Stop Waiting: Cynthia’s Colon Cancer Wake-Up Call

On this episode of The Hope Table, Erin Brinker sits down with colorectal cancer survivor Cynthia Hernandez and surgeon Dr. Joseph Ruan to talk about the diagnosis Cynthia never saw coming—found during a “check-the-box” colonoscopy with zero symptoms. They share how early screening saved her life, what actually happens during colon cancer surgery, and why so many younger adults are now at risk. Along the way, Erin explores how healing happens not just in hospitals, but around dinner tables and out in nature, and why we can’t afford to wait for a crisis to start truly living—and to start getting screened.

Transcript

Erin Brinker: 0:00

Erin, welcome to the hope table. I'm Erin Brinker. There's a strange trick our brains play on us. We all know intellectually that life is finite. We see the leaves change. We watch our children grow out of their shoes. We see the calendar pages flip, but we don't actually believe it. We live live. Rather, we live as if we have an infinite bank account of tomorrow's we spend our life in what I call the waiting room of life. We're waiting for the weekend, we're waiting for the kids to get through school. Or waiting for that vacation or for things that at work to finally calm down. Oh god. How many times have I said that we treat the present moment like a hurdle we have to jump over to get to the good stuff. But today's show is a radical invitation to stop waiting. What a great message. In a few minutes, you're going to hear a conversation that changed the way I look at my own morning coffee. I sat down with two incredible people, Dr Joseph Erin, a physician who understands the intricate, microscopic battle of the human body, and Cynthia Hernandez, a woman who didn't just study that battle. She lived it and she fought it. Cynthia is a colon cancer survivor. When you put a medical expert in a survivor in the same room, the conversation stops being about sickness and starts being about the sheer terrifying beauty of being alive. Before we play that tape, I want to talk to you about why we lose sight of that beauty in the first place. One of the things that struck me in talking with Cynthia and Dr Erin is how much healing happens away from the hospital, specifically at the dinner table. Think about your table for a second. In our modern world, the table has become a pit stop. We eat standing up over the sink. We sit on the couch with a laptop balanced on our knees. We've turned the act of eating into a purely mechanical task, refueling a car so it can keep driving. And I'm not gonna lie, you know, what's on my kitchen table? I have mail, I have water bottles, I have Clorox wipes. It's like a storage right in the middle of my house, which, you know, that's not what it was intended to do throughout human history, the table was the center of the universe. It's where stories are told. It's where we look into the eyes of the people we love and realize I am known. These are my people. Dr Ruan can tell you about the physiological importance of nutrition, but Cynthia can tell you about the spiritual importance of a shared meal when you're facing a diagnosis, a bowl of soup made by a friend isn't just calories. It's a message that says you're worth tending to. It's an act of connection that reminds the body it has something worth fighting for. I want to challenge you this morning or tonight or this afternoon, whenever you're listening, who are you sitting with? And are you really there, or are you just occupying the chair we need to reclaim. The table. We need to reclaim eye contact, because at the end of the day, we aren't remembered for our resumes. We're remembered for how we showed up for dinner. And I will tell you that I especially when my kids were teenagers, and you know, I just was busy with work and whatever other excuse I could come up with. I often was distracted or we didn't eat together. And, you know, I can make lots of excuses, but it just I didn't, didn't make it as much of a priority as I should have. And then there's the world outside our windows. We are the first generation of humans to spend 90 of 90% of our lives indoors, crazy, right? We live in boxes. We work in boxes. We move between those boxes in smaller metal boxes on wheels. We've disconnected ourselves from the very thing that sustains us, and that's the Earth itself. When you hear Cynthia talk about her journey, you'll hear a theme of, well, reconnecting, what I'll call rewilding. There's something about the wind in your face and the smell of rain and a hot pavement that pulls you out of your own head. So much of this fight against really scary things like cancer, it's the people, it's the connection, it's the heart, it's the soul, it's the medicine, but it's so much more than that, and getting outside is a big part of that. So we step outside, our nervous system begins to regulate. Our perspective shifts. When you look at an oak tree that has survived 100 100 storms, your own storm feels less lonely. It's easy to think of a walk in the park as a luxury, something we do when we have extra time. But if Cynthia's story teaches us anything, it's that getting outside is a necessity. It's a reminder that the world is vast and beautiful and it's still turning regardless of what lab results say or what the news says, let's be honest. It's a way to breathe in the perspective that we're part of something much larger than our current struggle. So why are we here today? We're here because Cynthia Hernandez and Dr Joseph Erin have a message that we shouldn't wait for crisis to hear. We shouldn't wait for a Dr. To tell us our time is limited, to realize our time is precious. Part of that too, is don't react. Be proactive about your own body, getting your checkups, getting that colonoscopy, and he's going to reinforce all of this. And so is Cynthia. Get get the mammogram, get everything, the prostate test, if you're male, all of it. Get the test done, and chances are it'll be nothing, but if it's something, then you will have given yourself more time to heal, more time to fight, more time to be alive and present in your life. Life is made of micro moments. It's the steam on your glasses when you drink tea, it's the sound of your partner's keys in the door, it's the way the light hits the floor at four o'clock in the afternoon. These aren't the things that happen between the big events. These are the big events as you listen to this roughly 45 minute interview, I want you to do me a favor. Don't just listen for medical facts. Don't just listen for survivors timeline. Listen for the pulse. Listen for the underlying heartbeat of two people telling you that today, this ordinary, maybe even frustrating, mundane day, is a gift you've already received. Let's get into that conversation now. Here are Dr Joseph Erin and Cynthia Hernandez. You might remember back in January, we had a conversation with Dr Timothy Jenkins about gastrointestinal health in general. Today, I've got two very, very special guests to talk about sort of the same subject, specifically, colorectal cancer. Cynthia Hernandez is a department administrator in allergy and dermatology with 26 years of service, and that is at Kaiser Permanente. She's a colorectal cancer survivor, and with her is Dr Joseph Erin. He's Assistant Chief of the department of general surgery, and she was he was Cynthia's surgeon as she was going through her journey. Dr Erin and Cynthia Hernandez, welcome to the show.

