Colorectal Cancer Q&A

Col­orec­tal can­cer is com­mon, affect­ing approx­i­mate­ly 1 in every 20 Amer­i­cans over the course of their life­time. Stay­ing up-to-date on rec­om­mend­ed can­cer screen­ings has proven to be a high­ly effec­tive way to detect can­cer ear­li­er, start treat­ment soon­er and slow dis­ease pro­gres­sion. Can­cer screen­ings are par­tic­u­lar­ly effec­tive for col­orec­tal can­cer because it pro­gress­es slow­ly. Our board-cer­ti­fied Gas­troen­terol­o­gists, Drs. Kashyap Kat­wala, MD and Rafi Ali, MD and Cia­rán Bradley, MD, FACS, board cer­ti­fied in surgery and sur­gi­cal oncol­o­gy answer your com­mon ques­tions about col­orec­tal can­cer, the risk fac­tors you should be aware of and what treat­ment options are available.

Col­orec­tal Can­cer Screen­ing & Symp­toms Q & A with Gas­troen­terol­o­gists Kashyap Kat­wala, MD and Rafi Ali, MD

What are the most com­mon risk fac­tors asso­ci­at­ed with col­orec­tal cancer?

Risk fac­tors com­mon­ly linked to col­orec­tal can­cer include: 

  • Age: Col­orec­tal can­cer is most com­mon in indi­vid­u­als over the age of 50, how­ev­er, over the last sev­er­al years the num­ber of col­orec­tal can­cer cas­es being diag­nosed in patients under the age of 35 has been on the rise
  • Hered­i­tary fac­tors and genet­ics: A fam­i­ly his­to­ry of col­orec­tal can­cer or a per­son­al his­to­ry of polyps or oth­er types of can­cers increas­es your risk
  • Hav­ing oth­er gas­troin­testi­nal con­di­tions: Cer­tain con­di­tions includ­ing Crohn’s dis­ease, colon polyp syn­drome, inflam­ma­to­ry bow­el dis­ease (IBD) or ulcer­a­tive col­i­tis can increase your risk
  • Smok­ing: If you are a cur­rent smok­er or have smoked in the past, you are at risk to devel­op sev­er­al types of can­cers includ­ing col­orec­tal caner

When should you start screen­ing for col­orec­tal cancer?

All indi­vid­u­als 50 years of age or old­er should be screened for col­orec­tal can­cer. Indi­vid­u­als con­sid­ered to be at a high­er risk may be advised by their pri­ma­ry care physi­cian to start screen­ing soon­er or more fre­quent­ly. It is nev­er too ear­ly to start talk­ing with your physi­cian about your risk for col­orec­tal can­cer and estab­lish­ing a screen­ing sched­ule appro­pri­ate for you.

How can I reduce my risk of devel­op­ing col­orec­tal cancer? 

A diet that is high in fiber and low in fats can low­er your risk of col­orec­tal can­cer. Your physi­cian my also rec­om­mend you take cer­tain sup­ple­ments like cal­ci­um or low dose aspirin. If you cur­rent­ly smoke, tak­ing steps to quit will low­er your risk for sev­er­al can­cers, includ­ing col­orec­tal cancer.

How is col­orec­tal can­cer diagnosed?

A colonoscopy is the most accu­rate way to detect col­orec­tal can­cer ear­li­er, when it is most treat­able. Colono­scopies help detect polyps and a sam­pling of tis­sue (biop­sy) can be obtained to con­firm the diagnosis.

What are the symp­toms of col­orec­tal cancer?

Col­orec­tal can­cer often does­n’t pro­duce notice­able symp­toms until the can­cer has reached a more advanced stage and can include: 

  • Abdom­i­nal Pain
  • Changes in bow­el habits
  • Fatigue
  • Rec­tal bleed­ing or blood in your stool
  • Unin­ten­tion­al weight loss

What are the sur­vival rates for col­orec­tal cancer? 

The five year sur­vival rate for col­orec­tal can­cer varies sig­nif­i­cant­ly based on the stag­ing of the can­cer at the time it is diag­nosed. The ear­li­er the can­cer is detect­ed and treat­ment is start­ed, the bet­ter the out­come, which is why can­cer screen­ings are so important.

