Hello, folks. Dr. Maurice Selby here, medical director, producer, and co-host of **Health in Harlem** on WHCR 90.3 FM and the **Health in Harlem Podcast**.
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Hello, ladies and gentlemen of the listening audience. My name is Maurice Selby, a.k.a. Dr. Mo Selb.
My name is Reed.
And you're listening to the one and only **Health in Harlem** on WHCR 90.3 FM, New York, the Voice of Harlem, and the **Health in Harlem Podcast**, featured on Apple Podcasts, Spotify, Podbean, Amazon Music, and many others.
Sorry, I had to throw that in there.
And with that said, ladies and gentlemen, March is **National Colorectal Cancer Awareness Month**, the official designation announced by President Bill Clinton in February of 2000.
It's insane, man. We're coming up on 30 years soon for this designation. But 26 years in, if anything, I am always really excited about this program when we talk about colorectal cancer, because I think as scary as it can be, ladies and gentlemen, especially as we get into some of the trends that are happening and that you probably see happening before you in the news media, when we talk about advances in diagnosis and care of colorectal cancer, there are many opportunities.
And so I'll say that, right, just to start it off: this is an empowerment program.
We do have to acknowledge that colorectal cancer is the third most common cancer diagnosed in the U.S., with more than 150,000 Americans diagnosed each year. It is the second leading cause of cancer-related death. And essentially, we're talking about the deadliest cancer in people under 50 years of age.
But again, opportunities are before us, right? Screening has significantly reduced mortality. We're going to talk about all of that. We're going to hit all of those points.
We have joining us tonight Dr. Arpit Chhabra. He is an attending radiation oncologist and director of education at the New York Proton Center, specializing in the treatment of central nervous system tumors, head and neck cancers, as well as malignancies of the gastrointestinal and genitourinary tracts. He is also an associate clinical professor in the Department of Radiation Oncology at Mount Sinai.
Before joining the New York Proton Center, Dr. Chhabra completed a dedicated proton therapy fellowship at the University of Maryland and was a practicing radiation oncologist with the Central Connecticut Radiation Oncology Group, specializing in the treatment of all adult malignancies, including colorectal cancer.
And also, we have to shout out Dr. Chhabra because he is the one who sort of kicked off this partnership with the New York Proton Center last year, joining us for the first time in April 2025.
Just excited to have you back, Dr. Chhabra. It's great to see you, as always, and thank you for spending this time with us and our listening audience.
Maurice and Reed, thank you for having me back. And as you said, I very much appreciate the invitation again, and we really look forward to continuing this partnership. So thank you both.
We'll jump right into the conversation here because we have a lot to cover, ladies and gentlemen. I was looking at this outline and thinking, man, we’ve got to beast through this. But this is really, really important information.
So why is colorectal cancer still such a major public health problem, despite everything we kind of mentioned up to this point—the availability of screening, the awareness campaign, just talking about it? What is sort of the biggest concern with it, I guess, still?
I think it's a very, very important question. You certainly highlighted the fact that colorectal cancer is one of the cancers that we have really effective screening tools for.
The challenge is that screening only works if individuals actually get screened.
And right now, we unfortunately see a large gap in screening uptake due to things like access, lack of awareness, and sometimes just hesitation about invasive procedures like colonoscopies.
So unfortunately, despite having good screening options, when screening does not happen, these cancers are often diagnosed at later stages, which makes them much more difficult to treat at that time.
The tools are there. It's just a public health challenge to make sure that they're used consistently and equitably.
And if we were to talk about sort of trends, right? I guess in talking about this sort of 26-year awareness nationally, especially when we talk about it each year in March in observance of National Colorectal Cancer Awareness Month, what are we seeing as far as trends with this illness?
Yeah, I think over that two-and-a-half-decade span that you're alluding to, a lot has actually changed.
One of the biggest trends right now, unfortunately, is actually the rise of colorectal cancer among young adults—people in their 30s and 40s.
What's interesting is that in older adults, overall colorectal cancer rates are actually going down, largely because screening is very effective. But in younger individuals, the incidence has actually been increasing over the past couple of decades, sort of this time period that we're talking about.
And it's kind of difficult to understand exactly why that's happening. Obviously, I say it’s multifactorial, like many things in health care are. That includes diet, obesity, and lifestyle. But the reality is that younger patients are also, unfortunately, not getting screened as frequently yet, and so the cancer is also presenting at later stages in this younger population.
And you know, what's interesting to me is that I've seen this. I think a lot of folks out there will relate as well. I'm talking from a personal standpoint.
