Beating Colorectal Cancer
Colorectal cancer is the second leading cause of cancer death in the United States. The good news is that it is preventable, and new therapies are extending survival while preserving bowel function. The key is early detection.
Mike Lee of Oak Creek is living proof that finding colorectal cancer early can make all the difference. When Mike experienced rectal bleeding in 2002, his primary care physician referred him to Froedtert & the Medical College of Wisconsin. There, a colonoscopy revealed a small growth in his rectum.
“I got a call on a Friday night from my doctor,” said Mike, who was then 56. “He told me the biopsy was positive for cancer and that he needed me to contact the hospital.”
Mike was soon back at Froedtert & the Medical College to meet with a surgeon. Besides being worried about the cancer, Mike was concerned that damage to his bowels would mean a permanent colostomy. In a colostomy, the large intestine is re-routed to an opening created in the abdomen, where it empties into a bag.
“I was quite distressed at this time,” Mike said. “I am pretty active – I ride a motorcycle and take long trips across the country.” His surgeon immediately put him at ease regarding bowel function. “He said, ‘I know what you are worried about, and I want to tell you that I will take care of that and it’s not going to happen.’”
A Common AnxietyMany people share Mike’s concern. In 2008, more than a quarter of a million Americans will be diagnosed with cancer of the colon, rectum or anus. Only rarely do colon tumors result in a permanent colostomy, but patients with rectal or anal cancer face the real possibility of a significant body change.
Kirk Ludwig, MD, Medical College of Wisconsin colorectal surgeon, is an expert in surgical techniques for preserving the sphincter muscles that enable bowel control. “In the past, surgical decisions were based on how low the tumor was,” he said. “The more modern way of looking at it is not how low, but how deep — if the tumor is not directly involved in the muscle, we try to leave the sphincter and anus intact.”
Nationwide, more than 50 percent of all rectal cancer patients end up with a permanent colostomy. “For patients who see surgeons who specialize in colorectal cancer, however, the rate is about 20 percent,” Dr. Ludwig said. “When you are treated by a specialized colorectal surgeon, you are much more likely to end up with your sphincter intact.”
The smaller the tumor, the better the chance of avoiding a colostomy, so early detection is key.
“Colorectal cancer is preventable with screening through colonoscopy and removal of polyps, which are actually precancerous lesions,” said Thangam Venkatesan, MD, Medical College of Wisconsin gastroenterologist. “If polyps are not removed, they can grow into cancer, so regular screening is important. Screening begins at age 50 for people with average risk, but should begin earlier if there is a family history of cancer.”
During a colonoscopy, which is a outpatient procedure done while a patient is sedated, a physician uses a special instrument to inspect the patient’s large intestines and remove any abnormal growths. Removing a polyp prevents the onset of cancer. In addition, tumors detected by colonoscopy tend to be found earlier than tumors detected by symptoms, and early detection increases the likelihood of achieving a cure.
Extra ConfidenceFortunately for Mike, physicians discovered his cancer at a fairly early stage. “The tumor was into the intestinal wall, but it had not gone outside,” he said. “We caught it at the absolute best time.”
Most patients with rectal cancer receive chemotherapy and radiation to shrink the tumor, then undergo surgery to remove the remaining cancerous tissue. The chemo medication is normally administered through an IV. As Mike geared up for this treatment, a new possibility arose. Stuart Wong, MD, Medical College of Wisconsin medical oncologist, talked to Mike about taking part in a clinical trial for a new pill form of the standard drug. Mike readily agreed.
The chemotherapy phase went well. Mike experienced no nausea, hair loss or extreme fatigue, but he did suffer from painful cracking of the skin in his palms and fingers. “I do a lot of work on the computer, so I wore finger cots to try to get through,” he said. At the same time, Mike received radiation therapy daily for five and a half weeks. Because the process went smoothly, other than time needed for treatment and recovery, he was able to maintain his usual work schedule.
