 Welcome back. So, watching the breakfast on Plus TV Africa, a colorectal cancer awareness month is observed in March to highlight the importance of screening for colorectal cancer as well as to promote healthy lifestyle habits that can decrease the presence, risk of developing cancer of the colon, rectum, or the anus, three distinct cancer types referred to collectively as colorectal cancer. The International Agency for Research on Cancer, the IARC, estimates that the global burden of colorectal cancer will increase by 56% between 2020 and 2040 to more than 3 million new cases per year. Now, the estimated increase in the number of deaths from the disease is even bigger or larger by 69% to about 1.6 million deaths worldwide in 2040, very grim statistic I might add. Most of the increases are expected to occur in countries with a high human development index. Now, we would like to know what colon cancer is and how it can be prevented. And I'm glad to say we have joining us live from New York City in the United States of America to answer this all-important question and other questions. Health expert Dr. Nesochio Kekebukwe, and we're glad to have you. Dr. Kekebukwe, good morning to you and thanks for joining us. I take it that it's still morning in your part of the world. Good morning. Thank you for having me. Yes, it is. It's 3 AM over here, but I'm happy and glad to be with you. Thanks for taking the time to wake up and join us for this very important subject. So for those who are wondering, what exactly is colon cancer and can you help us explain the difference between colon cancer and colorectal cancer? So when we're talking about any cancer in general, you have to just understand that a cancer is an abnormal growth of tissue. Basically, growth of cells that are just kind of going out of control that have been damaged. These cells become damaged or changed due to what we call DNA mutations. Just means that there's been a change to the DNA in some of the cells and then these cells just kind of grow out of control. When this occurs in the region of the body known as the colon or the rectum, we call it a colorectal cancer, meaning that you now have this abnormal proliferation of cells in this region of the body. So that's just a basic rudimentary of fundamentals to kind of understand what a colon cancer is. Now these mutations or changes that can come about to some of those cells in the body, they can be inherited, meaning that it's something that was passed down in your family line, or it can just be acquired, meaning over the course of time this can occur. The majority seem to be acquired over one lifetime. Some of these changes that can lead to a colorectal cancer, but we're not sure why exactly this happens, but we do know that there are risk factors that contribute to having this happen. Okay, so let's talk about the risk factors now that can cost it because you have mentioned the fact that it could be hediditry, and so there might be some genetic factors to that one. But what are the risk factors that can cost the colon cancer? So the various risk factors that can contribute to colon cancers include certain behaviors and lifestyle choices that one may choose over the course of their life. So for instance, studies have shown us if you are somebody who is a smoker that increases your risk dramatically for colon cancer. If you are somebody that adheres to a certain kind of diet, certain dietary choices can contribute to it. So the food that you eat, it really does matter. So a diet that's high in processed foods, red meat, those kinds of dietary habits can highly contribute as well to colon cancer. If you are somebody who is obese or overweight, that excess weight on your body also contributes as well to the potential development of a colon cancer over time. So adhering to a healthy weight throughout the course of your life being physically fit and active, that helps reduce your risk. A sedentary lifestyle also increases one's risk of colon cancer as well. So just maintaining overall healthy lifestyle choices and lifestyle changes over the course of your life will really help reduce your risk. And also something to note, those that drink a lot of alcohol, increased or excessive alcohol use can also increase one's risk for colon cancer through the course of your life. And of course there are those other factors that you cannot control that increases your risk. So we just talked about some of the factors that you have some control over because you can change some of the things in your lifestyle like diet, exercise, the habit that you are a smoker and you can stop smoking. The things that you can't control that would increase your risk just being older. As everyone gets older, the risk of colon cancer increases. And we touched upon the hereditary component as well. So if you do have a family member, a first degree family member, meaning your mother or your father or sibling that has had colon cancer, colorectal cancer, that increases your risk as well. So key thing is you need to kind of be aware of what your risks are. You need to know what your family history is of colon cancer. And most certainly you should always speak to your doctor to determine if you are at high risk, average risk or a low risk for a colorectal cancer. Quite interesting and lots to think about there. Let's look at the signs and symptoms. I mean what do people need to look out for to be able to say I need to get myself checked and then do we need to wait till we see these signs and symptoms. So first of all tell us about the symptoms and signs. And of course later you'll tell us what people need to wait or they can go ahead and do some sort of screening before they even see these symptoms and signs. There are certain signs and symptoms that should be one to head to their doctor right away. So a couple of things to keep in mind. If you are noticing that you are having blood in your stool or rectal bleeding, that is really a big sign that you