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Colon Cancer

 

Colon cancer, also called colorectal cancer, is cancer of the colon or rectum.  It is more common in people over 50, but can affect people younger than 50 too. Because of the complexity of colon cancer The future for a cure relies heavily on analysis on a genetic level then adapting the results to the individual.  Symptoms do not always appear right away, but can include blood in stool, changes in bowel habits and stomach discomfort.

 

Treatment

 

Radiation Therapy for Colon Cancer

 

Radiation therapy is not a common way to treat colon cancer, though it may be used in certain circumstances. Radiation therapy, often with chemotherapy, is frequently used in the adjuvant or neoadjuvant setting for the treatment of rectal cancers, whereas chemotherapy alone is more common for the adjuvant and neoadjuvant treatment of colon cancers.

 

Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. In advanced stages of colon cancer, radiation therapy is often given instead of surgery when an operation cannot be performed. Radiation therapy is also commonly given in combination with chemotherapy. Chemotherapy drugs have the ability to kill cancer cells directly and help make radiation therapy more effective in killing cancer cells.

 

Radiation therapy for colon cancer is typically delivered by a machine that aims x-rays at the body (external beam radiation). External beam radiation therapy (EBRT) for colon cancer is given on an outpatient basis, 5 days a week, for approximately 5 to 6 weeks. If ERBT is used as palliative treatment for stage IV cancer, it may be given for a shorter time, one day to three weeks. EBRT begins with a planning session, or simulation, during which the radiation oncologist places marks on the body and takes measurements in order to line up the radiation beam in the correct position for each treatment. After the simulation session, the patient begins a program of daily treatments. During treatment, the patient lies on a couch and is treated with radiation from multiple directions to the pelvis. The radiation oncologist may perform a second planning session or simulation near the end of treatment to focus the radiation to the area where cancer cells are most likely to remain. The last 3-5 days of treatment may be directed at this area.

 

Side Effects of Radiation Treatment

 

Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become somewhat fatigued as treatment continues. Loose stools or diarrhea are also common and urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. When radiation therapy is given in combination with 5-fluorouracil chemotherapy, diarrhea can be worse. In a small percentage of patients, an obstruction or blockage in the small bowel can occur, which may require hospitalization or even abdominal surgery to relieve. Radiation therapy can also cause chronic changes in bowel function, resulting in loose stools and, when severe, inflammation of the prostate.

 

Strategies to Improve Treatment

 

The progress that has been made in the treatment of colon cancer has resulted from improved development of radiation treatments and surgical techniques and participation in clinical trials. Future progress in the treatment of colon cancer will result from continued participation in appropriate clinical trials. Currently, there are several areas of active exploration to improve radiation treatment of colon cancer.

 

New Radiation Therapy Modalities: Some radiation oncology centers have special treatment equipment for certain circumstances. For small early cancers, a focused radiation beam can be aimed directly at the cancer in the colon. Intra-operative radiation therapy (IORT) refers to treatment in a specially equipped operating room where a single dose of radiation is given during surgery. The radiation doctor is able to see the area being treated directly and move sensitive normal structures, such as the small bowel, away from the radiation beam. IORT is usually administered when surgery is being performed for locally extensive cancer or stage II-IV cancer that has recurred in the pelvis. Some studies have shown good rates of control of recurrent tumours when surgery is combined with both IORT and traditional radiation therapy.[1] IORT is not indicated in patients with multiple recurrent cancers due to the high frequency of nerve damage if many tumours are treated.

 

Newer Radiation Techniques: External beam radiation therapy (EBRT) can be delivered more precisely to cancer-containing areas by using a special CT scan and targeting computer. This capability is known as three-dimensional conformal radiation therapy, or 3D-CRT. The use of 3D-CRT appears to reduce the chance of injury to nearby normal body struct

 

ures, such as the bladder or rectum. Since 3D-CRT can better target the area of cancer, radiation oncologists are evaluating whether higher doses of radiation can be given safely with greater potential for cancer cures.

 

Newer Radiation Machines: Most EBRT uses high energy x-rays to kill cancer cells. Some radiation oncology centers use different types of radiation generated by special machines. These different types of radiation, such as protons or neutrons, appear to kill more cancer cells with the same dose. Radiation therapy that combines protons or neutrons with conventional x-rays is being evaluated in clinical trials.

 

Surgery for Colon Cancer

 

In patients with potentially curable colon cancer, a properly performed surgical operation is essential for optimal results. In the majority of such cases, operative intervention involves a resection (removal) of the primary cancer and regional lymph nodes.

 

There are several different types of surgical procedures used in the treatment and management of colon cancer. The size and spread of the cancer helps determine the appropriate procedure to use.

 

PRIMARY SURGICAL MANAGEMENT OF COLON CANCER

 

Polypectomy: Some cancers appear to be less aggressive and are limited to the head of a single polyp. These cancers present no evidence of spread to the lymph system, blood vessels and nervous system, and therefore, may be removed with a local excision. In an effort to avoid unnecessary invasive surgery, these cancers can be removed during a colonoscopy. During a colonoscopy, a long flexible tube that is attached to a camera is inserted through the rectum and is used both to view the internal lining of the colon and to perform the removal of a small cancer (local excision.) A properly performed local excision can be a safe and effective procedure.

 

Conventional surgery (open colectomy): Conventional surgery for colon cancer requires surgeons to create a large opening in the abdomen in order to reach the cancer. This procedure involves the removal of the cancer, along with some of the normal bowel and lymph nodes that were surrounding the cancer. After this removal, the two cut ends of the colon are sewn together. In some instances, a temporary colostomy is created and the two ends of the colon are reconnected at a later time. A colostomy is an opening where the large intestine is attached to the abdominal wall and allows passage of stool into a replaceable bag outside of the patient’s body. In some instances, when the cancer cannot be completely removed, the two ends are not re-sewn together and the patient has a permanent colostomy.

 

Laparoscopic surgery: Laparoscopic surgery, also called minimally invasive surgery, allows surgeons to do procedures by making only a few small incisions in the abdomen.  A small tube that holds a video camera is inserted into the abdomen, creating a live picture of the inside of the patient’s body. This picture is displayed on a television screen so that physicians perform the entire surgery by watching the screen. The cancer is removed through another, slightly larger incision.

