Better prognosis in colon cancer

For these treatments with medicines, the patient goes to the medical oncologist, such as professor Kees Punt, medical oncologist at the UMC St Radboud in Nijmegen. His area of ​​interest is cancer of the gastrointestinal tract and in particular colorectal cancer (colorectal carcinoma). He tells more about this disease, its origin and its treatment.

How do you know something is wrong?
“People often have abdominal pain, sometimes in combination with a changed defecation pattern. They go to the toilet more, or less often, and the composition of the stool is different. Blood loss in the stool is a very specific signal and you really have to go to the doctor.”

“You can see from the color of the stool where something is wrong: if there is bright red blood, it is low in the intestines. If the stool is black, then the condition is higher. Fortunately, not all complaints also directly mean that you have a tumor. These kinds of complaints have more causes and other factors also play a role in colorectal cancer.”

As?
“Age, for example. Colon cancer mainly occurs at a later age. More than 90 percent of cases occur after the age of 50. Heredity plays only a small role.”

“Polyps are often the preliminary stage of colorectal cancer; if there are many polyps, the risk of malignant degeneration is greater. In short: the risk of colorectal cancer with a changed stool pattern is greater in a 60-year-old than in a 30-year-old .”

Does diet play a role?
Of course. There is a clear relationship between the development of (bowel) cancer, diet and culture. The typical dietary patterns play a role in this. In the western world, colorectal cancer is common, while stomach cancer is much more common in Japan.”

“Japanese who have emigrated and adopt a Western diet, on the other hand, get colon cancer more often. In Japan, for example, people eat much more salty fish and that may be an explanation for the higher number of stomach cancer patients. In the West we eat more junk food and there are many more overweight people.”

“You can therefore encourage the development of disorders with your diet, and you run a greater risk with a poor diet. Conversely, you cannot say that a good diet can completely prevent you from getting cancer. say that diet can exert a beneficial effect on a once-existing cancer.”

Can colon cancer be treated?
“Yes, it is treatable, but the question is: what is the outcome? To determine that, it is very important at what stage the cancer is discovered, and especially whether there are metastases.”

“Without metastases in other organs, there is about a 50 percent chance that the disease will disappear after surgical removal. The other 50 percent will get the disease back. We can treat a small part of it surgically again with a chance of a cure.”

“For the most part, palliative drug treatment is the only option. The goal of palliative treatment is to prolong life and/or maintain or improve quality of life.”

What treatments are there?
“With cancer in the colon, you can remove a (large) piece of the intestine. If the tumor is in the rectum (rectum), it is technically more difficult to remove the tumor in its entirety. This makes a local rectal tumor nowadays pre-irradiated, which reduces the chance of local recurrence of the disease.”

“If there are metastases in no more than one organ, we will look at whether it is possible to remove it. If this is successful, post-treatment with chemotherapy gives the best chance of long-term survival.”

“Calculation is no longer possible in the group of people whose metastases cannot be removed. However, the results of treatment with drugs have improved in recent years.”

What kind of treatment is that?
“The backbone of that therapy is chemotherapy. Three of these have been proven effective in colon cancer. A recent Dutch study by the Dutch Colorectal Cancer Group (DCCG), the CAIRO study, found that if you combine these agents, survival is no better than if you administer them sequentially.”

“Sequential administration means for the patient that the side effects per treatment are somewhat less. In addition, a new class of cancer drugs has been introduced, the ‘targeted’ therapy. This therapy inhibits the specific signals that are important for the growth of cancer cells.”

“An example of this is a drug that inhibits the new formation of blood vessels in the tumor. In combination with chemotherapy, this is now the standard treatment for metastatic colon cancer.”

What is the prognosis?
“Twenty years ago there was virtually no effective therapy for metastatic colorectal cancer and half of the patients died within 7 to 8 months. With the application of the latest therapies, this limit has been pushed to almost two years.”

“Another way to look at the results is the percentage of patients who are alive 1 year after being diagnosed with metastatic disease. Without treatment, this was about 35 percent, and today it’s 75 percent.”

“As more and more new drugs become available, there is hope for more gains, but good clinical research remains necessary. A good example is the recent Dutch CAIRO2 study, in which the addition of a 2nd ‘targeted’ therapy to the standard treatment of chemotherapy (plus one ‘targeted’ drug). To everyone’s surprise, this addition was found to result in worse survival.”

How do you view alternative medicine?
“There has never been any scientific evidence that alternative therapies, nutritional supplements, diets or extra vitamins help. In fact, there is evidence that these types of supplements, such as vitamin C, can counteract the effect of chemotherapy.”

“All these alternative therapies play on the desperation that understandably lives in many patients. But a cancer patient does not deserve to be fooled.”

What are the expectations for the future?
“There are developments in many areas. It is slowly but surely becoming clear that people over 55 should be screened. There are two methods for this: checking the stool for traces of blood or an endoscopy of the colon.”

“Such a population screening has to be set up properly, because it has quite a few consequences with regard to capacity and therefore costs. Ultimately, a screening method must be easy to implement and reliable.”

“Other developments include more insights into the heredity of colorectal cancer, which makes it easier to detect, technical advances in surgical methods, which allow better removal of metastases, and, as mentioned, new drugs that can improve the prognosis of patients.”