Colorectal Cancer Fact Sheet

Colorectal Cancer

• According the American Cancer Society “Cancer Facts and Figures 2014”, colorectal cancer is still the second leading cause of cancer related deaths, more than prostate and breast cancer. It is estimated that 137,000 US citizens will develop colorectal cancer in 2014 with a total of 50,310 deaths. Breast cancer will kill 40,340 women and men, while prostate cancer will kill 29,480 men. The risk increases with age as 90% of colorectal cancer was diagnosed in patients 50 years old or older. (https://www.cancer.org/acs/groups/content/@research/documents/document/acspc-041770.pdf)

• Prevention
  • Colonoscopy with removal of polyps was shown to decrease the death of colorectal cancer by 53%.¹ (https://www.nejm.org/doi/full/10.1056/NEJMoa1100370) (https://www.cancer.gov/ncicancerbulletin/030612/page5)
  • Not all endoscopists are equal and if the endoscopist is not well trained, polyps and cancers can be missed. Adenoma detection rate is an indicator of the quality of the endoscopist and if the doctor has an adenoma detection rate in men of 25% and in women 15% than he/she is a good endoscopist. Techniques used to improve adenoma detection include:
    • slow removal of the scope (equal or greater than 6 minutes) and spending more time evaluating the proximal colon;
    • looking behind colonic folds;
    • use of irrigation to clean poorly prepped areas;
    • and better distension of the colon ² (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099297/).
• Obesity is linked to many cancers including colorectal cancer
  • “Results from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) show that 68 percent of U.S. adults age 20 years and older are overweight or obese. In 1988-1994, by contrast, only 56 percent of adults age 20 and older were overweight or obese.” (https://www.cancer.gov/cancertopics/factsheet/Risk/obesity)
  • Fat cells produce hormones linked to cancer, proteins (adipokines) that can stimulate or inhibit cell growth. Obesity increases insulin resistance which is associated with higher levels of insulin and insulin-like growth factor-one which may promote the development of certain tumors. Obesity is associated with chronic inflammation which is linked to organ damage and cancer. (https://www.cancer.gov/cancertopics/factsheet/Risk/obesity)

• Factors which can be modified to lower the risk of colorectal cancer include:
  • diets low in red or processed meat and saturated fats;
  • diets high in fruits, vegetables and unsaturated fats (https://www.cancer.org/acs/groups/content/@research/documents/document/acspc-041770.pdf);
  • and increased exercise with at least three days of 30 minutes or more of exercise.
• Treatment
  • Treatment for colorectal cancer includes surgery with or without chemoradiation therapy depending on the stage of the tumor and the location. Colon cancer does not warrant radiation therapy, only surgery and chemotherapy if necessary. Rectal cancer is staged first, prior to surgery, and if the cancer is thought to be at a higher stage pre-operative chemoradiation therapy is performed, followed by surgery and then more chemotherapy. (https://www.cancer.org/acs/groups/content/@research/documents/document/acspc-041770.pdf)
• Prognosis
  • For early stage cancer, prognosis or survival with surgery is 90%. Unfortunately due to lower than normal screening rates for colorectal cancer only 40% of colorectal cancers are detected early. Therefore “The one- and five-year relative survival rates for people with colorectal cancer are 83% and 65%, respectively. (https://www.cancer.org/acs/groups/content/@research/documents/document/acspc-041770.pdf)

References:

1. Zauber, AG. Winawer, SJ. O’Brien JM. Colonoscopic Colectomy and Long-Term Prevention of Colorectal Cancer Death. NEJM 2012;366:687-696
2. Coe, S, Wallace, M Flat Polyps: Endoscopic Detection and Treatment. Practical Gastroenterology 2012: 49-55.