Counting blessings in the fight against colorectal cancer

By Michael Gibson Morris/NEMS Daily Journal

In the fight against colorectal cancer, there’s much to be thankful for.
More colorectal cancer is being prevented or caught early when its very treatable because of increased screening, said Tupelo gastroenterologist Dr. Stephen Amann.
“Colon cancer screening is finally turning the corner,” Amann said. “Screening has made a difference.”
Even against advanced colon cancer, oncologists have better tools to fight the disease and buy patients more time. Before the 1970s, people with colon cancer that had spread to the liver lived less than six months, said Tupelo oncologist Dr. Chris Croot. Now Croot has a patient who has made it five years with metastatic colon cancer.
“She wouldn’t be here if not for the drugs,” Croot said.
For colorectal cancer survivor Kelly Cofer, the string of blessings starts with his neighbor Lyle Megginson.
Cofer decided to get a colonoscopy in February 2008 at age 47 after Megginson was diagnosed with colon cancer. Cofer had no obvious symptoms and he could have put it off until after the big 5-0. He was diagnosed with colorectal cancer either at a very late Stage II or very early Stage III.
Cofer’s oncologist at M.D. Anderson Cancer Center in Houston, Texas, told him he owed Megginson a tremendous debt. He said Cofer should call his friend and tell him he saved Cofer’s life.
Cofer finished active treatment in January and has been doing well.
“At every turn I’ve been fortunate,” Cofer said.

More options
Colorectal cancer is one of the few cancers that give doctors something they can see and act on before it becomes cancer. But outside the colon, there are no warnings.
“Unfortunately, there’s no symptoms until it’s too late,” Amann said. “That’s why you’ve got to have screening.”
Colorectal cancer has a very clear progression. A non-cancerous polyp – a little growth that comes out of the colon wall – will eventually grow into an invasive cancer.
“If you take the polyp out, you have prevented colon cancer,” Croot said.
Wider screening for colorectal cancer has made a tremendous difference in colon cancer.
“A lot can be attributed to Katie Couric,” whose began an awareness campaign after her late husband was diagnosed with late-stage colon cancer.
Access is still an issue.
“Not all insurers cover colon cancer screening,” Amann said, although it is covered by Medicare.
Where access to screening is good, more colorectal cancer is found early, Croot said. Where access is poor, there’s a migration to later stage disease.
In addition to gains in screening, there also have been gains in treating colorectal cancer. In the early stages, all patients may need is surgery, Croot said.
But even people with colon cancer that has spread to the liver – the most advanced stage – there’s been significant improvement.
Even 10 years ago, the average survival for a metastatic colon cancer patient was 13 to 14 months, Croot said. Over the past decade, physicians have new drugs like Avastin, which attacks a tumor’s blood supply and monoclonal antibodies that very specifically target tumors and spare healthy tissue that builds on the successes of other chemotherapy regimens, Croot said.
“When we use those drugs together, the average survival is up to 24 months,” Croot said.
The next big leap is using gene profiles to identify risk of reoccurrence, so those patients can be treated more aggressively.
Researchers have identified a profile for breast cancer patients that has been very effective, and so far, the studies have been strong on a profile for colorectal cancer.
“If that works out, it will be really great,” Croot said, and it should be widely available relatively soon.

Personal journey
After his experience, Cofer is now a herald for the value of screening.
“I plead with my friends, go have colonoscopy,” Cofer said.
Cofer had a relatively common form of colorectal cancer, but because of an unusual location at the extreme end of the colon, his physicians recommended he get treatment at well-respected M.D. Anderson where the surgeons had more experience in resecting that area.
“In Tupelo, they do 10 a year,” Cofer said. “My surgeon does 10 a week.”
Because his oncologists couldn’t rule out lymph node involvement, they treated him as if he had Stage III disease.
Instead of going straight to surgery, Cofer went through a round of oral chemotherapy and radiation before surgery to shrink the tumor.
“We were fortunate,” Cofer said. “I was incredibly responsive to the oral chemo and radiation.”
After surgery in July, the tumor had been reduced to scar tissue and all of his lymph nodes were clear.
After recovering from surgery, Cofer went through a very aggressive chemotherapy regimen over six months.
“It was tough,” Cofer said. “I could not have gotten through this without Kathy … I’m not John Wayne.”
Son Kyle has been very steady, too, through the whole journey.
“The biggest blessing is that it’s me going through it,” Cofer said. “He’s not going through it; Kathy’s not going through it. It would be even more difficult to watch them.”
Cofer’s journey through cancer has left him with a determination not to get too wrapped up in the mundane details of life.
“When you go through something like this you really become aware of your mortality and your desire to live,” Cofer said.
Because so many people beyond his family reached out to him during his treatment, he’s also determined to keep reaching out to others going through cancer.
“It’s like joining a bad fraternity,” Cofer said. “You feel close to those who’ve gone through it, because you know what hell they’ve gone through.”