March was National Colorectal Cancer Awareness Month, and, for Dr. Michael Del Rosario, the director of the division of colorectal surgery at AtlantiCare, colon cancer is a topic that he is “very motivated to talk about.”
“It’s something that not enough people know or talk about. It’s one of the top three causes of cancer death in the United States, equally in men and woman, the number one being lung and then number two being breast in women and prostate in men. Colon cancer is number three in the United States, leading to a significant number of mortalities ... In people under 50, really young people, colon cancer is the number one cause of cancer death in this population,” Del Rosario told The Gazette.
Del Rosario said that colon cancer is not talked about enough, partially due to what is considered the taboo nature of the disease.
“There was a time when, for example, breast cancer was almost a taboo subject for women to talk about, but then the numbers came out, seeing how many women were getting breast cancer. Now, women are very comfortable talking about breast cancer at the dinner table. It should be the same way with colon cancer, and that’s what I try to educate the public about. You have to not bury this in the sand. You have to bring it out and talk about it and know the facts, identify who’s at risk and who needs to be screened. It’s just part of annual maintenance in order to ensure your longevity. Be comfortable talking about it and get the facts,” Del Rosario said.
According to Del Rosario, one issue is that many physicians themselves don’t fully know the recommendations for screening.
“They don’t know when to send their patients to get screened for colon cancer, what age, what signs and symptoms if any. It’s very hard for me to believe, which is why I like to give this talk to the public, because a lot of times the patient has to be their own advocate in order to maintain their own health,” Del Rosario said.
If a patient’s physician is not up-to-date on the facts, Del Rosario said that encourages patients to “do your own research and see what you can find.”
“Sometimes you just have to stick up for yourself. Nowadays, we have Google and the internet and all that—though there is a lot of garbage out there—an educated patient is going to do better, in terms of maintaining their own health,” Del Rosario said.
Del Rosario said that the recommendation for a patient to undergo their first colonoscopy used to be once they reached 50 years old, but it has since dropped to 45, for the “intuitive reason that we’re just seeing colon cancer in younger people.”
“Your first colonoscopy, in an average-risk individual—meaning you could be an Olympic athlete and a vegetarian, never smoked, never drank—you still need a colonoscopy at age 45, based solely on age. Age alone is the risk factor for developing colon cancer. If you’re completely healthy, and you’ve never had one, get your first colonoscopy at 45,” Del Rosario said.
One indication for getting a colonoscopy, Del Rosario said, is the development of symptoms, including abdominal pain, bloody stool, weight loss or a change in bowel habits. However, he said, the reverse is also true.
“Don’t wait for those symptoms to get screened, because usually, when you develop symptoms, the issue—the colon cancer, if you have it—is already at a later stage ... Most people, when they’re diagnosed with colon cancer, are asymptomatic; 50 percent of people have no symptoms whatsoever. It’s found routinely on screening,” Del Rosario said.
Del Rosario himself received his first colonoscopy when he was 40 years old.
“I had some symptoms, and also because of the stuff I was seeing in my office. I would see people with colon cancer every week—this was 10 years ago—and I was seeing it in patients younger and younger and younger. I had some issues—some symptoms that I couldn’t explain—so I got my colonoscopy, and fortunately it was good ... I’m not really a doctor person; I don’t see doctors as much as I should, but it tells you something that I went to get a colonoscopy. I just had my second one,” he said.
Colonoscopies do not have to be performed every year, Del Rosario said, so “don’t dread that.”
“If your initial colonoscopy is good, you shouldn’t need one from anywhere from five to 10 years. That’s how it works, and that shouldn’t scare people into not getting a colonoscopy,” he said.
Del Rosario said that, usually, the worst part of a colonoscopy is not the procedure itself but the preparation for it.
“The procedure itself is the best sleep you’ll ever get. You go under a light sedation—it’s not general anesthesia—and the procedure takes about 10 or 15 minutes. The night before you have to drink some laxatives to clean your bowels out, and you’re not going to go far from the toilet. That’s the worst part, but you have peace of mind after,” he said.
Besides the diagnostic benefits of a colonoscopy, Del Rosario said that there can also be therapeutic benefits.
“If you have small polyps, which are the precursors to colon cancer, you can remove those polyps. As corny as it sounds, the colonoscopy can be the ounce of prevention—where you remove that polyp that will, over years, grow into colon cancer—versus leaving it there and having to undergo the pound of cure, which is seeing me for surgery, which is a much more invasive procedure, then possibly chemotherapy, which is the whole nine yards. It’s just a preventative measure to get your colonoscopy and remove the polyp before it has a chance to turn into cancer,” Del Rosario said.
Del Rosario noted that the methods of treating colon cancer have advanced over the years as well.
“The traditional, old-fashioned way of removing a colon cancer was, basically, you operate on a patient and you cut them wide open. It’s a big incision, and it’s very painful. There’s a higher infection rate, and a higher hernia rate, a higher complication rate and a slower return to society. Nowadays, we do things minimally invasive, where we use instruments, whether it be laparoscopic or robotic even,” Del Rosario said.
Del Rosario said that AtlantiCare utilizes the da Vinci Surgical System, a robotic surgical system designed specifically for minimally invasive procedures. Del Rosario said that AtlantiCare has the only da Vinci system in South Jersey.
“The world’s a busy place, whether you’re 30, 40 years old or you’re 60, 70 and retired; people don’t have much time, and they can’t be kept down. They want to get back into life, back into work or whatever they do. The minimally invasive surgery helps them return to society quicker after a big surgery, and that’s really what I specialize in. We’re happy to offer that to the South Jersey community since 2003. There are many communities that don’t have the luxury of having a minimally invasive surgery to treat their cancer. It’s the best way to go, currently,” he said.
A recent hurdle that Del Rosario noted in proper colon screening has been in response to the novel coronavirus (COVID-19) pandemic.
“The pandemic has delayed life in general, and especially healthcare and people’s access to healthcare for many different types of problems, especially screening of cancers. For different reasons, people are afraid to seek healthcare, or they’re not able to get in to see a doctor. We definitely are seeing a surge in new diagnoses of colon cancer, because of delays in getting colonoscopies,” Del Rosario said.
Del Rosario acknowledged that, for several months, hospitals were forbidden from performing elective procedures, but, since that time, hospitals have initiated numerous safety protocols.
“If a patient needs a screening, it can be done safely with minimal risk of getting COVID-19 while undergoing the procedure. Now, a year later after the pandemic, you should not be delaying your healthcare or screening for cancer because of a fear of COVID. The safety protocols have been in place for quite some time now, and they’ve been very effective. Don’t let that be a reason to not be screened,” he said.
Del Rosario said that late is better than never to receive a screening, but sooner is also better than later.
“I am quite saddened by some of the stuff I’m seeing regularly where I wish they had gotten a screening a little sooner, or seen a doctor a little sooner. Many patients are saying they were afraid to come in, but we’re here. The doctors are here. The safety protocols are in effect. We’re here to take care of people,” Del Rosario said.