I've seen this since I was an undergrad. A mentor of mine who was in the Black Male Initiative, a faculty member, was diagnosed as a young man at the time—what I would estimate was his 30s or 40s. I remember him being diagnosed, and us even as a group sort of talking about how you look at that as a young man being diagnosed with colorectal cancer, and his approach to processing that, but then getting treated successfully, fortunately.
But I remember that. This is in undergrad.
Even as a resident, one of my attending physicians was diagnosed as another young person in their mid-30s at the time. I think that was the oldest they could have been at that point.
So I've seen this—not just personally, but also in professional practice as well. Working in the emergency department, I can recall many patients where that was sort of the time we discovered, or at least got a person on the path to, a diagnosis of colorectal cancer.
And then if you didn't have a personal relationship, everybody listening to this program has seen what has been happening around us. Chadwick Boseman, James Van Der Beek most recently—both associated publicly with this disease.
I remember in 1998, during that Yankees run, multiple World Series at the end of the millennium, Darryl Strawberry. I remember that. This was even before the national awareness designation, right? Sort of being raised, this consciousness of this entity being raised.
So it just struck me in working on this program. I think sometimes it can be quite nebulous, or we don't really see the increased rates of some of the illnesses that we talk about on this program. But this one—I know I've seen it, and I know folks, and I’m pretty sure there are listeners out there now that have people they’re personally connected to or related to who have been diagnosed.
It's definitely becoming more common news, unfortunately, in the public domain.
So you're absolutely right. I think it's one of those cancers that people are becoming more aware of in this younger population as a result of that. And hopefully, while that's definitely distressing and difficult news, hopefully it's also motivation for a lot of what we're going to be talking about today, which is screening and prevention.
If we were to—because one of the things that comes up, Dr. Chhabra, and I know people have probably approached this with you many times—is what is behind these increased rates that we're seeing in younger individuals?
So it is quite difficult to pin down exactly what the reason is. I think it is quite multifactorial, and the exact answer is still not yet definitive.
Certainly, as we were alluding to, various dietary factors, various lifestyle factors, obesity, and even changes in gut bacteria and the microbiome—all those are factors that are likely contributing to what we're seeing.
Got it.
And then if we were to talk about colorectal cancer on a spectrum of prevention, what is unique about this particular cancer in comparison to some of the other things that we hear about—breast cancer, lung cancer, and things of that nature?
I think what's really somewhat unique is that screening is not just finding cancers early, but it's actually preventing them from happening in the first place. That's very unique for screening.
The reason being, a lot of colorectal cancers arise from precancerous polyps that haven't yet turned into cancer but would grow slowly over many years and turn into cancer. These can be identified on colonoscopy and removed before they turn into cancer.
So colorectal cancer becomes one of those cancers where screening is really not just about early detection of cancer, but even prevention through removal of these high-risk polyps. That makes it a really powerful strategy, obviously, to get screened.
Early detection and prevention. Ladies and gentlemen, hold on to those words, because I think sometimes we can get lost in the sauce with all of the stuff that we just sort of went through—the increasing rates, young people, public figures that we've seen lose their lives because of this, and even just the challenges with a diagnosis of colorectal cancer.
But just take a moment and focus on those words: **early detection and prevention**. Prevention. I want everybody to focus on that part right there—prevention.
Yeah, we definitely need to delve into this.
So what actually happens, if we can even just talk about some physiology? I think our listening audience—and I know this is something that’s fascinating for me in terms of how our body works—what is happening at the most basic level from a biological standpoint when we talk about colorectal cancer and its development?
Yes. So I guess a little science 101 for the evening.
Most colorectal cancers start as small growths in the colon, and these are the growths—the polyps—that we were referencing. Most of these polyps are benign, not cancerous, when they begin.
But over time, some of them can accumulate mutations at the genetic level that can cause these polyps to grow uncontrollably—the cells to grow uncontrollably.
When they grow at such a pace, they can kind of lose their normal ability to regulate growth and repair. The polyps can start becoming more invasive cancers, start going deeper into the colon wall, and can potentially spread elsewhere.
That whole process can take many, many years. It's not over days or months, but really potentially many years.
That's why screening is so effective, because you can find these polyps before they’ve turned cancerous, or anywhere in that developmental process. So if we can remove them early enough, we can interrupt that progression before cancer ever develops.
Got it. So might anyone have symptoms of that sort of slow-growing process? Is it common for a person to even have symptoms of these polyps developing in their colon? Might they know?
