MedStar Health Blog

The techniques used to diagnose and treat colorectal cancer have become better each and every year—in fact, many of them didn’t exist or were in early research stages 10 to 20 years ago. As a result, we’re able to diagnose smaller lesions at earlier stages resulting in superior treatments.

Colorectal cancer is a common disease that’s expected to affect about 146,000 Americans in 2019 and occurs when the inner lining of the colon or rectum develops abnormal cells. The most common symptoms that I see in patients with colorectal cancer include:

• Abdominal pain or rectal pain
• Constant urge to use the bathroom
• Mucus, sometimes mixed with blood
• Persistent change in bowel habits, usually lasting more than a few days
• Rectal bleeding

For a number of years, we’ve noticed colorectal cancer rates decrease, likely because of the increase in people undergoing colorectal cancer screenings. However, as overall rates have gone down, the number of cancers diagnosed in young people—from their 20s to 40s—has risen. We’re not entirely sure why this is, but it might have something to do with increasing rates of:

• Drinking alcohol (especially in men)
• Eating processed food and red meats
• Obesity
• Sedentary lifestyles
• Smoking

LISTEN: Dr. Ayscue discusses common techniques to diagnose and treat colorectal cancer in the Medical Intel podcast.

How We Diagnose Colorectal Cancer

We typically diagnose colorectal cancer through fecal tests or a virtual colonoscopy. Fecal tests can include a:

• Fecal occult blood test: This test checks for blood in the stool that’s typically not visible to the naked eye, which can suggest the presence of polyps or cancer. Fecal occult blood tests require some dietary restrictions and multiple stool samples, are relatively affordable, and only are performed annually. Some polyps and cancers are difficult to detect using this method, however, compared to other methods.
• Fecal immunochemical test (FIT): The FIT test screens for blood that comes from the rectum and colon. It’s offered for free through our community program for patients who qualify in certain wards in D.C. And it’s usually covered by insurance for those who do have insurance. The only downside of the FIT test is that it’s not great for smaller polyps.
• Fecal DNA test: This tests for both blood and fecal DNA, is able to detect over 90 percent of colorectal cancer, and can identify more polyps than the FIT test can. One thing to keep in mind is the fecal DNA test, which only is required every three years, is more expensive than other fecal tests if it isn't covered by insurance.

A virtual colonoscopy uses a computerized tomographic (CT) scan to generate images of the colon in the hopes of spotting polyps. A virtual colonoscopy is recommended every five years, can spot up to 94 percent of larger polyps and cancer, and generally requires a bowel prep similar to colonoscopy.

If any of these minimally or less invasive tests are positive, then the patient must undergo a video colonoscopy so that lesions can be biopsied—tested for abnormal tissue or cancer—and possibly removed. A colonoscopy is performed with a small flexible tube called a colonoscope that’s passed through the rectum and into the last part of the small intestine. Using video technology and advanced endoscopic equipment, we both take tissue samples and remove polyps whenever possible.

How We Treat Colorectal Cancer

We typically treat colorectal cancer through minimally invasive techniques, such as laparoscopic surgery, where we remove colon or rectal cancer by placing instruments into the abdomen and then remove the colon through a relatively small incision. In some cases, radiation or chemotherapy is used before or after surgery to treat any possible cancer cells that might have been left behind because they were too small to see.

Additionally, we can use robotic techniques in which the instruments are connected to robotic arms that are controlled by a surgeon, allowing them to have even finer control of the instruments and tissues and get into spaces that otherwise wouldn’t be reached as well.

Recovery typically involves staying at the hospital for one to four days after surgery, and most patients use non-narcotic pain medications only while in the hospital. People typically are on their feet and can eat within a day of surgery.

A Success Story

We saw one woman in her mid-50s who received a FIT test that came back positive. As a result, we did a colonoscopy and identified and removed several polyps. We then performed a robot-assisted colon resection to remove one large polyp that couldn’t be removed with the colonoscope, and this ended up containing precancerous cells. She did well and was home within three days. Had this patient waited another year or two to get screened, she might have had cancer that required more intensive treatment.

Why It’s Important to Get Screened Early

In 2018, the American Cancer Society released new colonoscopy recommendations that adults with average colorectal cancer risk should begin getting colonoscopies at 45 instead of 50, due to the trend we’re seeing of younger people developing colorectal cancer.

If people get screened before they experience any symptoms, we’re more likely to be able to remove any polyps we find, helping prevent cancer from forming. And if we do find a cancer, it’s more likely to be in an early stage—meaning that it’s more curable.

