Colon and Rectal Awareness

FPSC Clinic
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3/19/12

What is Cancer?
A group of 100 different diseases The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

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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

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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
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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 HNPCC is 70% to 90%, which is several times the risk of the general population

The risk of colorectal cancer in families with

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 3/19/12 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 with FAP

Colorectal cancer usually occurs by age 40 in people Mutations (changes) in the APC gene cause FAP; genetic

testing is available

Yearly screening for polyps is recommended

3/19/12 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 persons 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
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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 3/19/12

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

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What Are the Symptoms of Colorectal Cancer?

Bright red or dark blood in the stool

A change in bowel habits: diarrhea, constipation, or a

feeling that the bowel does not empty completely

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

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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

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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)
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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

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Types of Chemotherapy
Adjuvant chemotherapy is given after surgery

to maximize a patients chance for cure

Neoadjuvant chemotherapy is given before

surgery

Palliative chemotherapy is given to patients

whose cancer cannot be removed to delay or reverse cancer-related symptoms and substantially improve quality and length of life
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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
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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
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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

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Colorectal Cancer Staging

Staging is a way of describing a cancer, such

as the depth of the tumor and where it has spread have to determine a patients prognosis

Staging is the most important tool doctors 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)
3/19/12 depends on the stage of the cancer

The type of treatment a person receives

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

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 IV Colorectal Cancer

The cancer has

spread outside of the colon or rectum to other areas of the body treated with chemotherapy. Surgery to remove the colon or rectal tumor may or may not be done

Stage IV cancer is

Additional surgery to

The Role of Clinical Trials for the Treatment of Colorectal Clinical trials are research studies involving Cancer 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 3/19/12

prevention, screening, diagnosis, treatment,

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

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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 3/19/12

Coping With the Side Effects of Cancer and effects are treatable; talk with the doctor its Treatment Side
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

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Follow-Up Care
Doctors visits Serial carcinoembryonic antigen (CEA)

measurements are recommended colorectal cancer

Colonoscopy one year after removal of Surveillance colonoscopy every three to five

years to identify new polyps and/or cancers

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