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What you should know about colon cancer screening

Friday, March 11, 2016

This is an excerpt of an article that appeared in the Ithaca Journal. Read the whole story here

Colon cancer is predicted to kill nearly 50,000 people in the United States this year. Despite screenings that can detect and prevent colon cancer early, about a third of Americans do not get screened. That screening rate holds true in the Southern Tier.

While March is Colorectal Cancer Awareness Month, the cancer was brought into the spotlight this week with the news of Cornell University President Elizabeth Garrett's death Sunday at the age of 52.

A little over a month ago, on Feb. 8, Garrett announced to the Cornell campus community she had colon cancer. She said she was beginning an aggressive treatment program at Weill Cornell Medicine. On Feb. 19, she underwent surgery, and Cornell University Acting President Michael Kotlikoff said Feb. 22 she was released from the intensive care unit. She died March 6.

Colorectal cancer — cancer that affects the colon or rectum — is the third-most common cancer in both men and women, and the second-leading cause of cancer-related deaths in the United States. The American Cancer Society estimates there will be 95,270 new cases of colon cancer in the U.S in 2016.

Doctors recommend most people get screened starting at age 50. Because incidence and mortality rates are higher for African-Americans, doctors recommend they be screened at 45. People with a family history of colorectal cancer are also advised to start getting screened earlier.

Barbara Lang, of Dryden, got her first colonoscopy at 51, and at that first screening, her doctor found a cancerous polyp. She had no family history of colon cancer and did not have any glaring symptoms of it — like a change in bowel habits, rectal bleeding or unintended weight loss — that brought her to the doctor.

Looking back, however, Lang thinks back spasms she had over a two-year period might have been tied to the cancer. But otherwise, she was healthy and active. She was as an open-water swimmer.

Lang was diagnosed with Stage IIIC colon cancer. People diagnosed at that stage have about a 53 percent survival rate, according to the American Cancer Society.

Typically, colon cancer takes a long time to develop. It usually starts out as a polyp — a small clump of cells on the lining of the colon or rectum — that can, over the course of 10, 15 or more years, grow into an invasive cancer. If a polyp is spotted in a colonoscopy, it can be surgically removed.

Photo of Manish Shah, M.D. From there, additional treatment, such as chemotherapy, may be recommended, said Dr. Manish Shah, director of the Gastrointestinal Oncology Program at Weill Cornell Medicine.

"Depending on aspects of the pathology, we would decide on additional treatment like chemotherapy to treat microscopic disease. So in that setting, when the disease is localized to the colon, it hasn't spread, and we are doing surgery and also maybe chemotherapy, we do have good chances to eradicate the disease so that it doesn't come back again," Shah said.

After Lang's diagnosis, things moved quickly. "It certainly flips your world upside down, there's no doubt about that," she said.

Lang received local treatment at Cayuga Medical Center, under the care of Dr. Charles Garbo. She had a polyp and a small section of her intestine removed. She also underwent chemotherapy. She was diagnosed in fall 2006 and underwent chemotherapy until spring 2007. She detailed her experience at the time in a series of columns that ran in The Ithaca Journal.

Screening can prevent cancer

Shah said he finds it surprising that in the United States, only a third of eligible patients get colonoscopies each year. "If we could make that only 5 percent of people who don't get screenings, that would make a big difference," Shah said.

Though screening can prevent cancer, the Centers for Disease Control and Prevention estimate that one-third of adults ages 50 to 75 have not been tested. That holds true in the Ithaca, Binghamton and Elmira areas.

Tompkins County has a 64 percent colon cancer screening rate for adults between 50 and 75 years old, according to the New York State Department of Health. The rate is 66 percent in Broome County, 62 percent in Chemung County and 54 percent in Tioga County.

Unlike other types of cancers where screenings detect cancer — like a mammogram for breast cancer — colonoscopies can actually prevent colon cancer, said Bob Riter, executive director of the Cancer Resource Center in Ithaca. During a colonoscopy, doctors can find precancerous polyps and remove them before they become problematic.

The death rate from colorectal cancer has been dropping for decades, likely because polyps are being found more often by screening and removed before they can develop into cancer, according to the American Cancer Society.

