It’s normal to feel a bit nervous after a colon cancer diagnosis. Questions about treatment options, lifestyle changes and life expectancy are common. The good news: most patients with colon cancer can be cured.
We spoke with colon and rectal cancer surgeon George Chang, M.D., to learn more about colon cancer.
What are the most common treatment options for colon cancer, and how does that vary by stage of diagnosis?
The primary treatment for colon cancer is surgery, where we remove the part of the colon with cancer. For patients with early-stage colon cancer, surgery may be the only treatment that they need. Surgery is typically followed by chemotherapy for patients whose cancer has spread to their lymph nodes.
Patients with more advanced disease, including those with stage IV cancers that have spread to other organs, may have potentially curative options as well.
At MD Anderson, when we plan a patient’s treatment, we determine the best combination and sequence of treatment for our patients to get the best outcome. This includes good pre-operative planning to ensure that the right sequence of treatments is delivered.
After successful treatment, how likely is a colon cancer recurrence?
For any cancer, there is a risk of recurrence. There are two kinds of recurrence for colon cancer:
Local recurrence refers to when a patient’s cancer returns in the same area as before. For example, a patient with a tumor with more aggressive features or a patient who did not receive high-quality surgery is more likely to have local recurrence. Still, local recurrence is not common. MD Anderson has a less than 1% risk of local recurrence in colon cancer, which is largely due to achieving clear surgical margins and complete resection of all tumor-associated lymph nodes during the initial surgery. A clear margin indicates that no cancer cells are present and all the cancer has been removed. We want to get it right the first time.
Distant recurrence is more common and is related to the cancer stage at diagnosis. This is when the cancer spreads to other parts of the body away from the original cancer. The risk of distant recurrence is very low for stage I and stage II cancers. The risk is higher for stage III colon cancer, but your risk also depends on the specific features of the cancer. We can reduce the risk of recurrence for patients at high risk by giving chemotherapy as part of the initial treatment. After treatment, we continue to monitor for signs of recurrence with blood tests and yearly CT scans.
Can patients live a long time after their colon cancer diagnosis?
Most patients can expect to resume a normal life. We have shown that some patients who have stage I colon cancer, for example, live longer than the general population. We call that relative survival when we compare the survival of cancer patients to the general population of similar age, sex and race. This is likely because usually you're going to see a doctor regularly and treat other general health issues. Being diagnosed with colon cancer at an early stage heightens many people’s awareness about their health.
For patients with more advanced colon cancer, life expectancy depends on if we can cure them so that the cancer doesn’t come back. If so, their life expectancy should be close to normal.
Colon cancer patients who don’t have a recurrence can live as long as they would otherwise.
If the cancer does come back, lifespan depends on the patient’s treatment options. Patients with recurrence can be potentially cured if surgery can be performed. Even some patients who aren’t eligible for surgery can live a long time, thanks to a growing number of treatment options. At MD Anderson, we individualize the treatment to the patient and their specific tumor characteristics to provide the best treatment possible. We measure survival in years, not months.
What longer-term side effects may patients face after colon cancer treatment?
With colon cancer, the main side effects primarily stem from chemotherapy. The most common one is neuropathy, which is a tingling, weakness or numbness in the hands and feet caused by nerve damage. We try to prevent neuropathy by adjusting the chemotherapy dosage or changing the medication if the patient starts to develop symptoms. I’ve seen patients who come in with bad neuropathy because they were treated outside of MD Anderson and continued getting treated even though they were having a lot of symptoms. Sometimes patients are determined to finish their treatment, or their doctors were determined to give them full treatment. As a result, now they've got permanent disability related to neuropathy. We could have potentially averted that by dose optimization or modification of their treatment regimen. I think that's something we do really well at MD Anderson: tailoring treatment to patients to decrease those symptoms. We also offer a lot of support programs for patients.
What are the most exciting clinical trials at MD Anderson for colon cancer patients?
While many patients will have chemotherapy after surgery to reduce the risk of recurrence, not all patients need it and not all patients will benefit from it. We're really interested in how we can be smarter about who we treat. That's the focus of a lot of our clinical trials right now.
At MD Anderson, we’re also looking at identifying patients with minimal residual disease, which describes a situation when cancer cells are present but are not yet detectable by CT scans or traditional blood tests. Those cancer cells release DNA that looks different from normal DNA. We can now detect tiny levels of that DNA by looking at the blood of patients who have undergone successful treatment with no signs of cancer to see if they have any of these DNA elements. Patients who are DNA negative are at a very low risk for recurrence; patients who have these DNA elements are at very high risk for recurrence.
What’s one myth or piece of misinformation you’d like to address about colon cancer?
“I'm too young to get colon cancer” is a common myth. Unfortunately, a growing number of young patients are being diagnosed with colon cancer, which has resulted in the screening guidelines recently changing to recommend getting your first colonoscopy at 45 and not 50. If you’re having colon cancer symptoms, such as blood in your stool or an unexplained change in your bowel habits, talk to your doctor about whether you need a colonoscopy.
The other myth is that it doesn't matter where you get your treatment. It does. Where you go and where you go first matters. The patient’s best treatment opportunity is with the initial treatment. A colon cancer diagnosis is scary, and many patients think they need to get surgery right away after diagnosis. But that's not true. It’s more important to get completely evaluated, get treatment from a team of experts who specialize in treating your specific cancer and plan the right treatment for your specific case from the beginning. That’s our focus at MD Anderson.