colorectal cancer 101 overview who is the colon cancer alliance? what is colorectal cancer? how can...

Colorectal Cancer 101Colorectal Cancer 101

OverviewOverview

• Who is the Colon Cancer Alliance?

• What is Colorectal Cancer?

• How Can You Help?

•Colon and rectal cancerColon and rectal cancer •ScreeningScreening

•Stages •Diagnosis

•Risk factorsRisk factors •TreatmentTreatment

•Statistics •Prevention

Who is the Who is the Colon Cancer Alliance Colon Cancer Alliance

(CCA)?(CCA)?

The (CCA) is a national patient advocacy

organization dedicated to ending the suffering

caused by colorectal cancer.

Who is the CCA?Who is the CCA?

• The CCA has over 37,000 members.

• The growth and success of the organization is due

in large part to the skills and energy of our

volunteers.

What does the CCA do?What does the CCA do?

• In order to increase rates of screening and

survivorship, the CCA provides:

• Patient Support Patient Support

• Education Education

• Research Research

• AdvocacyAdvocacy

Patient Support ServicesPatient Support Services

– Toll-free Helpline: Toll-free Helpline: 1.877.422.20301.877.422.2030

– Buddy Program – Peer to Peer SupportBuddy Program – Peer to Peer Support

– Support through Local Chapters Support through Local Chapters

– MyCRCConnections.orgMyCRCConnections.org – Online Community– Online Community

– Regional Seminars/Online Webinars Regional Seminars/Online Webinars

Education ServicesEducation Services

Education ServicesEducation Services

Education ServicesEducation Services

Supports ResearchSupports Research

The CCA works to increase

federalfederal, statestate, and private private

funding funding for research

devoted to finding more

effective treatments for

colorectal cancer.

Supports Advocacy Supports Advocacy EffortsEfforts

The CCA is dedicated to

advancingadvancing and

championingchampioning the cause of

colon cancer.

What is Colorectal Cancer?What is Colorectal Cancer?

Colorectal Cancer FactsColorectal Cancer Facts

The second leading cancer killer in the United States.

• One person in the United States dies of One person in the United States dies of

colorectal cancer every 9.3 minutes. colorectal cancer every 9.3 minutes.

Survival depends on early detection.

• 90% five-year survival rate in early detected 90% five-year survival rate in early detected

cases.cases.

What is Colorectal What is Colorectal Cancer?Cancer?

Definition of colon cancerDefinition of colon cancer:

Cancer that forms in the tissues of the colon (the

longest part of the large intestine). Most colon cancers

begin in cells that make and release mucus and other

fluids.

American Cancer Society © 2009. www.cancer.gov.

What is Colorectal What is Colorectal Cancer?Cancer?

Definition of rectal cancerDefinition of rectal cancer:

Cancer that forms in the tissues of the rectum

(the last several inches of the large intestine

closest to the anus).

American Cancer Society © 2009. www.cancer.gov.

What is Colorectal What is Colorectal Cancer?Cancer?

• Colorectal cancer is

cancer that occurs in

the colon or rectum.

Sometimes it is called

colon cancercolon cancer, for short.

What is Colorectal What is Colorectal Cancer?Cancer?

• The coloncolon is the large

intestine or large bowel.

The rectumrectum is the

passageway that

connects the colon to the

anus.

Colon Cancer and Colon Cancer and PolypsPolyps

• Colorectal cancer comes from polyps.

• One of every three One of every three adults has polyps.

PolypsPolyps

• In most people, colorectal cancers develop

slowly slowly over a period of several years.

• Before a cancer develops, a growth of tissue or

tumor tumor usually begins as a non-cancerousnon-cancerous polyp polyp

on the inner lining of the colon or rectum.

PolypsPolyps

• A tumortumor is abnormal tissue and can be benign

(not cancer) or malignant (cancer).

• A polyp polyp is a benign, non-cancerous tumor.

Some polyps can change into cancer but not all

do.

Most Common Polyps:Most Common Polyps:Inflammatory

• Most often found in patients with ulcerative colitis or

Crohn's disease.

• Often called "pseudopolyppseudopolyps" (false polyps), they are just a

reaction to chronic inflammation of the colon wall.

• They are not the type that turns to cancer. They are usually

biopsied to verify type.

Most Common Polyps:Most Common Polyps:

Hyperplastic

A common type of polyp which is usually very small

and often found in the rectum. They are considered to

be low risk for cancer.

Most Common Polyps:Most Common Polyps:

Tubular adenoma or adenomatous polyp

• About 70% of polyps removed are of this type.

