Treatment of colon cancer

							Treatment of colon cancer
Surgery, and the sooner the better. In fact, most, if not all, colon cancers begin as benign (harmless) "polyps" that subsequently turn malignant (cancerous). These polyps can be removed very easily during endoscopy (colonoscopy). Once it has been determined that you have a tendency to form polyps, you should have endoscopy at least once a year. If a cancer is found and it has not spread to distant sites, surgery to remove all of it is the best choice in nearly all cases. The doctor also looks for possible spread and will take small samples of other tissues that might contain cancer seeds. Even if the cancer has spread, there may be a chance for removing it all under special circumstances. For instance, removing a single satellite cancer or up to five depending on size and location (called a metastasis) from the liver has been successful enough in prolonging life that it is a recommended treatment for selected cases. Removing metastases if only found in the liver or the lung may improve the cure rate from 25 percent to 30 percent. Colostomy Even if the cancer cannot be cured, the surgeon may need to deal with complications such as bowel obstruction. In such cases, the surgeon does as little as necessary to relieve the immediate problem. Often this involves bypassing an obstruction by creating a colostomy -an opening in the abdominal wall (called a stoma) where the large bowel is connected, and a bag is then attached to catch the stool. Caring for a colostomy is not as easy as having natural bowel movements, but many people lead normal lives. Often a colostomy can be trained to move once a day so that only a bandage need be worn over it. A colostomy may also result from curative surgery if the cancer is too close to the anus. The surgeon will try to reconnect healthy bowel above and below the cancerous section that has been removed, but if the lower piece is too short, a colostomy may be the only solution. In some cases, a colostomy is only temporary and can be taken down after you have healed from the rest of your surgery. Help for colostomy care is available nationwide from the United Ostomy Association and from local professionals who specialize in ostomy care. Radiation Radiation is used before or after surgery for rectal or pelvic colorectal cases, or both, in selected cases, usually when there is little chance of curing the disease. Radiation does not cure colon cancer, but it can shrink it and slow its growth. Colon cancers in certain areas, particularly low in the pelvis near the anus, often receive radiation treatment after surgery because they are so likely to have spread locally. Radiotherapy is used primarily for rectal cancer and will decrease the risk of local recurrence. Radiotherapy with chemotherapy can improve chances for disease-free survival. Chemotherapy Many different combinations of cancer-killing chemicals are used in colo-rectal cancer. Adjuvant chemotherapy when lymph nodes are positive and stage III decreases the risk of recurrence and death. In the past few years, combination chemotherapy using 5FU-leucovorin, Irinotecan and Oxaloplatin are showing promising results. Should you face this possibility, you will need to have a thorough discussion with your doctor of the latest studies and recommendations.

Immunotherapy Biological treatment, sometimes called biological response modifier (BRM) therapy or immunotherapy, attempts to mobilize the body to fight cancer. These new, experimental procedures use materials made by the body or made in a laboratory to boost, direct or restore the body's natural defenses against disease. Biological agents that have shown success in triggering an immune response against some cancers include interferons, interleukins, colonystimulating factors, T cells, tumor vaccines, tumor necrosis factors and gene therapy. For example, clinical trials are underway using patient's own cancer cells or with the patient's white blood cells mixed with tumor proteins, to produce immunity against further cancer growth. Such "colon cancer vaccines" may offer hope in extending patients' lives. Clinical studies are in progress using monoclonal antibodies such as MOAB17-1A. Anti-EGRF (C-225) or VGEF (epidermal or vascular growth factor receptors) and bevacizumab (Avastin®) have shown positive results when combined with chemotherapy. A recent phase III trial compared bevacizumab (Avastin®) with IFL (irinotecan/5FU/leucovorin) produced a significant improvement in survival of nearly five months compared with IFL alone.

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/canc/colc/colontreat.asp @ 8/3/2006 Chemotherapy
Chemotherapy Chemotherapy is the use of anti-cancer drugs to eliminate cancer cells from the body. This is called a "systemic" form of cancer therapy, because medication is delivered either intravenously or taken by mouth as a pill or capsule. Chemotherapy is used in colon cancer as an adjuvant program to help prevent recurrence or if it has spread outside of its site of origin to other parts of the body (metastasized).

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/canc/colc/colc_meds_type.asp @ 8/3/2006
Known risk factors for colorectal cancer include...

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Age - more than 90 percent of people diagnosed are over age 50. Personal history of benign polyps. Inflammatory bowel diseases. Chronic inflammation of the colon, such as in ulcerative colitis and Crohn's disease, increases the risk. Family history. The risk of colon cancer increases two to three times if a primary firstdegree relative (parent, sibling or child) has the disease. Familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC) are conditions in which multiple benign polyps become cancer and both have a strong genetic link. Low-fiber, high fat diet, increased red meat intake.