Yeah, I think one of the other things—a little bit of a scary thought—is that early colorectal cancers can sometimes present without symptoms.
The reason is that tumors can grow slowly over this long period of time. The colon itself is a pretty large space, so you could get a small tumor or a small cancer that’s already developed in one of these polyps, but it’s not blocking anything. It’s not causing significant pain, discomfort, bleeding, or any changes in bowel habits.
Those kinds of symptoms—like bowel habit changes, pain, bleeding, or discomfort—may not happen until the tumor is much more advanced. So at an earlier, smaller stage of this cancer, you could have cancer develop before symptoms even appear.
Again, really emphasizing why screening is so critical.
And this is another one of those silent killers, if you will, folks, that we’ve talked about in the past on this program. Hypertension—that’s what we traditionally refer to as the silent killer, right? You don’t have symptoms until the damage is done.
But it’s kind of similar with colorectal cancer. Especially when it comes to these polyps, these growths, as Dr. Chhabra said—they can be pretty silent.
And I’ll tell you from my own experience, I’ve shared this before on the program, ladies and gentlemen—I’ve had two colonoscopies up to this point. And with the first one, I did indeed have some polyps that were removed, and I had no clue.
Maurice Donovan Selby had no clue they were there, right?
Remember, folks, I got screened because my father passed away from colorectal cancer. That’s why I had to get that screening early. But I had no symptoms.
Everything—I always joke around as an emergency doc—there’s very little that I’m not willing to share. Everything was flowing smoothly, man. I had great bowel movements. But I had polyps. I had polyps and I would have never known. And Lord knows what they could have become if it were not for the screening, folks.
Yeah, I had to throw that in there. It’s just so scary. It’s scary, but I think this is empowering for folks to know.
But I think you also touch upon where our discussion was going, which is that there are some people who are at higher risk, and they have to understand what kind of adjustments to their screening they have to take relative to the general population, right?
So someone who has a family history like yourself, someone who might have an inherited genetic syndrome, someone who might have inflammatory bowel disease, which could be ulcerative colitis or Crohn’s—these are all individuals who can be at increased risk.
So these are individuals who do have to understand the different recommendations in terms of screening for them versus maybe the general average-risk population.
So I just wanted to kind of mention that as you brought that point up.
Got it. And by all means, too, the other part I wanted to add in, Dr. Chhabra, was that if you are having symptoms, ladies and gentlemen—because I don’t want to dissuade anyone out there listening from the fact that if you are having symptoms, you need to get evaluated.
If you have abdominal pain that is not clear in terms of what’s causing it, especially if it’s been going on for some time, if you experience changes in your bowel habits, especially if you start having blood in your stool, noticeable blood in your stool, weight loss—unexplained weight loss, right? You’re not on any diet, you haven’t been doing some fitness routine or challenge or something like that, and you’re just dropping weight—those could be signs as well.
Even things like anemia. It’s not uncommon in the emergency department for us to take care of patients and uncover that, hey, this person is anemic. Why are they anemic? And we sort of go through the questions and try to figure out why. But that can be a harbinger or an early sign of colorectal cancer.
And some of that anemia could even be just unexplained tiredness, difficulty, or unexplained shortness of breath. You’re walking up the stairs and you were fine a couple of weeks ago, and all of a sudden something just feels quite unusual.
I think, to your point, these are things that people should certainly be vigilant about, take notice of, and then seek appropriate medical care.
Word.
Yeah, so definitely want to get that out there for folks. I don’t want folks walking around thinking that, well, if I don’t have symptoms, then everything’s okay. It can’t be something like colorectal cancer.
But yes, especially if you’re having symptoms, get that checked out. Definitely want to get those things checked out.
So what are some additional risk factors? We kind of talked about family history and things like inflammatory bowel disease, but are there any other risk factors that a person should be mindful of, especially when you talk about modifiable versus non-modifiable?
Yeah, I think the modifiable ones are the ones I want to emphasize. And the reason they’re called modifiable is that there’s something we can do about them to minimize our risk.
That’s obviously diets that are high in red meat and processed foods. These are things that do correlate with a higher risk of colorectal cancer. Physical inactivity, obesity, reducing alcohol use, as well as smoking cessation—and not starting in the first place—but if you are smoking, then obviously minimizing that.
These are all really, really important risk factors you can change to minimize your risk.