 

Laparoscopic surgery appears to be about as likely to be curative as the standard approach for earlier-stage cancers.1 Potential advantages of the procedure include less pain, a shorter hospital stay, and a quicker recovery. However, there is still limited information from randomized trials about the approach. In addition, laparoscopic surgery requires special expertise and patients need to be treated by a skilled surgeon who has done many of these operations.2

 

SURGERY FOR RECURRENT OR METASTATIC DISEASE

 

At the time of diagnosis, 10 to 20% of patients with colorectal cancer have cancer that has spread (metastasized) to areas of the body that are distant from the area where the cancer started. The most common sites of metastasis and relapse are the liver, lungs, kidneys, duodenum, pancreas and pelvis (including the bladder). In most patients, metastases occur at multiple sites and are treated with systemic chemotherapy for palliation (relief of symptoms but not cure). Some patients who have cancer that has spread to a single area or recurrence near the original site are candidates for surgery to remove the metastases.

 

Treatment of the liver: When it’s possible to completely surgically remove all liver metastases, surgery is the preferred treatment. Although surgery offers some patients the chance for a cure, a majority of patients with liver metastases are not candidates for surgery because of the size or location of their tumours or their general health. Some of these patients may become candidates for surgery if initial treatment with chemotherapy shrinks the tumours sufficiently. If the tumours continue to be impossible to remove surgically, other liver-directed therapies may be considered. These other therapies include radiofrequency ablation (use of heat to kill cancer cells), cryotherapy (use of cold to kill cancer cells), delivery of chemotherapy directly to the liver, and radiation therapy. Relatively little information is available from clinical trials about the risks and benefits of these other approaches, but they may benefit selected patients.

 

Palliative surgery: Palliative treatment is treatment that is intended to relieve symptoms, such as pain, but is not expected to cure disease. The main purpose of palliative treatment is to improve the patient’s quality of life. Palliative surgery to remove a portion of the colon may be recommended for some patients with advanced colon cancer to prevent bleeding, obstruction, and symptoms related to the cancer.

 

 

Colon Cancer Screening/Prevention

 

Colorectal cancer is the second leading cause of cancer death in the United States. The disease strikes both men and women, with more than 140,000 cases diagnosed each year. Approximately 50,000 people die from colorectal cancer each year. The good news is that earlier detection of colorectal cancer through screening, coupled with improved treatment, has led to better colorectal cancer survival. Mortality rates have declined by almost three percent per year since 1998.

 

The chance of an individual developing cancer depends on both inherited genetic factors as well as environmental or behavioral factors. By understanding what factors can increase the risk of colorectal cancer, you may be able to take steps to reduce your risk or to detect the cancer at an early stage.

 

Hereditary Factors

 

People with a family history of colorectal cancer are at increased risk for the disease, but risk is particularly elevated to people with certain inherited genetic conditions. Familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC; also called Lynch Syndrome) each greatly increase the risk of colorectal cancer. FAP and HNPCC account for a relatively small percentage (5-10%) of all colorectal cancers, but people with these conditions have a high lifetime risk of colorectal cancer, and often develop cancer at a much younger age than other people.

 

HNPCC is the most common type of hereditary colorectal cancer, and results from inherited mutations in genes involved in DNA mismatch repair.2 In individuals with HNPCC, the average age at diagnosis of colorectal cancer is about 45 years. Other cancers that are more common in HNPCC families include cancers of the endometrium (the lining of the uterus), ovary, small intestine, ureter, and renal pelvis.

 

FAP results from inherited mutations in the adenomatous polyposis coli (APC) gene. People with FAP tend to develop numerous colorectal polyps, and polyps may occur as early as the preteen years.

 

All people with a family history of colorectal cancer should discuss their history with their physician in order to identify the optimal approach to surveillance and prevention. Screening may need to begin at a very early age for some people.

 

Other Factors

 

Inflammatory Bowel Disease (IBD): The two major types of inflammatory bowel disease—ulcerative colitis and Crohn’s disease—substantially increase the risk of colorectal cancer. An estimated 10-15% of deaths among people with IBD are due to colorectal cancer.3 Because of this increased risk, people with IBD often undergo earlier and more frequent colorectal cancer screening.

 

Diet: Many aspects of diet have been studied in relation to colorectal cancer, often with mixed results. Dietary factors that have been reported to increase the risk of colorectal cancer include red meat and alcohol.4 Research suggests that consideration of an individual’s overall dietary pattern may also be important. A study of more than 76,000 women, for example, found that a diet rich in fruits, vegetables, legumes, fish, poultry and whole grains was linked with a lower risk of colon cancer (but not a lower risk of rectal cancer) than a diet high in red and processed meats, sweets, and refined grains.

 

Obesity: Obesity has consistently been linked with an increased risk of colon cancer in men.56 The extent to which obesity influences colon cancer risk in women is less clear, although larger waist circumference has been linked with increased colon cancer risk (but not rectal cancer risk) in both men and women.

 

Smoking: Studies of the link between tobacco and risk of colorectal cancer have been inconsistent. A pooled analysis of the Women’s Health Initiative studies found an increased risk of rectal cancer among smokers, but no increased risk of colon cancer.78 Some previous studies, however, have reported a link between smoking and colon cancer.

 

Prevention

 

We may not be able to completely eliminate our risk of developing colorectal cancer, but there are steps that we can take to reduce our risk.

 

Diet: Eating a diet rich in fruits, vegetables, and whole grains may reduce the risk of colorectal cancer in addition to providing other health benefits. Since red meat and alcohol may increase the risk of colorectal cancer, these should be consumed in moderation (if at all). Finally, since obesity may increase the risk of colorectal cancer, it’s important to eat a diet that allows you to achieve or maintain a health body weight.

 

Exercise: Studies suggest that regular physical activity reduces the risk of colon cancer.9 10 11 Exercise may also reduce the risk of rectal cancer, but results for rectal cancer have been somewhat mixed.

 

Talk with your doctor before starting an exercise program. If your doctor decides that it’s appropriate for you, you may benefit from following exercise guidelines such as those provided by the American Cancer Society.12 Developed for the general population (and not specifically for cancer survivors), the guidelines recommend that adults engage in at least 30 minutes of moderate-to-vigorous physical activity on five or more days per week. A longer duration of exercise (45 to 60 minutes) may provide additional benefits.

