Ready for "all clear" - Porchia Toussaint
“My dad was 54 years old when he passed away,” says Porchia Toussaint, who was 31 when she learned her dad had stage 4 colon cancer. “His doctor told my brother and I that because we were his kids, we needed to get follow-up colonoscopies. I had no idea what a colonoscopy was. It was an interesting process. The actual procedure was fine. They put me to sleep and when I woke up the doctor said, ‘You did great. We didn’t find anything.’ They found two polyps in my brother, which they removed.”
Polyps in the colon can potentially become colon cancer. “They said to repeat getting a colonoscopy every five years,” Toussaint says. “It’s preventive care, since colon cancer is slow-growing. My brother and I now go for regular colonoscopies. I think you should get tested, especially if it runs in your family. I have my colonoscopy next week and hopefully, they say it’s all clear and to come back in five years.”
Listen to your body - Cameron Kalunian
“I was 35 years old when I started seeing some blood in my stool,” says Cameron Kalunian, whose primary care physician sent Cameron to a gastroenterologist to determine the cause. “They performed a sigmoidoscopy, which is a less invasive test than a colonoscopy. They found a large tumor at my colorectal junction.”
Kalunian underwent colorectal surgery in late 2019, with Jonathan Sack, MD, who found a tumor and treated it. Kalunian was declared in remission within a month.
Because Kalunian took quick action upon seeing symptoms, his colon cancer was identified in stage 1.
“They did my surgery laparoscopically, so I only have a tiny scar on my abdomen. I was impressed with how cutting-edge all the technology at UCLA Health was,” he says. “My anesthesiologist, rather than putting me on a morphine drip or IV for pain medication, gave me a spinal tap. So I had a lesser dosage of medicine, which meant I was less likely to have complications. I was home three days after the surgery and was back at work within two weeks of my surgery. Every aspect of the care I received was thorough and reassuring. I felt the comprehensive care and felt that my interests were being taken care of.”
Initially, Kalunian says, he assumed because he was young there was no way he could have colon cancer.
“I didn’t have a family history, but I had seen in the media that there is a higher prevalence of early-onset colon cancer,” he says. “I think there are a lot of stigmas associated with the testing. Ultimately, it wasn’t a big deal. I think, now, I’ve had four colonoscopies and you get better at it each time. You know what to expect and it’s not scary. The most important thing is, if you have symptoms to follow up on them. Listen to your body. Blood in the stool is something to pay attention to and take very seriously.”
Just do it - James Weatherall
“My new primary care physician was shocked that I hadn’t had a colonoscopy yet,” admits 62-year-old James Weatherall. James chose UCLA Health for his medical care after moving to Los Angeles. “I went in for my colonoscopy, expecting nothing, but came out of it with a tumor. My whole world changed. It was a T2N0 [Stage 2 tumor with zero evidence of spread to lymph nodes] but after a biopsy, they upgraded it to a T3, meaning it was larger than they originally thought. It was pure luck that the cancer had not spread to my lymph nodes. Dr. Anne Lin, my surgeon, was wonderful. She removed 14 lymph nodes to ensure there was zero trace of the cancer left. She was able to do this very complex surgery laproscopically with minimal scarring. It was amazing. After the surgery, Dr. Lin gave me the option of pursuing chemotherapy as an extra precaution step. I met with Dr. Joel Hecht who recommended chemotherapy pills. As he described it, 'it was chemo with a small c, not chemo with a big C'.”
James took medication for six months before undergoing a CT scan. Sighing with relief, he says, “It showed no signs of lingering cancer! While I was technically in remission, they said I should have only a small party. I'll have to return every six months for new CT scans. If after three years my scan is still clear, then I should have a little bigger party. If after five years my scan is still clear, then I should throw a big party! In my book, I owe it to my primary care physician, Dr. Benjamin Waterman for pressuring me to get my colonoscopy. Had I continued to procrastinate, I don’t know how quickly my tumor would have grown. Every time I meet my contemporaries, I’m not shy about talking about colonoscopies. I didn’t have any symptoms, so my colonoscopy was considered a screening test. From that standpoint, it was a successful screening. It saved my life. When your doctor tells you it’s time for a colonoscopy, just do it.”
