Carla Richardson of Beverly on the southwest side of Chicago loves it when her grandson tells her, “You’re lookin’ fresh Nonnie!” She jokes, “This is what 77 looks like. But then again, I’m an old hippie.”

Richardson also credits her "fresh look” to her positive attitude and the consistent care she’s been receiving at OSF CompleteCare 55+. The clinic at 99^th and Western Avenue in Evergreen Park opened a year ago this month. It offers a new kind of primary care targeting older adults with ongoing health conditions who are looking for community, hands-on care and 24/7 access to real providers, not chatbots.

For Richardson, the vibe is great.

“They’re glad to see you. You don’t feel like you’re a patient. You feel like you’re going somewhere where someone really cares about you. They keep in touch with you, which is so important. I get texts from Taylor [Taylor Wen, PA, her OSF CompleteCare 55+provider] on MyChart, and it’s just an interaction that is rare.” 

Richardson was diagnosed four years ago with pulmonary sarcoidosis, and she has a history of pulmonary embolism and pneumonia. Plus, she has to be on blood thinners. Frustrated with her previous care, she tried OSF Complete Care 55+ shortly after it opened, and she’s been thrilled with her experience.

“My first experience with Taylor was just phenomenal. She was knowledgeable, patient, and she seemed like she cared. And going to doctors, sometimes you're just a patient number. And I didn't feel that here.”

Wen, a physician assistant, also sent Richardson to get a bone density scan where Richardson learned she had severe osteoporosis – so bad that she had to reduce the weight of her purse for fear it would break her wrist. Richardson is so grateful because she believes knowledge is power.

Staying connected to consistent care

Although she doesn’t consider herself computer savvy, Richardson says she’s learned to use OSF MyChart, and it keeps her connected to Wen.

“It’s easy to use, and it helps me monitor and keep up with my own health issues. I like the fact it reminds me when I have appointments coming up. I’m retired but I’m still busy.” 

Richardson remembers when doctors made house calls and says the care she’s getting now reminds her of that.

“When the doctor would come to your house with his bag. I know it was 100 years ago. But it’s so personal now, here. And you go to other places, and you’re waiting and waiting. And no one really seems to care.” 

The 6,300 square-foot clinic features 12 exam rooms and on-site labs. Sandy Valino Stock, DO, medical director of OSF CompleteCare 55+, says many people enjoy the option to connect digitally 24/7. Virtual visits make it easy to get answers to questions, especially after hours when symptoms aren’t severe enough for emergency care. Richardson says that kind of convenience could save her from long waits in the emergency department, only to be sent home with a quick evaluation and remedy.

Dr. Valino Stock says about half of the people who use the clinic take advantage of virtual visits, while the other half are seen in-person.

“Patients love the virtual concept because they don’t have to miss as much work. It’s just convenient for them,” Dr. Valino Stock shares. “Sometimes it’s a case where the patient comes into the clinic and their loved one wants to be tuned in, but they’re at work. So, they can be virtual during that visit, and they can be present if they need to be.” 

More than half of the clinic’s patients have high blood pressure and/or high cholesterol, one-fourth have diabetes and significant osteoarthritis, and about 10% have heart failure.

But consistent care is helping improve those conditions. For example, almost 80% of patients are now meeting blood pressure and A1c targets, up from 34% and 58% respectively.

The clinic has also seen success in increasing completion rates for screenings such as mammograms, bone density tests and colonoscopies. These preventive steps are often overlooked, but they play a key role in long-term health.

GLP1 medication management is available

As people age, weight management can also become more difficult as metabolism naturally slows. Dr. Valino Stock explains that metabolism typically declines by 1% to 2% each year after age 20. At CompleteCare 55+, more than half of patients are overweight or meet obesity criteria. This is important because extra weight on the body leads to most of the medical conditions being treated.

GLP-1 medications such as Mounjaro or Ozempic are, as Dr. Valino Stock put it, “magical” in helping people lose weight. But the GLP-1 journey requires regular check-ins and medication management.

“We see them monthly for the most part as they’re getting started on these GLP-1s. So, patients have better success at getting healthier, whether it’s controlling their blood sugars or lowering their weight and doing it in a healthy manner where they can maintain their muscle and minimize the side effects.” 

Many who enroll in OSF CompleteCare 55+ are women in pre-menopause and menopause. The outlook for Hormone Replacement Therapy (HRT) for menopause has fundamentally shifted in the past 10 years. Following major reviews, experts now recognize that for most healthy women under 60 or within 10 years of the onset of menopause, the benefits of HRT far outweigh the risks.

