The 411 on colorectal cancer
The latest information about colorectal cancer treatment - and what's on the horizon.
Screening saves lives. With cancers of the colon and rectum, together known as colorectal cancers, the survival rate is on the rise and the incidence of new cases is dropping. Between 1984 and 2004, colorectal cancer rates dropped by nearly 26 percent, according to the National Institutes of Health.
Still, not enough of us are getting the screenings that prevent these cancers or catch them early. Not by a mile.
Right now, only about half of the people who should be getting screened for colorectal cancer — everyone 50 or older and younger people with special risk factors like being black or having these cancers in their family — are getting the recommended tests, says Dr. Neal Meropol, director of the gastrointestinal cancer program at Fox Chase Cancer Center.
In Pennsylvania, only 10 percent of people with insurance that pays for the gold-standard test, a colonoscopy, are being tested, according to Dr. Craig Thompson, director of the Abramson Cancer Center at the University of Pennsylvania.
Those who neglect the recommended tests are missing two golden opportunities because colon cancer screening can both find cancer early, when the cure rate is best, and prevent cancer entirely by finding and then removing pre-cancerous polyps. "Colorectal cancer is one of the cancers where the impact of screening is greatest," Meropol says.
Treatment for colorectal cancers, as outlined below, is also very effective, with an overall survival rate of 65 percent, according to the National Cancer Institute. "It is one of the few cancers that can be cured even in advanced stages," Meropol says.
In the U.S. today, there are more than a million colorectal cancer survivors who have beaten the disease, thanks to advances in surgery, chemotherapy, radiation and early detection. They'd tell you: Get over your qualms and get tested.
Today's care
A surgical resection, which cuts away the cancer and some normal tissue on either side of it, and then rejoins the two sides of the bowel, is the main treatment for colorectal cancers. It's the only treatment needed when the cancer is caught very early.
In early stage colorectal cancer, laparoscopic resections (done through thin, lighted tubes placed into the abdomen) may be an option. The advantage is smaller incisions and faster recovery times.
With more advanced cancers, treatment may include chemotherapy and sometimes radiation after surgery to catch microscopic traces of cancer that might remain. Radiation also can be used to shrink tumors before they're removed.
Chemotherapy typically includes a drug called 5-FU, often with the helper drug leucovorin. A new way of pacing the treatment, called the de Gramont regimen, calls for two days of chemotherapy every other week.
FOLFIRI and FOLFOX are two versions of the de Gramont regimen that use different drugs with 5-FU. Another option is the medicine Xeloda, which is taken by mouth and turns into 5-FU when it reaches the tumor.
For advanced colorectal cancers, the medicines Avastin, Erbitux and Vectibix are three effective monoclonal antibodies (like the antibodies that fight germs, only these attack cancer).
Colorectal cancers are staged and grouped into T, N and M categories to help set the best course of treatment. The distinctions are complicated, so it's good to consult a decision tree. Visit go.philly.com/cancer for a handy one from the National Comprehensive Cancer Network.
If you've just been diagnosed, a call to the American Cancer Society toll-free helpline is a good way to begin sorting things out. The number is 800-227-2345.
On the horizon
New scrutiny in screenings. Until recently, doctors looked mainly for raised polyps during colonoscopies. But a new study shows that "flat lesions"are more dangerous, so practitioners will also be paying closer attention to those. They're harder to see, so patients will need to be especially scrupulous about taking the laxatives their doctor prescribes before the tests.
More personalized medicine. A new molecular test called RAS gene mutation testing has shown promise in trials and could soon become a standard step in the treatment of advanced colorectal cancer, Meropol says. Pathologists would use the test to examine tumors for a very specific genetic abnormality that could help oncologists pick the best therapy for individual patients.
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