Transcript Document

Presents
PLWC Slide Deck Series:
Understanding Colorectal Cancer
2005
What is Cancer?
A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body
What is Colorectal Cancer?
Third most common type of cancer and second most
frequent cause of cancer-related death
A disease in which normal cells in the lining of the colon
or rectum begin to change, grow without control, and no
longer die
Usually begins as a noncancerous polyp that can, over
time, become a cancerous tumor
What is the Function of the Colon and Rectum?
The colon and rectum
comprise the large
intestine (large bowel)
The primary function of
the large bowel is to turn
liquid stool into formed
fecal matter
What Are the Risk Factors
for Colorectal Cancer?
Polyps (a noncancerous or precancerous growth
associated with aging)
Age
Inflammatory bowel disease (IBD)
Diet high in saturated fats, such as red meat
Personal or family history of cancer
Obesity
Smoking
Other
Hereditary Colorectal Cancer Syndromes:
HNPCC
Hereditary non-polyposis colorectal cancer (HNPCC),
sometimes called Lynch syndrome, accounts for
approximately 5% to 10% of all colorectal cancer cases
The risk of colorectal cancer in families with HNPCC is
70% to 90%, which is several times the risk of the general
population
People with HNPCC are diagnosed with colorectal cancer
at an average age of 45
Genetic testing for the most common HNPCC genes is
available; measures can be taken to prevent development
of colorectal cancer
Hereditary Colorectal Cancer Syndromes: FAP
Familial adenomatous polyposis (FAP) accounts for 1% of
colorectal cancer cases
People with FAP typically develop hundreds to thousands of
colon polyps (small growths); the polyps are initially benign
(noncancerous), but there is nearly a 100% chance that the
polyps will develop into cancer if left untreated
Colorectal cancer usually occurs by age 40 in people with FAP
Mutations (changes) in the APC gene cause FAP; genetic
testing is available
Yearly screening for polyps is recommended
Attenuated familial adenomatous polyposis (AFAP) is related
to FAP; people have fewer polyps
Hereditary Colorectal Cancer Syndromes
Several other less common syndromes can increase a
person’s risk of colorectal cancer
Talk with your doctor about finding a genetic counselor if
you have a history of colorectal cancer in your family and
family members developed cancer before age 50
For more information, visit www.plwc.org/genetics
Colorectal Cancer and Early Detection
Colorectal cancer can be prevented through regular
screening and the removal of polyps
Early diagnosis means a better chance of successful
treatment
Screening should begin at age 50 for all “average risk”
individuals or sooner if you have a family history of
colorectal cancer, symptoms, or a personal history of
inflammatory bowel disease
Screening Methods for Colorectal Cancer
Colonoscopy (currently the best way to prevent and detect
colorectal cancer)
Virtual colonography
Sigmoidoscopy
Fecal occult blood test
Double contrast barium enema
Digital rectal examination
What Are the Symptoms of
Colorectal Cancer?
A change in bowel habits: diarrhea, constipation, or a feeling
that the bowel does not empty completely
Bright red or dark blood in the stool
Stools that appear narrower or thinner than usual
Discomfort in the abdomen, including frequent gas pains,
bloating, fullness, and cramps
Unexplained weight loss, constant tiredness, or unexplained
anemia (iron deficiency)
How is Colorectal Cancer Evaluated?
