Daniel O. Herzig, M.D.
Dr. Herzig specializes in the surgical treatment of colon and rectal diseases. In addition to starting Oregon’s first colorectal cancer registry, his research interests include colorectal surgery outcomes and hereditary colorectal cancer syndromes.
Early detection for colon and rectal cancers is key to survival
Screening guidelines and recommendations for colon cancer are being revised again, with a shift toward a shared decision-making model.
One message remains clear: a test (by any method) is better than no test. It is recommended that colon cancer screening be part of routine health maintenance in patients over 50. However, which specific screening method to use on each patient must be evaluated by each provider. Selecting an option can also be an opportunity to consider patient preference and risk tolerance.
Each screening method has benefits, risks and costs. A critical comparison of these methods is prevention versus detection. Though stool tests are noninvasive and convenient for patients, a positive result will trigger a colonoscopy anyway. Also, a positive result may indicate a cancer, rather than a removable polyp. However, compliance may be more successful with a stool test.
Comparing colonoscopy, FIT and Cologuard
Colon cancer can only be prevented when in the polyp stage, and colonoscopy is the only method for reliably detecting early polyps. However, colonoscopy is an invasive and expensive procedure that also requires bowel prep and takes several hours from prep to recovery.
• FIT (fecal immunochemical test)
Similar to earlier iterations of stool cards, FIT analyzes occult blood in the stool specific to human hemoglobin, so it doesn’t require dietary restrictions before the test. Though very inexpensive and easy to perform, this screening is designed to catch cancers rather than polyps.
• Cologuard DNA stool test
Approved by the Food and Drug Administration in 2015, this screening analyzes both stool and blood biomarkers associated with colorectal cancer. Pricier than FIT, the DNA test is also more effective at catching cancers.
Possible demographic shift should raise awareness
In February, the Journal of the National Cancer Institute released longitudinal study results showing that though colorectal cancers are declining overall, a younger cohort (under 50 years old) is experiencing an increase. The cause for higher risk in young adults is unclear, but about one-third of newly diagnosed rectal cancers are in patients under 55. Because these patients are under the standard screening age, most are getting a cancer diagnosis once they are symptomatic. In light of this apparent change in age risk, it is important to dispel the assumption in younger patients that rectal bleeding is a result of hemorrhoids. A random occasion may be considered an outlier, but if symptoms persist, a colonoscopy is recommended even if the patient is under 50.
Rectal cancer calls for specialized team
Unlike most colon cancers that are straightforward to treat, rectal cancer is complex. Data supports that rectal cancer patients require specialized expertise. At OHSU Knight Cancer Institute, we offer a multidisciplinary team and a personalized approach. Rectal cancer patients benefit from getting treatment in a center with a high volume and comprehensive team, trained in the specialized radiology, pathology, radio-oncology and more unique to rectal cancer.
OHSU quality metrics
Though colonoscopy is an excellent tool, the usefulness is dependent on the physician doing the screening. At OHSU, we have the quality metrics to prove our technology and technique. We also specialize in endoscopic mucosal resection for larger polyps. If cancer is found, our doctors have extensive knowledge about treatment options for colon and rectal cancer. Additionally, we are the only treatment program in Oregon that specializes in inherited colon cancer syndromes.
Oregon Colorectal Cancer Registry (OCCR) For people with a f amily history of colorectal cancer, particularly inherited syndromes, joining the OCCR can provide risk assessment, access to topical information and streamline patient visits. Those interested in joining complete a questionnaire and provide medical records for evaluation.
For more information, visit www.ohsuknightcancer.com/occr
When to consult or refer
If your patients have any of the following issues, contact us.
- Large polyps that need advanced techniques to remove via colonoscopy.
- Strong family histories of colon cancer who want to pursue genetic testing.
- A diagnosis of colon or rectal cancer.
For a consultation, please call the OHSU Physician Consult & Referral Service at 503-494-4567. To refer a patient, please fax to 503-346-6854. For more information on treatment options and to meet our team, visit www.ohsuknightcancer.com/colon.Back to articles