 

Moderate-intensity activity includes brisk walking and cycling on level terrain. Vigorous activity includes cycling or walking up hills and jogging.

 

Detection and Treatment of Precancerous Polyps: For cancers such as breast cancer, screening does not prevent the development of the cancer; rather, screening detects the cancer at an early stage when treatment is most likely to be successful. In the case of colorectal cancer, however, screening can sometimes prevent the development of cancer by identifying precancerous polyps. Removing these polyps can prevent the later development of cancer. Colorectal cancer screening tests are described in more detail below.

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDS): NSAIDS are used to reduce inflammation and pain; they include drugs such as aspirin and ibuprofen. Studies have suggested that NSAIDS reduce the risk of colorectal cancer.13 The potential benefits of regular use of these drugs, however, must be weighed against the potential risks. In 2007, the U.S. Preventive Services Task Force (USPSTF) recommended against routine use of aspirin or other NSAIDS for the prevention of colorectal cancer in individuals at average risk of colorectal cancer.14

 

The following points contributed to this decision:

 •While higher doses of aspirin appear to reduce the risk of colorectal cancer, lower doses of aspirin do not. Higher doses of aspirin increase the risk of gastrointestinal bleeding, and aspirin has also been linked with an increased risk of hemorrhagic stroke.

 •Similarly, while there is some evidence that non-aspirin NSAIDS may reduce the risk of developing colorectal cancer, these drugs increase the risk of gastrointestinal bleeding and kidney problems. In addition, the class of NSAIDS known as COX-2 inhibitors has been linked with an increased risk of cardiovascular problems.

 

The USPSTF notes, however “These recommendations do not apply to patients with a personal history of colorectal cancer or other conditions that put them at high risk for the disease.” It is also important to note that these recommendations do not alter previous recommendations about the use of low-dose aspirin in people at increased risk of cardiovascular disease.

 

Patients at high risk for colorectal cancer as a result of personal or family history may wish to talk with their doctor about steps they can take to reduce their risk. A study of people with hereditary non-polyposis colorectal cancer (HNPCC) found that daily aspirin use cut the risk of colorectal cancer by roughly half.15

 

Calcium: Calcium may provide a modest colorectal cancer benefit. One study showed that patients taking 1200 mg of calcium daily demonstrated a 20% reduction in colorectal adenoma formation and a 45% reduction in advanced adenoma formation.16 Physicians surmise that a reduction in adenoma formation would lead to a reduction in cancer rates. Furthermore, calcium and Vitamin D may work synergistically to decrease adenoma formation.

 

Vitamin D: Vitamin D is a fat-soluble vitamin that comes from dietary supplements, foods such as fortified milk and cereal, certain kinds of fish (including salmon, mackerel, and tuna), and exposure to sunlight. Vitamin D is hypothesized to play a role in the prevention of some types of cancer, including colon cancer. According to results from two large studies – the Health Professionals Follow-up Study and the Nurses’ Health Study – individuals with higher blood levels of vitamin D may have a reduced risk of developing colon cancer.18

 

Preventive surgery: Preventive surgery may be recommended for some people at very high risk of colorectal cancer, such as those with FAP. Surgery is performed to remove the colon (and sometimes the rectum and other organs as well) before cancer develops.

 

Screening and Early Diagnosis

 

For many types of cancer, progress in cancer screening has offered promise for earlier detection and higher cure rates. The term screening refers to the regular use of certain examinations or tests in persons who do not have symptoms of cancer.

 

Screening is crucial for the prevention and early detection of colorectal cancer. The American Cancer Society currently recommends that people at average risk of colorectal cancer begin being screened for colorectal cancer at the age of 50.  Screening may need to begin at a much earlier age for people with a personal or family history of adenomatous polyps, FAP, HNPCC, colorectal cancer, or chronic inflammatory bowel disease.

 

Several screening strategies are currently available. These include the fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy and double contrast barium enema. The frequency of screening depends on the method. In general, FOBT is performed every year, sigmoidoscopy is performed every five years, and colonoscopy is performed every 10 years. Individuals interested in colorectal cancer screening should discuss the options with their physician in order to determine the most appropriate procedure.

 

According to recommendations from the U.S. Preventive Services Task Force (USPSTF), routine colorectal cancer screening should continue until the age of 75.19 Patients over this age may wish to talk with their physician about the need for continued screening.

 

Fecal Occult-Blood Test (FOBT): The fecal occult-blood test checks for hidden blood in the stool. Recently, results from an 18-year study indicated that annual or biannual FOBT could significantly reduce the incidence of colorectal cancer. If positive, this test indicates the presence of bleeding polyps and the need for further screening, such as colonoscopy. The further screening tests allow the identification and removal of polyps, which results in a reduced incidence of colorectal cancer.

 

Fecal Immunochemical Test (FIT): Fecal immunochemical tests are a newer type of fecal occult-blood test. Unlike traditional FOBT, FIT does not require drug or dietary restrictions on the part of the patient.

 

Flexible sigmoidoscopy: During this procedure, a physician uses a lighted tube to look inside the rectum and the lower part of the colon (sigmoid colon) for polyps or areas suspicious for cancer. The physician may perform a biopsy in order to collect samples of suspicious tissues or cells for closer examination. This is an outpatient procedure that does not require sedative anesthesia or pain medication. There are no or few complications associated with this procedure.

 

Colonoscopy: During this procedure, a longer flexible tube that is attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon and rectum for polyps or other abnormalities. The physician may perform a biopsy in order to collect samples of suspicious tissues or cells for closer examination. This is a more difficult procedure than sigmoidoscopy to perform, requiring anesthesia or heavy sedation, but it allows the entire colon (sigmoid colon, descending colon, transverse colon, and ascending colon) and rectum to be viewed. Significant complications occur in 0.1-0.3% of patients or less.1920

 

Double-contrast barium enema: A chalky substance called barium is inserted through the rectum and into the colon and rectum. The patient then undergoes x-rays of the colon and rectum so that the physician can evaluate the area for polyps or other abnormalities. The barium helps open the colon so that the x-rays are more detailed and clear.

 

While these screening strategies help to monitor for the development of adenomatous polyps and colorectal cancer, other tests exist which may allow physicians to identify patients who are at risk for the development of colorectal cancer.

