We are marking Colon Cancer Awareness Month with a valuable discussion about the importance of early detection of colorectal cancer as well as the latest treatments that can offer hope and improved outcomes for patients. In this episode, two colorectal surgeons from MUSC Health Midlands division, Dr. Kasim Mirza and Dr. Jarrott Moore, discuss MUSC’s multidisciplinary approach and full spectrum of treatment options for patients diagnosed with colorectal cancer in the Midlands Division.

Erin Spain, MS: Welcome to

Advance with MUSC Health.

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I'm your host, Erin Spain.

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This show's mission is to help you find

ways to preserve and optimize your health

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and get the care you need to live well.

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On today's episode, we're marking

Colon Cancer awareness month with a

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valuable discussion about the importance

of early detection and the latest

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treatments that are offering hope

and improved outcomes for patients.

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Joining me are two colorectal surgeons

from MUSC Health Midlands division..

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Dr.

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Kasim Mirza And Dr.

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Jarrott Moore.

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Dr Mirza, can you start us off today by

talking about a colon cancer diagnosis?

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What is it like when a patient

is given this diagnosis and what

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are the steps that you take them

through after receiving this news?

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Dr. Kasim Mirza: To all patients

who present with this diagnosis,

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it can be overwhelming.

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it's never welcome news to hear.

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And I would always tell people that

it's better to know than to not know.

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And that first step of having a diagnosis,

now we're able to really get a grasp on

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what the problem is and get you treated.

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And if you're presenting to our clinic

or, our colleagues in Charleston, you can

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know that you're going to get the right

approach and a good multidisciplinary

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approach to give you the most up to

date and best cancer treatment possible.

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And we'll be with you every step of

the way through the diagnosis treatment

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phase and then surveillance, we're

going to be with you for years to come.

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Dr. Jarrott Moore: It's important

that you have physicians that are

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qualified and competent and that you

know are going to see you through it.

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Putting your trust in the physician

who's done it before, who's seen

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cases just like yours, we can

see you through a scary time.

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Dr. Kasim Mirza: And I see our role as

specialty surgeons, really one where

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I want to put the patient back in the

driver's seat where they're making

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decisions and our job is to help them

make the best informed decisions they can.

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Every patient's different and

what's right for one patient may

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not be right for another patient.

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And our job is to help them through

that decision making process as

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much as it is to do the technical

process treating a cancer surgically.

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Erin Spain, MS: And as you mentioned

to you two are surgeons, but

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there is an entire team that you

work with to help a patient once

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they've been diagnosed with cancer.

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Tell me about that team.

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Dr. Jarrott Moore: if a person is

diagnosed with cancer, they, uh, are

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sent to us, and then part of their care

is a multidisciplinary conference, where

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the vast majority of cancer patients are

presented, where it involves not only The

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colorectal surgeons, but also the medical

oncologist, the radiation oncologist,

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the radiologist, and the pathologist.

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We come up with an individualized

treatment plan for each patient based

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on a multidisciplinary approach.

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We do offer The full breadth of

surgery for colon cancer, whether it be

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minimally invasive or traditional open

surgery we are all quite adept at both.

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From beginning to end, patients are going

to have a pretty broad team of people

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taking care of them from start to finish.

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Erin Spain, MS: In the past to have

had access to this multi-disciplinary

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team from MUSC Health, you

may have had to travel far.

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You may have had to go to Charleston.

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Tell me about the convenience of

offering access to all MUSC Health has

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to offer here in the Midlands division.

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Dr. Jarrott Moore: We've been here in

the Midlands now for about five months.

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And one of the first things we

wanted to do, was to start up this

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multi disciplinary conference.

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And we typically meet twice per month.

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It's always sort of interesting how

different specialties approach cancer

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and the benefits of a multidisciplinary

conference where you can sort of bounce

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it off of your colleagues, because

oftentimes they'll have ideas that

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you didn't have and vice versa, you'll

have ideas that they didn't have, but

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when you put all your heads together,

you can typically come up with a,

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individualized plan that's optimal.

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Erin Spain, MS: As I mentioned March

as colorectal cancer awareness month.

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But it's important to note that

there are differences between

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colon cancer and rectal cancer.

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Can you talk about those?

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Dr. Kasim Mirza: So for colorectal cancer,

some of the treatment really depends a

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lot on whether the tumor is found in the

colon or the rectum, but for any cancer,

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the next step after a diagnosis is to

get more information and fully understand

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what the stage of the cancer is.

