Colorectal Cancer 101 Overview Who is the Colon Cancer Alliance? What is Colorectal Cancer? How Can...
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Transcript of Colorectal Cancer 101 Overview Who is the Colon Cancer Alliance? What is Colorectal Cancer? How Can...
Colorectal Cancer 101Colorectal Cancer 101
OverviewOverview
• Who is the Colon Cancer Alliance?
• What is Colorectal Cancer?
• How Can You Help?
•Colon and rectal cancerColon and rectal cancer •ScreeningScreening
•Stages •Diagnosis
•Risk factorsRisk factors •TreatmentTreatment
•Statistics •Prevention
Who is the Who is the Colon Cancer Alliance Colon Cancer Alliance
(CCA)?(CCA)?
The (CCA) is a national patient advocacy
organization dedicated to ending the suffering
caused by colorectal cancer.
Who is the CCA?Who is the CCA?
• The CCA has over 37,000 members.
• The growth and success of the organization is due
in large part to the skills and energy of our
volunteers.
What does the CCA do?What does the CCA do?
• In order to increase rates of screening and
survivorship, the CCA provides:
• Patient Support Patient Support
• Education Education
• Research Research
• AdvocacyAdvocacy
Patient Support ServicesPatient Support Services
– Toll-free Helpline: Toll-free Helpline: 1.877.422.20301.877.422.2030
– Buddy Program – Peer to Peer SupportBuddy Program – Peer to Peer Support
– Support through Local Chapters Support through Local Chapters
– MyCRCConnections.orgMyCRCConnections.org – Online Community– Online Community
– Regional Seminars/Online Webinars Regional Seminars/Online Webinars
Education ServicesEducation Services
Education ServicesEducation Services
Education ServicesEducation Services
Supports ResearchSupports Research
The CCA works to increase
federalfederal, statestate, and private private
funding funding for research
devoted to finding more
effective treatments for
colorectal cancer.
Supports Advocacy Supports Advocacy EffortsEfforts
The CCA is dedicated to
advancingadvancing and
championingchampioning the cause of
colon cancer.
What is Colorectal Cancer?What is Colorectal Cancer?
Colorectal Cancer FactsColorectal Cancer Facts
The second leading cancer killer in the United States.
• One person in the United States dies of One person in the United States dies of
colorectal cancer every 9.3 minutes. colorectal cancer every 9.3 minutes.
Survival depends on early detection.
• 90% five-year survival rate in early detected 90% five-year survival rate in early detected
cases.cases.
What is Colorectal What is Colorectal Cancer?Cancer?
Definition of colon cancerDefinition of colon cancer:
Cancer that forms in the tissues of the colon (the
longest part of the large intestine). Most colon cancers
begin in cells that make and release mucus and other
fluids.
American Cancer Society © 2009. www.cancer.gov.
What is Colorectal What is Colorectal Cancer?Cancer?
Definition of rectal cancerDefinition of rectal cancer:
Cancer that forms in the tissues of the rectum
(the last several inches of the large intestine
closest to the anus).
American Cancer Society © 2009. www.cancer.gov.
What is Colorectal What is Colorectal Cancer?Cancer?
• Colorectal cancer is
cancer that occurs in
the colon or rectum.
Sometimes it is called
colon cancercolon cancer, for short.
What is Colorectal What is Colorectal Cancer?Cancer?
• The coloncolon is the large
intestine or large bowel.
The rectumrectum is the
passageway that
connects the colon to the
anus.
Colon Cancer and Colon Cancer and PolypsPolyps
• Colorectal cancer comes from polyps.
• One of every three One of every three adults has polyps.
PolypsPolyps
• In most people, colorectal cancers develop
slowly slowly over a period of several years.
• Before a cancer develops, a growth of tissue or
tumor tumor usually begins as a non-cancerousnon-cancerous polyp polyp
on the inner lining of the colon or rectum.
PolypsPolyps
• A tumortumor is abnormal tissue and can be benign
(not cancer) or malignant (cancer).
• A polyp polyp is a benign, non-cancerous tumor.
