Although it may feel uncomfortable to talk about colorectal cancer, it's important to be familiar with the risk factors, symptoms, screening and treatment. This knowledge can lead to prevention, early detection and better outcomes.

In recognition of March as Colorectal Cancer Awareness Month, Janice Rafferty, MD; Slobodan Stanisic, MD; and Aruna Puthota, DO from The Christ Hospital Physicians recently hosted a webinar to discuss what you should know about preventing and treating colorectal cancer.  

Learn the facts

Colorectal cancer is the third most common cancer worldwide and the second leading cause of cancer-related deaths. But the good news is that it can be prevented and treated effectively, says Dr. Puthota.

Colorectal cancer is a collective term. It includes colon cancer, which occurs in the large intestine, and rectal cancer, which is in the rectum at the end of the large intestine.

“When you eat, food empties into your small intestine," Dr. Puthota says. “Then it travels to the large intestine, or colon. It empties out of your body through your rectum."

Dr. Puthota points out some common myths to be aware of about colorectal cancer​:

Myth #1 - Colorectal cancer is more common in men.

The truth is that colorectal cancer affects men and women equally.

Myth #2 - Screening is only for those who have a family history.

Actually, 75 to 85 percent of new colorectal cancer cases occur in people with no family history.

Myth #3 - Screening is only for those who have symptoms.

Some colorectal cancer cases do not have any symptoms.  

While those are myths, some factors may increase your risk of colorectal cancer. These include:

• Age - over 50
  
• Colon conditions - including ulcerative colitis and Crohn's disease
• Diabetes - poorly managed Type 2 diabetes
• Family history - and some genetic conditions
• Lifestyle - a diet high in red meat and processed foods, inactivity, overweight and smoking
• Race - Black Americans are 20 percent more likely to get colon cancer and 40 percent more likely to die from it
• Radiation - history of radiation to the abdomen or pelvis

Recognize the symptoms and get regular screening

You should be aware of signs of colorectal cancer as well. These include:

• Abdominal pain
  
• Blood in your stool or on the toilet paper
• Change in appetite or taste
• Change in the shape or formation of your stool
• Fatigue
• Sudden weight loss

“You never should worry alone, so talk with your doctor about these symptoms," Dr. Puthota says. “Anyone with symptoms should have a colonoscopy."

But sometimes, no symptoms are present. That's why it's vital to get screened for colorectal cancer.

“By screening for colorectal cancer, you can identify it earlier when it's more likely to be curable," Dr. Puthota says. “You may just save your life or that of someone you love."

You should have regular screening tests between ages 45 to 75. However, if you have a parent, sibling or child with colorectal cancer, you should undergo testing earlier. Typically, you'll want to begin screening 10 years before the age your relative was when they were diagnosed.

“So, if your parent was diagnosed with colon cancer at 50, you should be screened regularly starting at age 40," Dr. Puthota says.

Doctors can test for colon cancer using several methods. The most common tests are a colonoscopy and a Cologuard® test.

Colonoscopy

Colonoscopy is the gold standard because it is up to 94 percent accurate. It takes place in a hospital or outpatient center. It is painless, and you are asleep under anesthesia.

A gastroenterologist uses a scope inside your colon and rectum to look for polyps, which are clumps of cells that may develop into cancer. Doctors can remove polyps during the procedure.

Any polyps removed during the procedure are then examined under a microscope. If the polyps show signs of cancer (malignant), you will see a surgeon and oncologist. In general, if the colonoscopy was normal and you have no family history, you can repeat your screening colonoscopy every 10 years.

“What can make people uncomfortable about colonoscopies is not the procedure itself, but the preparation," says Dr. Puthota.

To prepare for a colonoscopy, you must empty your colon. That means fasting from food the day before the test and drinking a laxative solution. This laxative stimulates you to have multiple bowel movements.

Some people don't like the taste of this solution. And you will spend a lot of time in the bathroom. But even so, a colonoscopy can keep you from having colon cancer or help detect it early, when treatment is generally more effective.

