Targeted Colon Cancer Treatment
- A 36-year-old mom dismissed stomach pain symptoms for years and assumed they were from poor diet and pregnancy until she finally received a colonoscopy, which screened for colon cancer and found a large, aggressive tumor. She’s since started chemotherapy for treatment.
- Colon cancer is very treatable and curable if caught early. Colon cancer screenings can involve at-home tests such as Cologuard, but a colonoscopy is more effective, according to SurvivorNet experts.
- A colonoscopy involves a long, thin tube attached to a camera that examines the colon and rectum for polyps (small growths in the colon that aren’t yet cancerous). If polyps are found, doctors can remove them during the procedure.
- Colorectal screenings are recommended to begin around age 45. However, people at increased risk—such as those with a family history of the disease—may want to screen sooner. Discussing your screening options with your doctor is recommended.
- Over the years, colon cancer treatment advances have become more precise with targeted treatments, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.
Colonoscopies remain one of the most effective ways to catch colon cancer early, a disease increasingly affecting those under 50. However, access comes at a steep price for younger individuals who fall outside the recommended screening age.
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Her diagnosis came after being tested for Crohn’s disease, which is a type of inflammatory bowel disease that impacts the digestive tract and stems from the mouth down to the anus, according to the Centers for Disease Control and Prevention.
Heather received an ultrasound on her stomach, which found something unusual on her liver. A follow-up biopsy and, finally, a coloscopy helped reveal she had a large tumor that had spread beyond the colon, meaning it was metastatic.
‘As soon as they ordered the colonoscopy, they saw the tumor right there on her colon,’ Cory said.
Treatment swiftly began. Cory is continually impressed by Heather’s mettle amid grueling treatment and its side effects.
“She’s truly amazing,” Cory told news outlet SI Live.
“I don’t understand exactly what she’s going through, but I understand pain. I understand the highs and lows,” Cory, a military veteran, added.
The Candrillis has since launched a GoFundMe to help with medical bills, especially since they struggled to get their insurance to cover her colonoscopy because Heather was younger than the recommended age of 45.
“Insurance is helpful, but we’ve been told that, even with insurance, this can go up to at least $500,000,” Cory added.
A silver lining the couple has found hope in is that Heather’s treatment has shown great promise.
“Because it’s working so well, they keep giving it to her. It’s really, truly doing amazing work,” Cory said.
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Help With Navigating Cancer Treatment
Helping You Understand Colon Cancer
Colon cancer is very treatable and curable if caught early. Colon cancer screenings can involve at-home tests such as Cologuard, but a colonoscopy is more effective, according to SurvivorNet experts. A colonoscopy involves a long, thin tube attached to a camera to examine the colon and rectum. If no polyps are discovered, the next screening won’t be needed for ten years. Polyps are small growths in the colon that are not yet cancerous but can potentially develop into cancer.
“When we see a polyp, we actually physically take the polyp out through the colonoscope,” Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, explained.
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
The American Gastrointestinal Association lowered the recommended initial age for a colorectal screening from 50 to 45. However, experts recommend screening earlier for some people who may be at an increased risk of developing colon cancer, such as having a family history of the disease.
WATCH: Colon cancer symptoms.
The most poignant signature of colon cancer is a change in bowel habits. Changes in the size or shape of bowel movements may cause constipation or diarrhea. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor deep in the colon.
Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss. Finally, some tumors bleed a small amount over a long period, resulting in anemia (low red blood cell count) that is picked up on blood work.
Advances in Treatment for Colon Cancer
“There are a lot of advances being made in colorectal cancer,” Dr. Heather Yeo, a colorectal surgeon at Weill Cornell Medicine, previously told SurvivorNet.
Colon cancer treatment is more targeted, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.
WATCH: Understanding Your Options with Metastatic Colon Cancer
Biomarkers are key to tailoring specific treatments. Biomarkers are molecular patterns becoming more commonly used in colon cancer diagnosis, prognosis, and management. According to the National Cancer Institute, a biomarker is “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or a condition or disease,” such as cancer.
“In colon cancer, we’re starting to look more and more at people’s biomarkers, so we’re starting to take the cancers, sequence them, understand where the different mutations are to figure out whether or not someone has a normal gene here or an abnormal gene,” Dr. Yeo explained.
“Those are the areas that people want to be able to target a little bit more. We’re getting close to more what we would call precision medicine, meaning we can start looking at people’s genetic mutations and think about how they might respond to different drugs.”
There are different types of biomarkers, including DNA, proteins, and genetic mutations found in blood, tumor tissue, or other body fluids. The biomarkers most commonly used in colon cancer management are:
Genetic mutations within the tumor, such as MMR/MSI, KRAS, BRAF, and HER2
Bloodstream carcinoembryonic antigen (CEA)
CEA is a protein produced by most tumor cells (but not all) and can be picked up in the bloodstream. High CEA levels do not establish a colon cancer diagnosis. However, higher CEA levels correlate with a worse prognosis and potential metastasis. Carcinoembryonic antigen is important for post-treatment follow-up to ensure the cancer hasn’t returned. Be sure to check with your doctor before treatment starts to ensure a CEA blood sample has been obtained.
More on Treating Colon Cancer
Surgery and chemotherapy are common approaches to colorectal cancer.
Some examples of Food and Drug Administration (FDA) approved chemotherapy drug treatments include:
- FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
- FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
- CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin
- FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
- Trifluridine and tipiracil (Lonsurf)
Among metastatic colon cancer patients, multiple treatment options exist, including surgical and non-surgical options.