Some polyps can change into cancer but not all
do.
Most Common Polyps:Most Common Polyps:Inflammatory
• Most often found in patients with ulcerative colitis or
Crohn's disease.
• Often called "pseudopolyppseudopolyps" (false polyps), they are just a
reaction to chronic inflammation of the colon wall.
• They are not the type that turns to cancer. They are usually
biopsied to verify type.
Most Common Polyps:Most Common Polyps:
Hyperplastic
A common type of polyp which is usually very small
and often found in the rectum. They are considered to
be low risk for cancer.
Most Common Polyps:Most Common Polyps:
Tubular adenoma or adenomatous polyp
• About 70% of polyps removed are of this type.
• Adenomas carry a definite cancer risk which rises as
the polyp grows larger.
Most Common Polyps:Most Common Polyps:
Villous adenoma or tubulovillous adenomas
• About 15% of polyps removed are of this type.
• These are the most serious type of polyp with a very
high cancer risk as they grow larger.
Most Common TumorsMost Common Tumors
• More than 95%95% of colorectal cancers are
adenocarcinomasadenocarcinomas.
• These cancers start in cells that form glands that
make mucus to lubricate the inside of the colon and
rectum.
Less Common TumorsLess Common Tumors
• Carcinoid tumors: These tumors develop from
specialized hormone-producing cells of the intestine.
Less Common TumorsLess Common Tumors
Gastrointestinal stromal tumors (GISTs):
• These tumors develop from specialized cells in the
wall of the colon.
• Some are benign; others are malignant (cancerous).
• Can be found anywhere in the digestive tract, they
are unusual in the colon.
Less Common TumorsLess Common Tumors
Lymphomas:
• These are cancers of immune system cells that
typically develop in lymph nodes.
• May also start in the colon and rectum or other
organs.
What Are The Stages of What Are The Stages of Colorectal Cancer?Colorectal Cancer?
Stages of Colon CancerStages of Colon Cancer
• The process used to find out if cancer has spread
within the colon/rectum or to other parts of the
body is called stagingstaging.
• It is important to know the stage in order to plan
treatment.
Colorectal Cancer Colorectal Cancer StagingStaging
Staging OverviewStaging Overview
• Stage 00: This is the earliest stage possible. Cancer
hasn't moved from where it started; it's still restricted
to the innermost lining of the colon.
• Stage II: Cancer has begun to spread, but is still in the
inner lining.
Staging OverviewStaging Overview
• Stage IIII: Cancer has spread to other organs near the
colon or rectum. It has not reached lymph nodes.
• Stage IIIIII: Cancer has spread to lymph nodes, but has
not been carried to distant parts of the body.
Staging OverviewStaging Overview
• Stage IVIV: Cancer has been carried through the lymph
system to distant parts of the body. This is known as
metastasis. The most likely organs to experience
metastasis from colorectal cancer are the lungs and
liver.
Five-Year Survival Rates Five-Year Survival Rates by Stage at Diagnosis by Stage at Diagnosis
StagesStages
Localized: Cancer that is confined to the
place where it started.
Regional: Cancer that has grown beyond the
organ of origin to regional lymph nodes and/or
organs and tissues next to the original site.
Distant: Cancer that has spread from the original
(primary) tumor to distant organs or distant lymph
nodes.
What Are The Risk and What Are The Risk and Protective Factors? Protective Factors?
At RiskAt Risk
• Men Men and women women age 50 50 and older
• Tobacco usersTobacco users, are obeseobese, and/or are inactiveinactive
• Personal or Family history Personal or Family history of colorectal cancercolorectal cancer or
even non-cancerous colorectal polyps
• Personal or family history of Irritable Bowel Personal or family history of Irritable Bowel
SyndromeSyndrome
Risk FactorsRisk Factors
Strong Moderate Modest
Advanced age High red meat dietHigh red meat diet High fat diet
Country of birthCountry of birth Previous adenoma or cancer
Smoking and alcohol Smoking and alcohol consumptionconsumption
FAP/HNPCC
Familial adenomatous polyposis /Hereditary non-polyposis colorectal cancer
Pelvic irradiationPelvic irradiation Obesity
Long-standing ulcerative Long-standing ulcerative colitiscolitis
CholecystectomyCholecystectomy
Protective FactorsProtective Factors
Moderate Modest
High physical activity High vegetable/fruit diet
Aspirin/NSAIDS (Non-steroidal anti-Aspirin/NSAIDS (Non-steroidal anti-inflammatory drugs).inflammatory drugs).
