Screening For Colon Cancer
- Iconic NFL coach Vince Lombardi, best known for leading the Green Bay Packers to success between 1959 and 1967, passed away from colon cancer on September 3, 1970. Former Packers players have suspected Lombardi may have ignored his colon cancer symptoms, which could be why the disease was found at a late stage.
- Colon cancer, or colorectal cancer, affects your large intestine (colon) or the end of your intestine (rectum). It is highly treatable especially if caught early with screening.
- A colonoscopy is a procedure doctors use to screen for colon cancer by looking inside your colon. Experts recommend screening begin at age 45; however, if you are at higher risk screening may begin earlier. It’s best to discuss your risk of colon cancer and screening time with your doctor.
- The American Gastrointestinal Association lowered the recommended initial age for a colorectal screening from 50 to 45.
- Dr. Heather Yeo, a colorectal surgeon and surgical oncologist at Weill Cornell Medicine and New York-Presbyterian, previously told SurvivorNet, “Colon cancer is considered a silent and deadly killer. What happens is people often don’t know that they have colon cancer. They don’t have any symptoms. That’s why we screen for colon cancer in the United States.”
- Colon cancer symptoms will most notably impact your bowel habits. If you notice a change in your bowel habits or changes in your stool, talk to your doctor. Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss.
At the time when Lombardi was alive, it was a different era of men and how they focused on their health, so it’s understandable if men were to feel shame if they needed to undergo an invasive exam like a prostoctopy, to detect cancer in the rectum and anus. Therefore, it’s possible Lombardi’s cancer diagnosis was found at a late stage due to symptoms being ignored.
According to Kramer, if Lombardi had been living in this day and age, in his 50s, he might have agreed to have an early screening exam done, like the non-invasive screening test called Cologuard, which was approved by the U.S. Food and Drug Administration (FDA) decades after Lombardi’s passing.
Kramer added, “You can’t be afraid to be examined. You have to overcome that somehow. Early screening is as critical as overcoming the objections to the examinations.”
In an earlier interview with ESPN, cornerback Mike Bass, who also spent time with Lombardi in his Packers years, recounted, “When it came over the wires that he had an undisclosed illness, in the back of your mind your thoughts go back to things you may have noticed, his popping pills to settle his stomach.
“He was very quiet about those things.”
Lombardi reportedly didn’t feel like his normal self in the summer of 1970 and was first told he had a stomach virus. However, a June 27 surgery revealed he had a benign tumor in his colon, according to ESPN.
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Mike Bragg, also a former professional football player who played under Lombardi, remembers when Lombardi had been admitted into the Georgetown University Hospital which overlooked the field the team practiced on.
Recalling when Lombardi visited the field in his hospital gown saying, “I’m glad you’re here working out together. I want you to stay together. I don’t want you going across the picket line unless you all go,” Bragg said, “He didn’t have that twinkle in his eye. We knew something was wrong. He never got out of the hospital.”
Bass noted, “You could see he was frail. He wanted to show toughness. We did some exercises he wanted us to do, but that tone in his voice wasn’t the tone we were used to and it bothered all of us.”
Meanwhile, Dr. Zuri Murrell, a nationally recognized colorectal surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, took to his Instagram page recently to spread awareness for colon cancer and the importance of screening for the disease.
Dr. Murrell captioned his recent post, featured an image of Lombardi celebrating after a win, “Vince Lombardi is considered one of the greatest coaches in the history of the NFL, and his death was as sudden and unexpected as his rise to fame at the helm of the Green Bay Packers.
“It’s believed Lombardi began suffering from digestive problems as early as 1967 and refused to undergo a proctoscopy exam — a procedure that may have detected the cancer early enough to save his life.”
“You Shouldn’t Die From Embarrassment”: Colon Cancer Can Be Prevented
He continued, “Admitted to Georgetown University Hospital on June 24, 1970, tests revealed anaplastic carcinoma in the rectal area of his colon, an aggressive cancer.
“On July 27, a terminal diagnosis was confirmed through exploratory surgery. On September 3, 1970, at 7:12 a.m., Lombardi passed away in Washington, D.C., surrounded by his wife, parents, two children, and six grandchildren. He was only 57.”
Following Lombardi’s death, the Vince Lombardi Cancer Foundation was created to help find a cure and help prevent others from getting diagnosed.
Expert Colon Cancer Resources
- Yes, Women Do Get Colon Cancer
- Does Alcohol Impact the Risks for Colon and Other Cancers?
- Common Misconceptions About Colon Cancer
- Anxiety Around Colon Cancer Diagnosis
- Colon Cancer Diagnosis: What Happens After the Colonoscopy
- Colon Cancer Screening Options And Genetics: Myth Busting With Dr. Heather Yeo
The Vince Lombardi Cancer Foundation explains, “In June 1970, Coach Lombardi was diagnosed with an aggressive form of colon cancer and died just 10 weeks later on September 3 at the age of 57. The NFL commemorates his legacy by adorning the Super Bowl trophy with his name and he was inducted into the Pro Football Hall of Fame shortly after his passing.
