Written By: Eliana Maia-Goldstein and Kenneth Dandurand
Edited By: Zemen Habtemariam and Kenneth Dandurand
In light of March being colorectal cancer awareness month, it’s important to raise community awareness about the disease and consider the prevention steps you can take.
What Exactly Is Colorectal Cancer?
Colorectal cancer is defined as an atypical, uncontrolled growth of cells in the colon or rectum. Once this growth has started, it can continue through the wall of the colon, into nearby tissues and, if left untreated, can eventually spread to other organs throughout the body.2 In the early phases, colorectal cancer usually presents with no symptoms, which is why early, and routine preventative testing is so essential to avoiding negative outcomes 2 As the cancer progresses you may experience various signs and symptoms (see Table 1). These range from a change in bowel habits, or constipation or diarrhea lasting more than a few days to cramping or pain in the lower abdomen, bleeding from the rectum, or blood in the stool after a bowel movement, along with other associated symptoms.2
The American Cancer Society estimates in 2022 there will be 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer in the United States.1 Furthermore, CDC statistics estimate, as of 2018, there are 141,074 cases of colon and rectal cancer3. While this seems significant, the overall rates of colorectal cancer have been decreasing by an average of 1% per year. This is largely attributed to the increase in screening and lifestyle modifications. The lifetime risk of developing colorectal cancer is about 4.3% in men and 4% in women.1 In terms of associated deaths, it is the second leading cause of cancer-related deaths in women and the third leading cause of respective deaths in men1. It is estimated to cause a combined projected 52,580 deaths in 20221. The risk factors associated with an increased prevalence of developing colorectal cancer are increasing age, unhealthy diet, obesity, alcohol consumption, and smoking. In addition, certain racial minorities tend to be more at risk of exhibiting it; these include Non-Hispanic Black/African Americans, American Indians, and Alaskan Natives.2 Correctable lifestyle factors (e.g., obesity, exercise, and smoking) is recommended to be corrected to help lower your lifetime risk. A patient who lives a healthy lifestyle has a 27-52% lower risk of colorectal cancer as compared to those without.1 People also may not think to consider family history. A familial history of colorectal cancer carries significant risk; as a result, screening recommendations can vary for these types of patients.
How Do I Know if I Have Colorectal Cancer?
Routine screening is the best method available for the prevention or early detection of colorectal cancer due to its slow growing nature2. The current American Cancer Society screening recommendations are that all adults aged 45 and older undergo screening until the age of 753. If a patient is 76-85 years of age the decision to be screened regularly should be based on life expectancy, overall health, personal preferences, and prior screening history. Over the age of 85 screening is no longer recommended2. There are multiple options in terms of screening (see Table 2), including options with visual examinations (colonoscopies) performed at a health care facility or high-sensitivity stool tests which can be done from home. Visual exams require laxatives before the procedure as well as the need to undergo anesthesia and can be less tolerable than home stool tests 4. The benefit, however, is that you can wait up to 10 years between colonoscopies which is the longest screening interval of any method3. Using a stool test (for example: gFOBT, FIT, Cologuard) involves screening the stool for blood that comes from tumors3. These tests are less invasive and carry less risk but need to be repeated annually with the exception of Cologuard which can be repeated every 3 years. If any results are abnormal, it must be followed up with a colonoscopy to confirm.4
What Do Treatment Options for Colorectal Cancer Look Like?
To briefly go over treatment, many agents are available based on the severity of the disease and the location of the tumor.5,6 If a patient has colon cancer that is well localized, they will likely undergo surgery to remove the tumor and no further treatment may be needed 5. However, if the tumor has invaded nearby tissue and began to spread to other parts of the body it is more likely to come back even after tumor removal so additional treatment with chemotherapy agents such as fluorouracil, oxaliplatin, or vascular endothelial growth factor inhibitors5. For rectal cancer, surgery is usually the mainstay of therapy followed by a course of radiation or chemotherapy to prevent recurrence of disease6. The chemotherapy used in rectal cancer is similar to that used in colon cancer5
The prognosis for colorectal cancer is promising but mixed. The overall 5-year survival rate for all forms of colon and rectal cancer are 64 and 67 percent, respectively. However, the same survival rate for specifically localized forms of those cancers are over 90 percent in both cases7. This tells us that patients have the best odds of survival and recovery when the cancer is detected early, before it has spread across the body at all.
