The Latest in Colorectal Cancer Care
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Colorectal cancer is a leading cause of cancer deaths in the U.S. As a surgical oncologist, I’ve seen how screening saves lives. When we find colorectal cancer early, treatment is often simpler and outcomes are better.
In addition to proven screening strategies, advanced treatment approaches are making a difference for patients. From screening through treatment, here are some important things to know about today’s colorectal cancer care.
Screening is still crucial—and it starts earlier
One of the most important changes in recent years is that the recommended screening age has moved from 50 to 45 (and even earlier for those at high risk). That’s because colorectal cancer is being diagnosed more frequently in younger adults. We don’t know exactly why that is, but it may be related to diet and other lifestyle factors.
The gold standard screening test is still colonoscopy. It doesn’t just detect cancer; it can find and remove precancerous polyps before they turn into cancer. If your colonoscopy is normal, you may not need another for 10 years.
Advanced stool DNA testing is easy—but not for everyone
At-home stool DNA testing continues to evolve. Newer versions aim to detect more cancers while also reducing false positives. The test, done every three years, checks for abnormal DNA and blood in the stool. In recent years, the test has become available to people ages 45 and up.
Stool testing is incredibly accessible—you can order a test kit and have it mailed to your home. But not everyone qualifies for it. In some situations, a colonoscopy is the right test. And if your stool test is positive, we typically recommend a follow-up colonoscopy.
I also want to emphasize this: If you have symptoms—such as rectal bleeding, changes in bowel habits, stools that are thinner than usual, or persistent abdominal discomfort—don’t brush them off as “just hemorrhoids” or “just your diet.” If you have symptoms like these, you need a diagnostic evaluation—often a colonoscopy—rather than a screening test.
Virtual colonoscopy is helpful in some situations
This test, also called a CT colonography, is sometimes considered an alternative to colonoscopy. But it isn’t a test I’d recommend unless your provider specifically suggests it.
As I tell my patients, it’s not as glamorous as it sounds. You have to do a bowel prep that can be even more intensive than a traditional colonoscopy prep. And if the scan shows something concerning, you still need a colonoscopy for further evaluation.
That said, virtual colonoscopy can be useful for people who:
- Cannot safely undergo anesthesia because of severe heart or lung disease or a prior adverse reaction.
- Had an incomplete colonoscopy because the scope couldn’t pass through, even with a good bowel prep.
Advanced biomarker testing helps match treatment to the tumor
Once someone is diagnosed with colorectal cancer, we routinely test the tumor for certain markers that can help us assess whether a cancer might be linked to an inherited syndrome. In addition, we can use more advanced tests to look for specific gene or protein changes in the tumor. This testing can help guide which treatment options might work best. For example, it can clarify options if a first treatment isn’t effective—or whether a patient may qualify for a clinical trial that targets a specific biomarker.
In academic cancer centers like Fox Chase Cancer Center, biomarker testing is fairly standard for determining treatment options from the start. And if you’re starting chemotherapy, it’s something you may want to discuss with your treatment team.
Robotic-assisted surgery enhances precision
Treatment of most colorectal cancers still involves surgery to remove the section of the bowel where the cancer is located. The trend has moved toward minimally invasive surgery, which uses small incisions and a camera to see inside the body. More recently, we’ve expanded the use of robotic-assisted colorectal surgery for many of these procedures.
Robotic technology has wrist-like instruments for precise movements in tight spaces deep within the pelvis, which can help us remove the cancer completely while protecting nearby structures. And the high-definition cameras have a zoom function, so we can see very clearly—sometimes even better than with traditional open surgery.
As I tell my patients, the robotic platform can make complex colorectal surgery more controlled. When we have more control in the operating room, it can translate to a safer, more precise operation.
Also, the incisions are smaller than with traditional surgery. So there’s less postoperative pain, and patients often recover faster.
With any colorectal surgery, we want to avoid an anastomotic leak, where the surgical connection between bowel sections fails. In my experience and with help from the robotic platform, the leak rate for my patients has been very low.
And it’s worth noting that I see patients and operate with the robotic-assisted system at the Fox Chase Cancer Center–Chestnut Hill location, too.
One thing I clarify for my patients: The robot does not operate independently. I control its movements, and we have a whole team in the operating room to assist me.
A hepatic artery infusion pump can help treat metastatic colorectal cancer
The liver is the most common place for colorectal cancer to spread. We often treat liver metastases with surgery, radiation, and chemotherapy. For some patients with multiple tumors—or for whom traditional treatments no longer work—a hepatic artery infusion pump can be a good option. This implanted device delivers chemotherapy directly into the arteries that supply the liver.
At Fox Chase, we have an active clinical trial evaluating this approach for people with metastatic colorectal cancer. I often collaborate with my colleague Jason Castellanos, MD, MS, FACS, a liver surgeon. I remove the primary tumor in the colon while he places the pump into the liver. Patients then receive chemotherapy through the pump after they have recovered.
The advantage of the pump? It delivers chemotherapy where it’s needed most, and it can reduce side effects that come from chemotherapy circulating throughout the body. The pump is only available at select centers with expertise in this technology.
Comprehensive colorectal cancer care
At Fox Chase, we care for the full spectrum of colorectal cancer, from early-stage tumors to advanced metastatic disease, where clinical trials may be an option. We treat everything in between, using the latest approaches and a personalized plan. In other words, our team brings together the expertise and resources to help you get the most effective care and support.
To make an appointment with a Fox Chase provider, please call 888-369-2427 or schedule an appointment online.
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