By Parker Lynch
In a recent study conducted in Canada, 5,026 patients with colorectal cancer (CRC, all younger than 50) were evaluated between 2007 and 2018. This study evaluated the time between a patient’s first presentation with CRC and their treatment initiation. The overall objective of this study was to determine if a longer time from presentation to treatment start would result in worse survival rates for CRC patients, particularly those under 50.
Relation Between Treatment Start and Disease Outcome
The median age of the participants was 44 years, with about an equal number of males and females:
- 25.2% overall had metastatic disease
- 31.2% had rectal cancer
The lower-urgency subset consisted of 2,548 patients. Patients with metastatic CRC had shorter median (IQR) overall intervals (83 days) compared with those with less advanced disease. Five-year overall survival was 69.8%. Overall intervals longer than 18 weeks were not associated with significantly worse overall survival (OS) or cancer specific survival (CSS) compared with those waiting 12 to 18 weeks. Additional analysis by the researcher where patients were stratified by stage of disease did not show significantly worse OS or CSS with increasing overall interval lengths.
One would expect the findings to support that a later treatment start would result in worse outcomes for the patient. In other words, starting treatment as soon as possible would yield the best prognosis for patients. However, this study found something quite different: time from presentation to treatment was not associated with advanced disease or poor survival. This finding insinuates that a patient has a little bit of “leeway” in terms of the time it takes for them to begin their actual treatment, without having to worry that this delay will correspond to decreased survival.
Another Study With a Different Perspective
In another study, the administrative time of adjuvant chemotherapy following a curative surgical procedure for stage 3 CRC was evaluated. Specifically, researchers wanted to determine if there was a so-called “sweet spot” for when a patient should begin chemotherapy to maximize their chances of survival.
In this study, 159 patients with stage III CRC, who had undergone a curative resection, were enrolled. Patients were categorized into 3 groups representing different timings to initiate chemotherapy treatments:
- less than 2 weeks (group 1)
- 3 to 4 weeks (group 2)
- more than 5 weeks (group 3)
The OS and relapse-free survival rate (RFS) were analyzed to evaluate the effectiveness of adjuvant chemotherapy. The 5-year OS was:
- 73.7% in group 1
- 67.0% in group 2
- 55.2% in group 3
The 5-year RFS was:
- 48.8% in group 1
- 64.7% in group 2
- 57.1% in group 3
When specifically considering CRC patients who have undergone resection procedures, it was loosely determined that chemotherapy should be administered 6-8 weeks after one undergoes an operation. However, the administration prior to the 6-week mark didn’t result in a statistical difference in outcomes.
This, however, should not encourage patients to “wait out” their cancer; rather, that time should still be spent on interactions with providers to come up with a treatment plan. CRC, on average, takes around two years before it metastasizes to other organs such as the lungs, liver, lymph nodes, peritoneum, etc. Though this sounds like a lot of time, it is always best to be aware of one’s condition as soon as possible.
The Dangers of Misdiagnosis
When CRC is discovered at an advanced stage, it can be one of the deadliest and most difficult cancers to tackle. This is why misdiagnosis is such a prominent fear and active issue within the CRC community, particularly among younger CRC patients, who often struggle with getting the right diagnosis in the first place.
When a younger person experiences CRC symptoms, it is often easy for them to be excused as hemorrhoids, irritable bowel syndrome, inflammatory bowel disease, or other gastrointestinal conditions. When properly diagnosed after the initial misdiagnosis, patients would have typically already progressed to a more intense and worrisome stage of CRC, therefore making their treatment plans and overall survival rates more complicated.
Every CRC patient is different–they may vary in age, sex, predisposing health, stages of CRC, etc. Therefore, it is impossible for researchers to determine the perfect time in which every single patient should start treatment while keeping their survival rates in mind. However, the dangers of waiting too long are known. Though beginning chemotherapy treatments early (less than six weeks after resection procedures) don’t typically have a significant impact on one’s survival rate, significant delays in initiating treatment may result in negative outcomes.
Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Rise in CRC Among Young Adults Continues to Baffle Researchers
Cancer incidence has been growing among younger adults—not just in the U.S., but globally. According to a recent analysis, the three decades between 1990 and 2019 saw almost an 80% increase in incidence of early-onset cancer. Following breast cancer, cancers of the digestive tract (stomach and colorectal) have seen a rise among young adults—in 2019, 37% of early-onset cancers diagnosed across the world were in the colon and rectum.