• Adenomas carry a definite cancer risk which rises as

the polyp grows larger.

Most Common Polyps:Most Common Polyps:

Villous adenoma or tubulovillous adenomas

• About 15% of polyps removed are of this type.

• These are the most serious type of polyp with a very

high cancer risk as they grow larger.

Most Common TumorsMost Common Tumors

• More than 95%95% of colorectal cancers are

adenocarcinomasadenocarcinomas.

• These cancers start in cells that form glands that

make mucus to lubricate the inside of the colon and

rectum.

Less Common TumorsLess Common Tumors

• Carcinoid tumors: These tumors develop from

specialized hormone-producing cells of the intestine.

Less Common TumorsLess Common Tumors

Gastrointestinal stromal tumors (GISTs):

• These tumors develop from specialized cells in the

wall of the colon.

• Some are benign; others are malignant (cancerous).

• Can be found anywhere in the digestive tract, they

are unusual in the colon.

Less Common TumorsLess Common Tumors

Lymphomas:

• These are cancers of immune system cells that

typically develop in lymph nodes.

• May also start in the colon and rectum or other

organs.

What Are The Stages of What Are The Stages of Colorectal Cancer?Colorectal Cancer?

Stages of Colon CancerStages of Colon Cancer

• The process used to find out if cancer has spread

within the colon/rectum or to other parts of the

body is called stagingstaging.

• It is important to know the stage in order to plan

treatment.

Colorectal Cancer Colorectal Cancer StagingStaging

Staging OverviewStaging Overview

• Stage 00: This is the earliest stage possible. Cancer

hasn't moved from where it started; it's still restricted

to the innermost lining of the colon.

• Stage II: Cancer has begun to spread, but is still in the

inner lining.

Staging OverviewStaging Overview

• Stage IIII: Cancer has spread to other organs near the

colon or rectum. It has not reached lymph nodes.

• Stage IIIIII: Cancer has spread to lymph nodes, but has

not been carried to distant parts of the body.

Staging OverviewStaging Overview

• Stage IVIV: Cancer has been carried through the lymph

system to distant parts of the body. This is known as

metastasis. The most likely organs to experience

metastasis from colorectal cancer are the lungs and

liver.

Five-Year Survival Rates Five-Year Survival Rates by Stage at Diagnosis by Stage at Diagnosis

StagesStages

Localized: Cancer that is confined to the

place where it started.

Regional: Cancer that has grown beyond the

organ of origin to regional lymph nodes and/or

organs and tissues next to the original site.

Distant: Cancer that has spread from the original

(primary) tumor to distant organs or distant lymph

nodes.

What Are The Risk and What Are The Risk and Protective Factors? Protective Factors?

At RiskAt Risk

• Men Men and women women age 50 50 and older

• Tobacco usersTobacco users, are obeseobese, and/or are inactiveinactive

• Personal or Family history Personal or Family history of colorectal cancercolorectal cancer or

even non-cancerous colorectal polyps

• Personal or family history of Irritable Bowel Personal or family history of Irritable Bowel

SyndromeSyndrome

Risk FactorsRisk Factors

Strong Moderate Modest

Advanced age High red meat dietHigh red meat diet High fat diet

Country of birthCountry of birth Previous adenoma or cancer

Smoking and alcohol Smoking and alcohol consumptionconsumption

FAP/HNPCC

Familial adenomatous polyposis /Hereditary non-polyposis colorectal cancer

Pelvic irradiationPelvic irradiation Obesity

Long-standing ulcerative Long-standing ulcerative colitiscolitis

CholecystectomyCholecystectomy

Protective FactorsProtective Factors

Moderate Modest

High physical activity High vegetable/fruit diet

Aspirin/NSAIDS (Non-steroidal anti-Aspirin/NSAIDS (Non-steroidal anti-inflammatory drugs).inflammatory drugs).

High fiber dietHigh fiber diet

High folate/methionine intake

High calcium intakeHigh calcium intake

Postmenopausal hormone therapy

Most at RiskMost at Risk

• Alaska Natives Alaska Natives and American IndiansAmerican Indians, African-African-

AmericansAmericans, and HispanicsHispanics are more likely to be

diagnosed with colorectal cancer in advanced stages.

• As a result, the percentage of minorities who die of

colorectal cancer is higher than for Caucasians.

High Risk-Populations: High Risk-Populations: African AmericansAfrican Americans

• Third Third most common cancer among African-

Americans.

• Less likely to have polyps detected in their earliest,

most treatable stages.

• Less likely to live five or more years after being

diagnosed with colorectal cancer.