You know, I want to bring attention to alcohol because last year, at the start of 2025, January 3rd actually—that was the day—I remember this because it was profound to me and the rest of our team on **Health in Harlem** when Vivek Murthy, the former United States Surgeon General, put out that advisory talking about alcohol and its connection to various cancers.
One of them was GI cancers, including colorectal cancer.
And it’s just something that at that time—the reason why he put out this advisory was because he was citing research showing that half of Americans had no clue about the connection between alcohol use or alcohol consumption and increased cancer risk.
Even in a close network of friends and family, it came up in conversation, and I mentioned it like, “Hey, one of the things that reduces risk is drinking less alcohol.” Everybody was shocked.
And this was a year later after that advisory went out. So we still have challenges.
Ladies and gentlemen, we still need to keep that at the forefront of our minds: the link between alcohol consumption and increased cancer risk, including colorectal cancer.
So just something to be mindful of. That’s the most important thing. We need to be mindful and understand this because it is modifiable, right? We cut that out and then we can potentially reduce our risk of developing these things at all.
Yes.
So if we were to shift into really one of the most powerful tools, I guess we can argue—actually, Dr. Chhabra might argue he has the most powerful tool when we get to talking about treatment.
But when we talk about even just preventing this in the first place, what is it about screening? What’s the hoopla, I guess?
Yeah. So let’s talk a little bit about the recommendations.
For the average-risk adult—and this doesn’t apply to the higher-risk individuals we were referencing earlier in the talk—but for the average-risk adult, the American Cancer Society and the U.S. Preventive Services Task Force recommend starting screening at about 45 years old.
There are many different forms of screening, different options. I’m sure everyone’s seen the Cologuard commercial.
Oh my goodness.
Yeah. So that’s a stool-based test, and that is definitely one option for individuals based on their risk profile.
There’s obviously colonoscopy, which most people have heard of. There’s also CT-based imaging colonography where you can image the colon.
So all of these are different ways of screening and testing, and they all have different indications in terms of your risk level, but also different recommendations in terms of how frequently they should be done because they’re looking for something different.
So it is something to talk to your medical provider—your primary care physician—about: what’s the right test for you, your family history, your medical history, your lifestyle, your risk profile, and then also how frequently it should get done.
Got it. Yeah, definitely have that conversation, folks, with your primary care physician—or even if you are seeing a specialist, especially if you’re having some of those symptoms that we were talking about earlier, like blood in your stool or unexplained abdominal pain.
Definitely ask about these options.
And really what excites me about this is that we do have options, right? That is the thing.
I think when folks talk about colorectal cancer screening, they sort of automatically jump to a lot of the invasive things, such as colonoscopy, as screening tools, when actually, ladies and gentlemen, we have a menu of options before us now.
At this point in time in medicine, there are options, and you are empowered when you know what those options are.
And as Dr. Chhabra said, they have different characteristics—different strengths and weaknesses—but that is why we want you to engage your provider, whoever takes care of you, your primary care physician, physician assistant, nurse practitioner, whoever you go to for regular medical care, or whoever you might be engaging for specialty care.
These are the questions you should ask. What are my options? What is the menu of options before me? And why, based on my risk level, might one particular test be better than another or more useful than another when it comes to screening?
Anything that you’ve encountered, Dr. Chhabra, as far as common pushback from patients or questions—because yes, we’ve talked about access being one of the barriers—but I think, again, going back to folks having that vision of this really sensitive test and potentially invasive procedure, any sort of common apprehensiveness about it?
Yeah, you mentioned lack of access. That’s obviously one barrier that we sometimes see to screening.
Unfortunately, insurance is another one, which I wish weren’t the case. But I think in all of health care, insurance can sometimes be a barrier. Obviously, if you have the right indications and the medical necessity as an individual, that should not be an issue. You should get insurance approval for these procedures.
Then there’s also just day-to-day logistics, right? We have busy lives personally and professionally. Sometimes it’s difficult to take time off, go to a facility, and be in recovery. Those are all real barriers that we have to address.
There may also be a knowledge gap, and hopefully some of what we’re doing tonight is going to minimize some of that. But there is obviously a knowledge gap from community to community.
So these are definitely some of the things outside of access that do present barriers to screening.
Got it.
What should a person’s expectations be during—and let’s just start with colonoscopy—what should a person expect from that process or that visit?
Yeah. So obviously, first and foremost, colonoscopy has now become a very routine and very safe, seamless procedure. So I want to begin by putting that right out there. It’s a very, very safe, very routine procedure that is done now for screening in many individuals.
You’ve obviously had two of them, so you can certainly talk about your personal experiences.