Expert Care at MedStar Washington Hospital Center

We focus on treating colorectal cancer at MedStar Washington Hospital Center, and it starts with our robust screening program in which a nurse navigator helps ensure you receive the right screening. We also have a strong team of gastroenterologists, surgeons, radiologists, and, if needed, cancer treatment doctors who all are dedicated to preventing and treating colorectal cancer with the latest techniques.

Treating colorectal cancer today is much easier than it was years ago. Make sure you receive screenings when they’re recommended to ensure the best possible outcomes.

When someone comes into the emergency department (ED) with major burns over a large area of their body, it’s obvious that they need immediate medical attention. However, smoke inhalation—though less obvious to detect—is just as dangerous.

People who breathe in smoke during a fire can have life-threatening consequences even if they have no other injuries. As the National Fire Protection Association notes, twice as many people die from smoke inhalation in fires than from burns. Fortunately, people who live in the D.C. area can turn to the specialists at our regional Burn Center, the only adult burn treatment facility in the Washington metropolitan area, for quick recognition and treatment of smoke inhalation.

Who’s at Risk for Smoke Inhalation?

A typical patient with smoke inhalation is someone who’s been trapped in a closed-space fire, such as in a home or vehicle fire. Fire consumes oxygen for fuel, and as a fire grows, less oxygen is left for the person to breathe.

Along with inhaling smoky air, the patient may breathe in harmful, noxious chemicals from items burned in the fire’s path, such as carpet, curtains, and furniture. Some of the many chemicals that can be found in the smoke of a house fire include:

• Ammonia
• Carbon monoxide
• Chlorine
• Hydrogen chloride
• Hydrogen cyanide
• Hydrogen sulfide
• Sulfur dioxide

This poisonous smoke can make the victim feel lightheaded, dizzy, or disoriented, making it harder for them to escape. If a person faints or falls unconscious, they will continue to breathe in the harmful smoke, which only compounds its effects. If you are ever in a fire, make every effort to get out right away. Even if you are not close to the flames, the smoke can cause serious or even fatal injuries on its own.

How Smoke Inhalation Affects the Body

The poisonous chemicals in smoke can damage a person’s airway and lungs, as well as reduce the amount of oxygen available to the body. A person may develop carbon monoxide poisoning, cyanide poisoning, or complications of exposure to another harmful chemicals from the smoke.

Smoke inhalation’s symptoms aren’t as obvious as those of a major burn, so many people think they are fine as long as they get out of a house fire before suffering skin injury. Unfortunately, smoke inhalation injuries, while not typically visible, can still be fatal without expert diagnosis and treatment. There are a number of symptoms we advise patients to watch for after they’ve been exposed to smoke in an enclosed space. These include:

• Changes in skin color (pale, bluish, or reddened skin)
• Chest pain
• Cough
• Confusion or fainting
• Headache
• Irritated eyes
• Nausea or vomiting
• Noisy breathing or hoarse voice
• Shortness of breath

People who have heart failure, arrhythmia, or other forms of heart disease are especially at risk from smoke inhalation. Their lungs are put under greater stress from lack of oxygen, which also strains the heart and could even trigger a heart attack. But even otherwise healthy people can develop heart-related complications from smoke inhalation due to the lack of oxygen being supplied to the body.

Diagnosing and Treating Smoke Inhalation

During the past decade, we have realized that patients with smoke inhalation benefit from being taken care of by burn specialists who are experienced in dealing with the effects of fire and smoke.

When someone who could have smoke inhalation comes into the Burn Center, our first step is to supplement the oxygen they are breathing. We often examine a patient’s airway with a scope to look for internal evidence of smoke injuries. If a patient has evidence of this type of injury, a chest X-ray and blood tests are common to determine whether:

• They have been poisoned from chemicals in household smoke
• Their oxygen levels are too low
• Their lungs, heart, or kidneys have been injured from lack of oxygen

Our top priority for any patient with smoke inhalation is to open their airway as soon as possible. If the airway is swollen or damaged, we might need to place a tube down the patient’s throat to allow oxygen to enter the lungs. This procedure is called intubation. We also can provide medications to relax the lungs and widen the airways.

Next, we focus on raising the patient’s oxygen levels. The most common way we do this is through supplemental oxygen, either through a mask over the patient’s nose and mouth or through a tube called a nasal cannula that sends oxygen through the patient’s nostrils. If the patient is having trouble getting oxygen throughout their body, we can provide medications to neutralize chemicals they have inhaled.

