Colorectal Cancer Survivorship: Second Primary Cancers Cancer...Colorectal Cancer Survivorship: Second Primary Cancers ... Colorectal Cancer Survivorship: Second Primary Cancers ... Second Primary Cancer in Colon Cancer

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    PowerPoint Slides English Text Spanish Translation Colorectal Cancer Survivorship: Second Primary Cancers

    VideoTranscript

    Supervivencia al cncer colorrectal: Segundos cnceres

    primarios Transcripcin del video

    Professional Oncology Education

    Colorectal Cancer Survivorship: Second Primary Cancers

    Time: 7:40

    Educacin Oncolgica Profesional Supervivencia al cncer colorrectal: Segundos cnceres

    primarios Duracin: 7:40

    Therese B. Bevers, M.D. Professor, Clinical Cancer Prevention Medical Director, Cancer Prevention Center The University of Texas, MD Anderson Cancer Center

    Dra. Therese B. Bevers Profesora de Prevencin Clnica del Cncer Directora Mdica del Centro de Prevencin del Cncer MD Anderson Cancer Center de la Universidad de Texas

    Colorectal Cancer

    Survivorship:

    Second Primary Cancers

    Therese B. Bevers, M.D.

    Professor, Clinical Cancer Prevention

    Medical Director, Cancer Prevention Center

    I am Dr. Therese Bevers, Professor of Clinical Cancer Prevention and Medical Director of the Cancer Prevention Center at the University of Texas MD Anderson Cancer Center. Im going to talk today about second primary cancers in colorectal cancer survivors.

    Soy la Dra. Therese Bevers, profesora de Prevencin Clnica del Cncer y directora mdica del Centro de Prevencin del Cncer en el MD Anderson Cancer Center de la Universidad de Texas. Hoy hablar sobre los segundos cnceres primarios en los sobrevivientes de cncer colorrectal.

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    Objectives

    Upon completion of this lesson, participants will be able to:

    Identify risk of second primary cancers after

    colorectal cancer

    Outline mechanisms related to the development of these second primary cancers

    Discuss risk reduction and screening strategies for

    second primary cancers

    The objectives of this lesson are to identify the risk of second primary cancers after having had colorectal cancer; outline the mechanisms related to the development of these second primary cancers; and discuss risk reduction and screening strategies for second primary cancers.

    Los objetivos de esta leccin son: identificar el riesgo de segundos cnceres primarios despus del cncer colorrectal, delinear los mecanismos relacionados con el desarrollo de estos segundos cnceres primarios, y analizar estrategias para reducir los riesgos y detectar segundos cnceres primarios.

    Second Primary Cancer (SPC)

    New primary cancer developing in a person with a

    history of cancer

    A neoplasm that:

    Arises in a tissue distinct from the first primary

    Develops subsequent to the initial cancer by some

    defined time period

    Krueger H et al., Prog Exp Tumor Res 2008 40:7-16

    Lets start off with the definition for second primary cancers. This is a new primary cancer developing in a person with a history of cancer. However, upon thinking about that it is somewhat simplistic because the questions begin to arise, What about a cancer occurring in the same organ as the patient already had a cancer? So, to be more specific, a second primary cancer is a neoplasm that arises in a tissue that is distinct from the first primary and it develops subsequent to the initial cancer by some time --- defined time period. Typically, this is greater than two months.

    Comencemos definiendo qu es un segundo cncer primario. Es un nuevo cncer primario que se desarrolla en una persona con historial de cncer. Esta es una explicacin un tanto simplificada, pues surgen preguntas como: Qu hay de un cncer que aparece en el mismo rgano donde el paciente ya tena cncer?. Ms especficamente, un segundo cncer primario es un neoplasma que se origina en un tejido diferente al del primer cncer y que se desarrolla con posterioridad al cncer inicial, generalmente ms de dos meses despus.

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    Metachronous Colorectal Cancer

    By our definition, metachronous colorectal cancer is

    not a SPC

    Common, even after controlling for familial patterns

    Occur at higher rate than first primaries of the colorectum

    Genetic factors other than Familial adenomatous polyposis

    (FAP)/ Lynch Syndrome have been implicated

    Krueger H et al., Prog Exp Tumor Res. 2008 40:85-91

    By our definition, metachronous colorectal cancer is not a second primary cancer even after controlling for familial patterns. However, we do see that it occurs at a higher rate than first primaries of the colorectum. This is probably related to genetic factors other than those due to familial adenomatous polyposis or Lynch Syndrome.

    Segn esta definicin, el cncer colorrectal metacrnico no sera un segundo cncer primario, pero aun despus de hacer un control de patrones familiares, vemos que ocurre a una tasa superior que los primeros cnceres primarios de colon y recto. Esto probablemente est relacionado con factores genticos distintos de los de la poliposis adenomatosa familiar o el sndrome de Lynch.

