Colorectal Cancer: Screening, Treatment, Advances in Cancer Management

Colorectal cancer by the numbers

Globally, colorectal cancer (CRC) is the 2^nd most common cancer in females and the 3^rd most common cancer in males. African Americans or Black individuals outpace White Americans by 20 percent in annual CRC rates by race. As indicated in figure 1, for every 150,000 new CRC diagnoses, there exist approximately 50,000 deaths in the same year. To put it into perspective, every time three individuals receive a CRC diagnosis, one person dies as a result of the debilitating disease. However, in the last 20 years, the number of new CRC diagnoses has decreased steadily. What could possibly cause this decline?

An ounce of prevention…

Implementation of screening tests over the most recent decades affects both incidence (number of new diagnoses) and mortality (number of deaths). One, in particular, is the colonoscopy. This screening modality is effective in both screening and diagnosing. Many of us have heard of it. The scope allows the general surgeon or gastroenterologist (or another qualified provider) to visualize the inside of your colon on a screen. They look for irregularities in the wall of the colon – things like polyps, diverticuli, or masses – and take a biopsy, or a tissue sample, to send to the pathologist for confirmation. This wait can be downright miserable, especially if you’ve been showing signs and symptoms of colorectal cancer (i.e., unexplained weight loss, blood in the stool, change in stool frequency or consistency, constipation, belly pain). Should what you most feared become true, there is some information that is helpful to know and discuss with your primary care physician, general surgeon, and oncologist. Colonoscopy screening, no matter your sex at birth or gender identity, begins at age 45. There can be exceptions and reasons to screen earlier (e.g., family history, genetic syndromes). Nonetheless, if you have a friend, cousin, child, or parent who just turned 45, make sure to tell them it is time to get their colonoscopy. Perhaps wait until after their birthday party, though.

A pound of cure…

Anxious, depressed, angry, scared, and 100 percent miserable may describe how you are feeling now. You have every right to feel that way. However, you and your loved ones should continue to remain informed. When you meet with your doctor after receiving the CRC diagnosis, be sure to ask the doctor these three main questions:

1. What is the stage of my cancer?
2. What are my treatment options?
3. What can I do for support?

To answer the first question, the answer can range from Stage 0 to Stage 4. Stage 0 is the least invasive type of cancer and has not begun to grow through the wall of the colon or rectum nor spread to lymph nodes or distant organs. At Stage 4, primary cancer in the colon or rectum has metastasized (“spread”) to another organ, like the liver or lung. Everything between Stage 0 and Stage 4 – Stages 1, 2, & 3 – depends on the size of the tumor and degree of lymph node involvement. 

Initially, treatment involves the surgical removal of part or all of the colon or rectum. Medical professionals refer to this surgical procedure as a colectomy (colon) or a proctectomy (rectum). While follow-up scans are imperative to ensure cancer has not returned, new advances in cancer diagnostics may offer useful information to help clinicians gauge whether cancer may return. 

Measuring circulating tumor DNA (ctDNA) levels through a blood test can help predict whether or not cancer will return. In many cases after surgery, if the ctDNA level is negative, cancer does not return. However, if the ctDNA level is positive, cancer will likely return at some point. The positive aspects of this approach include:

1. Knowing if your surgery was successful in removing all of the cancer
2. If the level is positive, getting an early start on chemotherapy
3. Once the chemotherapy is started, the actual ctDNA level can tell you if the treatment is working
4. You don’t have to wait around for an MRI or CT/PET scan to tell you whether your cancer is back

And as always when I write, I like to leave a link to actively recruiting clinical trials for colorectal cancer. But remember, you can always speak to any of your healthcare providers for information. And remember, the Cancer Support Community is here to help you and your loved ones navigate through this challenging time. 

Until next time,

Lee Quist, DO, MBA

Dr. Quist is currently offering his in-depth knowledge of clinical research and oncology to the Cancer Support Community by writing cancer-related blogs and newsletter articles. He received a medical degree from Lake Erie College of Osteopathic Medicine, a dual-specialty MBA from Walsh University, and his Bachelors in Biology from the University of Pittsburgh-Johnstown, which resides in the same county he was born and raised. His professional skillset falls within the fields of regulatory affairs, medical writing, and medical education. Dr. Quist’s ambitions hope to somehow positively impact the lives of those living with cancer. He also contributes his time and energy into educating today’s adolescent population and their caregivers on what he calls the current “mental health pandemic” or “the other pandemic”. He loves to spend time outdoors with his family, especially fly-fishing for Great Lakes Steelhead from October through April.