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So for a colon cancer, that would

involve getting a CAT scan of the

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chest, abdomen, and pelvis typically,

as well as some baseline blood tests,

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including a CEA blood level, which is a

tumor marker that we'll use to monitor

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throughout the courses of treatment.

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For rectal cancer, that also involves

getting a separate type of imaging with

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more detail on the pelvis called an MRI.

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Dr. Jarrott Moore: So you have diagnosis

phase, then a staging phase, which is

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mostly imaging and, some lab tests,

and then comes the treatment phase.

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And sometimes that means going

straight to surgery and sometimes

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it means starting with chemotherapy.

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Sometimes it means starting

with radiation it all depends on

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exactly the location of the tumor.

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If it's in the colon, it's generally

going to be, surgery up front unless it's

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a very advanced cancer, in which case

sometimes chemotherapy is used up front

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and sometimes chemotherapy without surgery

is used if it's a very advanced cancer.

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Erin Spain, MS: Remind us of the

ways that cancer spreads in the body.

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Dr. Kasim Mirza: the two ways

cancer is generally spread are

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through the lymphatic system.

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So, it's a lymph nodes.

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Lymph nodes exist all over the body.

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A lot of times patients will think

of lymph nodes around their neck when

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they get sick or in their armpits.

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But we also have lymph nodes inside our

belly that are around all our organs.

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And in the case of the colon and

the rectum, there are lymph nodes

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that are right around those organs.

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So that's one place

that cancer can spread.

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And another would be

through the bloodstream.

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And spread through the bloodstream

tends to have cancer cells spread

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further away from where they started.

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In the case of colorectal cancer, most

commonly, if there is distant metastatic

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spread, it would be to the liver, which

is another intra abdominal organ and

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the lungs, which are in the chest.

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There are other more rare and distant

disease spread that can occur,

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but those are the most common.

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Dr. Jarrott Moore: So after we do the

staging workup preoperatively, there's

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postoperative staging that occurs and

just sort of to allude to what Dr.

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Mirza was saying, if it's a stage

four cancer, That means it's spread

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to some distant organ, again,

typically either the lungs or liver.

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but the other three stages are broken

down into how deeply it involves the

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bowel wall and whether or not the

lymph nodes around it are involved.

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And each of those has subcategories,

but sort of briefly, a stage 1 cancer

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is one that's a partial thickness

tumor that doesn't involve the lymph

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nodes and hasn't spread anywhere.

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A stage 2 cancer is a full thickness

cancer Full thickness of the wall of

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the bowel but does not involve the

lymph nodes and hasn't spread in a

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stage 3 cancer is one that involves

any distance of or any thickness of

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the bowel wall, but also involves the

lymph nodes but not a distance spread.

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Erin Spain, MS: Your team

can offer minimally invasive

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approaches to these surgeries.

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Tell me about that and how these

types of minimally invasive procedures

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can help people recover faster.

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Dr. Kasim Mirza: So minimally invasive

approaches for colon and rectal cancer.

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, generally include laparoscopic surgery,

robotic surgery, and transanal surgery.

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our primary goal as cancer surgeons

is to do the best cancer operation

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we can with the goal of being

treating and curing cancer, and in

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some cases treating and relieving

symptoms when a cure is not possible.

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Minimally invasive approaches offer

patients, , a generally a speedier

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recovery and in most cases, less pain

and less time in the hospital without.

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sacrificing any of the outcomes as

far as an approach and treatment

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for their cancer diagnosis.

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Erin Spain, MS: Can people lower their

risk of colorectal cancer coming back

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after they've had surgery and treatment?

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What can they do to

prevent it from returning?

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Dr. Jarrott Moore: People who have

stage 1 and stage 2 cancers are

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generally treated solely with, surgery.

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if you have a stage 3 cancer and

you're treated solely with surgery,

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your risk of, of it returning

is on the order of about, 50%.

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But you can significantly

reduce that risk by having

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chemotherapy given after surgery.

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beyond surgery and chemotherapy, the

longer term surveillance, you're not

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really focused on necessarily preventing

cancers, but looking for recurrence.

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The best thing one can do to

prevent a new cancer from forming,

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it's having colonoscopies.

