Colorectal Cancer Awareness Month

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:07Welcome to Yale Cancer
00:07 --> 00:08answers with your host.
00:08 --> 00:11Doctor Anis JGP are Yale Cancer answers
00:11 --> 00:13features the latest information on
00:13 --> 00:15cancer care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront of
00:17 --> 00:20the battle to fight cancer this week.
00:20 --> 00:21It's a conversation about colorectal
00:21 --> 00:23cancer and other GI malignancies
00:23 --> 00:25with Doctor Stephen latency.
00:25 --> 00:27Dr Latency is an assistant professor
00:27 --> 00:29of clinical medicine and medical
00:29 --> 00:31oncology at the Yale School of Medicine,
00:31 --> 00:34where Doctor Jaguar is a professor
00:34 --> 00:35of surgical oncology.
00:36 --> 00:38So Steve, maybe we can start
00:38 --> 00:40off by you telling us a little
00:40 --> 00:41bit about colorectal cancer,
00:41 --> 00:43given that it is colorectal
00:43 --> 00:45cancer Awareness Month,
00:45 --> 00:46tell us more about what it is,
00:46 --> 00:48how common it is and who gets it.
00:50 --> 00:51Absolutely. Colorectal cancer
00:51 --> 00:56is the most common of the GI or
00:56 --> 00:59gastrointestinal malignancies that I see,
00:59 --> 01:01and I think that that everyone
01:01 --> 01:03sees who's in the field.
01:03 --> 01:06It's the third most common serious cancer
01:06 --> 01:08in the United States behind prostate
01:08 --> 01:12cancer and lung cancer for men and behind
01:12 --> 01:15breast cancer and lung cancer for women.
01:15 --> 01:17And it's also the third most common cause
01:17 --> 01:20of cancer death in the United States.
01:20 --> 01:22So clearly a very important health
01:22 --> 01:23problem in the United States.
01:25 --> 01:27And who's at risk for
01:27 --> 01:28developing colorectal cancer?
01:28 --> 01:30Is everybody equally at risk,
01:30 --> 01:32or are there certain risk
01:32 --> 01:33factors that put some people
01:33 --> 01:35at a higher risk than others?
01:36 --> 01:38Anyone can get colon cancer,
01:38 --> 01:41but it is mostly a disease
01:41 --> 01:42that becomes common.
01:42 --> 01:44More common as we get older.
01:44 --> 01:47The average age at diagnosis of
01:47 --> 01:49colon cancer is in the range
01:49 --> 01:52of the late 60s to early 70s,
01:52 --> 01:56but it's well known that the age of
01:56 --> 01:59diagnosis is starting to go down for
01:59 --> 02:02reasons that are currently unclear
02:02 --> 02:04and still under investigation.
02:04 --> 02:06But more and more of us are
02:06 --> 02:07starting to see patients.
02:07 --> 02:09With colorectal cancer in their
02:09 --> 02:1240s or sometimes even younger,
02:12 --> 02:15and so are there certain risk factors that
02:15 --> 02:18put people more at risk aside from age,
02:18 --> 02:21I mean certain racial groups.
02:21 --> 02:24Foods that you might eat diseases
02:24 --> 02:28that you might have gene mutations.
02:29 --> 02:32The most important risk factor for
02:32 --> 02:35colorectal cancer is family history,
02:35 --> 02:39and it's estimated that up to 20% of
02:39 --> 02:42colorectal cancer patients have a
02:42 --> 02:45hereditary component to their disease.
02:45 --> 02:48It may well be more than that too,
02:48 --> 02:51and as research continues and other
02:51 --> 02:53genetic factors are identified,
02:53 --> 02:56we may well find that more than
02:56 --> 02:5920% of patients have a hereditary
02:59 --> 03:00component to their cancer.
03:00 --> 03:04Some of these cases are
03:04 --> 03:06due to Lynch syndrome.
03:06 --> 03:09Which may account for up to two to
03:09 --> 03:124% of cases of colorectal cancer,
03:12 --> 03:15and it is common enough that most
03:15 --> 03:19centers involved in the treatment of
03:19 --> 03:22colorectal cancer are now testing
03:22 --> 03:25all colon cancer specimens for
03:25 --> 03:28possible underlying Lynch syndrome.
