CANTON—Colorectal cancer is the third most common cancer diagnosed in both men and women each year in the United States, excluding skin cancer.
It is estimated this year 151,030 adults in the United States will be diagnosed.
What steps can be taken to help prevent colon cancer and if there is a diagnosis, what then?
Dr. Erin Bailey, General Surgeon with Graham Health System, said there are often no symptoms for colorectal cancer or polyps that may lead to cancer until the cancer is advanced and often beyond cure, “That is why it is imperative to get regular screening colonoscopies even if there are no symptoms. Screening colonoscopies currently begins at 45 years old unless you have a family history of colorectal cancer in which the patient should discuss their personal risk factors and recommendations with their physician.”
Risk factors vary, said Bailey, “If a patient has multiple family members with cancer—colorectal or otherwise—genetics (DNA) may play a role in their personal risk for colorectal or other cancers. There are several known genetic mutations that have been proven to increase the risk of cancer in those patient’s who carry those mutations.”
Further, Bailey said, if a patient is found to carry one of these mutations, blood relatives should be informed so they can be screened for those mutations if they choose to.
“These patients will be offered tailored screening recommendations depending on their specific mutation and history,” said Bailey.
General Surgeon, Dr. Jason Douglas, also with Graham Health System, echoed Dr. Bailey reiterating the US Preventative Services Task Force, American Cancer Society and other agencies recommend colon cancer screenings for average risk individuals start at 45 years of age, “Regular screenings should persist until the patient is at least 75 years old with further screening recommendations deferred to the patient’s physician.
Dr. Douglas explained the testing/screening process, “There is some confusion regarding the best way to detect and prevent colon cancer. It should be noted that tests such as fecal occult blood testing and Cologuard may find abnormalities within the stool, but they do nothing to treat it. Many precancerous lesions will go undetected by these tests. Cologuard, for instance, detects somewhere between 42-69 percent of precancerous polyps, depending on its size and characteristics. Furthermore, these polyps can be removed during colonoscopy which will prevent colon cancer by over 50 percent.”
Douglas said many of his patients share their concerns with him about the discomfort during the procedure, “However, many screening centers, including Graham Hospital, use sedation for the procedure, which reduces discomfort and usually results in forgetting the experience. Some patients worry about complications from the procedure. The most worrisome complication is perforation (a hole in the colon), which can lead to septic shock and death, if not treated in a timely fashion. The risk of perforation is about 1 in 3,000. While we cannot completely eliminate risk from the procedure, the risk of this complication is low (0.02-0.08 percent), and the benefit is high, considering about 1 in 25 (4 percent) Americans will be diagnosed with colon cancer in their lifetime.
What happens after a diagnosis is made?
Graham Health System’s General Surgery Specialist, Dr. Rozana Dwyer said there are four stages of colon and rectal cancer, “Each stage is dependent upon the depth of cancerous cells through the layer of the colon wall and if there is invasion to another organ.”
She went on to explain treatment methods vary depending on diagnosis, “Colon cancer and rectal cancer are treated differently. For colon cancer at earlier stages, removal of the colon mass and its lymph nodes is performed. If there are lymph nodes with cancer in it seen under the microscope, then chemotherapy is recommended after surgery. For stage 4 cancers, sometimes chemotherapy is offered first, and removal of the primary cancer and sometimes cancer in other organs is performed at the same time, if a curative attempt is possible. Rectal cancer, at an early stage without lymph node involvement can be removed through the anus but is generally treated with radiation and chemotherapy first, then surgery. There are current clinical trials in both colon cancer and rectal cancer research.”
Over the last decade or so, there has been considerable improvement for treatment of colon cancer and subsequently survival rates have improved.
Dwyer said that is true particularly for stage 4 colon cancers, “What used to be a dim prognosis for any extracolonic cancer involvement (stage 4 disease), has improved up to 40 percent+5 year survival rate for removal of primary and limited extracolonic cancer disease or metastasis. That means, if the surgeon can remove the primary colon cancer and metastasis in the liver and even lung, then the patient has a higher chancer of survival at the 5 year mark. In general, the chemotherapy used for colon cancer has over a decade of good data with excellent responses for the most common colon cancer. There are national, large ongoing studies in rectal cancer that teritary care centers are participating in that are challenging the ‘standard care’ as we learn more about rectal cancer biology.”
According to Dr. Dwyer, each patient’s treatment schedule varies depending upon their diagnosis, “Although there are generalized treatment plans for stages of colon or rectal cancer, each cancer patient’s treatment schedule is individualized based on the type of cancer, the risk of recurrence, the medical condition of the patient, and what the patient is willing to participate in. Most patients with colon or rectal cancer are presented at a tumor board where multiple physicians participate in the patient’s care and discuss each newly diagnosed cancer. The Surgeons at Graham Medical Group participate in these tumor boards especially for colon or rectal cancer as well as breast cancer.”
This article originally appeared on Canton Daily Ledger: Three Graham surgeons discuss colon cancer, prevention, diagnosis