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Q+A: Colorectal Cancer

January 15, 2020

Cathy Eng, MD, the David H. Johnson Professor of Surgical and Medical Oncology, co-director of Gastrointestinal Oncology and co-leader of the Gastrointestinal Cancer Research Program, is one of the nation’s top colorectal cancer experts.

Q: How prevalent and deadly is colorectal cancer?

A: In the U.S. alone, it is estimated that over 145,000 individuals will be diagnosed with colorectal cancer. About one-third of these individuals, unfortunately, will die from this disease. Relative to other cancers, colorectal cancer is the second leading cause of cancer death for men and women combined.

Q: What are the symptoms?

A: An initial symptom is change in bowel habits, which includes color of stool, the consistency of stool, having blood when you wipe. Symptoms of more advanced disease are weight loss, night sweats, loss of energy. Another symptom is being anemic, particularly if you are iron deficient. For rectal cancer, early symptoms besides changes in stool are urgency and a feeling of incomplete evacuation and pressure when sitting. Some rectal cancer patients have told me they’ve been misdiagnosed with hemorrhoids. If you have a problem that doesn’t resolve itself on its own within one or two months, you need to go back to your primary care physician or go get a second opinion. If you are having those symptoms, make sure your provider does a rectal exam.

Q: What can be done to prevent colorectal cancer?

A: Most current guidelines, which have been in place for years, say you should get a colonoscopy at age 50. That’s because the average age patient in the U.S. is 67 and it takes five to 10 years for a polyp to become cancerous. If you are younger and having concerning symptoms, bring it to the attention of your doctor and ask about a colonoscopy. If the symptoms are consistent with rectal cancer, a flexible sigmoidoscopy might be a reasonable enough test. At home, you can do a Cologuard test. At the end of the day, any testing is better than no testing.

Q: Who is most at risk?

A: Honestly, anybody is at risk. Sometimes, people think this is a cancer people get because it is inherited. The majority of cases, probably 75% to 80%, are spontaneous development. In fact, most of my young patients have no inherited familial risk factors. People who are at increased risk include those with inflammatory bowel disease, Crohn’s disease and ulcerative colitis.

Q: Are there any promising advances on the horizon?

A: Definitely. That is the whole purpose of what I, my colleagues and other researchers across the country do. There are a lot of new and interesting drugs for colorectal cancer. Some of them are in early development, but the reality is we know we need more options for our patients, not only standard chemotherapy but also targeted agents and immunotherapeutic combinations. The reality is if you have surgically unresectable stage IV disease, the median survival is roughly between 32 and 36 months and the five-year survival is only 13%. The No. 1 thing is to catch it early and get it removed.