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Increased consumption of charcoal-broiled foods. Lack of exercise.

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/canc/colc/colc_gen_risk.asp @ 8/3/2006 Prevention of Colorectal Cancer
There is no known way to directly prevent colorectal cancer, but you can reduce the risks, mainly through lifestyle changes and screening.

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Regular screening for colorectal cancer should begin at age 50 with the fecal occult blood test and the sigmoidoscopy. Know your family history for cancer and tell your doctor. Eat a diet high in fiber, from whole grains, fruits and vegetables, and low in animal fat and red meat. Exercise regularly and keep your weight in the normal range.

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/canc/colc/colc_gen_prev.asp @ 8/3/2006

Preventing Colon Cancer
Strict science has given us little means to prevent this disease. Reduced animal fat and red meat in the diet, reduced alcohol intake, elimination of tobacco and possibly an increase in dietary fiber, and fruits and vegetables are the only suggestions illuminated by research. Miracle cures of advanced cancers and other diseases have been achieved by methods that go beyond the capabilities of science to evaluate. Presumably these same measures would assist in prevention as well as cure. Measures include laughter, exercise and bodily fitness. Prayer and meditation, a positive attitude, and stress reduction help in supportive care but have not been proven to prevent colorectal cancer. The common grounds for most of the diet recommendations are:

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Red meat and animal fat are usually minimized. Fish (particularly salmon) and sometimes poultry are often included. Refined (white) sugar and sometimes all sugars are eliminated. Honey and molasses get mixed reviews. Whole grains (brown rice, whole wheat, oats) are recommended, usually as the mainstay of the menu. Some recent studies suggest bran probably plays a role in colon cancer prevention. Eggs get mixed reviews.

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Get about 1,200 milligrams to 2,000 milligrams of calcium a day whether through a pill or food. Some studies suggest calcium might help reduce colon cancer cell growth. Vegetables that are red, orange and yellow are encouraged. The color represents chemicals believed beneficial. Vegetables that are green and leafy, including seaweeds, are a mainstay and are usually a large part of other diets. Fats and oils of all kinds (except olive oil and fish oil) are to be minimized. A wide variety of "nutritional supplements" such as vitamins, minerals, enzymes, herbs and algae (now known as nutraceuticals) are usually included, with specific recommendations depending upon the condition you want to deal with.

Many of these recommendations are solid and well-grounded in general medical research, although their specific effect in preventing or curing cancer is not proven. Others have only anecdotal or theoretical support. None of them can get you into any trouble, with the exception of some herbal remedies.

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/canc/colc/colonprev.asp @ 8/3/2006

Smoking Linked to Colon Cancer
If you smoke, the American Cancer Society (ACS) has another reason why you should quit. A 14-year study shows that smokers and ex-smokers are more likely to die from colorectal cancer than people who never smoked. Deaths from cancer of the rectum and colon were lowest among nonsmokers and highest among people who smoked for more than 20 years, reported a study of 781,351 men and women between 1982 and 1996. People who had quit smoking had a lower death rate than current smokers but higher than nonsmokers. The study results appeared in the Journal of the National Cancer Institute. The more than 6,800 people die from colon cancer each year because of smoking represent 12 percent of the 56,000 colon cancer deaths that year, says Ann Chao, Ph.D., a research scholar at the ACS and first author of the study. Colon cancer is expected to strike more than 106,000 Americans in 2004 and is the second-leading cause of cancer death in the U.S. after lung cancer. The more you smoke, the greater the risk In the study, the death rate was 30 percent higher for people who smoked cigarettes 20 years or more compared to people who never smoked, Chao says. Men who smoked cigars or pipes for 20 years or more had a 34 percent increase in colorectal cancer deaths. Compared to nonsmokers, women who quit smoking had a 22 percent higher risk of dying from colorectal cancer and men who formerly smoked had a 15 percent increased risk, the ACS study found. The good news is that people who quit smoking 20 years ago or longer died from colorectal cancer about as often as people who did not smoke at all.

