Latest / Flourish- A Prisma Health Podcast / Your Guide to Colorectal Cancer: Detection, Treatment, and Hope

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Your Guide to Colorectal Cancer: Detection, Treatment, and Hope · Flourish- A Prisma Health Podcast

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  Scott Webb: Today I'm joined by Dr.
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  Ien Rupp, colorectal surgeon with Prisma Health, and she's
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  here to discuss colorectal cancer detection treatment and hope.
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  Scott Webb (Host): This is Flourish, the podcast brought to you by Prisma Health.
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  I'm Scott Webb.
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  Scott Webb: Doctor, it's nice to have your time today.
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  We're gonna talk, colorectal cancer detection, treatment, and hope most
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  importantly, before we get there though, what does it mean if we
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  find a polyp during a colonoscopy?
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  And is that the same thing as a tumor?
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  Dr. Irena Rupp:
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  a polyp is an abnormal growth in the colon, but when we look
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  at it And we remove it during colonoscopy, vast majority of these
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  are going to not, be a cancer.
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  A good portion of them will be a type of tissue that can eventually
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  evolve into a cancer, given enough time And the right environment.
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  The vast majority of them are not a cancer.
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  In fact, of all the screening colonoscopies we do, we find
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  a cancer 1% of the time.
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  So.
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  Polyps are actually quite common.
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  We find polyps on about 50% of vocal colonoscopies that we do.
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  And of those, a good portion will be pre-cancerous, isn't have a potential
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  to develop into a cancer, but we either remove them or they potentially n
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  necessarily progress to that stage.
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  Scott Webb: for sure.
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  Dr. Irena Rupp:
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  Tumor on the other hand, generally implies that there is a large, mass.
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  So can it be a polyp?
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  It can be a polyp, but kind of a very, very large one where just taking it out
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  with, a colonoscopy, is not necessarily, always of an option due to sheer size.
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  The tumor can be synonymous with a very large polyp.
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  It can also be synonymous with cancer.
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  Scott Webb: Okay.
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  Yeah, and I think you kind of covered this, but I wanted to
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  make sure we underscore this.
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  How often is colon cancer found during a regular screening?
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  Dr. Irena Rupp:
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  Less than 1% of the time providing that the screening is true screening
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  exam, And the patient is asymptomatic.
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  So we're not having abdominal pain, we're not having bleeding.
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  We don't have any major family history that put its elevated risk, no bowel habit
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  changes, and no positive fit or Cologuard test that led to the colonoscopy.
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  If any of those preexisting conditions are there, the chance of there being
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  something found, either a polyp or an actual cancer is gonna be
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  higher, but again, very, very low.
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  Scott Webb: low.
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  Very low.
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  Yeah.
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  So then what happens, doctor, if colon cancer is found?
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  Dr. Irena Rupp:
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  So then, the first thing that happens is identification and biopsy.
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  Colon cancer is the most common cancer to happen in colon, but it's not the
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  only one, so it's very, very important.
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  When we diagnose, you know, a mass that looks like a cancer And the
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  colon that we biopsied and confirm that it's actually colon cancer.
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  There are several other types such as neuroendocrine tumors, GSTs
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  and rest, sarcomas and lymphomas.
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  That can also happen in the colon, And the treatment for
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  them is going to be different.
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  The second thing that happens once we confirm that This is true colon cancer,
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  is staging and staging to be simply put.
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  How far along is this?
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  , And it uses several radiology modalities.
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  Most commonly a CT scan of the chest, abdomen, pelvis to determine has the
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  tumor really just stayed in the colon or has it gone to any other organs, which
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  again, guide our treatment and management.
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  So once we get the staging accomplished, then we can talk
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  about the plan of treatment.
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  The tumors confined to the colon and has not spread anywhere else than the main,
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  upfront treatment for That is surgery.
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  Scott Webb: wondering, doctor, about the stages of cancer.
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  I hear about stages when it comes to any kind of cancer.
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  Are there different stages for colon cancer and if so, how is the staging done?
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  Dr. Irena Rupp:
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  So staging, for colon cancer upfront at diagnosis is
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  With the CT scan to make sure that it is not, an advanced disease.
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  So we are ruling out.
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  Stage four disease, which would mean the tumor might have gone
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  to other organs and therefore the treatment upfront may not be surgery.
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  If That is not the case, then we are up against either stage one, two, or three.
