How We Diagnose and Treat Colorectal Cancer with the Latest Techniques

The techniques used to diagnose and treat colorectal cancer have become better each and every year—in fact, many of them didn’t exist or were in early research stages 10 to 20 years ago. As a result, we’re able to diagnose smaller lesions at earlier stages resulting in superior treatments.

Colorectal cancer is a common disease that’s expected to affect about 146,000 Americans in 2019 and occurs when the inner lining of the colon or rectum develops abnormal cells. The most common symptoms that I see in patients with colorectal cancer include:

• Abdominal pain or rectal pain
• Constant urge to use the bathroom
• Mucus, sometimes mixed with blood
• Persistent change in bowel habits, usually lasting more than a few days
• Rectal bleeding

For a number of years, we’ve noticed colorectal cancer rates decrease, likely because of the increase in people undergoing colorectal cancer screenings. However, as overall rates have gone down, the number of cancers diagnosed in young people—from their 20s to 40s—has risen. We’re not entirely sure why this is, but it might have something to do with increasing rates of:

• Drinking alcohol (especially in men)
• Eating processed food and red meats
• Obesity
• Sedentary lifestyles
• Smoking

LISTEN: Dr. Ayscue discusses common techniques to diagnose and treat colorectal cancer in the Medical Intel podcast.

How We Diagnose Colorectal Cancer

We typically diagnose colorectal cancer through fecal tests or a virtual colonoscopy. Fecal tests can include a:

• Fecal occult blood test: This test checks for blood in the stool that’s typically not visible to the naked eye, which can suggest the presence of polyps or cancer. Fecal occult blood tests require some dietary restrictions and multiple stool samples, are relatively affordable, and only are performed annually. Some polyps and cancers are difficult to detect using this method, however, compared to other methods.
• Fecal immunochemical test (FIT): The FIT test screens for blood that comes from the rectum and colon. It’s offered for free through our community program for patients who qualify in certain wards in D.C. And it’s usually covered by insurance for those who do have insurance. The only downside of the FIT test is that it’s not great for smaller polyps.
• Fecal DNA test: This tests for both blood and fecal DNA, is able to detect over 90 percent of colorectal cancer, and can identify more polyps than the FIT test can. One thing to keep in mind is the fecal DNA test, which only is required every three years, is more expensive than other fecal tests if it isn't covered by insurance.

A virtual colonoscopy uses a computerized tomographic (CT) scan to generate images of the colon in the hopes of spotting polyps. A virtual colonoscopy is recommended every five years, can spot up to 94 percent of larger polyps and cancer, and generally requires a bowel prep similar to colonoscopy.

If any of these minimally or less invasive tests are positive, then the patient must undergo a video colonoscopy so that lesions can be biopsied—tested for abnormal tissue or cancer—and possibly removed. A colonoscopy is performed with a small flexible tube called a colonoscope that’s passed through the rectum and into the last part of the small intestine. Using video technology and advanced endoscopic equipment, we both take tissue samples and remove polyps whenever possible.

How We Treat Colorectal Cancer

We typically treat colorectal cancer through minimally invasive techniques, such as laparoscopic surgery, where we remove colon or rectal cancer by placing instruments into the abdomen and then remove the colon through a relatively small incision. In some cases, radiation or chemotherapy is used before or after surgery to treat any possible cancer cells that might have been left behind because they were too small to see.

Additionally, we can use robotic techniques in which the instruments are connected to robotic arms that are controlled by a surgeon, allowing them to have even finer control of the instruments and tissues and get into spaces that otherwise wouldn’t be reached as well.

Recovery typically involves staying at the hospital for one to four days after surgery, and most patients use non-narcotic pain medications only while in the hospital. People typically are on their feet and can eat within a day of surgery.

A Success Story

We saw one woman in her mid-50s who received a FIT test that came back positive. As a result, we did a colonoscopy and identified and removed several polyps. We then performed a robot-assisted colon resection to remove one large polyp that couldn’t be removed with the colonoscope, and this ended up containing precancerous cells. She did well and was home within three days. Had this patient waited another year or two to get screened, she might have had cancer that required more intensive treatment.

Why It’s Important to Get Screened Early

In 2018, the American Cancer Society released new colonoscopy recommendations that adults with average colorectal cancer risk should begin getting colonoscopies at 45 instead of 50, due to the trend we’re seeing of younger people developing colorectal cancer.

If people get screened before they experience any symptoms, we’re more likely to be able to remove any polyps we find, helping prevent cancer from forming. And if we do find a cancer, it’s more likely to be in an early stage—meaning that it’s more curable.

Expert Care at MedStar Washington Hospital Center

We focus on treating colorectal cancer at MedStar Washington Hospital Center, and it starts with our robust screening program in which a nurse navigator helps ensure you receive the right screening. We also have a strong team of gastroenterologists, surgeons, radiologists, and, if needed, cancer treatment doctors who all are dedicated to preventing and treating colorectal cancer with the latest techniques.

Treating colorectal cancer today is much easier than it was years ago. Make sure you receive screenings when they’re recommended to ensure the best possible outcomes.