But that hopefully will minimize some of the fear of the procedure itself.
Trying to get a little more granular so individuals can understand: the day before the colonoscopy, you have to prep. You have to clean out your bowel so they can get good visualization of polyps, early cancers, or anything abnormal they’re looking for.
When they do the procedure the next day, you’re actually sedated. You’re quite comfortable and taking a nap. So you don’t really remember or feel much of the examination or the procedure, during which they are using a camera, passing it through the colon so they can look for abnormalities and remove polyps that may look high-risk or concerning.
So it becomes, hopefully with that said, much more understandable how comfortable, routine, and safe it is than what it may sound like at first glance.
Got it. And I can tell you from experience, folks, that the worst part was the prep—the day before, not being able to eat anything after a certain point.
And actually, with some of the prep regimens now, you can get a little closer to the procedure before you have to stop eating or drinking altogether. Whereas before we were talking about a whole day of eating nothing.
I’ll tell you from experience, my first prep was like that, and unfortunately, I didn’t get the best prep.
So as much as it’s the most painstaking from the standpoint of not being able to eat anything and taking these medications that essentially clean you out—and by clean you out, I mean that you defecate, you poop all of the contents out—you really want to pay attention to that prep, ladies and gentlemen, because again, it’s going to improve the visibility, right? It improves their ability to see everything, including polyps or precancerous lesions, and then get those out, and also to see the rest of the colon.
I can tell you from experience with a not-so-great prep, I don’t know what I did wrong, but I did. I remember having to go back and being told, yeah, it wasn’t the best prep. But I went back a year later and had it done again, and fortunately everything was clear with that.
But I did do both preps, and I remember having to do the GoLYTELY prep, which is literally an all-day process.
Yes, ladies and gentlemen, I was in the restroom a lot.
Essentially, it was a means to an end. And I would argue again that that was probably the most inconvenient part, because as Dr. Chhabra said, I was asleep during the procedure, comfortable, woke up, they monitored me as the anesthesia wore off, my wife came and picked me up, and I went on about my day.
And really, the most important thing was having peace of mind. Because as we said, Lord knows what could have become of those polyps, those precancerous lesions, had I not gone and had this done.
Things could have been very different for me at this point, especially in light of my family history.
So it’s just one of those things. And ask questions. If you have more questions about this procedure, ask your provider. We also always avail ourselves on this program. We’ll try to answer, or at least get you to the point where you can get the answers to your questions as you learn more about these screening modalities.
And as far as addressing the challenges with access to these screenings, Dr. Chhabra, in underserved communities such as Harlem, and in many areas of New York City, what has been shown to be effective in addressing those challenges?
I can’t emphasize enough: education, education, education. Knowledge is one of the biggest things to address those barriers, regardless of which community we’re talking about.
I think podcasts like this are literally a lifesaver for someone who goes out and gets a colonoscopy or other screening.
Additionally, from more of a medical standpoint, I’ll go back to those Cologuard commercials—they work.
So in the average-risk adult, not someone at high risk, stool-based tests—or mail-in tests that you can do in the comfort of your own home—are one way of screening.
They are limited compared with colonoscopy because obviously you’re not within the colon and you can’t remove a polyp if something abnormal is there.
But as a means of increasing and making screening more accessible and easier, they definitely work and are definitely widely utilized because they are a lot easier and more comfortable to do.
But I would emphasize that they’re for a very specific population and that if something is found on them, that generally triggers moving on to a colonoscopy to get a better evaluation.
But it is still a really good start to increase the uptake of screening overall.
Got it. So yeah, ladies and gentlemen, education, as Dr. Chhabra said. We are giving you that information, and now you are empowered by that to get these things done.
And again, ask those questions. What options are available to you? What are the benefits—the pros and cons—with each approach, and especially having that tailored to what your risk factors are, such as family history and other conditions that might increase or modify your risk?
Now, this is the part where I think there’s also some excitement here, Dr. Chhabra, because one of the things that I know I can make the case for, or that I see before me when we talk about Americans’ interest in their health—as much as folks might want to debate how we are as a society in terms of how we pay attention to our health—people care. People care. People want information. They want to be empowered with that information and use that to reduce their risks.
So I take that as kind of a challenge before us. Let’s compete with those influencers out there and talk about what we can do to reduce our risk.
Now, I’m going to warn you, ladies and gentlemen: there’s no magic pill that we’re selling you, no supplement or anything like that. That’s not what we’re talking about here.
But we are talking about some tangible things that you can do, that have been shown to reduce the risk of colorectal cancer development.