03:28 --> 03:32Other underlying risk factors include
03:32 --> 03:35inflammatory bowel disease like ulcer
03:35 --> 03:37diff colitis or Crohn's disease.
03:37 --> 03:41Intake of red meat and processed meats.
03:41 --> 03:44Excessive alcohol use obesity
03:44 --> 03:47and lower physical activity,
03:48 --> 03:50so some of those things are things
03:50 --> 03:51that you can do something about,
03:51 --> 03:53and some of those things are things
03:53 --> 03:54you can't do something about,
03:54 --> 03:56so you can't really change
03:56 --> 03:58your family history.
03:58 --> 04:01It is what it is, but for the other things.
04:01 --> 04:05So for example, the history of
04:05 --> 04:08alcoholism or the history of obesity
04:08 --> 04:12or consuming retter processed meats.
04:12 --> 04:14Those are things that you
04:14 --> 04:15can do something about,
04:15 --> 04:17so I guess the question that
04:17 --> 04:19many of us might be asking is OK,
04:19 --> 04:22so if I lose weight and I stop
04:22 --> 04:24drinking and I avoid red meat,
04:24 --> 04:26do I actually reduce my risk
04:26 --> 04:27of colorectal cancer?
04:27 --> 04:29Or once it's done, it's done?
04:30 --> 04:33The answer is, I think these are
04:33 --> 04:36factors that are good for our
04:36 --> 04:38health in many different ways,
04:38 --> 04:42not just for decreasing our risk
04:42 --> 04:44of colon or colorectal cancer,
04:44 --> 04:46but it is never too late,
04:46 --> 04:49I think to do ourselves some good
04:49 --> 04:53and these are risk factors that.
04:53 --> 04:56Add up over the years and I
04:56 --> 04:58think prolonged exposure to
04:58 --> 05:00things like excessive alcohol,
05:00 --> 05:01red and processed meats,
05:01 --> 05:05things like that can increase our risk.
05:05 --> 05:08And so our risk won't go down overnight
05:08 --> 05:11when we adopt A healthier lifestyle,
05:11 --> 05:12but it certainly will.
05:12 --> 05:14Overtime and I think it's
05:14 --> 05:15never too late to do so.
05:17 --> 05:19And so for the risk factors
05:19 --> 05:22that you can't do anything
05:22 --> 05:24about your family history.
05:24 --> 05:26Inflammatory bowel disease.
05:28 --> 05:31It tell us more about screening
05:31 --> 05:33for these populations.
05:33 --> 05:35Should everyone get screened,
05:35 --> 05:37should people who have risk
05:37 --> 05:38factors get screened more often
05:38 --> 05:40or with different modalities talk
05:40 --> 05:42a little bit more about that.
05:43 --> 05:46Absolutely. I think screening for
05:46 --> 05:50colorectal cancer is one of the most
05:50 --> 05:53important interventions we can do.
05:53 --> 05:55Colon cancer is a common cancer as
05:55 --> 05:58we've seen, but thankfully it's
05:58 --> 06:00potentially treatable and even
06:00 --> 06:04curable if diagnosed in early stages,
06:04 --> 06:07and this makes it an ideal condition
06:07 --> 06:10to approach with cancer screening.
06:10 --> 06:13Which means testing apparently
06:13 --> 06:16healthy patients to detect cancer
06:16 --> 06:18or a precancerous condition.
06:18 --> 06:21In the precancerous condition in this case,
06:21 --> 06:22is colonic polyps.
06:22 --> 06:26We know that colon cancer generally
06:26 --> 06:28develops from benign polyps,
06:28 --> 06:31known as adenoma dis polyps,
06:31 --> 06:33which overtime can become malignant
06:33 --> 06:36and turn into colon cancer.
06:36 --> 06:39If the polyps can be taken out
06:39 --> 06:41before they develop into cancer,
06:41 --> 06:43colorectal cancer can be prevented
06:43 --> 06:45and screening, I think,
06:45 --> 06:47is important for everyone.
