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8/2/2019 Colon and Rectal Awareness
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3/19/12
FPSC Clinic
Colon and RectalAwareness
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A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body
What is Cancer?
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Third most common type of cancer andsecond most frequent cause of cancer-relateddeath
A disease in which normal cells in the lining ofthe colon or rectum begin to change, growwithout control, and no longer die
Usually begins as a noncancerous polyp thatcan, over time, become a cancerous tumor
What is Colorectal Cancer?
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What is the Function of the
Colon and Rectum?
The colon and
rectum comprise thelarge intestine (largebowel)
The primary functionof the large bowel isto turn liquid stoolinto formed fecalmatter
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Polyps (a noncancerous or precancerousgrowth 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
What Are the Risk Factorsfor Colorectal Cancer?
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Hereditary non-polyposis colorectal cancer(HNPCC), sometimes called Lynch syndrome,accounts for approximately 5% to 10% of allcolorectal cancer cases
The risk of colorectal cancer in families withHNPCC is 70% to 90%, which is several timesthe risk of the general population
People with HNPCC are diagnosed withcolorectal cancer at an average age of 45
Genetic testing for the most common HNPCCgenes is available; measures can be taken to
prevent development of colorectal cancer
Hereditary Colorectal CancerSyndromes: HNPCC
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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 polypsare initially benign (noncancerous), but there is nearly a100% chance that the polyps will develop into cancer ifleft untreated
Colorectal cancer usually occurs by age 40 in people
with FAPMutations (changes) in the APC gene cause FAP; genetic
testing is available
Yearly screening for polyps is recommended
Attenuated familial adenomatous polyposis (AFAP) isrelated to FAP; eo le have fewer ol s
Hereditary Colorectal CancerSyndromes: FAP
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Several other less common syndromes canincrease a persons risk of colorectal cancer
Talk with your doctor about finding a geneticcounselor if you have a history of colorectalcancer in your family and family membersdeveloped cancer before age 50
For more information, visitwww.plwc.org/genetics
Hereditary Colorectal CancerSyndromes
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Colorectal cancer can be prevented throughregular screening and the removal of polyps
Early diagnosis means a better chance ofsuccessful treatment
Screening should begin at age 50 for allaverage risk individuals or sooner if youhave a family history of colorectal cancer,symptoms, or a personal history ofinflammatory bowel disease
Colorectal Cancer and EarlyDetection
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Colonoscopy (currently the best way to prevent anddetect colorectal cancer)
Virtual colonography
Sigmoidoscopy
Fecal occult blood test
Double contrast barium enema
Screening Methods forColorectal Cancer
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A change in bowel habits: diarrhea, constipation, or afeeling 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 gaspains, bloating, fullness, and cramps
Unexplained weight loss, constant tiredness, or
What Are the Symptoms ofColorectal Cancer?
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Diagnosis is confirmed with a biopsy
Stage of disease is confirmed by pathologists
and imaging tests, such as computerizedtomography (CT or CAT) scans
Endoscopic ultrasound and magneticresonance imaging (MRI) may also be used tostage rectal cancer
How is Colorectal CancerEvaluated?
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Foundation of curative therapy
The tumor, along with the adjacent healthy
colon or rectum and lymph nodes, is typicallyremoved to offer the best chance for cure
May require temporary or (rarely) permanentcolostomy (surgical opening in abdomen thatprovides a place for waste to exit the body)
Cancer Treatment: Surgery
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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
Cancer Treatment:Chemotherapy
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Adjuvant chemotherapy is given after surgeryto maximize a patients chance for cure
Neoadjuvant chemotherapyis given beforesurgery
Palliative chemotherapy is given to patientswhose cancer cannot be removed to delay orreverse cancer-related symptoms andsubstantially improve quality and length of life
Types of Chemotherapy
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The use of high-energy x-rays or otherparticles to destroy cancer cell
Used to treat rectal cancer, either before orafter surgery
Different methods of delivery
External-beam: outside the body
Intraoperative: one dose during surgery
Cancer Treatment: RadiationTherapy
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Starves the tumor by disrupting its bloodsupply
This therapy is given along withchemotherapy
Bevacizumab (Avastin) was approved by theU.S. Food and Drug Administration (FDA) in2004 for the treatment of stage IV colorectalcancer
New Therapies:Antiangiogenesis Therapy
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Treatment designed to target cancer cellswhile minimizing damage to healthy cells
Cetuximab (Erbitux) was approved by the FDAin 2004 for the treatment of advancedcolorectal cancer
New Therapies: TargetedTherapy
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Staging is a way of describing a cancer, suchas the depth of the tumor and where it hasspread
Staging is the most important tool doctors
have to determine a patients prognosisStaging is described by the TNM system: the
size (the depth of penetration of the Tumorinto the wall of the bowel), whether cancer
has spread to nearby lymph Nodes, andwhether the cancer has Metastasized (spreadto organs such as the liver or lung)
The type of treatment a person receives
depends on the stage of the cancer
Colorectal Cancer Staging
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Stage 0 Colorectal CancerKnown as cancer in
situ, meaning thecancer is located inthe mucosa (moisttissue lining thecolon or rectum)
Removal of thepolyp (polypectomy)is the usual
treatment
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Stage I Colorectal CancerThe cancer has
grown through themucosa and invadedthe muscularis(muscular coat)
Treatment is surgeryto remove the tumorand somesurrounding lymph
nodes
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Stage II Colorectal CancerThe cancer has grownbeyond the muscularis ofthe colon or rectum buthas not spread to thelymph nodes
Stage II colon cancer istreated with surgery and,in some cases,
chemotherapy aftersurgery
Stage II rectal cancer is
treated with surgery,radiation therapy, and
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Stage III Colorectal CancerThe cancer has
spread to theregional lymph
nodes (lymph nodesnear the colon andrectum)
Stage III coloncancer is treatedwith surgery andchemotherapy
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Stage IV Colorectal CancerThe cancer hasspread outside of thecolon or rectum toother areas of thebody
Stage IV cancer istreated withchemotherapy.
Surgery to removethe colon or rectaltumor may or maynot be done
Additional surgery to
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Clinical trials are research studies involvingpeople
They test new treatment and preventionmethods to determine whether they are safe,effective, and better than the best knowntreatment
The purpose of a clinical trial is to answer aspecific medical question in a highlystructured, controlled process
Clinical trials can evaluate methods of cancerprevention, screening, diagnosis, treatment,
The Role of Clinical Trials forthe
Treatment of ColorectalCancer
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Informed consent: Participants shouldunderstand why they are being offered entryinto a clinical trial and the potential benefitsand 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 ongoingpatient safety
Clinical Trials: Patient Safety
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Phase I trials determine safety and dose of anew treatment in a small group of people
Phase II trials provide more detail about thesafety of the new treatment and determinehow well it works for treating a given form ofcancer
Phase III trials take a new treatment that has
shown promising results when used to treat asmall number of patients with cancer andcompare it with the current, standardtreatment for that disease; phase III trialsinvolve a large number of patients
Clinical Trials: Phases
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Side effects are treatable; talk with the doctoror nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain relieversare available
Antiemetic drugs can reduce or preventnausea and vomiting
For more information, visitwww.plwc.org/sideeffects
Coping With the Side Effects
of Cancerand its Treatment
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Doctors visits
Serial carcinoembryonic antigen (CEA)measurements are recommended
Colonoscopy one year after removal ofcolorectal cancer
Surveillance colonoscopy every three to fiveyears to identify new polyps and/or cancers
Follow-Up Care
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