Colorectal Cancer Q&A
Learn more about colorectal cancer (cancer of colon and rectum) with DuPage Medical Group specialists Kashyap Katwala, MD and Rafi Ali, MD board certified in gastroenterology, and Ciarán Bradley, MD, MA, board certified in surgery and surgical oncology.
Drs. Katwala and Ali explain some important facts about colorectal cancer. They highlight some risk factors, diagnostic approaches and treatment options. Dr. Bradley provides further in-depth explanations of surgical options and follow-up care.
What are the factors that contribute to risk for colorectal cancer?
Factors contributing to colorectal cancer include age, family history of colon cancer, smoking and history of certain other cancers. Inflammatory Bowel Disease (IBD) (Ulcerative colitis and Crohn’s disease) as well as some uncommon inherited colon polyp syndromes are also known risk factors.
Who should be screened and when?
All individuals 50 years of age or older, anyone younger than 50 but with a significant family history (ask your primary care physician for advice) and those with Inflammatory Bowel Disease (IBD).
Are there ways to reduce your risk/prevent colorectal cancer?
There is evidence that a high-fiber, low-fat diet, appropriate dietary Calcium supplementation, and low dose aspirin are protective against colorectal cancer. And of course, if an individual smokes tobacco, they should quit. Screening methods such as colonoscopy are very effective in preventing colorectal cancer.
How is colorectal cancer diagnosed?
Colorectal cancer usually does not produce symptoms until advanced stage. Colonoscopy is the most accurate method available for diagnosing colorectal cancer. It allows for identification of cancer location and for sampling tissue (biopsy) for a definitive diagnosis. Screening colonoscopy can identify cancer at an early and curable stage.
What are the symptoms of colorectal cancer?
Symptoms of colorectal cancer may include fatigue related to low blood count (anemia), change in bowel habits, abdominal pain, rectal bleeding and unintentional weight loss.
What are the survival rates for colorectal cancer?
- The five-year survival rate for colon cancer discovered at an early stage (cancer restricted to the colon) is about 90%.
- The five-year survival rate for colon cancer found at the regional stage (spread to surrounding tissue) is about 70%.
- The five-year survival rate for colon cancer found at an advanced stage (spread to other organs) is about 12%.
- This highlights the importance of early detection and preventative measures such as screening colonoscopy.
Q & A with Dr. Bradley
Generally, what type of doctors will a patient need to see throughout their care for colorectal cancer?
Generally speaking, the treatment for colorectal cancer is a collaborative effort involving a medical oncologist; a general, oncologic, or colorectal surgeon; and a radiation oncologist. Each doctor administers a specific type of cancer treatment: chemotherapy drugs (medical oncologist), surgical operation to remove the tumor (surgeon), or radiation therapy (radiation beams to shrink or kill the tumor). Any given patient may or may not need treatment from all three doctors, but they are each involved in the multidisciplinary discussion to design and plan every patient’s treatment course.
What are the treatment options for colorectal cancer?
No one patient receives the same treatment for colorectal cancer. Treatments include a surgical operation to remove the cancerous tumor and its associated segment of large intestine (colon or rectum); Chemotherapy drugs to kill any microscopic tumor cells that may be trying to spread through the body; or external radiation beams to shrink tumors or kill microscopic tumor cells left behind at the surgical site. The choice of treatments, timing, and combinations depends upon the stage of the cancer (degree it has started to spread), location in the colon versus rectum, and, most importantly, a patient’s overall health, quality of life and preference.
If radiation therapy or chemotherapy is needed – is it better to have before or after – and why?
There are pros and cons to receiving chemotherapy and/or radiation therapy before or after surgery for colon or rectal cancer. This is guided primarily by the location of the cancerous tumor. For instance, in colon cancer, if surgery is an option, it is preferred prior to other treatments, because the information obtained after removal and pathologic analysis of the tumor helps guide the decision to continue on with other treatments. Some patients with colon cancer are treated adequately with surgery alone.
For rectal cancer, treatment timing is dependent upon the degree to which the cancer has grown into the wall of the rectum and whether any lymph nodes appear to be harboring spread of the tumor (which we can better test for in rectal rather than colon cancer). For tumors that are not deep or do not appear to have involved lymph nodes, surgery is the best first option. For deeper tumors or ones that show involved lymph nodes, usually a combination of chemotherapy and radiation therapy is recommend prior to surgery, which is then followed by additional chemotherapy.
Is minimally invasive surgery ever an option for colorectal cancer?
Minimally invasive surgery is almost always an option. Several randomized controlled trials in the surgical literature have shown equal oncologic outcomes (adequate removal of the tumor with similar prognosis between traditional and minimally invasive surgery) with, in some studies, quicker, less painful recovery for patients undergoing minimally invasive operations. Options for minimally invasive surgery include laparoscopic surgery (surgeon and assistant hold fiber optic camera and long, thin instruments through small incisions) or robotic surgery (robotic arms hold camera and instruments that are controlled by surgeon sitting at a 3-D viewing console). The benefits of laparoscopic versus robotic surgery are still hotly debated, although more and more surgeons are adopting this approach. The decision to undergo robotic surgery should be based upon a particular surgeon's experience and comfort with the new technology, and assurance that the same, complete, cancer operation is obtainable.
Reasons for why a patient might not be a candidate for minimally invasive colorectal surgery include multiple previous operations creating too much scar tissue in the abdominal cavity or other serious illnesses that might make the minimally invasive approach too dangerous compared to traditional open surgery.
Generally, how often are checkups needed after treatment?
Every patient should undergo a colonoscopy at least within one year of treatment for colon and rectal cancer. Other follow-up tests include a history and physical examination by a cancer doctor, selected blood tests, and X-rays or CT scans. These checkups are usually a few times a year at first, and then are spread farther apart as time goes on and no cancer recurrence is discovered. The exact timing and intensity of follow-up visits and tests is influenced greatly by the stage and prognosis of the original colorectal cancer.