Dr. Prodyot Ghosh, a gastroenterologist with Bloomington Hospital Photo by David Snodgress

MODERATOR: Good morning everyone, and welcome to today's INstride magazine Q&A.

Dr. Prodyot Ghosh, a gastroenterologist with Bloomington Hospital, is here to answer your questions about colon cancer prevention and treatment. Feel free to send those questions now.

Dr. Ghosh, welcome. Are you ready to get started?

PRODYOT GHOSH: Yes

QUESTION: Dr Ghosh , I recently underwent a colonoscopy (SIC) .afterward I was informed I had a precancerous pollop. What extra precautions should I take after finding this out ?

Don Gambill, Bloomington

PRODYOT GHOSH: Generally it is important to follow up with periodic colonoscopy check ups---if you had 3 or more precancerous polyps next check up is recommended in 3 years, if you had less than 3 then follow up in 5 years. There are certain situations when your doctor may recommend a more frequent check up. While the jury on this is not out yet--aspirin 81 mg, calcium tablets may be of some benefit.

QUESTION: I really don't have a question. I would like to say this. Dr. Ghosh is the best DR. of gastroenterologist I have ever been too. I would highly recommend him to anyone. He took very good care of my husband, & then I had a problem a couple of times & he was excellent in his treatment. He has very good bedside manners, he is a Dr. who actually cares about his patients. He doesn't get you in his office & tell you what you want to hear, he tells you like it is, but in a careing way. we need more DRS. like him.

Sharon K. Brewer, Springville

PRODYOT GHOSH: Thank you, Sharon for those kind words.

QUESTION: Hi Dr. Ghosh,

This isn't a question, it's a compliment! I had put off having a colonoscopy for years because of the horror stories I had heard about the terrible tasting prep, etc. Kudos to you for seeking out better alternatives. I could not complain about much regarding the prep or procedure. I have told everyone that I was pleasantly surprised that it wasn't much of a big deal at all. I appreciated your concern that it was a pain free experience.

Kathy, Bloomington

PRODYOT GHOSH: Thank you. I think as a Gastroenterologist it is important that we and our staff make this experience as pleasant as possible---that way patients don't feel scared about getting this test which undoubtedly has helped in reducing the incidence of colon cancer nationwide.

QUESTION: What would be the most important preventive care apart from having regular colon checks, that we can do on a daily basis? Is our diet a major factor? Thank You

Patty Martin, Bedford

PRODYOT GHOSH: There is no doubt that diet is a major factor--parts of the world that eat less meat clearly have a lower risk--- colon cancer is without question a combination of our genes and the environment--in this case our diet. As i mentioned before aspirin,calcium may be beneficial---studies have not been conclusive. High fiber diet while helpful in preventing constipation and diverticulosis has not conclusively shown to benefit colon cancer prevention (Harvard Study).

QUESTION: Hello and thank you in advance! I am 33 and have been having issues with stomach discomfort, nausea, and occasional vomiting. My doctor speculates I am experiencing reflux issues, and has tested me for gallbladder problems, and h-pylori, both of which were negative. She also has me taking Prilosec daily (a 6 week regime of which I have been on for about 3 weeks now). Early on I felt like the Prilosec may have been helping, but for the past few days I have been experiencing the nausea and stomach discomfort quite a bit more. I have altered my diet by cutting out caffeine, alcohol, spicy foods, and have slowly been limiting my fatty food intake. Is there anything else I should be asking my doctor about? is there anything that can help with my symptoms in the meantime? Thanks again!

Aaron O., Bloomington

PRODYOT GHOSH: It is possible you could be having Gastroparesis. Stomach ulcers and reflux generally improve with Prilosec or similar class of drugs. It would be a good idea at some point if you are no better to get an endoscopy and follow it up with a trial of meds to help Gastroparesis. Stay on a low fat diet and stay physically active.

QUESTION: Colo-rectal cancer has killed three people who were very close to me. Radiation and chemo prolonged the life of one of them for 4 years, but for the other two, those therapies seemed only to prolong their agony and give them false hope. They died a few months after diagnosis. Do people actually ever survive colo-rectal cancer? And if early diagnosis is key to survival, then why are colonoscopies recommended only once every 10 years? Thanks.

Dawn Hewitt, Bloomington

PRODYOT GHOSH: Colorectal cancer is the 3rd leading cause of cancer deaths in the US. One can expect about 50,000 deaths annually and 150,000 new cases being diagnosed each year. The key to success is early diagnosis. This may surprise you, but majority of colon cancer patients are cured--in the range of 90%. While there are various screening strategies colonoscopy in average risk patients every 10 years is clearly the best and proven to be cost effective. Colon cancer is staged from A to D---Stage D is incurable in most situations which is probably what your near and dear ones had.

Why colonoscopy every 10 years--this is an often asked question. The basis for this recommendation is that most but not all colon cancers start as polyps and these are usually slow growing. When designing a National Prevention recommendation experts had to take into account the cost and the benefit of more frequent check ups and 10 years was considered optimal.It has also to be remembered that if one has a Parent or sibling or kid with colon cancer the intervals are 5 years.

It is also important to point out that if some one is having symptoms-rectal bleeding, iron def anemia or a change in bowel habits the procedure may have to be done sooner.

QUESTION: Hi. Dr. Ghosh, When do you recommend someone have a colonoscopy? Age for a man? Woman? Thanks.

Sarah Morin, Bloomington

PRODYOT GHOSH: Current recommendations are the same for men and women. We, Gastroenterologists stratify this on the risk of the individual, If one is average risk--- no immediate family with colon cancer screening colonoscopy begins at age 50 for both men and women. If an individual has a parent, sibling or a child with colon cancer, he is considered higher risk,we start at 40 or 10 years before the family member had colon cancer. For example if someones Dad had colon Cancer at 45, we would start screening colonoscopy at 35.

One other thing---the age 50 is currently widely used. It is becoming clear the African Americans are at a higher risk for colon cancer and early onset colon cancer. There is increasingly a trend to start screening in African Americans at age 45. Two other groups that seem to have a higher risk are chronic smokers and obese individuals--we may see recommendations in future to start screening heavy smokers(20 Pack years) and individuals with BMI greater than 30 earlier than at age 50. At this point this is largely a decision between patients and there doctors.

QUESTION: What are the risk factors for colorectal cancer? And, when should you begin regular screenings?

Amanda, Bloomington

PRODYOT GHOSH: As I mentioned before it is a combination of genes and our environment. About 20 % of colon cancers patients have a clearly identifiable family history of colon cancer. Parts of the world where meat consumption is high colon cancer incidence is high, Smoking is definitely a risk factor as is obesity. Then there are diseases of the colon like ulcerative colitis and Crohns where the incidence of colon cancer is higher. Begin screening at age 50 if average risk---you may like to look up my answer to Sarah's question.

MODERATOR: Thank you all for joining us today, we hope you enjoyed this Q&A. And thanks to Dr. Ghosh for taking time from his schedule to visit. Please join us next Tuesday for our eye health and vision chat with Dr. Spitzberg.