It’s been called the “silent killer,” but advances in colorectal cancer prevention, detection and treatment have changed the outlook for this cancer that impacts nearly 148,000 lives and causes more than 53,000 deaths in the United States each year, according to a 2020 American Cancer Society report.
“Colorectal cancer is not a death sentence for most people,” said Joseph “J.R.” Cali Jr., MD, assistant professor of surgery at McGovern Medical School at UTHealth Houston and a colon and rectal surgeon with UT Physicians Colon and Rectal Clinic at Memorial City. Dr. Cali, who is affiliated with Memorial Hermann Health System, stated “With updated screening guidelines and newer screening technology, we’re finding colorectal cancer at earlier stages, when it’s most treatable. And treatments are also evolving.”
Vinu Ninan, MD, a family medicine doctor with Memorial Hermann Medical Group (MHMG) in Sugar Land, admits that most people dread having a colorectal cancer screening, the most common of which is a colonoscopy. He assures his patients, though, that the preparation for this test has gotten much easier recently, and there are other tests to consider.
“Colonoscopy is still the gold standard to diagnose cancer of the colon and rectum,” Dr. Ninan said. “But at-home tests that use stool samples sent to a lab can also be used to uncover abnormalities that could indicate the presence of cancer.”
A fecal immunochemical test or “FIT” test detects the presence of blood in the stool. Stool DNA tests detect blood, as well as abnormal cells. While these tests are performed in the privacy of your own home and may be preferable to colonoscopy, Dr. Ninan explains that positive results from them must be followed up by a colonoscopy to confirm the source of the blood or abnormalities.
Dr. Cali points to another benefit of opting for a colonoscopy first. “Colonoscopies can also treat cancer and even prevent cancer when non-cancerous or pre-cancerous polyps are found and removed during the procedure,” Dr. Cali said. Furthermore, the analysis of removed polyps helps guide further screenings and treatment plans.
According to Dr. Ninan, no matter what test you choose, it’s important to get a screening when it’s time. For most people with an average risk of colorectal cancer, the U.S. Preventive Services Task Force (USPSTF) now recommends getting a baseline colorectal cancer screening at age 45, down from 50 just a few years ago. The USPSTF also recommends screenings through age 75.
“We’re seeing younger people with colorectal cancer, now,” Dr. Ninan said. While it’s still unclear as to why this trend is emerging, mounting evidence suggests that diets high in animal fats, especially from eating red meat, and low in fiber may be one cause. Smoking has also been shown to correlate with higher incidence of colorectal cancer, as does having a sedentary lifestyle that leads to obesity.
Dr. Ninan educates his patients about proper nutrition, quitting smoking and getting regular exercise to help manage their risk for colorectal cancer, but family history is also a major contributor, he says.
“When patients have a first-degree relative, such as a parent or sibling, with a colorectal cancer diagnosis, we recommend they get screened 10 years prior to when that relative was diagnosed,” Dr. Ninan said. “This allows us to get ahead of disease progression, so you have a reduced chance of developing cancer.”
Dr. Ninan also advises people to pay attention to symptoms that may indicate colorectal cancer. These include:
“These symptoms don’t necessarily mean colorectal cancer but should be checked out by a physician,” Dr. Ninan said. He refers patients to gastroenterologists for screening.
Dr. Cali explains that if a colonoscopy reveals colorectal cancer, follow-up tests, including CT and MRI imaging of the chest, abdomen and pelvis, will be needed to determine the stage of the cancer and the subsequent course of treatment.
“At Memorial Hermann, a multidisciplinary team of specialists, including gastroenterologists, colorectal surgeons, oncologists and radiation oncologists meets several times a month’ to evaluate patients’ tests to determine the best treatment options for them,” Dr. Cali said. “This helps avoid fragmented care for patients and improves their prognosis.”
That multidisciplinary team also includes Nurse Navigators, who help patients navigate their cancer journey, scheduling surgery, chemotherapy, radiation therapy and any other care they need.
Additionally, two of Memorial Hermann’s hospitals – Memorial Hermann The Woodlands Medical Center and Memorial Hermann Southeast Hospital – have achieved accreditation by the National Accreditation Program for Rectal Cancer (NAPRC). “For patients with cancer of the lowest portion of their large intestine – the rectum – this accreditation means they will receive research-supported care,” said Dr. Cali, who has been instrumental in achieving these accreditations.
“Treating colorectal cancer often involves surgery to remove the diseased portion of the colon,” Dr. Cali said. “Rectal cancer, found in the lowest part of the large intestine, requires a complex treatment plan because of its location within the pelvis. So, we need different protocols to ensure optimum function following surgery.”
Depending on the stage of the cancer, surgery may be preceded or followed by chemotherapy or radiation therapy to prevent cancer cells from spreading.
Dr. Cali and Memorial Hermann’s multidisciplinary team are hopeful about treatment with patient-specific chemotherapy and immunotherapy, which are based on the tumor’s genetic profile, and are being tested in clinical trials.
“What’s important to note about colorectal cancer is that especially with early detection through available screenings, most people have treatable cancer,” Dr. Cali said.