06:47 --> 06:50But you're absolutely right that for
06:50 --> 06:52patients with certain risk factors,
06:52 --> 06:55especially genetic or familial risk factors,
06:55 --> 06:57the recommendations are different
06:57 --> 06:59and one important recommendation
06:59 --> 07:02is that people with a strong
07:02 --> 07:04family history of colorectal cancer
07:04 --> 07:07should generally start screening.
07:07 --> 07:1010 years prior to the earliest case
07:10 --> 07:13of colorectal cancer in their family.
07:13 --> 07:14For example,
07:14 --> 07:17if a family member had colorectal
07:17 --> 07:19cancer at age 50,
07:19 --> 07:20these patients would want to
07:20 --> 07:22start screening at age 40.
07:23 --> 07:27And so you know when we talk about screening,
07:27 --> 07:30many people have heard about colonoscopy.
07:30 --> 07:33But now there's virtual colonoscopy
07:33 --> 07:37where you kind of swallow a camera.
07:37 --> 07:40Some people have heard about fecal
07:40 --> 07:43occult blood tests or fecal DNA tests,
07:44 --> 07:46which don't require a camera being
07:46 --> 07:49put up your bottom end and find
07:49 --> 07:52that a little bit more palatable.
07:52 --> 07:53Can you talk a little bit more?
07:53 --> 07:55About the different modalities
07:55 --> 07:57of colorectal screening,
07:57 --> 08:00the advantages and disadvantages of each.
08:02 --> 08:03Absolutely, and.
08:03 --> 08:06We know that there's not one
08:06 --> 08:08screening option anymore.
08:08 --> 08:09There are several,
08:09 --> 08:12and it's not just one size fits all.
08:12 --> 08:15One modality may be different than
08:15 --> 08:18the other for an individual patient.
08:18 --> 08:21Colonoscopy is certainly the most
08:21 --> 08:24accurate and most potentially
08:24 --> 08:28effective intervention for screening.
08:28 --> 08:31Not only is it the most accurate way to
08:31 --> 08:34detect polyps or even detect cancers,
08:34 --> 08:36but it has the.
08:36 --> 08:38Added benefit of being able to treat.
08:38 --> 08:41Colon polyps, by removing them
08:41 --> 08:44before they develop into cancer.
08:44 --> 08:47The downside of course of that test is
08:47 --> 08:50it requires the notorious bowel prep,
08:50 --> 08:54which is not too fun for anyone and also
08:54 --> 08:57requires sedation for the procedure.
08:57 --> 08:58For most healthy patients,
08:58 --> 09:00if they undergo colonoscopy
09:00 --> 09:02and don't have any polyps,
09:02 --> 09:05it should be repeated every 10 years.
09:05 --> 09:07If they do have polyps,
09:07 --> 09:09then depending on the number
09:09 --> 09:11and type of polyps found,
09:11 --> 09:14the tests may need to be done sooner.
09:14 --> 09:17Other options include stool testing
09:17 --> 09:20for occult blood, fecal, occult blood,
09:20 --> 09:23and the best one is called a
09:23 --> 09:26fecal immunochemical test or fit.
09:26 --> 09:28It is non invasive.
09:28 --> 09:31And certainly much easier to go through,
09:31 --> 09:33but it is less accurate if that
09:33 --> 09:34one is chosen.
09:34 --> 09:37It should be done yearly.
09:37 --> 09:40And a newer one which many people
09:40 --> 09:44may have heard about is a stool
09:44 --> 09:47testing for polyp or tumor DNA.
09:47 --> 09:50You may have seen this one on TV and
09:50 --> 09:52it's marketed as the Cologuard test.
09:52 --> 09:55It's another noninvasive test which
09:55 --> 09:58actually detects small amounts of DNA
09:58 --> 10:01that are shed by polyps or by cancer
10:01 --> 10:05and can be detected in the stool.
10:05 --> 10:07It's a non invasive test.
10:07 --> 10:11It is more accurate than the.
10:11 --> 10:13Fecal occult blood test,
10:13 --> 10:16but still less accurate than colonoscopy,
10:16 --> 10:19and if it's positive it requires
10:19 --> 10:22follow up with colonoscopy to confirm
10:22 --> 10:25the diagnosis and to actually treat
10:25 --> 10:27whatever the condition may be.
10:27 --> 10:31A polyp or potentially a cancer.