need to get checked out right away. So rectal bleeding, blood in the stool, get checked out. If you have unintentional weight loss, basically you just notice that you've been losing weight without even trying, coupled with other gastrointestinal symptoms, that's a sign as well. So you might notice that you've been having consistent or chronic gastric or mid-abdominal pain that was not there before. And you're noticing that weight loss that you didn't intend to have, that is a sign as well. Basically changes in your bowel habits from your baseline. So if you're someone who's had pretty much normal bowel habits and all of a sudden you're noticing this change whereby you might have excessive outer diarrhea, excessive amounts of constipation. It's a change from your normal bowel habits. You need to get checked out as well. If you notice the caliber of your stool is changed, meaning that you notice that now your stool is now pencil thin. That's a sign as well that you need to get checked out. But with that said, some people who are found to have colon cancers, sometimes they don't even have any symptoms. So that's why we really hone in on getting screened. Screening is so key. So to answer the second part of your question, absolutely not. You should not be waiting until a symptom develops. What you should be doing is adhering to the guidelines. Basically stating that at a certain point in your life, you need to initiate screening with what we call a colonoscopy, which is a procedure that looks and visualizes the colon to determine if there are any abnormalities like abnormal growth, like polyps or any changes that look like they are pre-cancerous or cancerous in nature. And the key is the timing of it all. When are we going to start having these screening colonoscopies? In the past, it used to be at age of 50, we'd start these screening colonoscopies, but what the research has shown us is that more and more individuals are presenting with polling cancers at an earlier age. The incidence is on the rise pretty much globally in the States, in the US and Nigeria as well. We're seeing a lot more of these colorectal cancers at a younger and younger age, so therefore the guidelines have changed no longer at the age of 50 that we start the screening colonoscopy. We now start the screening colonoscopy at the age of 45. With that said, it might be a little bit different for certain people that have a family history. So let's say you're an individual who has a family history of a first degree relative, let's say mom, dad, or siblings who have a colon cancer and let's say they were diagnosed at the age of 40. You want to be screened 10 years before the time that first degree family member was diagnosed. So if they were diagnosed at 40, their screening should be starting at the age of 30, because you're just at higher risk by virtue of having that first degree family member with a colorectal cancer. So all that to say, 45 for somebody who's at average risk, you have a family history. It really depends on the age at which that family member was diagnosed. You're concerned about your risk. It's always great to just check in with your doctor because they can really just guide you in regards to what you need to be doing and at what stage you need to be getting screened for colorectal cancer. Interesting. You talked about, and it's interesting you also looked at talk about the age and you're saying it's no more for people 50 and above. It's affecting younger people. Is there a sex specific aspect to this? Is it more prevalent in a particular sex, male or female? That's the first question. The second question I have for you is, I know someone who had cancer. And based off of what you're saying, I think it was colon cancer. It's almost bringing tears to my eyes as you're talking because it was a painful loss, but at a time they had to do a sort of a process, a procedure to cut some part of his intestines. I believe some tract in his body so that they could stop the growth. But unfortunately, he lost the battle. But at a point, he began to, there was a bit of a desire to take some sort of sand and when we tried to inquire why he felt like eating sand, it was said that he lacked some nutrients and we advised to put him on plantains. And I think the plantain has irony of not mistaken. Is there something about this related to colon cancer? So to answer your initial question to determine who we are seeing that will have colon cancer is more, I think the key is not even looking at the difference in the tenders that are having colon cancer, higher incidents, but race plays a big factor. And that's why I really want to discuss this topic because we're just showing more and more the incidents in blacks. It is on the rise. It is increasing. We tend to be at higher risk. So it is key, male or female, if you are someone who is black, African, you need to really adhere to these screening guidelines to make sure you're not at risk and you are not developing these cancers at a earlier stage in life. So get to the second part of what you were asking. And again, I'm sorry for the loss of that friend that didn't survive their cancer, the polar cancer. The treatment really is going to depend on the stage of their colorectal cancer, right? With colorectal cancer, after it is diagnosed and what is being to have this condition, what your team of doctors will do is something called staging. Staging is basically letting us go. At what point this cancer has progressed to? And this is based on a few things. It's based on location, tumor size, and if the cancer has metastasized, meaning to spread to different parts of the body. So the different stages begin with stage zero, that's the earliest stage. Then it can progress to stage one, stage two, stage three, and stage four. Stage four is the end stage, that's the later stage of colorectal cancer. And that means at that point, the cancer is pretty much metastasized and spread to different areas and organ systems