March is Colorectal Cancer Month
By Charles Catcher, MD

Colorectal cancer is cancer of the large intestine or rectum. Approximately one-third of people who develop the disease die as a consequence, making it the second-leading cause of cancer death. The good news is that this cancer can be caught at an earlier stage with appropriate screening tests.

There is general agreement by experts that all adults should undergo screening for colorectal cancer at age 50, and even earlier for those people believed to be at higher risk.

What are the known risk factors for development of colorectal cancer?

Family history – The occurrence of colorectal cancer in a family member increases the risk of developing colorectal cancer, especially if it is a parent, sibling, or child, several family members are affected, or if the cancer has occurred at an early age, for example before age 55.

Prior colorectal cancer or polyps – Individuals who have previously had colorectal cancer or those who have had polyps before the age of 60 are at an increased risk.

Increasing age – 90 percent of these cancers occur after age 50.

Race – Black Americans have a higher risk of dying from colorectal cancer than white Americans. The risk is also high in native Alaskans and low in American Indians.

Lifestyle factors – Several factors may increase the risk of developing colorectal cancer including: a diet high in fat and red meat and low in fiber, a sedentary lifestyle, and cigarette smoking. Factors that may decrease the risk include folic acid, calcium supplements and aspirin.

There are other conditions that more dramatically increase the risk of developing colorectal cancer, however they occur far less often including familial adenomatous polyposis in which individuals have hundreds of polyps throughout their colon, hereditary nonpolyposis colon cancer and inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.

Screening tests – Four tests are currently utilized for colorectal screening: fecal occult blood test, sigmoidoscopy, barium enema, and colonoscopy. The present screening recommendation is all individuals age 50 and older should have a screening colonoscopy. This test is the most sensitive test at detecting cancer, as well as polyps that may lead to cancer. If an initial test is negative in the low-risk patient, it does not have to be repeated for 10 years. People at higher risk often need to begin screening at an earlier age and may need more frequent exams.

Management of colorectal cancer – Surgery is the primary treatment of colorectal cancer. Surgical removal of the cancer is essential in order to achieve the possibility of a cure. The diagnosis of cancer is usually made at the time of the colonoscopy with a biopsy of the cancer. Once a cancer diagnosis is made, patients undergo staging in order to determine if the cancer is localized or if it has spread. Staging usually includes blood tests, chest x-ray and a CAT scan of the abdomen and pelvis. If the cancer is localized, in most cases it will be surgically removed. A surgeon attempts to achieve a sufficient enough resection in order to achieve an adequate amount of normal tissue on both sides of the cancer. In addition, tissue surrounding the tumor is removed, which will usually include several lymph nodes; helping determine an individual’s prognosis and the possible need for more therapy such as radiation or chemotherapy.

Adjuvant therapy – Adjuvant (meaning additional) therapy of colorectal cancer may include chemotherapy, radiation therapy or both. Chemotherapy alone is usually recommended for patients in whom it is suspected that residual cancer remains in the body after surgery. This occurs most commonly in patients whose cancer involves the lymph nodes or who have a tumor, which resulted in either a complete blockage of the large intestine or created a hole in the intestine called a perforation. Radiation is chiefly used with chemotherapy to treat patients with rectal cancer who may have a higher recurrence risk. Those individuals who have tumors that penetrate into the fatty tissue surrounding the rectum or who have lymph nodes containing cancer may benefit from radiation therapy in addition to chemotherapy. These treatments potentially improve a patient’s outcome by decreasing the risk of cancer recurrence.

Therapy for metastatic cancer – Several treatments are now available to treat colorectal cancer that has spread to other organs via the blood (metastases). These therapies include chemotherapy and angiogenesis inhibitors. There are new chemotherapeutic drugs now available that have increased our ability to fight metastatic colorectal cancer. In addition, new drugs are available that block the growth of new blood vessels, which are essential in order for tumors to grow. These drugs, called angiogenesis inhibitors are given along with chemotherapy to increase our ability to fight the cancer. Though these treatments are not curative, they have enhanced our ability to prolong an individual’s life and improve their quality of life.

In summary, colorectal cancer, if caught early, is highly curable. Additionally, we have methods to treat patients adjuvantly that allow us to increase our patient’s chances for cure. We have new, exciting drugs that we can use in patients who have metastatic disease, that improve survival, as well as enhance quality of life.

We have great hope that as new treatments evolve, we will have the ability to have greater impacts on our patients’ lives.

Home | Our Practice | Staff | Research | Helpful Information | Cancer Topics
Education | Directions | Remembering a Loved One | Contact Us
Privacy Statement | NHOH In The News | Disclaimer