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And so, All of these cancers will start,

some point as an abnormal cell becomes

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polyps and those polyps become cancer.

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Not all polyps become cancer,

but, uh, that's where the cancers

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tend to come from, at least the

types that we're talking about.

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and having colonoscopies and catching

those polyps early, we know that

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particular patient is in now in a

different category, they're in a

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higher risk category from the average

population because they have proven

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that they can develop polyps and those

polyps can turn into cancer within them.

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So they are at higher risk than the

average person and so they will have

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much more frequent colonoscopies

after they've had surgery for colon

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cancer than the average person would.

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Someone who's at average risk does

not require colonoscopy as frequently

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as a person who has already proven

that their body can develop cancers.

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Erin Spain, MS: How frequently would

someone be getting colonoscopies

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after they've had that initial

diagnosis and surgery and treatment?

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Dr. Kasim Mirza: After treatment for

colorectal cancer, a surveillance

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colonoscopy will be performed at one

year and then more frequently for the

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first 10 years after their treatment.

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Patients who've had a diagnosis of

colorectal cancer will never have an

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interval longer than five years, given

that we know, based on their biology,

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that they have a higher risk and

ability to form colorectal cancers.

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Erin Spain, MS: March is all

about colon cancer prevention and

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reminding people about screenings.

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What are some lifestyle things that

people can do to help lower their

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risk of developing colon cancer or

possibly having colon cancer return?

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Are there things that we can do in

our daily life to improve our risk?

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Dr. Kasim Mirza: As is truee of a

lot of cancers, , there are some

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known risk factors that patients

who develop colorectal cancer

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oftentimes will have as risks.

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And that includes smoking,

alcohol use, obesity.

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When we think about these sorts of things,

the approach to reducing your risk overall

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would be living a healthy lifestyle,

exercising, reducing your alcohol

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intake, avoiding smoking and tobacco use.

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From a hereditary standpoint, there's

a subset of colorectal cancer that

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does have a hereditary component.

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And a big point there for all patients

to know would be to look into your family

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history, talk to your family members.

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It's always better to

know than to not know.

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And when we can successfully.

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find out about patients family

histories, sometimes an entire family

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can be more aware of what their risk

is based on their family history

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and their heritable risk factors.

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And once we know that, can be screened

more appropriately and reduce the risk

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of developing a colorectal cancer, or

if they do develop one, Making sure

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that it's caught at an early standpoint

when it's treatable and curable.

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A lot of studies that are going on now

as well about risk factors and things

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that might increase the likelihood

of developing colorectal cancer.

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There are studies looking at how

the bacteria that live in our gut

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and our colon and rectum may have a

large interplay with our own biology

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and change factors like inflammation

within the colon and rectal wall, and

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the risk of developing a colon cancer.

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A general approach to this would

be having a healthy diet, avoiding

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as many processed foods as you can.

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There was a study looking at consuming

red meats that showed a small increase in

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the risk of colorectal cancer, and that's

certainly something that we can point to.

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And I think of that as kind of the tip

of the iceberg in terms of a holistic

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approach to taking care of your health,

eating a good diet, avoiding lots

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of processed foods, exercising, and

avoiding toxins like Tobacco, smoke

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and alcohol as part of a approach to

reducing your risk of colorectal cancer?

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Dr. Jarrott Moore: For solid organ tumors,

particularly for colon cancers, you have

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to think about what a cancer is and,

it is mutated genetics within a cell.

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Every cell in your body

divides, all the time.

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And so the more frequently a cell divides,

the more likely there are to be mutations.

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And people's cells have

mutations all the time.

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And your own immune

system can be affected.

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can sort of seek out those

abnormal cells and, and destroy

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them before they take hold.

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And so you have your own immune system

that sort of helps prevent cancer.

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But the more frequently something

mutates, the more frequently it

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divides, the more frequently there are

mutations and cells that divide quite

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rapidly, like the lining of the gut.

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The lung cells, those ones

that are going to be at higher

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risk of developing, cancers.

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And so, on one hand, you have

to understand that there are

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mutations that happen all the time.

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And you can do things that increase

your risk of cancer mutations occurring.

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If you do things that are toxic to

the local environment like smoking,

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that increases the risk of mutations.

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So say you had one in a million of your

cells had a mutation in it, but then you

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smoke and these are just made up numbers.

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But say you smoke and now you have

a hundred out of a million still,

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it's a, it's a very small number.