On average, about 37 people are diagnosed with colon and rectum cancer, and 17 people die from it each year in Tompkins County, according to data compiled by State Cancer Profiles. In Broome County, an average 113 people are diagnosed each year and about 39 people die from it. In Chemung County, an average of 34 people are diagnosed, and 10 people die. In Tioga County, an average of 32 are diagnosed and eight die from colorectal cancer.

Research and treatment

Before Garrett died, she expressed a desire to create a fund at Weill Cornell Medicine— where she was being treated — to advance colon cancer research. Weill Cornell Medical College, in New York City, is one of the top-ranked clinical and medical research centers in the U.S. Weill Cornell Medicine was founded in 1898 and became affiliated with New York-Presbyterian Hospital in 1927.

The President Elizabeth Garrett Fund for Colon Cancer Research was launched Tuesday.

Garrett was one of several hundred patients with colon cancer who doctors at Weill Cornell Medicine see every year.

Research and treatment for colon cancer has been evolving in a very positive way, Shah said. He has been in practice about 17 years.

"It can be disheartening when many patients with cancer, colon cancer but other cancers as well, ultimately they die of their disease, and people feel like we haven't made that much progress, but we have. We've made a lot of progress, and it's come with a lot of research — in terms of understanding the disease biology, understanding the genetics that lead to resistance — so I think there is hope certainly that we can even do better," Shah said.

In the last 15 to 20 years, there has been progress in drug treatment, Shah said. Initially, he said, one treatment drug was used called fluorouracil, but now there are eight or nine drugs available. In just the past 18 months, Shah said two new drugs have been approved, and there is also excitement around the field of immuno-oncology, where doctors activate the immune system against the cancer.

One of the dilemmas in cancer research is "Why doesn't the immune system recognize the cancer as a foreign thing and then try to attack it like they would bacteria or viruses? One reason why is because cancers express proteins that inactivate the immune system that interacts with it," Shah said. Cancers express proteins that turn off or kill T-cells that would otherwise kill the cancer.

"There (is) now a new class of drugs that block that process, and allow the T-cells to remain active and able to fight the cancer," Shah said.

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Colorectal cancer facts

What is colorectal cancer?

It's a cancer that starts in the colon or rectum. The two are often grouped together because they have many features in common. Colorectal cancer affects men and women.

What causes colorectal cancer?

Most colorectal cancers begin as a growth in the inner lining of the colon or rectum called a polyp. Some types of polyps can change into cancer over the course of several years, but not all polyps become cancer.

Several lifestyle-related factors have been linked to colorectal cancer, like being overweight or obese, physical inactivity, certain types of diets — like a diet high in red and processed meats — can raise colorectal cancer risk. Diets high in vegetables, fruits and whole grains have been linked with lower risk of colorectal cancer. Other lifestyle links include smoking and heavy alcohol use, according to the American Cancer Society.

One colorectal cancer risk factor that is not possible to change is age. While younger adults can develop colorectal cancer, chances increase after the age of 50. People with a personal history of colorectal polyps or cancer have an increased risk, as do people with a personal history of inflammatory bowel disease.

People with a history of colorectal cancer in a first-degree relative, like a parent, sibling or child, have an increased risk, and the risk is even higher if that relative was diagnosed when they were younger than 45. However, most people with colorectal cancer have no family history of it, the American Cancer Society says.

What are signs of colorectal cancer?

Precancerous polyps and early-stage colorectal cancer do not always cause symptoms, which is why screening is important.

Some signs and symptoms of colorectal cancer include a change in bowel habits, like diarrhea, constipation or narrowing of the stool; a feeling that you need to have a bowel movement that is not relieved by doing so; rectal bleeding; blood in the stool, which may make it look dark; cramping or abdominal belly pain; weakness and fatigue; and unintended weight loss.

What types of screening tests are available?

According to the CDC, there are three tests to find polyps or colorectal cancer:

  • High-sensitivity FOBT (Stool test) once a year.
  • Flexible sigmoidoscopy. A doctor will check for polyps by putting a short, thin, flexible lighted tube into the rectum and lower third of the colon. This should be done every five years. When done in combination with the FOBT, it should be done every three years.
  • Colonoscopy. Similar to a flexible sigmoidoscopy, a doctor will use a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and entire colon. This should be done every 10 years.