Cynthia Hernandez: 6:55

Thank you. Thank you for having us. Thank you.

Erin Brinker: 6:58

So we'll start with you, Cynthia, tell me about your life before your diagnosis.

Cynthia Hernandez: 7:05

Well, I guess I could say, you know, working 26 years at Kaiser, a lot of you know what we do is we're busy with work and managing patient care and our departments. And on the I guess on the personal side, I do have two daughters that are currently both in college right now. I have one attending nursing school at UCLA, and the other one tending PA school at UC San Diego.

Erin Brinker: 7:33

Wow, outstanding for both of them.

Cynthia Hernandez: 7:34

Yes, yeah. So I'm very proud of them. And you know, it's, it's, it's been a journey for both of them as well. But, you know, my main job outside of work is, is being a mom. Even though they're, they're college age, they still do need their mother. But, yeah, I'm still very busy with with, you know, still kind of helping them through their journey through college. And that's, you know, that's pretty much it, besides working. And, you know, we do love going to Disneyland and things like that.

Erin Brinker: 8:09

But because Disneyland,

Cynthia Hernandez: 8:13

yes, it's Disneyland.

Erin Brinker: 8:15

So, so did you just go in for a routine colonoscopy? Did you have some discomfort? What was happening?

Cynthia Hernandez: 8:22

So I did. I didn't have any symptoms at all. What ended up happening was, I, you know, being in healthcare. It, you know, as crazy as it sounds, we kind of don't go to the doctor, or don't take care of ourselves.

Erin Brinker: 8:38

You know, Physician, heal Thyself is a

Cynthia Hernandez: 8:40

phrase for a reason. Yeah. And so we tend to not go and take care of the things that we need to do, even though they might be down the hall or, you know, the next floor down or the next floor up. And so, at least for me, that's, that's how it was. For me is like, you know, you're here every day, if you if you need something, you might do an E visit, or do something like that. And, you know, I just decided one, you know, I just decided one year. So it must have been 2024, that I was like, You know what? I'm gonna get all my screenings done this year. I'm gonna, you know, check off those boxes of, you know, all of my prophylactic things that you know, I can do to help, you know, Mammo, mammogram, colonoscopy, pap smears, so all of those things I wanted to make sure that, you know, I had my screening done. And I did do that, and then that that kind of led me to my colonoscopy and my diagnosis, but I did not have any symptoms at all. So it was, it was literally just a check the box, let me check and make sure that I'm okay. So thankfully, I went ahead and, you know, scheduled that.