10:31 --> 10:34It's also important to note that the
10:34 --> 10:36Cologuard test is not approved and
10:36 --> 10:39not recommended for people who are
10:39 --> 10:41at increased risk for colon cancer,
10:41 --> 10:42for example,
10:42 --> 10:45those with a strong family history
10:45 --> 10:48or a known hereditary condition.
10:48 --> 10:50It's only approved for those who are
10:50 --> 10:53known to be at average risk of colon cancer.
10:53 --> 10:55This one should be repeated
10:55 --> 10:56every three years.
10:57 --> 10:59What about other tests?
10:59 --> 11:05So things like very enemas or flexible
11:05 --> 11:07sigmoidoscopies or virtual colon
11:07 --> 11:09Agra fees are those recommended
11:09 --> 11:12and tell us more about those.
11:14 --> 11:18Absolutely. A barium enema is an older
11:18 --> 11:22test where barium is instilled into the
11:22 --> 11:25colon and X ray pictures are taken.
11:25 --> 11:28It's done less frequently now.
11:28 --> 11:31It too is not the most comfortable test,
11:31 --> 11:34although it's less invasive than
11:34 --> 11:37a colonoscopy on still an option,
11:37 --> 11:40but less commonly done these days.
11:40 --> 11:44CT, Colon ography or virtual colonoscopy.
11:44 --> 11:49It's sometimes known is a CT scan or
11:49 --> 11:53cat scan of the abdomen where the
11:53 --> 11:58interior of the colon is virtually
11:58 --> 12:02recreated using computerized techniques.
12:02 --> 12:04It is somewhat easier to undergo
12:04 --> 12:05than a colonoscopy,
12:05 --> 12:08but it still does require the bowel prep.
12:08 --> 12:10It requires the clean out,
12:10 --> 12:11as they say,
12:11 --> 12:14and it has the disadvantage that
12:14 --> 12:18if it shows an abnormal finding,
12:18 --> 12:20a colonoscopy would still be
12:20 --> 12:22necessary to establish the diagnosis
12:22 --> 12:24and potentially treat it.
12:25 --> 12:28And and some people talk about doing
12:28 --> 12:30kind of partial scope tests like
12:30 --> 12:32sigmoidoscopies are those recommended?
12:34 --> 12:37A flexible sigmoidoscopy is an option.
12:37 --> 12:39It is a shorter scope and it
12:39 --> 12:41goes into the sigmoid colon.
12:41 --> 12:44The lower part of the colon.
12:44 --> 12:49It requires a less extensive bowel prep
12:49 --> 12:52and it generally does not require the
12:52 --> 12:55same sedation that colonoscopy does.
12:55 --> 12:59The downside of that test is that it
12:59 --> 13:01doesn't evaluate the entire colon,
13:01 --> 13:06and so a cancer or a polyp farther up.
13:06 --> 13:07Would be missed,
13:07 --> 13:10but it is an option for for
13:10 --> 13:13some patients who are unable to
13:13 --> 13:15tolerate the full colonoscopy.
13:17 --> 13:19So all really great information on
13:19 --> 13:21different kinds of screening tests
13:21 --> 13:24when we come back after taking a
13:24 --> 13:26short break for a medical minute,
13:26 --> 13:28we'll learn more about who should
13:28 --> 13:31get which kind of screening test and
13:31 --> 13:33and and more about colorectal cancer
13:33 --> 13:36in general and why it's so important
13:36 --> 13:38to screen for it and find it early.
13:38 --> 13:40Please stay tuned to learn more
13:40 --> 13:42about colorectal cancer and other
13:42 --> 13:44GI malignancies with my guest
13:45 --> 13:46doctor Stephen Latency.
13:47 --> 13:49Funding for Yale Cancer answers comes from
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13:54 --> 13:56Presented by the Smilow Cancer Care
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13:59 --> 14:01Register at yalecancercenter.org or
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14:10 --> 14:13be diagnosed with head and neck cancer
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14:57 --> 15:00More information is available at
15:00 --> 15:02yalecancercenter.org you're listening
15:02 --> 15:04to Connecticut Public Radio.
15:04 --> 15:05Welcome
15:05 --> 15:07back to Yale Cancer answers.
