By UPMC Hillman Cancer Center |Photographs from UPMC

Colorectal cancer is a major public health problem here in the U.S. and specifically here in Pennsylvania. It is the second leading cause of cancer deaths, and nearly one-third of all adults between the ages of 50 and 75 have not been screened. Interestingly, colorectal cancer is one of the most curable types of cancer, when detected early.

The month of March is designated as National Colorectal Cancer Awareness Month. Since first designated by President Bill Clinton in 2000, it has grown to become a time of year when thousands of patients, survivors, caregivers, and advocates throughout the country join together to spread colorectal cancer awareness. It has also become a time for many to talk to their friends and family about the importance of screening and for doctors to encourage their patients to get screened.

We talked with Dr. Edward Chu, Chief of the Division of Hematology-Oncology and UPMC Hillman Cancer, about colorectal cancer. Dr. Chu has great advice on when you should be screened and why, and information on what studies are underway for this cancer. 

Edward Chu, MD, is a professor of Medicine and Pharmacology & Chemical Biology at the University of Pittsburgh School of Medicine, Stanley M. Marks-OHA Chair in Hematology-Oncology Research, Chief of the Division of Hematology-Oncology, and the Deputy Director of the UPMC Hillman Cancer Center. He specializes in the treatment of GI cancers with a specific focus on colorectal cancer, and he directs the Phase I clinic, where early-phase clinical trials are offered to all patients with cancer.

What is colorectal cancer?

Dr. Chu: Colorectal cancer occurs when malignant cells form in the tissues of the colon and rectum. The colon, also called the large intestine, has four parts: ascending colon, descending colon, transverse colon, and sigmoid colon. It’s responsible for the last stages of digestion. The sigmoid colon connects to the rectum and continues the process of removing waste from the body. Colorectal cancer can occur in any section of the large intestine or in the rectum.

What are the warning signs of colorectal cancer?

Dr. Chu: Some of the early warning signs may include: blood (bright red or very dark) in the stool; a change in bowel habits; weight loss for no known reason; fatigue; diarrhea, constipation or feeling the bowels don’t fully empty; frequent gas pain, bloating, fullness, or cramps. Unfortunately, there are some patients who will not present with any of these warning symptoms, and this highlights the importance of colon cancer screening.

How is colorectal cancer detected?

Dr. Chu: The best detection is early detection, and for colorectal cancer, the gold standard is colonoscopy. Unless you have a family history or another reason that puts you at a higher risk for colorectal cancer, individuals should have regular colonoscopy screenings every 10 years starting at the age of 50. African Americans should begin screenings at age 45, as they present with colon cancer at an earlier age than Caucasians.

The goal of colonoscopy is to identify polyps, which are the precursors for colorectal cancer, and to find colon cancer at its earliest stage. Without detection or treatment, polyps can become cancer that grow deeper into the tissue and then can spread to other parts of the body. A colonoscopy can find these polyps and remove them during the procedure. The tissue samples are then reviewed by the pathologist to detect the presence of any cancer cells, and based on this analysis, we can then determine if any additional treatment is needed.

Why do you think so many people are reluctant to get screened?

Dr. Chu: Most patients believe the preparation for colonoscopy is difficult, and we find that women are much more concerned about the prep than men. It is typically done the night before and it requires that you drink a good amount of special fluids that will help to fully empty the colon so that there is a better chance of visualizing the entire colon. The prep has changed over the years, and most patients have commented that it was not as terrible as they originally expected. Here’s the most important reason you should get a colonoscopy: When caught early, colon cancer can be successfully treated and cured in up to 90-95 percent of cases. The preparation is far less invasive and far less problematic than getting treated for colon cancer. A colonoscopy is the only procedure that can find and remove polyps before they become cancerous.

Are there any new research or findings involving colorectal cancer?

Dr. Chu: You should be aware of a test called Cologuard that was approved by the FDA in 2014 as a non-invasive approach to screen for colon cancer. It is the first screening test that detects the presence of altered DNA in a patient’s stool that may suggest the presence of polyps or colon cancer. The beauty of this test is that it is completely non-invasive and can accurately detect the presence of colon cancer about 90 percent of the time. Unfortunately, a colonoscopy is still required to make the diagnosis of polyp or colon cancer.

There is also a great deal of research to use peripheral blood and look for the presence of altered DNA in the same way that this stool test is being used, and I suspect that we will hear more about these blood screening tests in the next few years.

UPMC Hillman Cancer Center,

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