 

Predictive genetic testing: If your history suggests that your family has HNPCC or FAP, your doctor may discuss genetic testing with you. If you undergo genetic testing and are found to carry one of the HNPCC or FAP gene mutations, there are steps that you can take to manage your cancer risk.

 

Strategies to Improve Screening and Early Detection of Colon Cancer

 

The potential for earlier detection and higher cure rates increases with the advent of more refined screening techniques. In an effort to provide more screening options and perhaps more effective prevention strategies, researchers continue to explore new techniques for the screening and early detection of cancer.

 

Several new strategies for the screening of colorectal cancer have recently emerged. Despite progress in this area, it is still important that individuals continue to utilize the standard screening procedures in an effort to maintain health and detect colorectal cancer early when it is most treatable. However, these new procedures hold promise for earlier and more reliable detection of colorectal cancer and some individuals may be interested in participating in clinical trials that will help to determine the effectiveness of these new techniques.

 

DNA stool test: This newer screening procedure involves looking for abnormal DNA in stool samples. Changes in DNA occur as tumours develop in the colon. The tumours shed cells into the intestine, which makes it possible to detect the abnormal DNA cells in stool samples. This simple, non-invasive screening procedure has proven effective in some clinical studies21 but is expensive to perform. Research is ongoing to determine the feasibility of using this as a standard screening procedure.

 

Virtual colonoscopy: In virtual colonoscopy (also called CT colonography), spiral CT scanners scan the entire colon to produce a 3-D image. The procedure allows for the complete visualization of the colon more quickly and less invasively than with conventional colonoscopy, although patients who have polyps detected will still need to undergo conventional colonoscopy to have the polyps removed. Virtual colonoscopy is a promising new technique, but more research may be needed before it becomes a standard screening procedure for colorectal cancer.

 

Stage I Colon Cancer

 

Following colon cancer surgery, the cancer is classified as a Stage I colon cancer if the final pathology report shows that the cancer is confined to the lining of the colon. Stage I cancer does not penetrate the wall of the colon into the abdominal cavity, has not spread to any adjacent organs or local lymph nodes and cannot be detected in other locations in the body.

 

Depending on features of the cancer under the microscope, Stage I colon cancer survival rates are high: approximately 90% of patients are cured with colorectal surgery alone and will not have evidence of cancer recurrence.

 

Despite undergoing surgical removal of the cancer, a minority of patients with Stage I colon cancer may experience recurrence of their cancer. It is important to realize that a few patients with Stage I disease already have small amounts of cancer that have spread outside the colon and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the colon are referred to as micrometastases. The presence of micrometastases causes the relapses that follow treatment with surgery alone. An effective treatment is needed to eliminate micrometastases in order to improve the cure rate achieved with surgical removal of the cancer. Efforts are currently underway to find such a therapy.

 

The following is a general overview of treatment for Stage I colon cancer. Treatment may consist of surgery with or without adjuvant (post-surgery) treatment. Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing some patients’ chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied and whether the patient decides to receive treatment. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this Web site is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

 

SURGERY

 

Surgery to remove the cancer is the primary treatment for Stage I colon cancer. In some cases, it’s possible to completely remove a cancerous colon polyp during colonoscopy. In other cases, colon cancer surgery may involve open surgery (which involves a single large incision) or laparoscopic surgery (which involves several small incisions).

 

ADJUVANT THERAPY

 

The delivery of cancer treatment following local treatment with surgery is referred to as “adjuvant” therapy and may include chemotherapy, radiation therapy and/or targeted therapy. Adjuvant chemotherapy is commonly used for patients with Stage III colon cancer and may also be used in selected patients with Stage II colon cancer. The goal of chemotherapy in these patients is to reduce the risk of cancer recurrence. Thus far, clinical trials have not been performed evaluating adjuvant treatment in patients with Stage I cancers because of the very high cure rate achieved with surgery alone.

 

STRATEGIES TO IMPROVE TREATMENT

 

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of Stage I colon cancer will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active exploration to improve the treatment of Stage I colon cancer include the following:

 

Improvement in Predicting Need for Adjuvant Therapy: Undetectable areas of cancer outside the colon are referred to as micrometastases. The presence of micrometastases may cause the cancer to relapse following treatment with surgery alone, but physicians currently cannot predict which patients will relapse.

 

Adjuvant chemotherapy has been shown to decrease the risk of cancer recurrence in patients with Stage III colon cancer, but benefits in patients with Stage I cancer — who have a high rate of cure with surgery alone — have not been demonstrated. New methods of determining which patients with early-stage colon cancer are at highest risk of cancer recurrence may identify a subset of patients who could potentially benefit from adjuvant treatment. A test that is being used for some patients with Stage II colon cancer is the Oncotype DX colon cancer test. The test estimates the risk of cancer recurrence by evaluating the activity of certain genes in a sample of tumour tissue.

 

Stage II Colon Cancer

 

Following surgical removal of colon cancer, the cancer is referred to as Stage II if the final pathology report shows that the cancer has penetrated the wall of the colon into the abdominal cavity, but does not invade any of the local lymph nodes and cannot be detected in other locations in the body.

 

Stage II adenocarcinoma of the colon is a common and frequently curable cancer. Depending on features of the cancer, 60-75% of patients are cured without evidence of cancer recurrence following treatment with surgery alone. Stage II cancer can be further divided into three stages:  IIA, IIB, and IIC. In Stage IIA, the tumour has grown through the outermost layers of the colon into tissues surrounding the colon. In Stages IIB and IIC, the involvement of other tissues and organs is more extensive. Stage II colon cancer does not, however, involve the lymph nodes or distant parts of the body.

 

Despite undergoing complete surgical removal of the cancer, 25-40% of patients with Stage II colon carcinoma experience recurrence of their cancer. Typically, cancer recurs because there are small amounts of cancer that had spread outside the colon and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the colon are referred to as micrometastases. The presence of micrometastases causes the relapses that follow surgical treatment. An effective treatment is needed to eliminate micrometastases and improve cure rates of Stage II cancer. Efforts are currently underway to find such a therapy.