Yeah, I mean, I think in the era of longevity, as we are in, and to your point of everyone becoming more health-conscious, while it’s not necessarily always the easiest thing, you’re absolutely right. There are tangible, modifiable lifestyle changes that can make a huge difference in reducing the risk of colorectal cancer.
A lot of these are pretty tried and true, and also pretty common knowledge in the sense that they’re not only going to reduce the risk of colorectal cancer, but also diabetes, heart disease, and other conditions.
That’s regular exercise. Diet plays a huge role. You mentioned it: fiber, fruits, vegetables, whole grains, minimizing red meat and highly processed foods. These are all huge things that someone can take in their own hands and control, which becomes important.
Yeah, man. And I think going back—there’s nothing sexy about what we’re telling you, ladies and gentlemen. You probably came here, at least for a portion of this program, thinking, man, they’re going to give me the magic recipe.
And I’m like, no, there’s no magic. These are basic things.
And I think really the thing that I’m happy about, ladies and gentlemen, is that there’s nothing we’re selling you. No gym membership, no health club membership that you’ve got to go get to be physically active and do these crazy routines and stuff.
I mean, it’s great if you want to put that effort in. No pain, no gain—that’s great. But we’re talking about walking around the block. Like, that simple.
It’s exactly that. And that’s to your point, right? It’s easy changes, and it doesn’t have to happen overnight. Little bits every day—building blocks—make a huge difference.
A bowl of oatmeal in the morning. Whole grains, not the processed stuff. Not the extra sugary stuff with all the additives. You can get whole oats and boil that down. Or you can take granola and put that into something like yogurt, again without all the additives and stuff.
So we’re not talking about magic. We’re not talking about spending $99.99 a month on some subscription. We’re talking about basic things.
Now, we do acknowledge there are challenges. When we talk about fresh fruits and vegetables, whole grains, and things that are minimally processed—guess what? They can be expensive. I think we can all attest to that.
But we do know, and we have the evidence and research behind this, that there are real tangible benefits when we do these things.
Also on this program, we are never the ones to make these recommendations in a blanket way and say that you have to do it this way all the time, every time.
I will encourage you—especially with the weather changing and summer coming—if you go to a barbecue, enjoy the good food that’s there. Maybe a person wants to have a beer or something like that. We’re talking about everything in moderation, ladies and gentlemen.
Now, obviously, the more you cut out, the better you stand to benefit from the standpoint of reducing the risk of developing things like colorectal cancer.
But at the same time, we understand that you’re human, right? You go overseas—and I’m a street-meat fan, man. When I travel, I’m going to eat everything I can get my hands on, and I’m going to enjoy that experience. But at the same time, I’m going to be mindful of other things that I consume so that I’m not in excess and therefore increasing my risk.
That’s the best way to sustain good habits, right, is that for the most part, you’re sustaining good habits, but you’re absolutely right: sometimes in moderation, we all have to sort of enjoy these things.
Perhaps they can enjoy these things. Yeah. Yeah, man.
So ladies and gentlemen, we can do it. I know we can. I know we can.
Now, this is the part that becomes more difficult in this program. Ultimately, there will be some of us who are diagnosed with colorectal cancer.
As much as we try to reduce our risk through all the things that we’ve talked about in this program, it is inevitable that some of us will develop this.
Now, we’ve set things up with early detection. We’ve kind of promised that we can treat this, ladies and gentlemen.
So, Dr. Chhabra, let’s get to that point. Maybe we discover something on colonoscopy. Maybe somebody was symptomatic and went in and, after evaluation—maybe in someone’s emergency department, or maybe in a gastroenterologist’s office—they are diagnosed with colorectal cancer.
So what are the next steps?
Yeah, what I would say is that over the last decade, what we’ve learned is that treatment has become much more personalized. There is no longer really a one-size-fits-all approach.
Each person’s specific situation—their age, their stage, their family history, their lifestyle, their personal and professional responsibilities—we take all that into account to really bring together a group of individuals: surgeons, chemotherapy doctors or medical oncologists, radiation oncologists, pathologists, so many different individuals who now work together closely to design the best treatment plan for that patient.
Got it.
And I guess this is a challenging question in and of itself, because everything is so personal. But if we took an average case, what would be the next step to get some of those more personalized answers, if you will, about treatment approaches and what a person’s options might be when it comes to either further diagnosis or more specific information?
Yeah. So I think if you are someone who is diagnosed with colorectal cancer, you will generally see a few different individuals as part of your care plan to decide what the best treatment is for you.
