Treatment for throat and mouth cancers, also referred to as oropharyngeal or head and neck cancers, will depend on location and stage of the cancer as well as other factors. Dr. Phillip Pirgousis, a Mayo Clinic head and neck surgeon, says patients have safer, less invasive surgical treatments available to them thanks to ongoing innovation.
In the past decades the incidence of colorectal cancer (CRC) in people under the age of 50 years has increased, which is referred to as early-onset CRC or young-onset CRC (YO-CRC). YO-CRC is expected to account for 11% of colon cancers and 23% of rectal cancers by 2030. This trend is observed in different parts of the world and in both men and women. In 20% of patients with YO-CRC, a hereditary cancer syndrome is found as the underlying cause; however, in the majority of patients no genetic predisposition is present.
Beginning in the 1950s, major changes in lifestyle such as antibiotic use, low physical activity and obesity have affected the gut microbiome and may be an important factor in YO-CRC development. Owing to a lack of screening, patients with YO-CRC are often diagnosed with advanced-stage disease. Long-term treatment-related complications should be taken into account in these younger patients, making the more traditional sequential approaches of drug therapy not always the most appropriate option.
To better understand the underlying mechanism and define relationships between environmental factors and YO-CRC development, long-term prospective studies are needed with lifestyle data collected from childhood.
Myth. Colorectal cancer is the second-leading cause of cancer-related death in men and women combined. Roughly 1 in 25 women will have colorectal cancer, and about 1 in 23 men will have colorectal cancer. To put that in perspective, when watching a football game, of all the players on the field, about one player would be diagnosed with colorectal cancer in their lifetime.
Fact. The rate of colorectal cancer is increasing in people under 50. Rates of colorectal cancer in people under 50 have doubled since 1990. In people over 65, the diagnosis rates have been decreasing, most likely because of colorectal cancer screening.
ANSWER: Colon cancer is one of the most common malignancies in the U.S., with more than 100,000 new cases diagnosed each year. Over a lifetime, it is estimated that 1 in 23 men and 1 in 26 women will be diagnosed with colon cancer. Typical colon cancers start as a polyp-like growth in the inside layer of the colon, which can be seen during a colonoscopy. Most cancer organizations recommend starting colonoscopy screenings at age 45.
When the treatment team is concerned about achieving negative margins, or removing the entire tumor with an edge of normal tissue around the specimen, intraoperative radiation therapy may be considered. Intraoperative radiation therapy rarely is used for colon cancer, but, when necessary, the area of concern is directly targeted with a single fraction of radiation during surgery.
When a mass is found during a colonoscopy or cancer is suspected, biopsies are taken and reviewed by a pathologist. In this scenario, most patients are asymptomatic. Without preventive colon cancer screenings, a tumor may grow to an advanced stage before it causes any symptoms that a patient or health care professional would recognize. The most common signs and symptoms of colon cancer are anemia, which may lead to fatigue; abdominal pain; blood in the stool or other bowel changes; weight loss; and signs of obstruction.
Once colon cancer is diagnosed, the next step is a staging examination. This involves a history and physical examination; blood work; confirmation that a full colonoscopy has been performed; and CT scans of the chest, abdomen and pelvis. The results of these tests will allow your health care professional to assign a clinical stage. In stages 1 and 2, the tumor remains in the colon wall with no evidence that it has spread further. With stage 3, there is concern that the tumor cells have spread to the regional lymph nodes, and in stage 4 colon cancer, the tumor cells have spread outside of the local area to other organs — most commonly the liver, lungs or peritoneum.
Surgery is the mainstay of treatment for stages 1, 2 and 3 disease and is usually the first step in the treatment process. The segment of the colon bearing the tumor is removed, along with the draining lymph nodes. The ends of the intestine are reconnected, and the specimen is sent to the pathologist who then performs a histologic examination of the colon and the associated lymph nodes. The pathologist will assign a final pathologic stage to the tumor, which will dictate the need for any additional treatment.
Risks factors for developing this type of cancer include environmental exposures like smoking, high blood pressure, a history of kidney failure, obesity, or not having a healthy weight. And there are also hereditary syndromes that may your risk for kidney cancer.
Dr. Thai Ho, a Mayo Clinic oncologist who specializes in genitourinary malignancies, says there are no screening tests specifically for kidney cancer. When it is discovered early, it’s usually from an imaging test for another issue.
Early diagnosis and treatment often lead to better outcomes. A diagnosis of lung cancer often begins when a chest X-ray or computed tomography (CT) scan shows a nodule—an area of abnormal tissue—in the lungs. If the nodule is suspicious or grows over time, doctors will perform a biopsy to collect a tissue sample that can be tested for the presence of cancer cells. Bronchoscopy is a widely used procedure for biopsying lung nodules.
In traditional bronchoscopy, a doctor manually guides a thin tube, called a bronchoscope, into the patient’s mouth or nose, down the throat, past the vocal cords and windpipe, and into the passageways of the lungs. The bronchoscope is equipped with a light, camera, and biopsy tools that allow doctors to visually examine and biopsy nodules. But robotic bronchoscopy is different. Like traditional bronchoscopy, it’s a minimally invasive procedure that allows doctors to biopsy nodules in the lungs.
