Duke Cancer Institute’s colorectal surgery team has implemented several quality improvement initiatives. Karen L. Sherman, MD, MS, a Wake County-based colorectal surgeon, explains that expertise in minimally-invasive surgical techniques and the enhanced recovery after surgery (ERAS) program have contributed to the program’s successful outcome measures, such as reduced length of stay in the hospital. 

“Implementing new guidelines for colorectal cancer screening will also improve outcomes. The recommended age for screening colonoscopy has decreased from age 50 to 45 for patients with an average risk,” says Sherman. “Screening colonoscopy can help diagnose colorectal cancer while in earlier stages, leading to better outcomes.”

Colorectal cancer screening recommendations with colonoscopy changed in 2021 due to the higher incidence of colorectal cancer in younger people. “While the majority of patients diagnosed with colorectal cancer are age 65 and older, we are seeing patients with colorectal cancer in their 20s, 30s, and 40s”, says Sherman. 

There are many risk factors for developing colorectal cancer, including lifestyle, environmental factors, obesity, smoking, sedentary lifestyle, alcohol intake, and genetics, though genetics only influences a small portion of colorectal cancer cases.

For patients with a first-degree family member who has had colorectal cancer, screening begins 10 years younger than the age of the family member at the time of their diagnosis. Patients should also be aware of symptoms. Rectal bleeding, a change in bowel movements, unintentional weight loss, and iron deficiency anemia, should prompt a discussion with a primary care physician.

“Don’t hesitate to refer a patient of any age with symptoms for a colonoscopy because it could expedite important care for them,” says Sherman. 

Sherman and her team, including colorectal surgeon Katharine Louise Jackson, MD, MBBS, are experts in minimally invasive robotic and laparoscopic surgical techniques. Minimally invasive surgery leads to a faster return to regular activities, less pain, and a quicker discharge after surgery. 

Treatment is individualized based on the stage and location of the cancer. After surgery, some patients need a temporary or permanent ostomy bag. “Many patients don’t need this, but if they do, we help them manage this change,” says Sherman. 

The team’s commitment to optimal outcomes reflects their ability to implement the Enhance Recovery After Surgery (ERAS) program. ERAS is a collection of evidence-based protocols that help reduce the risk of perioperative complications in colorectal patients. 

The team also participates in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). NSQIP is a nationally-validated program that measures the quality of surgical care.

Effectively treating colorectal cancer takes a multidisciplinary team. Surgery is the primary treatment for colon cancer, and sometimes chemotherapy. Rectal cancer treatment usually involves a combination of surgery, chemotherapy, and radiation therapy.

“We have a team of medical oncologists, radiation oncologists, and a stoma nurse at Duke Cancer Center Raleigh, and we coordinate appointments with multiple providers as needed,” says Sherman. 

Specialists review cases at multidisciplinary tumor boards so each patient receives multiple expert opinions for a coordinated, personalized care plan. After surgery, patients are monitored based on guidelines supported by the National Comprehensive Cancer Network (NCCN) surveillance program.