 

The following is a general overview of treatment for Stage II colon cancer. Treatment may consist of surgery, radiation, chemotherapy and/or targeted therapy (drugs which act by a different mechanism than chemotherapy to target tumour cells). Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied and whether the patient decides to receive treatment. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

 

Surgery

 

Conventional surgery for colon cancer requires surgeons to create a large opening in the abdomen in order to reach the cancer. This procedure involves the removal of the cancer, along with some of the normal bowel and lymph nodes that were surrounding the cancer. After this removal, the two cut ends of the colon are sewn together. In some instances, a temporary colostomy is created and the two ends of the colon are reconnected at a later time. A colostomy is an opening where the large intestine is attached to the abdominal wall and allows passage of stool into a replaceable bag outside of the patient’s body. In some instances, when the cancer cannot be completely removed, the two ends are not re-sewn together and the patient has a permanent colostomy.

 

Adjuvant Chemotherapy

 

The delivery of cancer treatment following local treatment with surgery is referred to as “adjuvant” therapy and may include chemotherapy, radiation therapy, and/or targeted therapy. Adjuvant chemotherapy improves outcomes among patients with Stage III colon cancer, but the benefits among patients with Stage II colon cancer are less clear. A review of previously published clinical trials reported that adjuvant chemotherapy may improve disease-free survival, but does not appear to improve overall survival, among patients with Stage II colon cancer.1 Routine use of adjuvant chemotherapy is not recommended for patients with Stage II colon cancer, but it may be considered for some patients, particularly those whose cancers have high-risk features.2 Risk of cancer recurrence can be estimated based on the specific characteristics of the cancer, as well as by genomic tests such as Oncotype DX.3

 

ONCOTYPE DX

 

A newer test that may help guide treatment decisions for patients with Stage II colon cancer is the Oncotype DX colon cancer test. This test—which is similar to a test that is commonly used for patients with early-stage breast cancer—is performed after surgery but before final decisions are made about adjuvant (post-surgery) therapy. The test estimates the risk of cancer recurrence by evaluating the activity of certain genes in a sample of tumor tissue. Risk of recurrence can vary greatly among patients with Stage II colon cancer, and use of the Oncotype DX test in combination with other markers of risk may help to individualize treatment decisions.

 

Treatment of the Elderly

 

A large percentage of patients with colon cancer are 65 years or older. Sometimes elderly patients and/or their physicians may believe that believe that treatment will be more toxic for elderly patients than it is for their younger counterparts. Due to this perceived intolerability of therapy, elderly patients often do not receive optimal treatment.4 Many older patients are able to tolerate standard treatment, however, and receipt of standard treatment improves cancer outcomes. Elderly patients with colon cancer eligible for adjuvant therapy should speak with their physician regarding their individual risks and benefits of adjuvant therapy.

 

Strategies to Improve Treatment

 

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of Stage II colon cancer will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active exploration to improve the treatment of Stage II colon cancer include the following:

 

New Adjuvant Chemotherapy Regimens: Several new chemotherapy drugs show promising activity for the treatment of advanced or recurrent rectal cancer. Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as neoadjuvant and/or adjuvant treatment is an active area of clinical research.

 

Laparoscopic surgery: Laparoscopic surgery is used for many types of surgery with the short-term advantages of less pain, fewer wound complications, quicker post-operative recovery, and shorter hospital stays. Instead of making one long incision in the abdomen, the surgeon makes several smaller incisions. Special long instruments are inserted through these incisions to remove part of the rectum and lymph nodes. One of the instruments has a small video camera on the end, which allows the surgeon to see inside the abdomen. Once the diseased part of the rectum has been freed, one of the incisions is made larger to allow for its removal.

 

Laparoscopic-assisted surgery appears to be about as likely to be curative as the standard approach for earlier-stage cancers.5 However, there is still limited information from randomized trials about the approach. In addition, laparoscopic surgery requires special expertise and patients need to be treated by a skilled surgeon who has done a lot of these operations.

 

Targeted Therapies: Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target”, targeted therapies may slow cancer cell growth or increase cancer cell death. Targeted therapies may be used in combination with other cancer treatments such as conventional chemotherapy. Targeted therapies that have shown a benefit for selected patients with advanced colon cancer include Avastin® (bevacizumab), Erbitux® (cetuximab), and Vectibix® (panitumumab).

 

Managing Side Effects: Techniques designed to prevent or control the side effects of cancer and its treatments are called supportive care. Side effects not only cause patients discomfort, but also may prevent the delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that treatment is delivered as planned and that side effects resulting from cancer and its treatment are appropriately managed.

 

Stage III Colon Cancer

 

Following surgical removal of colon cancer, the cancer is classified as Stage III if the final pathology report shows that the cancer has spread to the lymph nodes but not to distant sites in the body.

 

The following is a general overview of treatment for Stage III colon cancer. Treatment may consist of surgery, chemotherapy, targeted therapy (drugs which act by a different mechanism than chemotherapy to target tumor cells) and/or radiation. Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing a patient’s chance of cure or prolonging survival.

 

In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied and whether the patient decides to receive treatment. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

 

Surgery

 

Conventional surgery for colon cancer requires surgeons to create a large opening in the abdomen in order to reach the cancer. This procedure involves the removal of the cancer, along with some of the normal bowel and lymph nodes that were surrounding the cancer. After this removal, the two cut ends of the colon are sewn together. In some instances, a temporary colostomy is created and the two ends of the colon are reconnected at a later time. A colostomy is an opening where the large intestine is attached to the abdominal wall and allows passage of stool into a replaceable bag outside of the patient’s body. In some instances, when the cancer cannot be completely removed, the two ends are not re-sewn together and the patient has a permanent colostomy.

 

Adjuvant Chemotherapy

 

The delivery of cancer treatment following local treatment with surgery is referred to as “adjuvant” therapy and may include chemotherapy, radiation therapy, and/or targeted therapy. Adjuvant chemotherapy is administered to patients with Stage III colon cancer for the purpose of reducing the risk of cancer recurrence.

 

ONCOTYPE DX

 

A newer test that may help guide the management of Stage III colon cancer is the Oncotype DX colon cancer test. This test—which is similar to a test that is commonly used for patients with early-stage breast cancer—is performed after surgery but before final decisions are made about adjuvant (post-surgery) therapy. The test estimates the risk of cancer recurrence by evaluating the activity of certain genes in a sample of tumor tissue. Risk of recurrence can vary among patients with Stage III colon cancer, and use of the Oncotype DX test in combination with other markers of risk may help to individualize treatment decisions.