Smoke inhalation injury might not be as obvious as a major burn. If you have been in an enclosed-space fire and have any of the symptoms of smoke inhalation, get help fast to prevent serious injury or death from this often silent fire risk.

The popularity of vaping continues to soar. From 2017 to 2018, vaping increased by nearly 80 percent among high schoolers and 50 percent among middle schoolers. And while the implications vaping has on people’s lungs are well documented, the effects it can have on dental health are less known.

Vaping is done through devices such as the Juul and Cig-A-Likes and contains nicotine, just like cigarettes. In fact, a JuulPod, which often lasts between four and six days, contains about 20 cigarettes worth of nicotine.

More than 7,000 types of vaping flavors exist, most of which were developed for the food industry—not vaping. While we are aware of potential short-term implications of vaping, the 20- to 30-year health implications are less clear.

LISTEN: Dr. Giurintano discusses vaping and dental health in the Medical Intel podcast.

Top Health Concerns of Vaping

The most common dental health implications we see with vaping are irritation of the oral mucosa and higher rates of overgrowth of a fungus called Candida albicans. The overgrowth of this fungus can result in oral thrush, an infection in the mouth that requires treatment with anti-fungal medication.

Additionally, the vape substances that carry nicotine also usually contain glycerin and propylene glycol. While these chemicals aren’t dangerous in and of themselves, they can cause:

• Potentially cancer-causing molecules to be released into the body when you vaporize them
• Irritation in the upper aerodigestive tract, which includes the inside of the mouth, lips, nose, esophagus, and windpipe
• Severe inflammation of the bronchi and lungs

Many people who vape also transition to smoking cigarettes for the nicotine. As a result, they face the long-term complications of smoking cigarettes, which include:

• Lung cancer
• Oral cancer
• Periodontal disease, or a severe gum infection
• Laryngeal (voice box) cancer

Is Vaping Better Than Smoking Cigarettes?

While we are still early in the process regarding research into the long-term implications of vaping, the short-term effects and lack of knowledge are enough for people to avoid it. In fact, the American Head & Neck Society says that the lack of clear scientific evidence regarding the safety and effectiveness of vaping leads the organization to not endorse using e-cigarettes as a safer alternative to cigarettes.

Vaping also presents secondhand smoke concerns. Studies have shown that e-cigarettes are not emission-free, as ultrafine particles formed from the vapor from e-cigarettes can be deposited into the lung. While we need more research to conclude the long-term effects of this, it is likely that being around the vapor from e-cigarettes could have negative effects on the lungs.

Get Help to Quit Vaping

To help people quit vaping—and smoking cigarettes—we offer smoking cessation programs that provides adults counseling, support, and the encouragement needed to quit. Please speak to your doctor for more information on enrolling in these programs.

The Food and Drug Administration (FDA) only began regulating the e-cigarette industry in 2016. While vaping is regularly advertised as harmless, it is important that people both understand the effects it can have on our health and be on the lookout for what future research might reveal.

The pituitary gland is about the size of a pea, and it’s located behind the eyes and the bridge of the nose on the bottom side of the brain. Though it’s tiny, it can cause huge problems if a tumor develops there.

When someone finds out that they have a pituitary tumor, their first reaction usually is one of fear or worry. They might wonder, “What’s going to happen to me? Where do I go to get help?” At other centers, answering these questions can be a challenge. It’s often difficult to navigate complex routes of testing, diagnosis, and treatment for pituitary tumors.

But it’s different for patients at the MedStar Pituitary Center at MedStar Washington Hospital Center. Our center brings together pituitary specialists with a single goal: giving patients expert care for pituitary tumors, including surgery, if needed. And our dedicated team produces results:

• Less than five percent of our pituitary surgery patients need hormone replacement therapy after surgery, compared to 15 to 20 percent at other centers
• The typical rate of pituitary tumors recurring, or coming back after surgery, is less than 15 percent, but ours is less than two percent; and for our patients who make it to five years after surgery without recurrence, their risk drops to less than one percent

WATCH: Dr. Aulisi discusses the MedStar Pituitary Center

Understanding Pituitary Tumors

The pituitary gland is what we call the “master gland,” as it produces hormones that help control many of the body’s processes, including:

• Healthy bone and muscle mass
• Normal function of the reproductive system
• Temperature regulation
• Thyroid function

It’s often surprising to people when I tell them how common it is to have a pituitary tumor. One review of multiple studies found that the prevalence of noncancerous pituitary tumors is about 17 percent. But the real number might be even higher. The American Cancer Society notes that as many as one in four people might have a pituitary tumor without knowing it.

