What goes down there at the Colorectal Specialists?

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The colorectal cancer doctors are in: Dr. Marc Lopez and Dr. Dione Sacdalan are only the 20th and 21st graduates of the 29-year-old PGH program for colorectal cancer specialists. They’re available for consult at the country’s first outpatient colorectal specialty clinic in the country, located at the MEDICard Lifestyle Center in Makati.

In the Philippines, we can take heart in the fact that we have a lot of competent cardiologists around. And for those with sagging spirits who need a lift somewhere, they can revel in the fact that we do have a lot of very good plastic surgeons/dermatologists. But did you know that there are less than 40 colorectal surgeons in the Philippines, and that MEDICard Lifestyle Center has launched the first outpatient colorectal specialty clinic in the country?

  The clinic, which opened only last October, is designed to make cost-effective care for colorectal problems accessible to the public, what with colorectal diseases now the fourth leading cause of cancer deaths globally.

  “We can see patients for consult. We can also do out-patient procedures under local anesthesia. We can do endoscopies, minor operations like excisions of hemorrhoids, management of fissures in the operating room of this building,” says Dr. Dione Parreño-Sacdalan, one of only two practicing female colorectal surgeons in the country today, the other being Dr. Catherine Sim Co. Both are affiliated with PGH and The Medical City.

 Dr. Sacdalan had her post-residency training in colorectal surgery at the Philippine General Hospital (PGH). She also had further training focusing on anorectal diseases and minimally invasive surgery at the Chulalongkorn Memorial Hospital in Thailand and had colorectal observership stints in the University of Minnesota Medical Center in Minnesota and Memorial Sloan-Kettering Cancer Center in New York, USA.

 “We’re the first organized group of colorectal surgeons offering outpatient clinic services in the country,” Dr. Marc Paul Jose Lopez introduces himself. “There are a lot of concerns among a good part of the population about colorectal diseases, anorectal diseases such as hemorrhoids, abscesses (pigsa) and fissures (punit sa puwit). The spectrum goes further down to colorectal cancer, which is at present on the rise.”

 Dr. Marc Paul Jose Lopez is one of the two male colorectal surgeons in the clinic, the other one being Dr. Carlo Cajucom. Dr Lopez had his post-residency training in colorectal surgery at PGH and his post-fellowship training in advanced laparoscopic colorectal surgery in Vietnam. He also had further training in colorectal surgery specializing in anorectal diseases and laparoscopic colorectal surgery in Thailand. He is currently a consultant at PGH, Asian Hospital and Medical Center, and Manila Doctors Hospital.

While there’s no clear shred of evidence on what causes colorectal cancer, the problem is mostly associated with low fiber and high animal fat intake.  

 Dr. Sacdalan gives us the lowdown: “There are different regions in the gastrointestinal tract. From the mouth, the food goes to the esophagus and then to the stomach. And then it goes to the small intestines, then the large intestines or the colon, and then down into the rectum and out into the anus. In cases of colorectal cancer, we have to differentiate where the mass is because the management differs. That’s one of the things we’re able to provide to our patients: an in-depth discussion not only of the disease but how it will affect them and their families.”

 What are the symptoms?

 “Still most common when it comes to the colon is abdominal pain; for rectum, it’s blood in the feces,” Dr. Lopez asserts. “Symptoms of abdominal pain, difficulty in defecation, blood in your stools may already indicate that in all likelihood your tumor may be in an advanced stage or it may already be huge. That’s why we advocate screening for the general population when they’re not feeling anything yet. The recommendation is that at 50 years of age, particularly for those with no family history of colorectal cancer, without any symptoms, they come in and we can perform a screening procedure on them. It can start earlier if the patient’s father or mother has colorectal cancer.”

 “We catch these patients already in an advanced stage because we don’t have a screening program similar to what they have in the States or Australia, where patients have access to medical care,” Dr. Sacdalan explains. “And if we recommend colonoscopy, for instance, for an average-risk patient, it would cost a lot. The cost in itself is prohibitive (a colonoscopy generally costs P15,000 to P25,000, depending on who will do it, where it will be done, etc.).”

