It is an exciting time to be a gastrointestinal oncologist, because of the array of advances in detection, prevention and treatment of colorectal cancers available today.
In February, a study published in the New England Journal of Medicine reported the best evidence to date that colonoscopies, a colorectal cancer screening test, can actually prevent cancer deaths. Early detection has always been a goal of colonoscopy because colorectal cancers that are caught early are more amenable to surgical cure. The premise of this study, however, was that the removal of precancerous polyps during colonoscopy might prevent the cancer from ever occurring. This prospect seemed to be realized by the finding of a greater than 50 percent decrease in death rate from colorectal cancer among patients who had a screening colonoscopy.
Decreasing the incidence of colon cancers in addition to detecting early colon cancers before they have an opportunity to spread is an incredible achievement in the existing screening programs. Colorectal cancer is among the most common of all cancers diagnosed today, with more than 140,000 cases diagnosed annually in the United States. Roughly 100,000 cases are colon and 40,000 are rectal cancers. These can be very lethal cancers, with more than 50,000 people dying yearly from colorectal cancer.
I work closely with gastroenterologists, surgical oncologists, radiation oncologists, and other medical specialties in the multidisciplinary care of colorectal cancer patients at Penn Medicine. All of us work relentlessly to bring the most aggressive and individualized care plans to every patient. I also personally explain the rationale for each therapy and how to manage the side effects and symptoms of the cancer and the treatments for them.
Patients with early stage or locally advanced colon cancers often meet with me after their surgery to determine if they can benefit from postoperative (adjuvant) chemotherapy to enhance their chance for cure. I like to call it an “insurance policy” for increasing the chances that the cancer won’t come back. The chemotherapy regimens in this postoperative setting are quite tolerable and do not involve extreme nausea, fatigue, or hair loss.
But even when colon cancer has spread outside the original location and is considered stage IV cancer, there are many treatment modalities available including innovative clinical trials for colorectal cancer, biologic therapies and immunotherapies. Penn uses advanced molecular profiling of every patient’s individual cancer to help personalize the therapy.
In my next post, I will talk about how Penn Medicine takes a personalized approach to cancer treatment.
Learn more about the Abramson Cancer Center’s Gastrointestinal Cancers Program.
