Integrated Care for Colorectal Cancer: Oncology, Gastroenterology & Nutrition - Dr Amit Javed

Colorectal cancer (CRC) is a multifaceted disease requiring a holistic approach to achieve optimal patient outcomes. The integration of oncology, gastroenterology, and nutrition in colorectal cancer care is paramount, as each speciality contributes uniquely to prevention, diagnosis, treatment, and survivorship.

By fostering interdisciplinary collaboration, healthcare providers can address the diverse needs of CRC patients more effectively, improving both clinical outcomes and quality of life.

Role of Oncology in CRC Management

Oncologists play a central role in the treatment of colorectal cancer, employing strategies that range from chemotherapy and radiation to immunotherapy and targeted therapies.

Oncology's focus is on halting disease progression, mitigating recurrence risks, and managing metastatic cases. In recent years, personalized medicine has emerged as a cornerstone in oncology, with molecular profiling enabling tailored treatment plans.

For instance, targeted therapies like EGFR inhibitors or BRAF inhibitors are determined based on specific genetic mutations in CRC tumours.

Oncologists are also pivotal in coordinating care among multidisciplinary teams. Regular tumour board discussions ensure that treatment plans are cohesive, balancing curative intent with palliative care as needed.

However, while oncology provides the backbone of cancer treatment, it cannot address all the clinical and lifestyle challenges patients face. This is where gastroenterology and nutrition come into play.

Gastroenterology’s Contribution to CRC Care

Gastroenterologists are integral in both the early detection and ongoing management of colorectal cancer. Screening techniques, such as colonoscopies, play a crucial role in identifying precancerous polyps and early-stage cancers when treatment is most effective.

Advances in endoscopic technology, such as high-definition colonoscopy and artificial intelligence-based polyp detection, have further enhanced diagnostic precision.

Additionally, gastroenterologists are often the first to address symptoms like bleeding, changes in bowel habits, or unexplained weight loss, which may prompt earlier cancer diagnosis.

Post-treatment, they help manage complications such as bowel dysfunction, which is common after CRC surgeries like colectomies or anastomoses.

Conditions like radiation proctitis or strictures following therapy often fall under their expertise, ensuring that patients maintain gastrointestinal functionality and quality of life.

Furthermore, gastroenterologists collaborate closely with oncologists in managing liver metastases in stage IV CRC patients. Interventional techniques such as radiofrequency ablation (RFA), transarterial chemoembolization (TACE), or endoscopic ultrasound-guided interventions provide minimally invasive options to treat complex cases.

Nutrition: A Foundational Pillar in CRC Care

Nutrition is a vital yet often underemphasized component of comprehensive colorectal cancer care. Proper nutritional support can mitigate treatment side effects, prevent malnutrition, and improve overall resilience during therapy.

Dietitians and nutritionists are indispensable in creating individualized plans that address the unique needs of CRC patients at various stages of treatment.

During chemotherapy or radiation, many patients experience anorexia, nausea, diarrhoea, or mucositis, all of which can lead to significant weight loss and nutritional deficiencies.

Tailored interventions, such as the incorporation of high-protein, calorie-dense diets or the use of supplements like omega-3 fatty acids, can combat these challenges.

For surgical patients, rehabilitation programs often include nutritional optimization to improve surgical outcomes. Postoperatively, nutritional counselling supports recovery by managing complications like short bowel syndrome or changes in digestion due to ostomies.

Evidence also suggests that dietary modifications—such as increasing fibre intake or reducing red and processed meat consumption—may reduce CRC recurrence risks.

Case for Integrated Care

The integration of oncology, gastroenterology, and nutrition ensures that no aspect of colorectal cancer care is overlooked.

For instance, a patient undergoing chemotherapy might benefit from oncologists determining the treatment regimen, gastroenterologists managing therapy-induced diarrhoea, and dietitians advising on a low-residue diet to alleviate symptoms.

Moreover, multidisciplinary team meetings encourage shared decision-making, where specialists collaborate to evaluate treatment options from diverse perspectives. This reduces the risk of fragmented care, ensures timely interventions, and promotes holistic patient management.

Colorectal cancer care is a dynamic and complex process requiring the combined expertise of oncology, gastroenterology, and nutrition. By integrating these disciplines, healthcare providers can address the full spectrum of patient needs—from early detection and treatment to symptom management and survivorship.

As the field continues to evolve, prioritizing collaborative care will remain essential in improving outcomes and enhancing the quality of life for colorectal cancer patients.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.