These trends are also reflected in the U.S. population. Here’s a startling prediction: by the year 2040, colorectal cancer (CRC) is estimated to be the second-leading cancer in the 20-49 age group and the top cause of cancer-related death in that age group.
The Need to Raise Awareness Among Providers
What is frustrating for the early-age onset CRC (EAO-CRC) community is that young individuals are not your typical candidate for developing colon cancer, which means their symptoms are either dismissed or attributed to some other gastrointestinal issue. According to cancer epidemiologist Yin Cao, 50% of EAO-CRC cases are among those under 45 years of age. Current guidelines recommend that someone with an average risk for CRC should start screening at age 45, so anyone younger may not get screened despite their symptoms.
An average-risk person is someone who does not have a known family history of CRC or a known genetic condition that’d increase their risk for developing CRC.
As a result, diagnosis is delayed, which raises the risk of an advanced-stage disease that may be harder to treat. One such study among nearly 1,200 EAO-CRC patients found that 71% were diagnosed at an advanced stage (stage III or IV).
*Information on the various stages of CRC can be found here.
What’s Leading to the Rise in EAO-CRC?
While there are a lot of guesses, researchers and clinicians are not quite sure. There are talks about a birth cohort effect, which is a term that describes the unique experiences or exposures faced by a group of individuals based on their year of birth. For example, Americans born prior to 1945 have been found to have a lower risk of being obese.
Going back to CRC, medical oncologist Christopher Lieu told ScienceNews that those in their 40s today are at a greater risk of developing CRC than those who turned 40 a decade ago (so now in their 50s). Several different risk factors are being investigated in those who develop EAO-CRC:
However, there’s no definitive answer for the cause. The best preventive efforts include being physically active, managing your body weight, reducing the intake of processed food and integrating fresh fruits and vegetables in your diet.
What Do We Know?
What is definitely known are the telltale symptoms: pain in your abdomen, abnormal bowel movements (unexplained diarrhea or constipation), blood in your stools/rectal bleeding, unexplained weight loss, weakness. It is important to pay attention to these symptoms, which are often misdiagnosed as inflammatory bowel disease or hemorrhoids, especially in young adults. Any two of these signs could indicate a serious problem with your gastrointestinal tract—potentially, cancer.
Intestinal Bacteria: Biomarkers and Targets for Colorectal Cancer
By Parker Lynch
According to a study published in Cancer Biology & Medicine, the role of intestinal bacteria in the development of colorectal cancer (CRC) has been receiving a lot of attention in recent years. Various bacteria such as Fusobacterium nucleatum, Escherichia coli, Bacteroides fragilis, Enterococcus faecalis, and Salmonella sp., have been known to cause DNA damage. Additionally, these bacteria also help tumor cells evade the body’s immune response, creating a pro-inflammatory environment. The DNA damage and other hindrances upon one’s immune system and bodily function have been associated with the development and progression of CRC.
These bacteria can be useful biomarkers for CRC. Additionally, progress is being made in developing effective antibacterial therapies, which could prove useful in the treatment of CRC.
Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Pathways to Nutritional Prevention: an Infographic
Nutrition & Colorectal Cancer Prevention Series: Blog 3
In the previous installments of this blog series, we explored both the molecular pathways behind dietary prevention of colorectal cancer (CRC) as well as the barriers within the built environment that prevent individuals from properly accessing those preventative nutrients. This post will further explore strategies and resources that can aid communities in achieving a balanced diet.
With rising costs of living and barriers in the built environment such as food deserts, reducing CRC through dietary prevention can feel like a daunting task, but there are many resources available that can provide support in this process.
So how can individuals identify resources that are available to them? This can be done through a multi-pronged approach from accessing fresh food from local organizations to engaging in nutritional education classes.
Where can you find these resources? Findhelp.org is a database that provides direct links to resources in your zip code. Individuals can input their location and find resources from direct food access, to community gardens, to education.
Our infographic below provides a snapshot of how integrating dietary pathways can help CRC prevention.
Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Photo credit: Nathan Dumlao on Unsplash
How Quickly Should a CRC Patient Start Their Treatment? Does It Matter?
By Parker Lynch
In a recent study conducted in Canada, 5,026 patients with colorectal cancer (CRC, all younger than 50) were evaluated between 2007 and 2018. This study evaluated the time between a patient’s first presentation with CRC and their treatment initiation. The overall objective of this study was to determine if a longer time from presentation to treatment start would result in worse survival rates for CRC patients, particularly those under 50.