In summary, colorectal cancer is an easily preventable cancer due to the slow growing nature of the tumors and the numerous screening options available to patients. It is strongly recommended to routinely keep up with screening and discuss with your health care provider all risks and benefits present.
References:
“As FDA Narrows Use of New Alzheimer’s Drug, Providers Proceed With Caution.” Claire Wolters. VeryWellHealth, July 9, 2021, https://www.verywellhealth.com/fda-narrows-use-alzheimers-drug-aduhelm-5192029
FDA Grants Accelerated Approval for Alzheimer’s Drug. Jun 7, 2021. News Release. Available from: https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-drug
“FDA Adviser Who Stepped down over Alzheimer's Drug Approval Says There's No ‘Good Evidence That It Works.’” CBS News, CBS Interactive, 21 June 2021, www.cbsnews.com/news/fda-adviser-alzheimers-drug-aduhelm/.
Full Prescribing Information. Aduhelm [Package insert]. Biogen. 2021. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761178s000lbl.pdf
“Major health centers, insurers push back against Ad helm.” Jacob Bell. BioPharma Dive, 15 July 2021, https://www.biopharmadive.com/news/biogen-aduhelm-cleveland-clinic-sinai-insurers/603392/
“Alzheimer's Disease Fact Sheet.” National Institute on Aging, National Institute on Aging, U.S. Department of Health and Human Services, 8 July 2021, www.nia.nih.gov/health/alzheimers-disease-fact-sheet.
About the Author
Eliana Maia-Goldstein, PharmD, written in conjunction with professional rotation at Clinical Pharmacy Associates, Inc.
Eliana is a current fourth year pharmacy student at the University of Maryland School of Pharmacy expected to graduate in May of 2022. She is currently enrolled in a dual degree program, pursuing both a Doctor of Pharmacy (PharmD) as well as Masters in Pharmacometrics. After completion of pharmacy school, she will be completing a fellowship at Rutgers University in conjunction with Daiichi Sankyo in quantitative clinical pharmacology. Her professional interests include population based pharmacokinetic/pharmacodynamic modeling, biostatistics, and clinical pharmacology trial design. She has no other current professional affiliations at this time. Outside of work, her hobbies include baking, spending time with family, and painting.
Zemen Habtemariam, PharmD
Zemen Habtemariam
Pharmacy Practice Fellow for Clinical Pharmacy Associates
Dr. Zemen Habtemariam, PharmD, is a Pharmacy Practice Fellow for Clinical Pharmacy Associates. He received his B.S. in Chemistry from University of Maryland, College Park and received his Doctor of Pharmacy degree from the University of Maryland School of Pharmacy. He serves as the Pharmacy Practice Research Fellow for Clinical Pharmacy Associates, Inc. He has had broad range of pharmacist experience in community, managed care, and clinical trial settings. He has previously served as the Pharmacist of Record on multiple investigational drug trials. He also assisted in coordinating transitions of care for atypical antipsychotic patients for the Maryland Medicaid Peer Review Program, and conducted comprehensive medication reviews for Spanish-speaking patients for AdhereHealth
Kenneth Dandurand, RPh, MS
Co-Founder and CEO of Clinical Pharmacy Associates, Inc. and Co-Founder and President of MedNovations, Inc. Board Member Asperger/Autism Network
Ken is an ASHP residency trained clinical pharmacist with a BS from Northeastern University and a Master’s from Oregon State University. As an entrepreneur and researcher for 35 years he co-founded Clinical Pharmacy Associates and MedNovations successful leaders in providing direct pharmaceutical care via tele-pharmacy. He is dedicated to improving the delivery of medication therapy management to consumers. To that end, Ken has authored a chapter in the Book “Misadventures in Health Care: Inside Stories” titled “Prescription for Error.”