High Risk-Populations: High Risk-Populations: African AmericansAfrican Americans

• Younger mean age at diagnosis (60-66 years)

• The American College of Gastroenterology (ACG)

recommends that screening begin at age 45 in

African Americans.

High Risk Populations: High Risk Populations: American Indians and American Indians and

Alaskan NativesAlaskan Natives• 2nd leading cause of death among American

Indians and Alaska Natives over the age of 45.

• Higher death rates than Caucasians

and African Americans.

High Risk Populations: High Risk Populations: HispanicsHispanics

• 33rdrd most commonly diagnosed cancer.

• Hispanics have the lowest lowest rates for colorectal

cancer screening, along with American

Indian/Alaska Natives.

How Common is Colorectal How Common is Colorectal Cancer?Cancer?

Colon Cancer RatesColon Cancer Rates

Colorectal Cancer Rates Colorectal Cancer Rates by Raceby Race

Colon Cancer RatesColon Cancer Rates

• Colorectal cancer is the thirdthird most commonly

diagnosed cancer and the third leading cause of

cancer death in both men and women in the United

States.

• About 72% 72% of cases arise in the colon colon and about 28%28%

in the rectumrectum.

Deaths from Colon Deaths from Colon CancerCancer

Colorectal Cancer Colorectal Cancer Deaths by RaceDeaths by Race

Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,

Race & Sex Race & Sex 2001-20052001-2005

Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,

Race & Sex Race & Sex 2001-20052001-2005

Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,

Race & Sex Race & Sex 2001-20052001-2005

Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,

Race & Sex Race & Sex 2001-20052001-2005

Colorectal Cancer Colorectal Cancer DeathsDeaths

• Colorectal cancer is the #2#2 cancer killer in the United

States.

• African Americans African Americans are particularly at risk of dying of

colorectal cancer.

• More men men than women die of colorectal cancer

because they are typically diagnosed at a later stage.

How Do You Screen For How Do You Screen For Colorectal Cancer?Colorectal Cancer?

Screening OptionsScreening Options

Tests that Find Polyps and Cancer

Recommended

Flexible sigmoidoscopy Every 5 years

Colonoscopy Every 10 yearsDouble contrast barium enema Every 5 years

CT colonography (virtual colonoscopy) Every 10 years

Screening OptionsScreening Options

Tests that Mainly Find Cancer Recommended

Fecal occult blood test (FOBT) Every year

Fecal immunochemical test (FIT) Every year

Stool DNA test (sDNA) Uncertain

Screening OptionsScreening Options

• Fecal occult blood test (FOBT)

This test checks for hidden blood in stools. Currently,

two types of FOBT are available: guaiac FOBT and

immunochemical FOBT.

Screening OptionsScreening Options

• Sigmoidoscopy:

In this test, the rectum and lower colon are examined

using a lighted instrument called a sigmoidoscope.

Precancerous and cancerous growths in the rectum

and lower colon can be found and either removed or

biopsied.

Screening OptionsScreening Options

• Colonoscopy:

The rectum and entire colon are examined using a

lighted instrument called a colonoscope.

Precancerous and cancerous growths throughout the

colon can be found and either removed or biopsied,

including growths in the upper part of the colon.

Screening OptionsScreening Options

• Virtual colonoscopy (computerized tomographic

colonography, CTC):

Special X-ray equipment is used to produce

pictures of the colon and rectum that are

assembled by a computer into detailed images

that can show polyps and other abnormalities.

Screening OptionsScreening Options

• Double contrast barium enema (DCBE):

In this test, a series of X-rays of the entire colon and

rectum are taken after the patient is given an enema

with a barium solution and air is introduced into the

colon. The barium and air help to outline the colon

and rectum on the x-rays.

Screening OptionsScreening Options

• Digital rectal exam (DRE):

In this test, a health care provider inserts a

lubricated, gloved finger into the rectum to feel for

abnormal areas. DRE allows examination of only the

lower part of the rectum. It is often performed as

part of a routine physical examination.

Screening OptionsScreening Options

• The decision to have a certain test will take into account several factors, including the following:

the person’s age, medical history, family history, and general health

the accuracy of the testthe accuracy of the test

the potential harms of the test

the preparation required for the testthe preparation required for the test

whether sedation is necessary during the test

the follow-up care after the testthe follow-up care after the test

the convenience of the test

the cost of the test and the availability of insurance coveragethe cost of the test and the availability of insurance coverage

Most Effective Screening Most Effective Screening MethodMethod

• Getting a colonoscopy can reduce the average person's risk of dying from colorectal cancer by 90%90%.

Why is colonoscopy #1?Why is colonoscopy #1?

