Actor’s death from colorectal cancer a sign of a troubling trend
The recent death of actor James Van Der Beek from colorectal cancer at the age of 48 has once again brought attention to a troubling trend in the United States. Colorectal cancer is now the leading cause of cancer deaths in Americans under the age of 50. This is occurring even as cancer survival rates have climbed significantly in recent years.
Medical oncologist Edward Wyluda, DO, at the Davenport-Mugar Cancer Center at Cape Cod Hospital said that he and his colleague, medical oncologist Peter Ward, MD, have both noticed more younger patients being diagnosed with advanced colorectal cancer.
Because of that trend, the national guidelines have changed, Dr. Wyluda said. The guidelines used to be for all patients to have a screening colonoscopy at age 50. Now the guidelines recommend screening at age 45.
Researchers are at a loss to explain why younger people are being diagnosed with colorectal cancer at higher rates. Smoking and drinking alcohol are known to increase the risk for a lot of malignancies, Dr. Wyluda said. He added that at this time, most likely more of these patients have an inherited genetic mutation that may be contributing to having colorectal cancer at a younger age. Diet (processed meat), alcohol, tobacco, and a more sedentary lifestyle may also be playing a role.
“For most malignancies there are things we can see that can increase the risks, but a lot of times we don’t know why it happens,” he said.
Pay Attention to Symptoms
One of the strongest symptoms of colorectal cancer is blood in the stools. Many patients may dismiss this symptom as hemorrhoids, which can be a deadly mistake. The presence of blood in the stool should always be checked as a potential colorectal cancer. Sometimes patients don’t notice actual blood, but a dark stool is a possible clue that blood is present, he said.
Dr. Wyluda listed the other possible symptoms of colorectal cancer:
- Unexplained weight loss
- Changes in appetite
- Abdominal pain
- Changes in bowel habits and constipation
- Abdominal distension
- Lower blood count
- Developing iron deficiency and worsening anemia
"If these are persistent symptoms that are ongoing for months to years, there is a higher chance is going to spread to other areas, too."
Treatment Even in Advanced Stages
Dr. Wyluda correctly guessed that Van Der Beek was initially diagnosed with an advanced cancer where it is more difficult to get a cure – but not impossible.
“A lot of cancers that are stage 4 are not curable, but with colon cancer we do have some options still for cure,” he said. “We have patients where maybe the cancer started in the colon, but then it spread to the liver or even to the lungs. If these lesions are not significant, sometimes what we can do is start them off with systemic therapy, chemotherapy, and, if we’re getting a response, they could be candidates for possibly a partial liver resection or a partial lung resection and still possibly get to a remission.”
If the cancer has spread throughout the abdomen and pelvis with numerous lesions on one or more organs, it’s not curable. But in other cases, treatment with immunotherapy can help. It’s not common but if a tumor tests MSI-High, it could respond very well to immunotherapy, he said.
"I've had a patient with advanced colorectal cancer spread to the liver with MSI-High testing,” Dr. Wyluda said. “We put the patient on just immunotherapy and they had an excellent response to the point where we weren’t seeing any disease. So, there are these special cases where we see an advanced colorectal malignancy respond completely to just immunotherapy alone without any chemotherapy. They are not common, but we do have cases like that."
Colonoscopy and Communication With Primary Care
The standard of care to prevent colorectal cancer is a colonoscopy. If a polyp is found, it is removed so it doesn’t progress to a malignant stage. Both polyps and tumors are biopsied. If a tumor is found, doctors will do imaging to ensure that it hasn’t spread to other sites. They then go on to do surgery to remove the tumor.
During the surgery, the surgeon will also check the lymph nodes, Dr. Wyluda said. The cancer is staged based on size, grade, and lymph node involvement, as well as other factors Those things tell the team whether there would be any benefit to using some kind of chemotherapy afterwards to bring down the risk of recurrence.
It’s important to let your primary care physician know if you have a family history of colorectal cancer because you would qualify for colonoscopy before the age of 45, he said.
The most important take-away is the importance of colonoscopies, he said. While there are other stool tests that check for blood, they aren’t as effective as a colonoscopy. If blood is detected using one of those tests, the patient would still need a colonoscopy.
“That’s going to be the definitive way to really know,” Dr. Wyluda said. “CT scans do not always pick up findings inside the intestines, therefore direct visualization with colonoscopy is the gold standard for screening."