Relation Between Treatment Start and Disease Outcome
The median age of the participants was 44 years, with about an equal number of males and females:
The lower-urgency subset consisted of 2,548 patients. Patients with metastatic CRC had shorter median (IQR) overall intervals (83 days) compared with those with less advanced disease. Five-year overall survival was 69.8%. Overall intervals longer than 18 weeks were not associated with significantly worse overall survival (OS) or cancer specific survival (CSS) compared with those waiting 12 to 18 weeks. Additional analysis by the researcher where patients were stratified by stage of disease did not show significantly worse OS or CSS with increasing overall interval lengths.
One would expect the findings to support that a later treatment start would result in worse outcomes for the patient. In other words, starting treatment as soon as possible would yield the best prognosis for patients. However, this study found something quite different: time from presentation to treatment was not associated with advanced disease or poor survival. This finding insinuates that a patient has a little bit of “leeway” in terms of the time it takes for them to begin their actual treatment, without having to worry that this delay will correspond to decreased survival.
Another Study With a Different Perspective
In another study, the administrative time of adjuvant chemotherapy following a curative surgical procedure for stage 3 CRC was evaluated. Specifically, researchers wanted to determine if there was a so-called “sweet spot” for when a patient should begin chemotherapy to maximize their chances of survival.
In this study, 159 patients with stage III CRC, who had undergone a curative resection, were enrolled. Patients were categorized into 3 groups representing different timings to initiate chemotherapy treatments:
The OS and relapse-free survival rate (RFS) were analyzed to evaluate the effectiveness of adjuvant chemotherapy. The 5-year OS was:
The 5-year RFS was:
When specifically considering CRC patients who have undergone resection procedures, it was loosely determined that chemotherapy should be administered 6-8 weeks after one undergoes an operation. However, the administration prior to the 6-week mark didn’t result in a statistical difference in outcomes.
This, however, should not encourage patients to “wait out” their cancer; rather, that time should still be spent on interactions with providers to come up with a treatment plan. CRC, on average, takes around two years before it metastasizes to other organs such as the lungs, liver, lymph nodes, peritoneum, etc. Though this sounds like a lot of time, it is always best to be aware of one’s condition as soon as possible.
The Dangers of Misdiagnosis
When CRC is discovered at an advanced stage, it can be one of the deadliest and most difficult cancers to tackle. This is why misdiagnosis is such a prominent fear and active issue within the CRC community, particularly among younger CRC patients, who often struggle with getting the right diagnosis in the first place.
When a younger person experiences CRC symptoms, it is often easy for them to be excused as hemorrhoids, irritable bowel syndrome, inflammatory bowel disease, or other gastrointestinal conditions. When properly diagnosed after the initial misdiagnosis, patients would have typically already progressed to a more intense and worrisome stage of CRC, therefore making their treatment plans and overall survival rates more complicated.
Every CRC patient is different–they may vary in age, sex, predisposing health, stages of CRC, etc. Therefore, it is impossible for researchers to determine the perfect time in which every single patient should start treatment while keeping their survival rates in mind. However, the dangers of waiting too long are known. Though beginning chemotherapy treatments early (less than six weeks after resection procedures) don’t typically have a significant impact on one’s survival rate, significant delays in initiating treatment may result in negative outcomes.
Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Colon Capsule Endoscopy with AI: A Promising Approach for Early Cancer Detection
By Deepthi Nishi Velamuri
Colon cancer is the third most common cancer in the U.S., and early detection is essential for improving survival rates. Colon capsule endoscopy (CCE) is a minimally invasive procedure that uses a small camera to examine the colon. It is a good alternative to colonoscopy for people who are unable to undergo traditional colonoscopy, such as those who are obese or have a history of bowel obstruction.
However, CCE can be time-consuming and labor-intensive to analyze. This is where artificial intelligence (AI) can help. AI-powered software can be used to automatically analyze CCE footage, identify potential polyps, and flag them for further review by a doctor.
A study published in the journal Colorectal Disease found that AI-powered software was able to detect polyps with a high degree of accuracy. The study also found that AI-powered software could reduce the time required to analyze CCE footage by up to 70%.
These findings suggest that AI-powered software could make CCE a more feasible option for wider use. This could lead to earlier detection of colon cancer and improved survival rates.
