![](https://www.plusonline.nl/sites/plusonline/files/styles/pol_carousel/public/istock-865952342.jpg?itok=Nmh3aGM9)
Colon cancer population screening
Partly thanks to the bowel cancer screening programme, the number of bowel cancer patients appears to be decreasing. And there is more good news.
Colon cancer is one of the most common cancers. In the Netherlands, about 14,000 new patients are added every year (colon cancer or rectal cancer). But there is good news, knows Miriam Koopman, internist-oncologist at UMC Utrecht and professor of Medical Oncology at Utrecht University. “The number of colon cancer patients is decreasing for the first time. This is partly due to the national screening,” she explains. “Since 2014, all Dutch people between the ages of 55 and 75 have been invited in phases to participate in the population screening, also known as the poop test. Colon cancer is relatively most common in this age group. The participants have to put some stool in a tube and put it in the post. The stool is examined in a laboratory. Fortunately, most of the results are negative. By that I mean that nothing is found, that there is no blood in the stool.”
View research
If blood is demonstrated for a participant in the population screening, he or she will be informed. “The next step”, says Koopman, “is a colonoscopy or visual examination. This examination can tell more about what is causing the blood in the stool. If there is a tumor, it is about how far the disease has progressed. The stage of discovery makes a huge difference to how further treatment will proceed.” According to her, that is also the biggest advantage of the national screening. “Normally you don’t notice that you have colon cancer. You only notice it when you get symptoms and unfortunately it is often too late. Then the cancer is too far advanced to be treated properly. It is precisely to prevent this danger that we have introduced the population screening. And given the downward trend that seems to have started, that research is already bearing fruit.”
Treatment options
The good news is that there are more and more treatment options. These do not work equally well for every type of colon cancer. Koopman: “In practice, we make a distinction between a number of types of colon cancer, based on, among other things, the location in the intestine where the tumor is located. With more research we are expected to be able to distinguish many more types of colon cancer. With this we hope to offer every patient a tailor-made therapy. After all, you want a patient to be helped and not to have to deal with all kinds of unwanted side effects unnecessarily.”
For the largest group of patients – in whom colon cancer is detected at an early stage – the choice is simple. “Surgery is the first choice. In most cases, the surgeon can remove the colon tumor completely. Healing is therefore the goal.” If the tumor is slightly deeper in the intestinal wall, the operation is supplemented with chemotherapy. “The problem with this is that only two out of ten patients actually benefit from that chemotherapy. In three out of ten it doesn’t work and in five out of ten, that is half, the tumor would not have come back even without the chemo.”
Two different drugs are usually used: oxaliplatin and capecitabine. Both drugs have their side effects. In addition to the usual stomach and intestinal complaints and diarrhea, an infusion with oxaliplatin causes tingling in the hands and feet, especially when it is cold. According to Koopman, patients complain about ‘a numbness’. “They can keep that feeling for the rest of their lives. Of course you don’t want that, especially if the drug doesn’t help. So we need to do a lot more research in order to be able to determine in advance whether a patient actually needs the drug and how likely it is that it will work.”
Decision aid
For patients with metastases, the chance of a cure is not too great, according to Koopmans. Only if there are few metastases, there is a chance that surgery or local treatment will still be of benefit. In most patients with metastases, the goal of treatment is to stabilize the disease and allow patients to live as long as possible and/or to provide the highest possible quality of life. Again, there are all kinds of treatment options, no fewer than seven different ones. For example, there are four different types of chemotherapy. For a small group (5 percent) with a specific tumor characteristic, it seems that immunotherapy also works well.
In addition, other treatments are possible for some patients. “For example, we can inject a few radioactive spheres into the body via a blood vessel in the groin,” says Koopman. “We are doing a lot of research into this method, which we call radio embolization, here at UMC Utrecht. We deliver the globules very specifically to the metastases in the liver, with the aim that the cancer cells will die and the healthy liver cells are spared as much as possible.” However, it is not easy to determine in advance which patient will respond best to a treatment or combination of treatments. To help patients make their choice, Koopman and her colleagues have developed an online decision aid. Here are some short questions. The patient can also read back the various treatment options with associated schedules and side effects. A personal treatment plan is then drawn up in consultation with the doctor.
Unnecessary side effects
According to Koopman, much more research is needed. For example, too little is known about how it is possible that a certain treatment works well for one patient and not for another. “We would prefer to know that before the treatment. And there’s a lot more we don’t understand. Cancer is a complicated disease that is not the same for everyone.” Partly for this reason, together with a few others, she founded the website Samen against bowel cancer in March last year. “Doctors, researchers and patients can learn from each other. We especially need a lot of information from the patients about their illness and treatment, but also tissue with certain characteristics and blood. This type of research requires the consent of the patient.” There is now a database with the data of thousands of patients. “Of course without being traceable to a specific person,” she emphasizes. “We can learn new things from this, which ultimately lead to better treatment methods, tailored to individual patients.” The future, she expects, will be tailor-made treatment. “I hope that we will soon be able to give patients a course of chemotherapy or a combination of courses that will certainly benefit them. Side effects may always remain, but it would be nice if we could keep unnecessary side effects to a minimum.”
Reducing risk
Finally, does Koopman have any advice to prevent colon cancer? Colon cancer, she explains, is like other cancers caused by various mistakes in our DNA. According to her, there are no recommendations to specifically prevent colon cancer. There are ways to reduce the risk. “My advice is above all that you should live healthy. By that I mean don’t smoke and don’t drink too much. Also try to get enough exercise.” In addition, a healthy diet is important. “You can safely eat meat, and even red meat, but in moderation. According to recent research, daily fiber intake may slightly lower the risk of colon cancer. Grain products such as wholemeal bread and brown rice, but also vegetables, fruit, legumes and nuts have a positive effect on digestion.”
Figures and facts colon cancer research
The risk of developing colon cancer at some point in your life is 4 to 5 percent. 9 out of 10 cases occur in people 55 years of age or older. About 5,000 people die of colon cancer every year. This death rate is expected to decrease with the bowel cancer screening programme. Everyone aged 55 to 75 receives an invitation every two years to participate in the bowel cancer screening programme. Last year, 1,411,998 (72.7 percent of those invited) people participated in the population screening. 71,632 people (5.1 percent of the participants) had an unfavorable test result (stains of blood in the stool). 59,321 people underwent a follow-up examination. Colon cancer was subsequently discovered in 4203. Polyps, possible precursors of colon cancer, were removed from 23,220 participants. Removing precursors prevents colon cancer from developing. If colon cancer is detected early, the treatment is more likely to be successful. The treatment is often also less strenuous. But not all polyps lead to colon cancer. So it may not be necessary to remove polyps. Furthermore, the stool test does not provide 100 percent certainty. So there is a chance that you will get a favorable result even though colon cancer is indeed present. The stool test detected 85 percent of participants who have colon cancer in the first round. That is why everyone with a favorable stool test result is invited again two years later. Participating more often gives more certainty about the result.
This article previously appeared in Plus Magazine February 2019. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!
Sources):
- Plus Magazine