March is the national Colorectal Cancer Awareness Month and this year marks the 20th Anniversary since being officially recognized in the US. Colorectal cancer is the third leading cause of cancer-related deaths in the US and is the most common cause of cancer death in men younger than 50. The incidence is rising in young people. 1 in 5 colorectal cancer patients are 20 to 54 years old. A recent study showed that 51% of people age 50 to 54 have not had a colonoscopy. Awareness of the risks and promoting screening are vital for prevention.
Exercise, a healthy diet, and a biodiverse gut microbiome are all important factors in colorectal cancer prevention. Exercise reduces the risk of developing many types of cancer, including distal colon cancer by 23%. The gut microbiome is an area of intense research. Foods or supplements that increase the gut microbiome such as fiber, whole grains, fruits and vegetables have been shown to reduce the risk of colorectal cancer. Foods that decrease gut microbiome diversity, such as processed meat and sugar increase the risk of colorectal cancer. Probiotics provide a high dose of a few types of bacteria and decrease the biodiversity of the gut microbiome. While we have no proof that the use of probiotics increases the risk of colorectal cancer, we should use caution with these supplements in at-risk patients.
Chemotherapy after surgery: Less is more
After surgery for newly diagnosed colon cancer, approximately 20 % of patients will have spread of cancer to 1-3 lymph nodes (Stage IIIA). Recent studies have shown that giving 3 months of chemotherapy is just as effective as 6 months with fewer side effects. Most notably, neuropathy is less severe and more reversible. The quality of life during and after treatment has greatly improved for patients Stage IIIA disease without compromising good outcomes.
Chemotherapy for Stage IV disease. More is better for right-sided colon cancer
The standard chemotherapy for Stage IV disease has been FOLFOX (3 chemotherapy drugs 5-FU, leucovorin, and oxaliplatin) combined with a biologic agent bevacizumab. Recent studies have shown patients with right-sided colon cancer who develop stage IV disease have shorter survival and are more likely to have an inherited predisposition such as Lynch Syndrome. Using a 4-drug chemotherapy combination (FOLFOXIRI) with bevacizumab increases survival over the 3-drug combination in patients with right-sided disease. The right colon is derived from the midgut and the left colon comes from the hindgut. This embryologic difference may lead to differences in the biology of the disease. Patients with Stage IV right-sided colon cancer require more intense chemotherapy
Targeted therapy for Stage IV disease: chemotherapy-free regimen for BRAF mutated colon cancer
All patients with colorectal cancer must have genomic testing done on their tumor specimens. BRAF mutations occur in roughly 10% of all colorectal cancer. The combination of the targeted therapy cetuximab and the oral BRAF inhibitor encorafenib is effective and prolongs survival. This chemotherapy-free regimen is an example of effective treatment with a better quality of life.
So now that we are all aware that exercise prevents cancer, I invite you to join us at the annual “Get Your Rear In Gear” 5K Race on Saturday March 28 at Independence Park, at the corner of Hawthorne Lane & 7th Street. Oncology Specialists of Charlotte (OSC) has sponsored this event for many years since the inception 11 years ago. Every year OSC nominates a patient ambassador. Our team has been the largest team for several of these years with up to 200 runners/walkers. This year our patient ambassador is a father/husband diagnosed with stage IV colon cancer at the age of 39. Join our team and come out to this event. Our team is “It’s Miller Time!” found online at www.coloncancercoalition.org