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Help and hope for patients with colon cancer

Long term survival is possible with the new aggressive medical and surgical therapies
SHAVAUGHN MOSS
Guardian Lifestyles Editor
shavaughn@nasguard.com

Published: Dec 18, 2012

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As little as 10 years ago, a stage four colorectal diagnosis meant that the doctors simply sent that person on their way and that there was nothing much they could do to in the form of treatment. With advancement in medicine, surgery and radiation, the combined efforts mean that there is a chance at survival.

At a recent Doctors Hospital Lecture Series, Dr. Theodore Turnquest, a medical oncologist, and Dr. Wesley Francis, a surgical oncologist, spoke on colorectal cancer advancements in treatments and surgical procedures and gave hope to many people.

“The world of colon cancer is changing quite rapidly and what it was 10 years ago or 15 years ago is much different than it is right now,” said Dr. Turnquest, who did a Bahamian study with physician William Seymor, looking at colon cancer rates at the Princess Margaret Hospital from 2008-2010. They found that on average, there are about 42 new colon cancer cases a year, which he described as a “pretty good clip” when it’s taken into consideration that about 90 new breast cancer cases are seen a year.

“Colon cancer is creeping up there,” said Dr. Turnquest of the cancer that is the second leading cause of cancer deaths annually. And he said there is no predilection between men and women. “It was almost equal, so it’s not a male disease or a female disease. Both sexes in The Bahamas are equally affected [by] colon cancer, and the average age of diagnosis is about 63 — a little younger than [he] would expect it to be.”

According to Dr. Turnquest, statistics from the United States show that the incidence has been decreasing in the U.S. over the last couple of years, however the five-year survival rate which means all those who get diagnosed is about 64 percent which he said is actually pretty good, but he said is still not fantastic if you get colon cancer because it’s almost a 50-50 shot. The average age of diagnosis he said is about 70 with about 63 percent being over the age of 65.

In the Bahamian study, Dr. Turnquest said that average body mass index (BMI) they calculated on average was 28 — which is pretty much in the obese category.


Risk factors

The medical oncologist said risks of colorectal cancer include age, (the older, the more likely a person can develop colon cancer). He also spoke to genetic syndromes, and people who have inflammatory bowel disease.

“What we really look for with this thing are polyps … almost like a warty growth that happens on your skin can happen inside your colon. It becomes very important to screen for these things because colon cancers we know happen over a period of time, over many years, and this is one of the first signs of developing colon cancer. As far as the risk factors go, diet which is one of our big problems — a high fat, low fiber diet, alcohol use, excessive calorie intake which leads to that high BMI which we are seeing already.”

The doctor said it is a good idea for people with a family history of colon cancer, to get screened. He also said that a smoking history also contributes to colon cancer.


Prevention

Dr. Turnquest said a high fiber, low fat diet may actually decrease a person’s risk by a third, depending on their situation. And that people should look to consume higher antioxidant foods, fruits and vegetables and basically eat healthy, and take in their Calcium and Vitamin D. He said there are some medications that have been shown to reduce a person’s risk of developing new polyps, but he said it’s still up in the air.


Screening

He encouraged screening because colon cancer unlike other types of cancer cannot be felt.

“You can only rely on what comes out, so it makes screening a little more invasive and a little harder,” said Dr. Turnquest. And he said there are a number of tests that doctors will actually use to detect colon cancer, including a digital rectum exam that entails putting a finger into the rectum to palpate tumors.


When and how to screen

The screening guideline for the American Cancer Society is age 50, a number the doctor described as the magical age for screening for colon cancer.

When you turn 50, somebody in some way shape of form should have screened you for colon cancer. Just like most women when they turn 40 have breast, breast, breast, when you hit 50 you should have colon, colon, colon.

He also said that a change in their normal bowel routine is something people should look out for, including anorexia, abdominal pain or weight loss, which he said are very normal symptoms – things that people often blow off, but when they’ve been diagnosed, can be colon cancer.


Stages

Colon cancer ranges from stage one to four. At stage three, the disease is in one of the patient’s lymph nodes. At stage four, it has metastasized and spread to the nodes and beyond. And used to be thought of as the stage that was completely incurable. That five-year survival rate has been changed, and is now up to 12 percent.


Treating colon cancer

“The paradigm used to be when I was training was surgery first, and for most stage one and stage two colon cancer that’s all you really need — and even stage three, surgery then chemotherapy, but for rectum cancer that actually has changed, it’s actually no longer surgery first and now is chemotherapy and radiation first in most situations, but not all situations,” said Dr. Turnquest.