in the body. Based on the stage, that really dictates the kind of treatment that one may have to treat a colorectal cancer. So the treatment modalities can range from a couple of things. It can be surgical incision, it can be chemotherapy, it can be radiation. It can be a combination of all of those things, but it really depends on the point. Your cancer has been by, was it in the earlier stages, whereby we have a lot more treatment modalities to help have a better rate of survival, or is it at the end stages. We obviously always want to catch these cancers at the very early stages of the cancer. Again, that's why it is key to screen, even if you're not having symptoms. The takeaway is start the screening process at the recommended time, which is at age of 45. All right, so let's take a look at this. So you have the medical sector saying that you have the lung cancer, post-treat cancer, contributing so much about 41.9% if I'm not mistaken to the colon cancer. And I'd like to find out. So for those who probably would have suffered different kinds of cancer, the colon cancer could actually contribute to having maybe the skin cancer, the lung cancer, post-treat cancer, breast cancer. I want you to confirm how valid that statement is in our reporters. And secondly, what makes colon cancer distinct or different from every kind of cancer that you have, just like I have mentioned, the post-treat, the lung cancer, the breast cancer, or the skin cancer, in which of you. So to answer the initial question, when one develops a colon cancer, it always has the potential to pretty much grow even further and affect other organ systems, what we call metastasis. Meaning that if it's not caught early and we don't find it soon enough, there is that potential for it to spread to the lungs, spread to various regions of the body, metastasized to lymph nodes in various other organ systems. So it can contribute to the development of what we call metastasis, other areas of the body. So that's something that we need to be aware of. I think when we're comparing different cancers, it's kind of a complex thing to do. You can just make a statement that one cancer may be potentially worse than the other, because you have to put things in perspective with the clinical picture of the patient and what organ system it's affecting and the patient's overall health. With that said, one thing I think that is really key and what we need to focus on in any cancer in general is prevention, preventive health. That's something that is not so much focused upon in Nigeria. If we have good preventive health metrics and measures in a strong fortified health care system whereby there is this focus on prevention, or we should potentially be able to find out about the potential of these developments of these cancers in various organ systems at different points in one's life. So all that to say, if we have a focus on prevention and if you are seeing your doctor for your annual checkup, your doctor should really be letting you know at what point you should be screening for the different kinds of cancers. So, for instance, all women that are at the age of 40 or older should be screened for a mammogram to make sure that there's no issue with breast cancer. In the case for colon cancer, you start the screening for everyone at the age of 45. This guidance really should be dictated by your care team when there's a focus on prevention. If there is no focus on prevention, you get to a point whereby a lot of these cancers in general are found at the later stages of the disease process. All right, Dr. Okekeboko, you talked about prevention and one of the methods or directives you've given for prevention is to go for screening. And you mentioned the colonoscopy. Now, I'm aware that some persons listening may not know what you mean by colonoscopy, so can you please break down that down for us? And also, how often should this be done? You've talked about from the age of 45 upwards, but how often should a colonoscopy be done? You know, is it every two years? Is it once a year? And please tell us. So, when I'm referring to the colonoscopy, this is pretty much a procedure whereby a scope, a tube with a camera at the end of it, the best way to understand it, is based through the bottom of an individual through the rectum. And basically, the gastroenterologist will visualize the entire colon. So all that means is that this screening method is enabling that doctor to look and visualize through the colon to see if there have been any kind of potential growths, abnormal growths, any kind of tumors, any kind of cancers that are visualized. How often does that need to be done? It all depends on what is found when we do that initial screening colonoscopy. So let's say you do the initial screening colonoscopy at 45, and it's A-O-K, there's nothing that's found on the screening colonoscopy, no abnormal growth. It looks like a very healthy colon. The next time that you would have to do the colonoscopy would be the 10 years later. But you would have to basically have your regular checkups with your doctor, of course, if there were any symptoms that developed in the interim, it might have to be sooner than that, but it would be 10 years after the initial screening if the initial colonoscopy were found to be OK. That all changes. Yeah, please go. I was going to say those guidelines change based upon what may or may not be found. So let's say that upon screening, a certain kind of polyp and abnormal growth is found. That would change things. It's like something that's able to be removed, and the pathology report shows a certain form of a disease process, and it really all depends on the time frame for when the next screening would be shorter. It might be at a five-year interval. It might be at a three-year interval. It really depends on what is actually found. I know I've heard somewhere talk of testing the feces. Is this something that can be done to also check to see if one has colon