5 GI Symptoms No Woman Should Ignore

When it comes to gastrointestinal conditions, symptoms can be as mild as a nagging stomach ache, or as serious as a sharp pain that lasts all day.

“Any symptom that lasts more than a few weeks, or causes interruptions in sleep or your daily schedule should not be ignored,” says gastroenterologist, Farzana Rashid, MD, at Penn Medicine Radnor. “However, there are several symptoms that should never be ignored, as they could be the sign of a more serious problem.”

Dr. Rashid says the following gastrointestinal (GI) symptoms should never be ignored:

Blood

GI bleeding is not normal and needs to be evaluated. There are many different causes of GI bleeding including an ulcer, hemorrhoids and cancer. “Anyone experiencing blood in the stool or blood in vomit needs to be formally evaluated,” explains Dr. Rashid. “At Penn Medicine Radnor, physicians perform procedures like endoscopy, colonoscopy and capsule endoscopy, which uses an encapsulated camera to view the GI tract, in order to evaluate and diagnose GI bleeding.” These procedures are also available on Saturday mornings to accommodate patients.

Change in Bowel Habits

Farzana Rashid, MD,

Women who notice a change in bowel habits should seek evaluation.“If you are passing less frequent stools than you were, or if you have diarrhea that lasts longer than two weeks, you should be evaluated by your health care provider,”says Dr. Rashid. “Diarrhea can be a symptom of something simple like a change in medications or an infection, or more complex like celiac disease or inflammatory bowel disease.”And when it comes to constipation, what is normal? “The answer depends,” says Dr. Rashid. "You know your body the best. There is no rule that states you must have a bowel movement once a day, but if you notice you are going a lot less frequently than you are used to, you should see a physician.”

Long-Standing Heartburn

Since the advent of over-the-counter medications that treat heartburn, many women have become used to self-medicating to treat their frequent heartburn. “Over-the-counter medications are okay, but if symptoms are not getting better in a few days, you should seek medical attention,” says Dr. Rashid.

That’s because long-standing heartburn can be a symptom of something more serious. Long-standing heartburn from acid reflux can cause other problems down the road. “It’s also important to understand that prolonged uses of some over-the-counter medications can have certain side effects including the possible increased risk of bone fractures,” adds Dr. Rashid. Generally speaking, if you are experiencing frequent heartburn, see your doctor.

Difficulty Swallowing

If you have problems coordinating your swallowing, difficulty getting food from your mouth down your esophagus, or you feel like food keeps getting stuck in your chest, it’s important to consult with a physician. “Difficulty swallowing or getting food through the esophagus into the stomach can mean there is an inflammation or some sort of narrowing or blockage within the esophagus,” says Dr. Rashid. “An upper endoscopy or a barium esophagram can be done to see what is going on. Also, Penn offers swallow studies, which are useful for patients who have problems coordinating their swallowing.”

Anemia

When most people think of anemia, or low iron in the blood, the first thing that may come to mind is diet. While having a balanced diet rich in iron can help raise low iron levels in the blood, there may be other causes of iron deficiency. “Women experiencing frequent and/or heavy menstruation may develop anemia,” says Dr. Rashid. “But anemia can also be a symptom of bleeding or malabsorption within the GI tract.” In other words, even adjustments to one’s diet may not have an effect if the body is losing blood or isn’t absorbing the nutrients. “Symptoms of anemia include feeling tired, dizzy, having heart palpitations, or being short of breath,” says Dr. Rashid. “A blood test can determine if someone is anemic; however, only GI testing can determine if there is a cause within the GI tract.”

Gastroenterology Services at Penn Medicine Radnor

At Penn Medicine Radnor, there are seven gastroenterologists experienced in gastrointestinal disorders, including colon cancer evaluation, irritable bowel syndrome, gastroesophageal reflux disease, GI bleeding and celiac disease. Dr. Rashid says a multidisciplinary approach to care at Penn means patients benefit from the expertise of all specialties within the health system. Patients have access to radiology services, pharmacy, and laboratory testing on site at Radnor. “Women who come to Penn have access to nationally recognized leaders not only in gastroenterology, but in all specialties,” she says. “We all work together, which means more comprehensive care under one roof.”

Learn more about gastroentrology at Penn Medicine.