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But you have a hundred times the

mutations that you would otherwise

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normally have, and those will eventually

escape your own immune system.

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So the way to lower your risk is to

avoid things that will increase the rate

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of mutation within your dividing cells.

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I mean, your dividing cells are

healthy cells, but when one escapes

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and it's abnormal or cancerous,

it can become a full blown cancer.

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just be aware that, you know, cells

are, reproducing all the time, very

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few of them will have mutations,

but they do have mutations, and the

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thing to do is to avoid things that

increase that rate of mutation.

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Erin Spain, MS: You both spend a lot of

time with colorectal cancer patients,

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but you do perform other procedures

and see patients with other conditions.

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Can you share that with me?

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What other types of cases you see?

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Dr. Kasim Mirza: We take care of

patients with both malignancies, like

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colorectal and anal cancers, as well

as benign conditions, in the abdomen.

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That includes things like diverticulitis.

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Inflammatory bowel disease,

which is on the Crohn's disease

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and ulcerative colitis spectrum.

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Other conditions that may be related

to diseases outside of the colorectal

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and anal systems, and that may lead

to obstructions of the colon or

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rectum, as well as complications

from radiation to the, bowel.

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And on the anorectal side, there's a lot

of, Everyday and more common diagnoses

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that really can change people's lives

in a big way, and that's hemorrhoids

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and anal fissures, cryptoglandular

disease that leads to anorectal fistulas.

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as well as pelvic floor disorders

that can affect people's continence,

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lead to chronic constipation, as

well as prolapse of pelvic organs.

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Dr. Jarrott Moore: It seems like

a good time to point out there are

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actually four people in our group.

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There's Dr.

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Mirza and me, and then also Dr.

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Sylvia Kim and Dr.

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Sidney Morrison.

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And a simple way to think of it is

that if it involves the colon, the

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rectum, or the anus in any Fashion,

Then we probably deal with it, if it's

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surgical, for sure we deal with it.

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, from bottom to top, The

things, You know, Dr.

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Mirza has already mentioned

Hemorrhoids, fissures, fistulas, etc.

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Things of the anal canal, But

also, I think importantly, One of

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the things that gets overlooked

a lot, is fecal incontinence.

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That is something that.

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People are oftentimes, embarrassed

about, you can even get to a point

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where you won't leave the house, which

can be obviously life altering, and you

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can miss out on things that bring you

enjoyment, oftentimes people will have

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the assumption that they're stuck with it.

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This is just sort of a consequence

of, me aging or whatever it may be,

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and they're either embarrassed to talk

about it with their doctors, which is

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understandable, or, they don't think

that anything can be done about it.

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But it is something that we can treat

and we can treat quite well these days.

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I Think it's one of the more easily

overlooked aspects of colorectal

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surgery and it is something that can

be treated surgically, again, very

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good outcomes and it can be life

changing for people who have it.

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Erin Spain, MS: so the last question

is what we ask everyone who comes on

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the show and that's, what do you do

to optimize your health and live well?

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Dr. Jarrott Moore: I'm up to date

with my colonoscopies, number one.

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think having a primary care doctor

that you see, a regular basis,

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whether that's annually or more

frequently, I think that's important.

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Primary care doctors,

they're there for a reason.

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Think we've all either had personally

having to ourselves or someone that you

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know who has, who thought they were in

perfect health only for their primary care

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doctor to pick something up and, you know,

thankfully pick it up before there were

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ever any symptoms and, you get treated.

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So primary care doctors are worth

their weight in gold, as far

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as, your general overall health.

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Dr. Kasim Mirza: I'll tell you that I'm

married to a primary care doctor who's

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family medicine trained, and it truly

is starting point and a super important

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part of your daily health maintenance.

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Don't wait until, you know, New

Year's day, start getting on a

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better exercise regimen, slowly

start trying to cut out some of the

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unhealthier, Habits and foods keep up

on your colorectal cancer screening.

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Seeing as this is a colorectal

cancer awareness month, go out,

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see your primary care doctor, get

referred, get your screening done.

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Erin Spain, MS: Great way to end the show.

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Well, thank you both of you for

coming on the podcast and sharing

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all this valuable information.

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We appreciate it.

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Dr. Kasim Mirza: Thank you.

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Erin Spain, MS: For more

information on this podcast,

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check out Advance.MUSCHealth.org.