Colorectal Cancer Awareness Month

By Sansum Clinic

This Colorectal Cancer Awareness Month, Sansum Clinic and Ridley-Tree Cancer Center urge age-eligible community members to understand their risks and to get screened.

CURRENT STATISTICS

Approximately 153,000 patients will be diagnosed with colorectal cancer in the United States this year, and 10% of those diagnosed will be younger than age 50. While the overall rate of people diagnosed with colorectal cancer has been dropping since the 1980s due to screening tests, the number of people younger than age 55 diagnosed with colorectal cancer doubled from 11% (1 in 10) in 1995 to 20% (1 in 5) in 2019, according to the American Cancer Society. Colorectal cancer is on track to become the leading cause of cancer death in adults under 50.  In the U.S., colorectal cancer is the third most commonly-diagnosed cancer and the second most common cause of cancer-related deaths overall.

“In most cases, each patient’s colorectal cancer is molecularly different, and therefore responds differently to treatment. Researchers are constantly working to advance our understanding of how to prevent, detect and treat colorectal cancer.  This is why I am passionate about my work as chief investigator in some of our clinical trials, and it’s why we encourage patient participation, when it’s a good fit,” said Mukul Gupta, MD, Ridley-Tree Cancer Center Medical Oncologist & Hematologist.

Additional research shows that certain lifestyle factors like excess body weight, physical inactivity and smoking increase colorectal cancer risk in adults. Consumption of red and processed meat, starchy foods, refined carbohydrates, sugary drinks and moderate to heavy alcohol use are also associated with a higher risk of developing cancer. Conversely, eating a variety of whole foods including fruits and vegetables, whole grains, legumes, fish or poultry, and consuming fewer red and processed meats are associated with lower cancer risk.

African-Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups, according to the American Cancer Society. Many non-medical factors create barriers and can influence access to cancer healthcare.  Cancer disparities happen when barriers to high-quality cancer prevention, early detection, and treatment result in differences in cancer incidences and outcomes because of social determinants such as race, ethnicity, age, income, sexual orientation, gender identity, or geographic location.  As the American Cancer Society states, much of the inequality in these social determinants among people of color stems from historical and persistent structural racism.  Ridley-Tree Cancer Center is committed to offer equitable cancer care to all patients.

PREVENTION IS KEY

45 is the recommended age to begin colorectal cancer screening, preferably a colonoscopy. If you have symptoms, a family member with colorectal cancer or polyps, or specific inherited conditions, you should get a colonoscopy earlier than age 45. During a colonoscopy, doctors can find precancerous polyps and remove them before they become cancerous. If cancer is found in its early stages, it is easier to treat.

In 2021, the U.S. Preventive Services Task Force issued new colorectal cancer screening recommendations stating that people of average risk should start screening at age 45. In response, most health insurance companies now cover the cost of the test at a younger age. Medicare insurance quotes are available for enrollees.

“Colon and rectal cancer is largely a preventable disease, yet it is the second most common cause of overall cancer deaths. A colonoscopy is the gold standard screening test, and it can actually prevent the development of cancer,” commented Cristina Harnsberger, MD, Sansum Clinic fellowship-trained colorectal surgeon. “For those diagnosed with colorectal cancer, surgery can often lead to a cure, but unfortunately this is not always the case. Getting a colonoscopy could save your life.”

Sansum Clinic’s Gastroenterology Department has a highly-specialized team with expertise in performing colonoscopies.

SIGNS & SYMPTOMS OF COLORECTAL CANCER

If you have symptoms like rectal bleeding, change in frequency and consistency of bowel movements, abdominal pain or anemia, consult your doctor to schedule a colonoscopy.