You’ll see a surgeon. You’ll see a medical oncologist—these are individuals who deliver immunotherapies, chemotherapies, targeted therapies. You’ll see a radiation oncologist like myself who delivers various forms of radiation treatments.
These are the individuals that you will likely see along your journey, and they, along with yourself, will decide the best care.
Got it.
And I think—now this is not something that has happened to me, ladies and gentlemen—but from the conversations I’ve had, at the point of diagnosis, or at least even just entertaining this as a diagnosis for a patient, one of the things that I’ve seen is individuals sort of going through what everybody is familiar with as the Elisabeth Kübler-Ross stages of grief.
And so all of the things that come with that: the denial, the anger, maybe even the question, “Well, what caused this? Why would this happen?”
I think that is valid, ladies and gentlemen. To experience those emotions is going to be different for everyone. But anyone who receives a diagnosis like this, or has recently received that diagnosis, I want to validate you and say that those are sentiments that are human.
And that is something that I think there are providers out there who will help you, right, help marshal you through all of those emotions that many people will experience with a diagnosis like this.
One of the things, too, that I want to acknowledge about knowing how medicine works—especially within our medical system, which has many challenges—is that getting those additional answers that are needed, whether it is what might have led to this, or what the next steps are as far as treatment, can take time.
I say all of that to say that I want folks out there to understand: hang in there. Because those first few weeks, even months, can be frustrating when it comes to getting those next-step answers.
As Dr. Chhabra is saying, there may be multiple specialty visits. You’re going to see multiple doctors. They are going to be asking you questions and approaching your care from different vantage points.
But really hang in there, because getting those additional tests done—things like biopsies, tissue sampling, more blood work—all of that is a means to an end, to get the answers needed so that you can get a tailored treatment plan, essentially.
We’re in an age where that’s what it’s going to take, right? Asking more questions, doing some more testing. We stand to find a treatment plan that is not only going to be effective—as effective as possible—but also takes into account who you are as a person.
And I’m glad you threw that in there, Dr. Chhabra, because folks have to make ends meet. Quality of life while undergoing treatment and additional procedures matters.
We are in a different age in medicine, ladies and gentlemen. We are willing to engage folks on those things so that you can still live your life—or try to meet your goals in your life—and get treatment that is going to be effective and take all of that into account.
So now, when we talk about proton therapy—and this is something that was new to me actually from our initial programs talking about the New York Proton Center—and thank you again, Dr. Chhabra, for introducing this on **Health in Harlem**—when we talk about the role of therapy like proton therapy in the treatment of colorectal cancer, where does it stand in the spectrum of options?
And I think your emphasis on control, cure, treating the disease, and quality of life will really piggyback on what I’m about to say.
I’ll begin by saying that first and foremost, radiation therapy, as I mentioned, is one of the many different tools in our toolbox to cure and treat patients with colorectal cancer.
Radiation itself is used predominantly for rectal cancers that may be a little more locally advanced—maybe larger in size or spread to surrounding lymph nodes.
In those situations, radiation is generally given along with chemotherapy before surgery to shrink the tumor and reduce the risk of the cancer returning after surgery. That makes surgery potentially more effective and allows a surgeon to have a higher likelihood of taking the cancer out cleanly, giving you a better and higher chance of cure.
In some cases where tumors respond really well to radiation and chemotherapy—where there is no cancer left at all after radiation and chemotherapy—there is now an entirely new paradigm where individuals can avoid surgery entirely and can have what’s called an organ-preserving strategy.
Basically, you don’t need to get the surgery at all because the cancer responded so beautifully to radiation and chemo. Those patients are obviously followed much more closely, as you can imagine, but there’s a large percentage of patients in that scenario who can avoid surgery altogether.
So you can see how radiation plays a really pivotal role: either before surgery to help the surgeons, or in some scenarios where you may be able to avoid surgery entirely.
And so, when we talk about radiation, proton therapy is a type of radiation. It’s one form of external radiation that uses protons. These are specific types of particles that have a positive charge.
That’s different from traditional external radiation, which uses X-rays to treat cancers.
The major difference is how the radiation is delivered within the body.
With conventional radiation, these X-rays pass through the tumor but deposit radiation beyond that because they are X-rays.
Proton therapy behaves very differently. Protons are programmed to stop at very specific distances and depths within the body.
This allows us to deliver radiation very precisely to the tumor while reducing unnecessary radiation exposure to the surrounding healthy tissues.