"The sooner you quit, the lower your risk," Chao says. Chao says results of the study should prompt smokers not only to quit, but also to be vigilant about getting screened regularly for colon cancer. "A person's smoking history probably should be taken into consideration in considering when they should be screened. That's something people should discuss with their doctor," she says. The ACS recommends regular screenings for men and women starting at age 50, but many Americans are skipping these exams. A survey by ACS found 41 percent of people older than 50 had not had a colonoscopy or sigmoidoscopy, diagnostic tests that detect and remove cancerous and precancerous polyps, which are mushroom-shaped growths on the lining of the rectum and colon. Without a thorough exam, you may never know if you have the disease until it has spread to other parts of your body, the ACS says. New support for an old test The fecal occult blood test (FOBT), which detects invisible amounts of blood in your stool that could indicate the presence of polyps, could have a bigger impact than originally suspected in preventing colon cancer deaths. Another study of 46,551 patients by the University of Minnesota found that people who received an FOBT screening every year were 20 percent less likely to develop colon cancer. "I think that amplifies the value of screening,'' says Timothy R. Church, Ph.D., the principal investigator for the 25-year study. The results were published in the New England Journal of Medicine. An FOBT can be done at home, which is appealing to people who are reluctant to go to their doctor for testing, says Church, an associate professor in the division of environmental health at the University of Minnesota School of Public Health. If blood is found in your stool during a fecal occult blood test, your doctor will probably recommend that you undergo a colonoscopy (described below) to find the source of the bleeding. "Because many polyps are detected and removed after a positive fecal occult-blood screening, a reduction in the incidence of colorectal cancer is inevitable, and our study shows that," Church says. Recommended screenings Men and women with no known risk factors or symptoms should undergo one of the three screening options beginning at age 50, according to the ACS: 1. Fecal occult blood test (annually) and a sigmoidoscopy (every five years). During a sigmoidoscopy, a 2-foot-long lighted tube is inserted into the lower third of your colon where more than half of all polyps are detected. The test takes about 10 to 20 minutes and is usually done in your doctor's office without anesthesia. 2. Barium enema (every five to 10 years). Your large intestine is coated with barium sulfate, then injected with air and x-rayed to locate abnormal growths. The test takes about 30 to 45 minutes. 3. Colonoscopy (every 10 years). This procedure, which takes about 30 to 60 minutes, is the most invasive, but also the most accurate, and is usually performed in a hospital. The doctor probes all 5 feet of your large intestine with a flexible tube while you are sedated. The tube, which is about as thick as a finger, is equipped with a light and connected to a video display monitor for your doctor to view the inside of your colon. The colonoscope also can be used to remove small polyps and stop bleeding.

A digital rectal exam should be done at the same time as a sigmoidoscopy, colonoscopy or barium enema. Also, you should consider more frequent exams before age 50 if your personal or family health history increases your risk of developing colorectal cancer.

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/suba/smok/alert12162000.asp @ 8/3/2006 Your Treatment Plan
There are four types of treatments for colorectal cancer: surgery, radiation, chemotherapy and immune therapy. Often, a combination of these methods is used. Surgery The main treatment for colon cancer is surgery. You may need to have the entire colon or only a portion of it removed. If cancer is confined to the polyp, then only the polyp is removed, and the colon is left completely intact. If a segment of colon containing the tumor is removed, a margin of colon on either side of the tumor is removed as well. One end of the colon is surgically attached to a carefully constructed opening called a "colostomy," which is used to expel fecal matter instead of the anus. Depending on the kind of surgery, the colostomy is either temporary or permanent. The colostomy is more likely to be permanent if the tumor is located in the distal rectum. However, there are procedures that preserve rectal function. Radiation therapy Radiation treatment uses a directed beam of high-energy X-rays to destroy cancer cells mainly in the pelvis (rectal). The goal is to destroy only the cancer cells without harming surrounding normal tissue. External beam radiation uses a machine (like a CT scanner) to direct a beam of energy below the skin surface to target the tumor a few centimeters below. Internal radiation therapy (brachytherapy), used in early stage rectal cancer, delivers the radiation directly by inserting thin plastic tubes through the anus. Chemotherapy Chemotherapy is the use of anti-cancer drugs to eliminate cancer cells from the body. This is called a "systemic" form of cancer therapy, because medication is delivered either intravenously or taken by mouth as a pill or capsule. Chemotherapy is used in colon cancer as adjuvant therapy usually for Stage III (lymph node positive) or if it has spread outside of its site of origin to other parts of the body (metastasized). Immunotherapy Immunotherapy is a treatment that uses parts of the immune system to fight disease. Monoclonal antibody therapy is a passive immunotherapy that can be effective if the immune system is weakened and cannot take an "active" role in fighting the cancer. Monoclonal antibody therapy works against the VEGF (vascular epithelial growth factor) protein using bevacizumab or cetuximab along with chemotherapy. It has had a significantly higher response rate and a prolonged disease-free survival than combination chemotherapy for metastatic colon cancer.

http://www.adventisthealthcare.com/AHC/Atoz/dc/caz/canc/colc/colc_trea_plan.asp @ 8/3/2006