he third most commonly diagnosed cancer in the country (excluding non-melanoma skin cancers), it is the second leading cause of death from cancer in men and the third in women. According to the Canadian Cancer Society, more than 25,000 citizens were diagnosed with colorectal cancer last year and an estimated 9,300 died from the disease. Yet as recently as eight years ago, potentially only 56 percent of Canadian patients — and less than half in some parts of the country — were getting a precise picture of the stage of their colorectal cancer.

Falling short of the magic number

Health-care practitioners have known for at least 15 years that to most accurately determine the stage of cancer in a patient's colon or rectum — and thus devise the best treatment plan — at least 12 lymph nodes in nearby tissue need to be removed by surgeons and assessed by a pathologist for possible cancer spread. However, that magic number wasn’t being met for many Canadian colorectal cancer patients, says Dr. Geoff Porter, a Professor of Surgery and Ramia Chair in Surgical Oncology at Dalhousie University in Halifax. “So, the concern is how many of those patients were potentially under-staged.” Under-staged individuals might not have received possibly life-saving or life-prolonging treatment, such as chemotherapy.

Data to the rescue

Now, thanks in large part to national efforts to collect, standardize, and report back on cancer data — including data on lymph nodes and colorectal cancer — that figure has increased to “well over 70 percent,” says Dr. Porter, who serves as Expert Lead for Clinical Care for the Canadian Partnership Against Cancer (the Partnership), which provides leadership in achieving the goals of the Canadian Strategy for Cancer Control. “There are multiple kinds of approaches that have been taken, one of which, and a very important one, is the monitoring of (lymph node removal and testing) and feeding those results back, and we’ve seen a consistent rise across the country in the proportion of patients who are meeting that benchmark.” That kind of national reporting on cancer care is generating a more co-ordinated offensive for colorectal and other cancers. The Partnership’s annual Cancer System Performance Reports are “about making sure provinces and territories have the information to see where they’re leading in the country and where they’re lagging,” notes Shelly Jamieson, CEO of the Partnership. “And, the idea is this report back can motivate and accelerate change.”

Electronic reporting

Clinicians are now encouraged to use synoptic — or standardized — reporting of surgery and pathology evaluation with the use of an electronic template. Dr. Porter says that traditionally, physicians produced sometimes lengthy narratives about what happened in the operating room or was found in the pathology evaluation. Often the information was unclear or missing key details. By contrast, a synoptic electronic report is “more comprehensive, more complete, more timely. And, it also serves as a reminder around what are those important elements of either the surgery or the pathology report.”

The future

This standardized reporting work can produce data that acts as a motivator for screening programs that help catch signs of cancer sooner. Jamieson cites the Partnership’s National Colorectal Cancer Screening Network, in place since 2007. “It took 50 years to make sure that all parts of the country had a cervical cancer screening program,” she says. “And, then it took 10 years for various jurisdictions to organize breast cancer screening programs. Yet, in the space of only three years, the entire country introduced various colorectal screening programs. That means Canadians are being screened for colorectal cancer, which is a huge killer, in a much faster way. And, why are we doing that? Well, the evidence — the data said screening actually saved lives and that inspired the country to make sure it was a focus.”