“If no contraindications, we can help women sleep better, have a little bit more energy, feel themselves and just continue life because life is very busy. So, if we can help a woman get a good night’s sleep, everything changes for that woman.” 

Beyond direct medical care, digital health care navigators at a “Connect Bar” in the lobby also help with insurance issues, coordinating appointments with specialists and navigating OSF MyChart and other tools to monitor their health. Events such as Tech Tuesday also allow for group sessions to address technology challenges.

Navigators also connect people with resources to address social needs such as transportation to appointments or senior centers or food insecurity. Through educational events with speakers on health topics and partnerships with local organizations, clinic leaders continue to learn more about the needs of the people they're serving.

Additionally, regular outreach efforts keep providers connected. For example, at the OSF CompleteCare 55+ clinic, any community member can access free blood pressure screenings from 10 a.m.-noon every first and third Tuesday of the month.

Learn more here about OSF CompleteCare 55+ primary care.

Video clips with Carla Richardson

Video clips with Dr. Sandy Valino Stock

B-roll-OSF CompleteCare 55+

Jason Bill, MD, an interventional gastroenterologist with OSF HealthCare, says the trend is concerning and highlights the urgent need for awareness, earlier detection and preventive screening.

Not only is it being diagnosed more, a JAMA study released in January reveals colorectal cancer is now the leading cause of cancer-related death in adults 50 and younger. The findings suggest colorectal cancer is the only major cancer that has increased in the last two decades, averaging a 1.1% increase every year since 2005. The American Hospital Association (AHA) reports colorectal cancer ranked fifth in cancer deaths from 1990-1994.

A troubling rise in diagnoses among younger adults

“We are seeing much younger people being diagnosed with colon cancer. Unfortunately, these younger people are being diagnosed at later stages of disease, as well," Dr. Bill says. "There is clearly something going on. A lot of research is happening behind the scenes that's trying to sort out what is causing this."

Dr. Bill says researchers are actively investigating the causes behind the increase in cases. While no single explanation has been confirmed, experts believe multiple factors may be contributing.

“There seems to be a birth cohort effect, meaning those born after a certain time, seem to have an increasing incident of colon cancer diagnosis,” Dr. Bill says. “So, what that leads people to believe, is that there must an environmental trigger to the increased incidence. The most likely culprits include ultra-processed foods and the obesity epidemic. Further research is going into other exposures including microplastics.”

Genetics and inherited conditions can increase risk

Genetics can play a significant role in colorectal cancer risk. One inherited condition, known as Lynch syndrome, increases the likelihood of developing colorectal cancer and other cancers.

Lynch syndrome is caused by inherited mutations in genes responsible for repairing damaged DNA – including MLH1, MSH2, MSH6, PMS2 and EPCAM. When these repair systems don’t function properly, damaged DNA can accumulate, increasing the risk of cancer over time.

“In those who have a family history, be a little more aggressive and more sensitive, mindful of your symptoms. With rectal bleeding in a young person, we need to treat that more aggressively and strongly recommend a colonoscopy,” Dr. Bill says.

Doctors may recommend genetic counseling and testing for individuals with strong personal or family histories of colorectal cancer or related cancers. Identifying inherited risk factors can help patients and providers create personalized screening and prevention plans.

 “No one loves the idea of getting a colonoscopy, but it is the right thing to do. If you have any symptoms you’re concerned about, talk to your primary care provider and they can move you forward to get a colonoscopy. But the best advice is to get screened when it’s appropriate and be mindful of the symptoms,” Dr. Bill adds.

Screening guidelines may miss at-risk younger adults

Colorectal cancer screening guidelines have evolved in recent years. The American Cancer Society recommends routine screening beginning at age 45 for people at average risk.

While research is ongoing, Dr. Bill notes that current guidelines may not fully address this younger population; however, the decrease in the screening from 50 to 45 was an important step.

Colonoscopies don’t just detect cancer – they prevent it

A colonoscopy remains the gold standard for colorectal cancer screening, not only detecting cancer but preventing it, Dr. Bill says.

“It’s a test where we’re able to examine the colon and prevent cancer,” Dr. Bill says. “In those patients who have decided to not get a colonoscopy, any screening is better than nothing. That’s where the mailed stool kits come in handy.”

During a colonoscopy, physicians can identify and remove polyps (abnormal growths) that can develop into cancer if left untreated. These samples can then be analyzed to determine cancer risk.

