Advanced endoscopic technique successfully treats early-stage colorectal cancer

In the months before his wedding, Queens resident Roberto Pineda Sanchez noticed persistent rectal bleeding, a dangerous symptom he almost ignored. Thankfully, he decided to bring it up to his doctor—a potentially lifesaving choice that led to his swift and successful treatment for colorectal cancer.

"He said it's probably a hemorrhoid or fissure or something that will eventually resolve on its own, but recommended a colonoscopy just to be sure," said Pineda Sanchez. "When he suggested that, I had a physical reaction where my body knew that was the right thing to do."

Gastroenterologist Sameer Dhalla, MD, performed the colonoscopy. He identified a few polyps that were easily removed—as well as a concerning lesion that couldn't be removed through standard techniques.

Pineda Sanchez was referred to Nikhil Kumta, MD, director of endoscopy at NYU Langone's Tisch Hospital and Kimmel Pavilion, for further evaluation. Dr. Kumta recommended an advanced, minimally invasive technique called endoscopic submucosal dissection (ESD).

While standard endoscopic removal techniques often involve taking out a lesion in multiple small pieces, ESD enables physicians to carefully carve out the lesion from the wall of the gastrointestinal tract in a single piece. This allows a pathologist to confirm that the entire lesion, including its borders, has been removed, which dramatically reduces the risk of recurrence. For early-stage cancer, it can result in a complete cure, eliminating the need for major surgery, chemotherapy, or radiation.

ESD is technically demanding and requires specialized training and experience, so it's primarily performed at high-volume centers. In Roberto's case, final pathology confirmed an early-stage colorectal cancer, and ESD allowed us to completely remove the lesion without more invasive treatment."

Nikhil Kumta, MD, director of endoscopy at NYU Langone's Tisch Hospital and Kimmel Pavilion

NYU Langone is among a small number of centers in the United States with the expertise to perform ESD at high volume, and its team helps train physicians nationally and internationally.

Now cancer-free, Pineda Sanchez has a lot to celebrate. He just marked his first wedding anniversary, is preparing to turn 40, and continues routine surveillance with his care team.

A growing concern for younger adults

Pineda Sanchez's case reflects a concerning trend: More young adults are being diagnosed with colorectal cancer. A recent study from the American Cancer Society found that it is now the leading cause of cancer deaths in people under 50.

Had Pineda Sanchez ignored his symptoms and waited until the routine screening age of 45, his outcome could have been very different.

"If this had gone undetected for another five or six years, it likely would have progressed to a more advanced stage," said Dr. Kumta. "At that point, he likely would have required much more intensive treatment."

Colorectal cancer screening is recommended beginning at age 45 for average-risk adults, and earlier for those with risk factors such as a strong family history or inflammatory bowel disease. For younger adults who aren't considered high risk, like Pineda Sanchez, diagnosis almost always follows the onset of symptoms.

Symptoms that warrant evaluation include:

• rectal bleeding or blood in the stool
• changes in bowel habits
• narrow stools
• unexplained weight loss
• abdominal pain
• iron-deficiency anemia

"Trust yourself if you feel like something is wrong," said Pineda Sanchez. "It could be nothing, but for me it wasn't. Getting it checked made all the difference."