Colorectal cancer, which affects the colon (the large intestine) or the rectum, can be prevented or even cured when it’s caught early enough. That’s why the in 2018, the American Cancer Society (ACS) updated its guidelines for screening people at average risk for CRC to add a “qualified” recommendation to begin screening at age 45 years (compared with the previous starting age of 50 years) and a strong recommendation to screen those age 50 years and above. The U.S. Preventative Serves Task Force does not give preference for any one screening test over another and advises that patients be offered a choice among screening modalities including stool-based and colon visualization (endoscopic and radiologic) tests. Here’s the latest on what’s available.
Most tests for colorectal cancer have been around for a long time. These include colonoscopies, barium enemas, and stool tests. Some look for polyps -- growths that can turn into cancer. Others find cancer in its earliest stages. In addition to those, a couple of new methods have emerged in recent years.
Cologuard. For this test, you collect a stool sample at home and ship it to a laboratory. Doctors there check the DNA in your stool to look for genetic changes linked to colorectal cancer. They also look for blood in your stool, which can be a sign of cancer. If the test finds anything, your doctor may want to do a colonoscopy to confirm the results.
Capsule Colonoscopy. Capsule colonoscopy is a technique where the patient swallows a double-ended capsule containing a tiny wireless video device that views the colon during the device’s transit. The procedure requires no sedation and does require a bowel preparation preceding the capsule’s ingestion. It helps your doctor find polyps. Colonic capsule endoscopy does not allow for biopsy or polyp removal, so patients with lesions detected typically require subsequent colonoscopy for evaluation and/or treatment. The US Food and Drug Administration (FDA) has approved capsule colonoscopy only for patients who had an incomplete colonoscopy.
Longtime therapies for colorectal cancer include surgery and chemotherapy. The last 10 to 15 years have seen major advances in the treatment of metastatic colorectal cancer. A number of drugs known as targeted therapies have been developed to fight cancer that has spread to other parts of your body. They include antibodies targeting the epidermal growth factor receptor (EGFR), such as cetuximab and panitumumab. There are also therapies for preventing cancer cells from building new blood vessels - aflibercept, bevacizumab, ramucirumab, and regorafenib (Stivarga).
Your doctor will help you decide which options are best for you.