By Dr. Gerard Fumo
Hartford HealthCare Cancer Institute
Colorectal cancer is one of the most preventable cancers if precancerous growths are removed during a colonoscopy. In part, because of the advances in screening, detecting and removal of early cancers, we have seen a steady decline in the overall incidence of colorectal cancer by approximately 2 percent per year.
Colorectal cancer remains the third-most common cancer in the United States with approximately 140,000 new cases diagnosed each year. There also has been a steady rise of approximately 2 percent per year in the incidence in younger people (less than 50 years of age). Although most guidelines have not changed their recommendations on screening, this observation has led to at least one organization, the American Cancer Society, to change their recommended screening age from 50 to 45.
The unsettling trend in incidence further underscores the need to understand cancer survivorship because colorectal cancer affects more people over a wide spectrum of ages. When people are diagnosed with colorectal cancer, undeniably, their life will change. As defined by the National Coalition for Cancer Survivorship and the National Cancer Institute, this is when cancer survivorship starts, immediately after the diagnosis.
At the Hartford Healthcare Cancer Institute, we partner with our patients, guiding them and helping them rebuild their lives. Patients experience fear of the unknown and, soon after, the reality of what they are about to face. The journey then involves active treatment and ultimately continues throughout the remainder of a cancer survivor’s lifetime. Although there are different ways to define the phases of survivorship, regardless of the definitions, it is clear that it is a continuous journey and each phase greatly affects the next. At the initial phase, it’s important to educate, guide and provide support from an entire oncology team that not only includes care providers but also navigation, social, dietary and spiritual services.
Many methods are involved in the active treatment phase of colorectal cancer. Each can impact a survivor’s outcome and quality of life. At the Cancer Institute, our gastroenterologist and surgeons are using the least invasive techniques, such as endoscopic or laparoscopic resections to achieve the best outcomes with the least morbidity and quickest recoveries.
For example, strategies, both operative and non-operative, are evolving to decrease the chance of permanent ostomy bags. Meticulous radiation planning and techniques help limit injury to normal pelvic structures and prevent nerve damage. Selective use of chemotherapy decreases side effects and the potential for permanent neuropathy. Advances in supportive care medications provide the real opportunity to carry on normal daily activities throughout the course of the therapy phase.
Yet despite every best effort, there are many lasting effects of cancer therapy. An ostomy bag may be an obvious lifestyle change. Others may experience ongoing fatigue, psychosocial distress, body image distress or sexual dysfunction. Some may say that this next, “extended or permanent phase” of the journey is “life after cancer.” This phrase can potentially be interpreted as a defining point in one’s life.
Rather, I’d like to think that life will continue to be defined by the individual. There are currently well over 1 million colorectal cancer survivors in the United States. The oncology community encourages all survivors to embrace a survivorship program and be proactive about their health and well-being. Once treatment is completed, a survivorship care plan will outline diagnosis, stage, therapy, appropriate surveillance and long-term monitoring.
A care plan will also account for genetic information and modifiable risk factors. Survivors can take control of their own lives by continuing the education process and pursuing appropriate resources, diet, exercise and behaviors. The Hartford HealthCare Cancer Institute is dedicated to providing the necessary resources for all our colorectal cancer survivors on an ongoing basis.
Dr. Gerard Fumo is the physician lead of the gastrointestinal disease management team at Hartford Healthcare Cancer Institute. For more information about colorectal cancer, click here.