No more “one size fits all” cancer treatment

As part of National Colorectal Cancer Awareness Month, we asked Katherine Cooper, MD, Trinity Health Medical Group, Hematology and Oncology and Lacks Cancer Center – Grand Rapids, to share insights about exciting new treatment options that are revolutionizing the fight against this disease.

First, let’s talk numbers 

If you were to name the most common cancers, what would be on your list? It might surprise you to learn that, excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society estimates more than 150,000 people will be diagnosed with colorectal cancer in 2026. 

What’s even more sobering is who this cancer affects. 

Colorectal cancer used to manifest itself most frequently in older adults, especially those over 50. It also used to have a fairly high mortality rate. Years of emphasis on screening have dramatically improved both the incidence and the mortality rate of this cancer for people over 50. That’s the good news. 

Unfortunately, the same can’t be said for younger adults: Colorectal cancer is now the leading cause of cancer death in adults under 50.

Now, more than ever, effective treatments are essential to halt colorectal cancer in its tracks. 

Not all cancers are the same 

It may also surprise you to learn that “cancer is not just cancer.” For example, even though adenocarcinoma is the most common type of colorectal cancer, it can present differently based on the person.

“With colorectal cancer, it’s important to understand the mutations that happen as cells divide and grow,” Dr. Cooper noted. “These events, in turn, create potential targets for treatment of these cells. We can use our knowledge of those features to develop a personalized, or customized, treatment approach. Rather than using a standardized course of treatment for every patient, we specifically choose treatments that target the features of the cancer cells that are present.” 

What types of personalized treatment are available? 

Colorectal cancer is often diagnosed through a biopsy of a mass found during a colonoscopy. If cancerous cells are present, they can then be tested for their unique features to help guide a personalized treatment plan. 

The following are some of the many available personalized treatment options, which may be considered in three categories:

• The first is immunotherapy. Essentially, this treatment stimulates the patient’s own immune system to attack cancer cells. “One of the ways immunotherapy can be used is in conjunction with surgery,” says Dr. Cooper. “When immunotherapy is used with chemotherapy after surgery, we can significantly decrease the chance that the cancer will return. Rather than simply extending life, in this setting we can increase the chance of cure.” 

• A second personalized option targets specific gene mutations or enzymes to slow or stop the growth of cancer cells. Dr. Cooper points out that this kind of treatment can interrupt the cancer cell signaling pathway. “These mutations contribute to cancer growth and spread,” she notes. “Just as putting a lid on a burning candle causes the flame to die out, we can use specific drug combinations to slow the growth rate of some cancer cells.” 

• A third approach involves adjusting the dosage of chemotherapy to increase tolerance. “Approximately 3-8% of the population has a gene mutation that affects their ability to metabolize, or break down, commonly used chemotherapy drugs,” Dr. Cooper said. “If we know that in advance, we can adjust the dosage so they tolerate it better. This allows them to complete the course of treatment that’s needed to fight the cancer.”

How do personalized treatments impact outcomes? 

In general terms, early detection leads to better outcomes. American Cancer Society statistics show that if it is detected early and localized (meaning there is no sign that the cancer has spread outside of the colon or rectum), the relative survival rate at five years is 91%. 

For Dr. Cooper, the personalized treatment options are especially compelling. “This is such an exciting time to work in the field of oncology,” Dr. Cooper says. “Treatment advances are increasing cure rates and allowing people to live longer with a better quality of life.” 

For example, the addition of immunotherapy to chemotherapy used after surgery in the curative setting increased the number of patients alive without recurrence at three years by 9%. Even in cases where colorectal cancer has metastasized, some of the personalized treatments have been found to improve survival by many months, or even years. 

Dr. Cooper is full of hope. “The bottom line is that early diagnosis, combined with personalized treatment, can lead to better outcomes.”

Can colorectal cancer be prevented? 

You can take concrete, evidence-based steps to prevent colorectal cancer. A well-balanced diet with plenty of fruits and vegetables, limiting red meats and processed foods, and regular exercise are two of the best ways to defend yourself. Avoiding smoking, limiting alcohol use and achieving/maintaining a healthy body weight also reduces cancer risk. 

Screening is more important than ever

As mentioned earlier, the incidence of colorectal cancer in younger adults is on the rise.  That has led to changes in the guidelines for screening. New guidelines recommend that patients have their first screening colonoscopy at age 45 instead of age 50. When colorectal cancer is found during early screening, it’s usually smaller and might be easier to treat. 

Unfortunately, only about 20% of people ages 45-49 are up to date on colorectal screening, which is lower than any other age group. “I realize that no one looks forward to a colonoscopy!” Dr. Cooper acknowledges. “However, it’s important to have a baseline evaluation and monitor regularly for changes. By keeping up with screening, we can catch colorectal cancer early and treat it, allowing the best chance of cure.”

Learn more about colorectal cancer care at Trinity Health Michigan.