Cancer Care Centers of Brevard’s Dr. Ravi Shankar: Know the Facts About Colorectal Cancer
By Dr. Ravi Shankar, Cancer Care Centers of Brevard // November 11, 2016
third most common cancer in the U.S.
BREVARD COUNTY, FLORIDA – The bad news about colorectal cancer is that, according to the Cancer Facts and Figures 2016, colorectal cancer is the third most common cancer and the third leading cause of cancer-related deaths in the United States. The good news is that it is one of the most preventable diseases in modern society.
Oncologists at Cancer Care Centers of Brevard want people to understand that what they don’t know can hurt them. In 2016 alone, an estimated 134,490 new cases of colorectal cancer are expected to be diagnosed according to statistics released by the American Cancer Society (ACS). Florida alone will account for 9,710 new cases in 2016.
Even though there have been improvements in the overall colorectal incidence rates, a retrospective SEER CRC study found that the incidence of colorectal cancer is increasing in patients less than 50 years old.
The authors estimate that for younger patients aged 20 to 34 years, the incidence of colorectal cancer will increase by 90 percent and 124 percent respectively. The exact etiology of this rise is not known, but experts say early detection is the key to curbing these numbers.
Colorectal cancerous tumors form when cells that line either the colon or rectum become abnormal and grow out of control.
The best method of detection is through regular screenings. Screening exams allow doctors to detect polyps – little growths along the inner wall of the colon or rectum. These mushroom-like growths are usually benign, but some may develop into cancer over time. Regular screenings allow doctors to detect polyps and remove them before they develop into colon cancer.
These tests are critical since a person may or may not exhibit symptoms at first. Early stages of colorectal cancer do not normally exhibit any symptoms at all.
However, as the disease progresses, some of the following symptoms may develop: rectal bleeding, blood in the stool, abdominal pain or discomfort, change in the quality, consistency or frequency of bowel movements and unexplained fatigue or weight loss, and anemia.
Colorectal cancer can be detected through several different types of screening tests, the most common of which are the colonoscopy, sigmoidoscopy, and digital rectal exam. In addition to these exams, there also is the fecal occult blood test, which tests for small amounts of blood in the stool.
Other screening methods include the double contrast barium enema, virtual colonoscopy and positron emission tomography (PET), a three-dimensional scanning procedure that some believe provides the most accurate diagnostic test for detection of recurrent colorectal cancer.
Additionally, an emerging technology in screening for colorectal cancer is stool DNA testing. This procedure involves looking for specific markers from adenoma and cancer cells that are not degraded during the digestive process.
The American College of Gastroenterology recommends that those people with no risk factors for having the disease, should commence screening tests at least at the age of 50 years.
A CANCER AFFECTING BOTH GENDERS
When thinking of colorectal cancer, most people assume the disease occurs mostly in men.
However, both men and women should have regular screenings because the disease affects women almost as much as it does men.
Nearly 63,670 women in the U.S. will be diagnosed with colorectal cancer in 2016, compared to 70,820 men. Studies also have discovered that women who have had cancer of the ovary, uterus, or breast are at higher risk of also developing this type of cancer.
Famous women who, through their own diagnoses, have helped dispel the myth that colorectal cancer is a male disease, include Supreme Court Justice Ruth Bader Ginsburg and movie actress Audrey Hepburn. Sadly, actress Elizabeth Montgomery, best known for her starring role in the “Bewitched” television sitcom, died just eight weeks after her cancer was diagnosed.
An American Cancer Society study revealed that, in addition to age, the risk of getting colorectal cancer is increased by “certain inherited genetic mutations (familial adenomatous polyposis [FAP] and hereditary non-polyposis colorectal cancer [HNPCC]).”
Additionally, a personal or family history of colorectal cancer and/or polyps, a personal history of chronic inflammatory bowel disease or a longstanding occurrence of ulcerative colitis or Crohn’s disease of the colon also can increase the risk.
The National Cancer Institute states that heavy alcohol use might also increase risk. Men and women who are overweight, lack physical activity, smoke, have a diet high in red or processed meat and don’t get enough fruits and vegetables also are at greater risk.
Diets rich in fish, fresh fruits and vegetables are recommended to lower risk. Plus, men and women who quit smoking and engage in physical activity also greatly reduce their risk. In fact, some studies show these combined lifestyle changes could decrease the risk of colorectal cancer as much as 60 to 80 percent.
