Colorectal cancer: Grim irony accompanies treatment advances
March 1, 2013 | by Tami Dennis
Colorectal cancer screening saves lives but – because not enough people are being screened – they’re not able to take advantage of the best chance of curing their disease.
As the American Cancer Society notes, the lifetime risk of developing colorectal cancer is about one in 20, with colorectal cancer listed as the third-leading cause of cancer-related deaths in the United States. That’s when men and women are considered separately; it’s the second-leading cause when both sexes are combined. During March, deemed National Colorectal Cancer Awareness Month, such numbers are expected to get increased attention.
All told, the disease is expected to claim about 50,830 lives in the U.S. during 2013.
For Julian Sanchez, M.D., an assistant clinical professor in the Division of Surgical Oncology at City of Hope, that knowledge is difficult to bear. The ability to cure colorectal cancer is one of the reasons he chose his specialty.
“Colorectal cancer is not just treatable, but curable,” he says. “The cancer can be removed, and patients can go on to live long, healthy, cancer-free lives. Their disease becomes a thing of their past."
Already doctors and other health experts know who should be screened for colorectal cancer – the U.S. Preventive Services Task Force is very clear on that. It recommends screening using fecal occult blood testing, simoidoscopy or colonoscopy for people beginning age 50. The point of the screening is to find precancerous polyps before they turn cancerous.
But determined though he is to cure disease, not even Sanchez supports earlier screening for most people. “Colorectal cancer is generally a disease of the elderly, and age is the largest risk factor for developing cancer,” he says. “The only patients who should be screened at an earlier age are those with a specific risk factor.”
Who’s at risk:
Those risk factors, beyond age, for colorectal cancer include:
-An identified genetic disease that predisposes a person to colon cancer, such as familial adenomatous polyposis or Lynch syndrome. People with these diseases should start colonoscopy as young adults.
-A family history of colorectal cancer, even without an identified genetic disease. People who have a first-degree relative (mother, father, sibling or child) who developed colon cancer, should start screening either at age 40 – or 10 years before the age the family member was diagnosed, whichever is first.
-Ulcerative colitis. People with this condition should start screening 8 to 15 years after their ulcerative colitis diagnosis.
-And, perhaps, being African-American. There is some limited and recent data suggesting that African-Americans should be screened starting at age 45 because they have been showed to develop cancer at a younger age, Sanchez says.
-Having any symptoms at all. These include blood in the stool (noticed during a bowel movement); persistent stomach pain, aches or cramps; and unexplained weight loss.
The earlier treatment starts, the better a colorectal cancer patient’s odds of living a long, healthy, cancer-free life. And treatment, Sanchez notes, has improved significantly in recent years – in several areas.
What can be done:
Among the areas seeing treatment advances:
-Molecular and genetics research. “We have identified several genes that, when mutated, impact colon cancer survival and response to chemotherapy. This has been used as a guide to tailor treatment to each tumor individually,” Sanchez says. “This technology will only get more complete and accurate. I really think this is the future of multimodality therapy.”
-Medical oncology. New chemotherapy drugs have arrived, and several more are being studied; among the most promising are those that target specific cancer pathways.
-Surgery. Minimally invasive techniques continue to gain in popularity and in scope, including laparoscopic and robotic techniques.
“We have been pushing the envelope to aggressively excise rectal cancers without the need for permanent ostomy,” Sanchez says. “Of course some rectal cancers cannot be excised without permanent ostomy, but surgical techniques have become more aggressive and precise. We are currently investigating the role of surgery in patients who have had an excellent response from their chemoradiation, meaning that in the future, select patients with rectal cancer who had an excellent response from chemoradiation may not need a large surgery.”
Further, he adds: “We also have become more aggressive in terms of patients with stage 4 disease, which has already metastasized. We are treating more and more patients with metastasis with both surgery and ablative techniques.”
But, again, although the advances in colorectal cancer have been significant, patients can’t get treated if they’re not first screened.
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