Colorectal Cancer Treatment, Screening and Research

M. D. Anderson Cancer Center
Cancer Newsline Audio Podcast Series
Date: February 16, 2009
Duration: 0 / 14:33

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Lisa Garvin:

Welcome to Cancer Newsline, a weekly podcast series from the University of Texas M. D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention providing the latest information on reducing your family’s cancer risk. I’m your host, Lisa Garvin.

Today we are talking with Dr. Cathy Eng, associate professor in GI medical oncology here at M. D. Anderson. We are going to be talking about colorectal cancer. I think at least we know in the profession that colorectal cancer is very preventable. Do you think that message has gotten out to the public at large?

Cathy Eng, M.D.:

First and foremost, thank you Lisa for having me here today.

Unfortunately I do not think that enough people understand how preventable colorectal cancer is. I think many individuals are aware of the disease but many still fail to get screened. The standard recommendations are screening at the age of 50 unless you have inherited risk factors which would require you to be screened sooner. But unfortunately to date, at least based on the most recent media information, less than 60 percent of individuals are being screened appropriately that are eligible for screening. Many people fail to realize that this all starts with a benign growth which is a polyp and it takes about 5 to 10 years for that polyp to become cancerous. The whole point of a colonoscopy is to find those polyps, get them visualized and have them potentially removed if it’s amenable to removal during the procedure and hopefully avoid the diagnoses of colon cancer itself.

Garvin:

What do you think the barriers to screening are? Is it the colonoscopy itself that’s an invasive procedure? Granted, they’re sedated, but what are the barriers to people getting screened?

Dr. Eng:

I think in part, people are not very familiar with a colonoscopy is versus a flexible sigmoidoscopy. A colonoscopy obviously allows the endoscopist to visualize the entire colon going all the way to the right side of the colon where a little bit more than 20 percent of colon cancers are. A flexible sigmoidoscopy does not go to the right side of the colon. A colonoscopy as you stated does require anesthesia. The patient is usually unaware of what is occurring, although some individuals still find it quite embarrassing to request such a study. A flexible sigmoidoscopy is much more uncomfortable because the patient is likely awake and does not visualize the right side of the colon. It is not the gold standard. The gold standard would still be a colonoscopy. Other barriers, unfortunately given this economy, are insurance coverage. People sometimes do not realize that it is covered by their insurance or sometimes even their internists sometimes forget to remind them to get screened. But, there are individuals that do not have health insurance that are unable to get screened, and that is another barrier.

Garvin:

Screening in this case with this cancer is quite effective, is it not?

Dr. Eng:

Yes. A colonoscopy as I stated earlier is the standard of care and it would be able to detect most of the lesions that are polyps that would be able to possibly be, if concerning, would be able to be removed. Obviously it involves a good prep for the procedure which some patients obviously are also concerned about undergoing. It is uncomfortable for a day, but a good prep is very important because some lesions are flat lesions and they are harder to visualize, and if you don’t have a good prep for the procedure, you may miss some of those lesions.

Garvin:

Let’s talk about the disease itself. Are we seeing statistics improving, not improving, or how is it overall with awareness, detection and treatment?

Dr. Eng:

Overall, the numbers of individuals diagnosed is slightly less than the year prior. However, it still remains that approximately, if I’m correct, about 147,000 individuals are diagnosed and a third of those patients will still die of this disease. So, it’s very important that individuals get diagnosed early on should they be diagnosed with colorectal cancer. Once again, this is a preventable cancer, so we are trying to avoid that diagnosis as much as possible and encourage the screenings. Obviously if the patient has an appropriate screening he will not need another colonoscopy for another 5 to 10 years depending upon the original findings from the procedure.

Garvin:

Most colorectal cancers are what we call sporadic there is really no know cause, but isn’t there a hereditary factor in some colon cancers?

Dr. Eng:

You bring up a very good point. Most people actually fail to recognize that colorectal cancer is sporadic. Most people think it’s due to an inherited form of colorectal cancer, and actually that only represents approximately 5-7 percent of all colorectal cancers diagnosed. So yes, there are some rare syndromes associated with familial forms of colorectal cancer, but as you stated earlier, the majority of individuals have sporadic development of colorectal cancer. That’s why once again, screening is very important, because if you had a known familial inherited form, you would undergo regular screening.

Garvin:

Lifestyle factors probably play a big role in development of colorectal cancer, or so some research has led us to believe. Can people actually prevent colorectal cancer with lifestyle choices?

Dr. Eng:

I would say that, obviously there are some very healthy choices regarding your lifestyle that may decrease your risk of developing colorectal cancer. Please keep in mind it is still the third most commonly diagnosed cancer. Granted, there are some environmental factors. For instance, individuals that move from Asia to the US are at increased risk once they become used to the American diet. I think that we are all aware that everything, for instance alcohol and red meat, should all be eaten in moderation. Those are just some contributing factors. There is data to support that there is no increased harm associated with certain diets as well as alcohol, so that is still up in the air. It’s very controversial. I think, once again, the most important thing is to maintain a healthy diet and lifestyle as much as possible, which also decreases your risk of other cancers. Number one, just remember to get screened.