One treatment option includes an oral treatment called Fruquintinib, which is a targeted therapy for adults with metastatic colorectal cancer who have tried other treatments. Results from a trial published last year showed the drug improved overall survival and progression-free survival, measuring the time before the cancer returns or spreads. It works by blocking the growth of blood vessels, which increases tumor growth.
Once you get to the metastatic setting, many patients “just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda to do this deal to in-license fruquintinib. We hope to give patients another option.”
Fruquintinib has been approved in China since 2018 and was originally developed by Chinese biopharmaceutical company HUTCHMED. Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong, and Macau in January 2023.
Managing Chemotherapy and Its Side Effects
Chemotherapy has brought on a series of ups and downs for Heather as she continues battling metastatic colon cancer.
Chemotherapy is an effective tool for oncologists to help treat cancer by stopping cancerous cells from growing, dividing, and spreading to other organs. Chemo works by traveling through the bloodstream, killing cancerous cells. However, the process also impacts healthy cells, leading to side effects.
Patients almost universally experience fatigue, often alongside gastrointestinal side effects, such as nausea. Doctors have many effective medications to combat chemo-induced nausea. “But mitigating that fatigue often depends on the patient,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle.
“Neuropathy is probably one of the most challenging side effects,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. Neuropathy results from damage to the peripheral nerves. It usually resolves after chemotherapy treatment, but sometimes symptoms can persist. While it’s typically characterized by numbness or a pins-and-needles sensation in the hands and feet, neuropathy can have several different symptoms, including:
- Weakness in the hands or feet
- Stabbing or burning pain in the hands or feet
- Difficulty gripping, such as when holding a fork
- Difficulty with fine motor skills, such as writing or buttoning a shirt
Nausea and vomiting are common side effects of chemotherapy. When chemotherapy affects the rapidly dividing cells in the stomach lining, the resulting cellular havoc in the gastrointestinal tract can lead to side effects such as nausea and vomiting. However, doctors can help patients mitigate the hit with various medications before, during, and after treatment.
“Part of the chemotherapy prescription includes a set regimen of anti-nausea medications,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. “We also ensure that patients have medications at home that they can use should they develop nausea after treatment.”
Hair loss is another side effect of chemotherapy.
WATCH: Coping with hair loss.
“For cancer patients, losing one’s hair can be unbelievably stressful. To start with, the dread of losing one’s hair can lead to some sleepless nights and feelings of anxiety,” Dr. Samantha Boardman, a New York-based psychiatrist and author, told SurvivorNet.
Chemotherapy can cause hair loss. It usually begins about three to four weeks after chemotherapy and continues throughout treatment.
This happens because this treatment targets quickly dividing cells throughout the body, including cancer cells and hair cells.
Most patients can expect regrowth four to six weeks after treatment. However, when your hair grows back, you may notice some changes in its color and texture.
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Tips for Navigating Chemo Side Effects
When dealing with fatigue, doctors don’t have an arsenal of weapons to combat fatigue in terms of prescription medications. However, you can do several things to help minimize the hit and restore your energy.
- Exercise: While it may be counterintuitive, physical activity can help alleviate side effects, especially fatigue. “Although ovarian cancer is not common, we often draw upon the experience of patients with breast cancer and colon cancer that have shown that physical activity can not only improve quality of life but may also have beneficial impacts on cancer outcomes,” Dr. Urban says.
- Eat well: Even though nausea may interfere with your ability to eat a healthy diet, it’s essential to ensure you’re eating appropriately, getting enough protein, and not losing weight. Not only will nourishing your body support your recovery, but it may also help you feel more energized.
- Sleep: Want to mitigate fatigue? Be sure to maintain your regular sleep-wake cycle while on treatment. Sticking to a set sleep schedule helps reduce fatigue by ensuring enough hours for your body to heal and restore itself each night. It may also help you recover more quickly by keeping energy levels high during the daytime.
Treating Neuropathy Symptoms
Doctors have several strategies for helping patients deal with this side effect. Once a patient begins experiencing the symptoms of neuropathy, they’ll be carefully monitored to ensure they don’t get worse. Before each chemotherapy infusion, the attending oncologist will assess whether the symptoms have progressed. If the symptoms worsen, they may adjust the dose or delay treatment. They may also try switching to another chemotherapy drug.
How to Get a Handle on Nausea
Most of these anti-nausea medications last for more than eight hours. One of the infusions commonly used reduces the degree of nausea for up to three days.
Complementary approaches may also be helpful. A few favorites:
- Ginger: Studies consistently show that ginger helps alleviate chemotherapy-induced nausea. The potent herb appears to have an anti-spasmodic effect on the gut. Not a fan of raw ginger? Suck on ginger candy, sip ginger ale, or make a steaming cup of ginger tea.
- Pressure bracelets: at your local pharmacy, these bracelets provide consistent pressure on a particular acupressure point on the wrist to reduce nausea.
- Deep breathing: Moving air in and out of your lungs with a few deep breaths can help relieve nausea, particularly if you pair deep breathing exercises with meditation. It can also help you relax and release stress and anxiety.
WATCH: Managing chemo side effects.
Coping with Hair Loss
If losing your hair is a concern before cancer treatment, know that you have options, such as wigs, hats, wraps, and scarves.
Another option that can minimize hair loss is cryotherapy, “just a fancy way for saying cold therapy,” says Dr. Renata Urban, gynecologic oncologist at the University of Washington in Seattle.
Cryotherapy involves wearing cold caps or special cooling caps before, during, and after each chemotherapy treatment.
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