PROS CONS

Most sensitive Perceived as invasivePerceived as invasive

Long lasting protectionLong lasting protection Highest risk

Single session diagnosis and therapy

Requires bowel Requires bowel preparationpreparation

ComfortableComfortable Imperfect sensitivity

Adherence Rates for Adherence Rates for Cancer ScreeningCancer Screening

Men are more likely to get screened for colorectal cancer Men are more likely to get screened for colorectal cancer than women.than women.

Colon Cancer ScreeningColon Cancer Screening

Just over halfJust over half of the U.S. adults aged

50+ 50+ have had a colonoscopy or

sigmoidoscopy.

Latest Screening StatsLatest Screening Stats

• The percentage of adults aged 50 years and older

who reported having had a home FOBT within

one year and/or lower endoscopy within 10 years

before the survey increased from 54 percent in

2002, 57 percent in 2004, and to 60 percent in

2006.

Latest Screening StatsLatest Screening Stats

• The percentage of adults who reported never

being screened for colorectal cancer decreased

from 34 percent in 2004, 32 percent in 2004, and

to 30 percent in 2006.

• Good news Good news – more and more people are getting

screened.

Why Low Screening Why Low Screening Rates?Rates?

1. lacked health insurance

2. those with no usual source of healthcare

3. those who reported no doctor's visits within the

preceding year.

Physicians on Low Physicians on Low Screening RatesScreening Rates

• Believe that patients don’t want screening.

• Unclear about guidelines.

• Low awareness of screening benefits.

• Lack of skills to perform screening.

• Structural issues (lack of practice “systems”).

• Low reimbursement.

• Context of visit and time.

Patients on Low Patients on Low Screening RatesScreening Rates

• Low awareness of CRC as a health threat.

• Lack of knowledge of screening benefits.

• Fear, embarrassment, discomfort.

• Time.

• Cost.

• Access.

• Physician didn’t recommend.

How is Colorectal Cancer How is Colorectal Cancer Diagnosed?Diagnosed?

DiagnosisDiagnosis

• If a patient has test results that suggest cancer

and/or has symptoms, the doctor will ask about

personal and family medical history and gives a

physical exam. Multiple screening tests may be

required.

Colon Cancer RatesColon Cancer Rates

• It is estimated that 148,810148,810 men and women

(77,250 men and 71,560 women) were diagnosed

with and 49,96049,960 men and women died of cancer

of the colon and rectum in 2008.

What Are The Treatment What Are The Treatment Options?Options?

TreatmentTreatment

• Depends mainly on the location of the tumor in the

colon or rectum and the stage of the disease.

• May involve surgery, chemotherapy, biological therapy,

or radiation therapy.

• It is important that the patients works with their

doctors to develop a plan that meets their needs.

TreatmentTreatment

• Cancer treatment is either local therapy or systemic

therapy.

TreatmentTreatment

• Local therapy: Surgery and radiation therapy are local

therapies. They remove or destroy cancer in or near

the colon or rectum. When colorectal cancer has

spread to other parts of the body, local therapy may

be used to control the disease in those specific areas.

TreatmentTreatment

• Systemic therapy: Chemotherapy and biological

therapy are systemic therapies. The drugs enter the

bloodstream and destroy or control cancer

throughout the body.

SurgerySurgery

• Surgery is the most common treatment for colorectal

cancer.

• There are three basic types of surgery: colonoscopycolonoscopy,

laparoscopy laparoscopy and open surgeryopen surgery.

ColonoscopyColonoscopy

• A small malignant polyp may be removed from the

colon or upper rectum with a colonoscope.

• Some small tumors in the lower rectum can be

removed through the anus without a colonoscope.

LaparoscopyLaparoscopy

• Early colon cancer may be removed with the aid of a thin,

lighted tube (laparoscope).

• The surgeon sees inside the abdomen with the laparoscope.

The tumor and part of the healthy colon are removed. Nearby

lymph nodes also may be removed.

• The surgeon checks the rest of the intestine and liver to see if

the cancer has spread.

Open SurgeryOpen Surgery

• The surgeon makes a large cut into the abdomen to

remove the tumor and part of the healthy colon or

rectum.

• Some nearby lymph nodes are also removed. The

surgeon checks the rest of the intestine and the liver

to see if the cancer has spread.

ChemotherapyChemotherapy

• Chemotherapy uses anticancer drugs to kill cancer

cells.

• The drugs enter the bloodstream and can affect

cancer cells all over the body; they are usually

given through a vein, but some may be given by

mouth.