Here are some of the benefits of using AI-supported footage analysis in CCE:
Overall, AI-supported footage analysis is a promising approach for improving the accuracy, efficiency, and patient experience of CCE. It is a technology that is worth watching as it continues to develop.
Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Image by Gerd Altmann from Pixabay
Tackling Fresh Food Inequality: Navigating the Landscape of Food Deserts and Nutrition
Nutrition & Colorectal Cancer Prevention Series: Blog 2
The first installment of this blog series provided an overview of the molecular pathways that enable dietary interventions to prevent and reduce the spread of colorectal cancer (CRC) cells in the body. These pathways have laid the foundation for this week’s installment: addressing the systemic barriers that prevent individuals from accessing the nutrition they need to reduce CRC risk.
Connecting the Dots: Access, Healthy Food, and CRC
The link between food deserts (areas with limited access to low-cost yet nutritious food) and health outcomes is well established. Like most health disparities in the U.S., black, brown, and low-income communities are more likely to live in locations with sparse options for fresh, healthy dietary choices. Individuals living in these food deserts often need to drive an extended distance to access fresh fruits and vegetables, as the options near their residences are canned, frozen, or unavailable. Additionally, food swamps are similarly deficient in healthy nutritional options but are marked by a high ratio of fast food to fresh food options. Lack of proximity to fresh and less processed foods contribute to the social determinants of health and make it far more difficult for individuals in these communities to engage in proactive prevention.
In an article published in May of this year, researchers explored the epidemiologic links between counties with high food desert and food swamp scores and obesity-related cancer mortality rates. Individuals residing in counties with high food swamp scores were found to have significantly (77%) higher odds of obesity-related cancer mortality. The authors similarly identified a positive dose-response relationship between obesity-related cancer mortality and food desert and swamp scores.
Improving Access to Fresh Foods in These Communities
While individuals living in these geographic locations have substantial barriers, local organizations can help provide services that bridge the gap. Many local food pantries have developed programs to bring fresh foods to communities in need. Volunteers will pack pre-selected boxes of fresh ingredients and set up a free farmer’s market in a community that lacks access to those ingredients, eliminating the transportation barrier and making dietary prevention, or the process of maintaining a balanced and nutritious diet to prevent disease, a more accessible goal.
Feeding America has an online tool that locates mobile food pantries with a click and a zip code. Local food pantries may also provide delivery services to elderly or disabled individuals, so check in with your local organization to learn more!
Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Picture credit OpenClipart-Vectors from Pixabay.
Supporting the Support System: Resources for Colorectal Cancer Caregivers
By Deepthi Nishi Velamuri
When someone you care about is diagnosed with colorectal cancer (CRC), it impacts the entire family. Taking on the role of caregiver can greatly affect your physical, mental, and emotional health. That’s why it’s so important for caregivers to have access to support and resources. This article summarizes information and services available specifically for those who provide care to CRC patients.
Understanding Caregiver Burden
Types of Caregiver Support Resources
Numerous resources have been developed that can help caregivers make informed decisions. Here are example of some of these resources:
Self-Care Tips for Caregivers
Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Image credit: Tim Goedhart on Unsplash
Enhancing Colorectal Cancer Prevention with Diet: Molecular Pathways and Improved Outcomes
Nutrition & Colorectal Cancer Prevention Series: Blog 1
The link between nutrition and colorectal cancer (CRC) prevention is well established. Researchers have found that low-inflammation diets, such as Mediterranean diets, are associated with lower risk of CRC. This study also affirmed the link between sugar intake and CRC risk, with individuals who consume beverages high in sugar being more likely to develop rectal adenomas.
Other studies have explored the links between highly processed foods and development of colorectal adenomas. In addition to highly processed foods, canned foods have also been shown to increase risk of colorectal polyps when measured against fresh fruits and vegetables.
These associations provide evidence that a low-inflammation diet that is low in sugar and processed foods can lower the risk of developing CRC; however, there is limited research on the impact of nutritional interventions on those who are already diagnosed.
Can Dietary Interventions Improve CRC Outcomes?
A study published earlier this year explored the answers to that very question.
In accordance with previous research, the authors found that the Mediterranean diet was effective in reducing CRC tumor growth. The mechanisms that are responsible for this inhibited tumor cell growth include the presence of beta-carotene, which is found in a number of fruits, vegetables, and fish. When beta-carotene interacts with fibroblast activation markers, the fibroblasts repress tumor cell growth in the colon.
