Expert advice for better colorectal cancer prevention and detection
Did you know that obesity and a sedentary lifestyle combined are the second leading cause of cancer after tobacco use? According to Khalid Matin, M.D., F.A.C.P., a medical oncologist specializing in the treatment of colorectal cancer at VCU Massey Cancer Center, lifesyle factors such as diet and exercise play an important role in preventing most cancers, especially colon and rectal cancers, which together are the second leading cause of cancer-related deaths in the U.S.
Matin suggests eating a diet high in fiber and vegetables and limiting consumption of processed or red meat to no more than once a week, if possible. Recently, the World Health Organization (WHO) classified processed meat as a carcinogen (a substance that causes cancer) and warned that red meat is a probable carcinogen. Processed meat is a meat that has gone through a chemical process to increase its shelf life, examples are smoked meats, jerky and hot dogs.
“While processed meats won’t cause cancer immediately, the evidence shows that eating it regularly does add up and place people at a greater risk for colorectal cancer,” says Matin. “I urge people to substitute red meat for white meat, such as chicken, and fish. And if they do eat red meat, it should be fresh and processed as little as possible.” He mentions that it is especially important for young children who are still growing to get a head start on these types of eating habits because their bodies are not yet fully developed.
In Virginia, only about 65 percent of eligible adults follow the recommended colorectal cancer screening guidelines. VCU Massey is joining the National Colorectal Cancer Roundtable in advocating for a screening rate of 80 percent by 2018.
According to the Centers for Disease Control and Prevention, men and women should begin regular screening starting at age 50, as follows:
- High-sensitivity fecal immunochemical test (FIT), which checks for hidden blood in stool samples, should be done every year.
- Flexible sigmoidoscopy, where physicians use a flexible, lighted tube (sigmoidoscope) to look at the interior walls of the rectum and part of the colon, should be done every five years with FIT every year.
- Colonoscopy, where physicians use a flexible, lighted tube (colonoscope) to look at the interior walls of the rectum and the entire colon, should be done every 10 years. During this procedure, samples of tissue may be collected for closer examination, or polyps may be removed. Colonoscopies can be used as screening tests or as follow-up diagnostic tools when the results of another screening test are positive.
Those at higher risk for colorectal cancer should talk to their primary care doctor about beginning screenings sooner or having them performed more frequently. People who are at greater risk for colorectal cancer include those who have a family history of first-degree relatives with colorectal cancer; symptoms such as blood in the stool, change in bowel habits, weight loss, constipation or abdominal discomfort; prior radiation to the abdomen; and/or a personal or family history of inflammatory bowel conditions or ulcerative colitis.
There have been advancements in colorectal cancer screenings. Fecal immunochemical test (FIT) recently replaced fecal occult blood testing (FOBT), as it only detects blood from the lower intestine and is generally more reliable than FOBT. Additionally, the FDA has now approved stool DNA testing, which checks for genetic changes that are sometimes found in colorectal cancer cells. This test is meant for people who do not wish to undergo the usual preparation required for a colonoscopy; however, if the results are abnormal, often a colonoscopy is required for an accurate diagnosis.
For those who have been diagnosed with colorectal cancer, most will undergo surgery to remove the tumor, and they may also receive chemotherapy and/or radiation before or after surgery. Matin stresses the importance of a second opinion and understanding the difference between cancer care providers. “Academic medical centers typically perform more surgeries and treat more complex cancers, and patients often have better outcomes as a result. Also, surgeons at academic medical centers often specialize in one type of surgery instead of general surgery.
“Additionally, academic medical centers may offer clinical trials that aren’t available at community providers. For example, Massey has a clinical trial examining shortened neo-adjuvant (before surgery) radiation treatments. The trial reduces radiation treatments from five weeks of daily radiation to just five days of radiation at higher dose rates. This not only saves patients time by not having to travel to treatment as often, it also allows patients to get to surgery faster.” Massey also has clinical trials for patients with advanced colorectal cancer, using novel therapies that have been developed in collaboration with our scientists at VCU.
Matin also recommends that patients take advantage of local resources available to help them and their caregivers. In addition to information on its website, Massey has a variety of support services available to patients, hosts support groups as well as workshops on a variety of health-related topics, and also partners to provide community resource centers in Danville, Lawrenceville and Petersburg.