“In general, we can tell you right then and there what your findings are," Dr. Bill points out.

This immediate feedback provides patients with clarity and allows care teams to quickly determine next steps if needed.

Symptoms and risk factors shouldn’t be ignored

Even for adults under age 45, certain symptoms and medical histories may warrant earlier screening. These include:

• Rectal bleeding
• Anemia (low red blood cells)
• A strong family history of colorectal cancer
• Family history of polyposis syndromes
• Personal history of inflammatory bowel disease, including ulcerative colitis or Crohn’s disease
• Sudden abdominal pain
• Unexplained weight loss

If you're concerned your at-risk for colorectal cancer or are experiencing any of the symptoms above, it's time to speak with your primary care provider and request further screening. 

Lifestyle changes can help lower risk

While some risk factors, such as genetics, cannot be controlled, healthy lifestyle choices can help reduce colorectal cancer risk. Experts recommend:

• Avoiding tobacco use
• Limiting or avoiding alcohol
• Reducing consumption of ultra-processed and processed foods
• Exercising regularly
• Maintaining a healthy weight
• Avoiding prolonged sedentary behavior
• Eating a fiber-rich, balanced diet

These steps support overall digestive health and may reduce cancer risk over time.

Screening saves lives

Colorectal cancer is highly treatable when detected early – and often preventable through routine screening.

If you're concerned, OSF HealthCare offers a colorectal cancer risk assessment that can help you figure out when you should start screening.

Video Interview Clips

OSF Cancer Institute B-Roll

September is Prostate Cancer Awareness Month. It's a reminder that the disease is manageable when caught early.

Uwais Zaid, MD, a urologist who provides care at OSF HealthCare, is urging men to get screening appointments on their calendar at the right time. That’s critical, he says, because some people who develop prostate cancer will not show symptoms.

“It is something we certainly do take seriously in urology,” Dr. Zaid says.

What is the prostate?

The prostate is a male gland about the size and shape of a walnut. It surrounds the upper part of the urethra, or the tube that carries urine from the bladder. The prostate makes some of the fluid that’s part of semen.

Risk factors

Dr. Zaid says the risk for prostate cancer increases with age.

Other risks: “African American men are at a higher risk,” Dr. Zaid says. “Certain dietary things like too much red meat and greasy, fatty food. And certain type of exposures such as Agent Orange for some of our veterans.”

And like most other ailments, a family history of prostate cancer should put you on higher alert.

Screening: how and when

Dr. Zaid says prostate cancer screening involves two simple tests. One is a blood test that measures the amount of a hormone produced by your prostate called prostate-specific antigen (PSA). An abnormally high reading might warrant further examination by your health care provider.

The other test is a digital rectal exam, where your provider will feel for lumps on the prostate.

Don’t get that confused with a colonoscopy, the more invasive screening that looks for colon cancer, Dr. Zaid says.

“It doesn’t require any special or horrible bowel prep,” Dr. Zaid says of the prostate exam. “It’s about a 20 second thing we do in the clinic that can save your life.”

You should always see your health care provider anytime something seems off with your body. But the American Urological Association has guidelines for when to get a prostate cancer screening.

“For most men, we want them to start screening with an annual PSA [test] at age 54 to 69,” Dr. Zaid explains. “For certain men, you want to start earlier if you have a risk factor.”

After age 69, Dr. Zaid says you should talk to your primary care provider about what screenings are right for you.

What should you not do?

Don’t think this type of cancer is so common that you should just let it run its course. Dr. Zaid says there are aggressive types of prostate cancer that can be deadly.

Also, Dr. Zaid warns of herbal remedies for cancer in general. He says your best bet is to see a doctor.

Treatment

Dr. Zaid says treatment for prostate cancer depends, in part, on how much the cancer has spread.

If it’s contained to the prostate gland, he says radiation (sending radiation waves to destroy the cancer cells) or surgery to partially or fully remove the gland are options.

“If the prostate cancer has escaped the prostate gland, there are a lot of treatment options,” Dr. Zaid explains. “This is actually a very active area [in medicine] with all sorts of research and new medications.”

Hormone therapy may be an option here, the doctor says.

“It’s very manageable,” Dr. Zaid says on treatment of the disease.

Interview clips

Previous coverage

OSF HealthCare library: Prostate cancer

OSF HealthCare Newsroom: Urinary incontinence and the link to prostate cancer

A colonoscopy at age 15

But why? Those at an average risk of colorectal cancer are recommended to start getting colonoscopies once every ten years, starting at 45 years of age.

