March is Colorectal Cancer Awareness month. Although colorectal cancer is among the leading causes for cancer-related deaths, treatment for the disease has been steadily improving.
That includes surgery, which traditionally, has been a fairly invasive process. This is something that Evie Carchman, MD, FACS, is working to change. Carchman, a UW Carbone Cancer Center member and an assistant professor in the Department of Surgery, has a clinical practice that focuses on managing colon and rectal disease, and specializes in using minimally invasive surgical techniques.
“Most colorectal surgeons have moved to minimally invasive approaches to improve patient satisfaction, patient care and patient outcomes,” Carchman said.
UW Health clinics offer two types of minimally invasive approaches: laparoscopic and robotic. Whereas robotic surgeries allow for three-dimensional visualization of the surgical field and increased movement of instruments, the surgical procedure itself is the same regardless of the approach used, says Carchman. From the surgeon’s perspective, advances in technology have meant that these procedures provide the benefit of helping people recover from their surgery faster.
“They have less pain, they get out of the hospital faster, and they get back to normal activities faster,” Carchman said. “I think any minimally invasive approach – either laparoscopic or robotic – provides several advantages to the patient.”
Outside of the clinic, Carchman’s lab researches anal cancer with the goal of helping bring new therapies to her patients and preventing this devastating disease.
“There’s a social taboo associated with talking about anal cancer and precancerous lesions,” Carchman said. “It’s not like breast cancer or colon cancer, which are pretty common diseases. This is pretty rare.”
Although diseases of the colon, rectum, and anus are often grouped together, Carchman explained that the approaches to preventing and treating anal cancer reflect the key differences in how anal cancer starts compared to colorectal cancer.
“Anal cancer is mainly caused by persistent infection with the human papillomavirus while rectal cancer is associated more with genetic mutations that some people inherit from their parents or that they obtain throughout the course of their life,” she said.
This link between chronic HPV infection and anal cancer makes the disease similar to cervical cancer. Clinicians and researchers alike are interested in ways to prevent the anal cancer, but unlike with cervical cancer, much less is known about how best to treat precancerous anal lesions to prevent cancer development.
“It’s a hard conversation to have with patients, when discussing screening and treating precancerous lesions, as we don’t know how much benefit they are receiving based on currently available data.” Carchman said.
The current best practice at UW’s high resolution anoscopy clinic, which Carchman directs, is to destroy those precancerous lesions with cautery, excision or topical treatments to prevent them from turning into cancer.
“Ideally, everybody would get the HPV vaccine, which would actually decrease the chances of getting anal cancer,” Carchman said.
However, since national HPV vaccination rates are still very low, Carchman and her colleagues are exploring other interventions. She is the principal investigator of a phase I clinical trial studying the effect of using artesunate suppositories to treat high-grade premalignant anal lesions. She also has a basic science laboratory that uses preclinical models to advance the research.
Her research group is looking into the potential use of topical treatments to inhibit different cellular pathways as other means to halt the progression of precancerous lesions into cancer.
“We are exploring therapies that will be better tolerated by patients, with fewer side effects, and that don’t interact usually with other medications that the patient may be on for other chronic medical conditions,” Carchman said.
In the company of a robust virology program – including research on the role HPV in cancer from Paul Lambert, PhD – Carchman hopes her lab can take advantage of the resources available on UW’s campus. Using preclinical models of anal cancer, her group can test hypotheses about this rare disease and the safety of new treatments.
“We can hopefully take all that knowledge gained from them to translate it to something that’s going to actually improve patient care,” she said.
University of Wisconsin Hospitals and Clinics Authority