TREATMENT OF COLORECTAL CANCER

Treatment for colorectal cancer most often includes surgery. The stage or extent of the cancer impacts treatment. People with cancer in their colon that has not spread to other parts of the body usually have surgery as the first course of treatment.  Afterwards, patients may receive chemotherapy, immunotherapy and/or targeted therapy to treat their cancer. Treatment for people with cancer in their rectum and/or anus (which are the last parts of the GI tract) is quite different than treatment for people with colon cancer. Treatment for rectal and anal cancer most often involves a combination of radiation, chemotherapy and possibly surgery. Rectal cancer treatment can span multiple months to one year, and often involves multiple surgeries. Ridley-Tree Cancer Center’s Gastrointestinal (GI) Cancer Program provides comprehensive medical expertise and supportive care to treat cancers and conditions of the digestive system, including colon, rectal and anal cancer.  

The colorectal cancer treatment team at Ridley-Tree Cancer Center is using a new protocol for some rectal cancer patients who may be able to avoid surgery. Chemotherapy and radiation in some patients can cause the tumor to shrink and go away completely even before surgery is performed. In this “watch and wait” approach, patients are closely monitored by physicians and undergo tests every 3-4 months to make sure the tumor does not return. Although some patients are able to enroll in this protocol, the majority of patients still require surgery to reach a cure. This same protocol is also being used to manage some patients’ anal cancer.

Treatment of colorectal cancer with a multidisciplinary team improves outcomes. The resources that we have in Santa Barbara for colorectal cancers are extensive in relation to the size of our community. We have the ability to provide top-notch care that would be delivered at major academic medical centers. At Ridley-Tree Cancer Center, colorectal cancer patients receive care from a multidisciplinary team of experts in gastroenterology, pathology, surgical oncology, colon and rectal surgery, medical oncology, radiation oncology, diagnostic and interventional radiology, nuclear medicine, clinical research, genetic counseling, oncology nutrition and patient navigation.  New digital technology in Ridley-Tree’s Nuclear Medicine Department improves the diagnosis and treatment of colorectal cancer. The new digital PET/CT uses less radiation, and can provide greatly-enhanced image quality, faster, improving the patient experience. Additionally, digital PET/CT scans are used by radiation oncologists who utilize the imagery to guide radiation therapy, so the treatment is even more precise and accurate.

Ridley-Tree Cancer Center physicians, staff members and community cancer experts attend weekly Gastrointestinal Tumor Board Conferences to discuss patients diagnosed with colorectal or other GI cancers to determine together the best multidisciplinary plan.

Cancer patients have access to a wide array of clinical trials through the Clinical Research Department and Ridley-Tree Cancer Center’s associations with clinical research networks. Ridley-Tree will soon open the BNT-122-01 study, examining the efficacy of a colorectal cancer personalized immunotherapy.  The Clinical Research Department is also participating in that trial’s companion epidemiological study BNT000-001. Three other colorectal cancer clinical trials, GO-010, RGX-202-01 and MIRATI 849-010 are underway at Ridley-Tree. Patients with interest in participating in a clinical trial should speak with their oncologist. All patients seeking to join any clinical trial must meet certain criteria in order to qualify.

UNDERSTANDING YOUR RISK FOR COLORECTAL CANCER

Some people may need to be screened for colorectal cancer before age 45. About 10% of colon cancers are hereditary. Lynch syndrome is the most common hereditary form of colorectal cancer. People with Lynch syndrome have between a 20-60% lifetime risk of developing colorectal cancer, compared to 4% in the general population. Certain factors like having colorectal or endometrial cancer before age 50, and/or having multiple family members with colorectal, endometrial or other cancers, can increase an individual’s risk of having a hereditary colorectal cancer condition, such as Lynch syndrome. You may wish to discuss these factors with your healthcare provider or a genetic counselor.  Details like the ages of family members when they were diagnosed with colorectal cancer, and/or whether you or family members have a history of colon polyps, are important to mention. Personalized screening recommendations made by a healthcare provider or genetic counselor can lead to prevention and early detection of colon cancer. Ridley-Tree’s genetic counselors are experts in this area. Genetic counselors have education and specialized training to help patients with a personal and/or family history of cancer, better understand and manage their risks. Genetic counselors do this by using genetic risk assessment, and the option of genetic testing.