"My dad was diagnosed after just turning 26. Because it was colon cancer, they recommended I be seen ten years before. The doctors said when I turned 15 to get a colonoscopy," Jaxson says. He was just a baby when his father passed away.

Jaxson’s father, Michael, was an avid runner in great shape. Angie Brown, Michael’s wife and Jaxson’s mother, says Michael had no family history of colon cancer, and never drank or smoked. At the age of 26, Michael was diagnosed with stage 3 colon cancer. He underwent six months of chemotherapy and was in remission for almost four years. In 2013, Michael was diagnosed with a rare form of stage 4 colon cancer called signet ring cell adenocarcinoma.

“If he can do it, I can do it!”

Angie says for years, she has helped prepare her sons to know the importance of cancer screening, and that they’d have to undergo a colonoscopy from a young age.

“He figured that if he could go out there and show people that a 15-year-old boy is willing to go through a colonoscopy, without having any symptoms, then anybody can do it,” Angie says. “We had a good amount of people who sent messages and said, ‘if he can do it, I can do it!’”

Jaxson says it helped to know from a young age that the day was coming. Afterwards, he said it “wasn’t that bad.”

"They have you roll over on your side, then they inject the stuff in, and it works like a charm. You're out and don't remember a thing. Best sleep you'll ever get," Jaxson laughs. 

Jaxson’s bravery can inspire others

Daniel Martin, MD, a gastroenterologist with OSF HealthCare, oversaw Jaxson’s treatment. He says Jaxson’s bravery to undergo something uncomfortable, yet potentially lifesaving, should be inspiration for everyone.

"Colon cancer, if caught early (even if not caught at a polyp stage), is a very treatable condition. Where in the early stages of disease, greater than 90% of those patients are going to be disease free at five years," Dr. Martin says. "One of the advantages of colorectal cancer screening is that we can prevent the disease. With colorectal cancer, in a colonoscopy, you can identify the precursor lesions called polyps and remove them during the exam."

Colon cancer is the third-most diagnosed form of cancer in both men and women.

“Lung is first for both, breast cancer is second for women, then colorectal cancer is third. For men, prostate is second, colorectal cancer is third. Colon cancer is the second-leading cause of cancer mortality in this country,” Dr. Martin explains.

The prevalence of colon cancer, along with the rareness of Michael’s signet ring colon cancer, led Angie and Michael to launch the Michael P. Brown Colon Cancer Foundation which lives by the motto “Get Busy Living.”

“A lot of people think you’re guaranteed a long life, especially if they’ve had parents who lived into their 80s and 90s,” Angie says. “You just never know what’s going to happen. If you have a bucket list, start doing those things. Don’t wait until you’re retired.”

The Foundation hosts Michael’s 5K Run for Life each year, raising money for signet ring research

“We try to be an outlet for people to get information about signet ring colon cancer. My husband used to field most of those calls, but now I do. My boys are getting involved too,” Angie says. “If there’s a parent who has cancer, they’re willing to talk to kids about that.”

Signs and symptoms of colon cancer

"The most common concern would be bleeding in your stool. But that would also include abdominal pain that's new or different," Dr. Martin says. "Or changes in the frequency or caliber of your stools."

This was mainly the case with Michael, Angie says.

“Initially, my husband’s symptom was belly pain. He was put on a couple of different medications because it was thought to be a stomach ulcer,” Angie says. “It didn’t work. He started having constipation, diarrhea and vomiting. We went into the emergency department, and he got the diagnosis of colon cancer.”

Traditionally, colon cancer is seen in people in their 60s and 70s. However, more younger people are starting to be diagnosed with colon cancer, Dr. Martin says.

"Specific to colorectal cancer, there are various options available now for screening. We recommend procedural screening with colonoscopy whenever possible. But with the advent of stool studies that are readily available and have been covered by insurance, that has helped increase the pool of patients who are receiving appropriate screening," Dr. Martin says. These readily available options are so important, Dr. Martin says, because most colon cancer patients are getting diagnosed at a later stage in the disease.

In the past, things like smoking, obesity and unhealthy lifestyle choices have been thought to cause colon cancer. Dr. Martin says in addition to that, more recent studies have shown processed foods to be a concern as well, adding that our gut's microbiome may show early indicators of cancer. A study done by Harvard Medical School investigators found that certain types of gut bacteria could lead to the development of precancerous colon polyps. 

