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Cancer Education Slides

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Slide 1 :

Cancer Education Slides Colorectal Cancer 2008

Slide 2 :

What is Cancer? A group of 100 different diseases The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

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What is Colorectal Cancer? An estimated 148,810 people diagnosed in the United States in 2008 Third most common type of cancer and third most frequent cause of cancer-related death in men and women A disease in which normal cells in the lining of the colon or rectum begin to change, grow without control, and no longer die Usually begins as a noncancerous polyp that can, over time, become a cancerous tumor

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What is the Function of the Colon and Rectum? The colon and rectum comprise the large intestine (large bowel) The primary function of the large bowel is to turn liquid stool into formed fecal matter

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What are the Risk Factors for Colorectal Cancer? Polyps (a noncancerous or precancerous growth associated with aging); about 10% of polyps are flat and have high risk of becoming cancerous Age Inflammatory bowel disease (IBD) Diet high in saturated fats, such as red meat Personal or family history of cancer Obesity Smoking Race: Blacks have higher rates Other

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Hereditary Colorectal Cancer Syndromes: HNPCC Hereditary non-polyposis colorectal cancer (HNPCC), sometimes called Lynch syndrome, accounts for approximately 5% to 10% of all colorectal cancer cases The risk of colorectal cancer in families with HNPCC is 70% to 90%, which is several times the risk of the general population People with HNPCC are diagnosed with colorectal cancer at an average age of 45 Genetic testing for the most common HNPCC genes is available; measures can be taken to prevent development of colorectal cancer

Slide 7 :

Hereditary Colorectal Cancer Syndromes: FAP 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 polyps are initially benign (noncancerous), but there is nearly a 100% chance that the polyps will develop into cancer if left untreated Colorectal cancer usually occurs by age 40 in people with FAP Mutations (changes) in the APC gene cause FAP; genetic testing is available Yearly screening for polyps is recommended Attenuated familial adenomatous polyposis (AFAP) is related to FAP; people have fewer polyps

Slide 8 :

Hereditary Colorectal Cancer Syndromes Several other less common syndromes can increase a person’s risk of colorectal cancer Talk with your doctor about finding a genetic counselor if you have a history of colorectal cancer in your family and family members developed cancer before age 50 For more information, visit www.cancer.net/genetics

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Colorectal Cancer and Early Detection Colorectal cancer can be prevented through regular screening and the removal of polyps Early diagnosis means a better chance of successful treatment Screening should begin at age 50 for all “average risk” individuals (black people age 45) or sooner if you have a family history of colorectal cancer, symptoms, or a personal history of inflammatory bowel disease

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Screening Methods for Colorectal Cancer Colonoscopy (currently the best way to prevent and detect colorectal cancer) Virtual colonography Sigmoidoscopy Fecal occult blood test Double contrast barium enema Stool DNA test

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What are the Symptoms of Colorectal Cancer? A change in bowel habits: diarrhea, constipation, or a feeling 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 gas pains, bloating, fullness, and cramps Unexplained weight loss, constant tiredness, or unexplained anemia (iron deficiency)

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How is Colorectal Cancer Diagnosed? Diagnosis is confirmed with a biopsy Blood tests Stage of disease is confirmed by pathologists and imaging tests, such as computerized tomography (CT or CAT) scans Endoscopic ultrasound and magnetic resonance imaging (MRI) may also be used to stage rectal cancer

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Colorectal Cancer Staging Staging is a way of describing a cancer, such as the size of a tumor and if or where it has spread Staging is the most important tool doctors have to determine a patient’s prognosis Staging is described by the TNM system: the size and location of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to other areas of the body) Some stages are divided into smaller groups that help describe the tumor in even more detail Treatment depends on the stage of the cancer Recurrent cancer is cancer that comes back after treatment

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Stage 0 Colorectal Cancer Known as “cancer in situ,” meaning the cancer is located in the mucosa (moist tissue lining the colon or rectum) Removal of the polyp (polypectomy) is the usual treatment

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Stage I Colorectal Cancer The cancer has grown through the mucosa (tissue lining the colon or rectum) and invaded the muscularis (muscular coat) Treatment is surgery to remove the tumor and some surrounding lymph nodes

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Stage II Colorectal Cancer The cancer has grown beyond the muscularis of the colon or rectum but has not spread to the lymph nodes Stage II colon cancer is treated with surgery and, in some cases, chemotherapy after surgery Stage II rectal cancer is treated with surgery, radiation therapy, and chemotherapy