cancer? So some of the tests that you're referring to, just testing the fecal matter, what we're checking for is to see if there's what we call occult blood, evidence of residual blood that is showing up in the stool. That is found in the stool. You can't, per se, diagnose and state that you now have a colon cancer, but it does allow one to understand that there is something going on that is unusual if you do have that occult blood. That would prompt one to have to have that colonoscopy, that screening test and visualize the colon to determine exactly what is going on in the colon. Colonoscopy is pretty much the bold standard in regards to trying to figure out what is going on with your colon health. Some of those fecal tests to find occult blood, those things kind of if you, it's an indicator to let you know that something is off and you need to have that colonoscopy anyhow to determine exactly what is the problem for one now. All right, so let's look at it now in a holistic formal pattern, however you want to put it, the fact that there's awareness that's going on for colon cancer. So what should generally people know about? What should one know about whether the female gender or you have the male as it is and everyone involved generally as the campaign continues? So the main takeaway is really knowing the symptoms. We talked about the red flag symptoms and basically getting screened at the appropriate age. But that said, looking at things holistically, you have to make sure that you always adhere to overall healthy lifestyle choices to lower your risk for colon cancer. These lifestyle choices that you make will also lower your risk for other illnesses, for other kinds of cancers. So if there's one thing you want to do at this point is really make sure you're adhering to a healthier diet. If your diet is high in red meat, processed meats, you wanna eliminate that. You really wanna fortify the kind of diet and foods that you're eating and make sure that it's enriched with whole grains with vegetables, fruits, things that will be good for not only your colon health, but also for other organ systems. You wanna make sure that you are actually maintaining physical activity on a day-to-day basis. Visual recommendation, you should be getting at least a minimum of 30 minutes of exercise five days a week, bare minimum. If you're not doing that and you're leading a sedentary lifestyle, that's really a problem that's gonna affect your overall health and increase your risk for not only colon cancer, but also for other illnesses and conditions. So you wanna make sure that you also eliminate poor lifestyle choices. If you're a smoker, you need to quit. Today's the day to quit. Highly increase your risk of colon cancers, other kinds of cancers, and other health conditions. And you wanna minimize your alcohol intake. These are all day-to-day lifestyle choices that every single person has control over in order to basically try to optimize your health and get you in a better path towards better colon health and better overall health in general. So would you classify this lifestyle choices like you have mentioned as non-pharmaceutical ways of preventing colon cancer? I'm not referring to any kind of pharmaceutical treatment modality to you on the right path. This is kind of something that everyone can do on a day-to-day basis. If you're somebody that has just not been physically active or not moving around as much as you have, maybe because of the contaminate, you are indoors all the time, you didn't have the chance to exercise. Today is the day to start, really to get the body moving, get the heart pumping. There are things that you can do on your own that you don't have to depend on pharmaceuticals or medications to optimize your health. Exercise, taking a walk, that's free. You don't have to pay for that. You can just initiate that into your lifestyles. So I talked about non-pharmaceutical. Yes, non-pharmaceutical. So exercising, that's non-pharmaceutical. That's something you have control over doing on a day-to-day basis. Non-pharmaceutical, adhering to proper choices in regards to your diet. Meaning not going out to eat so often, not eating a lot of as fruits, not eating a lot of processed fruits. These are non-pharmaceutical choices that you can make on a day-to-day basis that can really help optimize things. All right, Doc, what's the outlook for one diagnosis with colon cancer, colorectal cancers where what are the chances of survival? Is there some statistic somewhere to tell the people surviving at a high rate or is it difficult to come out of? So it all depends, again, on the stage of the cancer. So just to give you kind of general outlook on things. If the cancer is diagnosed and found at an earlier stage, meaning from stage zero to stage four, which is the end stage, if your cancer is diagnosed and taken care of and treated during stage zero, your overall survival is much greater, it's much more improved, compared to somebody who has been diagnosed at the end stage, at stage four. Again, that's why we focus on the screenings because you're screened during those intervals that we discussed and you find the colon cancer at the very early stages, your overall health outcomes, your overall response to treatment, your overall survival is improved when it's found at the early stages. All right, we're hearing from the International Agency for Research and Cancer that over the next 18 years, we'll be having a quite astronomically increasing in the deaths from the disease. And they're saying that most of the increases are spread to the current countries with a high human development index. And we know where the countries that have a high human development index, which is a measure of how well human development is in these countries in key dimensions, like healthy life, long life and all that are. These countries are in the global north, as it were, you know, places like where you are. So is this to say that we in the global south