Dr. Martin credits the OSF HealthCare cancer tumor boards and medical teams for creating a more organized process over the last five to 10 years that takes care of patients from diagnosis to treatment. 

Jaxson says now that it’s all said and done, the colonoscopy process was not as bad as most people think. This is on par with what most patients say, Dr. Martin adds. His word of caution? Many of his patients undergoing a colon cancer diagnosis wish they would have gotten colonoscopies earlier on.

To schedule a screening, speak with your primary care provider first and get a referral. You can find more information about colonoscopies on the OSF HealthCare website.

Jaxson Brown Video Interview Clips

Angie Brown Video Interview Clips

Dr. Daniel Martin Video Interview Clips

The colonoscopy has a special place in comedy, but colorectal cancer is no laughing matter. The reality is that a colonoscopy is the best way to detect the second-deadliest type of cancer.

However, fear prompts many people to avoid a colonoscopy. Now, comes a new, less invasive way to screen for colorectal cancer – a new FDA-approved blood test that can be used for people who have an average risk. Dr. Harishankar (Hari) Gopakumar, MD, a gastroenterologist at OSF Medical Group in Bloomington says the new test is aimed at improving the screening rate for colon cancer which currently stands at 63% of all eligible people.

“This blood test could bridge some of gap; that is where I see its main role. If for whatever different reason somebody is not able to get one of the approved colon cancer screenings, other than this latest blood-based test, this could be a bridge to offer some form of screening to them.”

The American Cancer Society says overall, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 25 for women. However, each person’s risk might be higher or lower, depending on their risk factors for colorectal cancer, including but not limited to family history.  In people younger than 55 years of age, rates have been increasing by 1% to 2% a year since the mid-1990s, so it’s recommended screening start at 45 years, beginning with a baseline colonoscopy.

The recently approved blood test is easier than the current stool sample option that’s available for people at average risk, but Dr. Gopakumar suggests it is not good for detecting pre-cancerous cells. He says the sensitivity is enough to detect about 13% of pre-cancerous lesions. The success at detecting actual cancer is about the same with the blood test as the stool-based analysis. However, Dr. Gopakumar stresses testing a stool sample offers a better way to detect those early-forming cancer cells and that’s what’s most important.

Detecting colorectal cancer sooner

“Our goal is to be able to pick up these pre-cancerous lesions way before they even have a chance to become cancer and then treat them because at that stage, it’s relatively easy to treat the polyp – you take the polyp out. Nothing after that except maybe a follow up colonoscopy. That is where the difference comes in.”

Currently, about 60–70% of colorectal cancers are diagnosed at an advanced stage. Research suggests if the healthy population regularly submitted to annual screening, the 5-year survival rate could be increased to 73% (currently 65%). So, does Dr. Gopakumar think this new blood test could become part of annual exam testing?

He thinks it could eventually, but not until the test is improved to increase early cancer cell detection.

“This is probably an early stage and with more effective (technology) where we can match the sensitivity and specificity numbers where they detect what we need to detect – close to the stool-based testing or even better than that – then I see this as the future, but it may be a bit further out.”

Dr. Gopakumar says the blood test should not replace the more intensive colonoscopy procedure which, for people with average risk, should be given every 10 years. The FDA recommends getting the blood test every three years starting at age 45 for people not at high risk.

With the various options now available, Dr. Gopakumar recommends having a conversation with your medical provider.

“Make an informed decision so you get the best test that you can and it’s most appropriate for you so you can feel confident you got what you needed done in an appropriate and efficient way.”

The Affordable Care Act (ACA) requires both private insurers and Medicare cover the costs of colorectal cancer screening tests, because these tests are recommended by the United States Preventive Services Task Force (USPSTF). This includes a blood test, but Dr. Gopakumar says check with your insurer and make sure whether prior authorization is needed and to know whether you will have a co-pay.

Video clips with Dr. Hari Gopakumar

Terminology

David Rzepczynski, MD, an OSF HealthCare gastroenterologist, says it’s important to first lay out some similar sounding terminology.

• Diverticulum (singular) or diverticula (plural): These are the bulges that form when an inner part of the colon sticks out through a weak spot in the colon wall.
   
• Diverticulosis: This is the name of the condition when the bulges occur.
   
• Diverticulitis: This describes when the bulges become inflamed.

Causes, symptoms and diagnosis

Dr. Rzepczynski says diverticulosis occurs when your colon is trying to push stool forward, and the organ is not as bulky as it should be. The diverticula bulges then form.