Erin Brinker: 9:56

Wow. So you're just thinking like you said, check the box. Well, I know I. Need to be doing this. I hear these doctors who work around me all the time talk about going for your screening, and I'm sure it's going to be fine. What a pain in the neck, and you had to go in and do it. Yeah, glad you did.

Cynthia Hernandez: 10:10

I am and I think one of the things that also I forgot to mention that kind of pushed me to do my screenings is I did have one of my best friends in high school lost her sister, who was 30 years old, to colorectal cancer screening. Actually. I think it was her funeral actually occurred right before my colonoscopy. So it was kind of fresh in my mind. And so, you know, it was kind of something I wanted to do for myself, because, but, you know, for her, her Her story is her story. You know, she had symptoms and probably had it for a few years. Was fighting it for a few years, and unfortunately, lost that fight. But it was kind of a driver for me to go and get screened as well.

Erin Brinker: 11:05

So Dr Ruan, were you the one who did her screening, or was she referred to you after her diagnosis?

Dr. Joseph Ruan: 11:13

Yeah, so she was referred after the diagnosis.

Erin Brinker: 11:18

And so when they when they so, how did you learn about your diagnosis?

Cynthia Hernandez: 11:21

Cynthia? So I actually had my colonoscopy done at an outside facility, and they, they pretty much told me there, when I was done having my colonoscopy, and I was waking up and getting ready to get discharged, you know, I was ready to go. I was ready to go get a good meal because, you know, I had not eaten anything the day before, and so I was kind of excited to be done. And, you know, the the provider that did perform my colonoscopy did come and meet with me and just let me know that they did find a mask. So that was, you know, pretty jarring, because I was expecting, you know, you're good to go, you know, we'll see you, you know, five years, 10 years, you know. So that's kind of how I found out he didn't, he basically told me that there was a mask that was found. I did ask him, like, you know, his professional opinion. And obviously he sees these, you know, day in and day out. So, you know, pretty much he was able to tell me that it's, it's most likely a cancerous mass.

Erin Brinker: 12:31

Wow. Now does cancer run in your family?

Cynthia Hernandez: 12:35

No, not that I know of. As far as colorectal cancer, no, I would be the first one. My mom is actually from Thailand, so she has a lot of, you know, distant relatives, but I don't really know their medical history, but as far as you know, I remember, we don't really have something like that of running in the family.

Erin Brinker: 13:00

How terrifying. So you really weren't thinking that this was even a remote possibility for you correct. Wow. All right. So, Dr, Ruan, so how when did you meet in her journey? When did you meet Cynthia? And then what did that, you know? How did you tackle this with her?

Dr. Joseph Ruan: 13:17

Yeah. So after her colonoscopy, then she was referred, and we met, and we were able to talk and go over all the results we did do. Cynthia also had a staging CT scan to evaluate for to help finish the evaluation to see if there was any evidence of cancer spread to other parts of the body, and that, fortunately came out all negative. Oh, thank god. Yeah. I remember looking at that report, and it was a very short report, which is always good. And then after that, we talked about treatment, which was surgery.

Erin Brinker: 13:57

So I'm going to ask a very basic question, do they do cut out the the just the mass, do you cut out, like, the piece of colon, and so sew the other two pieces together like, you know, close that that wound. What does that look like from a surgical standpoint?

Dr. Joseph Ruan: 14:16

Yeah, yeah. Basically, what you said, it's, we find the area of the cancer and remove that portion of the colon along with the lymph nodes. We get the lymph nodes because we need to have a thorough evaluation. The pathologists need to look at the lymph nodes to give us proper staging information. And so after we take that part out, we take the two ends and reconnect it back together.

Erin Brinker: 14:42

So with the lymph node, lymph nodes that when you take those out, those are the groin lymph node lymph nodes,

Dr. Joseph Ruan: 14:49

aren't they? Yeah, actually we, so we do have lymph nodes in the groin, but the lymph nodes that we're talking about specifically are the ones that are. Around the intestines. So we do have lymph nodes all over the body.

