March Is Colorectal-Colon Cancer Awareness Month

by Jane Ashley

Did you know that colorectal cancer is one of the few cancers that can be prevented? Although sometimes the brunt of watercooler jokes, the colonoscopy is the “gold” standard of screening. If polyps are found, they are removed and biopsied. Colorectal cancer begins as a benign polyp, so if you have a benign polyp and it’s removed, you prevented colorectal cancer from developing.

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Colorectal Cancer Facts

• Colorectal cancer is the second leading cause of cancer deaths in women and men combined. Almost 150,000 people are diagnosed with colorectal cancer annually in the U.S. Over 53,000 people will die from colorectal cancer in 2020.
• About 70 percent occur in the colon, and about 30 percent occur in the rectum.
• About 1 out in every 23 people will develop colorectal cancer within their lifetime.
• Survival rates are increasing since the 1980s — thanks, in part, to broader use of colonoscopies for screening so that precancerous polyps are removed so that cancer is detected at an earlier, more treatable stage.
• There are more than 1.4 million colorectal cancer survivors alive today in the U.S.
• Median age for diagnosis for colon cancer in men is 68, and in women, it’s 72. For rectal cancer, it’s 63 for both women and men. Treatment for both colon and rectal cancer utilizes the same chemotherapy drugs — pelvic radiation is often added to rectal cancer treatment to help prevent recurrences.

Colorectal Cancer Under 50

Risk Factors

Risk factors include those we commonly hear about for other cancers — obesity and a sedentary lifestyle. Additional risk factors for colorectal include eating too much red meat and processed meat, including bacon and meats preserved with nitrates.

Other notable risk factors are ones that can’t be changed by our behavior:

• African-Americans are about 20 percent more likely to develop colorectal cancer. Death rates are 40 percent higher in African-Americans. The increased death rate may be due, in part, to lack of access to screening so that diagnoses occur at a later stage.
• First-degree relatives (siblings, children, or parents) of people who develop colorectal cancer are two-to-three times more likely to develop colorectal cancer.

Disturbing Trend

While cancer rates have been declining for those over 50 (due to increased awareness and screenings), a disturbing new trend is occurring in the people under 50.
• 11% of colon cancer diagnoses are in those under 50.
• 18% of rectal cancer diagnoses are in people under 50.
• 72% of these diagnoses are in people in their 40s, previously thought “too young to have colorectal cancer.”
• Younger patients may be misdiagnosed. Young women who are pregnant are told that it’s hemorrhoids related to their pregnancy. Physician-delayed diagnosis, due to missed symptoms or initial diagnosis mistakes, may occur in up to 50 percent of younger patients.
• Younger-onset rectal cancer is increasing at nearly twice the rate of younger-onset colon cancer.
• Younger-onset colon cancer occurs most often in the distal colon, the part of the colon just above the rectum.

Biomarkers in Colorectal Cancer

Biomarkers are a protein or antibody that tumors make, or your body produces in response to a cancerous tumor. Biomarkers help direct your oncology team towards the treatment option that will work best for your specific situation.

Only about 5% of colorectal cancer is hereditary. 95% of mutations occur randomly. Biomarker testing is not always offered to patients. Educate yourself to know how you need to be effectively treated. NOTE: Most of this testing has been developed in the last five years.
• Every colorectal cancer patient should be tested for high microsatellite instability (MSI-high). About 15% of patients are MSI-high, which means the cells are very unstable. MSI-high tumors often attract the attention of our immune system, which translates into these patients being candidates for immunotherapy.
• Every Stage IV colorectal cancer patient should be tested for the four primary biomarkers: KRAS, NRAS, BRAF, and HER2. BRAF and HER2 are markers in breast and ovarian cancer too. The presence of any of these biomarkers helps your medical team select the most appropriate treatment and give some indication of potential effectiveness.

Colorectal Cancer Down By53

Screening Methods

Colonoscopy is the gold standard of screening. The recommended age to begin is at age 45 or 50 unless you have a 1st-degree relative who had colorectal cancer. In that case, you should start colonoscopies 10 years before the age that they were diagnosed. A colonoscopy is recommended every 10 years if no polyps are found and every five years if polyps are found.

Many people are too squeamish or uncomfortable to schedule a colonoscopy. The prep is challenging, but the good news is that there are several other non-invasive ways to effectively screen for colorectal cancer. We, as cancer patients, should never forget to have recommended screenings for different kinds of cancer, including screening for colorectal cancer. It would be a shame to survive another kind of cancer and get caught “with our pants down” and allow colorectal cancer to sneak up on us.

Here are some alternative screening methods to detect colorectal cancer.

• Fecal Immunochemical Test (FIT or iFBOT) – a simple stool sample test that detects blood in your stool. If blood is detected, more testing will be required to determine the source of the blood. Recommended annually.
• Guaiac Fecal Occult Blood Test (FOBT) – another simple stool sample test to detect blood in your stool. If blood is detected, you’ll need more testing. Recommended annually.
• Flexible Sigmoidoscopy - an exam performed in your gastroenterologist’s office to detect polyps in the rectum and lower colon. A significant drawback is that this will only detect left-sided colon cancer, leaving you at risk for cancer in your transverse and ascending colon. Recommended every 5 years.
• Virtual Colonoscopy – uses X-rays and computers to examine your rectum and colon. It’s less invasive, but not covered by all insurance. If a polyp is detected, you’ll still have to have a colonoscopy to remove and biopsy the polyp. Recommended every 5 years.
• Stool DNA (Cologuard ) – the newest stool sample test that detects DNA changes consistent with colorectal cancer or precancerous polyps. If positive, the patient needs a colonoscopy. Recommended every 3 years. Covered by Medicare and Medicaid and many private insurance companies.

Additional Resources

To learn more about colorectal cancer, its treatments and its biomarkers that guide treatment, these two organizations have excellent resources available that you can download so that you can talk to your medical team.

Colorectal Cancer Alliance

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Fight Colorectal Cancer

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Friday, March 6th is Wear Blue Day — to raise awareness for Colorectal Cancer. Join in and wear BLUE!

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