The condition has been more common in people over 60, but Dr. Rzepczynski says health care providers are seeing a rise in cases in people in their 40s and 50s.

Diverticulosis can run in families. It’s also tied to your lifestyle.

“A diet that has more red meat, less grain and less fiber might put you at a higher risk,” Dr. Rzepczynski says.

Smoking, excess alcohol and obesity are also risk factors.

Symptoms of diverticulosis include abdominal pain or constipation. But it often comes with no symptoms and is found during a colonoscopy.

Treatment

Dr. Rzepczynski says in mild cases, a provider may tell you to change your lifestyle, such as getting more fiber in your diet. This makes bowel movements smoother.

“Often, people will look to use fiber supplements,” Dr. Rzepczynski says. “The amount of fiber intake from supplements pales in comparison to what you can get from your diet.”

Also, eat a healthier diet overall. Dr. Rzepczynski says there used to be a myth that nuts, popcorn and seeds would get lodged in the colon bulges. He says studies have shown those foods are not a risk factor.

Other lifestyle tips: exercise and cut out tobacco and alcohol.

Dr. Rzepczynski says more serious cases of diverticulosis can come with two complications. One is bleeding.

“You could have a blood vessel on the outside of the diverticulum. If it ruptures into the diverticulum, it could cause sudden bleeding from the rectum,” Dr. Rzepczynski says.

Dr. Rzepczynski says bleeding from diverticulosis is not common. He ballparks it at around one in 2,000 cases. People on blood thinning medication who develop diverticulosis have a higher risk of bleeding.

While unpleasant, Dr. Rzepczynski says most bleeding cases resolve on their own.

The second, more serious complication is diverticulitis, or when the diverticula bulges become inflamed. This happens when there is a tear in the diverticulum, and bacteria from stool leaks. And it can lead to a host of other problems: pockets of pus known as abscesses, issues passing stool and a urinary tract infection.

Symptoms of diverticulitis include pain in the lower left abdominal area, abnormal bowel movements, nausea and vomiting. If you have these symptoms, it’s important to been seen by a health care provider quickly. A doctor may order a computed tomography scan (commonly called a CT scan) to diagnose diverticulitis.

Dr. Rzepczynski says it’s not common for diverticulosis to progress to diverticulitis, and most cases of diverticulitis can be treated at home with oral medication. But, he says 12 to 15% of diverticulitis patients spend time at the hospital. Treatments there include antibiotic medication through intravenous therapy (IV) and surgery. If surgery is necessary, a doctor will drain any abscesses then remove the inflamed area of the colon.

“They’ll try to reconnect the colon at that time,” Dr. Rzepczynski explains. “But if the surgery is done on an emergency basis, sometimes the person may have a colostomy where part of the colon is coming out through the skin. That’s a temporary measure.”

A colostomy comes with a bag on the outside of your body that collects the waste that would normally leave your body via a bowel movement.

Dr. Rzepczynski warns that surgery isn’t a permanent fix. He says around 15% of diverticulitis patients who have surgery end up with another bout. It reinforces the importance of lifestyle changes. You should also get on a colonoscopy schedule as advised by your health care provider.

Learn more

Read more about how to avoid diverticulosis on the OSF HealthCare website.

Interview clips

Anal and rectal cancer occur in parts of the body near each other, and they both have prevention steps and time-tested treatments. But they are different types of cancer, says Raman Kumar, MD, a colorectal and general surgeon with OSF HealthCare.

Rectal cancer

Dr. Kumar says the rectum is the last part of the colon, where stool is stored.

Signs of rectal cancer include bleeding, irregular bowel movements (such as the shape of the stool changing and the inability to have a complete bowel movement), weight loss, fatigue and pain in the rectal area.

Rectal cancer impacts men and women roughly equally, and it’s seen “at almost any age,” Dr. Kumar says. If you smoke and eat a lot of red meat and processed food, your risk will go up.

Anal cancer

Dr. Kumar says the anus is where stool comes out. He says signs of anal cancer can be like those of rectal cancer. But often, he says an anal cancer diagnosis starts when a person believes they have hemorrhoids, or when the veins or blood vessels around the anus and lower rectum become swollen and irritated due to extra pressure.

“It turns out not to be a hemorrhoid. It could be a mass or a lesion. You could have some bleeding, especially when you’re wiping with toilet paper or wet wipes,” Dr. Kumar says.

Anal cancer’s prevalence in the United States is “very low,” Dr. Kumar says, with around 8,000 cases per year. Around two-thirds of the cases are women, and it’s more common in age 50 and up.