Erin Brinker: 15:03

We have them in our intestine, near our intestine. I didn't know that. That's right.

Dr. Joseph Ruan: 15:06

We actually have a lot in our intestines. The intestines are have quite a bit of function in terms of our immune system and the lymph nodes are there part of it.

Erin Brinker: 15:19

Now our patients who undergo that kind of lymph node surgery, are they at greater risk for developing edema? I've seen people with with lymphedema in their legs, and it's it looks very painful. Are they at a greater risk for that?

Dr. Joseph Ruan: 15:33

Yeah, that's a great question. So with intestinal surgery, when we remove that part of the intestines, we're removing the lymph nodes that serve that section, and so it doesn't have the same issues of edema like it does in the legs.

Erin Brinker: 15:47

That's good, because that looks, that looks really painful. So, so what was the prognosis for Cynthia? So did Cynthia? Did you? And this is really for both of you all, and maybe we'll start with Dr Ruan. Did she? Was she facing chemotherapy, radiation? What was the was there ongoing treatment? And what did that? What did that

Dr. Joseph Ruan: 16:07

look like? Yeah, so fortunately, in syphilis case, the she was very early stage, and all her lymph nodes that were removed were all negative, and so she did not need to have any chemotherapy. Oh, thank God. So with surgery alone, she was able to achieve, you know, basically a cure.

Erin Brinker: 16:26

So that's that must have been a relief to you, Cynthia.

Cynthia Hernandez: 16:31

Oh, yes, it was,

Erin Brinker: 16:33

you know, especially since you just watched a friend go through that journey and did not have that outcome.

Cynthia Hernandez: 16:40

Yeah, I still get, you know, very emotional

Erin Brinker: 16:44

about it. I bet, I bet,

Cynthia Hernandez: 16:49

yeah, very thankful though, you know, Dr Ruan and his team and, you know, just the whole medical center, everybody was amazing.

Erin Brinker: 16:58

So it, you know, I so, how old was the friend? This your friend's sister, who, when she passed away of colon cancer, um,

Cynthia Hernandez: 17:09

she was 30, I believe. Oh my gosh, yeah. So, you know, I kind of seen like, you know, through the she was battling it for probably about three or four years, and you could see, like, just her decline, you know, just just in pictures alone, you can see her decline. So it was very like, I think that's kind of what scared me, because I had, like, seen her, what was going on with her, and, you know, it's, it's a scary diagnosis, I think, for everybody. And then maybe I'm just not strong, because somebody could get a diagnosis like that and be like, you know, let me, let me not worry until I find out. But I, I kind of went to the dark place. Sure it was, I'm sure Dr Ruan can probably, you know that I had to get some sedatives before, you know, surgery, because I was just very, you know, I was very emotional. I still get emotional, but I have, I am a big advocate, you know, for colorectal screening, just based on my story alone. Because, you know, you're, I was just walking around thinking everything was fine. And I'm pretty sure, you know, and I'm not sure Dr Wuhan, but I'm pretty sure that it was probably growing for a couple years, I think,

Dr. Joseph Ruan: 18:31

yeah, yeah. And it is a extremely scary thing, because these things, you know, the cancers, when they grow, especially early on, there's no symptoms at all. We're just totally unaware that something like that could be growing in our body, and then to hear all of a sudden. It's very scary.

Erin Brinker: 18:52

And here's the thing, you're allowed to grieve. And grief is a funny thing. It it rears its ugly head when you're least expecting it, something will trigger a memory or an emotion, and there you are, and then to face that grief and and not knowing what your journey is going to look like. Yeah, of course, you were terrified. That's a normal human reaction. You're allowed to be emotional. That's scary.

