Dr Richard Goldberg of Fight Colorectal Cancer: 5 Things Everyone Needs To Know About Cancer
An Interview With Savio P. Clemente
You can’t catch cancer from another person: There is no reason to avoid being around people who have cancer. It is important that people with advanced cancer can continue to interact with family and friends. Even those with late-stage disease need to have companionship and company.
Cancer is a devastating and terrifying disease. There is so much great information out in the universe — at our fingertips on our phones, tablets, or laptops; on TV and in newspapers — but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?
In this interview series called, “5 Things Everyone Needs To Know About Cancer,” we are talking to experts, such as oncologists, researchers, and medical directors, about cancer to address these questions. As a part of this interview series, I had the pleasure of speaking with Dr. Richard Goldberg.
Richard M Goldberg, MD, served as West Virginia University Cancer Institute’s (WVUCI) Director, and Director of the WVU Cancer Signature Program from 2016 to 2019. He served as a member of WVU health sciences Vice President and Executive Dean, Clay Marsh’s leadership team. As WVUCI’s Director, he oversaw the clinical, research, and teaching missions of the cancer institute and its component organizations, which include satellite clinical and clinical research locations dispersed throughout West Virginia. Dr. Goldberg serves on several national scientific advisory committees, and on the scientific advisory committee for a number of pharmaceutical companies at the corporate level. He is a Fellow in the American College of Physicians and the American Society of Clinical Oncology. Dr. Goldberg also serves as a board member for the national advocacy organization Fight Colorectal Cancer.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory? Who or what inspired you to pursue your career? We’d love to learn more.
I grew up in upstate New York in the country. I had a formative childhood experience where I was stung by a bee and had an anaphylactic reaction. We happened to live across the street from a surgeon who was washing his dishes and saw me go down and realized what was happening. This was during the days when doctors still carried their little black bags. He saved my life that day and that was when I decided I wanted to be a physician one day. I became an oncologist because of a teacher named Dr. Martin York at Emory University where I did my residency. I have been a colorectal cancer and gastroenterologist (GI) cancer physician and researcher for more than 40 years working at various places including the Mayo Clinic, University of North Carolina, Ohio State University, and finishing my career as the director of the West Virginia University Cancer Institute, where I was working with underserved populations who have difficulty getting access to quality cancer care.
I have been active in writing and running clinical trials and managing clinical trials programs over the years. I feel fortunate to have seen the progress in colorectal cancer treatment over the years. But until we can save every single person who is diagnosed with colorectal cancer we will not have seen enough progress.
This is not easy work. What was your primary motivation and drive behind the work that you do?
I was seeing patients every day who had GI cancers. When I started as an oncology fellow in 1982, there was only one drug, Fluorouracil (5-FU), that helped people with advanced GI cancers, and it did not help very much. The average person with colon cancer that had spread beyond the colon would live about eight months without chemotherapy and when treated with 5-FU patients had about 12 months of life expectancy. Now with advances in treatment, patients are averaging closer to 30 months of life expectancy, and some patients that are diagnosed with late-stage colorectal cancer are seeing no evidence of disease. When I started, there was a big unmet need for colorectal cancer treatment. Those of us that were working in the field caring for patients every day wanted things to be better. That is the reason why I worked so hard on advancing research in this disease during my career.
What are some of the most interesting or exciting projects you have worked on? How have they helped others?
One of my biggest contributions came from working on a phase 3 trial for patients with advanced colorectal cancer. In Phase 3 studies we compare standard of care to one or more new treatments. The new treatment in this particular study was a drug called Oxaliplatin. Oxaliplatin is a chemotherapy drug that was discovered in Japan and initially developed in Europe, and there were some early reports of promising results with it. We worked with the National Cancer Institute to start a clinical trial looking at standard of treatment compared to an Oxaliplatin containing regimen known as Folfox. The results were very positive and led to the FDA approving Oxaliplatin for treatment in patients with advanced metastatic colon cancer. That drug program is still the standard of care for patients today, over 20 years since the original study was published.
I also worked on the initial studies done with an immunotherapy drug called Pembrolizumab (Keytruda®) that we found to be exceptionally helpful in people with an inherited susceptibility to colorectal cancer known as Lynch syndrome. People who had advanced disease responded dramatically to this treatment. Some of my patients are more than eight years out from their initial diagnosis and appear to be cured. That was an exciting step forward, and the results were unexpectedly good.
My other work focused on the genetics of colorectal cancer. We have a much better understanding now of how genetics play a role in treatment and how to use gene testing to identify family members of people with colorectal cancer who have an especially high risk for developing cancer. This field has evolved rapidly from what we knew when I first started in oncology.
