Chesapeake Surgical Specialists
For Beth Jaklic, becoming a physician was always a given, but it wasn’t until she was on a Navy ship in the Persian Gulf that she decided to focus on colorectal surgery. “I started thinking about it at the end of my surgical residency,” she says, “I was on the USS GEORGE WASHINGTON as a general surgeon, and I decided that’s what I wanted to do.”
Besides knowing she wanted to be a surgeon, she’d also known she wasn’t going to be ready to settle down in one place after medical school, so she applied to the Navy scholarship program and was accepted at the University of Virginia – her first choice. She did both her internship and residency in general surgery at the National Naval Medical Center in Bethesda, followed by a fellowship in colon and rectal surgery at the University of Minnesota at Minneapolis.
“When you’re a general surgery resident, you see a lot of trauma, cardiothoracic cases, the ‘glamorous’ stuff, ” she says. “It’s not until you become more senior and you get to do the bigger, abdominal cases and the complex anorectal cases that you discover how rewarding that is.” She was drawn to colorectal surgery because her practice wouldn’t be limited to a specific age or gender. And she’d have the opportunity to develop more involved doctor-patient relationships. She explains: “With general surgery, it’s largely an acute problem that you fix, and then you’re done. With colon and rectal cases, you’re dealing with issues that are more chronic, especially cancer. With cancer, you often make the diagnosis, you do the workup, you do the surgery and you follow them for at least five years.”
And, she adds, the operative aspects and procedures, and the opportunities to work with other physicians, remain a huge draw. Dr. Jaklic retired from the Navy in 2012, and joined the staff of Chesapeake Surgical Specialists. She had not only found her specialty, but her home as well. “I really like Hampton Roads,” she says. “I knew I wanted to stay.”
Treating colorectal cancer remains a challenge: it’s still the third most commonly diagnosed cancer and the second leading cause of cancer death in both men and women in the US. It’s estimated that there will be 140,000 new cases of colorectal cancer in 2015, and 56,000 deaths. But the news isn’t all bad, Dr. Jaklic assures her patients – although even to that good news she must append a caveat: “There’s been a 30 percent drop in colorectal cancer in the last decade, but that’s only in people over the age of 50.” The caveat? The incidence of colorectal cancer is rising in people under 50. In fact, a November 5, 2014 article in JAMA Surgery noted that the increase in colorectal cancers is most pronounced among men and women between the ages of 20 and 35.
While it’s not known for certain what accounts for the rise in colorectal cancer among the young, Dr. Jaklic agrees with the American Cancer Society that the decreased incidence in older Americans is due to increased screening. “Unlike any other screenings we do – PSAs, mammograms – colonoscopy is the only one that detects precancerous lesions and gets rid of them before they do permanent harm,” she says. “I tell patients that almost all colon cancers start out as polyps, and a colonoscopy will find and remove them. And I tell them about the very high cure rate – 90 percent if detected early. Some of them are surprised to learn that.”
She tells them something else that surprises them: they don’t need a colon at all. “I explain that the colon mainly just absorbs water and packages up the stool, but has very little to do with nutrient absorption,” she says. She understands the reluctance of her patients to seek medical attention when they experience symptoms: “A lot of patients are under the impression that any kind of colon surgery involves having a colostomy,” she says. “I’m surprised at how often people think they’ll need to wear a bag for a while or forever, when we’d never even consider it.”
Unfortunately, this thinking keeps many patients from seeking treatment at all. And yet, Dr. Jaklic stresses, “with current technology, and sometimes after radiation, we’re able to get lower and lower and remove all but the very lowest of tumors, and still put things back together with no need for permanent colostomy.” And because she’s able to perform 99 percent of her cancer surgeries laparoscopically, her patients have less pain, and a shorter hospital stay and recovery time.
It’s not just the advancement in surgical techniques, she adds. “We’re doing more with genetics , modifying chemotherapy based on the specific genetic properties of the individual colon cancers. We can more specifically tailor a chemotherapy regimen so we’re not giving chemo to people who wouldn’t benefit from it.”
With DNA testing, Dr. Jaklic says, “We can look for syndromic conditions like Lynch syndrome and polyposis in at-risk patients that help us determine whether anyone in the patient’s family needs to get screened earlier, and guide treatment for the index patient.” And, she notes, there are tests coming closer and closer to fruition that will allow physicians to test for cancer in a patient’s stool, without bowel prep. “Unlike colonoscopy, where we’re actually finding benign polyps and removing them, this is more of a marker of cancer that’s already there, or an advanced polyp – but without the necessity of bowel prep, we can screen more people.” And, she hopes, because it’s a lab test, more people will undergo the life-saving screening.
