Colorectal Cancer: The Good News – Really

Just over 100,000 Americans will be diagnosed with colon cancer this year, while another 44,000 will be diagnosed with cancer of the rectum.¹ Additionally, an estimated 51,020 Americans will die of colorectal cancer (CRC) in 2019, making CRC the second-leading cause of cancer-related deaths.¹ Combine those grim statistics with a disturbing uptick in colorectal cancer diagnoses in adults aged 20 to 54 years,² and it may be difficult to believe that there’s much in way of good news regarding colorectal cancer.

But there is.

The death rate from CRC fell by 51% from 1976 to 2014,³ and Andrew M. Bernstein, DO, says that new therapies that have become available in the last several years are driving even further gains in survival. “We’re now able to employ targeted therapies that interfere with specific steps in the development and spread of cancer, and we’ve also become much better at identifying which therapy is going to be most beneficial for which patient,” says Dr. Bernstein, a medical oncologist and hematologist who practices in Pompton Plains, NJ, with Regional Cancer Care Associates, LLC (RCCA), one of the nation’s largest networks on oncology specialists.

“For example, epidermal growth factor receptor, or EGFR, is a protein found on the surface of both normal cells and cancerous cells. When the protein binds to a receptor on the cell’s surface, it triggers that cell – be it healthy or malignant – to begin the process of growing and multiplying. It is roughly akin to a key fitting into a lock, allowing a door to be opened. Targeted therapies such as erbitux and vectibix bind to EGFR on cancer cells, preventing the protein from instead binding to the receptor on the cell’s surface. By blocking that connection, the medications block activation of the cancerous cell’s growth process,” Dr. Bernstein explains.

Beyond being effective, targeted therapies generally have milder side effects than chemotherapy, the oncologist adds. While roughly one-third of patients with advanced colorectal cancer are candidates for targeted therapies, the medications are not effective in patients whose cancer is driven by mutations in genes such as KRAS, NRAS, and BRAF. “We employ sophisticated genetic analysis of colorectal tumors to identify their mutation profiles and match the patient with the treatment strategy that will be most effective for him or her,” says Dr. Bernstein.

The cancer specialist adds that immunotherapies – drugs that enhance the cancer-fighting abilities of the body’s immune system –are beginning to play a larger role in CRC following their initial use in lung cancer, melanoma, Hodgkin Lymphoma, and other cancers. “Through our use of cutting-edge treatments such as targeted therapy and immunotherapy, as well as our extensive clinical trial program, we’re able to provide patients with the latest innovations in cancer care in the community setting,” Dr. Bernstein says of RCCA, which has 30 care sites in New Jersey, Connecticut, and the Maryland/Washington, DC area.

His RCCA colleague Mohammad Pazooki, MD, notes that new evidence and strategies also are enabling cancer specialists to make more-effective use of three therapies that long have been the foundation of CRC treatment. “Surgery, chemotherapy, and radiation continue to play important roles in our management of the disease, and in recent years we have made great strides in identifying which combinations of those treatments – and which sequences of their use  – best serve a patient given the stage and nature of her cancer,” says Dr. Pazooki, who practices with RCCA in West Hartford, CT, and Manchester, CT. He continues that clinical trials are refining strategies for giving chemotherapy before surgery in certain patients and circumstances, to determine when and how radiation is best employed, and to understand how best to use long-established treatments in concert with newer therapies.

“Compared to just a few years ago, we have a greatly expanded ability to draw on different therapies, and various combinations and sequences of therapies, to create truly individualized treatment plans,” says Dr. Pazooki. He adds that this personalized medicine approach is enhanced by growing knowledge of the genetic basis of colorectal cancer. “For example, we now know that in roughly 15% of cases of colorectal cancer – or 1 in 7 patients – the DNA has an impaired ability to repair mismatches in the genetic code, resulting in a condition called microsatellite instability, or MSI. In MSI, there is genetic hypermutability, or a very strong predisposition to mutation, which in turn causes cancer. Immunotherapy can be very effective in the setting of microsatellite instability.”

While close attention to developments at the molecular level help shape treatment decisions, Dr. Pazooki adds that at RCCA, the primary focus remains on the patient’s overall well-being. “Beyond seeing increased survival with colorectal cancer in recent years, we’re also seeing a better quality of life in most patients,” he says.

Julianne W. Childs, DO, a medical oncologist and hematologist practicing with RCCA in Cape May Courthouse, NJ, and Marmora, NJ, says a reduction in treatment side effects plays a big role in this improved quality of life. “Some of the newer therapies we use are better tolerated than chemotherapy. Meanwhile, we have many more resources in out toolbox to prevent the nausea, treat the diarrhea, and manage the blood-count side effects that can accompany chemo,” Dr. Childs notes.

