Screening for Colon Cancer

A Leading Cause of Cancer-Related Death
According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer-related deaths in the United States. Colon cancer is cancer of the large intestine (the colon), which makes up the lower part of the digestive system. Rectal cancer is cancer of the last several inches of the colon.

“Many cases of colon cancer begin as small groups of noncancerous cells called polyps,” says Richard Curtis, MD, Chief of Gastroenterology at Newton-Wellesley. “Over time some of these polyps can become colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason, we recommend regular, preventive screening tests to identify polyps before they become cancer.”

The GI Unit
The Gastroenterology (GI) Unit at Newton-Wellesley Hospital offers patients access to an expert team, high-quality patient care and the most advanced endoscopy services. The GI Unit has become a center of excellence not only for Newton-Wellesley Hospital, but also for the Greater Boston area.

“We have state-of-the-art tools available for our patients,” says Dr. Curtis. “We are one of a few hospitals in the state certified by the American Society for Gastrointestinal Endoscopy and work to keep current with the latest innovations and technology in the field.”

The Unit provides advanced services and uses the latest technology to manage each patient’s GI needs. This comprehensive care includes diagnostic and therapeutic endoscopy; management of inflammatory bowel disease in adults (see sidebar); diagnosis and management of malignant disease; proctology (disorders of the rectum and anus); diagnosis and management of incontinence; and management of stomal problems.

Colonoscopies
“Colonoscopies are one of the primary services we provide to our patients. We perform more than 15,000 procedures a year – making us one of the largest centers in the state,” says Dr. Curtis.

This life-saving procedure screens for colorectal cancer by allowing the physician to see inside the colon and test abnormal areas. A colonoscopy is an internal examination of the colon and rectum, using an instrument called a colonoscope. The colonoscope has a small camera attached to a flexible tube that can examine the entire length of the colon. During the exam, the physician is able to view the colon through the camera. If necessary, tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may also be removed with electrocautery snares. The GI Unit offers all types of anesthesia to make patients as comfortable as possible during the procedure.

“Approximately 30 percent of these screenings will show meaningful abnormalities such as polyps. Removal of these polyps results in a lower risk of colon cancer,” says Dr. Curtis. “Our multidisciplinary team works together to provide the most advanced screening techniques as well as surgical and oncology services, if needed by the patient.”

Endoscopic Ultrasound
If a tumor is found, the GI team also provides patients with endoscopic ultrasound capabilities. Endoscopic ultrasound is advanced imaging used to stage and diagnose colon cancer. The procedure combines endoscopy and ultrasound in order to obtain images and information about the colon. During an endoscopy procedure, a long flexible tube, called an endoscope, is used to visualize the colon. A small ultrasound transducer is installed on the tip of the endoscope, which allows physicians to obtain high-quality, accurate and detailed ultrasound images of the tumor.

“We use endoscopic ultrasound to learn more about the nature of the tumor and to determine how it should be treated,” says Dr. Curtis. “Staging cancer is becoming an important use of endoscopic ultrasound. This procedure can provide very crucial information regarding the depth of the cancer and the spread of cancer to adjacent tissues and lymph nodes.”

Collaboration with the Vernon Cancer Center
If patients should need further care, Newton-Wellesley is able to offer patient care options from diagnosis to recovery.

“Patients with abnormal colonoscopies or colon cancer are able to continue their care in one, convenient location,” says Dr. Curtis. “We offer a combined, seamless team approach using all the capabilities of our colorectal surgeons and our oncologists, who provide the latest cancer treatments.”

The expert team at the Vernon Cancer Center utilizes various cancer treatment methods including surgery, chemotherapy and radiation as well as cutting-edge treatments now available by looking at the cell biology of a tumor. Having a better understanding of cancer cells allows oncologists at the Cancer Center to deliver personalized cancer treatment.

“Colon cancer is curable in early stages,” says Revati Rao, MD, Oncologist at the Vernon Cancer Center at Newton-Wellesley. “Screening by colonoscopy plays a critical role in detecting early cancers. At the Cancer Center, we utilize surgery, chemotherapy and radiation, which can all play a role in colon cancer treatment.”

The Center works closely with our Pathology Department at the Hospital to determine whether or not certain cancer cells have specific mutations that can be treated with new drugs that are tailored to specifically target the tumor cells. Testing for a specific mutation in colon cancers helps determine the 60 percent of these cancers that respond well to a targeted drug. Testing on this mutation is currently being done at Newton-Wellesley for all recurrent colon cancers.

“Drug development has changed the management of metastatic colon cancer,” adds Dr. Rao. “As survival data is improving with each new drug, the disease is now a chronic illness for many patients. Molecular testing has also added a clinical benefit by offering patients personalized treatment.”

Screening Patients Saves Lives
The GI Unit is also one of the few centers that screens for familial cancer risk on all patients who come for their colonoscopies. “We ask each patient to complete a screening questionnaire to determine if anyone in their family may be at high risk for colon cancer,” adds Dr. Curtis. “There are many cases of unrecognized high risk and by surveying our patients we are able to identify this risk and recommend preventive options and closer surveillance.”

According to Dr. Curtis, screening for colorectal cancer saves lives. There is no single cause of colon cancer, but family history, colorectal polyps, inflammatory bowel disease, immunodeficiency disorders and other cancers are contributing factors. “Regular screening for colorectal cancer and knowing your family history can help prevent a cancer diagnosis,” adds Dr. Curtis. “I recommend that everyone age 50 and above take preventive measures and be screened.”

Once a patient undergoes a colonoscopy and the screening results are normal, he recommends a follow-up screening every 10 years. However, patients with additional risk factors for colorectal cancer (family history of colorectal cancer, history of polyps and increasing age) or an abnormal initial colonoscopy or other screening test should be screened every three to five years.

“It is my hope that we continue to create awareness about the importance of screening for colorectal cancer,” says Dr. Curtis. “Newton-Wellesley Hospital is a convenient location for patients. We have highly-trained, experienced physicians that make the screening process as easy as possible. This is a cancer that can be prevented and we want to help people understand their risks and prevent future illness.”

Richard Curtis, MD
Chief of Gastroenterology, Newton-Wellesley Hospital
Dr. Curtis is board certified in internal medicine. He received his medical degree from Cornell University and completed his residency at University Hospitals in Cleveland, Ohio and his fellowship in gastroenterology at Brigham and Women’s Hospital.

Revati Rao, MD
Oncologist, Vernon Cancer Center, Newton-Wellesley Hospital
Dr. Rao received her medical degree from St. George’s University School of Medicine in Grenada, West Indies and completed her residency at Roger Williams Medical Center. She completed her fellowship in hematology/ oncology at the New England Medical Center.

For more information about Newton-Wellesley Hospital, please visit www.nwh.org or call CareFinder at 1-866-NWH-DOCS (694-3627) .