    Fifth Most Common Type of Cancer*

    Colorectal

    Lung

    Breast

    Prostate

    Second primary cancer

    *Excluding non-melanoma skin cancers

    Rheingold SR et al., Holland-Frei Cancer Medicine. 6th edition. Bast, RC et al. (eds)

    Hamilton: BC Decker 2000, pps 2399-2406

    You may be surprised to find out that collectively second primary cancers are the fifth most common type of cancer after excluding for non-melanoma skin cancers.

    Puede resultar sorprendente descubrir que, colectivamente, los segundos cnceres primarios son el quinto tipo de cncer ms comn, si excluimos los cnceres de piel distintos del melanoma.

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    Incidence of Second Primary Cancer:

    Colorectal Cancer

    Higher for individuals with early onset colorectal cancer

    Related to genetic syndromes

    Higher for females

    Female survivors live longer than male survivors

    Related to second primary cancer of breast and

    gynecologic organs

    Possibly genetic in origin

    Krueger H et al., Prog Exp Tumor Res. 2008 40:85-91

    In looking at the incidence of second primary cancers after having had colorectal cancer, we see it is higher for individuals with early onset colorectal cancer. And, this is likely related to genetic syndromes. Its also higher for females who live longer than their male counterparts. And, also, related to the fact that there are more s --- cancers that can occur in females such as breast, cervical, uterine, and ovarian than can occur in males, such as testicular or prostate.

    Al analizar la incidencia de los segundos cnceres primarios despus del cncer colorrectal, vemos que es mayor en las personas con cncer colorrectal temprano. Esto tal vez est relacionado con sndromes genticos. Tambin es mayor en las mujeres que viven ms que sus contrapartes masculinas. Asimismo, se relaciona con el hecho de que existen ms tipos de cncer en las mujeres (cncer de mama, cervical, de tero y de ovarios) que en los hombres (cncer testicular o de prstata).

    Second Primary Cancer in Colon Cancer

    Cumulative incidence of developing a second cancer among

    patients with cancer of the colon, both sexes, SEER 1973-2000

    Mysliwiec PA et al., NIH Publ. No. 05-5302. Bethesda, MD 2006

    If we look at the cumulative incidence of developing a second cancer among patients with a history of colon cancer that cumulative incidence is about 15%. We see that the vast majority of the cancers are in the digestive tract. And, there is a substantial percentage of metachronous colorectal cancers. It, however, is this constellation of cancers those that are not in the colon or rectum that we need to pay attention to, because if we did not identify these risks, we would not pick them up through routine surveillance of the patient for their colon cancer.

    La incidencia acumulativa de desarrollar un segundo cncer en los pacientes con historial de cncer de colon es del 15%, aproximadamente. La gran mayora de los cnceres se encuentran en el tracto digestivo y hay un porcentaje considerable de cnceres colorrectales metacrnicos. Debemos prestar atencin a los numerosos tipos de cncer que no ocurren en el colon o el recto. Si no identificamos estos riesgos, no los detectaremos en los controles de rutina de los pacientes con cncer de colon.

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    Second Primary Cancer in Colon Cancer

    Increased risk of:

    Tongue

    Oropharyngeal

    Stomach

    Small intestine

    Bile ducts

    Uterus

    Kidney

    Ureter

    Mysliwiec PA et al., NIH Publ. No. 05-5302. Bethesda, MD 2006

    Individuals with a history of colon cancer have an increased risk of the cancers listed on this screen. You will see that many of them in fact do arise in the GI tract.

    Las personas con historial de cncer de colon tienen mayor riesgo de sufrir estos cnceres y muchos de ellos se producen en el tracto gastrointestinal.

    Second Primary Cancer in Rectal Cancer

    Overall, risk for SPC not increased in rectal cancer patients

    Rectal cancer at younger age associated with 51%

    increased risk of SPC

    - Small intestine, bile ducts, uterus

    - Tumors associated with genetic predisposition

    Risk lower in patients diagnosed at older ages

    Risk of SPC increased in rectal patients treated with radiation

    Uterus, bladder

    Mysliwiec PA et al., NIH Publ. No. 05-5302. Bethesda, MD 2006

    Individuals with a pri --- history of rectal cancer overall are not at increased risk for a second primary cancer. However, if their rectal cancer occurred at a younger age, they actually do have a 51% increased risk of an SPC. This includes cancers of the small intestine, bile ducts, and uterus. And, again, these tumors often are associated with a genetic predisposition. Not surprisingly then, the risk would be lower in patients diagnosed with rectal cancer at an older age. Now, rectal cancer patients who were treated with radiation actually have an increased risk of second primary cancers occurring in the radiation field, such as the uterus or the bladder.

    En general, un historial de cncer de recto no conlleva un mayor riesgo de segundo cncer primario, pero si el cncer de recto ocurri a una edad temprana, el riesgo aumenta un 51%. Esto incluye los cnceres de intestino delgado, conductos biliares y tero. Estos tumores a menudo estn asociados con una predisposicin gentica. El riesgo es menor en los pacientes diagnosticados con cncer de recto a una edad mayor. Los pacientes con cncer de recto tratados con radiacin tienen mayor riesgo de segundo cncer primario en el campo irradiado, como el tero o la vejiga.

