Colorectal cancer 2016: Robotic surgery, more screening options

December 30, 2015 | by Veronique de Turenne

Screening for colorectal cancer will improve in 2016. So too will surgical techniques. The result of both will be improved survival and faster recoveries for patients.

To learn more about what to expect in the coming year, we spoke with two of City of Hope’s colorectal cancer specialists, Donald David, M.D., a gastroenterologist, and Stephen Sentovich, M.D., a colorectal surgeon. They answered five questions about new directions in colorectal cancer treatment and research in the coming year.

David, the chief of the Division of Gastoenterology since 1993, is also a clinical professor in the Department of Medical Specialties at City of Hope. He is a vocal advocate of regular colonoscopies for detecting colorectal cancer, particularly in people past the age of 50.
Sentovich, who joined City of Hope in 2014, is chief of the section of colon and rectal surgery. He is a clinical professor in the Division of Surgical Oncology, which is part of the Department of Surgery. A noted expert in his field, Sentovich is the author of numerous articles and has served as associate editor for the medical journal Diseases of the Colon & Rectum.
1. What treatment advances do you expect for colorectal cancer patients in 2016? 
“A new advance for colorectal cancer screening is the availability of Cologuard for screening,” David said, referring to an at-home screening test recently approved by the Food and Drug Administration. As with all cancers, early detection is key to successful treatment.
Cologuard works by identifying red blood cells and DNA mutations in the stool, which may indicate the presence of abnormal growths such as colon cancer or precursors to cancer.
“This is a noninvasive test on stool which is 92 percent accurate for diagnosing colorectal cancer,” David said.  
For colorectal cancer patients who require surgery, Sentovich sees great promise in the rapid advancement of robotic surgery. 
“Technical advances will allow for more patients to have robotic and minimally invasive surgery for colon and rectal cancer,” Sentovich said.
2. How significant is that? 
Although colon cancer is the third most common cancer in the United States and the second most common cause of death from cancer, half of those in the target screening population, which is people between 50 and 80, have never been screened for colon cancer, David said. That makes an accurate at-home test a significant step forward.
“This is an important alternative for colon cancer screening in patients who do not want to have a colonoscopy,” David said. 
Advances in robotic surgery have led to more precision, greater range of motion and easier access within the body. This means less physical trauma for the patient.
“Robotic and minimally invasive approaches result in less pain and a faster recovery,” Sentovich said.
3. How will this improve the patient experience or patient outcomes?  
An accurate at-home test opens up colorectal cancer screening to a wider population, David said.
“For patients who do not want to have a colonoscopy, it will not require bowel prep,” David said, referring to the procedure that ensures an empty bowel, a requirement for a successful colonoscopy.
“Although not quite as precise as a colonoscopy, it is completely noninvasive,” David said of the Cologuard test. “Patients with a positive test will need a colonoscopy to determine the cause of the positive result.”
Regarding the benefits of minimally invasive surgery, less injury to tissue can mean less postoperative pain and a faster return to daily routine, Sentovich said.
4. What research progress do you expect in 2016? 
Screening methods for colorectal cancer will continue to improve, David said.
“There will be new methods to more accurately diagnose colon cancer at an earlier and totally curable stage,” he said.  
As studies continue to examine robotic surgical techniques, Sentovich expects published reports to validate the value of this noninvasive approach. He also expects “further refinement of robotic and minimally invasive techniques.” 
5. Overall, where is the field of colorectal cancer treatment and research moving?
In addition to early detection and robotic surgery, David and Sentovich foresee a role for the emerging field of precision medicine, which takes into account the genetics, lifestyle and environment of a patient.
“Treatment and research are emphasizing minimally invasive, genetically targeted and personalized approaches to treatment,” Sentovich said.  “Given the success of all of the treatment modalities, the multidisciplinary approach to treatment is the most important factor for success, and is something that City of Hope excels at, and which differentiates us from other hospitals and medical centers. “

If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

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