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What is colorectal cancer, and how does AI help?

TriStar Health physician helps us understand colorectal cancer, polyps and how artificial intelligence helps us.

March 13, 2023

The American Cancer Society predicts that colorectal cancer will cause 52,550 deaths during 2023. The good news? The number of Americans diagnosed with the disease has continued to drop since the mid-1980s due in large part to regular screenings that lead to an earlier diagnosis. But, this downward trend occurs primarily in older adults. Rates of colorectal cancer are increasing annually for people younger than 50, and doctors are now recommending screenings for people who are age 45 and over.

This Colorectal Cancer Awareness Month, we’re shining a light on colorectal cancer signs, risk factors and evolving screening recommendations. Helping us do so is Dr. Francisco Gonzalez Garcia, gastroenterologist at TriStar StoneCrest Medical Center in Smyrna, Tennessee.

What is colorectal cancer?

Colorectal cancer is an umbrella term that refers to the specific group of cancers that originate in the colon or rectum. It’s the third most common type of cancer in the United States that affects both men and women.

“When we talk about cancer — any type of cancer — we’re talking about a disease that originates from our own cells. It’s not an infection. It’s basically an error that happens in the programming of our own cells that can be triggered by outside influences,” explains Dr. Garcia. “The skin that lines our colon must constantly repair itself throughout our life. So, when our colon is exposed to the toxins in pesticides and preservatives, we increase the chances that the cell repair process will experience a mutation, leading to cancer.”

Polyps don’t always mean cancer

When a cell in the colon experiences the error that makes it keep growing, it becomes a polyp. “First, it looks like a little bump. Then, it looks like a little mushroom. Then, it looks like a tree, and then it becomes a mass. But initially, it’s not a cancer,” says Dr. Garcia. However, if it’s suspected that a polyp might have developed cancer inside of, but is still contained, physicians might call that polyp high-risk or advanced.

For a long time, it was very rare for people younger than 50 to develop polyps in the colon. “In the previous 10 years, we’ve seen that these polyps are starting to show up earlier. This is the reason why the screening age was lowered to 45. We think they’re starting to develop in our 30s, and by age 45, they’re visible. The cells have to grow enough so we can see them.”

Screening is the best defense against colorectal cancer

What is a colonoscopy?

Colonoscopies, the best screening tool available, are often able to prevent colon cancer. “This is not surgery; this is a routine test. Patients shouldn’t expect to feel or remember anything from the procedure,” Dr. Garcia shares.

During a colonoscopy, doctors use a scope to find any abnormalities in the colon. What makes a colonoscopy unique compared to other screening tests is that precancerous polyps can actually be removed during the procedure, essentially preventing cancer down the road.

While preventing colon cancer is the ideal scenario, sometimes doctors do find cancer. But finding cancer during a routine colonoscopy is better for patients than waiting until symptoms occur. We can better treat colon cancer if discovered early.

“In the vast majority of colon cancers, you don’t have any symptoms until you have a cancer that’s invaded other structures. You don’t need any symptoms to need a colonoscopy at 45.”

Artificial Intelligence enhances colonoscopy screenings

Some TriStar Health hospitals are using artificial intelligence (AI) to enhance the detection of precancerous polyps during colonoscopies. The new technology is an exciting development in colorectal cancer detection as it bolsters a physician’s confidence in giving colonoscopy patients a clean bill of health if no polyp is detected. Dr. Garcia dives into the details.

“The same way your iPhone recognizes your face — even if you have makeup or look different — that’s the same way this works. I have a camera, and there’s a live video with a software program scanning every single pixel of the video. That software is trying to identify color patterns that are what you would see in a polyp.”

Polyp skin looks different than the normal colon skin, but sometimes that difference is subtle, or there might be stool in the frame. This can prevent the human eye from spotting these subtly differences in skin. The AI software helps sidestep these human oversights.

“They’ve trained the artificial technology (AI) with 10,000 pictures of polyps from different patients. As I’m going through your colon, this software is scanning every pixel. If it detects one of those patterns, it beeps,” said Dr. Garcia. Doctors then are able to take a closer look and determine if the polyp should be removed.

“This AI software is like having two people looking at your colon at the same time. It really increases our confidence when telling someone their colonoscopy is normal,” says Dr. Garcia.

Signs, symptoms and risk factors

Risk factors

While anyone can get colorectal cancer, certain factors can increase a person's risk. Some of these, such as lifestyle behaviors, can be controlled, while others can't. Risk factors for colorectal cancer include:

  • Smoking tobacco and alcohol use
  • Being sedentary without regular exercise
  • Eating certain processed foods or red meats in excess
  • Certain backgrounds, such as being an African American or an Ashkenazi Jew
  • Inflammatory bowel disease
  • Personal or family history of colon cancer or polyps

Dr. Garcia tells us that personal or family history is a specific risk factor with conditions to consider. People who have a first-degree family member — meaning mom, dad or siblings — who had colon cancer or polyps found when they were younger than 60 should get their colonoscopy at the age of 40 or 10 years younger than the age at which their family member was diagnosed. Whichever comes first.

Signs and symptoms

Often, colorectal cancer symptoms can resemble or be mistaken for other common problems. “The problem is that most every symptom related to colorectal cancer is most likely something else,” says Dr. Garcia. Because these signs to watch for are often convoluted, it’s important to talk to your doctor if any of these signs and symptoms persist.

  • Bright red, black or tarry blood in stool
  • Change in bowel habits (like diarrhea or constipation)
  • Consistent fatigue feelings
  • Discomfort in the abdominal area, including bloating or cramps
  • Frequent gas pains
  • Unexpected weight loss
  • Unusually narrow stools

However, not all colorectal cancers will cause symptoms early, which is why medical screening is the best early detection tool.

Colon screening and treatment in TriStar Health

Our gastroenterologists and endoscopy teams work together to create a comfortable and relaxing environment for patients during their colonoscopies. With multiple locations across Middle Tennessee and Southern Kentucky, TriStar Health offers convenient access to potentially life-saving procedures. In addition, TriStar Health is part of the Sarah Cannon Cancer Institute network of hospitals with access to cutting-edge cancer therapies, clinical trials and the latest advancements in surgical oncology care.  If you are interested in scheduling preventative cancer screenings, like a colonoscopy, please reach out to your primary care physician or call (615) 342-1919 to find a doctor.

March 13, 2023

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