“In honor of his legacy, the Vince Lombardi Cancer Foundation was established and works to prevent cancer, provide the best care to those fighting it and find a cure. Since we opened our doors in 1971, we’ve raised over $21 million to deliver on this promise. With your help, we will continue to prevent cancer, provide the best care to those battling it and find a cure. ”
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Colon Cancer: A Silent Killer
Dr. Heather Yeo, a colorectal surgeon and surgical oncologist at Weill Cornell Medicine and New York-Presbyterian, previously told SurvivorNet, “Colon cancer is considered a silent and deadly killer.
“What happens is people often don’t know that they have colon cancer. They don’t have any symptoms. That’s why we screen for colon cancer in the United States.”
The Rate of Colon Cancer is Increasing in Those Under 50
“You should be screened for colon cancer, even if you have no family history. Once you have your initial screening colonoscopy, if there are no polyps and you have no high-risk factors, usually once every 10 years is fine,” she advises.
“Colon cancer is a slowly progressing cancer. If you have any family history of colon cancer, you should be screened about 10 years before your family member had colon cancer. So if you have a family member that was 53, you should be screened at 43.”
Colon Cancer Appearing More in Younger People
Although the average age people are diagnosed with colon cancer is 68 for men and 72 for women, according to the American Cancer Society, the National Cancer Institute reports that since the 1990s, colorectal cancer cases have been rising among adults younger than 50.
Research published in CA: A Cancer Journal for Clinicians found the proportion of cases in people younger than 55 years old increased from 11% in 1995 to 20% in 2019.
“We know rates are increasing in young people, but it’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” cancer epidemiologist and lead study author Rebecca Siegel said.
Researchers are still trying to determine why younger people are being diagnosed in greater numbers. Some experts point to risk factors which include obesity, physical inactivity, and smoking as a possible explanation for the increase.
“We don’t know for sure why we are seeing earlier onset and death from colon cancer,” Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, told SurvivorNet.
“It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors,” Dr. Yeo added.
Screening for Colon Cancer
Luckily, most colon cancers can be prevented through routine screenings. Colon cancer screenings usually involve a colonoscopy, in which a long thin tube attached to a camera is used to examine the colon and rectum.
The advantage of a colonoscopy is that your doctor can remove any polyps found during the test before they turn into cancer. If no polyps are discovered, the next screening won’t be needed for about 10 years.
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A colonoscopy isn’t the only colon cancer screening test. There are other options, including stool tests that detect blood or DNA, and flexible sigmoidoscopy, which checks only the lower third of your colon.
Ask your doctor whether any of these tests would be good additions to a colonoscopy, based on your risks and/or personal preferences.
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“We know that colon cancers can be prevented when polyps are found early,” Dr. Yeo added. “Lowering the screening age helps somewhat with this, but access to care is a real problem.”
The American Gastrointestinal Association lowered the recommended initial age for a colorectal screening from 50 to 45.
“The fact that we have now reduced the screening age to 45 is a huge step,” Michael Sapienza, CEO of Colorectal Cancer Alliance, told SurvivorNet in an earlier conversation.
“It will allow us to potentially screen 15 million more eligible Americans a year and will certainly save lives. I also think what it’ll do is bring much-needed attention that even if you’re younger than 45 you should be paying more attention. I think that’s also a really important message.”
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What Increases Your Risk for Developing Colon Cancer?
For some people, certain risk factors can influence their risk of getting colon cancer. They include the following:
- Are older. About 90% of cases are in people aged 50 or older, according to the U.S. Centers for Disease Control & Prevention (CDC). Yet it is possible to get this cancer earlier in life.
- Have inflammatory bowel disease. Crohn’s disease or ulcerative colitis can, over time, cause cells in your intestines to turn cancerous.
- Have a family history of this cancer. Just under one-third of people who get colon cancer have family members with the disease.
- Have a gene mutation. About 5% of colorectal cancers are caused by an inherited genetic mutation that causes syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (Lynch syndrome).
- Don’t exercise very often. Staying active can lower your risk.
- Eat a diet that’s high in meat. Regularly eating red meats like burgers and steaks, and processed meats such as hot dogs and bacon might put you at higher risk. Eating more fruits, vegetables, and whole grains instead might lower your risk.
- You are overweight or obese. Having too much weight increases your risk of both getting colon cancer and dying from it.
- Drink a lot of alcohol. Limiting alcohol to one drink daily for women and two drinks daily for men could help lower your risk.
- Use tobacco. Long-term smokers are more likely to get this cancer than nonsmokers.