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    Three Second Primary Cancer

    Carcinogenic Pathways

    Common lifestyle/environmental factors

    Common genetic pathway

    Iatrogenic effect of treatment

    Krueger H et al., Prog Exp Tumor Res. 2008 40:1-6

    I would like to review the three carcinogenic pathways for the development of second primary cancer. These are common lifestyle or environmental factors, common genetic pathway, and iatrogenic effect of treatment.

    Veamos las tres vas cancergenas para el desarrollo de un segundo cncer primario: los factores comunes de estilo de vida o ambientales, la va gentica comn, y el efecto iatrognico del tratamiento.

    Common Lifestyle/Environmental Factors

    Obesity

    Known risk factor for colorectal cancer

    Increases risk for other cancers

    WCRF/AICR, Nutrition, Physical Activity, and the Prevention of Cancer:

    a Global Perspective. Washington, DC: AICR 2007

    We see that obesity is a known risk factor for colorectal cancer, but it has been well identified that obesity increases the risk for other cancers. So this is a common lifestyle factor that puts an obese colorectal cancer patient at increased risk for second primaries.

    La obesidad es un factor de riesgo conocido del cncer colorrectal y tambin aumenta el riesgo de otros cnceres. Es un factor comn de estilo de vida que en los pacientes obesos con cncer colorrectal aumenta el riesgo de un segundo cncer primario.

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    Obesity and Cancer

    Convincing increased risk:

    Breast (among postmenopausal women)

    Colon

    Endometrium

    Esophagus

    Kidney

    Pancreas

    Probable increased risk:

    Gallbladder

    Limited-suggestive

    increased risk:

    Liver

    WCRF/AICR, Nutrition, Physical Activity, and the Prevention of Cancer:

    a Global Perspective. Washington, DC: AICR 2007

    We see that theres convincing risk for obesity being linked to the development of colon cancer. It also has convincing evidence regarding the link to endometrial cancer and kidney cancer, both of which are increased in colon cancer survivors.

    Hay un riesgo convincente de que la obesidad est relacionada con el cncer de colon. Tambin hay pruebas convincentes en su relacin con el cncer de endometrio y rin, con mayor riesgo para los sobrevivientes de cncer de colon.

    Common Genetic Pathway

    Lynch Syndrome

    Uterus- May be sentinel cancer

    in women with Lynch Syndrome

    Small intestine

    Stomach

    Bile ducts

    Ovary

    Kidney

    Ureter

    Brain

    FAP

    Stomach

    Small intestine

    Thyroid

    Brain

    Watson P and Lynch HT. Cancer 1993 71(3):677

    Burt RW. Gastroenterology 2000 119(3):837Lu KH, et al., Obstet Gynecol 2005 105(3):569

    Now, there are common genetic pathways both Lynch Syndrome and Familial Adenomatous Polyposis. These are the cancers that can be seen with either of these syndromes and the ones highlighted in red are the ones that are more commonly seen in patients with a history of colorectal cancer.

    Existen vas genticas comunes para el sndrome de Lynch y la poliposis adenomatosa familiar. Estos cnceres pueden ocurrir con cualquiera de estos sndromes y los resaltados en rojo son ms comunes en los pacientes con historial de cncer colorrectal.

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    Iatrogenic Effects of Treatment

    Excess risk for SPC related to treatment seen only in

    rectal cancer patients treated with radiation therapy

    Uterus, bladder

    Decreased risk of prostate cancer

    Nascent but quiescent prostate cancers cured

    by spillover radiation

    Mysliwiec PA et al., NIH Publ. No. 05-5302. Bethesda, MD 2006

    Iatrogenic effects of treatment are those that are related to the treatment we actually use to bring about the full treatment of the cancer and, thus, making the colorectal cancer patient a survivor. There is an excess risk of second primary cancers for those rectal cancer patients who received radiation and that risk is confined to the radiation field so thus it would be the uterus or the bladder. Interestingly enough in men, there is a decreased risk of prostate cancer. Its been suggested that possibly nascent but quiescent, prostate cancers are cured by the spillover radiation for the rectal cancer treatment.

    Los efectos iatrognicos son aquellos relacionados con el tratamiento completo utilizado para combatir el cncer, que hacen del paciente con cncer colorrectal un sobreviviente. Existe un gran riesgo de un segundo cncer primario en los pacientes con cncer de recto que recibieron radioterapia, pero se limita al campo irradiado, es decir, el tero o la vejiga. Curiosamente, en los hombres reduce el riesgo de cncer de prstata. Se ha sugerido que los cnceres de prstata incipientes, pero quiescentes, se curan con la radiacin indirecta del tratamiento del cncer de recto.

    Managing Risk of Second Primary Cancers

    Controlling obesity through energy balance

    Calories in (diet) = calories out (exercise)

    Maintain BMI between 18-25

    Identify patients with BMI > 25

    Offer r...

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