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Physicians Update


Physicians Update

Fall 2010

Screening, Improved Technology Contribute to Decline in Colorectal Cancer Morbidity and Mortality


PU Fall 2010-Colorectal CancerColorectal cancer is the third most commonly diagnosed cancer among men and women, but the incidence and mortality rates from the disease have dropped substantially in the past two decades. Improved screening practices, in addition to more sophisticated treatment technologies, are key to changing the landscape, experts say.

“Mortality rates are down nearly 30 percent, which suggests we’re finding the cancer at an earlier stage, rather than an advanced stage,” says UCLA gastroenterologist Bennett Roth, M.D. “Like other cancers, early detection is associated with reduced mortality. Unlike most other cancers, appropriate screening can also help to prevent colorectal cancer before it advances.”

Experts believe that colorectal cancers start as benign polyps that can be detected and removed before they progress to cancer, which is why they emphasize the importance of screening according to appropriate guidelines, even in asymptomatic patients. General U.S. Preventive Task Force colorectal cancer screening guidelines recommend fecal occult blood testing (FOBT) every year, and flexible sigmoidoscopy every five years or colonoscopy every 10 years for men and women aged 50 to 75 years with average risk for developing colorectal cancer. These guidelines may vary based on family history of the disease and personal history of the disease or precancerous polyps.

“People with first-degree relatives who have had colorectal cancer or polyps should begin screening before age 50,” Dr. Roth says. “Additionally, the number, size and histology of polyps found during a colonoscopy, as well as other factors, influence the recommended intervals for future surveillance.”

While differences in the effective colorectal cancer screening technologies are still being investigated, the relatively inexpensive and noninvasive FOBT has been shown to reduce colorectal cancer deaths by up to 33 percent. Flexible sigmoidoscopy and colonoscopy are considered more effective than FOBT in detecting precancerous and cancerous growths and also allow physicians to see inflamed tissue, abnormal growths and ulcers. These tests, however, are invasive. Virtual colonoscopy, or computed tomographic (CT) colonography, is a newer, noninvasive method for visualizing the colon, but it is premature to replace virtual with conventional colonoscopy, Dr. Roth says.

“A problem with CT colonography is that the ability to find lesions 6–9mm in size is perhaps no better than 60 percent, so there will be polyps that are missed,” he explains. “Those are usually benign, but they may harbor advanced histology. More importantly, missed polyps may result in the patient receiving only routine future screening, which could mean they are not screened again for another five to 10 years.” Conventional colonoscopy is associated with a much lower chance (approximately 1 percent) of cancer developing after a negative colonoscopy, Dr. Roth says.

PU Fall 2010-Colorectal Screening“The bottom line is that we have to look very carefully to make sure we’ve gotten a good view of the colon,” he says. New light technologies and endoscopic microscopy have enhanced the ability to see and remove polyps at time of procedure, he adds.

A new, noninvasive test that looks specifically for mutations in DNA in stool samples is still being evaluated for its effectiveness in detecting colorectal cancer, Dr. Roth says.

“Surgery is the patient’s best chance for a cure, and we’re now able to effectively perform colon surgeries laparoscopically, which facilitates faster recovery, reduced trauma and less pain,” says UCLA colorectal surgeon James Yoo, M.D. “In terms of oncologic resection, lymph node retrieval, adequacy of resection and outcomes, we get the same results whether we operate using a laparoscopic or open technique.”

Dr. Yoo also emphasizes the importance of collaborating with other colorectal cancer specialists to provide integrated, multidisciplinary care. He is spearheading the establishment of a new colorectal cancer treatment center at UCLA, with the goal of coordinating multidisciplinary care for colorectal cancer patients.

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