15:07 --> 15:08This is doctor in East check
15:08 --> 15:10part and I'm joined tonight by
15:10 --> 15:12my guest doctor Steven Luttazzi.
15:12 --> 15:14We're learning more about colorectal
15:14 --> 15:16cancer and other GI malignancies.
15:16 --> 15:19In recognition of colorectal
15:19 --> 15:21cancer Awareness Month.
15:21 --> 15:23So Steve, right before the break we were
15:23 --> 15:26talking about all kinds of different
15:26 --> 15:28screening tests for colorectal cancer.
15:28 --> 15:30But one thing that has
15:30 --> 15:31changed in recent times,
15:31 --> 15:33I believe is the age at which
15:33 --> 15:35we should start screening.
15:35 --> 15:37So can you talk a little bit about
15:37 --> 15:39when we should start screening
15:39 --> 15:41and when we should stop screening?
15:41 --> 15:43Sure, until recently,
15:43 --> 15:47the recommendation for most average risk
15:47 --> 15:51patients was to start screening at age 50.
15:51 --> 15:53But as we discussed earlier,
15:53 --> 15:57the average age at diagnosis of
15:57 --> 15:59colorectal cancer has been decreasing
15:59 --> 16:02recently for unclear reasons,
16:02 --> 16:05and that has resulted in
16:05 --> 16:06a new recommendation.
16:06 --> 16:10Recently by the United States Preventive
16:10 --> 16:13Service Task Force that the age.
16:13 --> 16:17To start screening, be lowered to 45.
16:17 --> 16:20For most people.
16:20 --> 16:22Screening should generally
16:22 --> 16:25continue until age 75,
16:25 --> 16:30although I'll point out that the studies that
16:30 --> 16:35establish the upper limit for screening.
16:35 --> 16:38Really. Depend on the average
16:38 --> 16:41life expectancy in the population,
16:41 --> 16:43which thankfully is increasing.
16:43 --> 16:46So I think that one is a moving target
16:46 --> 16:47and continuing screening beyond
16:47 --> 16:50the age of 75 may be appropriate
16:50 --> 16:52for selected healthy patients.
16:52 --> 16:54And that's a personalized discussion
16:54 --> 16:56that should be held with the
16:56 --> 16:57patient and their provider.
16:59 --> 17:01Now the other thing that you had mentioned
17:01 --> 17:03before the break is that oftentimes these
17:03 --> 17:06screening tests are looking for polyps,
17:06 --> 17:08which can be benign,
17:08 --> 17:10or they can be precancerous,
17:10 --> 17:13but there are some forms of colon cancer
17:13 --> 17:16that don't present with polyps, right?
17:16 --> 17:18Especially the hereditary
17:18 --> 17:20nonpolyposis colon cancer.
17:20 --> 17:23Can you talk a little bit about that?
17:24 --> 17:28Oh, and these can be potentially
17:28 --> 17:32more difficult to prevent because
17:32 --> 17:35they don't have that easily
17:35 --> 17:37identified premalignant condition.
17:37 --> 17:40The most important feature, I think,
17:40 --> 17:42in identifying those patients
17:42 --> 17:45is their strong family history,
17:45 --> 17:49and if that family history can
17:49 --> 17:52be identified and that diagnosis
17:52 --> 17:54of a hereditary condition can be.
17:54 --> 17:58Established, these patients are excellent
17:58 --> 18:01candidates for starting screening at
18:01 --> 18:05an earlier age to detect a cancer.
18:05 --> 18:07Earlier, even one that did not
18:07 --> 18:08develop from a benign polyp
18:09 --> 18:11and most likely they should
18:11 --> 18:14be using colonoscopy so that
18:14 --> 18:16the the gastroenterologist or
18:16 --> 18:17the interventionalists who's
18:17 --> 18:20doing the colonoscopy can look
18:20 --> 18:22for even things that are not
18:22 --> 18:23necessarily classic polyps.
18:23 --> 18:24Is that right?
18:25 --> 18:27Absolutely right, and I'll
18:27 --> 18:30point out again that tests like
18:30 --> 18:33Cologuard are really best only for
18:33 --> 18:36patients who are at average risk,
18:36 --> 18:39not for patients with Lynch syndrome.