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Stage III Colorectal Cancer The cancer has spread to the regional lymph nodes (lymph nodes near the colon and rectum) Stage III colon cancer is treated with surgery and chemotherapy Stage III rectal cancer is treated with surgery, radiation therapy, and chemotherapy

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Stage IV Colorectal Cancer The cancer has spread outside of the colon or rectum to other areas of the body Stage IV cancer is treated with chemotherapy. Surgery to remove the colon or rectal tumor may or may not be done Additional surgery to remove metastases may also be done in carefully selected patients

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How is Colorectal Cancer Treated? Treatment depends on the stage of cancer More than one treatment may be used Colon cancer is treated somewhat differently from rectal cancer Surgery Chemotherapy Radiation therapy Targeted therapies, such as bevacizumab (Avastin), cetuximab (Erbitux), and panitumumab (Vectibix)

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Cancer Treatment: Surgery Foundation of curative therapy The tumor, along with the adjacent healthy colon or rectum and lymph nodes, is typically removed to offer the best chance for cure May require temporary or (rarely) permanent colostomy (surgical opening in abdomen that provides a place for waste to exit the body)

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Cancer Treatment: Chemotherapy Use of drugs to kill cancer cells Typical medications include fluorouracil (5-FU, Adrucil), leucovorin (Wellcovorin), oxaliplatin (Eloxatin), irinotecan (Camptosar), and capecitabine (Xeloda) A combination of medications is often used

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Types of Chemotherapy Adjuvant chemotherapy is given after surgery to maximize a patient’s chance for cure Neoadjuvant chemotherapy is given before surgery Palliative chemotherapy is given to patients whose cancer cannot be removed to delay or reverse cancer-related symptoms and substantially improve quality and length of life

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Cancer Treatment: Radiation Therapy The use of high-energy x-rays to destroy cancer cells Used to treat rectal cancer, either before or after surgery Different methods of delivery External-beam: outside the body Intraoperative: one dose during surgery

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New Therapies: Antiangiogenesis Therapy “Starves” the tumor by disrupting its blood supply This therapy is given along with chemotherapy Bevacizumab is approved by the U.S. Food and Drug Administration (FDA) for the treatment of stage IV colorectal cancer

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New Therapies: Targeted Therapy Treatment designed to target cancer cells while minimizing damage to healthy cells Cetuximab is approved by the FDA for the treatment of advanced colorectal cancer Panitumumab is a similar treatment to cetuximab

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The Role of Clinical Trials for the Treatment of Colorectal Cancer Clinical trials are research studies involving people They test new treatment and prevention methods to determine whether they are safe, effective, and better than the standard treatment The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

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Clinical Trials: Patient Safety Informed consent: participants should understand why they are being offered entry into a clinical trial and the potential benefits and 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 ongoing patient safety

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Clinical Trials: Phases Phase I trials determine the safety and dose of a new treatment in a small group of people Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a specific type of cancer Phase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the standard treatment for that disease; phase III trials involve a large number of patients

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Clinical Trials Resources Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org) CenterWatch (www.centerwatch.com) National Cancer Institute (www.cancer.gov/clinical_trials) EmergingMed (www.emergingmed.com)

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Coping with Side Effects Side effects are treatable; talk with the doctor or nurse Fatigue is a common, treatable side effect Pain is treatable; non-narcotic pain-relievers are available Antiemetic drugs can reduce or prevent nausea and vomiting For more information, visit www.cancer.net/sideeffects

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After Treatment Talk with the doctor about developing a follow-up care plan Regular physical examinations and/or medical tests may be required Serial carcinoembryonic antigen (CEA) measurements are recommended Colonoscopy one year after removal of colorectal cancer Surveillance colonoscopy every three to five years to identify new polyps and/or cancers More information can be found in the ASCO Patient Guide: Follow-Up Care for Colorectal Cancer Fear of recurrence is common; talk with your doctor about ways to cope

Slide 32 :

Where to Find More InformationCancer.Net Guide to Colorectal Cancer(www.cancer.net/colorectal) Overview Medical Illustrations Risk Factors Symptoms Diagnosis Staging With Illustrations Treatment Clinical Trials Side Effects After Treatment Current Research Questions to Ask the Doctor Patient Information Resources

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Cancer.Net (www.cancer.net) Comprehensive, oncologist-approved cancer information Guides to more than 120 types of cancer and cancer-related syndromes Coping resources Survivorship information Cancer information in Spanish Weekly feature articles The latest cancer news For patient information resources, please call 888-651-3038

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