Dr. Herbert Chen, acclaimed surgeon, researcher, and educator, is Chairman of the University of Alabama at Birmingham (UAB) School of 
Medicine’s Department of Surgery and Surgeon-in-Chief of UAB Hospital. In his previous practice at the University of Wisconsin, he saw many patients with all types of NETs and since joining the UAB team this past October he is in the process of building up his practice. Dr. Chen recently turned 50 and shortly before his birthday made an appointment to have his first colonoscopy. Dr. Chen shares his perspective on colonoscopy and its importance for neuroendocrine tumor patients. Read more about Dr. Chen’s experience with colonoscopy: “The Man Who’s ‘Seen Almost Every Colon in Birmingham’ Meets the Doctor Getting His First Colonoscopy.”
Q: Why is colonoscopy an important test; who should have this done and when?
A: I want to echo the recommendations of the American Cancer Society that every person should do a colorectal cancer screening at the age of 50. I chose to do a colonoscopy because they are effective and are performed routinely. Despite being a surgeon, I had the normal trepidation I think everyone feels about turning 50 and having a colonoscopy. But the procedure only took about 30 minutes, and everything went smoothly. My colonoscopy actually revealed a polyp. One of the advantages of having a colonoscopy, instead of another type of colon cancer screen test, is that many polyps can actually be removed during the colonoscopy before they turn into cancer. That was true of the polyp discovered during my procedure, so I was very glad I had a colonoscopy.
Q: What role does colonoscopy play in the diagnosis, treatment and follow-up for NET cancer patients?
A: Colonoscopies are mainly used to diagnose colorectal cancer, but they also can effectively find neuroendocrine tumors of the colon. Again, I believe it is very important to get a colonoscopy at age 50, and the fact that colonoscopies are able to detect multiple types of cancer is all the more reason to be sure and schedule an appointment.
Q: How often are neuroendocrine tumors found during a colonoscopy?
A: Theoretically all rectal neuroendocrine tumors should be found during a colonoscopy.
Q: If a neuroendocrine tumor is found during a colonoscopy what is the next step for a patient?
A: Just like the polyp found during my colonoscopy, many neuroendocrine tumors found during a colonoscopy can be removed immediately during the procedure. Some will require additional surgery, and your care provider will refer you to a surgeon for this procedure.
Q: What advice would you give to patients who have a NET found during colonoscopy?
A: Patients who have a neuroendocrine tumor that is found during a colonoscopy should be referred to a NET expert. I believe in a multidisciplinary care approach for neuroendocrine tumors. This entails a team of surgeons, oncologists, endocrinologists, radiologists working together to create an individualized care plan for each patient. A one-size-fits-all approach does not work for neuroendocrine tumors, which is why it is important that a team of doctors reviews the whole picture.
Q: Surgery is considered the only possible curative option for neuroendocrine tumors, as long as the primary tumor has not broken through a wall of an organ or metastasized. Do you agree with this and what advice would you offer NET patients regarding surgery?
A: Yes, surgery is the only curative therapy for neuroendocrine tumors. If your multidisciplinary care team recommends surgery, my advice to patients is to find a surgeon with extensive experience treating this disease. No matter the procedure, I always would recommend patients to look for an experienced physician. For instance, when scheduling my own colonoscopy, which in an extremely routine procedure, I sought out an experienced gastroenterologist.
Q: What advances have you seen and might be on the horizon for NET patients who are undergoing surgery?
A: The major recent advancement in neuroendocrine surgery is the increased usage of minimally invasive surgical techniques. Minimally invasive surgery is a great advancement because it can directly benefit patients by potentially reducing pain and recovery time when compared to traditional methods.
