Local doctors: New therapies are helping to battle colorectal cancer

Promising new therapies as well as new tools for early diagnosis are making the fight against colon and rectal cancer, commonly known as colorectal cancer, a bit more manageable, two local cancer specialists say.

Robert Whorf, M.D., of Florida Cancer Specialists & Research Institute in Bradenton and Mark S. Friedman, M.D., of Moffitt Cancer Center in Tampa, both say they are gaining ground in some areas, but still challenged in others in the fight against the disease — the third most common cause of cancer death in the United States, according to the American Cancer Society.

March is Colorectal Cancer Awareness Month.

“Are we winning? Yes and no,” Friedman said last week. “There are many studies that show that Americans are still poor about colon screening. There are 135,000 new cases of colon cancer each year in the U.S. and 50,000 are dying yearly from it. But we have definitely seen a decline related to early detection.”

At the root of colon cancer are polyps that form on the inner walls of the large intestine that can begin to grow into malignant colon cancers over time if they are not removed during a cancer screening, called a colonoscopy, Friedman said.

Colonscopies are recommended for those age 50 and repeated every 10 years if nothing is found and three to five years if polyps are found.

During the colonoscopy, a flexible tube with a camera on one end is placed through the rectum to look for polyps on the inside lining of the colon.

If any polyps are found, a doctor like Friedman, who is a gastrointestinal oncologist who also treats the liver, pancreas and other organs, can snip them out and send them to be tested.

“The colonoscopy is still the gold standard for screening,” Friedman said.

There are now colon cancer test kits that consumers can purchase and use at home. The user sends a fecal sample to a lab for testing.

Friedman said he welcomes the fecal kits into the fight against cancer, but they should be used in combination with the colonoscopy.

“The fecal kits are fairly good at detecting colon cancer through analyzing DNA strands in the stool,” Friedman said. “The problem is they don’t detect things that aren’t cancer that we are still concerned about, like the progression of polyps. These kits don’t detect polyps. We want to get the polyp before it becomes cancer, which the kit doesn’t help us do.”

A myth about getting a colonoscopy is that the preparation is miserable, Friedman said.

“The night before the patient takes a bowel prep that cleans them out, which used to be of a large volume and salty,” Friedman said. “But, nowadays, we use multi-formulations that are lower volume and more palatable.

“There are myths about colonoscopies that have been debunked,” Friedman added. “It’s painless. The patients are sleeping and it’s an out-patient procedure that takes about 20 minutes. Some fear it because of the Michael Jackson drug. We do administer propofol, but it is administered by an anesthesiologist who carefully monitors heart beat, blood pressure and other patient vital signs.”

New treatments for cancer

The gold standards to treat cancer in the colon are still chemotherapy, which calls on chemicals to kill cancerous cells; radiation, which kills cancer cells by exposing them to high-energy rays; and surgery, where all or part of the colon is removed, Whorf said.

But there are now adaptations to these three.

“There’s exciting research going on,” Whorf said. “There are newer surgical techniques whereby even large tumors may be removed through smaller incisions, aiding in quicker recovery time.”

For advanced cases of colon cancer beyond the strength of traditional chemotherapy, doctors are now using targeted drug therapy, which combines new drugs with the standard chemotherapy as well as immune-based therapy that stimulates the body itself to fight the cancer, Whorf said.

“Targeted drug therapy can prevent tumors from growing new blood vessels,” Friedman said. “These are medications that target a specific area of the tumor, whereas standard chemotherapy drugs target the individual cells.”

Immunotherapy uses a drug that stimulates one’s own immune system to kill cancer cells.

“They rev up your own immune system,” Friedman added.

Even radiation has an adaptation.

“We can now provide radiation directly into blood vessels to kill the cancer cell without harming the surrounding area,” Friedman said.

Both doctors say they can’t stress enough the importance of a colonoscopy — especially for patients who have certain symptoms.

“A change in bowel habits, rectal bleeding, non-specific abdominal pain, unexplained weight loss, anemia or low blood counts are all signs that it might be a colon problem,” Friedman said.

Colon on display

In honor of National Colorectal Cancer Awareness Month, Manatee Memorial Hospital has teamed up with the American Cancer Society to provide a giant walk-through colon in the hospital’s main lobby from 6 a.m. to 6 p.m. daily through Friday. Information will be available daily to help educate the community and staff on how important screenings are for colorectal cancer.

The giant colon is being provided by a grant from the American Cancer Society. It measures 10 feet long, 12 feet high and 12 feet wide and weighs 125 pounds. A representative from the American Cancer Society and the hospital will take attendees on a personal tour. Everyone will be able to see what a normal colon tissue looks like compared to diseased tissue. Various stages of diseases will be shown including: Crohn’s disease, polyp, a malignant polyp, colon cancer and advanced colon cancer.

This story was originally published March 27, 2017 at 2:53 PM with the headline "Local doctors: New therapies are helping to battle colorectal cancer."