The difference is that in robotic bronchoscopy, the doctor uses a controller at a console to operate a robotic arm. The robotic arm guides a catheter—a thin, flexible, and maneuverable tube equipped with a camera, light, and shape-sensing technology—through the patient’s airways. The robotic arm’s precise movements enable doctors to accurately direct the catheter around tight turns in the airways and into the hard-to-reach areas of the lungs. This means doctors can examine and biopsy suspicious nodules—and potentially detect cancer—in parts of the lungs that may be inaccessible with traditional bronchoscopy.
What’s more, the procedure is safe—serious complications are rare—and recovery is usually quick. “As part of the comprehensive Thoracic Oncology Program, we are now able to offer patients the option of robotic bronchoscopy,” says Yale Medicine interventional pulmonologist Christopher Morton, MD. “This technology will allow us to biopsy lung nodules and masses with improved accuracy and fewer side effects, in addition to lymph node biopsies that we already do. This will get patients diagnosed and referred to the appropriate treating physician quicker.”
“Many health conditions have a genetic link,” says Breanna Mitchell, a genetic counselor at Mayo Clinic Health System in Eau Claire. “Genetic testing can help you and your health care team understand if you have an increased risk for developing certain conditions that are present in your family. If you are at risk, you may be able to take preventive measures to decrease your risk or undergo genetic testing to clarify your risk.”
Here are nine common questions about genetic testing:
Most cancers are considered sporadic, meaning the cancer happens randomly or has environmental influences, such as smoking and lung cancer. About 25% of cancers are considered familial. This is when multiple members of a family are affected by cancer. These family members have some shared genetic factors in combination with shared environmental factors that lead to the development of these cancers.
“About 10% of cancers are considered hereditary or have a single specific genetic component that can be tested and increase a person’s risk for developing cancer,” Mitchell says. “Genetic counseling and genetic testing can help determine which category a person’s individual or family cancer falls into. It also can help estimate your risk for developing cancer.”
You may have an increased risk for some health conditions, including some types of cancer, based on your genes. A genetic test looks for specific harmful gene changes, called mutations or pathogenic variants, that can cause you to develop a genetic condition. Gene changes are like spelling errors within your body’s instruction manual.
Most genetic tests look for changes in a group of genes called a panel. However, testing may look for changes in a single gene when there is a known genetic mutation in your family. The most common genes typically thought of related to cancer risk are BRCA1 and BRAC2. These genes are associated with breast and ovarian cancer. It’s known that changes in other genes can increase risk for these cancers, as well.
There also are gene panels that assess risk for other cancers, such as colorectal, pancreatic, prostate, liver, uterine and endometrial cancers.
Learning about cervical cancer can be intimidating. Kristina Butler, M.D., a gynecologic oncologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.
Video timeline: 0:00 Introduction 0:38 What is cervical cancer? 1:16 Who gets cervical cancer? / Risk factors 2:23 Symptoms of cervical cancer 3:03 How is cervical cancer diagnosed? 4:26 Treatment options 5:20 Coping methods/ What now? 6:10 Ending
Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm.
However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.
Prostate cancer that’s detected early — when it’s still confined to the prostate gland — has the best chance for successful treatment.
Prostate cancer may cause no signs or symptoms in its early stages. When it’s more advanced may cause signs and symptoms such as:
COMMENTARY:
PSA screening will pick up prostate cancer very efficiently. However, it will also pick up slow growing cancer that might never be require treatment, and responding to the positive test could cause problems ranging from pain and convenience to erectile dysfunction and incontinence.
It takes 1000 men screened to produce one life-saving treatment for prostate cancer.
Risk reward analysis means that the younger you are, the more reasonable is a test, since you have many more years of potential life. The older you are, conversely, the less you have to gain. The problem is that most cancers are slow growing, and might never cause a problem, especially if you have only a few years left to live.
Most experts recommend a test when a man reaches the age of 45, but reserve annual testing for those who are at high risk, such as having a brother or father with aggressive prostate cancer.
When a man reaches the age of 70, most experts would decline to test.
Sometimes, emotional considerations present themselves; worry is very much a disease. For instance, the best man at my wedding stopped getting his PSA test about three years before he was diagnosed with fatal metastatic prostate cancer. I am inclined to continue getting my annual prostate test, and would worry if I didn’t.
A recent study in the journal Cancer reported that more than half of a group of men 75 years and older had PSA tests and biopsies.
As an interesting aside, the PSA test is the only test I have ever had rejected by Medicare, presumably because of this expert opinion factoring in the cost benefit analysis of using the test.
—Dr. C.
“Colorectal cancer is almost entirely preventable with proper screening,” says senior author Michael B. Wallace, M.D., division chair of Gastroenterology and Hepatology at Sheikh Shakhbout Medical City in Abu Dhabi, United Arab Emirates, and the Fred C. Andersen Professor at Mayo Clinic in Jacksonville, Florida. “The substantial decrease in miss rate using AI reassures health care providers on the decreased risk of perceptual errors.”
The most relevant cause of post-colonoscopy colorectal cancer (CRC) is the miss rate of colorectal neoplasia — the rate at which neoplastic lesions are not detected in a screening or surveillance colonoscopy. Some studies suggest that 52% to 57% of post-colonoscopy CRC cases are due to missed lesions at patients’ colonoscopies. It’s estimated that 25% of neoplastic lesions are missed following screening colonoscopy.
Mayo Clinic Gastroenterology and Hepatology, in collaboration with colleagues from around the world, found that using artificial intelligence (AI) in colorectal cancer screening produced a 50% reduction in the miss rate for colorectal neoplasia. Results of the study were published in the July 2022 edition of Gastroenterology.
Doctors Without Waiting Rooms 