Garvin:

We hear a lot, and there is a lot of controversy about this subject as well, about colonic irrigation or colon cleansing. A lot of people think that their colon harbors just pounds and pounds of undigested food and that’s a cancer risk and a lot of people think that by getting these procedures can actually prevent their risk of cancer. Is there any connection between these procedures and decreasing your risk?

Dr. Eng:

I would say there is no literature to support undergoing any of those so called colonics to decrease your risks of colorectal cancer. Colonics basically result in a large amount of fluid that is irrigated throughout your colon and to basically clean out your colon. The reality is that they probably do not provide any additional benefit. It’s an added cost and people don’t realize that they are at a slightly increased risk of getting a bowel perforation. In all honesty, there is no scientific proof that they benefit the patient and decrease the risk of cancer. The patient may feel better because their bowels have been “so called” cleansed, psychologically and physically, but it’s only temporary. I mean, if you were to undergo full bowel prep before a colonoscopy, it’s very similar. That would be for a certain purpose and that’s actually to visualize the colon. A colonic has no benefit, I believe, and I would not recommend it. Some patients do ask me about it and a lot of people say they want to do it because they think it will help with weight loss. Once again, it’s a temporary effect.

Garvin:

As far as the treatment field, is it mostly a surgical disease? How is colorectal cancer treated depending on stage, and so forth?

Dr. Eng:

For early stage disease, the best way for cure is surgical intervention. However, should a patient develop metastatic disease, then whether or not the patient should go to surgery is dependant on where the disease lies and whether or not the patient has surgically receptible disease. Stage 4 disease is very different, obviously, because it depends on where the patient has metastasized. Overall, for early stage disease, yes, surgery is the best intervention.

Garvin:

As far as colostomy bags go, are you able to decrease the dependence on a colostomy for some patients?

Dr. Eng:

I think overall most patients do learn what works for them regarding their dietary habits and how to take care of their ostomy. Obviously certain foods may irritate their bowel more than other foods. We also have an ostomy nurse meet with our patients after their surgical procedure and I believe even before just to give them an idea of what it entails. Some of these patients may get their ostomy reversed depending upon where their tumor was, or is. Overall I think patients learn to live with it and they would rather be cancer free than to forego having an ostomy.

Garvin:

A few years ago, I believe it was 2 or 3 years ago, you started an awareness fun run called SCOPE. Tell me about SCOPE.

Dr. Eng:

It was actually just not organized by me; it was organized by my co-chair Kimberly Tripp who was our former research nurse for the GI medical oncology department. Basically it is a 5K fun run and 1 mile fun run for children. SCOPE stands for Sprint for Colorectal Oncology Prevention and Education. Basically it’s to bring awareness to the community and hopefully nationally at some point about colorectal cancer. We are obviously aware that there are many races for other malignancies, especially for breast cancer, and I myself have served on the Komen Foundation before. It’s a wonderful opportunity to bring awareness to the community and to celebrate survivorship for those patients that are diagnosed with colorectal cancer who are currently be treated or who are true survivors in the sense of being cancer free. The whole point of this is to bring more awareness to the Houston community. We are the forth largest city in the country and we are one of those states that unfortunately less than 60 percent of individuals do get screened. Given the standing of M. D. Anderson, we hope that it will bring more awareness to the community. That is really our goal, to encourage prevention, to encourage education, and obviously to get those individuals that actually do have symptoms the recognition that they do need to be screened. That’s what our goals are.

Garvin:

I understand that the race is increasing in participation every year, so it seems like it is something that is catching on out there.

Dr. Eng:

Yes, the race has actually increased in size by 25 percent every year. We hit 1,000 runners last year and we hope to achieve 1,300 this year. It’s our forth year and we really do make a very large effort to really bring recognition to the survivors – the patients that are currently affected, and those that have completed their treatment already. We have a lot of activities for them, such as massage therapy, a full breakfast, and we have separate t-shirts for them. It’s a big event for their families also because it’s a way to celebrate the fact that they are alive and that their cancer really has not stricken them completely. It’s become part of their life, but they are functioning day to day.

Garvin:

Are there any final thoughts you have on the matter before we go today?

Dr. Eng:

I would just like to encourage individuals once again to get screened, and if they have any symptoms to discuss it with their doctor. If they are over the age of 50 and they have not had a screening test yet, they must bring it up with their doctor. It is the standard of care and there is no reason why it should not be completed. In all honesty, this is a preventable cancer and March is colorectal cancer awareness month and we hope the fact that it is colorectal cancer awareness month it will bring more recognition to this disease. Obviously if individuals are free on March 28, we would encourage them to participate in the 5K race. It’s a walk and run.

Garvin:

Great! Can you give us the date and time for the SCOPE fun run this year?

Dr. Eng:

It’s Saturday, March 28, 2009 and it starts at 8 am and the Web site is www.mdanderson.org\scope.

Garvin:

Great! Thank you, Dr. Eng for being with us today.

Dr. Eng:

Thank you very much!

Garvin:

If you have questions about anything you’ve heard today on Cancer Newsline, contact askmdanderson at 1-877-MDA-6789, or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.

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