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Q&A with Dr. Brandon Sheffield, Pathologist
In this Q&A, Dr. Brandon Sheffield, Pathologist with the William Osler Health System in Brampton, Ontario, answers your questions about colorectal cancer.
Does H. pylori play a factor in colorectal cancer?
No, not to my knowledge. But H. pylori is a well known risk factor for stomach cancer, so if you have an infection, make sure to get treatment!
Should patients ask their surgeon or oncologist to go through their pathology report?
It’s up to you. Rest assured that your surgeon (and oncologist, if you have one) will have gone over your pathology reports before your operation, after your operation, and before starting on any systemic therapy. If you would like to go through your pathology report with your care team, that is ok and feel free to ask. It is also ok to keep a copy of your pathology report for your own records.
How long does it take for a tumor to grow, I did not have any symptoms and was diagnosed with stage 3 colorectal cancer and the tumor was quite large I believe they said it was the size of a lemon on my ascending colon?
That’s really hard to say. Every tumor grows at a different rate. Typically, we recommend colonoscopies at intervals up to 10 years. This means that most tumors grow slowly and after ensuring the colon is clear, patients will be at a lower risk of developing a cancer in the near future. Some individuals, either due to previous cancers, polyps, or a strong family history may be at higher risk of developing colon cancer, and screening at shorter intervals may be indicated in these situations.
As far as developing symptoms goes, that can be tricky, some patients have symptoms from very small cancers, but other cancers can grow very large before being detected. Part of this can be explained by the location of the colon where the cancer starts. For instance, the cecum (on the right side of the colon) has a very wide diameter, and is also very stretchy, so tumors in this area tend to grow very large before they are detected.
Can we expect ctDNA to become a standard of care in cancer care?
Certainly. ctDNA, or liquid biopsy, carries tremendous promise as a tool in cancer care. Many centres are now offering this to patients, and additional laboratories are offering this privately to patients. If you think a ctDNA test may be helpful to you, please talk to your oncologist about it. This test is not publicly funded in Canada, but continued advocacy from both physicians and patients will help change that!