Chemo Side EffectsChemo Side Effects

• The side effects of chemotherapy depend mainly

on the specific drugs and the dose. The drugs can

harm normal cells that divide rapidly.

Chemo Side EffectsChemo Side Effects

• Blood cells: These cells fight infection, help blood to

clot, and carry oxygen to all parts of your body.

When drugs affect your blood cells, you are more

likely to get infections, bruise or bleed easily, and

feel very weak and tired.

Chemo Side EffectsChemo Side Effects

• Cells in hair roots: Chemotherapy can cause hair

loss. Your hair will grow back, but it may be

somewhat different in color and texture.

• Cells that line the digestive tract: Chemotherapy

can cause poor appetite, nausea and vomiting,

diarrhea, or mouth and lip sores.

Chemo Side EffectsChemo Side Effects

• Skin cells: Chemotherapy for colorectal cancer can

cause the skin on the palms of the hands and

bottoms of the feet to become red and painful. The

skin may peel off.

Biological TherapyBiological Therapy

• Some people with colorectal cancer that has

spread receive a monoclonal antibody, a type of

biological therapy.

• The monoclonal antibodies bind to colorectal

cancer cells inhibiting cancer cell growth and the

spread of cancer.

Radiation TherapyRadiation Therapy

• Radiation therapy (also called radiotherapy) uses

high-energy rays to kill cancer cells. It affects cancer

cells only in the treated area.

• Doctors use different types of radiation therapy to

treat cancer. Sometimes people receive two types.

Radiation TherapyRadiation Therapy

• External radiation: The radiation comes from a

machine. The most common type of machine used

for radiation therapy is called a linear accelerator.

Most patients go to the hospital or clinic for their

treatment, generally 5 days a week for several weeks.

Radiation TherapyRadiation Therapy

• Internal radiation (implant radiation or

brachytherapy): The radiation comes from

radioactive material placed in thin tubes put

directly into or near the tumor. The patient stays

in the hospital, and the implants generally remain

in place for several days.

Radiation TherapyRadiation Therapy

• Intraoperative radiation therapy (IORT): In some

cases, radiation is given during surgery.

Radiation Side EffectsRadiation Side Effects

• Side effects Side effects depend mainly on the amount of

radiation given and the part of the body that is

treated.

• They may include: nauseanausea, vomitingvomiting, diarrheadiarrhea, bloody bloody

stoolsstools, urgent bowel movementsurgent bowel movements, urinary problems urinary problems

and red, dry and tender skinred, dry and tender skin.

Treatment for Colon Treatment for Colon CancerCancer

• Most patients with colon cancer are treated with

surgery. Some people have both surgery and

chemotherapy. Some with advanced disease get

biological therapy.

• A colostomy is seldom needed for people with colon

cancer.

Treatment for Rectal CancerTreatment for Rectal Cancer

• For all stages of rectal cancer, surgery is the most

common treatment. Some patients receive surgery,

radiation therapy, and chemotherapy. Some with

advanced disease get biological therapy.

• About 11 out of 8 8 people with rectal cancer needs a

permanent colostomy.

How Can Colorectal Cancer Be How Can Colorectal Cancer Be Prevented?Prevented?

Prevention Prevention

• Get screened.Get screened.

• Know your family history.Know your family history.

• Stay active; exercise regularly.Stay active; exercise regularly.

• Eat a balanced diet with more fruits and vegetables Eat a balanced diet with more fruits and vegetables

and less meat.and less meat.

• Maintain a healthy weight.Maintain a healthy weight.

• Avoid smoking and excessive drinking.Avoid smoking and excessive drinking.

How Can You Help?How Can You Help?

Get InvolvedGet Involved

• Become a member of the CCABecome a member of the CCA

• Join the Online Colorectal Cancer CommunityJoin the Online Colorectal Cancer Community

• Become a Voices Coordinator or Ambassador Become a Voices Coordinator or Ambassador

• Join the Buddy Support ProgramJoin the Buddy Support Program

• Participate in an Undy 5000 walk/run Participate in an Undy 5000 walk/run

Get InvolvedGet Involved

• Attend a regional seminarAttend a regional seminar

• Create a Blue Star Tribute Page Create a Blue Star Tribute Page

• Make a donationMake a donation

• Volunteer with your local communityVolunteer with your local community

• Talk about colorectal cancer with family and friends.Talk about colorectal cancer with family and friends.

Colorectal Cancer:Colorectal Cancer:

Preventable. Treatable. Beatable!Preventable. Treatable. Beatable!

Toll-Free Helpline: 877-422-2030Toll-Free Helpline: 877-422-2030

www.CCAlliance.orgwww.CCAlliance.org