Digestive Trac • March 2016

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605-322-7797 To learn more, visit our website at AveraDigestiveDisease.org

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16-GAST-0400

GI Navigators: An Access Point for Questions and Consulations Changing Dynamics: Colorectal Cancer Rising Among Younger Adults Colorectal Screening: Avera joins the ‘80 by 2018’ Initiative

INSIDE THIS ISSUE: DIGESTIVE DISEASES • MARCH 2016

DigestiveTrac

CHANGING DYNAMICS Colorectal Cancer Rising Among Younger Adults

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Unfortunately, we’re seeing younger patients with colorectal cancer more frequently. While overall screening for this age group is not warranted, cancer should be considered and investigated as a possible cause whenever young adults present with concerning symptoms.

- Scott Baker, MD, fellowship-trained Colorectal Surgeon

A heightened focus on colorectal screening is working. The American Cancer Society reports that colon cancer incidence rates have dropped 30 percent in the U.S. over the last 10 years among adults age 50 and over.

That’s great news, yet National Cancer Institute data also shows that rates of colorectal cancer for people under age 50 have risen, particularly for rectal cancer.

After 2001, there has been an average annual increase of 2.1 percent in young onset colorectal cancer, compared to a 2.5 percent annual decrease among those 50 and older. Rectal cancer cases increased even more rapidly in younger patients, by an average of 3.9 percent.

It’s still unknown what is causing the increase.

Possible factors include a growing lack of awareness of signs and symptoms, dietary and lifestyle habits, and/or genetics.

A complex diagnosis and the wide range of specialties and sub-specialties within the health care system can be overwhelming to patients. In addition, referring physicians need an efficient way to connect their patients with the most appropriate care at the right time.

GI NAVIGATORS An Access Point for Questions and Consultations

Avera Digestive Disease Institute offers this important connection through two gastrointestinal (GI) navigators.

They serve as an access point for all questions, consultations and issues, and follow all patients with a digestive system cancer or other serious GI diagnosis.

GI NAVIGATORS: • Work with referring providers, patients, families and the care team from abnormal finding to diagnosis, treatment and survivorship • Maintain connection with patients and providers throughout all facets of treatment • Coordinate the GI Conference, in which a multidisciplinary team collaborates on diagnosis and treatment for individual GI cancer cases or complex benign GI diagnoses

Contact Avera DDI through our Navigators: Liz O’Neill, CNP | 605-322-7334 | elizabeth.oneill@avera.org

April Schnieder, CNP | 605-322-1355 | april.schnieder@avera.org

COLORECTAL CANCER SCREENING Screening guidelines:

Possible symptoms of colorectal cancer:

• Beginning at age 50 (45 for African Americans) • Family history may indicate a need for earlier or more frequent screening

• Any bleeding – whether it is bright red blood with bowel movements, or dark/black stools. Even if a patient has a history of hemorrhoids, bleeding from the rectum should not be ignored.

Screening tools:

• Anemia, characterized by feeling run down, fatigued and short of breath with reduced exercise capacity.

• Change in bowel habits, whether it be a change from commonly being constipated to loose stools, or from having well-formed stools and regular bowel movements to extreme constipation.

• Colonoscopy (gold standard): Every 10 years unless polyps, genetic condition or family history indicate a need for more frequent screening

• Unexplained abdominal pain

• Fecal immunochemical testing (FIT): Every year; colonoscopy if test is positive for hidden blood in the stool

Through diagnostic testing, colorectal cancer should be ruled out as a possible cause of any one of the above symptoms.

• CT colonography (virtual colonoscopy) every five years • Double contrast barium enema or flexible sigmoidoscopy every five years

Avera Digestive Disease Multidisciplinary Team The Avera Digestive Disease Institute brings together a multidisciplinary team to address cancer and other conditions of the digestive tract, all working toward the goal of seamless care and the best possible outcomes.

Gastroenterology Avera gastroenterologists ensure that each

SURGEONS

patient affected by digestive disease is treated with the fullest extent of expertise and the latest medical technology.

Avera’s surgical team includes a surgeon who is fellowship trained in colorectal surgery, and surgeons with specialized training and experience in pancreatic and liver surgery.

Techniques include the latest minimally invasive procedures, including scarless techniques.

MULTI-SPECIALTY EXPERTISE

Be A Survivor Learn more about successfully dealing with a colorectal cancer diagnosis.

BeASurvivorAveraColon.com

Avera cancer specialists including medical and radiation oncologists, radiologists and pathologists along with support personnel become part of the multidisciplinary team supporting digestive disease patients for cancer and complex diagnoses.

ENDOSCOPY Avera offers the full range of endoscopy services, including colonoscopy, for the purposes of diagnosis, biopsy, removal of polyps or lesions, and specialized procedures.

COLORECTAL SCREENING Avera joins ‘80% by 2018’ Initiative

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Colonoscopy is recommended for all adults over age 50. Yet the number of people who actually get screened lags way behind our goal of 80 percent. If all adults were screened as recommended, we would come very close to stamping out colorectal cancer completely.

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- Christopher Hurley, MD, board-certified Gastroenterologist

Colorectal cancer is the third leading cause of cancer death in the U.S., and a cause of considerable suffering for more than 140,000 adults who receive this diagnosis each year.

Screening reduces risk of colorectal cancer by 90 percent.

Each year during March, Avera Digestive Disease Institute takes the opportunity to remind practitioners and the public of the importance of screening for colorectal cancer.

When adults get screened for colorectal cancer, it can be detected early at a stage when treatment is most likely to be successful, and in some cases, it can be prevented through the detection and removal of precancerous polyps.

Yet about one in three adults between ages 50 and 75 – about 23 million people nationwide – are not getting tested as recommended.

Avera and the South Dakota Department of Health are among hundreds of organizations to join the 80% by 2018 pledge, a National Colorectal Cancer Roundtable initiative to work toward a shared goal of reaching 80 percent of adults age 50 and older screened for colorectal cancer by 2018.

There are several screening options, yet colonoscopy is the “gold standard.” In this test, endoscopists can examine

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the entire colon, and identify and remove potentially precancerous adenomatous polyps. Most polyps do not become cancerous, however, virtually all colorectal cancer starts from polyps, so it is highly preventive to remove them in a timely way.

It’s estimated that the average 60-year-old without special risk factors has a 25 percent chance of having a polyp.

There are hereditary conditions, including Lynch syndrome, Peutz-Jeghers syndrome and familial adenomatous polyposis (FAP) that increase risk of polyps. FAP is characterized by numerous precancerous polyps – perhaps hundreds to thousands. Left untreated, the condition leads to cancer of the colon or rectum.

For patients who cannot undergo colonoscopy or choose not to, annual fecal immunochemical testing (FIT) is a good second option. FIT is more specific and sensitive than guaiac-based methods, and easier for the patient to use, so it has become the preferred mode of fecal testing. Across 19 studies, FITs caught more than 75 percent of colon tumors, and were very good at ruling out cancer. If FIT results are positive, the patient needs to undergo colonoscopy.

To learn more, visit our website at AveraDigestiveDisease.org