Colorectal Cancer: What You Need to Know and Do to Help Achieve the Best Outcome

 The number of Canadians expected to be diagnosed with colorectal cancer this year, 24,300, would overflow the country’s largest hockey arena. That’s the fourth most common cancer, after breast, prostate and lung cancer. It is also the second biggest cancer killer in the country, yet perhaps surprisingly one of the most preventable, treatable and curable cancers if caught in its early stages. 

 A diagnosis of colorectal cancer is difficult news to receive and impacts people in many ways. Apart from the physical symptoms which can be complex, the anxiety and stress of a diagnosis can take its toll while facing the uncertainty of what lies ahead.

Being an active participant in care and treatment decisions may provide a way to deal with these challenges and help ensure patients get the care that best meets their needs and values. Working together with their medical team, patients can ensure the right treatment decisions are made for them, considering their personal situation and life goals. 

Personalized healthcare and precision medicines provide a whole new frontier of opportunities for patients. Significant advances in diagnostics and precision medicines have enabled those with advanced disease to match the mutations of their tumour with a specific treatment with meaningful improvements in quality of life and overall survival.

Catching it early

Colorectal cancer includes all cancers found in the colon and the rectum. Regular colorectal cancer screening of Canadian men and women of average risk between the ages of 50 -74 is crucial to both preventing colorectal cancer and curing early-stage cancers. The earlier the cancer is found, the greater the chances for a complete cure.

Asking your family doctor about colorectal cancer screening is an important first step to tailoring a screening program based on your individual risk factors. Both Colorectal Cancer Canada and the Canadian Cancer Society recommend a stool test, often referred to as the Fecal Immunochemical Test or FIT, every two years for individuals between the ages of 50 – 74 with an average risk for colorectal cancer. For individuals 75 years old and older, they should talk to their doctor about whether screening is appropriate for them and what would be the appropriate tests. If the results of the stool test are positive, there will be a follow-up with a colonoscopy to examine the colon and look for polyps or other abnormalities. Removing a polyp can prevent cancer from occurring. For individuals at high risk for colorectal cancer (e.g., if a first-degree relative was diagnosed with colorectal cancer or if there is a genetic disposition to this cancer), screening will likely begin with a colonoscopy.

Watching for signs and symptoms  

During the early stages of the disease, there may not be any symptoms, which is why regular screening is so important to detect colorectal cancer.

Potential signs of colorectal cancer to watch out for include: 

  • Unexplained changes in bowel habits, such as constipation or diarrhea
  • Change in size/shape of stools, such as being narrower than usual
  • The urge to have a bowel movement but nothing passes
  • Rectal bleeding
  • Blood in or on the stool, ranging from bright red to dark black
  • Persistent abdominal pain/discomfort, including bloating, fullness, cramps and gas pain
  • Unexplained weight loss
  • Weakness and fatigue
  • Anemia, caused by iron deficiency

If you experience any of these symptoms, be sure to inform your doctor as soon as possible. It is important to note that these symptoms could also be caused by other less serious health conditions than cancer, such as ulcers or hemorrhoids. They should still always be discussed with your doctor to receive the right diagnosis. 

Treatment options

If colorectal cancer is discovered, potential treatment options will depend on a number of factors, including the location of the tumour and its stage. Staging determines if the cancer is limited to its original area (stage 1) or how much it has spread elsewhere (stages 2-4).

Early-stage colon cancers may require surgery and preventative chemotherapy and treatment for later stage cancers may include targeted treatments and immunotherapy. Immunotherapy is a new type of treatment that stimulates the body’s own immune system to locate and kill cancer cells. For rectal cancer, radiation is often added to the treatment regime. 

More recently, as knowledge of the genetic differences in cancer tumours has advanced, determining the exact genetic profile of the tumour has become another important piece of information to help determine the most suitable treatment since certain new medications are designed specifically to work on tumours of a specific genetic type.

Playing an active role in care and treatment decisions 

There is an important role for patients in helping medical professionals weigh the treatment options based on the individual circumstances and preferences of the patient. Therefore, before making a decision about their care, patients should take the time to consider what is important in their life – their personal priorities, values, beliefs and goals. They should then share this information with their medical team so they can recommend the treatment and care that meet their particular needs.

“With so many more treatment options available today it is important for patients to know the options available to them and to be involved in their treatment decisions based on their own personalized genomic profile, their preferences and their circumstances,” said Barry D. Stein, President and CEO of Colorectal Cancer Canada, “Knowledge is power, and it can enable patients to self-advocate or assist  their caregiver to become an advocate on their behalf. Patients can become empowered and be involved in their treatment decisions and cancer care.”

Colorectal Cancer Canada has a comprehensive list of questions for patients to ask their medical team after they have been diagnosed and during treatment. Here are select questions patients can ask to help determine the best treatment plan for them:  

  1. What are my treatment options, and should I get a second opinion? 
  2. Do I need to get tested for biomarkers before beginning treatment? Biomarkers can provide valuable information about your colorectal cancer and potential treatments.
  3. How will my treatment impact my quality of life? For instance, will my treatment impact my ability to work, my intimate life or my hobbies and activities?
  4. What are the goals and possible outcomes of my treatment?
  5. Are there any clinical trials that I should consider participating in?

Decision-making in cancer care is an ongoing process over time, with further decisions needed after weighing the response to initial treatment, changes to the cancer or changes to the patient’s health or circumstances. 

There should always be an opportunity for patients to ask questions and share their personal perspective about cancer treatment options and next steps. Cancer patients and caregivers should be a welcome part of the conversation to help their medical team provide the best care possible. 

For more information on colorectal cancer, visit the following websites:

No content of this article is intended as medical advice. If you have questions about your health, consult a healthcare professional.

 Developed by C.A.R.P./Zoomer with financial support from Merck Canada Inc.