Diagnosis is confirmed with a biopsy
Stage of disease is confirmed by pathologists and
imaging tests, such as computerized tomography (CT or
CAT) scans
Endoscopic ultrasound and magnetic resonance imaging
(MRI) may also be used to stage rectal cancer
Cancer Treatment: Surgery
Foundation of curative therapy
The tumor, along with the adjacent healthy colon or
rectum and lymph nodes, is typically removed to offer
the best chance for cure
May require temporary or (rarely) permanent colostomy
(surgical opening in abdomen that provides a place for
waste to exit the body)
Cancer Treatment: Chemotherapy
Drugs used to kill cancer cells
Typical medications include fluorouracil (5-FU),
oxaliplatin (Eloxatin), irinotecan (Camptosar), and
capecitabine (Xeloda)
A combination of medications is often used
Types of Chemotherapy
Adjuvant chemotherapy is given after surgery to
maximize a patient’s chance for cure
Neoadjuvant chemotherapy is given before surgery
Palliative chemotherapy is given to patients whose
cancer cannot be removed to delay or reverse cancerrelated symptoms and substantially improve quality and
length of life
Cancer Treatment: Radiation Therapy
The use of high-energy x-rays or other particles to
destroy cancer cell
Used to treat rectal cancer, either before or after surgery
Different methods of delivery
External-beam: outside the body
Intraoperative: one dose during surgery
New Therapies: Antiangiogenesis Therapy
“Starves” the tumor by disrupting its blood supply
This therapy is given along with chemotherapy
Bevacizumab (Avastin) was approved by the U.S. Food
and Drug Administration (FDA) in 2004 for the
treatment of stage IV colorectal cancer
New Therapies: Targeted Therapy
Treatment designed to target cancer cells while
minimizing damage to healthy cells
Cetuximab (Erbitux) was approved by the FDA in 2004
for the treatment of advanced colorectal cancer
Colorectal Cancer Staging
Staging is a way of describing a cancer, such as the depth
of the tumor and where it has spread
Staging is the most important tool doctors have to
determine a patient’s prognosis
Staging is described by the TNM system: the size (the
depth of penetration of the Tumor into the wall of the
bowel), whether cancer has spread to nearby lymph
Nodes, and whether the cancer has Metastasized (spread
to organs such as the liver or lung)
The type of treatment a person receives depends on the
stage of the cancer
Stage 0 Colorectal Cancer
Known as “cancer in
situ,” meaning the cancer
is located in the mucosa
(moist tissue lining the
colon or rectum)
Removal of the polyp
(polypectomy) is the
usual treatment
Stage I Colorectal Cancer
The cancer has grown
through the mucosa and
invaded the muscularis
(muscular coat)
Treatment is surgery to
remove the tumor and
some surrounding lymph
nodes
Stage II Colorectal Cancer
The cancer has grown
beyond the muscularis of the
colon or rectum but has not
spread to the lymph nodes
Stage II colon cancer is
treated with surgery and, in
some cases, chemotherapy
after surgery
Stage II rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy
Stage III Colorectal Cancer
The cancer has spread to
the regional lymph nodes
(lymph nodes near the
colon and rectum)
Stage III colon cancer is
treated with surgery and
chemotherapy
Stage III rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy
Stage IV Colorectal Cancer
The cancer has spread
outside of the colon or
rectum to other areas of
the body
Stage IV cancer is treated
with chemotherapy.
Surgery to remove the
colon or rectal tumor may
or may not be done
Additional surgery to
remove metastases may
also be done in carefully
selected patients
The Role of Clinical Trials for the
Treatment of Colorectal Cancer
Clinical trials are research studies involving people
They test new treatment and prevention methods to
determine whether they are safe, effective, and better
than the best known treatment
The purpose of a clinical trial is to answer a specific
medical question in a highly structured, controlled
process
Clinical trials can evaluate methods of cancer prevention,
screening, diagnosis, treatment, and/or quality of life
Clinical Trials: Patient Safety
Informed consent: Participants should understand why
they are being offered entry into a clinical trial and the
potential benefits and risks; informed consent is an
ongoing process
Participation is always voluntary, and patients can leave
the trial at any time
Other safeguards exist to ensure ongoing patient safety
Clinical Trials: Phases
Phase I trials determine safety and dose of a new
treatment in a small group of people
Phase II trials provide more detail about the safety of the
new treatment and determine how well it works for
treating a given form of cancer
Phase III trials take a new treatment that has shown
promising results when used to treat a small number of
patients with cancer and compare it with the current,
standard treatment for that disease; phase III trials
involve a large number of patients
Clinical Trials Resources
Coalition of Cancer Cooperative Groups
(www.CancerTrialsHelp.org)
CenterWatch (www.centerwatch.com)
National Cancer Institute
(www.cancer.gov/clinical_trials)
Coping With the Side Effects of Cancer
and its Treatment
Side effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain relievers are
available
Antiemetic drugs can reduce or prevent nausea and
vomiting
For more information, visit www.plwc.org/sideeffects
Follow-Up Care
Doctor’s visits
Serial carcinoembryonic antigen (CEA) measurements
are recommended
Colonoscopy one year after removal of colorectal cancer
Surveillance colonoscopy every three to five years to
identify new polyps and/or cancers
More information can be found in the ASCO Patient
Guide: Follow-Up Care for Colorectal Cancer
Where to Find More Information:
PLWC Guide to Colorectal Cancer
(www.plwc.org/colorectal)
Overview
Medical Illustrations
Risk Factors and
Prevention
Symptoms
Diagnosis
Staging With
Illustrations
Treatment
Side Effects of Cancer
and Cancer Treatment
After Treatment
Questions to Ask the
Doctor
Current Research
Patient Information
Resources
Clinical Trials Resources
People Living With Cancer (www.plwc.org)
PLWC is the cornerstone of ASCO’s patient resources program
Visitors to PLWC will find:
 PLWC Guides to more than 90 types of cancer
 Coping resources
 Ask the ASCO Expert Series, including chats, Q&A forums,
and event transcripts
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