In the pelvis, that allows us to better protect a lot of the surrounding organs—the bowel, the bladder, and the reproductive structures. And so that precision of proton therapy becomes tremendously valuable.
And ladies and gentlemen, I’m going to refer you to our episode from April 2025, where Dr. Chhabra takes you into even more detail just talking about proton therapy itself.
But I think that’s one of the things that is really empowering in this day and age. We’re not just talking about treatment. I think one of the criticisms of “Western medicine” right now is folks saying, “Well, you know, they just want to put me on chemotherapy,” or do these really invasive procedures, and I’m just going to be going back for treatment because of it.
It’s like, no. Actually, when we talk about cancer care these days, folks, there are many cases where we are talking about cure—literally curing individuals of cancer.
And I think going back to what we talked about before, from screening and dealing with precancerous lesions—sort of the cure before the disease, if you will—but ultimately, for individuals that have been diagnosed, as we said, this is not for many patients the poor prognosis that it was decades ago, even with some cancers that might be a little bit more advanced.
You have to know—and this is why going back to making sure we follow through with your specialists to get the information you need and see what your options are and what the outcomes could be—because there are many cases, as Dr. Chhabra said, where individuals are cured from this illness.
In addition to that cure, the other important thing, going back to what you said, Maurice, is preserving function and maintaining the best possible quality of life after cure.
That’s where the role and goal of precision radiation, like proton therapy, becomes so critical—to treat the cancer effectively, but also minimize the risk of side effects.
As I alluded to, because protons have that unique ability to go to a specific distance and then stop and disappear, and because of that lack of exit dose, we can better protect the normal surrounding tissues.
We can minimize the risk of side effects during treatment—what we call short-term side effects—and also long-term side effects, months and years down the line.
That can include reducing the risk of bowel issues, reducing the risk of bladder issues, reducing fatigue, and allowing you to maintain a good quality of life during treatment, both personally and professionally, and then obviously also long-term after treatment is finished.
So cure is very important, as is preserving that function and quality of life.
Got it. Thank you for sharing that with us.
And as we wrap up, what would you say, Dr. Chhabra, are the key things—if there was anything our listening audience should take away from this program—some of the more important concepts or highlights? What would you say those few things are?
Yeah, I think I’ll reiterate some of what we’ve talked about tonight, which is if you remember one thing, it’s that colorectal cancer is one of those few cancers you can prevent.
Most of these cancers we talked about start as small polyps that grow slowly over time, and screening—early screening—allows us to detect and remove these polyps even before they turn into cancers.
And secondly, when treatment is needed, advanced cancer care, including precise radiation approaches like proton therapy, is really helping us treat these cancers effectively when they are discovered, while better protecting healthy tissues and maintaining an individual’s quality of life.
Got it. Thank you for that. Thank you, thank you, thank you.
And then lastly, where could individuals go to learn more about the Proton Center, maybe even the options available to them, or how they can get more information if a person were interested in learning more about that as a potential treatment option?
Absolutely. So we are obviously located locally here in East Harlem. I would encourage everyone to Google the New York Proton Center. It’s got our website and our contact information there.
I would encourage you to submit an inquiry, and our team will happily get back to you very, very quickly to answer any of your questions and see if you’re an appropriate candidate for proton therapy.
That’s what’s up.
And we’ll definitely include, as we did in the past, information about the New York Proton Center in our show notes.
You can also check out the New York Proton Center’s website at **nyproton.com**, as well as information on how you can reach Dr. Chhabra.
And we’re more than happy—I know, Dr. Chhabra, you were okay with this before—if we had any questions from our audience, sort of looping you in and bouncing those things off of you as well?
I would be more than happy to. Please, absolutely. We are always available to anyone and everyone for any questions.
Thank you very much, man. It was great to see you again.
Same. Same. Looking forward to—we’ll do this a third time for sure, actually. But thank you for having me.
For sure. Yeah, thank you very, very much.
I also want to thank Amy and Melissa for setting us all up and bringing us all together again.
And also shout out to the rest of our team: Reed Vero, Giorgio Maloof, Anastasia Data, and Michael Holmes—the **Health in Harlem** family. Shout out to you guys, always.
And with that said, ladies and gentlemen, thank you for tuning in to this program.
Again, the only thing that we ask of you is to share what you have learned with anyone that will listen.
And that’s basically it. That’s all we have, ladies and gentlemen.
And as always, this show is dedicated to the memory of Miss Gloria Thomas.
Harlem, take care of yourself.