Ride on - Stephane Strouk
“I was one hundred percent sure I had hemorrhoids,” recalls Stephane Strouk, an avid motorcyclist who decided to get a colonoscopy in 2016 to be sure. “I woke up, and the doctor said I had stage 3C colorectal cancer. I did 37 radiation treatments, five treatments per week. You meet wonderful people at radiation, and you see the advances in technology. They were pinpointing my tumor, and it worked. The tumor shrunk 40%, and my doctor was able to do the surgery, remove the tumor, and part of my colon. I was also doing chemotherapy in Santa Monica. It was difficult, but it was the coolest place on Earth. You go in and you’re facing the sea. You see the ocean and the palm trees and the blue sky. It feels like a five-star hotel. It was very relaxing and quiet. My whole team was the greatest, from the nurses to the doctors. They all become your friend in the end. They’re very human. They care.”
After a successful colorectal surgery, Stephane resumed life with an ostomy bag. He reveals, “The ostomy bag was the most difficult part for me. I’m on a motorcycle every day, no matter what. I have different motorcycles, and some of them I couldn’t ride because the bag would explode. I was back on my bike 10 days after my surgery. I went to radiation with my bike as much as I could. After seven or eight months, they removed the ostomy bag and reattached everything. It took maybe a year to adapt, but now everything is working. It’s wonderful. I live every day. I wake up in the morning, see the blue sky, ride by UCLA Health and thank my doctors. They made everything so easy.”
The home FIT test led to a colonoscopy and a new appreciation for colorectal cancer screening - Fuad Afifi
The 60-year-old retired chef typically prefers to be more private, but he’s opening up about the importance of cancer screening after losing his sister to the disease earlier this year.
“She was in her early 60s,” he says. “A very vibrant, outgoing person. Very athletic.” They had no family history of colorectal cancer, he adds. Colorectal cancer is the third most commonly diagnosed cancer in men and women in the United States. The American Cancer Society estimates nearly 105,000 new cases of colon cancer and more than 45,000 cases of rectal cancer will be diagnosed in 2021.There are often no symptoms of colorectal cancer until the disease has progressed. “If you don’t feel symptoms, you think that you’re OK,” Afifi says.
Before undergoing his first colonoscopy this year, Afifi previously opted for the fecal immunochemical test, or FIT, a non-invasive at-home test that requires laboratory submission of a tiny stool sample to be analyzed for traces of blood. The FIT must be performed annually. “It’s better to have any screening as opposed to no screening,” says Kevin Ghassemi, MD, a gastroenterologist with UCLA Health. “The fecal immunochemical test is a very reasonable test to look for blood in the colon, which, if present, will highlight the need for colonoscopy.” Afifi did the FIT in 2018 and again in 2020. The first time, the results were negative for blood. But last year, they came back positive, indicating further exam was needed.
Around the same time, his sister died. “She was diagnosed six months ago and it had already metastasized to the liver,” Afifi says. “That gave me a clue. It helped me put some sense into it. And I decided I really wanted to do the colonoscopy.” Colonoscopy requires dietary preparation beforehand to clean out the colon and sedation during the procedure. The exam uses a tiny camera on a scope to view the colon and remove any polyps, which are growths on the colon lining that can sometimes become cancerous. Polyps do not generally cause symptoms, Dr. Ghassemi says, and they don’t always bleed, “which is why the stool test does have some limitations.” In Afifi’s case, though, the FIT led to a colonoscopy, which in turn led to the discovery of polyps. “It was really a blessing that he decided to get this form of screening,” Dr. Ghassemi says. Dr. Ghassemi removed five pre-cancerous polyps during Afifi’s exam.
“I’m glad I did it,” Afifi says. “That’s what I know.” Now that he’s experienced a colonoscopy, Afifi calls it “a very simple procedure.” “It opened my eyes, actually,” he says. “Because a lot of people don’t want to do it, either because of some personal reason or they don’t want to drink the things to clear the colon. People might consider colonoscopy an invasive surgical procedure or a personal thing, and there’s a lot of people who don’t want to expose themselves to that.”
Despite evidence that screening reduces colorectal cancer cases and deaths, screening participation in the U.S. among adults 50 and older was only 67% before the pandemic, with even lower rates among people of color. Rates of colorectal cancer are higher among Black Americans than among whites. Black people are 20% more likely to be diagnosed with the disease and 40% more likely to die from it. Current recommendations call for screening to begin at age 50, though the U.S. Preventive Services Task Force is recommending the age be lowered to 45 due to an increased incidence of colorectal cancer in younger people. Those with a family history of the disease should begin screening even earlier.
For those hesitant to have a colonoscopy, the FIT might be a good place to start, Dr. Ghassemi notes. But Afifi now swears by the more thorough exam. “It’s awareness,” he says. “You have to be aware of your body. And you have to remove the fear. I’m not afraid of dying, but I am afraid of not taking the right precautions and doing what’s necessary to keep this body going.”
