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Treating Colorectal Cancer from All Angles

March 31, 2020

Brano Djenic, M.D., colorectal surgeon at Texas Oncology Surgical Specialists–San Antonio Downtown discusses treatments for all colorectal cancer stages.

Oftentimes the early symptoms of colon cancer are things like weight loss or changes in bowel habits that can be easily attributed to variations in dietary habits. Early in my career, the colorectal screening guidelines changed from being recommended at 50 to 45 years of age. In a single week, I saw five patients under the age of 40 – four in one single day – with wide ranges of newly diagnosed colorectal cancer stages – from early and operable to metastatic and inoperable. It’s this experience and witnessing firsthand the increase in rates of colon cancer in young adults that makes me more aggressive with screening patients, because colorectal cancer is very treatable when caught in time.

When people get screened according to the guidelines, we tend to find either pre-cancerous lesions or early cancerous lesions that are much easier to treat. Due to the colon’s flexible and long shape, it can accommodate a large amount of tumor before people feel more specific signs of colorectal cancer, which include rectal bleeding, obstruction, vomiting, and changes in stools. The most common symptom of colon cancer is change from a person’s usual bowel habits. As expected, those with symptoms at the time of diagnosis tend to have more advanced tumors while those diagnosed through a screening colonoscopy can catch the disease in earlier stages for more favorable outcomes. With quick diagnostic work and treatment plans intended to leave them disease-free, most colorectal cancer patients do very well. 

Treating Colorectal Cancers at Every Stage

For colon cancer, surgery and chemotherapy are the two primary treatment options. At stages I and II, surgery for colon cancer is often performed alone. As the stages advance to III, a combination of chemotherapy and surgery are used, especially if the patient has more aggressive features of the cancer determined by examining the cancer under a microscope. Stage IV disease is at times treated with surgery, but chemotherapy is the only recommended treatment that aims to prolong the life of a patient.

Though similar in some ways to colon cancer, rectal cancer can be treated with radiation as well as surgery and chemotherapy. Shorter course radiation treatments may be newer options for patients, and new biologic drugs and immunotherapy agents are also under review and may soon become part of the standard treatment. 

Surgical Advances for Treating Colorectal Cancers

Today, surgical advancements have made it possible for colorectal surgeons to treat patients with less disruption to their daily lives. For example, minimally invasive techniques like laparoscopy or robotic surgery, which are done through small incisions in the abdomen, can help patients recover more quickly and experience better quality of life. This may include ewer needs for permanent colostomy bags after surgery, also due to better techniques and improved non-surgical therapies like chemotherapy and radiation.

Beyond Surgery to Precision Medicine for Colorectal Cancers

There are new, promising immunotherapies and chemotherapy agents for treating more advanced cancers or specific sub-types of cancer on the horizon. Surgery may be avoided in certain cases, and radiation may not be needed for as long as we have thought. Instead of treating colorectal cancers in a generic way, precision medicine is starting to identify targets that we can use to attack the disease with fewer side effects, less toxicity, and hopefully better survival.

Instead of treating colorectal cancers in a generic way, precision medicine is starting to identify targets that we can use to attack the disease with fewer side effects, less toxicity, and hopefully better survival.”

Even more so, precision medicine is helping us gather the insights we need to develop new drugs so that we may be able to change the way we treat colorectal cancer patients as well as the quality of their survivorship. It is a very busy but exciting time in the world of colorectal cancer.

For upcoming webinars visit www.TexasOncologyFoundation.org.