18:39 --> 18:41Hereditary nonpolyposis colorectal
18:41 --> 18:45cancer were conditions like that,
18:45 --> 18:47and so you know.
18:47 --> 18:48But for the majority of patients,
18:48 --> 18:53polyps are a great way to find cancer early.
18:53 --> 18:56And as you mentioned before, the break.
18:56 --> 18:59With colonoscopy, when we find a polyp,
18:59 --> 19:02we can often do what's called a polypectomy
19:02 --> 19:05or take out that polyp right then and
19:05 --> 19:08there right during that colonoscopy,
19:08 --> 19:10tell us a little bit more
19:10 --> 19:11about the risks of that.
19:11 --> 19:14Is that something that's generally done,
19:14 --> 19:16or is that something that that you you
19:16 --> 19:19need to kind of go back and do another
19:19 --> 19:21colonoscopy to do a polypectomy?
19:21 --> 19:23Or is that something that you consent
19:23 --> 19:25people for before doing the colonoscopy?
19:25 --> 19:27To begin with so that everything
19:27 --> 19:29can happen all at the same time
19:29 --> 19:31in the majority of cases,
19:31 --> 19:34the polypectomy or removal of the tumor
19:34 --> 19:37can be done during the same procedure and
19:37 --> 19:42for most patients that will be planned.
19:42 --> 19:44And, as you say, consented beforehand
19:44 --> 19:47so that it can be done if necessary.
19:47 --> 19:49There are some cases,
19:49 --> 19:51including patients who are at high
19:51 --> 19:53risk for complications or patients
19:53 --> 19:56who were found to have a large polyp.
19:56 --> 19:59That cannot be removed through the scope.
19:59 --> 20:01It may be necessary to go back
20:01 --> 20:02for a second procedure,
20:02 --> 20:04or even for surgery,
20:04 --> 20:08and So what are the risks of a polypectomy?
20:08 --> 20:10Is that a pretty straightforward thing?
20:11 --> 20:13Thankfully, for most patients,
20:13 --> 20:15the risks are very low.
20:15 --> 20:17Sometimes a small amount of blood will be
20:17 --> 20:19seen in the stool after the procedure,
20:19 --> 20:22but a serious complications are rare,
20:22 --> 20:25and so the the advantage of course,
20:25 --> 20:27of doing a polypectomy is that you
20:27 --> 20:29can remove this and send it off to the
20:29 --> 20:32pathologist who can look at it and tell
20:32 --> 20:33you whether it's completely benign,
20:33 --> 20:35whether it's cancerous or
20:35 --> 20:37whether it's precancerous.
20:37 --> 20:38Tell us a little bit more about
20:38 --> 20:40the different types of polyps,
20:40 --> 20:43which polyps lead to cancer,
20:43 --> 20:45and you had mentioned that
20:45 --> 20:47sometimes with polypectomy.
20:47 --> 20:48We can actually cure patients,
20:48 --> 20:50so talk a little bit about that as well.
20:50 --> 20:51Sure,
20:51 --> 20:55the type of polyp that typically will
20:55 --> 20:57develop into colorectal cancer if
20:57 --> 21:00left alone is the adenomatous polyp.
21:00 --> 21:02And those are the ones that it's
21:02 --> 21:04really important to get out.
21:04 --> 21:06There are others,
21:06 --> 21:09including hyperplastic polyps that.
21:09 --> 21:11Are not pre malignant,
21:11 --> 21:14or at least are of questionable potential
21:14 --> 21:17to ever develop into malignant.
21:17 --> 21:20See those are usually removed too and
21:20 --> 21:24the diagnosis of the polyp type is
21:24 --> 21:26generally made after the polyp is removed.
21:26 --> 21:28Those ones thankfully have
21:28 --> 21:29a much lower risk
21:30 --> 21:34and so if polypectomy can remove these
21:34 --> 21:36adenomatous polyps and essentially
21:36 --> 21:39cure patients of colon cancer,
21:39 --> 21:40tell us a little bit.
21:40 --> 21:42More about when patients.
21:42 --> 21:45Are diagnosed with cancer on
21:45 --> 21:48colonoscopy and when they might require
21:48 --> 21:51surgery or other forms of treatment.
