Colorectal Cancer Care Makes Progress Through Steady Support

Will Chapman Jr., MD, a WashU Medicine colorectal surgeon at Barnes-Jewish Hospital, was a research fellow from 2017 to 2019 with the WashU Medicine colorectal group, led by Matt Mutch, MD. This fellowship was made possible by donor support through The Foundation for Barnes-Jewish Hospital and paved the way for incredible progress and treatments in colorectal cancer care.

During his time as a fellow, Dr. Chapman worked on a number of projects in colorectal care. His primary focus was building a comprehensive registry of colorectal cancer patients that continues today.

“Today, we have one of the largest active prospectively collected registries in the country with 1,200 patients with rectal cancer,” he says.

The colorectal team has used this registry in their work to show that a more condensed form of radiation treatment given over five days rather than five weeks is just as effective. The treatment protocol is now used in nearly all rectal cancer patients at Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine, Dr. Chapman says.

Barnes-Jewish Hospital is among the top programs in the country that have found rectal cancer can often be safely managed without surgery. “In a significant number of patients, the tumor was killed by chemotherapy and radiation, so surgery wasn’t needed,” he says. “In 2016, we changed our practice as a group and adopted a non-operative paradigm for patients who met the right criteria. That’s a big deal in our community.”

Breakthrough Device May Reduce Testing

The outgrowth of these observations and shift to a non-operative approach turned into the next big research endeavor the colorectal team has undertaken with support from donors through the Foundation.

While Dr. Chapman was a fellow in colorectal surgery at WashU Medicine and Barnes-Jewish Hospital, he started a photoacoustic ultrasound imaging project in the lab. The idea blossomed into a prototype that gained additional support from the National Institutes of Health and is currently in a clinical trial.

Dr. Chapman worked with a multidisciplinary team at WashU Medicine to develop the new technology using photoacoustic ultrasound imaging to better differentiate residual cancerous tissue from scar tissue after chemotherapy and radiation in patients with rectal cancer.

“After treatment, it’s hard to differentiate between scar tissue with residual disease versus scar tissue with no residual disease,” he explains. “That means we have to repeat testing in patients every three to four months with MRIs and colonoscopies so if there is residual disease and a tumor starts to grow, we can find it quickly and take the patient to surgery. But if you live several hours away or have a job and kids, it’s difficult to come back so often for testing.”

He says the hope is that this technology will help surgeons identify residual disease in a more definitive way to reduce the surveillance needed in patients.

“The device serves as an example of the impact philanthropy made in supporting critical early investigative work when it can be difficult to secure federal funding.”

Inspired To Do More

With the growing threat of young-onset colorectal cancer seen around the world today, Dr. Chapman is motivated to continue driving innovations and discoveries.

“By 2035, colorectal cancer will be the leading cause of death of people under 50,” he says. “That’s mind-boggling. That’s the impetus that gets us up out of bed every day and excited about what we’re working on. I intend to keep working on this throughout my career.”

“I have an unbelievable job,” Dr. Chapman continues. “I wish there were 48 hours in every day to do all the things we want to do.”

Targeting a New Threat: Young-Onset Colorectal Cancer

The colorectal program, led by Matt Mutch, MD, WashU Medicine colorectal surgery chief at Barnes-Jewish Hospital, is working on addressing the growing threat of young-onset colorectal cancer.

While the incidence of colorectal cancer in those over age 60 is decreasing due to better screening rates, Dr. Mutch says the incidence of rectal cancer in patients under age 50 has increased by 50%, and within the next decade it will likely increase by 100%.

Dr. Mutch says he has treated patients with colorectal cancer who are only 21 years old.

“This is a new area, and it’s happening all over the world. We’re trying to figure out what’s causing it and how to take care of these patients because it’s different.”

Since 2020, the colorectal team has seen about 200 patients through the Young-Onset Colorectal Cancer Program established at Siteman Cancer Center that focuses exclusively on providing care for colorectal cancer patients under 50. Siteman is one of only four centers in the country with a young-onset colorectal cancer program.

Currently, WashU Medicine scientists at Siteman are leading international research looking at this young-onset issue and gathering data, but it’s still in its infancy.

“This is possible because, as physicians and providers, we have a passion for it and understand the need,” Dr. Mutch says. “In addition, the pillars that make this successful are having the support of Siteman as a launching pad and having donors who believe in it and support it.”

In 2022, Ann Ruwitch and her husband, John Fox Arnold, became initiating donors to the Young-Onset Colorectal Cancer Fund to support research, patient care, education, and training.

“Dr. Mutch recognized the growing problem of young-onset colorectal cancer early on,” Ann says. “Look at how they’ve turned around care and cure for colorectal cancer with changes to treatment approaches and surgery. Their research was on the forefront of that. And now, people here are leading international research in colorectal cancer in younger people. That’s why this continued support from private sources is so important, especially today.”

Ann Ruwitch and her family have a rich tradition of making the world a better place to live. When Ann’s first husband, Wally Ruwitch, died of colorectal cancer at age 50, Ann and Wally’s parents created the Ruwitch Family Endowed Fund in Memory of Wallace R. Ruwitch at the Foundation. After nearly 30 years of focusing on saving more lives from colorectal cancer, their generosity has significantly advanced research and treatments.