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  The difference between stage one and two is the depth of invasion
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  of the tumor into the colon wall.
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  And stage three generally means the tumor has gone to lymph nodes, so
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  tissue that carries, lymph away from the colon and into the central circulation.
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  All of those tumors, stage one, two, and three get staged actually after surgery,
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  after we excise it, And the pathologist is able to evaluate the tumor depth
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  of invasion as well as lymph nodes.
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  Scott Webb: sure, yeah.
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  And I'm sure there's a range here, as you say, there's different stages,
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  obviously, but generally speaking, and maybe broadly speaking, doctor,
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  how is colon cancer typically treated?
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  Dr. Irena Rupp:
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  If we are catching it in a process where it has not spread to other
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  organs, the upfront treatment of colon cancer is typically surgery.
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  Surgical resection of the tumor.
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  That will allow us to then specifically determine the stage
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  and design any further treatments that may or may not be necessary.
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  We also evaluate molecular markers of the tumor, so the kind of chemicals the tumor
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  produces that make it more susceptible to certain medications versus other's.
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  Colon cancer believe and now is about 20 different diseases, if not more.
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  So it's actually very important for us to know some of those molecular profile
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  of the tumor to guide for the treatment.
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  Scott Webb: Yeah.
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  Wondering, I know that often with cancer, the C the big C is often
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  referenced, But when I think of the this, I think about the word cured.
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  And I'm wondering, doctor, I, is that a thing?
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  Can colon cancer be completely cured?
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  Is that possible?
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  Dr. Irena Rupp:
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  Yes.
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  So if we look at, SEER database, which is, run by the government And that looks
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  at survival rates for the last five years and it's an a rolling five-year basis,
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  65% of all diagnosis of colon cancer will survive five years and achieve a cure.
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  So 65% of all of those who get diagnosed with colon cancer
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  will survive five years plus.
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  And that's actually a wonderful result And we are improving on
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  that result every time we reassess.
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  So that number has, if anything, has gone up and up and up over the years.
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  So cure is absolutely possible, particularly.
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  Cure is extremely possible when we're talking about lower stage colon cancer.
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  So stage one, two, or three where the tumor has not gone to any other organs
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  and has stayed either in the colon wall or colon wall and lymph nodes.
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  Once the tumor has gone to other organs, the cure is much more difficult
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  to achieve because you then are talking about medical and surgical
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  intervention on multiple organs.
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  In a lot of cases That is still possible and there is possibility of cures in
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  some situations, but it is not widespread and survival goes down substantially
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  in the stage four disease where the tumor has spread to other organs.
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  Scott Webb: right will.
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  Some folks need a colostomy bag after colon cancer, doctor
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  Dr. Irena Rupp:
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  in certain situations That is a possibility.
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  Usually when we are talking about kind of acute situation
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  where somebody's very, very sick.
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  The tumor has caused a bowel perforation.
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  So there's a hole and there are stool leaking into the abdomen, And
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  the patient is really too sick to be tolerating reconstruction at that point.
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  In other situations, the tumor can cause, , obstruction, so a
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  blockage to the point that, again, you're getting very, very sick.
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  , And we have to remove it and do things quite expediently, to save a life.
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  A lot of those, ostomies, whether they're colostomies or temporarily
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  ileostomies, can be reversed.
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  And a lot of the times they do get reversed.
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  A lot of that reversal is really up to how well are we doing with
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  the rest of disease control?
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  What are our other underlying morbidities?
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  Heart, lung, liver, kidneys, and are we able to tolerate a second operation?
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  Scott Webb: of course.
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  Doctor, are there any signs or symptoms that colon cancer has spread for folks
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  and I, I guess it makes me wonder, you know, for somebody who maybe
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  was in stage one and is advancing through the stages, like how fast does
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  colon cancer spread or can it spread
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  Dr. Irena Rupp:
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  That's a very good question.
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  Colon cancer actually is a, interesting process because it has a varying behavior.
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  So depending on the type of mutations that led to the tumor being there, it
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  can actually be indolent and there for years, or it can spread very, very fast.
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  So not all colon cancers are created equal.
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  There are some very small tumors that can spread fast, and there are
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  some very large ones that never do.
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  So the behavior of it is, is very different.
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  How do you know that It's sort of what can be some of the
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  signs that it's progressing?
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  It can be very subtle.
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  And I'll be honest, a lot of the times when we see patient's who
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  have progressive disease, they don't necessarily have a whole lot of
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  symptoms, that are acute or severe.