21:52 --> 21:55Sure, it's certainly best if a cancer
21:55 --> 21:58is going to be diagnosed to diagnose
21:58 --> 22:01it on a colonoscopy in the earliest
22:01 --> 22:04stages rather than later when the
22:04 --> 22:07cancer has progressed to the point
22:07 --> 22:08that it's causing lots of symptoms,
22:08 --> 22:12or even when it is spread to other organs.
22:12 --> 22:16If a cancer is detected on colonoscopy,
22:16 --> 22:19sometimes the smallest ones are
22:19 --> 22:23removed through the colonoscopy alone.
22:23 --> 22:26But in most cases, if a cancer is
22:26 --> 22:29found at the time of colonoscopy,
22:29 --> 22:31surgery will be required
22:31 --> 22:33to remove the cancer.
22:33 --> 22:35Most colon cancers that have
22:35 --> 22:38not spread can be treated with
22:38 --> 22:40surgery as the first treatment,
22:40 --> 22:43with the goal of cure meaning to
22:43 --> 22:45get rid of the cancer completely
22:45 --> 22:48so that it never comes back.
22:48 --> 22:48And thankfully,
22:48 --> 22:52the cure rates are high in the range of
22:52 --> 22:5590% or higher for the earliest or stage.
22:55 --> 22:56One cancers,
22:56 --> 22:58when treated with surgery alone.
22:59 --> 23:02And so tell us more about that surgery.
23:02 --> 23:05Does that involve removing the entire colon?
23:05 --> 23:07Many people may be asking themselves,
23:07 --> 23:10does that mean that I'm left with
23:10 --> 23:13a bag hanging out of my abdomen?
23:13 --> 23:16Talk a little bit more about what
23:16 --> 23:18surgery looks like for patients who
23:18 --> 23:20are diagnosed with colorectal cancer?
23:21 --> 23:25Sure, for the great majority of patients,
23:25 --> 23:28surgery would involve removal of part
23:28 --> 23:31of the colon, not the entire colon.
23:31 --> 23:35And for most patients they will
23:35 --> 23:38be sort of hooked up again after
23:38 --> 23:41surgery so that bowel function
23:41 --> 23:45will be normal as it was before.
23:45 --> 23:47Most patients do not require a
23:47 --> 23:50colostomy or a bag following
23:50 --> 23:54curative surgery for colon cancer,
23:54 --> 23:56but it depends on the size and extent
23:56 --> 23:59and also the location of the tumor.
24:01 --> 24:04And so it sounds like if
24:04 --> 24:06you're detected early enough,
24:06 --> 24:09you can either have this polyp
24:09 --> 24:11and this very tiny cancer
24:11 --> 24:12removed through the colonoscope,
24:12 --> 24:15or you can have what sounds like
24:15 --> 24:17a pretty straightforward surgery,
24:17 --> 24:21removing part of the colon and
24:21 --> 24:22being reattached.
24:22 --> 24:24For curative intent,
24:24 --> 24:26so do these patients require
24:26 --> 24:28any further treatment.
24:28 --> 24:30In terms of chemotherapy
24:30 --> 24:31or radiation after that.
24:32 --> 24:35The answer is some people do,
24:35 --> 24:38and in some of the.
24:38 --> 24:40Colon cancers that have been
24:40 --> 24:43removed that are of higher stage,
24:43 --> 24:46including stage 3 cancers and
24:46 --> 24:48certain stage two cancers.
24:48 --> 24:51They may have a higher risk of
24:51 --> 24:53recurrence after surgery and may
24:53 --> 24:56benefit from treatment after the
24:56 --> 24:58operation to prevent recurrence.
24:58 --> 25:00That treatment generally consists
25:00 --> 25:04of chemotherapy or cancer drugs.
25:04 --> 25:04Thankfully,
25:04 --> 25:08chemotherapy to prevent recurrent colon
25:08 --> 25:11cancer has become significantly more
25:11 --> 25:14effective and also shorter in duration.