Keeping Up With Recommended Screenings
As a part of routine care, people who have had colitis for eight years or more may get a colonoscopy to screen for colon cancer every one to three years, depending on their individual level of inflammation.
In the general population, guidelines recommend colon cancer screening once every ten years starting at age 45. Follow up screenings sooner than ten years are based on whether you have any abnormalities.
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Doctors use colonoscopies to check for abnormal growths (polyps) in the colon that can be cancerous or develop into cancer. People with colitis tend to develop a different kind of polyp than other people do, and these polyps are more likely to contain atypical or pre-cancerous cells.
“So those polyps are one step closer to developing into cancer, whereas a lot of the polyps we find in the general population are benign,” Dr. Limketkai said.
Crohn’s disease, however, is a little bit different. Because this condition can affect any part of the GI tract, Crohn’s disease only raises risk for colon cancer if the inflammation is in the colon, which varies from one person to the next.
Does inflammation cause any other types of cancer? Dr. Stephen Freedland explains.
“If it spares the colon, then we don’t have to do all the surveillance that we do in colitis,” Dr. Limketkai explained. “Of course, you may need to have colonoscopies for other reasons, and while you’re doing that, you’re getting a screening anyway.”
When it comes to inflammatory bowel disease, the major risk factor for colon cancer is untreated disease. Treatment, which may include a combination of medication, dietary changes and routine endoscopies, keeps inflammation under control. Sticking to that treatment can help keep colon cancer risk to a minimum, too.
Treating Colon Cancer at Stages One, Two and Three
When it comes to treatment for colon cancer at stages one, two and three, there is the potential for a curative effect with surgical resection.
Colon Cancer Stages One, Two and Three
“As long as it hasn’t spread outside of the local area, it’s still considered a curable colon cancer,” Dr. Yeo told SurvivorNet.
According to Dr. Yeo, all patients with stage one to three colon cancers undergo surgery “if they’re healthy enough to tolerate it.” But there’s more nuance to the possibility of additional treatment for stages two and three.
“Stage 2 a little bit more in between,” she said. “It really depends on kind of the depth of the tumor into the colon wall and the risk that it has to spread.
If a stage two colon cancer has “bad features” identified by a pathology report, chemotherapy might be the right move.
“For example, if when they look at the pathology slides under the microscope, if they see that it’s involving some of the vessels nearby, then that is a higher risk factor,” she explained. “And then, those patients might be more likely to benefit from chemotherapy.”
Stage three colon cancers have spread to the lymph nodes. So, these patients “at least need a conversation of chemotherapy,” according to Dr. Yeo.
“For our patients with 3 or higher, they all need chemotherapy,” Dr. Yeo said.
Treatment Advances
Meanwhile, a new promising treatment for late stage colorectal cancer may soon be available for patients in need of options. The Food And Drug Administration (FDA) is currently reviewing the drug fruquintinib, an oral treatment by Takeda Oncology.
Fruquintinib is a targeted therapy for adults who have metastatic colorectal cancer and have tried other treatments. Results from a trial published in June showed the drug improved overall survival and progression-free survival, which is a measurement of the amount of time before the cancer comes back or spreads.
New Hope For Advanced Colorectal Patients: Drug Fruquintinib Shows Improved Overall Survival
When found early, colorectal cancer has a great prognosis. If detected before it spreads, 90% of those diagnosed have a 5-year survival. That is why so much emphasis is put into screening. But for those who are in a later stage, the prognosis is grim and there has been very little progress in treatment development.
Once you get to the metastatic setting, many patients “they just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda, to do this deal to in-license fruquintinib. We hope to give patients another option.”
Fruquintinib has been approved in China since 2018, and was originally developed by Chinese biopharmaceutical company HUTCHMED. Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong and Macau in January 2023.
Fruquintinib is an oral drug that inhibits angiogenesis, meaning it blocks the growth of blood vessels that increase tumor growth. It was investigated in two phase three trials for metastatic colorectal cancer.
“Both trials were robust large placebo controlled trials, and they both showed an overall survival advantage,” Elliott told SurvivorNet.
According to the study published in June, patients who received fruquintinib plus best supportive care (BSC) experienced 7.4 months of overall survival, compared to those who received a placebo plus BSC, who experienced 4.8 months of overall survival. And patients who received fruquintinib experienced 3.7 months of progression-free survival, over those who received placebo, who experienced 1.8 months of progression-free survival.
“I think what’s unique about fruquintinib is its manageable safety profile, as well as the fact that it didn’t decrease the quality of life of patients on the trial — which is really important in this late stage of disease,” Elliott told SurvivorNet.
The drug was granted Priority Review by the FDA and assigned a Prescription Drug User Fee Act (PDUFA) goal date of November 30, 2023. A marketing authorization application for the drug in Europe has also been validated.
Contributing: SurvivorNet Staff
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