50,000 lives a year but it also has one of the highest cure rates of all cancers.
The key is getting tested.
“We urge people to get tested and we hope for an increase in testing in March — or to at least get people thinking about it,” said Heleena McKinney, Health Promotions Coordinator of the East Central Division of the American Cancer Society.
Colorectal cancer is known as “the silent killer.”
“The biggest problem is that there might be no symptoms and people may still have the cancer,” said Deepak Kumar, MD, of Dayton Colon And Rectal Center.
Some of the more common symptoms of colon cancer are bleeding, change in bowel habits, weight loss, persistent anemia and tiredness.
“Unfortunately, by the time people develop those symptoms, that indicates that the tumor has been there a while and has been growing,” he said. “That is why the preventative screening in asymptomatic people becomes important.”
Guidelines from the American Cancer Society recommend colonoscopies beginning at age 50 unless there is a family history of colon cancer.
“Then it should be about 10 to 15 years earlier than the youngest sibling or parent was when their cancer was detected,” Kumar added.
“If you pick up the cancer at Stage One, the chance for cure can be as high as 80 to 90 percent,” he continued. “If you can get it in the polyp stage, you are nipping the whole process in the bud and not allowing the cancer to develop.”
He explained that polyps in the colon are the first indication of future cancer.
“We call it the Polyp-Cancer Sequence,” he said. “The polyp undergoes microscopic changes and will reach a point where it will be a benign growth. So, if you can get rid of the polyp when it is benign, you are really nipping the process in the bud and not letting it turn into a cancer.
“All polyps in due course of time will turn into cancer,” he said.
Once a person has polyps the doctor is likely to recommend more frequent colonoscopies than the five-year standard.
“There are some people where polyps will turn into cancer within a year so, in these cases, I don’t want to take a chance and I will do a colonoscopy every year or every two years to be sure nothing is happening,” Kumar said.
If the cancer has developed, then there are several options. A common recommendation is chemotherapy and radiation therapy before the surgery in the hopes of shrinking the tumor before the operation.
The traditional standard in the United States has been five weeks — 25 treatments of radiation. Edward Hughes, MD, PhD, of First Dayton Cancer Care Center, said that is not the norm in other countries — or in his clinic — where radiation oncologists are using five treatments with positive results.
“Wherever we can adopt fewer treatments with hard and fast evidence (of effectiveness), that’s what we do. So we are looking out for the patient’s convenience and looking out for the patient’s cost but, importantly, we are never going to compromise survival or having a patient with worse side effects,” he said.
He added that there has been a quiet revolution in the diagnosis and treatment of colon cancer.
“I think genetics has revolutionized not only the diagnosis of colon cancer but also in predicting treatment. So patients now come in and not just do a biopsy but actually do genetic profiling to help guide treatment.
“It not only gives you a prognosis on how you are going to do with therapy but it also predicts how your particular cancer is going to respond to chemotherapy,” he continued.
“Now in the experimental realm, it is going to become commonplace to be able to target specific pathways that are abnormal in cancer cells and to attack those with antibody molecules or chemotherapy agents,” he predicted. “In the same way, with those unfortunate patients where treatment has failed them and the colon cancer comes back, you can test those cells that are now recurrent and are probably different than the original cells that became resistant to chemotherapy and, again, they will have specific pathways you can attack”
Can the risk of colorectal cancer be minimized? Hughes said that European studies are showing that 20 to 30 percent of colon cancer has a correlation with obesity. Other studies are looking at the effects of diet – preferably low-fat, high-fiber.
“They were looking at patients who had colon cancer surgery and then chemotherapy and then randomized them with the patients who did diet and exercise programs. You were looking at decreasing the risk of recurrence by 25 percent,” he said. “Diet and exercise are blockbuster agents.”
First Dayton Cancer Care Center is the only such independent clinic in the Dayton area. Hughes listed convenience as one of the big advantages with parking nearly at the door — or the clinic has two shuttle cars who will pick up patients free of charge. The center treats all types of cancer with radiation oncology.
Dayton Colon and Rectal Center offers every service from screening colonoscopies to surgery to treatment.
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