25:14 --> 25:16Over the past 10 to 20 years,
25:16 --> 25:19with the discovery of more
25:19 --> 25:22effective chemotherapy drugs for
25:22 --> 25:25colon cancer so that patients who
25:25 --> 25:26previously needed chemotherapy
25:26 --> 25:29for as long as 6 to 12 months
25:29 --> 25:32may now be able to complete their
25:32 --> 25:34treatment in three to six months.
25:34 --> 25:38One of the active ongoing areas of
25:38 --> 25:41research is identifying those patients,
25:41 --> 25:43especially with earlier stage
25:43 --> 25:46stage two disease who really do
25:46 --> 25:47benefit from chemotherapy and
25:47 --> 25:50those who can safely forego it.
25:51 --> 25:53What about radiation? Does radiation
25:53 --> 25:56play a role in colorectal cancer?
25:57 --> 25:59Radiation is generally not
25:59 --> 26:02part of the treatment of colon
26:02 --> 26:05cancer after it's been removed.
26:05 --> 26:07We haven't spoken too much
26:07 --> 26:09about rectal cancer cancers in
26:09 --> 26:11the lower part of the colon,
26:11 --> 26:14which behave a little bit differently because
26:14 --> 26:17the anatomy in that part is different.
26:17 --> 26:20The drainage via lymph nodes and
26:20 --> 26:23the lymphatic vessels is different,
26:23 --> 26:26and many of those patients
26:26 --> 26:27will actually be treated.
26:28 --> 26:31Prior to surgery with a
26:31 --> 26:33combination of radiation therapy,
26:33 --> 26:36X ray treatment and chemotherapy.
26:36 --> 26:37Cancer drugs.
26:37 --> 26:40To shrink down the cancer.
26:40 --> 26:44And prevent the development of
26:44 --> 26:48distant disease and also to make
26:48 --> 26:51eventual surgery more successful and
26:51 --> 26:54hopefully to prevent the the need for
26:54 --> 26:57a colostomy or a bag in some patients.
26:58 --> 27:00So it sounds like the treatment of
27:00 --> 27:03rectal cancer is a little bit more
27:03 --> 27:05intense than that of colon cancer.
27:05 --> 27:06Are the prognosis of colon
27:06 --> 27:08cancer and rectal cancer similar,
27:08 --> 27:10or are they different?
27:11 --> 27:14It mainly depends on the
27:14 --> 27:16stage of the disease.
27:16 --> 27:19But for the locally advanced patients
27:19 --> 27:22who get chemotherapy and radiation
27:22 --> 27:25therapy followed by surgery,
27:25 --> 27:28if they complete treatment successfully,
27:28 --> 27:31they also end up with an excellent
27:31 --> 27:33prognosis and a good chance of cure.
27:34 --> 27:38So it sounds like for most patients
27:38 --> 27:40it really does matter at the stage
27:40 --> 27:42at which you find these cancers.
27:42 --> 27:45Going back to our earlier discussion
27:45 --> 27:48about the importance of of screening.
27:48 --> 27:49Now let's suppose that
27:49 --> 27:51you missed the screening.
27:51 --> 27:53Are there certain symptoms that you
27:53 --> 27:56should be watching for that should
27:56 --> 27:58be kind of like those you know,
27:58 --> 28:00red sirens that going off in your head,
28:00 --> 28:01telling you that you ought
28:01 --> 28:02to get checked out?
28:03 --> 28:06Yes, and it's absolutely right that
28:06 --> 28:09it's much better to detect and treat
28:09 --> 28:12the cancer before it develops symptoms.
28:12 --> 28:16But for patients who have
28:16 --> 28:18symptoms of colorectal cancer,
28:18 --> 28:22the most common ones are change in
28:22 --> 28:24bowel habits, blood in the bowel
28:24 --> 28:27movements were black tarry stools.
28:27 --> 28:29Later symptoms may include nausha,
28:29 --> 28:31abdominal pain and weight loss.
28:32 --> 28:34Doctor Steven Latency is an
28:34 --> 28:35assistant professor of clinical
28:35 --> 28:37medicine and medical oncology
28:37 --> 28:39at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public
28:55 --> 28:57radio funding for Yale Cancer Answers
28:57 --> 29:00is provided by Smilow Cancer Hospital.

Information

Colorectal Cancer Awareness Month with guest Dr. Stephen Lattanzi March 20, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095