Another factor contributing to improved quality of life, she adds, is that patients with colorectal cancer have more cause for hope today than ever before. Dr. Childs explains that in addition to an expanded array of medications and evolving approaches to using long-standing therapies, promising new strategies are being employed in advanced CRC. “When colon cancer spreads, the liver is one of the most common – and concerning – sites of metastasis. Now, recent research supports a more-aggressive approach to surgical resection – or removal – of multiple metastases to the liver. Additionally, an approach called hepatic arterial infusion that delivers chemotherapy to the liver through its main blood vessel has been shown to increase survival,” notes Dr. Childs.

While the cancer specialist says that the advances of recent years are likely to be exceeded by the progress to be seen in the years just ahead, she stresses that preventing colon cancer needs to remain the primary focus of patient and physician alike.

“A study published in the Journal of the National Cancer Institute two years ago reported a worrisome trend,” Dr. Childs says. “While new cases of colon and rectal cancer in people aged 55 and older have been going down for the past few decades, researchers found that the rate of CRC cases has been increasing in younger adults. From 1974 to 2013, the rate of rectal cancer diagnoses increased by 3.2% annually in people aged 20 to 29. Meanwhile, the rate of new colon cancer cases has gone up between 0.5% a year and 1.3% a year since the mid-1990’s in people aged 40 to 54.”

Dr. Childs adds that obesity, lack of physical exercise, reduced fiber intake, and consumption of red meat all are believed to play a role in the increased CRC rate in younger adults. In addition to changing their lifestyle and dietary habits to address those risk factors, Dr. Childs stressed that most people should have a first colonoscopy at age 45, while those with a family history of colon cancer should have a colonoscopy 10 years before the age at which their relative was diagnosed.

“The good news is that colon cancer is among the most-preventable of cancers, and that people have considerable power to protect themselves based on their habits and, particularly, on having regular colonoscopies,” Dr. Childs says.

The other good news, her RCCA colleague Dr. Bernstein adds, is that while 1 man in 22 and 1 women in 24 will develop CRC, those patients face an increasingly positive outlook. “Colon cancer is not only a treatable disease, but potentially is a curable disease for more and more people,” he says.

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RCCA includes more than 120 physicians supported by over 800 employees at 30 care delivery sites, providing care to more than 24,500 new patients annually and more than 245,000 existing patients. For more information, visit www.RCCA.com.

References

1. American Cancer Society. Key statistics for colorectal cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Accessed June 1, 2019.
2. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017. 109(8): doi: 10.1093/jnci/djw322.
3. Crooke H, Kobayashi M, Mitchell B, et al. Estimating 1- and 5-year relative survival trends in colorectal cancer (CRC) in the United States: 2004 to 2014. J Clin Oncol. 2018;36(4)_suppl:587-587

Colon Cancer by the Numbers

• 101,420 – estimated number of new cases of colon cancer in the U.S. in 2019
• 44,180 – estimated number of new cases of rectal cancer in the U.S. in 2019
• 51,020 – estimated number of deaths from colorectal cancer in U.S. in 2019
• 49% — percentage of men in U.S. who will develop colorectal cancer in their lifetime
• 15% — percentage of women in U.S. who will develop colorectal cancer in their lifetime

Source: American Cancer Society. Key statistics for colorectal cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Accessed June 1, 2019. American Cancer Society. Survival rates for colorectal cancer

5-Year Survival Rates for Colorectal Cancer

The following survival rates are provided by the American Cancer Society, based on information from a database administered by the National Cancer Institute. It is important to remember that these statistics are drawn from the recent past, and may not reflect the impact of the latest advances in diagnosing and treating cancer. Further, every person’s case is different, with overall health and many other factors influencing treatment outcomes. Patients should talk with their physician about their specific situation.

Percentage of patients alive 5 years after receiving a diagnosis

Source:  American Cancer Society. Survival rates for colorectal cancer. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html. Accessed June 1, 2019.

Dr. Bernstein

“Colon cancer is not only a treatable disease, but potentially is a curable disease for more and more people.”

Andrew M. Bernstein, DO

Dr. Pazooki

“Compared to just a few years ago, we have a greatly expanded ability to draw on different therapies, and various combinations and sequences of therapies, to create truly individualized treatment plans.”

Mohammad Pazooki, MD

Dr. Childs

“Colon cancer is among the most-preventable of cancers, and people have considerable power to protect themselves based on their lifestyle habits and, particularly, on having regular colonoscopies.”

Julianne W. Childs, DO