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  That would tip us off that This is happening.
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  Some of these things get found out on incidental scans for other
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  conditions or other concerns.
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  Some of the common signs that we notice are.
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  Just generalized a feeling unwell, particularly feeling very tired, weak,
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  dizzy, irregular bowel movements were previously, that was not the case.
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  More abdominal pain, weight loss, that's not explained and
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  not, , due to diet or medication changes, abdominal or rectal pain.
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  Particularly once that's persistent and not just a episodic and goes away.
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  Scott Webb: right, not just a, you know, well my stomach kind of hurts
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  today, but it's, some of these, you say that it's, it's persistent.
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  Give you a chance.
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  Doctor, I really appreciate your expertise today.
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  Talk about any advancements on the horizon that you're aware of when it comes to
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  colon cancer screening or treatment.
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  you mentioned about the survival rate, how it just keeps going up, which is
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  just, you know, great news and brought a smile to my face, but anything else?
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  Dr. Irena Rupp:
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  Yeah.
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  So a couple of things worth mentioning about colon cancer is that it is shifting
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  to be the disease of younger adults.
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  Currently it is the number one cause of cancer death for both
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  men and women under the age of 50.
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  So if you think about that, that's the population that generally is,
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  has a pretty low mortality overall, but that's the number one cause
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  of death for adults, less than 50.
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  So, it is shifting to be a disease of younger adults And the fact that mortality
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  and, prognosis is getting better, that's.
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  Based on the fact that we are screening and doing a pretty good job with older
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  adults, but we are not doing well enough with younger adults because a
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  lot of them are potentially under the screening age, which is currently 45.
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  And younger adults are increasing at about 3% per year in incidence of
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  colorectal cancer in this country.
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  So This is kind of the, big, gap where we are not screening, these
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  patient's because they're not yet coming due for a standard screening.
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  We're doing very well with the adults for screening.
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  What are the screening modalities?
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  So there are a number, There are several, stool-based tests, and
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  some of those can be done at home.
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  One of them is Cologuard.
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  It has an excellent, sensitivity, so ability to detect colon cancer.
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  I will say that it also has a 8% false negative rate.
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  Which one must always remember that that's not zero.
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  It also has a false positive rate of 13%, meaning comes back abnormal,
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  but there's actually nothing found.
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  There's also a fit test that's fecal immunohisto skull test, and That
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  is, also a very good sensitivity, a bit less than Cologuard, along
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  the lines of, you know, 73 to 93%.
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  But both of those tests, are not as good for detection of adenoma,
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  a type of polyp that, you know, ultimately develops into colon cancer.
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  Both of those tests are along the lines of 40, maybe up to 50% for adenoma detection.
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  So they're very good for cancer.
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  They're a little bit, under PPAR for adenoma, And for that colonoscopy
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  still remains the gold standard of care for both removal and detection.,
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  Of adenomas and, colon cancers.
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  There are additional things on the horizon.
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  As far as screening for colorectal cancers, there are a number of companies
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  in the world that are working on blood tests for, and not just colon
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  cancer, but a multitude of cancers.
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  Some of Those are FDA approved.
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  The unfortunate thing about those tests is that although
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  they are easy to do, they're.
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  Ability to pick up colon cancer, especially at early
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  stages, is still quite poor.
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  So substantially less, you know, viable alternative to a stool test or the
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  gold standard, which is colonoscopy.
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  I will also say that those that have symptoms have inflammatory bowel disease,
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  have family history of colon cancer, should really have a colonoscopy as the
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  screening exam because of its ability to,
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  detect adenomas, which ultimately can lead to cancer faster in those circumstances.
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  Where a stool-based study or a blood-based study will often not detect pre-cancerous
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  lesions and may give a false sense of security that things are well.
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  But family history is particularly one where colonoscopy, should be
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  favored over a stool-based study.
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  Scott Webb: Right?
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  Yeah.
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  And as you say, it remains the gold standard for now, , for a reason, and
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  you've given us some of the reasons today.
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  So appreciate your time and your expertise.
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  Thanks so much.
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  Dr. Irena Rupp:
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  Thank you.
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  Host: For more information and other podcasts just like this one, head on
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  over to prismahealth.org/flourish.
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  This has been Flourish, a podcast brought to you by Prisma Health.
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  I'm Scott Webb.
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  Stay well.