I am Dr.
Priyanka Kanth, and I lead the high-risk GI cancer prevention
clinic at MedStar Georgetown University Hospital.
I was always interested in colon cancer right from my residency
as an internal medicine doctor, and then I got an opportunity
to work as GI physician once I started doing my fellowship,
which was heavily invested in colon cancer prevention.
And I got to learn a lot about patients who are at a high risk for GI
cancers, including colon and other GI cancers.
I find it fascinating, this subject, because patients
could have higher risk for GI cancer and they may not know about it.
But if they know about it, we can actually do something about it.
We can surveil, find cancers early and treat early,
and that's what is the most exciting part of my job.
I have patients who are at a high risk for any GI cancer,
essentially mostly colon cancer, but other GI organs too.
A lot of them will carry
genetic mutation, which predisposes them to high risk.
And the risk of colon cancer, for example, can run anywhere from 10% to up to 100%,
depending on what genetic mutation they have.
So, I get to see these patients who carry
this mutation, they may or may not have cancer,
but they may have other indications to surveil them.
They could have polyps.
Colon polyps are these little bumps in the colon that can turn into cancer,
and they could have one or they could have many.
So, these are the main patients I see.
But there are also other patients who may not have any colon disease
and they have not developed cancer, but they are at a high risk
and those are the patients I tend to see as well.
This is a very exciting and unique clinic.
This is a clinic where I see these patients who carry a genetic mutation
and sometimes do not carry
a genetic mutation, but have family history of many cancers
and because of the genetic mutation or family history
that makes them at a higher risk for various cancer.
This clinic is a comprehensive care
plan clinic where they can see me and we look at everything,
not only GI, but we look at what are you at increased risk for?
And we try to manage in a very multidisciplinary fashion.
So, me being a gastroenterologist, I actually get to do
endoscopy on these patients or
colonoscopies on these patients,
but if they are at higher risk for other cancer, which tends to happen,
I also look at that and see if they are getting those surveillance as well or not.
And then I coordinate the care with other departments and other teams.
Around 5 to 10% of
all GI cancers have hereditary
So, the patient or families may be carrying a gene mutation,
and these patients can be surveilled early
by different modalities depending on the risk of the colon cancer.
So, sometimes they carry only 10% risk of colon cancer.
Sometimes it could be up to 90 to 100% risk.
And if we know that we can start surveillance using tools like colonoscopy,
endoscopy and other things and surveil them and catch cancers early
and treat them early.
Absolutely.
So, if we know that they carry a gene mutation, we can start surveillance,
which are, a lot of times,
driven by their family history, but also we have set guidelines on these patients
and we start, for example, if you're an average risk,
that means you do not carry a gene mutation
and you do not have a family history of colon cancer.
You start colonoscopy at age 45.
But if you carry a gene mutation, and depending on what it is,
it may sometimes start at age 10, sometimes start age 18-20.
So, we can really start
very early with tools like colonoscopy to prevent colon cancer.
Same thing happens for upper GI cancers. If you're at a higher risk, again
for certain condition,
which increases your stomach cancer risk or other small bowel risk.
And we can do endoscopy in the your situation
early on in your life before you can develop cancer and do it
more frequently so that we can catch it in case that happens.
So, if we do not have any family
history of colon cancer or if we don't carry a known
genetic mutation, all of us then have 5% risk of developing colon cancer.
And that's why we start screening at age 45 with any modalities
and usually we prefer colonoscopy or FIT test.
If you have a genetic mutation, it changes.
But without any known mutation, it's around 5%.
Two options
which we usually recommend are either colonoscopy or stool studies,
stool studies are very good at detecting colon cancer.
They're not as good at detecting colon polyps as compared to colonoscopy.
So, colonoscopy is gold standard because we can take a look, we can go
inside your colon and we can find a polyp and remove that.
Stool studies are also good modalities to detect colon cancer,
but they are, I would say, not great to detect polyps.
If you have
a known family history of one or more members with colon cancer
or early onset colon cancer, so less than age 50,
you should definitely talk to your primary care physician or other providers
and bring this up because you may need to be seen
by genetic counseling to see if you could be carrying a gene mutation.
That is one way to identify these patients who are at a high risk.
There are other ways to know how to prevent colon cancer is changing
some of the lifestyle factors. And certain lifestyle factors
include avoiding smoking tobacco and decreasing red meat diet.
Those are some very good things you can do on a daily basis,
which can help prevent colon cancer.
So colonoscopy is a
tool, it is a scope with a light and a camera,
and we can use it to see inside of your colon.
And usually it's done under sedation, so patients are very comfortable.
You're asleep for the procedure and there is no discomfort from this.
We can go inside and take a look, and things we are looking for are cancer,
polyps,
these are little growths that can turn into cancer.
Other things too, if there are inflammation or there are other things,
we can take biopsies, that means we can take a little sample
and look under a microscope and see if they could be something we can treat for.
So, colonoscopy
is a very good tool to detect colon cancer,
but also to prevent colon cancer, because once we remove
polyps, they do not get a chance to turn into cancer.
And that's why colonoscopy is the gold standard for screening for colon cancer.
MedStar Georgetown GI
brings in highly specialized gastroenterologists
who are very good at what they do, and they come together
to take care of a patient in a multidisciplinary way.
And this prevents bad outcomes
and it helps patient deliver the best care they can get.