For the benefit of our readers, can you briefly let us know why you are an authority on the subject of colorectal cancer?
I started concentrating on colorectal cancer when I was at the Mayo Clinic in the early-1990s and spent all of my time taking care of people with colorectal and other GI cancers. I saw so many patients that I really understood the disease and what patients with it needed. At the time, the Mayo Clinic had a research organization called the North Central Cancer Treatment Group that focused on cancer research in sites across the midwest. That is the organization through which we ran the Oxaliplatin clinical trial that I discussed earlier. These experiences allowed me to recognize the value of the treatment and gave me the opportunity to speak to physicians all over the world about the advancements that arose from our collaborative research, which have improved our understanding of and outcomes for colorectal cancer.
What is colorectal cancer?
Colorectal cancer refers to both rectal cancer and colon cancer. The colon, or large intestine, is about 5 to 6-feet long, beginning at the cecum and ending with the anus. The last 5 to 10-inches of the colon is called the rectum.
The exact type of colon or rectal cancer depends on where the abnormal cells first began and how fast they grew and spread. The main differentiator between these two cancers is where the tumor first forms — in the rectum, rather than in the rest of the colon.
Colorectal cancer may not show any symptoms at first, but as the tumor grows, it can disrupt your body’s ability to digest food and remove waste. This causes potentially severe bowel and abdominal problems including blood in the stool in some cases.
Colorectal cancer is preventable and treatable through screening.
What causes colorectal cancer?
Some of the risk factors include:
Age: Over 90% of people diagnosed with colorectal cancer are over age 50. As we age, we are more likely to grow colon polyps, which may undergo gene changes that turn normal tissue into cancer.
Race and Ethnicity: Of all racial groups in the U.S., African Americans have the highest incidence and mortality rates, although the cause of this is not currently known. Worldwide, Jews of Eastern European descent (Ashkenazi Jews) have the highest risk of colorectal cancer. Doctors may suggest earlier screening if your race and ethnicity present an increased risk.
Genetics: Carrying a a genetic syndrome like Lynch syndrome, or if you have a first-degree or second-degree relative has a genetic syndrome, you may be at increased risk.
Previously diagnosed stomach, bowel, or GI disease. If you’ve had inflammatory bowel disorder (IBD), such as ulcerative colitis or Crohn’s Disease, you may be at increased risk.
Other known factors include:
Inactivity (little physical activity and exercise)
Overweight and obese
Little fruit, vegetable, and fiber consumption
Smoking
Heavy alcohol use (more than one drink per day for women and two drinks per day for men)
A diet high in red meat (beef, pork, lamb), processed meats, and fats
Frying, grilling, broiling, or other methods of cooking meat at very high temperatures
What is the difference between rectal and colon cancer?
Cancer located specifically in the rectum is called rectal cancer, and cancer located in the rest of the colon is colon cancer. Some people also refer to colon and rectal cancers as bowel cancer.
Colorectal cancer occurs when abnormal cells form tumors in normal tissues of the intestines and digestive system.
How can colorectal cancer be prevented?
Getting screened for colorectal cancer is the most effective, and most important, way to prevent it and reduce your risk. However, there are lifestyle changes that can reduce your risk of polyps and colorectal cancer.
Don’t smoke, and if you do, stop smoking
Increase your physical activity (get at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity each week)
Maintain a healthy body weight
Avoid overall body fat, especially fat around your waist
Reduce how much red meat and processed meats you eat
Use alcohol in moderation
How is colorectal cancer detected?
Colon cancer and rectal cancer can be prevented with screening. Screening can also detect colorectal cancer early, when it’s most treatable.
The type of colorectal cancer screening you need will depend on your risk. If you have a higher risk of developing colorectal cancer, you should work with your doctor to create an individualized screening plan. If you’re experiencing any signs of colorectal cancer you should also talk to your doctor about getting screened.
Cancer used to almost be a death sentence, but today, that seems not to be the case. What are the odds of surviving colorectal cancer today?
Survival rates for colorectal cancer are remarkably individual and outcomes are improving even when the tumor has spread and a patient is at an advanced stage. If the cancer is removed surgically when its growth is limited to the colon wall where the cancer started, the survival rate is about 95%. If the cancer has spread to the lymph nodes, treatment with surgery, plus chemotherapy leads to no evidence of disease in about 75% of cases. In advanced colorectal cancer cases, only about 15% of patients will survive past five years, which is still much better than it was when I first started working in colorectal cancer research when the rates were about 5%. Clearly, early detection leads to better outcomes. Screening studies can detect colorectal cancer before it causes symptoms and becomes life-threatening.
Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What colorectal cancer treatment innovations are you most excited to see come to fruition in the near future?
