Colorectal cancer is the second leading cause of cancer and cancer deaths Nationwide. This year it is estimated, by the America Cancer Society, there will be over 150,000 new cases of colorectal cancer and over 50,000 deaths from colon cancer. In Louisiana it is the fourth in new cases of cancer (behind Prostate, Lung, and Breast) and the second leading cause of cancer deaths; and it is in a large part preventable. Everyone knows of someone who has had colorectal cancer, if you cannot think of anyone personally, let me name a few: Pope John Paul II, Ronald Reagan, Audrey Hepburn, Farrah Fawcett, Vince Lombardi, Ruth Bader Ginsburg, Charles M. Schulz (Peanuts comic strip), Elizabeth Montgomery, and Daryl Strawberry, just to name a few. And yes, you guessed it, it is in a large part preventable.
The colon and rectum are the last part of our digestive tract. The colon is approximately 5 feet long and is also known as the large intestine or large bowel. Its primary function is to carry waste out of our body and absorb water. The rectum is the last 6 inches of this tract. Interestingly, since 1975, the incidence of colon cancer has decreased.
There are many risk factors for Colorectal cancer, including age greater than 60, African American or Eastern European descent, family history of colorectal cancer, personal history of colorectal, breast, ovarian, or uterine cancer, ulcerative colitis or Crohn’s disease, as well as certain genetic conditions. These are all things we cannot control. However, diets low in fiber and high in fat, diets high in nitrosamines (barbecue, hot dogs, etc.) obesity, smoking, sedentary lifestyle, and alcohol are all risk factors that we can control.
Many patients with colorectal cancer have no symptoms. The symptoms that can occur include anemia, fatigue, change in bowel habits (diarrhea or constipation), weight loss, nausea and vomiting, rectal bleeding and changes in the caliber of your stool. Many of these symptoms are non-specific and could be caused by other things.
Colon and rectal cancer is diagnosed by colonoscopy. This allows both detection and the ability to obtain tissue for diagnosis. Other tests including labs and imaging help in determining the extent of disease, but colonoscopy is the best diagnostic method.
Once colorectal cancer is diagnosed, additional testing may be done to see if there is any spread. The best treatment is surgical removal of the cancer with a margin of normal tissue around all sides of the tumor. Depending on the individual characteristics of the tumor, chemotherapy with or without radiation may be necessary before or after surgery, or not at all. If the tumor is big and bulky and located in the rectum, it may be treated before surgery in an effort to shrink the tumor and make the surgery easier. Otherwise, treatment with chemotherapy depends on whether the pathologist sees any tumor in the lymph nodes. If there is no spread to the lymph nodes then further treatment may not be necessary. After treatment, you should be followed closely with a detailed surveillance schedule to ensure there is no recurrence, or if there is that it is caught at the earliest stages.
Colorectal cancer survival is based on the extent of disease at the time of diagnosis. The percent of people alive 5 years from the time of diagnosis ranges 90% for those with disease confined to the colon, to 71% and 14% for those diagnosed with cancer spread to lymph nodes and spread to other organs respectively. These statistics show that catching colon cancer in its early stages results in better survival in patients. This is accomplished by regular screening with colonoscopy.
So how is colorectal cancer preventable? That will be the topic of next weeks article.