Additionally, anti-inflammatory diets can suppress the growth of CRC tumors via immune system pathways. Tea polyphenols, most commonly found in green tea, add diversity to the gut microbiota by often raising short-chain amino acid levels, which in turn promotes the growth of anti-inflammatory gut bacteria. Elevated levels of these “good bacteria” help to modulate the environment within which CRC develops, and aid the immune system in preventing tumor cell growth and spread.
While it is important to understand these pathways, successful, consistent implementation of preventative diets is the key to unlocking the benefits that come from the pathways. The chart below, adapted from this study, provides a framework for workable diet and lifestyle interventions during the various stages of colorectal cancer treatment, from diagnosis to surgery. Key elements of these interventions involve exercise, protein intake, and supplementation of key nutrients such as omega-3 fatty acids.
Blog 2 in this series can be found here: Tackling Fresh Food Inequality.
Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Alcohol: Destroying Your Liver and Colon, Increasing Your Risk of Early CRC
By Parker Lynch
In a recent study conducted in Korea, it was found that higher levels of alcohol consumption increase an individual’s risk of early-onset colorectal cancer (early-onset CRC), specifically distal colon and rectal cancers. Using data from the Korean National Health Insurance Service, investigators retrospectively compared the drinking habits of 5.7 million Korean adults (all younger than fifty years old) and their corresponding CRC risk.
The study’s population was split into four groups (after being adjusted for age, sex, smoking status, exercise, income, and comorbidities):
During the mean follow-up period of 7.4 years, there were 8,314 cases of early-onset CRC overall. When being compared with the light drinking group, those in both the moderate and heavy drinking categories had a significantly higher CRC risk, though the most intense discrepancy was demonstrated among men. Among men, there was a:
Among women, there was a:
Overall, this study provides strong evidence that higher levels of alcohol consumption can increase one’s risk of early-onset CRC.
What Are the Implications of These Findings?
Although the aforementioned study is limited to generalizability among Korean citizens, its findings are still very important to consider when looking at the diverse American population.
In fact, the dangers of excessive alcohol use and its connection to increased CRC risk are not something that American researchers or doctors are unfamiliar with. In an article published by the Ocean Endosurgery Center, less than half of Americans are even aware that alcohol consumption has an impact on cancer risk at all. Additionally, the official Dietary Guidelines for Americans strongly suggests that men should not consume more than two alcoholic drinks per day, while women should drink no more than one. In terms of what is best for an individual’s health, researchers have determined that people really should only be drinking on special occasions.
Many Americans don’t know this information, and there must be a push for increased education and awareness so that people are able to make informed decisions about their own health. Regardless of whether or not people choose to drink after discovering the risks involved, everyone deserves to know the implications of potential lifestyle choices.
Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Photo credit: CHUTTERSNAP on Unsplash
Colorectal Cancer in Young Adults: What Are We Learning?
By Deepthi Nishi Velamuri
Colorectal cancer (CRC) is a disease that typically affects older adults, but it is becoming increasingly common in young adults. In fact, data indicate that 15% of patients diagnosed with CRC in the U.S. are under the age of 50 years and the mean age at diagnosis is 42.5 years.
There are a number of factors that may contribute to the rising risk of CRC in young adults. These include:
Prevention, Genetics, and Disease Outcomes
The good news is that CRC is often preventable. If you are at an increased risk, you should talk to your doctor about getting screened for the disease. Screening can help identify polyps, which are growths that can develop into cancer. If polyps are found, they can be removed before they have a chance to turn cancerous.
Young adults diagnosed with CRC are more likely to have advanced-stage disease at the time of diagnosis. This suggests that young adults are less likely to be screened for the disease—often despite showing symptoms such as rectal bleeding, abnormal or changing bowel patterns, fatigue, etc—which can lead to later-stage diagnosis and poorer outcomes.
A number of genetic mutations associated with CRC in young adults have been identified. These mutations can help identify people who are at an increased risk of the disease, and they can also be used to develop new targeted therapies.
Need for Improved Management of Young Adults
While we are still trying to understand the mechanism of CRC development in young adults, it is clear that this is a serious and growing problem. By understanding the risk factors for the disease and getting screened, young adults can protect themselves from CRC.
Here are some tips to reduce your risk:
Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.