colon and rectal awareness

8/2/2019 Colon and Rectal Awareness

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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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colon and rectal awareness

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