An Open Dialogue

Colorectal disease: No one likes to talk about it, so it often goes undiagnosed

Victor Pricolo, MD, Chief of General Surgery and Medical Director of the Colorectal Care Center at Southcoast Health, is trying to change that. Here, Dr. Pricolo talks to Health+ about colorectal disease prevention as well as how to improve treatment outcomes and quality of life for those diagnosed with colorectal diseases, including colon cancers. 

Health+: Why is colorectal disease a topic we don’t often hear about relative to other diseases?

Dr. Pricolo: When it comes to symptoms associated with colorectal disease, people tend to self-diagnose — and not correctly. They assume that a little spotting of blood in their stool is probably just hemorrhoids and end up just using a little cream or a suppository, and then forgetting about it. But that’s how cancer is missed.

The truth is that rectal bleeding or blood in the stool is never normal. It doesn’t mean you have to have surgery or that a situation is dire; it just means you should see a specialist and get screened for cancer so that you know all your options. And there are great specialists here at Southcoast’s Colorectal Care Center who can see you right away, close to home, to do that very thing.

Health+: Would you say that fear of a cancer diagnosis plays a part in that thought process for some?

Dr. Pricolo: Certainly. In many cases, when patients see blood in their stool or experience kinks in their bowel functions, the fear of cancer is actually there on some level. Unfortunately, we often manage fear by avoiding the issue — it’s a powerful deterrent to being checked. And that fear is not just of having cancer, but of having a body-image-altering procedure like a colostomy.

Everyone seems to know older relatives with bad colostomy experiences. And so the trip to the doctor alone is associated with bad news: “They’re going to give me a [colostomy] bag. I’d rather avoid it altogether than have a bag.”

So the danger with that, again, is the symptom may be nothing. But rather than living in fear, knowing your options is always best. Plus, in this day and age the number of patients who require a permanent colostomy is minimal. And management of colorectal cancer — if that’s what it turns out to be — is such that, the success rate is much higher than it was 10 or 20 years ago.

Other symptoms that may or may not be caused by colorectal cancer, like pain in the anal area, itching, a protrusion, bleeding or changes in bowel control, if addressed by a specialist like the ones we have at the Colorectal Care Center, can be successfully managed. There have been tremendous improvements in colorectal care in the last 10 years, so we can often even find out what the causes of those symptoms are. Most of the time the cause is not cancer. But it’s easy enough to come to this specialized Center to work with experts in this field to find out what the cause is and how to address it.

Health+: How do you and your team work to diagnose and treat such individuals?

Dr. Pricolo: The first step is always to assess risk factors, listen to the patients’ complaints, symptoms, medical history and examine them thoroughly. And then examine the cause of those symptoms. It’s not prudent to treat the symptoms without understanding their cause. In the Center, we have the ability to identify the cause and treat it appropriately. The treatment, of course, is going to be tailored to the cause of a patient’s symptoms.

Health+: Tell us more about that tailored-care approach.

Dr. Pricolo: That’s the thing that is unique about Southcoast and the Colorectal Care Center: We offer a one-stop shop where patients can get answers about why they are having these symptoms and how they can be optimally treated. After the initial assessment, we have the ability to line up specialists who will comprehensively, with a team approach, offer each patient a treatment plan that will take into account not just the best chance to cure his or her condition but also improve his or her quality of life and return them to unrestricted activity.

The combination of expertise, comprehensive services and programs, and equipment in one location is something you won’t find at most of the major academic centers in Boston. 

Health+: Many symptoms of colorectal disease affect quality of life. One notable symptom that many struggle with is incontinence. What are the challenges associated with incontinence in particular and how do you work to mitigate them for patients?

Dr. Pricolo: Incontinence, whether it’s urinary or fecal incontinence or both, is a subject patients are often reluctant to bring up. Some were told by their doctors years ago that they needed to live with it because it’s just part of old age. That’s just not the case anymore. In fact, there are some relatively new and very effective treatments that can tremendously improve quality of life.

In cases involving lessening or loss of bowel control — for instance, for women who’ve had traumatic deliveries of babies, even 30 or more years ago, or those recovering from cancer treatment or side effects of medication or radiation treatment, or even those managing diabetes — we offer effective ways of managing those symptoms.

It always starts with a thorough examination to determine what the cause of the symptom may be, taking a health history and assessing risk factors, such as genetics and lifestyle. We do examinations in the Center, but we also have an anorectal physiology laboratory that performs tests such as nerve studies and anorectal ultrasound.

These techniques can be applied to both functional disorders, like fecal incontinence, and tumors.

Health+: What preventive measures can be taken to help avoid or at least detect colorectal disease relatively early?

Dr. Pricolo: Colorectal cancer is extraordinarily preventable by a test that’s minimally invasive and highly effective, like a colonoscopy. In fact, unlike many other types of cancer, the majority of colon cancers start as a benign lesion that only over months or even years turns cancerous. This progression from benign to precancerous to cancerous is sort of unique to the colon, which gives us a great opportunity that we do not have in other body parts. But the earlier the better, meaning the earlier the cancer is detected, the higher the success rate, no matter what. And if we catch abnormalities before they turn cancerous, that’s better yet. The next best thing is to catch the cancer at the earliest possible stage when it’s curable with a minimal amount of intervention. Even if the cancer is diagnosed at an intermediate or locally advanced stage, the cure rate is still high. It may require multidisciplinary treatment, but we still are highly successful in achieving cures and preserving quality of life.

Health+: What about preventive or proactive treatments for colorectal conditions that can affect a person’s quality of life?

Dr. Pricolo: In the Center, we have the ability to identify the cause of various colorectal issues and treat them appropriately. That treatment may be office-based, it may involve changing diet, undergoing physical therapy including biofeedback, local management, or other therapies. Additional studies might also be necessary. We might suggest an endoscopy procedure, which we can do in the Center — like colonoscopy — or additional radiologic or physiology testing.

The most important thing is an accurate diagnosis so that a patient gets the appropriate treatment — that is what we focus on at the Center, getting to the root of the problem.

I know of instances where a patient was previously diagnosed with an issue, such as Irritable Bowel Syndrome. Then he or she began to experience new symptoms and thought it was because of IBS, but it wasn’t. It was something different that required a different treatment.

Once patients begin receiving the proper treatment — and that seldom means surgery — their health and quality of life can improve dramatically. Ultimately, that is our goal.

To schedule an appointment or colonoscopy with Dr. Pricolo, call 844-744-5544.