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 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

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 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 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 patients 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
Doctors 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)

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