The most exciting new developments in colorectal cancer today in my opinion are a class of treatments known as immunotherapy drugs. The goal of immunotherapy is to boost a patient’s immune reaction to the cancer cells, allowing them to fight the disease more effectively. These agents are incredibly effective in certain groups of colorectal cancer patients with inherited colorectal cancers. We are currently working on research that would allow immunotherapy to work for people who have the more common type of colorectal cancer, which is not inherited. There are some promising early results, which suggest that new approaches may allow for improved outcomes for those patients as well.
In the meantime, there are technological advances in radiation and surgical approaches to cancer, which means we can give patients treatments with less side effects and better results.
Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?
It is really important to have a community of supporters. Organizations like Fight Colorectal Cancer allow patients to find a community that have experienced the same things as them. Cancer can be an isolating disease, and it is critical that people continue to be supported by family and friends.
From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?
Cancer can be quite isolating. Many times, people are afraid to say the wrong thing. There are some guidelines on what to say and what not to say. But the most important thing is to be there for your loved one. Something as simple as cooking or taking the patient out of the house for an activity can be helpful. Isolation can be one of the hardest parts of the disease.
What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?
A myth that I would like to dispel is that cancer is a death sentence. While that seemed truer when I started my career in oncology, it is less true now. We are making progress against cancer. Fewer people are dying from it, so it is not an automatic death sentence.
The notion that there is nothing you can do about it is wrong. It is so important that people do regular screening tests to either prevent cancer entirely or catch it early when it is most treatable. It’s never too late to adopt healthy lifestyles that include being active and not eating too many red and processed meats.
Thank you so much for sharing all of that helpful information. Here is the main focus of our interview: Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer?” Please share a story or example for each.
Cancer is not a death sentence: Even advanced cancer can be curable. A patient was referred to me by doctors at Mayo Clinic because she had run out of treatment options. She was 26 years old when I met her. She had Lynch syndrome, and she enrolled in our clinical trial for Pembrolizumab (Keytruda®), which is now an approved treatment for inherited colorectal cancer. Seven years later, she has been off treatment for five of those years and is back doing full activities including singing and dancing in musicals. Even though it looked like she was in a hopeless situation because she was so ill that she was confined to a wheelchair when I first met her, she now has no evidence of disease.
Colorectal Cancer screening is easy: The notion that getting screened is too unpleasant or too hard is a misconception. There are lots of screening options, not just a colonoscopy. Also many people do not know that you are under anesthesia during your colonoscopy, so you do not experience any discomfort during the procedure. There are other screening tests including stool tests that you can do at home. Screening is getting easier, and it really makes a difference. Getting screened for colorectal cancer is easier than being treated for colorectal cancer.
You can’t catch cancer from another person: There is no reason to avoid being around people who have cancer. It is important that people with advanced cancer can continue to interact with family and friends. Even those with late-stage disease need to have companionship and company.
Cancer is not just an old person’s disease: While it is true that cancer is more common as we age, it is increasingly becoming more common in younger people. We have seen a dramatic decline in the number of older people dying because of colorectal cancer, and we believe this is due to better screening tests and treatment options combined. But also, we are seeing an upsurge in those under 50 being diagnosed with colorectal cancer. By 2030, colorectal cancer is projected to be the leading cause of cancer deaths in those ages 20–49. It is a misconception to believe that young people cannot be diagnosed with colorectal cancer. It is also common for young people with colorectal cancer to complain of symptoms that their physicians don’t recognize as possibly related to colorectal cancer. I have heard many stories of young people where their symptoms were written off as hemorrhoids or other things that delayed their diagnosis simply because their doctor thought they were “too young for cancer.”
Colorectal cancer is not embarrassing: Colorectal cancer is a preventable and curable disease if caught early. If people are screened and have precancerous polyps found during their colonoscopy, they can be removed by a gastroenterologist. This removal prevents the person from developing colorectal cancer. There is no better way to manage cancer than to prevent it. People find it embarrassing to talk about colon, polyps, stool, and prep. But my perception is that it is far more embarrassing to die of a preventable disease than it is to talk frankly about issues that can save your life.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
There is so much information now that healthy lifestyles are linked to cancer prevention, so I would like to see a larger emphasis on living healthy through our diet and exercise. Also, there are so many cancers that are linked to smoking cigarettes and other tobacco products. If I could do one thing that would have the biggest impact on the world it would be to get rid of tobacco products.
How can our readers follow your work online?
Follow my work through Fight Colorectal Cancer. You can find Fight CRC on Facebook, Instagram, Twitter, and LinkedIn. You can also follow their blog for the latest in colorectal cancer research and legislative change.
This was very inspiring. Thank you so much for the time you spent on this. We wish you only continued success.