  • Col­orec­tal can­cer dis­cov­ered at an ear­ly stage, when the can­cer has not spread out­side the colon, has about a 90 per­cent five-year sur­vival rate
  • Col­orec­tal can­cer found at a region­al stage, when the can­cer has spread to sur­round­ing tis­sues, has approx­i­mate­ly a 70 per­cent five-year sur­vival rate
  • Colon can­cer iden­ti­fied in an advanced stage, when the can­cer has spread to oth­er organs, has a five-year sur­vival rate of about 12 percent

Col­orec­tal Can­cer Treat­ment Q & A with Sur­geon Cia­ran Bradley, MD, FACS

What are the treat­ment options for col­orec­tal cancer?

Each col­orec­tal can­cer treat­ment plan varies by patient and takes into con­sid­er­a­tion a vari­ety of fac­tors includ­ing your over­all health, the can­cer stage and loca­tion. The most com­mon treat­ments for col­orec­tal can­cer include chemother­a­py med­ica­tions which pre­vent can­cer­ous cells from spread­ing, radi­a­tion ther­a­py to shrink or destroy tumors and surgery to remove the can­cer­ous growth. In some cas­es, you may receive a com­bi­na­tion of these treat­ments. Your can­cer treat­ments are a col­lab­o­ra­tive effort by an entire care team that includes a med­ical oncol­o­gist, a sur­geon who spe­cial­izes in oncol­o­gy-relat­ed pro­ce­dures, a radi­a­tion oncol­o­gist and oth­er sup­port staff.

If radi­a­tion ther­a­py or chemother­a­py is need­ed — is it bet­ter to have before or after surgery — and why?

There are pros and cons to receiv­ing chemother­a­py and/​or radi­a­tion ther­a­py before or after surgery for colon or rec­tal can­cer, depend­ing on the loca­tion of the can­cer­ous tumor. If you have been diag­nosed with colon can­cer and surgery is an option, we often rec­om­mend the surgery be per­formed pri­or to oth­er treat­ments, so that we can use the post-sur­gi­cal pathol­o­gy infor­ma­tion obtained to help guide all oth­er treat­ment deci­sions. In some cas­es, surgery may be the only treat­ment needed.

For rec­tal can­cer, treat­ment tim­ing depends on the degree to which the can­cer has grown and spread with­in the rec­tum and near­by lymph nodes (which can be bet­ter test­ed for in rec­tal rather than colon can­cer). For super­fi­cial tumors or tumors that have not spread to lymph nodes, surgery is the best first option. For deep­er tumors, or those that show involved lymph nodes, we usu­al­ly rec­om­mend a com­bi­na­tion of chemother­a­py and radi­a­tion ther­a­py pri­or to surgery, fol­lowed by addi­tion­al chemotherapy. 

Is min­i­mal­ly inva­sive surgery ever an option for col­orec­tal cancer?

Min­i­mal­ly inva­sive surgery options are avail­able and include laparo­scop­ic or robot-assist­ed surgery. Ben­e­fits of min­i­mal­ly inva­sive or robot-assist­ed surgery often include a small­er inci­sion and reduced recov­ery times. 

If you have had oth­er surg­eries in the past that have cre­at­ed sig­nif­i­cant scar tis­sue in your abdom­i­nal area or have oth­er health con­di­tions that might make the pro­ce­dure too dan­ger­ous com­pared to tra­di­tion­al open surgery, you may not be a can­di­date for min­i­mal­ly inva­sive surgery. Your sur­geon will work with you to select the sur­gi­cal option that is best for you.

In order to best pro­tect your­self against col­orec­tal can­cer, it is impor­tant you com­plete a colonoscopy at the age of 50. You should talk to your doc­tor now to deter­mine your risk for devel­op­ing col­orec­tal can­cer, and if you are deter­mined to be at a high­er-than-aver­age risk, your physi­cian may rec­om­mend you begin screen­ing before the age of 50 or be screened more fre­quent­ly. If you are at an aver­age risk, sched­ul­ing a screen­ing colonoscopy can be done with­out an in-per­son con­sult. Our nurs­es are avail­able to con­duct an over-the-phone assess­ment and pro­vide you with the infor­ma­tion and prep instruc­tions you will need in order to com­plete your colonoscopy. To find out more, or to sched­ule your colonoscopy, call 630−717−2600.

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