“The number one cause of anal cancer is HPV, the human papillomavirus,” Dr. Kumar says. “So, it is considered a sexually transmitted disease.”

But he says you don’t have to be sexually active to get anal cancer. Regardless, there are vaccines for the most common HPVs that cause cancer.

Prevention and treatment

Symptoms aside, Dr. Kumar says there’s a must-do for anal and rectal cancer prevention: get on a colonoscopy schedule as advised by your health care provider. A colonoscopy is when a provider inspects your colon and surrounding areas using a tiny camera on the end of a tube. Dr. Kumar says generally, colonoscopies start at age 45. But they could start earlier if you have a family history of cancer.

Other tips: Don’t smoke. Exercise regularly. Eat a healthy diet with plenty of fruits, vegetables and fiber. Thirty grams of fiber per day is a good goal, Dr. Kumar says.

If you do have symptoms of anal or rectal cancer, see a provider to get checked out.

Dr. Kumar says treatment for anal cancer is usually chemotherapy and radiation therapy. He says when treated properly, the typical five-year survival rate is around 80%.

“The only times we would operate on anal cancer are to get the original [cancerous] mass out and if the cancer comes back,” Dr. Kumar explains.

For rectal cancer, Dr. Kumar says around 40% of people can also be treated with chemotherapy and radiation. Others will need surgery to remove the cancer. But Dr. Kumar says medicine has progressed to where people can typically avoid a colostomy, or when a part of the colon is diverted outside the skin to bypass a damaged part of the colon. This is temporary and comes with a bag that collects the waste that would normally leave your body via a bowel movement.

Learn more

Read more about prevention and treatment of rectal and anal cancer on the OSF HealthCare website.

Interview clips

It’s important for women to keep track of health screening recommendations. Early detection of issues like breast cancer can mean a better outcome.

Since everyone’s situation is different, you should talk to your health care provider about what screenings are right for you and when to get them. But Deena Brown, a board-certified family nurse practitioner at OSF HealthCare, says there are a few screenings every woman should know.

• Breast cancer: Brown says women aged 40 and up should talk to their provider about a yearly mammogram that looks for breast cancer.

For adult women of any age, mammograms should be combined with monthly breast self-checks. Brown suggests doing a self-exam a week after your menstrual cycle. If you’re no longer menstruating, you can choose the same day each month (the first of the month, for example) to help you remember. You should feel for changes or other abnormalities like lumps, bumps, one breast being larger than the other, any nipple discharge and swelling or soreness under the armpit. Make an appointment with your provider if you notice any of those changes.

• Cervical cancer: Brown says cervical cancer screenings typically begin at age 21 and occur every three to five years.

“Those screenings involve a pap smear, which takes a cell sample from the cervix and looks for any abnormal cells that need to be addressed,” Brown says.

• Osteoporosis: The National Institutes of Health (NIH) says osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease or when the structure and strength of bones change. This can lead to a decrease in bone strength and an increased risk of bone fractures.

Brown says women over age 65 should be checked for osteoporosis. The NIH says the screening is typically a simple X-ray, and it should be done every two years.

“If the bone density is low, we can initiate treatment with medication to help increase the strength of the bones,” Brown says. “This helps prevent future fractures and debility for women.”

• Colon cancer: Screenings starting at age 45 can help detect colon cancer and other serious issues. A once-a-decade colonoscopy involves a doctor using a tube and camera to check for polyps or cancer in your colon and rectum. Another option is to take a stool sample at home, send it to a provider and they will look for abnormalities. Talk to your provider about which option is best for you.

How things can change

Brown says some women may need these screenings more frequently or earlier in life based on a family history of a disease or your own history.

“It’s all individualized,” she says.

“There are these screening recommendations, but we like to take a personalized approach to care and help address issues as soon as we can.”

In other words, seeing a doctor isn’t just about treating chronic conditions. It’s about preventing them too. And screenings are the best way to do that.

For more on women’s health services, visit the OSF HealthCare website.

Interview clips

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Staying the course for a colonoscopy

Colonoscopies have been considered the gold standard for colorectal cancer screening and prevention for decades. Now, however, a new study seems to call that belief into question, but health professionals argue the research can be easily misinterpreted.

The study, published in the New England Journal of Medicine, followed 85,000 participants over a ten year period. Trial participants were either invited to undergo a single colonoscopy screening or to receive their usual physician care with no colonoscopy.

