Elena Elez, oncologist Pau Donesa: “We are concerned about the increase in the incidence of colon cancer in people under 50 years old”

The oncologist who treated Po Dones Elena Elez (Lleida, 1978), remembers him as a person who did not lose his “identity” despite his illness. Musician Jarabe de Palo was diagnosed with colorectal cancer in 2015 and died five years later. Elez, Physician, Gastrointestinal Tumor Unit, Department of Medical Oncology, Val d’Hebron Hospital and researcher Institute of Oncology Val d’Hebron (VHIO) And CRIS Cancer Foundation, explains in EL PERIÓDICO the keys to this disease.

Are colon cancer cases increasing?

It is the third most common tumor overall in both men and women combined. And the incidence has increased significantly, but this is largely due to the implementation of early detection programs. These are stool occult blood tests, which allow not only to diagnose colorectal cancer in the early stages, but also – this is the most important thing – to identify precancerous formations, such as polyps or adenomas. This is why it is true that the incidence has increased.

“Colon cancer is a disease associated with aging: it is most often diagnosed between the ages of 50 and 69 years.”

Also among young people?

We are concerned that we are seeing an increase in youth, people under 50 years of age. Colon cancer is a disease associated with aging: it is most often diagnosed between the ages of 50 and 69 years. Population screening programs target this age group. The United States has already seen an increase in the incidence of colon cancer in people under 50 years of age. Here in Spain we are working to be able to identify it among this population group as well.

“The incidence has increased significantly, but this is largely due to the implementation of early detection programs”

Why is this happening?

We’re probably a little later than the US because the trend there is thought to be due to changing lifestyle habits. There are more sedentary lifestyles, changes in diet, eating more processed foods, less exercise, and it’s possible that all of these could be contributing to us seeing cancer at a younger age. However, these are hypotheses: today we are still figuring out why this happens, and whether this type of tumor in young people is different from what we see in older people.

“There is a more sedentary lifestyle, consumption of more processed foods and less exercise, but these are just hypotheses. More research is needed.”

Will the screening age for colorectal cancer be raised? How are things going with mom?

This needs to be determined. Step number one is what has already been done in the United States, namely the study of population registries – where diagnoses of a particular disease are officially recorded – where scientific societies and joint research groups are already starting to work.

Does colon cancer survival improve?

Survival rates for colorectal cancer have improved significantly. There are several reasons for this: the first is population screening programs. The sooner we diagnose it, the better. And at earlier stages there is better survival rate. However, up to 20% of all these patients have metastatic or disseminated disease—what we call stage IV—which occurs when cells are present in other organs. With colorectal cancer, you can often see cells that have metastasized to the liver, lungs, peritoneum…

What is the survival rate in these cases?

Statistics say that the five-year survival rate from diagnosis is about 20%. However, these are statistics and generalizations should be avoided. Fortunately, our better understanding of the biology of colon cancer has enabled the development of targeted therapies. We are already working with the concept of precision medicine because each tumor has its own survival mechanisms.

Targeted therapy has helped us prolong our lives. If 20 years ago the survival rate was about nine months, now there are patients who achieve a survival rate of 40 months.

And not all tumors are the same.

There are some common mutations that usually speed up the progression of the disease, but there are others that are specific to each tumor type. Today we take a piece of the tumor, extract the DNA of the tumor and sequence it. And we’ll see what mutations there are in this DNA. Thanks to these mutations, we have the opportunity to choose the most appropriate therapy for each patient.

And it improves survival.

The earlier introduction of targeted therapies has allowed us to gain many years of life and overall survival. That is, if earlier, 20 years ago, survival rate for colorectal cancer was about nine months, now there are patients who can achieve a survival rate of 40 months or even be cured. That is, each case must be assessed individually, and what is very important: these clinical cases should always be discussed by multidisciplinary commissions and a molecular characterization of the tumor should be carried out.

“Together with the CRIS Foundation, we are trying to understand why some patients respond so well and others do not, and to develop other drug combinations.”

They are working with support from the CRIS Cancer Foundation to develop these targeted therapies.

We have a very broad line of research focused on a very aggressive tumor type in colorectal cancer, that is, colorectal cancer with a mutation in the BRAF oncogene. Patients with this mutation have advanced disease, usually stage IV, and have a worse prognosis. In addition, these are tumors that respond less well to various treatments. These worsen the prognosis and are also tumors that respond less well to various treatments. That’s why we’ve been working on therapies targeting this specific oncogene since 2012.

And what did they see?

There are treatments that target this oncogene that work very well in certain types of patients. But there were others who, despite the same mutation, did not respond as well, and if they did, the duration of the response was short in time. So, with the help of the CRIS Foundation, we’re trying to understand why some patients respond so well and others don’t, and we’re developing other drug combinations that help us do that.

Worldwide, the survival rate for colon cancer is very high if we diagnose it in its early stages. But there are 20% of cases with lower survival rates.

Is colorectal cancer curable in most cases?

In the vast majority of cases (80%), we diagnose it in the early stages, and the five-year survival rate reaches 95%. Worldwide, the survival rate for colon cancer is very high if we diagnose it in its early stages. But then we have the remaining 20% ​​that I mentioned earlier—where the disease is disseminated—who have the lowest survival rate.

Doesn’t the Mediterranean diet protect against colon cancer?

Probably yes, which is why we said earlier that it would take us a little longer here in Spain to see the effect (which is already happening) in the US. Here are some habits—olive oil, eating fruits and vegetables, and finally a varied diet—that, when combined with exercise, protect against more than just cancer. But we tend to lead more sedentary lifestyles, drive or subway more, walk less, pollution may also play an important role… This is being studied, but probably all of this contributed to the disease, which previously took time. appear now to appear ahead of time.

What is the importance of organizations like the CRIS Cancer Foundation?

This is very important. Our healthcare system is excellent, but resources are inadequate. If cancer treatments have improved so much, it is because of research, because we understand why these tumors develop, why they survive, why they respond or are resistant to therapy: this can only be done through research. But the resources available for research are limited, so any help is greatly appreciated. What CRIS has going for it is that it has invested heavily in the role of a medical researcher who is involved in carrying out research tasks while practicing medicine.

You were Pau Dones’ doctor.

Yes, he brought attention to the problem of colon cancer from the very beginning. He helped many patients on a daily basis and also helped us develop research projects that even allowed us to develop new therapeutic strategies against this very aggressive tumor type (musician mutation in the BRAF oncogene).