Wrapping up March’s recognition of Colorectal Cancer Awareness Month, Baptist Health South Florida and Miami Cancer Institute [1] presented a Facebook LIVE [2] discussion about colorectal cancer treatment.
The roundtable discussion featured Miami Cancer Institute medical oncologist Antonio Ucar, M.D. [3], radiation oncologist Michael Chuong, M.D. [4], and surgical oncologist Eduardo Krajewski, M.D. [5] Host Tamara Beliard, an author and cancer survivor, asked the expert panel questions about colorectal cancer detection and the types of treatment available.
Prevalence of Colorectal Cancer
Dr. Ucar, citing American Cancer Society statistics, said that doctors diagnose 145,000 cases of colorectal cancer in the United States each year – 100,000 are specifically colon cancer and 45,000 are rectal cancer. It’s the second leading cancer among women and the third leading cancer among men.
The difference in the two forms of cancer, he says, is where they are located in the lower part of the gastrointestinal tract. Colon cancer describes tumors found higher in the colon and rectal cancer signifies tumors found in the last part of the large intestine, or colon. Treatment for each type of cancer varies, so they have distinct names.
Symptoms of this ‘Silent Killer’
Because colorectal cancer often has few symptoms until it reaches an advanced stage, it’s often called a “silent killer,” but Dr. Ucar says to prevent an advanced cancer, people should watch out for these telltale signs something could be wrong:
- Abdominal pain
- Rectal bleeding
- Dark stools, indicating potential blood in the stool
- Diarrhea
- Constipation
- Iron-deficiency anemia, resulting from bleeding in the gastrointestinal tract
“If you wait to act on these symptoms, that may mean the cancer is more advanced,” he said.
Risks for Colorectal Cancer
Dr. Ucar points to several factors that increase one’s risk of developing colorectal cancer. These risks include:
- Age – 90 percent of colorectal cancers develop after the age of 50
- Family history
- Diet high in red meat, saturated fat, processed and cured meats, refined sugars and flour
- Obesity
- Sedentary lifestyle
- Diabetes
Screening for Colorectal Cancer
If you have these risk factors, Dr. Ucar suggests talking with your doctor about following the American Cancer Society’s guidelines for colorectal cancer screening [6] and having your first screening at age 45 instead of 50, which is what the United States Preventive Services Task Force (USPSTF [7]) currently recommends for people at average risk for colorectal cancer. People with a first-degree relative – a parent or sibling – who developed colorectal cancer should be screened 10 years prior to the age at which that relative was diagnosed. So, if your father was diagnosed with colon cancer at 45, your first screening should be at 35.
“The ideal situation is to detect the cancer earlier, because the curability will be much higher,” he said.
Surgeon Dr. Krajewski, who also performs colonoscopies, says that while other screening methods [8] for colorectal cancer exist and can be effective in detecting the polyps that lead to tumors, the gold standard in colorectal cancer detection remains the colonoscopy [9].
Surgical Treatment of Colorectal Cancer
When colon cancer or rectal cancer is found during a colonoscopy, getting rid of the cancer is the next step to treating it.
“In 2019, surgery is still the best therapy for early cancers of the colon or rectum,” Dr. Krajewski said. “With early detection, surgery offers 80- to 90-percent curability.”
Dr. Krajewski, and other Baptist Health colorectal surgeons, perform open surgery or minimally invasive surgery, including laparoscopic or robot-assisted approaches, depending on the patient, the location of the cancer, its size and other factors.
Surgery removes tumors and surrounding tissue, which is analyzed by a pathologist to determine whether the cancer has spread to other organs or tissues. This “staging” of the cancer helps a medical oncologist, like Dr. Ucar, decide whether surgery is enough or if chemotherapy or radiation therapy may also be needed to stop the cancer from spreading to other areas of the body.
Recent advances in colorectal surgery and pre- and post-operative care have reduced complications and length of stay in the hospital following colorectal surgery from five days to two or three days. This helps patients get to other therapies more quickly.
Radiation Therapy and Proton Therapy for Colorectal Cancer
Dr. Chuong, who specializes in treating cancer with doses of radiation, says that new radiation treatments like Proton Therapy, allow for the delivery of cancer-killing radiation to tumors while sparing healthy cells and tissue surrounding the tumor. Proton therapy, he notes, can be especially helpful to patients with cancer that recurs in a location previously treated with surgery or other types of radiation. Other equipment, such as cyber knife, or radiation techniques, such as radioembolization, that are available at Miami Cancer Institute, may also be recommended for treatment of colorectal cancer, depending on the input of experts from many specialties.
Multidisciplinary Cancer Treatment
Dr. Chuong credits the multidisciplinary approach to cancer treatment, a hallmark of care at Miami Cancer Institute, with maximizing the effectiveness of treatments offered.
“We have a multidisciplinary weekly Tumor Board, where experts who represent different aspects of therapy meet, and everything about new cases is reviewed and discussed to reach a consensus treatment recommendation for the patients,” he said.
Combining the advanced technologies available in surgery, radiation therapy and chemotherapy, Dr. Chuong points out, means that even patients with advanced colorectal cancer may be cured.
With all the available approaches to treating colon cancer and rectal cancer, the expert panel of doctors featured on Baptist Health’s Facebook LIVE discussion agreed that early detection of colorectal cancer through recommended screenings offers the best hope of curability for this type of cancer.