Cynthia Hernandez: 19:16

Yeah, I'm just, you know, I'm just really grateful. You know that, you know I did have, like, a positive outcome, but I know that there's a lot of young people who don't. And, you know, I think it's important that we, you know, listen to your bodies if you're having symptoms. You know, obviously, in my case, I didn't have any. But you know, just, you know, be an advocate for yourself. You know, do a fit kit, you know, screening. You know, we get a lot of patients that will come in and they're flagging that they're needing to complete one, and we send two or three or four to their houses within a year, and we don't receive anything back. And, you know, it's very important, like it just, just take the kit. Home, complete it, drop it off, you know, it, it could save your life. Like I went in there, not, not thinking anything, you know, I really thought it was just going to be a routine screen. I might have had a couple polyps or two, you know, no way did I think it was going to kind of flip my world upside down for those few months. But, you know, mine was a positive story, and not everybody's is. And so the sooner that you, you know, screen yourself, the better. You know, I still talk about it, even to my co workers, even to you know, colleagues. I'm, I really am an advocate for for screening, and it's something like Dr Ruan said, you know, if it's caught early, it could, it could save your life. And we're hearing, even you know, on the news and with celebrities that you know they're getting this early and and dying from it. And it's if we can protect the people we love and our family and friends by advocating for it, you know, it's, you know, I it's gonna save lives if they can get themselves screened.

Erin Brinker: 21:09

So Chadwick Boseman from Black, Black Panther and many other things. He was only 43 when he passed away in 2020 and James Van Der Beek, who was 2026 he he died this year. Was only 48 correct?

Cynthia Hernandez: 21:25

And I did, I do think that they've said that Colorectal cancer is the number one, the number one killer of like, what ages is it? Ages 40 or 30 to 50, or something like that?

Dr. Joseph Ruan: 21:39

Yeah, it's it's a it's scary. It's actually alarming. The incidence of colorectal cancers has increased quite a bit since the 1980s up until now. And recently, we're seeing a lot, many, many more patients under the age of 50. And so, yeah, Cynthia's right. It's become the number one cancer killer and people under 50.

Erin Brinker: 22:05

So let's, let's kind of explore that a little bit. You know, you'd think that those numbers would be going down, because, you know, people are not smoking as much, not, certainly not the levels they were in 1980 where everybody smoked and in high schools in the late 70s and, you know, up to the very early 80s, there was a smoking section at high school for the students. I mean, that's, and I know that can increase your risk of all kinds of cancers. People still ate bacon back then. They still, you know, the processed meats were a thing. You know, why? I, you know, maybe that's the question that nobody can answer yet. But why is this on the upswing?

Dr. Joseph Ruan: 22:43

Yeah, that's a great question. I wish we knew that's that's the question that all of us are trying to wrap our heads around, is, what is it that is going on? Certainly, we see, you know, we, you know, diet and lifestyle probably have a huge impact on that, but we haven't been able to nail down what specifically it is that's causing this rise.

Erin Brinker: 23:09

So is being sedentary, which we are, as a as an as a nation and as a world, a lot more sedentary than people were 40 years ago. Does that play a role in colorectal cancer?

Dr. Joseph Ruan: 23:22

Yeah, it probably does. Certainly we see more diseases of the colon in patient in people who are sedentary, exercise does seem to be beneficial in lower rates in people who are very, very active. Is exercise alone enough, you know, it alone. It isn't. So there is, there is more than physical activity, but certainly physical activity is very, very important.

Erin Brinker: 23:52

You know, did we, I wonder, and I'm just kind of thinking out loud, did we eat more fiber back then? I mean, we were eating meat and potatoes and then the vegetables, maybe a salad. But dinner, I'm trying to think, of course, I was a kid, but, you know, in the 1980s what were people eating? I don't remember, but I don't, I don't think, I don't remember it being so much more healthy than what people are eating now,

Dr. Joseph Ruan: 24:12

fast food, yeah, and certainly there's, I think we are eating a lot more processed foods now than we have before, and that may be part of it,

Erin Brinker: 24:26

well, and I know, I know that that's being studied right now. It's just, you know, when you see something that's that's terrifying, like cancer, you want to know, wait a minute, okay, what do I have to do to make sure I never get that because it's terrifying. So, yeah, so, so if somebody I imagine that, that lots of people, when they go in for colonoscopies, have polyps, are polyps always pre cancerous or malignant?