And it’s all he said because of medical advances. He said in 1960, there was only one drug for colon cancer and that in 1985, another drug was added to the regimen. The next improvement did not come until 1988 when Dr. Turnquest was doing his fellowship. And at that time he said it was a big deal, because the drug worked and that they actually had something they could treat patients with colon cancer with. Another improvement he said came along in 2000. The big jump according to Dr. Turnquest happened in 2002 when he said the medical world got another drug that changed the paradigm for medical professionals because it worked really well — even in situations that they thought was just completely hopeless.

“Up to this point I would say most surgeons would see stage four cancer colon cancer and it would be an open and shut situation. Open, tumors everywhere and shut because there was really nothing we could do so it didn’t make any sense to do anything. In 2002, we really started to nudge the bar and actually get better survival. In 2004, we got a whole new different type of drugs, target therapies; so the history of colon cancer and the therapies changed quite rapidly. From the 1960s to 1985 we didn’t have anything. And in 1998 we had something good, and then all of a sudden we exploded with drugs that were really effective.”


Drug efficacy improvement

As the years go by, the doctor said the efficacy of the drugs have improved which means that the five-year disease free survival went from 67 percent up to 73 percent. And in absolute terms there was a two-and-a-half percent increase in overall survivors over six years for people with stage three colon cancer.

Because they were getting such great results Dr. Turnquest said they considered doing targeted therapy on people with stage four colon cancer who had been deemed incurable. If they couldn’t cure them, he said they could at least try to make them live a few more years. And he said a medication was found that increased the overall survival time with people with metastasized colon cancer that has some side effects — GI (gastrointestinal) perforation, non-healing of wounds and serious bleedings) – in people with colon cancers, but that if they spaced it out far enough after the surgeries that they didn’t really run into these issues, as much as just giving it right after surgery.

“Now that we have all these things, we put them all together. Stage four colon cancer used to be considered incurable and this is where our world has changed. And you can improve the five-year survival of up to 30 percent. I know that I can shrink a tumor and I know that I can get it almost gone, but we need our surgical colleagues to come in and remove it all from the body,” said Dr. Turnquest.


Evolution in surgery

Surgical oncologist Dr. Wesley Francis also said 10 to 15 years ago when surgeons opened up a patient to treat for colon cancer and they saw disease in the liver, they would just say that’s it. That there was nothing much they could do as the drugs to treat weren’t there. But now that the drugs have been developed, he said doctors started pushing the envelope.

“Just as we saw the evolution in chemotherapy, we saw an evolution in surgery,” he said.

“We have better [scans] that can display the anatomy better. We can see the relationship of the cancer to the different structures in the liver, so it really made things easier for us from an anatomical perspective to be able to remove these lesions within the liver, we did not have these before. CT scans, MRIs have gotten better and there has been the development of the PET Scan which is much more accurate and can determine whether or not disease is only in the liver or whether it’s elsewhere. So even with the advancement of chemotherapy there was a parallel advancement in things that made surgery easier for us and also to help us define people who would better benefit from our treatment.”

According to the surgeon previously they only operated on patients if the disease was a certain size and if doctors could get a certain margin. But today because they have good chemotherapy agents and surgery itself has become safer overtime, with the development of technology and doctors having a better understanding of what goes on in the liver and how to treat things in the liver, all of the traditional criteria have been expanded. Today he said the decision comes down to whether they can remove it all.

“If we can remove it all and leave the patient without any disease in the liver, then we’ll go after it. That’s the criteria that we have. One time ago we looked at one big organ, but based on improved imaging we have been able to separate it into different segments, so if you remove a segment the rest of the liver can function. What we’ve also realized because of improved imaging is that you can even remove almost half the liver and the rest would be fine because the blood supply is not the same time. Each segment has its own supply and can be removed and it doesn’t affect the other segments, so that is what the advancements in imaging and improving our understanding of the liver made surgery much more easier and we were able to offer better treatment to patients,” he said.


Outcomes

Dr. Francis said targeted therapies and surgery has shown significant improvement in survival for patients. And that screening is important for detection and prevention of advanced disease. He also said early detection is also crucial to better and overall treatment and the prevention of having significant disease elsewhere.

He too touted diet and exercise as important risk factors that can be controlled by the individual and said if patients with stage four colorectal cancer are carefully selected, that long term survival is possible with the new aggressive medical and surgical therapies.

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Last Updated on Tuesday, 18 December 2012 15:02
 

 

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