For patients with multiple cancers, colorectal cancer diagnosis could be lifesaving-or life-threatening: Study

“We expected isolated CRC patients to fare best, but patients with CRC diagnosed first, followed by another cancer had the best survival rates. This was surprising; we hypothesized patients with only a CRC diagnosis would do best,” said first author Anjelli Wignakumar, MBBS, BSc (Hons), a clinical research fellow at the Department of Colorectal Surgery, Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic Florida.

Potential Explanations

There are multiple potential reasons why Group B patients, with multiple cancers, would fare better than Group A, who only had CRC. The first is the increased surveillance and interaction with the medical system that comes with cancer diagnosis. Increased monitoring leads to cancers being caught earlier. Prior cancer treatment may prime the immune system to fight subsequent cancers. Healthier habits post-diagnosis could also improve outcomes.

Another difference was that “Group A patients were younger, presented more aggressively (higher liver metastases), and were less likely to receive surgery — possibly because their disease was further along,” said Dr. Wignakumar.

Clinical Implications

For providers, the researchers emphasize that patients with a prior history of non-CRC cancer may require more intensive CRC screening. “Group C (CRC as the second cancer) had the worst outcomes. Clinicians must treat these as high-risk cases and consider aggressive therapy,” said Sameh H. Emile MBBCh, MSc, MD, FACS, co-author and a project scientist at the Department of Colorectal Surgery, Ellen Leifer Shulman & Steven Shulman Digestive Disease Center, Cleveland Clinic Florida.

For patients: “Surviving CRC doesn’t make you immune to other cancers, but the next one could have better outcomes,” emphasized Steven D. Wexner, MD, PhD (Hon), FACS, senior author, and director of the Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic Florida. “Follow all recommended screenings — catching the next cancer early saves lives.”

Reference:

Wignakumar, Anjelli, Does the Sequence of Colorectal Cancer Diagnosis Matter for Patients with Multiple Primary Cancers? A Surveillance, Epidemiology, and End Results Database Cohort Study, Journal of the American College of Surgeons, DOI: 10.1097/XCS.0000000000001413.