Dr. Joseph Ruan: 24:52

Yeah, so that's a great question too. So when we when we talk about polyps, there are things that I. Might look like a polyp that we call polyp, but there's also polyps in that that are that we would call adenomas. So adenomas are tumors within the colon that have the potential of turning into a cancer. So in general, when patients go in for a colonoscopy, anything that looks like a polyp, it does need to be removed or sampled if it can't be removed, so that we know what it is polyps getting removed. Erin colonoscopy does have an impact, and we saw that with when colonoscopies first started back in the 80s. Since then that has that has led to a decrease overall in the number of patients getting colon and rectal cancers every year. And so that's why the overall rates have been decreasing. The overall rates of colon and rectal cancer have been decreasing, except for in patients under the age of 50, which has been increasing.

Erin Brinker: 26:07

Oh, interesting. Wow. So, so the the age for screening has, has for many years, it's been age 50. Is that changing?

Dr. Joseph Ruan: 26:18

Yeah, yeah. That recently changed back in 2021 the US Preventative Services Task Force, just based on the changing rates, did lower the screening age to 45 is that young enough? Well, that's a great question. So a lot of us feel that that's not young enough, and we probably need to push it down even further. My feeling is that probably in a few years, just with more data, the the task force will eventually change it to a lower age. But it takes a live. You know, it takes a lot to get to a national level where those things change,

Erin Brinker: 27:07

right, right? So Cynthia, talk about your daughters and and how they were, what happened in your family dynamic after you were diagnosed.

Cynthia Hernandez: 27:21

Well, it's interesting because my daughter, who's who's actually in PA school now, so I was having difficulty with the prep, you know, I couldn't get all of the go lightly down and, or, you know, the prep solution down.

Erin Brinker: 27:39

Yes, that's the worst part of the procedure, by the by the way, is that prep,

Cynthia Hernandez: 27:43

it is and, and I, you know, I was joking with her, and I was like, you know, this is medieval, and, you know, there's got to be an easier way. And, and I was going to reschedule, I was like, I can't do this. Like, feel sick to my stomach. I can't complete it. And she, you know, she was very, like encouraging and almost like scolding me, like you just, you already halfway through. You just need to get this done. And you know it's important. So, you know, thankfully for her, if I hadn't, you know, if I hadn't listened and just stuck through it, I probably would have rescheduled, probably months out, and probably delayed. You know, my care further, but, you know, I I know that there's a lot of people, even people that I work with, that I've been trying to nudge to get their colon screening done, and I think that's the part that kind of scares them the most, but, or doesn't scare them the most, but it's not fun, right? It's unpleasant,

Erin Brinker: 28:41

it is, it is, but I know it's less pleasant. Yes, it's, it's more it's less unpleasant than cancer.

Cynthia Hernandez: 28:49

Yes, exactly. And, you know, and that's, you know, that's kind of like my story to them, and, you know, I just, I try to encourage it as much as possible. But, yeah, so that's, that's kind of what happened. She was actually with me during my colonoscopy procedure, so she was there when the physician came out and shared the news. And so we kind of, this was my older one, my younger one at the time, was in school. But we kind of had to navigate it together,

Erin Brinker: 29:21

you know, so you had an advocate.

Cynthia Hernandez: 29:24

I did that's wonderful. I don't know if she was an advocate or she was like, you know, my you're gonna do this. Or

Erin Brinker: 29:36

you're like, Okay, nurse, ratchet, that's perfectly fine.

Cynthia Hernandez: 29:39

Yeah? So, yeah, it's, so, thankfully, she was there with me, you know, through it all. And it's, it's, I'm sure it was emotional and scary for her as well. But you know, it's just, it's the prep part. What, in this grand scheme of this whole thing is, is the easiest part? Right? You know, we get that, you know, that's the gonna be the easiest part. It's just, you know, get that, you know, Fit Kit done. You know, schedule your colonoscopy. If you're having any type of symptoms, just talk to your doctor. I just think it's, something that, like Dr Ruan said, is you don't want to wait until you have symptoms, right? So this is something that can be screened and caught early without by the time you have symptoms, it's, it's probably been there for quite a bit, you know. So just encouraging everybody to, you know, just do the simple thing. If you don't want to do your colonoscopy, do the fit kit. You know, at least have that screening done.