Multidisciplinary Care Improves Outcomes for Patients with Colorectal Cancer

The news on colorectal cancer is mixed, says an expert with Baptist Health Miami Cancer Institute. The good news?  Mortality from the disease has steadily declined over the past 25 years, according to the U.S. Centers for Disease Control & Prevention (CDC). But the bad news is that a troubling new trend has emerged in recent years that has doctors both puzzled and concerned.

“While overall mortality has decreased, the frequency of colorectal cancer, especially left-sided colorectal cancer, has increased over the past 30 years – particularly among people between the ages of 40 and 50,” says Antonio Ucar, M.D., an oncologist/hematologist at Miami Cancer Institute, which is part of Baptist Health Cancer Care.

Antonio Ucar, M.D., an oncologist/hematologist at Miami Cancer Institute, which is part of Baptist Health Cancer Care

Colorectal cancer is the fourth most common cancer in men and women, the CDC says, and it is the fourth leading cause of cancer-related deaths in the United States. Dr. Ucar points to statistics from the American Cancer Society (ACS) that show approximately 20 percent of new colorectal cancers diagnosed in 2019 were in patients under 55, compared to just 11 percent in 1995.

“As a result, you’re seeing groups such as the American Cancer Society and the American College of Gastroenterology adjust their recommendations on when to start colorectal cancer screening. They now recommend starting with a colonoscopy at age 45 instead of 50,” says Dr. Ucar. “It is important to comply with these recommendations.”

What’s behind the increase in younger people?

There are several proposed factors for the increased incidence among younger adults, Dr. Ucar says. “Sedentary lifestyle, obesity and a diet high in fats, processed meats and refined sugar are known risk factors for colorectal disease but there are many patients I see who are young, fit and slender and they still got cancer,” says Dr. Ucar.

Another possible reason for the increase? “More people are starting their colorectal cancer screenings earlier in life so we’re catching more younger adults that way,” he says.

Researchers lately have been directing their focus on the microbiome, which Dr. Ucar describes as “the bacterial microenvironment in the intestine that could lead to the production of carcinogenic substances that can increase the risk of colorectal cancer.” However, more research is needed, he says.

Not your grandfather’s colonoscopy

Dr. Ucar says that screening tests and procedures for detecting colorectal cancer are easier and

safer now than they’ve ever been. “For people who are concerned or scared of having a colonoscopy, I would start by doing a test to detect occult blood in the stools,” he suggests. “This is a simple test that could be done at the primary care physician’s office. Patients with a positive test can then have a colonoscopy.”

The preparation for a colonoscopy is not as cumbersome as it used to be, Dr. Ucar adds. “Now, the amount of fluid that is required to be taken to clean the gut is a lot smaller. Some patients can even take pills with water instead of the liquid preparation.” The procedure itself causes no pain and patients are usually asleep, he says, and if any suspicious-looking adenomatous polyps are seen, they can be removed at that time.

Strive for a healthier lifestyle

Preventing colorectal cancer starts with a commitment to embracing a healthy lifestyle, Dr. Ucar says. “Being more active, exercising regularly, avoiding obesity and avoiding certain types of foods in your diet are all factors that can potentially reduce your risk of colorectal cancer,” he says. Processed meats such as bacon, sausage, hot dogs and ham top the list of foods to avoid, according to Dr. Ucar, as are refined sugars and white flours.

“I always recommend that patients try to reduce fats of animal origin from their diet – red meats, especially – and cut back on refined sugars and white flours,” he advises. “If you have an excess of sugar in your body, it is eventually going to be metabolized into fat, and obesity is also a risk factor for colorectal cancer.”  Dr. Ucar encourages his patients to increase their consumption of fruits, vegetables and fish and to choose lean meats like poultry.

The benefits of multidisciplinary cancer care

Patients diagnosed with colorectal cancer need to know that it is “not a death sentence,” says Dr. Ucar. “The reality is that the earlier we find the cancer, the better the prognosis and the greater the curability,” he notes. “For patients with stage 1 or 2 cancer, many times surgery is enough to cure these cancers. With stage 3, most patients will need chemotherapy as part of their treatment but nowadays, even stage 4 colorectal cancer patients can be cured.”

Dr. Ucar stresses the importance of Miami Cancer Institute’s multidisciplinary approach to cancer care. “We have a multidisciplinary Tumor Board where we review cases with stage 4 colon cancer and discuss approaching these patients with a combination of chemotherapy, radiation therapy, immunotherapy, surgery and sometimes directed therapies like ablation procedures or radioembolization,” he explains. “Patients who 20 years ago were considered incurable can now be potentially cured using this multidisciplinary approach.”