This article originally appeared in the Penn Health for Women Newsletter and on the Penn Health for Women blog.

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How a Pair of Genes Changed a Life

“Muir-Torre is a hiccup in my genetic repair cells that creates a high risk of many types of cancer. But ironically, this genetic mutation also saved my life.” -Julia*, cancer survivor

Julia’s* cancer journey began in June 2009 when, at the age of 29, she was diagnosed with uterine cancer—a disease her mother Jane* battled and won years before. At the time of Julia’s diagnosis, Jane discovered she had Muir-Torre syndrome—a form of Lynch syndrome— an extremely rare genetic disease that makes its victims highly susceptible to cancer.

Further testing showed that Julia carried the MSH2 mutation, one of the two genes linked to Muir-Torre syndrome.

Julia found hope and answers about her rare genetic mutation at the Abramson Cancer Center’s Gastrointestinal Cancer Risk Evaluation Program from Anil Rustgi, MD, who identified her mutation and created a preventive care regimen, and from Steven Fakharzadeh, MD, PhD, a genetic skin disorder specialist who monitors her skin for mutations that can occur with Muir-Torre syndrome.

Julia’s story didn’t end there. During her treatments, and because of her MSH2 gene, she made the difficult decision to have a total hysterectomy. While this radical procedure took away her ability to have biological children, it led to a diagnosis of early stage ovarian cancer. Fortunately she did not need to undergo radiation or chemotherapy because both cancers were detected early in their most treatable stage.

“I was very lucky,” she explained. “Most women with ovarian cancer do not know they have it until it’s progressed.”

Today, Julia is cancer-free and actively spreading awareness about this complicated, rare genetic mutation that can be a precursor to cancer. She wants to pass on the most important lesson that she took away from her experience— knowledge and preventative care are the keys to survival.

She started with her family, and has already seen positive results. Her uncle who tested positive for Muir-Torre syndrome found a benign polyp during a colonoscopy. At 49, an age below the timeframe for routine testing, he is already benefiting from getting tested early.

“If I helped just one person think twice about their own family genetic makeup or current health status, then I know, despite everything, I made a difference.”

Read Julia’s personal account of her cancer journey here.

To learn how to support research efforts for Muir-Torre syndrome contact, Katie Dewees-Detzel at kdewees@upenn.edu or 215-746-1927.

*Pseudonyms

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A Team Approach to Treating Colon and Rectal Cancer

Cary B. Aarons, MD, is an assistant professor of surgery in colon and rectal surgery. In this blog, he discusses surgical treatment of colorectal cancer.

Colorectal cancer is the third most common type of cancer diagnosed in the United States. Fortunately, the overall prognosis for treating colorectal cancer is quite favorable if it is discovered early. In fact, up to 90 percent of patients whose colorectal cancer is diagnosed and treated in the early stages can be cured.

The management of colorectal cancer requires a team approach. From the time of diagnosis, comprehensive treatment demands a coordinated effort between the patient, family, gastroenterologist, oncologist, and surgeon. At Penn’s Abramson Cancer Center, every patient receives a multidisciplinary approach to their cancer care, meaning every member of the team involved in their care works together under one roof.

Experienced patient navigators also assist patients throughout the course of their treatment.

The treatment recommended primarily depends on the stage of the cancer, or the extent to which the cancer has spread.

Surgery offers the only potential for curing cancers localized to the colon and rectum. Invasive cancers localized to the colon typically require a partial colectomy, a procedure in which part of the colon is removed. This procedure is often done with laparoscopic surgery. The surgeon makes smaller incisions in the abdomen through, which specialized cameras and instruments can be inserted. This minimally invasive approach is often less painful and results in a quicker recovery. Laparoscopic and robotic-assisted surgery for rectal cancer are still being studied.

A physician may recommend chemotherapy and radiation be used initially to treat invasive cancers localized to the rectum to decrease the possibility of recurrence after surgery.

Advanced cases of colorectal cancer require chemotherapy and in select cases, there may be a role for surgery.

Learn more about treatment options for colorectal cancer at Penn’s Abramson Cancer Center.

Watch Focus On Gastrointestinal Cancers – an educational conference for patients with a gastrointestinal cancer.

March is colorectal cancer awareness month – learn more.

