This is the third in a series of instalments devoted to breakthroughs for the more common solid and blood cancers. This week is dedicated to colorectal cancer (CRC).

The colon is also known as the large intestine; it’s a tubular structure that is about 6 feet long and connects the small intestine to the anus. It consists of four parts, the cecum, colon, rectum, and anal canal. The colon facilitates water, electrolytes, and nutrient absorption, in addition to stool formation.

CRC begins in the majority of instances as a polyp and if removed early CRC can be averted.

CRC is one of the three leading causes of cancer deaths worldwide; the five-year survival rate of stage IV (the most advanced stage) is 14%. Most CRC deaths are avoidable by circumventing the preventable causes wherever possible (listed below) and by having periodic screening. If the polyp remains undetected the cells within can become malignant (cancerous) which in turn can spread within the colon’s wall and beyond. Cancer that begins in the rectum is called rectal cancer, while cancer in other areas of the large intestine is called colon cancer.

Cancer of the large intestine, in general, may be referred to as colorectal cancer. The following increases the risk of developing CRC: advancing age; family history, ulcerative colitis, certain genetic syndromes (which may also lead to ovarian, endometrial, and breast cancer), alcohol, cigarette smoking, obesity, animal fats, sugar, processed foods, red meats, diets low in fruit, vegetables, and fibre, being Black or Jewish, and a prior history of polyps or CRC.

The following reduces the chances of developing CRC: limiting alcohol intake, eliminating tobacco, regular exercise, polyp removal, aspirin, diets rich in fibre, reducing fat and processed food consumption, and regular screening.

Some recent discoveries, and advancements, regarding CRC:

• The New England Journal of Medicine recently reported a 100% success in eliminating CRC in a small cohort treated with Dostarlimab (immunotherapy) for six months. All remained cancer-free 25 months after the completion of their treatment. There were no significant side effects from the treatment in any of the study’s participants.
• In two studies it was shown that either the use of fruquintinib or the combination transtuzumab plus tucatinib can improve the prognosis for persons with previously treated metastatic colon cancer.
• Increased physical activity in those with Stage 3 CRC improved survival.
• Statin drugs slow the spread of CRC.
• UCLA Health research has shown that regular consumption of broccoli, cabbage, and cauliflower significantly reduces one’s risk of developing CRC.
• Taller adults have longer colons and seem to be at increased risk of getting CRC. They should consider undergoing screening five years before what is generally recommended.
• Cologuard home test has been found to be effective in detecting DNA and blood in the stool of CRC patients.
• Liquid biopsies are under development to detect CRC in its early stage via a simple blood test.
• Targeted therapy (e.g. Bevacizumab, Cetuximab, and Panitumumab) is increasingly being used to treat advanced CRC. This therapy destroys CRC cells while sparing non- cancerous cells.

Recently diagnosed colorectal cancer (CRC) patients should attend their doctor with a close family member or friend, and below are some questions that need to be asked:

• Where in the colon is the CRC located?
• Has the CRC spread? What is the stage? What is the prognosis?
• What are all the treatment options? Are all available locally? If not, what’s not?
• Would radiation and chemo/immunotherapy help reduce the tumour’s size before surgery?
• Would a colostomy bag be needed (temporarily or permanently) after surgery?
• Should additional tests be done before treatment is started?
• Would radiotherapy be required? If yes, where can such be accessed?
• Can copies of all the reports be provided?
• What are the goals and likely success of my treatment?
• Can copies of all the reports be provided?
• Is there any additional treatment that can be beneficial even if it means having to travel or pay to bring it into the country?
• Are other doctors going to be involved in my treatment?
• What are the possible side effects of the proposed treatments?
• Is a second opinion locally or overseas recommended or worth pursuing?

Pancreatic cancer will be covered next Friday.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg.com, 1(784)570-9300, (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.