife.

colon cancer is 90% curable whencaught early. colonoscopy can even preventcancer because it allows doctors to find and get rid ofprecancerous polyps. remember, nearly 50,000 people of colon cancer this year. that is enough people to fillmore than half the seats in the stadium. be sure to visit us at wviz. org/health to find out moreabout risk factors, screening,

prevention, treatment, andliving with colon cancer. you can also listen to ourrelated radio programming on 90. 3 wzvn. im rick jackson. from all of us that ideastream,angst for watching -- thanks for watching. >> funding for "confrontingcolon cancer" comes from the ideastream's broadcast andeducational channels -- the dr. fund of the cleveland foundation, providing information and

education.