Afifi says he hopes sharing his experience might prevent others from needlessly suffering the loss of a loved one, as he did with his sister. “I think she died unnecessarily,” he says. “I am doing this in her memory, because if I can save one life with my story, it means we save humanity.”
Keeping U connected through post-surgery app - Anne Lin, MD
“I focus a lot of energy on treating the patient as a whole person,” explains Dr. Anne Lin, a colon and rectal surgeon at Ronald Reagan UCLA Medical Center. “When I meet patients, often they already have the diagnosis of colon cancer. I talk to them about the next steps in their care. I tell them about the operation and what care will be like during their hospitalization and after their surgery. We have been using an app to help patients with their transition out of the hospital. We try to connect with patients with us during this vulnerable post-discharge time using a remote monitoring application.”
Dr. Lin developed the monitoring app with UCLA Health as a way to allow patients to send messages directly to their physician. She further explains, “We, the doctors, curate the questions sent for that particular patient and their problems. The patients have daily tasks, they can take photos of their wounds, and we are alerted of any early warning signs of an infection. The goal of the app is to enable patients to be more active participants in their care. It helps patients be more comfortable with the entire recovery process, and they’re empowered to improve their health. We’ve dramatically reduced emergency department visits and readmissions through the use of this app. It’s been a really wonderful thing because the patients feel connected to us. I feel like I have an understanding of where my patients are, and it helps me feel more comfortable about releasing them. In a hospital, they’re monitored really well, but then they go home and there is no monitoring. Knowing there will continue to be an exchange makes me feel very comfortable.”
Second opinion helped save my colon - Linda Kama'ila
“I went in for a routine colonoscopy, but the doctor was unable to remove a certain polyp, so they sent me to a surgeon who wanted to remove one-third of my colon,” recalls 64-year-old Linda Kama’ila, who immediately looked for a second opinion. “I would have been out of work for six weeks with two major surgeries. I try really hard to stay healthy, and being out of work for that long with lifelong consequences was really concerning. Online, I saw that UCLA Health offered a mucosal resection procedure. Dr. Danny Issa offered this outpatient procedure, and he got the benign polyp out. It was a great success and I got to keep all of my functioning. It was all done in two afternoons. UCLA Health’s quality can’t be beat because the staff is research-oriented. Dr. Issa’s work—which he’s still publishing-- shows that when there’s a history of benign polyps, there isn’t always a reason to do a major surgery as if the polyp is cancerous. I would have lost one-third of my colon for something that was not malignant. I’m so grateful to UCLA Health. It couldn’t have been a better experience.”
Any dietary and lifestyle changes a patient is willing to make can be hugely beneficial to theirhHealth - Nancee Jaffe, MS, RDN
“Dietary and lifestyle interventions can make a huge difference in colorectal cancer prevention,” explains Nancee Jaffe, lead dietitian at UCLA Health Digestive Diseases. “We’ve learned that 60% of colorectal cancer deaths could have been prevented by screening and lifestyle changes. Our hope is that by talking about screening practices and nutrition and lifestyle interventions, we can actually stave off this disease. Not exercising, drinking alcohol in more than moderation, smoking, and low amounts of fiber-rich foods are all problematic and can lead to colorectal cancer. Eating lots of fruits and vegetables, whole grains, beans, legumes, nuts, and seeds are good interventions. It’s not all or nothing. Any amount counts. Any difference a patient is willing to make will be hugely beneficial to their health.”
Removing Early Colon Cancers Endoscopically - Adarsh M. Thaker, MD
“I don’t do a lot of screenings because, in the majority of my colonoscopies, I’ve been referred to remove a polyp,” states Dr. Adarsh M. Thaker, an interventional endoscopist at UCLA Health Burbank Primary & Specialty Care. “We remove large polyps and even early colon cancers endoscopically, to prevent them from either turning into worse cancer or in order to avoid surgery. We put so much attention on polyps and colonoscopies because a polyp is a precancerous lesion. That means if you leave it be, in five or ten years, a significant number of polyps turn into colon cancer. In general, any polyp that has a biopsy that does not show cancer is still worth an endoscopist taking a look at it. We might be able to remove it in a low-risk, same-day procedure. In fact, our surgeons often send their patients to one of us to remove the polyps before they will consider doing surgery. I like the procedural aspect of telling a patient I was able to remove it all and that they are good to go.”