Fortunately, most of these tumors never cause problems and don’t need treatment. In fact, we often see patients with pituitary tumors that are picked up during imaging tests for some other reason, such as a head injury or a car accident.

On occasion, some patients will notice the effects of pituitary tumors and get checked out by their primary care doctors, who refer them to us. Once a patient is referred to the Pituitary Center, we move quickly:

• They’ll likely see me and one of our endocrinologists on the same day to determine whether the tumor is affecting their hormones.
• They’ll see our neuro-ophthalmologist to evaluate their eye function within the same week, as large pituitary tumors can press on the optic nerve and cause vision problems.
• In most cases, patients can avoid surgery by taking highly effective medications to control tumor growth.

But if a patient needs surgery due to severe symptoms or uncontrolled tumor growth, we’ll schedule it within a couple of weeks of their first appointment with us.

WATCH: Learn about the team approach at the MedStar Pituitary Center

We are a national referral center for pituitary tumors, and part of the reason for that is our high level of expertise in treating them surgically. We see 400 to 500 patients in the Pituitary Center each year. Of those, about a quarter to a third need surgery.

Pituitary Surgery Options

My colleague, otolaryngologist Stanley Chia, MD, and I most often remove pituitary tumors with a minimally invasive approach, which involves smaller incisions and less pain for patients. For many patients, it’s more like sinus surgery than brain surgery in terms of the impact on them. We use two minimally invasive techniques:

• Transsphenoidal: through a small incision in the nose or under the upper lip, along the cartilage that separates the nostrils, and into the brain
• Endonasal, or neuroendoscopic: through a small incision in the back of the nose and into the brain

If a patient isn’t a good candidate for one of these minimally invasive techniques, I can operate through an approach called a craniotomy, which is an opening I make in the patient’s skull.

We also have an advantage over every other hospital in the mid-Atlantic region: our advanced imaging tool, the Airo Mobile Intraoperative CT system. The Airo scanner gives us 3D image guidance that’s accurate to less than a millimeter. We can scan our patients during surgery to make sure we removed all of their tumor, and the 3D guidance gives us never-before-achieved surgical accuracy amid the delicate tissues around the pituitary gland to reduce the risk of damage to the blood vessels or nerves around the eyes and brain.

Recovery after Pituitary Tumor Surgery

We usually keep patients in the hospital for at least a few days after surgery. It’s important to monitor changes in endocrine function that can occur within the first two to three days after removal of a pituitary tumor. Patients need expert, inpatient care during this time because they can get sick quickly at home without monitoring.

After our patients go home, they are usually off work for one to two weeks after minimally invasive surgery or several weeks after a craniotomy. During this time, they are under activity restrictions, which typically include no:

• Bending at the waist
• Blowing the nose
• Heavy lifting
• Twisting at the waist

We also tell patients to watch for clear, watery drainage from the nose, which could be a sign of a leakage of cerebrospinal fluid (CSF), a potentially life-threatening condition. Some centers’ rates of patients with CSF leaks after surgery is as high as 30 percent, whereas ours is less than five percent.

A small number of patients will need to start hormone-replacement therapy (HRT) after their pituitary surgery, depending on the location of their tumor and how it affected their body’s hormone levels. And some patients who were on HRT before their surgery can stop taking it afterward. One of the more common benefits of pituitary surgery we see is increased fertility in women whose tumors affected their hormone levels.

Better Results for Patients after Pituitary Surgery

We are aggressive with tumor removal and treatment after surgery, such as radiation therapy, to provide the best results for our patients. And our persistence and precision pay off in successful patient outcomes. I recall a patient who previously had undergone pituitary surgery at another center. The surgeons there failed to remove her entire tumor, and she also experienced a CSF leak that wouldn’t stop, putting her at serious risk for meningitis. She was near death when she came to us, and her family was understandably hesitant for her to have another surgery. After answering their questions and thoroughly explaining the recommended procedure, we were able to find and remove what remained of her tumor and repair her CSF leak. Ten years later, this patient is doing well, but there’s no question she would have died without the care she received at MedStar Washington Hospital Center and the MedStar Pituitary Center.

Through this process of diagnosis, treatment, and follow-up care, all of us at the Pituitary Center form lifelong bonds with our patients. We check in with our patients over the years, and many refer their friends and loved ones to us if they develop pituitary issues of their own.

Everything has to come together for patients who have pituitary tumors. Someone has to notice their condition, they have to get an accurate diagnosis, and they have to find a team of experts to provide the care they need. My teammates at the MedStar Pituitary Center and I are dedicated to making that happen every day for each of our patients.