Colorectal cancer is showing up in an unsuspecting population

By Dr. Fadi Braiteh

Friday, May 19, 2017 | 10:25 a.m.

The devastating consequences of colorectal cancer are often underestimated early on by the patients and families that endure them. Many dismiss early symptoms, and it is not unusual that the cancer is detected in its advanced stages.

According to the Centers for Disease Control and Prevention, colorectal cancer is the second leading cause of cancer deaths among adults. In fact, more than 140,000 Americans are diagnosed with a form of colorectal cancer each year and more than 50,000 will succumb to the disease.

In Nevada, according to the American Cancer Society, nearly 1,200 Nevadans will be diagnosed with colorectal cancer and 500 will lose their battle in 2017 alone.

Colorectal cancer occurs in the colon or rectum. The colon is a part of the large intestine and the rectum is a passageway connecting the colon to the anus. Given where colorectal cancer stems from, there are a number of common symptoms, including abdominal pain, rectal bleeding, a change in bowel habits, bloody stool, abdominal cramping, fatigue and weight loss.

Noting the symptoms is vital in combatting colorectal cancer, but there are also a number of early detection measures and tests one may take as well. Since colon cancer is a disease that mainly affects the older population, with an average age of 65 or older, research has established the cost effectiveness and efficacy of screening procedures that not only improve life expectancy but also reduce the number of new cases of colon cancer. These measures include fecal occult blood detection, stool DNA test, CT colonography and — most importantly — a colonoscopy. The CDC recommends that beginning at age 50, men and women should have an initial colonoscopy, and every three to 10 years thereafter, depending on each case. Some earlier and more frequent screening is recommended for individuals with confirmed hereditary cancer predisposition.

Even when folks take the right proactive efforts, eat properly — which includes a high-fiber diet — and adhere to an active lifestyle, it still may not prevent some from being diagnosed with colorectal cancer, especially for the younger generation, a new trending public health problem.

The latest data

Recently released data from JAMA Surgery indicates that colorectal cancer in those 20 to 34 years-old will increase by more than 90 percent by the year 2030. Americans born in 1990 or later are now two times more at risk for colon cancer and four times more at risk for rectal cancer than in the 1970s.

So, why have these diagnoses become more prevalent in young people?

First and foremost, this is an isolated study in the United States and there is still a lot of work to be done in the realm of research to pinpoint contributing factors. We will need to see what other Western countries come through with to fully determine if this is a universal, geographical or demographical issue. With this disclaimer being said, there are a few key points to acknowledge as to why these rates may be increasing.

First of all, young people are not having screening measures at the rates those 50-and-older typically do, or should. This lack of screening allows undetected polyps to flourish within the body and ultimately become cancerous. If these polyps are spotted early, they can be surgically removed and help prevent a cancer diagnosis from ever happening. Colorectal cancer can be one of the most easily treatable cancers, if these polyps are eliminated.

Secondly, the rising obesity rates as well as dietary habits may be contributing to increasing colorectal cancer rates in those ages 20 to 34. While obesity rates and dietary habits have not been correlated to this specific study, it is well known that a healthy diet and regular exercise will only help in preventing a number of diseases, including cancer.

Recent advancements in treating colorectal cancer patients

Amid the latest statistics indicating rising rates of colorectal cancer in certain demographics, there have been some noteworthy advancements within the last 10 years.

There has been a noted improvement in the stage IV colon cancer survival rate. The five year survival rates of stage IV disease has improved significantly from less than 5 percent

30 years ago, to almost 17 percent now. For the subset of patients with surgically resectable liver and/or lung spread, those numbers have improved to 50 percent or better in recent years.

The improvement of survival rates is likely due to the recent advancements in cancer treatments including Regorafenib, TAS1-02, ziv-aflibercept and Ramucirumab. These agents all use precision medicine and genomic testing to better identify which treatment to deliver to which patient. Immunotherapy (or check point inhibitors) has also led to major advances in rare cases referred to as colon cancer with high microsatellite instability.

Meet Kyle

Kyle Silveroli remembers waking up to a lava-like, acidic burning in his stomach back in 2014. It was the latest in a number of health oddities that the young man was starting to take note of, including dramatic weight loss and sleeping more than usual. He was deep in the heart of Army training and attributed his persistent fatigue to the hard work he was putting in… but still knew something wasn’t quite right.

A PET/CT Scan identified a widely metastatic cancer, initially thought to be lung cancer. Kyle found it odd that he received a lung cancer diagnosis, given that he never smoked and was generally not subjected to secondhand smoke.

He was given six months to a year to live. He was discharged from the Army and immediately began preparing for a different type of battle — one that he never thought he’d have to face.

Kyle visited a hospital in Arizona and was then referred to CCCN in Las Vegas, where his parents, sister and extended family currently reside. After additional thorough testing, it was confirmed that Kyle didn’t have lung cancer, but stage IV colon cancer.

Kyle refused to give up and immediately began treatment — a personalized combination of chemotherapy and biologics to attack the blood supply to the cancer. This was used in combination with other drugs to curb the growth of the tumor in his liver, and another drug to protect his bones, which were ridden with cancer. Later on he was referred to receive liver-directed therapy with radioactive glass beads delivered directly into the tumor in his liver, a treatment called radioembolization.

Kyle remains on chemotherapy today — persevering through the dire outlook he was given more than three years ago.

According to Kyle, he is now feeling “a whole lot better” and “can now do more things than he could have imagined.” In fact, Kyle now works approximately 20 hours per week in security for one of the most popular nightlife venues on the Las Vegas Strip.

While he continues his courageous battle, Kyle remains hopeful for newer drugs to make it to the market. His ambitions include starting his own business or potentially dabbling in acting down the line. If that doesn’t work out, he’d love to be a firefighter or first responder. It only seems fitting that he want to return to such a line of work, given his original, heroic ambitions with the Army.