 She points out, “Screening will demonstrate possibly polyps and hinder growth later on. Or if there’s a cancerous mass already, we can recommend treatment while it is still at an early stage.”

 Dr. Lopez laments, “The sad part is that screening is not part of our national health program, even in hospitals, there’s no hospital-based screening program. Unfortunately, this being the state of health of the country, we get most of our patients in Stage III already. When in fact we can get them in the earlier stage, of course it follows that the prognosis or outcomes are expected to be better.”

 Dr. Sacdalan notes with concern, “What’s sad is people don’t know that screening is needed at age 50, or as early as 40, if there’s a history of colorectal cancer in the family.”

 Sadder still is the fact that today, there are more young people, as young as 20, getting colorectal cancer in an advanced stage.

“There have been studies by one of our colleagues, that for Filipinos, the average age at time of diagnosis is earlier than that of Westerners and that it’s more aggressive,” says Dr. Sacdalan.

 “MEDICard accommodates cardholders who come for screening,” Dr. Lopez assures patients.  

What took the colorectal clinic so long to open?

Dr. Lopez hastens to reply, “It took long to have this because there’s only a limited number of colorectal surgeons in the country. In the society, there are only around 40 colorectal surgeons. Right now, there are only three training programs in the country — one at PGH, Jose Reyes Memorial Medical Center, and a new one in Davao.”       

 Marc and Dione are only the 20th and 21st graduates of the 29-year-old PGH program. The focus should be on prevention, early consult, and early detection.

 There comes a ray of hope: “If we catch them in the late stages, there’s still very much a chance for cure,” Dr. Lopez stresses. “When it comes to survival for colorectal cancer, it’s very good now as opposed to, say, when I was just a trainee because there have been a lot of improvements not only in the surgical techniques but also in terms of the other therapies, like chemotherapy and radiation. Even patients in Stage IV whom we would write off already before, now have a chance of even a cure, if not a better life. For Stage I patients, more than 90 percent are doing well in five years. It’s really better to catch it early for a better prognosis and there will be better outcomes.”

 The MEDICard Lifestyle Center Colorectal Clinic is now in the forefront of colorectal care in the Philippines. They utilize the multi-disciplinary team approach of management. “It’s not just the surgeon who decides or recommends whatever’s needed for the patient,” Dr. Sacdalan points out. “We also involve the medical oncologist, radiation oncologist, and other specialties like palliative care if it’s Stage IV or a pain specialist. The permutation of options is endless. It’s important that all the specialties are around so they can come up with the best approach for this particular patient. We try to tailor the treatment, depending on the patient’s preferences, their goals for treatment, their financial capability.”

 Colorectal Specialists offers diagnostic examinations such as examination for common anorectal conditions, sexually transmitted diseases, endorectal and endoanal ultrasonography. It offers treatments for hemorrhoids and fissures, acute and chronic anal pain, fecal incontinence and constipation, anal abscess/anal fistula, anal warts, inflammatory bowel disease, colorectal tuberculosis. And of course, it specializes in comprehensive management of colon and rectal cancer.

 Its staff offers state-of-the-art treatment options for hemorrhoids like rubber band ligation, stapled hemorrhoidopexy and trans-anal hemorrhoidal dearterialization (or THD).

For colorectal cancer which will entail hospital admission, the colorectal specialists offer minimally invasive surgery or laparoscopic surgery, robotic colorectal surgery, and anal sphincter preservation, which can be done at their affiliate hospitals. Some benign anorectal diseases can be managed in the clinic setting under local anesthesia while others can be performed in the operating room but still as a day or out-patient procedure. Not all colorectal and anal problems are managed surgically. Non-operative treatment options may be recommended when deemed necessary.

 For any problems, embarrassing as they may seem, down there on your bottom, help is always available since there are colorectal specialists in the house!

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