Cologuard

This is a test kit that you can buy and use at home. You place the kit in your toilet bowl, have a bowel movement and send a stool sample to the company. They look at it under a microscope for traces of blood or common mutations in your DNA that occur with colon cancer.

“If they find either of these, your test is positive." Dr. Puthota says. You need to see your doctor, who will recommend a colonoscopy. If your result is negative, you repeat it in three years.

Understand the types of treatments

If you are diagnosed with colorectal cancer, your doctor first will determine if it is present only in one area or if it has spread to other parts of your body. This usually involves a physical exam, X-rays, blood tests, and a biopsy of polyps or tissue removed.

Results from these procedures show if your cancer has spread to your lymph nodes or other organs in your body. Based on this information, your doctor will assign a specific stage to your cancer.

Your colorectal cancer treatment depends on the stage of the cancer, its location, your medical history and your family history of colorectal cancer. You may have one type of treatment or a combination, Dr. Puthota says.

Surgery

Surgery removes the cancerous tissue in the colon or rectum. Your doctor may recommend open surgery or a minimally invasive procedure:

• Traditional open technique
  
• Requires a large incision in the belly, but has a long history of success
• Minimally invasive
• Includes robotic and laparoscopic procedures, which result in less pain, lower risk of infection, a shorter hospital stay and an easier return to normal activities

Chemotherapy

Chemotherapy drugs go into the bloodstream to travel throughout the body. The goal is to halt the growth of cancer tumor cells by killing them or stopping them from dividing and reproducing.

Chemotherapy typically lasts three to six months, depending on your cancer. It is a very effective treatment method, and many drugs are available, Dr. Stanisic points out.

“We have 22 drugs that are approved for colorectal cancer, and new treatments are advancing the field continually," Dr. Stanisic says. “That is reason for a lot of hope."

Radiation

Radiation is using X-rays on the body to shrink cancer tumors. It is often combined with chemotherapy at the same time to enhance its effectiveness, Dr. Stanisic says.

Immunotherapy

Given through the veins, this medicine stimulates your immune system to fight off the tumor cells. “We only give immunotherapy for very selective tumor subtypes, which we call mismatch repair deficient tumors," Dr. Stanisic explains.

Supplemental therapy

Lifestyle practices, such as maintaining a healthy diet and regular exercise, can help. Some doctors recommend taking vitamin D, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

But, Dr. Stanisic says that more studies are necessary to determine the effectiveness of vitamin D, aspirin and ibuprofen. 

Ongoing surveillance

The Christ Hospital Health Network has a program called TNT (total neo-adjuvant treatment regimen) for rectal cancer. After diagnosis and staging, you receive chemotherapy and radiation first, before any surgery.

“Up to 40 percent of patients have a complete tumor regression (the tumor shrinks or disappears) after chemotherapy and radiation," Dr. Rafferty explains. “This is what we call a complete clinical response or cCR."

Some patients that have a cCR and no evidence of a tumor may not need surgery. Your doctor may recommend watching and waiting.

“You still have to follow up and let us keep a very, very close eye on you with exams every three months as part of an intense surveillance regimen," Dr. Rafferty notes.

Partner with an expert team

At The Christ Hospital Health Network, patients work with a multidisciplinary team to address colorectal cancer. The team includes experts in:

• Colorectal surgery
  
• Gastroenterology
• Medical oncology
• Pathology
  
• Primary care
• Radiation oncology
• Radiology

Plus, The Christ Hospital is the only hospital in Ohio that is a Collaborative Member of the Dana-Farber Brigham Cancer Center. That means you get the best local care along with input from leading cancer researchers and experts.

Be sure to talk with your doctor about any concerns regarding colorectal cancer.

“If there is something persistent and new and different for you, tell your doctor about it and get the answers you need," Dr. Rafferty says.

“The bottom line is that no one should die of embarrassment when dealing with colorectal cancer," says Dr. Rafferty. “Frankly, a colonoscopy is a whole lot easier than going through radiation, chemotherapy and surgery."

To talk with a colorectal cancer expert from The Christ Hospital Health Network, call 513-​547-2242.