 

Treatment of the Elderly

 

A large percentage of patients with colon cancer are 65 years or older. Sometimes elderly patients and/or their physicians may believe that believe that treatment will be more toxic for elderly patients than it is for their younger counterparts. Due to this perceived intolerability of therapy, elderly patients often do not receive optimal treatment.[1] Many older patients are able to tolerate standard treatment, however, and receipt of standard treatment improves cancer outcomes. Elderly patients with colon cancer eligible for adjuvant therapy should speak with their physician regarding their individual risks and benefits of adjuvant therapy.

 

Strategies to Improve Treatment

 

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of Stage III colon cancer will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active exploration to improve the treatment of Stage III colon cancer include the following:

 

New Adjuvant Chemotherapy Regimens: Several new chemotherapy drugs show promising activity for the treatment of advanced or recurrent rectal cancer. Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as neoadjuvant and/or adjuvant treatment is an active area of clinical research.

 

Laparoscopic surgery: Laparoscopic surgery is used for many types of surgery with the short-term advantages of less pain, fewer wound complications, quicker post-operative recovery, and shorter hospital stays. Instead of making one long incision in the abdomen, the surgeon makes several smaller incisions. Special long instruments are inserted through these incisions to remove part of the rectum and lymph nodes. One of the instruments has a small video camera on the end, which allows the surgeon to see inside the abdomen. Once the diseased part of the rectum has been freed, one of the incisions is made larger to allow for its removal.

 

Laparoscopic-assisted surgery appears to be about as likely to be curative as the standard approach for earlier-stage cancers.[2] However, there is still limited information from randomized trials about the approach. In addition, laparoscopic surgery requires special expertise and patients need to be treated by a skilled surgeon who has done a lot of these operations.

 

Targeted Therapies: Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target”, targeted therapies may slow cancer cell growth or increase cancer cell death. Targeted therapies may be used in combination with other cancer treatments such as conventional chemotherapy. Targeted therapies that have shown a benefit for selected patients with advanced colon cancer include Avastin® (bevacizumab), Erbitux® (cetuximab), and Vectibix® (panitumumab).

 

Managing Side Effects: Techniques designed to prevent or control the side effects of cancer and its treatments are called supportive care. Side effects not only cause patients discomfort, but also may prevent the delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that treatment is delivered as planned and that side effects resulting from cancer and its treatment are appropriately managed.

 

Stage IV Colon Cancer

 

Colon cancer is classified as Stage IV if the final evaluation following surgical removal of the cancer shows that the cancer has spread to distant locations in the body; this may include the liver, lungs, bones, distant lymph nodes or other sites. While it is commonly thought that patients diagnosed with Stage IV colon cancer have few treatment options, certain patients can still be cured of their cancer, and others can derive significant benefit from additional treatment.

 

Patients with Stage IV colon cancer can be broadly divided into two groups:

 

•Those with widespread, metastatic cancer that cannot be treated with surgery (sometimes called unresectable cancer )

 •Those with cancer that has metastasized to a single site

 

When the site of metastasis is a single organ (such as the liver), and the cancer is confined to a single defined area within the organ, patients may benefit from local treatment directed at that single metastasis.

 

The majority of patients diagnosed with Stage IV colon cancer have unresectable or widespread disease. Historically, treatment outcomes for these patients were poor. However, new combinations of chemotherapy drugs and the addition of targeted therapies such as Avastin® (bevacizumab) have improved outcomes.

 

The following is a general overview of treatment for Stage IV colon cancer. Treatment may consist of surgery, radiation, chemotherapy, targeted therapy, or a combination of these treatment techniques. Multi-modality treatment, which is treatment using two or more techniques, has become an important approach for increasing a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied.

 

The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

 

This section covers the initial, also called first-line, treatment of Stage IV colon cancer. For information about the treatment of cancer that has recurred or progressed after initial treatment, visit Recurrent Colon Cancer.

 

CHEMOTHERAPY FOR WIDESPREAD, METASTATIC COLON CANCER

 

For over 30 years the chemotherapy drug fluorouracil (5-FU) was the standard treatment for metastatic Stage IV colon cancer that had spread to several sites in the body. 5-FU is typically administered with leucovorin, a drug that is similar in structure and function to the essential vitamin folic acid. Leucovorin (LV) enhances the anticancer effects of fluorouracil by helping the chemotherapy drug bind to and stay inside the cell for a greater period of time, producing longer lasting anticancer effects.

 

More recently, the addition of other drugs to 5-FU/LV has been found to provide additional benefit. Not all patients can tolerate these multi-drug regimens, however, and less intensive regimens are available.

 

Adding Targeted Therapy to Chemotherapy

 

Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target”, targeted therapies may slow cancer cell growth or increase cancer cell death. Targeted therapies may be used in combination with other cancer treatments such as conventional chemotherapy. Recently approved targeted therapies represent the most novel advance in the treatment of metastatic colorectal cancer in the last few years.

 

Targeted therapies that have shown a benefit for selected patients with metastatic colorectal cancer include Avastin® (bevacizumab), Erbitux® (cetuximab), and Vectibix® (panitumumab). Avastin blocks a protein (VEGF) that plays a key role in the development of new blood vessels. By blocking VEGF, Avastin deprives the cancer of nutrients and oxygen and inhibits its growth. Erbitux and Vectibix slow cancer growth by targeting a protein known as EGFR. Cancers with certain gene mutations are unlikely to respond to Erbitux or Vectibix, and tests are available to detect these mutations before treatment decisions are made.

 

TREATMENT OF COLON CANCER THAT HAS METASTASIZED TO A SINGLE SITE

 

Stage IV colon cancer commonly spreads to the liver or the lungs. Some patients who have cancer that has spread to a single area are candidates for surgery to remove the metastases.

