Colorectal cancer:
Early testing reduces fatalities
Very few people want to talk about colorectal cancer.
Fortunately, Roy Davis is one of them.
Now retired, he splits time between his home in Roxbury and Fort Myers, Fla., and is an active participant in cancer support groups at Boston Medical Center. Most recently, he was guest speaker at BMC’s Annual Survivor’s Luncheon.
Yes, Davis is a survivor.
“I consider myself very lucky,” he said. “The cancer was caught in time.”
Cancer of the colon and rectum, collectively termed colorectal cancer, is the third most common cancer in this country in both men and women.
According to the American Cancer Society, almost 149,000 estimated new cases will be diagnosed in 2008. It is also the second most common cause of cancer-related deaths, trailing only lung cancer. Almost 50,000 people are expected to die of colorectal cancer this year.
The exact cause of colorectal cancer is not known. But what is known are the many conditions that increase one’s risk for the disease — age, family or personal history of colorectal cancer, certain genetic conditions, inflammatory intestinal disorders and a history of colon polyps.
Common in people over the age of 50, many polyps — growths on the inner wall of the large intestine — are pre-malignant lesions that have a long latency period. If left alone, they can eventually turn into cancer.
Polyps are found and removed during a screening test — more commonly a colonoscopy — in which a lighted tube is inserted into the entire length of the colon and rectum.
According to Dr. David P. Ryan, clinical director of Tucker Gosnell Center for Gastrointestinal Cancers at Massachusetts General Hospital, “Thirty to 50 percent of the people who undergo screening at age 50 will have polyps.”
Approximately 1 percent of the polyps turn into cancer. “You don’t know which polyps become cancerous, so you take out all of them,” Ryan said.
In Davis’ case, he missed his scheduled colonoscopy. His grandmother had died at the age of 104 and her funeral was the same day as his appointment. He never rescheduled, a decision he now regrets.
“I never considered cancer,” he said. “I just didn’t feel well. I was very tired and I didn’t have an appetite. I was losing weight and was constipated. I had no idea what was wrong with me.”
He was working with the Boston Red Sox in 2005 when he said he started feeling worse and worse. Shortly after the team returned to Boston from spring training in Fort Myers, he went to the Boston Medical Center emergency room.
The doctors discovered bad news: he had a tumor on his rectum. He was immediately admitted and had a temporary colostomy performed.
A colostomy is a surgical procedure performed to allow removal of waste when there is an obstruction in the large intestine. It involves creating an opening in the abdomen through which waste can leave the body.
He was in the hospital about a week. The affect of the colostomy was immediate. His appetite returned, and he was functioning normally again.
After discharge, he elected to participate in a clinical trial for rectal cancer, which involved six weeks of radiation and chemotherapy. The treatment was successful in shrinking his tumor to the point that it could be easily removed, allowing the reversal of his colostomy.
The signs and symptoms of colorectal cancer are varied — a change in bowel habits, including diarrhea or constipation; a change in the size and consistency of the stool; blood in the stool; abdominal pain; fatigue or weight loss with no known reason.
According to Ryan, the two strong telltale signs that a person may have colorectal cancer are blood in the stool and a change in bowel habits, such as diarrhea or constipation, as was the case with Davis.
Sometimes there are no symptoms at all. Colorectal cancer is generally silent in the early stages and causes symptoms when it advances.
That is why screening is key.
If polyps are found and removed during screening, colorectal cancer, unlike most other cancers, can often be prevented.
The trick is to persuade people to get screened. There’s progress on that front.
In its Annual Report to the Nation, the National Cancer Institute partly attributes a drop in cancer death rates to increased screening for colorectal cancer.
Massachusetts boasts one of the highest percentages of eligible residents screened. In 2006, more than 57 percent of the state’s adults aged 50 years and older who were surveyed said they have had a sigmoidoscopy or colonoscopy — two screening tests for colorectal cancer — within the past five years. An encouraging note is that almost 60 percent of blacks interviewed reported to have been screened.
But there’s more work to be done.
It is estimated that as many as 60 percent of deaths from colorectal cancer could be prevented if everyone aged 50 and older were screened regularly.
When colorectal cancer is found in the early stages, the five-year survival rate is 90 percent. When it has spread to distant parts of the body, the rate is 10 percent.
The American Cancer Society recommends that people of average risk for colorectal cancer should begin screening at age 50. People of high risk, such as those with a familial history of the disease, should begin at an earlier age.
There are many screening tests — fecal occult blood test that looks for blood in the stool, and barium enema, sigmoidoscopy and colonoscopy that look for polyps and cancer.
Ryan has his preferences, and the flexible sigmoidoscopy that views only the lower third of the large intestine is not one of them. “I generally do not recommend a sigmoidoscopy,” Ryan said. “Colonoscopy is the gold standard.”
There’s good reason for his choice.
Many cases of colon cancer begin in the right side of the large intestine, a section the sigmoidoscopy misses. Ryan quotes a phrase often repeated by Dr. Daniel Podolsky, chief of gastroenterology at Massachusetts General Hospital: “A sigmoidoscopy is like a mammogram on one breast.”
Lifestyle also plays a part in reducing the risk of colorectal cancer. Some research has shown that diets high in fatty red meats and processed meats, such as bacon, ham and sausage, can increase a person’s risk for colon cancer. Lack of exercise, obesity, smoking and alcohol use may also pose a risk.
But Ryan is quick to point out that lifestyle changes do not take the place of colonoscopy. “You still need a colonoscopy regardless of diet,” he said. “Eating well does not mean you can’t get cancer.” |
| Roy Davis participated in a clinical trial to treat his rectal cancer. He has been in remission since October 2005. |
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David. P. Ryan, M.D.
Clinical Director
Tucker Gosnell Center for Gastrointestinal Cancers
Massachusetts General Hospital
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