or in the developing world and countries that have a low human development index should worry less about dying from colon cancer? I wouldn't say that those in Nigeria or on the African continent should worry us. Statistics are showing us that colon cancer, lorachal cancer, it's on the rise in blacks. It's on the rise in Africans. It's on the rise in this part of the world. So we should not kind of forget about the statistics that are showing that there is this kind of increased incidence based on race as well. Everyone should really maintain high alert and be aware about the possibility of this developing throughout the course of your life. Everyone is going to be at risk as we all get older. So this isn't something that should really be ignored or we shouldn't minimize the potential threat to your overall health that this can actually become. Okay, so let's talk about, you know, at the policy level, what do you think that government should do, you know, to help against the prevention or critical awareness in terms of colon cancer? There needs to really be more funding in the healthcare sector. Government really needs to focus on making sure that we have strengthened the healthcare system in Nigeria. Right now we're working with a very deep infrastructure when we're talking about healthcare system. There's an issue with overall access. Right now, if you ask the average Nigerian that is 45 or older, that they've ever gotten a colonoscopy, the chances are the answer is likely going to be, they're not gonna know where they need to go, how they're gonna access the colonoscopy. And chances are the likelihood of them getting screened, they're not gonna have any kind of, quote, checkup until they're actually developing symptoms. And at that point, when one develops symptoms, that's usually at the beta stages of the disease process. All that to say, there needs to really be a focus on fortifying the healthcare system, making sure there's an issue with access to care for all Nigerians, making sure that there's this focus on prevention so that they're able to really navigate the healthcare system and understand what needs to be done at various points in their life. This question of policy is very important because you've raised, you've told us that the steps you'll be taking to prevent and to screen, and you've talked about the colonoscopy, mammogram, and all that, the stages of treatment. You know, Nigeria, we live in a peculiar environment with a peculiar economic challenges. What are some of the lessons that you think we can borrow from the part of the world where you find yourself in terms of giving healthcare access, you know, in terms of screening and treatment and all that to people who are below the poverty line or people who are not part of those in middle class in the United States of America. We've heard of things like Obamacare and all that from this part of the world. What lessons can we on this side learn, especially in terms of government, in terms of policy, to make sure that those who are the base of society can have access to, you know, to the screening and prevention and treatment and all that. So, I mean, at this point, this is all chalked up to funding at the government level. There just needs to be fundamental restructuring of the healthcare system at this point in Nigeria. In regards to access, they're not a lot of basically free clinics or places available for Nigerians to get some of these treatments. A lot of things are basically you're paying out of pocket. If you don't have the funds and the means to do this, almost as if you're stuck or you're trapped in a situation that you can't get out of. I think it's not for the people in the country to figure out how we're going to increase the access. It's really on a policy level, it's really on a funding level to make sure those funds are really put into the healthcare sector to ensure that there is the possibility of having access to some of these things. But I think the takeaway for patients really would be to not ignore the signs and the symptoms. People often wait until things are kind of so severe, way too late. A lot of people are kind of like sticking time bombs getting to explore in regards to their health. A lot of things that are kind of swept under the rug and ignored. So the real takeaway is if you have access to a doctor that you trust that you can see, you really should have a routine checkup to make sure that you're not at risk for any of these issues that we are discussing. Any of these potential health conditions that can arise at various stages of life. So just don't ignore symptoms that can occur throughout the course of one's life. But with that said, we await for the government to really try to restructure healthcare in Nigeria and make it possible for increased access to all Nigerians. All right, so basically it's down to you take passenger responsibility for your health, while we wait for things to get better. Dr. Nesochie Okeke Bokeh, fantastic delivery from you. And of course, we're taking a lot away from this, I know of you as well, taking a lot away from this. She's a health expert and she's joined us live from New York. Thank you very much for your time. You've arrived and we have a great morning. You too. Wow, some grim, grim, grim statistics there and very important that people do the right thing to protect themselves. And of course, go get tested, go get screened, go do your colonoscopy, it's very important, especially if you're 45 years and above. Yeah, we're hoping that this actually pass, this message has been passed on and everyone will pay attention. But generally really, it's just unfortunate that we live in a culture society where we don't pay attention to our health. But I'm hoping that we'll understand the need to be responsible before we call on the government. And that's it this morning on our first segment, to take a break. All things Vinicore will bring you a second conversation right here. Stay with us.