Dr. Jeffrey Meyerhardt provides an overview on colorectal cancer, including common treatments and recent research.
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Cancer.Net®: Doctor-Approved Patient Information from ASCO®
Colorectal Cancer: An Introduction
What is Colorectal Cancer?
Jeffrey A. Meyerhardt, MD, MPH: The colon or rectum is the end of your digestive system. So we eat, it goes down our esophagus, stomach, small intestinal, the last part of your digestive system is your colon and your rectum. It’s where we do some absorption of nutrients as well as absorb water.
Colon and rectal cancer is the fourth most common cancer diagnosed in the United States. There is on average 150,000 people per year diagnosed with the disease.
About two-thirds of the time it’s in the colon, the rectum is the last four inches or so of the colon and that has about a third of the patients who are diagnosed with colorectal cancer.
So most people who are diagnosed with colorectal cancer have what’s called an adenocarcinoma. Adenocarcinomas are cancers of glandular tissue and so that’s the majority type. There are other types of colon cancer, small cell, occasionally lymphomas, carcinoid. But the vast majority are adenocarcinomas.
Treatment Options for Colorectal Cancer
Dr. Meyerhardt: The first thing for patients to know is that it’s a treatable disease and for a lot of patients it’s a curable disease. It’s particularly curable if it’s caught early, which is why colonoscopies for screening are so important to try to catch either before a patient even develops a disease with a polyp or to catch it early. The second is it is a team approach for both colon and rectal, but particularly for rectal cancer where there are different treatments that may be employed to help cure patients as well as treat patients of the disease.
So for colon cancer the primary treatment is surgery if it hasn’t shown evidence of spread to other parts of the body at the time of diagnosis. Patients who don’t have spread of disease at the time of diagnosis will have surgery. And then depending on what’s found and the things that are particularly important is how deep through the bowel wall it goes and whether there are any lymph nodes involved will determine whether they need further therapy, particularly chemotherapy.
For patients with rectal cancer caught very early they may go to surgery first and depending on what’s found they may also then need chemotherapy radiation after or they may just have surgery alone.
For patients who present with disease already spread then it’s a decision regarding surgery up front or starting with chemotherapy.
Surgical Advances for Colorectal Cancer
Dr. Meyerhardt: In terms of surgery probably the advance that’s occurred has been in two forms. One is laparoscopic surgery, which has been done for years for various conditions and been employed for colon and rectal cancer for at least a decade but now there’s actual studies that show that it’s not only as good as open surgery but it has some benefits in terms of shorter hospitalizations, improvement in time of pain and bowel restoration. So for a lot of patients laparoscopic surgery is appropriate both for colon and rectal cancer as long as it’s with a surgeon that has expertise and as long as their cancer is amenable to that. There are some people who will still need an open surgery.
For rectal cancer there’s also been advancements with a more defined surgery where it’s a more dissection of the tumor cutting it out that allows it to have a decreased risk or occurring in the rectal area.
Advances in Chemotherapy for Colorectal Cancer
Dr. Meyerhardt: For chemotherapy both there’s been some advances in earlier stage disease so now we employ three drugs as adjuvant, chemotherapy after surgery to try to reduce the risks of occurrence.
And for later stage disease there’s really been strides in terms of having increasing options for patients, both in terms of number of drugs and sequencing of drugs that have doubled the median survival in the past decade for patients with metastatic colorectal cancer.
There’s also been advances in terms of patients with metastatic disease, some of them undergoing surgery for their metastases and having a curative effect. In terms of what’s coming on the horizon what we’re learning more is that there are certain subtypes of colorectal cancer based on mutations that can help select certain therapies. Unfortunately we still have a long ways to go in terms of knowing which is the right therapy for which patients and how best to target as opposed to some other cancers where there is now multiple target therapies depending on the mutation.
Where to Get More Information
Dr. Meyerhardt: I think Cancer.Net has a very good resources both for learning about colon and rectal cancer as well as familial syndromes, things that people may inherit that increase their risk of colon and rectal cancer to learn more about the disease.
[Closing and Credits]
Cancer.Net®: Doctor-Approved Patient Information from ASCO®
ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology. ConquerCancerFoundation.org
Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia
Carolyn B. Hendricks, MD, The Cancer for Breast Health
Hasbro Children’s Hospital
Helen F. Graham Cancer Center at Christiana Care Health System
The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University
Video Footage and photography courtesy of:
St. Jude Children’s Research Hospital Biomedical Communications
Moffitt Cancer Center
University Hospitals Case Medical Center Seidman Cancer Center
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