Julio Garcia-Aguilar (Photo by Walter Urie)

The best defense very often is a good offense. This rings true for colon cancer, where screening for the disease is the most powerful way to gain the upper hand. In the second part of our conversation on the disease (for part one, click here), Julio Garcia-Aguilar, M.D., Ph.D., chair of the Department of Surgery, explains the importance of screening and gives us a glimpse of treatment options and where they’re headed.

eHope: What exactly is a precancerous polyp, and if my doctor removes one, does that mean I am cured?

Julio Garcia-Aguilar: A precancerous polyp is a growth of the lining of the colon that, if left alone, will turn into a cancer. If found during colonoscopy, polyps can be removed easily during the procedure without the need for surgery. Although polyps are cured by simple excision, it is important to keep in mind that a patient who has developed one polyp can develop others in the future. Therefore, patients who have had polyps should have periodic colonoscopies to search for new polyps. Your doctor will tell you how often.

EH: Why should I get screened for colon cancer?

JG-A: You should be screened because the disease is very common; one in every 17 Americans will develop it. Since polyps can take years to become cancer, screening takes advantage of this window of opportunity to remove the polyps and prevent cancer or to diagnose it before it spreads. If we can catch it early, treatment is more likely to be successful.

EH: When should I start getting screened?

JG-A: Because the risk of colon cancer increases with age, health officials recommend screening begin at age 50. But if someone in your immediate family has had colon cancer or polyps, you may need to start at an earlier age. Your doctor can tell you when it’s best to start screening.

EH: What are the different screening methods for colon cancer, and which is the most effective?

JG-A: The most popular way to screen is to perform a colonoscopy, but this is not the only way. Some methods look for polyps or cancer indirectly, by detecting traces of blood or other cancer products in the stool. This test is called a fecal occult blood test, or FOBT. The combination of an FOBT performed over three consecutive days and a flexible sigmoidoscopy is an accepted  method for screening average-risk individuals. Other techniques such as barium enema or CT-colography visualize the polyp or cancer using X-ray technology. Colonoscopy is probably the most effective one, but different patients may benefit from different tests. It is important to consult a doctor for a specific recommendation.

EH: What kinds of treatments are available for colon cancer?

JG-A: The main treatment for colon cancer is surgery; however, patients with advanced disease may also need chemotherapy and radiation.

EH: What’s new in colon cancer research?

JG-A: We’re always trying to do surgery in a way that’s less invasive and better tolerated by patients. In many centers, including City of Hope, surgery for colon cancer is performed laparoscopically or with the help of a robot. Both methods use smaller incisions and help reduce blood loss and other adverse effects, as well as recovery time. In addition, we are learning more and more about the molecular changes that occur in the tissue leading to the development of cancer. This is helping us develop more effective targeted drugs against colon cancer.