 

Treatment of the liver: When it’s possible to completely surgically remove all liver metastases, surgery is the preferred treatment. Although surgery offers some patients the chance for a cure, a majority of patients with liver metastases are not candidates for surgery because of the size or location of their tumors or their general health. Some of these patients may become candidates for surgery if initial treatment with chemotherapy shrinks the tumors sufficiently. If the tumors continue to be impossible to remove surgically, other liver-directed therapies may be considered. These other therapies include radiofrequency ablation (use of heat to kill cancer cells), cryotherapy (use of cold to kill cancer cells), delivery of chemotherapy directly to the liver, and radiation therapy. Relatively little information is available from clinical trials about the risks and benefits of these other approaches, but they may benefit selected patients.1

 

TREATMENT OF THE ELDERLY

 

A large percentage of patients with advanced colorectal cancer are 65 years or older. Because elderly patients commonly have concurrent illnesses or other medical difficulties that are perceived to exacerbate the side effects of chemotherapy, elderly patients are often treated with reduced doses of chemotherapy. Clinical studies have shown, however, that elderly patients get the same benefit from chemotherapy treatment as younger patients.

 

While a dose reduction or delay may sometimes be necessary, it may also compromise the optimal treatment of some patients. All patients over 65 should be closely monitored for toxic side effects of chemotherapy, especially during their initial chemotherapy administration cycle.

 

STRATEGIES TO IMPROVE TREATMENT OF STAGE IV COLON CANCER

 

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of Stage IV colon cancer will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active exploration to improve the treatment of Stage IV colon cancer include the following:

 

New Approaches to Treating Liver Metastases: Researchers continue to explore news ways to treat cancer that has spread to the liver. One approach that is being evaluated is radioembolization This strategy uses radioactive microspheres (small spheres containing radioactive material). The small spheres are injected into vasculature of the liver, where they tend to get lodged in the vasculature responsible for providing blood and nourishment to the cancer cells. While lodged in place, the radioactive substance spontaneously emits radiation to the surrounding cancerous area while minimizing radiation exposure to the healthy portions of the liver.2 Researchers are also exploring alternatives to radiofrequency ablation for the destruction of liver tumors, as well as new approaches to delivering chemotherapy to the liver.

 

New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies is an active area of clinical research.

 

New Approaches to Targeted Therapy: Targeted therapies such as Avastin, Erbitux, and Vectibix already play a role in the treatment of selected patients with advanced colorectal cancer, but researchers continue to explore new targeted therapies as well as new ways of using existing drugs. Developing tests to predict which patients are most likely to respond to which drugs is also an important focus of research. Tests to identify certain gene mutations in the cancer are already available, and can help guide the use of Erbitux and Vectibix.

 

Managing Side Effects: Techniques designed to prevent or control the side effects of cancer and its treatments are called supportive care. Side effects not only cause patients discomfort, but also may prevent the delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that treatment is delivered as planned and that side effects resulting from cancer and its treatment are appropriately managed.

 

Phase I clinical trials: New chemotherapy drugs continue to be developed and evaluated in patients with recurrent cancers in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and whether the drug has any anticancer activity in patients.

 

 

Recurrent Colon Cancer

 

When colon cancer has returned following an initial treatment with surgery, radiation therapy, and/or chemotherapy or has stopped responding to treatment, it is said to be recurrent or relapsed.

 

Patients with recurrent colon cancer can be broadly divided into two groups:

 

•Those with recurrent cancer that can be surgically removed with the goal of a cure

 •Those with more widespread cancer

 

Colon cancer may metastasize to the liver, lung, or other locations. When the site of metastasis is a single organ, such as the liver, and the cancer is confined to a single defined area within the organ, patients may benefit from local treatment directed at that single metastasis.

 

The majority of patients have unresectable or widespread disease. Historically, treatment outcomes for these patients were poor. However, new combinations of chemotherapy drugs and use of targeted therapies such as Avastin® (bevacizumab), Erbitux® (cetuximab), and Vectibix® (panitumumab) have improved outcomes.

 

Prior to using either Erbitux or Vectibix, patients may have a sample of their cancer tested for mutations in the KRAS gene. Cancers that contain a KRAS mutation are unlikely to respond to Erbitux or Vectibix.1 2

 

About this Treatment Information

 

The following is a general overview of treatment for recurrent colon cancer. Cancer treatment may consist of surgery, radiation, chemotherapy, targeted therapy, or a combination of these treatment techniques. Combining two or more of these treatment techniques–called multi-modality care–has become an important approach for increasing a patient’s chance of cure and prolonging survival.

 

In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.

 

Circumstances unique to each patient’s situation influence which treatments are utilized. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

 

Systemic Therapy for Colon Cancer that Has Recurred at Multiple Sites in the Body

 

Most patients with recurrent colon cancer have previously been treated with chemotherapy; the recurrent cancer may be resistant to whatever regimen the patient has already taken. Typically, doctors will prescribe a different treatment regimen from the previous regimen.

 

Combination Chemotherapy: Standard treatment of advanced colon cancer generally includes chemotherapy with 5-FU. Eloxatin® (oxaliplatin) and Camptosar® (irinotecan) are chemotherapy drugs that are often added to 5-FU. Eloxatin/5-FU/LV (FOLFOX) and Camptosar/5-FU/LV (FOLFIRI) have been shown to improve survival in patients with advanced colon cancer when compared to treatment with 5-FU/LV alone.3 FOLFOX and FOLFIRI have been shown to produce similar survival benefits, but have slightly different side effects.

 

Targeted Therapy: Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target”, targeted therapies may slow cancer cell growth or increase cancer cell death. Targeted therapies may be used in combination with other cancer treatments such as conventional chemotherapy. Recently approved targeted therapies represent the most novel advance in the treatment of metastatic colorectal cancer in the last few years.

 

Targeted therapies that have shown a benefit for selected patients with metastatic colorectal cancer include Avastin® (bevacizumab), Erbitux® (cetuximab), and Vectibix® (panitumumab). Avastin blocks a protein (VEGF) that plays a key role in the development of new blood vessels. By blocking VEGF, Avastin deprives the cancer of nutrients and oxygen and inhibits its growth. Erbitux and Vectibix slow cancer growth by targeting a protein known as EGFR. Cancers with certain gene mutations are unlikely to respond to Erbitux or Vectibix, and tests are available to detect these mutations before treatment decisions are made.

 

Targeted therapies are often used in combination with chemotherapy, but in some cases may be used alone.