Of those who were invited to have colonoscopies – whether they got one or not – there was an 18% reduction in developing the disease, and no significant reduction in the likelihood of colon cancer death.

Dr. Omar Khokhar is an OSF HealthCare gastroenterologist in Bloomington, Illinois. He says there is a sticking point in this study, which can be easily overlooked: Less than half (42%) of the group invited to get a colonoscopy actually went through with the screening. If you concentrate on those individuals only, the benefits of screenings are more apparent.

“The 42% of people who accepted the invitation for the colonoscopy arm of this study had a 31% reduction in colon cancer incidents, and a 50% mortality reduction from colon cancer,” Dr. Khokhar explains. “So I think if anything, this study tells us that if you get screened, if you get a colonoscopy, you will have a reduction in your risk of colon cancer, and death from colon cancer.”

The new study has gotten quite a bit of media attention, and the major concern from physicians is that prospective patients will see the headlines and then possibly not pursue screenings if they believe there is no significant benefit.

Dr. Khokhar says he and his colleagues welcome patients’ questions, especially from those who have concerns. He says part of his job is to explain the ins and outs of screenings, and allow patients to decide what type of care they prefer.

“There are things that we're experts on and we're not experts on, and I'm fully open to an informed patient. I encourage that conversation. Come to me armed with your data. I'll come with my data. And let's talk about it and then you can decide which risks you want to live with,” he says.

“It's simple to say I don't want to get it done. Then you're choosing the risk of not getting it done, and with 52,000 colon cancer deaths every year in this country, and the chance of getting colon cancer one in 25, which is 4% - it's not insignificant - then you choose to live with that risk. But ultimately, as a patient, you get to decide to at least have the conversation.”

The American Cancer Society recommends that all people at average risk of colorectal cancer start regular screening at age 45. However not all colorectal cancer screenings are created equally, and according to Dr. Khokhar, there is a reason the colonoscopy is considered the gold standard. Colonoscopies allow physicians to view the entire colon and both detect and remove polyps, small clumps of cells that can develop into cancer, during the same procedure.

“This is the only test where we can find a precancerous lesion and remove it at the same time,” says Dr. Khokhar. “The stool based tests, if they're negative, you have a clean bill for one to three years depending on which one you choose. If they are positive that needs to be followed up with a colonoscopy to make sure you don't have a precancerous polyp that we can address and get rid of during this colonoscopy.”

Lower risk patients may be eligible for one of several other non-invasive tests, including at-home stool tests Dr. Khokhar mentioned. These tests, including Cologuard, can be done outside of a physician’s office and can detect blood in the stool or abnormal DNA that may suggest cancer. 

Colorectal polyps and colorectal cancer don’t always cause symptoms, especially at first. That is why getting screened regularly for colorectal cancer is so important. If you do experience symptoms, they may include a change in bowel habits, blood in or on your stool (bowel movement), abdominal pain, aches, or cramps that don’t go away or unexplained weight loss. If you have any of these symptoms, talk to your doctor.

Interview Clips - Dr. Omar Khokhar (pronounced COE-car)

It was initially reported the 46-year-old Barker developed pancreatitis as the result of a colonoscopy, a procedure in which a scope is inserted into the rectum (that was later corrected to an endoscopy in which the scope is inserted down your throat and into the esophagus).

Dr. Bill says he was surprised to hear the original potential connection between Barker’s pancreatitis and a colonoscopy. He says while it is theoretically possible if the tip of the scope were to hit the tail of the pancreas during the procedure, he and others who have done thousands of colonoscopies have never seen the complication.

“The benefit of a colonoscopy by far outweighs the risks. You know, when we hear these things happen, there's such a large media presence behind celebrities having things happen and we can't really prove that the colonoscopy caused it. Right now it's just kind of correlation based on timing. It theoretically can happen, but I don't know how much I can stress that it is extremely rare,” says Dr. Bill.

Dr. Bill adds they are seeing a rise in colorectal cancer in younger people, so his threshold of when to perform a colonoscopy has gotten lower. He encourages anyone with rectal bleeding and other colorectal-based symptoms, even when in their 30s and early 40s, to get a colonoscopy just to be safe.

“I wouldn't focus on this one, you know, very rare adverse outcome. I would not let that sway you. Clearly we have a lot of evidence that supports colonoscopy for many different reasons. And so please don't let this sway your opinion on getting screened for colon cancer.”

Learn more about what is involved with a colonoscopy here.
 

Dr. Jason Bill interview clips