The surgery took place in June 2002. True to his surgeon’s word, Mike came through with no need for a permanent colostomy.
Afterward, Mike went back on the chemo regimen. Because of liver contraindications, he was eventually taken off the medication, but he recommends the clinical trial experience. “It gave me a lot of confidence because you are scrutinized so closely,” he said. “Also, being in a clinical trial made me feel I was a part of something that was a benefit to the people coming after me.”
Better Therapies, Longer SurvivalClinical research is improving treatments and survival rates for all colorectal cancers. According to Paul Ritch, MD, Medical College of Wisconsin medical oncologist, 10 years ago only one drug was available for colon cancer. “Now, there are six new drugs,” he said. “That includes three chemotherapy drugs and three new targeted agents.” In recent years, these drugs have doubled the median survival rate for patients with advanced colon cancer. “A lot of excitement lies in the possibility of continuing to incrementally add to that survival rate.” Dr. Ritch is beginning a clinical trial investigating a promising new drug that may further improve survival for patients with advanced colon cancer. “New drugs that are effective against advanced disease are also being tested in combination with other therapies – after surgical removal of the tumor, to prevent relapse and to increase the cure rate for earlier disease,” he said. “Results are encouraging.”
Surgical techniques have also improved. Dr. Ludwig said a major recent advance is the development of minimally invasive techniques for removing colon tumors. Using laparoscopic instruments, specially trained surgeons now perform the surgery through a few small incisions. Recovery time is reduced significantly. Dr. Ludwig performs hundreds of laparoscopic colon surgeries every year, and he teaches the procedure to physicians across the country.
Radiation therapy has also moved forward. According to Beth Erickson, MD, Medical College of Wisconsin radiation oncologist, radiation coupled with chemotherapy is capable of curing most cases of anal cancer. For these patients, intensity modulated radiation therapy systems (IMRT) – like the unique TomoTherapy® unit available at Froedtert & the Medical College – help decrease the impact of radiation on healthy tissues and organs. “We can vary the intensity of radiation, which reduces the amount of skin breakdown and diarrhea patients may experience,” she said.
Dr. Erickson and her colleagues are now taking part in a national clinical trial studying whether IMRT can reduce side effects for patients with rectal cancer. “The wonderful thing about being at an academic medical center is that you can participate in nationwide efforts that try to define the best therapies.”
Team Approach to CareAt the new Froedtert & the Medical College Clinical Cancer Center, physicians who specialize in surgery, medical oncology (chemotherapy), radiation oncology and other disciplines work in teams that are dedicated to specific cancers. “By focusing our attention on just one or two disease sites, we have special expertise to bring to our patients,” Dr. Erickson said. “We find out what works and offer the best care for specific kinds of cancer.”
Dr. Ludwig, who joined the Clinical Cancer Center in early 2008 after practicing for 12 years at Duke University, believes the team approach benefits patients. “Cancer treatment is no longer ‘one patient, one doctor’ – so it’s a good idea to group physicians by disease and give patients one contact for the whole team,” he said.
According to Mike Lee, the physicians at Froedtert & the Medical College provide more than advanced cancer care. “All through the process, it was a very personal relationship, not just clinical. They cared about me as a person.”
Mike passed his five-year milestone in 2007. “It is six years since the surgery, and the doctors tell me I’m good to go,” he said. “My chances of this particular cancer recurring are pretty slim.”
He said he has nothing but good memories of the physicians and staff at Froedtert & the Medical College. “I felt very well cared for and completely confident in putting myself in their hands,” he said. “I wouldn’t consider going anywhere else.”
Learn MoreJoin Dr. Ludwig at his Nov. 3 class to learn more about colorectal cancer and treatment. Dr. Ludwig will discuss screening strategies, minimally invasive surgeries, new treatments for rectal tumors that optimize survival and preserve function, as well as new chemotherapy and surgical approaches. To register, call 414-805-3666.
Source: Froedtert Today
Date: August 2008