 

Treatment of Colon Cancer that Has Metastasized to a Single Site

 

Stage IV colon cancer commonly spreads to the liver or the lungs. When metastases are limited to a single organ, treatment of that organ may improve outcomes:

 

Treatment of the Liver: When it’s possible to completely surgically remove all liver metastases, surgery is the preferred treatment. Although surgery offers some patients the chance for a cure, a majority of patients with liver metastases are not candidates for surgery because of the size or location of their tumours or their general health. Some of these patients may become candidates for surgery if initial treatment with chemotherapy shrinks the tumors sufficiently. If the tumors continue to be impossible to remove surgically, other liver-directed therapies may be considered. These other therapies include radiofrequency ablation (use of heat to kill cancer cells), cryotherapy (use of cold to kill cancer cells), delivery of chemotherapy directly to the liver, and radiation therapy. Relatively little information is available from clinical trials about the risks and benefits of these other approaches, but they may benefit selected patients.4

 

Treatment of the Elderly

 

A large percentage of patients with advanced colorectal cancer are 65 years or older. Because elderly patients commonly have concurrent illnesses or other medical difficulties that are perceived to exacerbate the side effects of chemotherapy, elderly patients are often treated with reduced doses of chemotherapy. Clinical studies have shown, however, that elderly patients get the same benefit from chemotherapy treatment as younger patients.

 

While a dose reduction or delay may sometimes be necessary, it may also compromise the optimal treatment of some patients. All patients over 65 should be closely monitored for toxic side effects of chemotherapy, especially during their initial chemotherapy administration cycle.

 

Strategies to Improve Treatment of Stage IV Colon Cancer

 

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of recurrent colon cancer will result from the continued evaluation of new treatments in clinical trials. Participation in a clinical trial may offer patients access to better treatments and advance the existing knowledge about treatment of this cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active exploration to improve the treatment of recurrent colon cancer include the following:

 

New Approaches to Treating Liver Metastases: Researchers continue to explore news ways to treat cancer that has spread to the liver. One approach that is being evaluated is radioembolization This strategy uses radioactive microspheres (small spheres containing radioactive material). The small spheres are injected into vasculature of the liver, where they tend to get lodged in the vasculature responsible for providing blood and nourishment to the cancer cells. While lodged in place, the radioactive substance spontaneously emits radiation to the surrounding cancerous area while minimizing radiation exposure to the healthy portions of the liver.5 Researchers are also exploring alternatives to radiofrequency ablation for the destruction of liver tumors, as well as new approaches to delivering chemotherapy to the liver.

 

New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies is an active area of clinical research.

 

New Approaches to Targeted Therapy: Targeted therapies such as Avastin, Erbitux, and Vectibix already play a role in the treatment of selected patients with advanced colorectal cancer, but researchers continue to explore new targeted therapies as well as new ways of using existing drugs. Developing tests to predict which patients are most likely to respond to which drugs is also an important focus of research. Tests to identify certain gene mutations in the cancer are already available, and can help guide the use of Erbitux and Vectibix.

 

Managing Side Effects: Techniques designed to prevent or control the side effects of cancer and its treatments are called supportive care. Side effects not only cause patients discomfort, but also may prevent the delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that treatment is delivered as planned and that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.

 

 

How to Detect Colorectal Cancer Earlier

 

Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. In the United States, colorectal cancer is the third-most-common cancer in both males and females and accounts for about 9% of cancer-related deaths each year. In 2012, more than 143,000 people were diagnosed with colorectal cancer and approximately 51,690 patients died from this disease. Detection of colorectal cancer in its earliest stage greatly increases the potential that it can be successfully treated.

 

SYMPTOMS OF COLORECTAL CANCER

 

Perhaps the most common symptom of colorectal cancer is a change in bowel habits. Other symptoms include:

 •Having chronic diarrhea or constipation

 •Feeling that your bowel does not empty completely

 •Finding blood (either bright red or very dark) in your stool

 •Finding that your stools are narrower than usual

 •Feeling frequent gas pains or cramps

 •Losing weight for no known reason

 •Feeling very tired all the time

 •Having nausea or vomiting

 

Most often, these symptoms are not due to cancer. A variety of daily life occurrences as well as other less serious health problems can cause those symptoms, too. But if you are experiencing symptoms that persist for more than a few days, you should consider seeing your doctor. It is always better to know what is causing symptoms such as these, and, if colorectal cancer is diagnosed, to be treated as early as possible.

 

DETECTION

 

Treatment for colorectal cancer is more likely to be effective when the disease is found early. Doctors have a wide range of screening options available to detect the presence of colorectal cancer, including tests that can help to find polyps or cancer before you experience symptoms. Finding and removing polyps may prevent colorectal cancer.

 

To find polyps or early colorectal cancer:

 •People in their 50s and older should be screened.

 •People who are at higher-than-average risk of colorectal cancer (including individuals whose close relatives have a history of colorectal cancer, people who have genetic alterations related to colorectal cancer, and who have ulcerative colitis or Crohn's disease) should talk with their doctor about whether to have screening tests before age 50, what tests to have, the benefits and risks of each test, and how often to schedule appointments.

 

The chart below lists several common types of colorectal cancer screenings with the suggested frequency of testing for the high-risk age groups.

 

Both polyps and cancer

 

•Digital rectal exam: A rectal exam is often part of a routine physical examination. Your doctor inserts a lubricated, gloved finger into your rectum to feel for abnormalities areas.

 •Colonoscopy: Your doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscopy. If polyps are found, they will be removed and examined under a microscope for signs of cancer.

 •Sigmoidoscopy: Using a lighted tube called a sigmoidoscope, your doctor checks inside your rectum and only the lower part of the colon for polyps and signs of cancer. If polyps or other abnormal tissue are found, the doctor removes them for examination under the microscope.

 •Double-contrast barium enema (DCBE): You are given an enema with a barium solution, and air is pumped into your rectum. Several x-ray pictures are taken of your colon and rectum. The barium and air help your colon and rectum show up on the pictures. Polyps or tumors may show up.

 •Fecal occult blood test (FOBT): Sometimes cancers or polyps bleed, and this test can detect tiny amounts of blood in the stool. If the FOBT detects blood, a colonoscopy or another test is necessary to determine the source of the blood.

 •Fecal immunochemical test (FIT): FIT is a newer kind of test that also detects occult (hidden) blood in the stool. However, this test is also less likely to react to bleeding from parts of the upper digestive tract, such as the stomach.

 

Source: http://www.nfcr.org/how-detect-colorectal-cancer-earlier