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Chat on colorectal cancer

Khalid Matin, M.D., F.A.C.P., is an expert in gastrointestinal cancers

In honor of Colorectal Cancer Awareness Month, ABC News National Health hosted a Twitter chat on the subject last week with everyone from clinicians to patients providing commentary. VCU Massey Cancer Center’s medical oncologist Khalid Matin, M.D., F.A.C.P., was able to answer questions and elaborate on the discussion topics posed by the moderator. An expert in gastrointestinal cancers, Matin is also the medical director of community oncology and clinical research affiliations at VCU Massey Cancer Center and an associate professor in the Division of Hematology, Oncology and Palliative Care in the Department of Internal Medicine at the VCU School of Medicine.

Below is a recap of the chat. Some of the responses have been slightly altered to provide context that could not fit into the original 140-character tweets. Be sure to follow @VCUMassey on Twitter to keep up with Massey’s latest groundbreaking research and clinical trials, learn about patient and caregiver resources and find out about volunteer and philanthropic opportunities while connecting with others who share similar interests and life experiences.

What is meant by colorectal cancer? How common is it? How big a problem?

Colorectal cancer is cancer of either the colon or the rectum, both part of your large intestine. Colorectal cancer is preventable and treatable. Click here to learn more! The good news is that with screening and treatment advances, colorectal cancer is one of the most preventable and treatable types of cancer.

What are the risk factors for colorectal cancer? Do most people who get the disease have risk factors?

Family history, underlying genetic predisposition are well established risk factors along with obesity, lack of exercise, low vitamin D levels, underlying inflammatory bowel disease and smoking.  History of colorectal polyps, colorectal cancer or inflammatory bowel disease increases one’s risk of getting colorectal cancer. The American Cancer society recommends that people who have no identified risk factors should begin regular screening at age 50.

Let’s talk about symptoms. How does colorectal cancer present? How did yours present?

Symptoms include blood in the stool, abdominal pain and weight loss.

Let's talk about screening in detail. First, who should be screened and when?

Everyone at age 50 should be screened, preferably with a colonoscopy unless there is a medical reason not to do the test. Positive family history? Start screening at 10 years earlier than the youngest relative to have colorectal cancer. Patients with genetic conditions need to be screened much sooner, sometimes starting as early as 20 years of age. If colonoscopy cannot be done, stool FIT testing, stool DNA and virtual colonoscopy testing are options. Talk to your doctor about which test is best for you, when to start and how often. Remember, screening is if you have no symptoms. If you have symptoms, talk to your doctor about getting a test sooner!

Let’s talk about the “how” of screening. How should screening be done? Colonoscopy? Sigmoidoscopy? Fecal blood cards?

The ideal screening is a colonoscopy at age 50. This should be repeated every 10 years with stool FIT testing annually. A flexible sigmoidoscopy is good for detecting polyps and cancers in the distal colon, but will miss right-sided colon lesions.

Is there anything people can do to prevent colorectal cancer in addition to having the recommended screening?

A diet high in fiber and low in red meat and processed foods, reducing weight and exercising are common ways you can lower risk. Less fiber in one’s diet has been shown  to have an increased risk in causing colorectal cancer. Patients with increased fiber, increased exercise and less processed foods have lower risk.  It's really important to maintain an active lifestyle and keep your weight in check

Let’s talk about research. Anything promising in colorectal cancer research?

There is interest in the role of aspirin and other nonsteroidals in preventing colon cancer, which is currently being investigated. There is also research into the addition of Celebrex to standard chemotherapy after cancer resection with the potential to improve the cure rate. Reducing the amount of chemotherapy from six to three months is an ongoing study as well. Research is also being done to evaluate if some rectal cancer patients may not need radiation therapy, thereby reducing side effects. For metastatic patients, many different targeted therapies are being explored at different phases of development.

For those who had colon cancer. What has been most challenging? What advice do you have for newly diagnosed patients?

Look into studies that may be appropriate. Always get a second opinion with someone who specializes in colorectal cancer. Stay positive! Maintain nutrition during treatment and stay active. Increased activity/exercise has been documented to improve chemotherapy results. Make sure you have a team of supporters, including family and friends, as they're a huge help in getting through treatment. If you can get a second opinion at an academic site, you'll likely get a multidisciplinary team to discuss your case and find the best option for you. Multidisciplinary teams will most likely consist of surgical, radiation and medical oncologists, radiologists and pathologists reviewing your case.

Let's talk about resources. What are good sources for honest, reputable information? Where can people get support?

Massey's website is a great resource, along with the American Cancer Society and the American Society of Clinical Oncology. Massey has a multidisciplinary team that meets on a weekly basis to discuss newly diagnosed colorectal cancer patients. After reviewing the case, consensus is reached on the best treatment options for the individual. Our physicians also interact with our cancer scientists on a regular basis to develop new studies. 

Written by: Liza Janssen

Posted on: March 24, 2015

Category: Research