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Colorectal Cancer 101: Increase Your Awareness

Cary B. Aarons, MD, is an assistant professor of surgery in colon and rectal surgery. In this blog, he discusses colorectal cancer, it’s causes, screening and treatment options, including surgery.

Among adults, colorectal cancer is the third most common cancer in the United States. It is also the second most common cause of cancer-related deaths every year.

These statistics generally mean very little to the average person until they are faced with a colorectal cancer diagnosis. Then, at least initially, nothing else seems more significant.

Fortunately, the overall prognosis is quite favorable if colorectal cancer is discovered early. Up to 90 percent of patients whose colorectal cancer is diagnosed and treated in the early stages can be cured.

Most colon and rectal cancers begin as adenomas, or small polyps, that can progress over time and invade the wall of the bowel. In their later stages, colon and rectal cancer cells can spread to other parts of the body.

Know your risk for colorectal cancer

Roughly 75 percent of colorectal cancers occur in individuals who have an average risk of developing the disease. However, certain factors have been identified that can increase your risk, including:

• Age: Most people diagnosed with colorectal cancer are over 50.
• A personal history of colorectal polyps or colorectal cancer
• Inflammatory bowel disease: Chronic inflammatory diseases of the colon, such as ulcerative colitis or Crohn’s disease, can increase the risk of colorectal cancer.
• Family history of colorectal cancer: First-degree relatives of individuals with colorectal cancer are at increased risk of developing cancer themselves.
• Inherited colorectal cancer syndromes: Genetic syndromes present in some families, such as, familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC), can increase the risk of colon cancer.
• Racial/Ethnic background: African Americans have a higher incidence of colorectal cancer as compared to other groups in the United States.
• Lifestyle factors: A diet high in fat and low in fiber as well as obesity can increase the risk for colorectal cancer.

Colorectal screening saves lives

Since the early 1980s, the mortality from colorectal cancer has decreased steadily in the United States. In large part, these declines can be attributed to increased awareness and more pervasive screening. However, recent data show that one in three adults between the ages of 50 and 75 are not up to date on recommended screening for colorectal cancer.

Common screening tests for individuals of average risk include:
Fecal occult blood test - recommended annually
Flexible sigmoidoscopy OR double contrast barium enema - recommended every five years
OR
Colonoscopy - recommended every 10 years

Screening should begin at age 50 for the average person.

Other modalities such as CT colonography (virtual colonoscopy) and stool DNA testing are also being used but have not been widely adopted.

Individuals at increased risk (see risk factors outlined above) should be screened more frequently with colonoscopy.

Watch CANPrevent Colorectal Cancer – a conference designed to help those at risk for colorectal cancer.

March is colorectal cancer awareness month – learn more.

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Join the Abramson Cancer Center on Twitter

Today, Penn Medicine is live tweeting from three Focus On Cancer conferences.

 

 

 

 

 

Focus on Gastrointestical Cancer Conference

Penn’s Focus On Gastrointestinal Cancer Conference provides patient-focused information about the latest advances in gastrointestinal cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues; as well as the opportunity to network and gain support from other gastrointestinal cancer survivors.

Follow @PennMedicine for live tweeting throughout the conference with the hashtag #GICancerACC.

Chat with the Experts
Visit www.OncoLink.org/Webchat to participate in a live webchat with gastrointestinal cancer experts from the conference. The webchat takes place at 11:45 AM, ET March 2.

Focus on Pancreatic Cancer Conference

Penn’s Focus On Pancreatic Cancer Conference provides patient-focused information about the latest advances in pancreatic cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues; as well as the opportunity to network and gain support from other pancreatic cancer patients and survivors.


Follow @PennMedicine for  live tweeting throughout the conference with the hashtag #PanCancerACC.

You can also join the conference via free livestream at PennMedicine.org/Abramson/PanCaLive from 7:30 am to 3 pm EST on March 2.

Chat with the Experts
Visit www.OncoLink.org/Webchat to participate in a live webchat with pancreatic cancer experts from the conference. The web-chat will take place March 2, 1:15 pm, ET.

CANPrevent Colorectal Cancer Conference

Penn's CANPrevent Colorectal Cancer Conference provides information about colorectal cancer prevention, screening, managing high-risk, and genetic factors that contribute to colorectal cancer.

Follow @PennMedicine for live tweeting throughout the conference with the hashtag #CANPreventACC.

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