Colorectal cancer is one of those diseases in which the earlier it is detected, the greater the survival rate. That is because once it is detected, physicians can go about devising the best possible treatment.
Two key prognostic factors, in addition to the patient’s personal outlook, will be the stage and location of the intrusive cancer.
The primary treatment recommendation for a person diagnosed with colorectal cancer is surgery. Surgery alone is the treatment of choice if the cancer is very limited and has not spread.
In some patients, this may mean only a colonoscopy and removal of a small growth in the colon (eg: polyp). The physician uses the colonoscope – a lighted tube, mounted with a tiny video camera, to help find and remove any small cancerous polyps in the colon or rectum.
This procedure was used to treat President Ronald Reagan when it was discovered he had polyps in his colon. Patients will likely feel more uncomfortable listening to how the procedure is carried out versus actually undergoing the procedure.
In the case of larger tumors, surgeons may use a laparoscopic approach to locate and remove the tumor. Laparoscopy is a procedure in which a slender tube with a camera and various surgical instruments are slipped into the abdomen, and the surgeon removes the cancerous colon and reconnects the remaining colon.
If the body does not allow a reconnection, then the patient may be fitted with a temporary or permanent colostomy bag to allow the removal of solid waste material from the body.
Another modality available involves chemotherapy and radiation treatments given either before or after surgery.
The basic tenets of chemotherapy are fairly well known. Cancer patients are given medications that aggressively target cancer cells in the hope of destroying the disease altogether.
The role of radiation in pure colon cancers is limited to those who have local spread of the disease without evidence of distant metastases. In these patients, after surgery and along with chemotherapy, radiation can be given to control local recurrence.
Radiation therapy is much more common for those with rectal cancer, since the rectum (which is within the pelvis) does not move around as much as the colon (which is within the abdomen) and is easier to target. In rectal cancer, radiation can be used after surgical removal of the tumor in those with locally advanced disease.
An exciting development in treating rectal cancer is the use of pre-operative chemotherapy and radiation. These two treatments given together help shrink the tumor, which increases the chance of a complete removal during surgery, and hence can improve the chances of reconnecting the remaining rectum. By doing this, the patient may avoid being fitted with a permanent colostomy.
Cancer Care Centers of Brevard provides a variety of treatments for colorectal cancer, including 3-dimentional conformal radiation therapy and Intensity Modulated Radiation Therapy (IMRT), as well as targeted chemotherapeutic approaches.
Organ preservation techniques consisting of neoadjuvant chemo-radiation followed by sphincter sparing rectal surgery is the norm in early to intermediate stage low rectal cancers.
Colorectal cancer kills an average of 694,000 people worldwide per year. The best defense is a good offense – regular screenings to detect pre-cancerous polyps, knowing the risk factors, and making dietary and lifestyle changes that lower the risk.
For additional information please call Cancer Care Centers of Brevard at 321-952-0898 or visit our website at CancercCareBrevard.com
ABOUT THE AUTHOR
Dr. Ravi Shankar is board-certified in radiation oncology. He was an assistant professor of radiation oncology genitourinary, gynecology oncology and sarcoma programs at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida.
- 2014 – Adjunct Professor, Biomedical Department, Florida Institute of Technology, Melbourne, FL
- 2014 – President, Brevard IndoAmerican Medical & Dental Association (BIMDA), Melbourne, FL
- 2014 – Chairman, Tumor Conference, Holmes Regional Medical Center, Melbourne, FL
- 2014 – Chairman, Tumor Conference, Wuesthoff Health Systems, Melbourne, FL
- 2004 – Assistant Professor of Radiation Oncology Genitourinary
Gynecology Oncology and Sarcoma Programs
H. Lee Moffitt Cancer Center & Research Institute Tampa, FL
- 2003 – Clinical Fellowship in Brachytherapy
Continuum Cancer Center, Beth Israel Medical Center New York, NY
- 1996 to 1998 – Post Doctoral Research Fellowship
EPR Laboratory, Johns Hopkins University, Baltimore, MD
- 1988 to 1991 – Master of Surgery (M.S.) in General Surgery
Madras Medical College and Government General Hospital Madras, India
- 1981 to 1986
Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.)
Madras Medical College and Government General Hospital, Madras, India