High fiber dietHigh fiber diet
High folate/methionine intake
High calcium intakeHigh calcium intake
Postmenopausal hormone therapy
Most at RiskMost at Risk
• Alaska Natives Alaska Natives and American IndiansAmerican Indians, African-African-
AmericansAmericans, and HispanicsHispanics are more likely to be
diagnosed with colorectal cancer in advanced stages.
• As a result, the percentage of minorities who die of
colorectal cancer is higher than for Caucasians.
High Risk-Populations: High Risk-Populations: African AmericansAfrican Americans
• Third Third most common cancer among African-
Americans.
• Less likely to have polyps detected in their earliest,
most treatable stages.
• Less likely to live five or more years after being
diagnosed with colorectal cancer.
High Risk-Populations: High Risk-Populations: African AmericansAfrican Americans
• Younger mean age at diagnosis (60-66 years)
• The American College of Gastroenterology (ACG)
recommends that screening begin at age 45 in
African Americans.
High Risk Populations: High Risk Populations: American Indians and American Indians and
Alaskan NativesAlaskan Natives• 2nd leading cause of death among American
Indians and Alaska Natives over the age of 45.
• Higher death rates than Caucasians
and African Americans.
High Risk Populations: High Risk Populations: HispanicsHispanics
• 33rdrd most commonly diagnosed cancer.
• Hispanics have the lowest lowest rates for colorectal
cancer screening, along with American
Indian/Alaska Natives.
How Common is Colorectal How Common is Colorectal Cancer?Cancer?
Colon Cancer RatesColon Cancer Rates
Colorectal Cancer Rates Colorectal Cancer Rates by Raceby Race
Colon Cancer RatesColon Cancer Rates
• Colorectal cancer is the thirdthird most commonly
diagnosed cancer and the third leading cause of
cancer death in both men and women in the United
States.
• About 72% 72% of cases arise in the colon colon and about 28%28%
in the rectumrectum.
Deaths from Colon Deaths from Colon CancerCancer
Colorectal Cancer Colorectal Cancer Deaths by RaceDeaths by Race
Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,
Race & Sex Race & Sex 2001-20052001-2005
Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,
Race & Sex Race & Sex 2001-20052001-2005
Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,
Race & Sex Race & Sex 2001-20052001-2005
Colorectal Cancer Colorectal Cancer Death Rates by State, Death Rates by State,
Race & Sex Race & Sex 2001-20052001-2005
Colorectal Cancer Colorectal Cancer DeathsDeaths
• Colorectal cancer is the #2#2 cancer killer in the United
States.
• African Americans African Americans are particularly at risk of dying of
colorectal cancer.
• More men men than women die of colorectal cancer
because they are typically diagnosed at a later stage.
How Do You Screen For How Do You Screen For Colorectal Cancer?Colorectal Cancer?
Screening OptionsScreening Options
Tests that Find Polyps and Cancer
Recommended
Flexible sigmoidoscopy Every 5 years
Colonoscopy Every 10 yearsDouble contrast barium enema Every 5 years
CT colonography (virtual colonoscopy) Every 10 years
Screening OptionsScreening Options
Tests that Mainly Find Cancer Recommended
Fecal occult blood test (FOBT) Every year
Fecal immunochemical test (FIT) Every year
Stool DNA test (sDNA) Uncertain
Screening OptionsScreening Options
• Fecal occult blood test (FOBT)
This test checks for hidden blood in stools. Currently,
two types of FOBT are available: guaiac FOBT and
immunochemical FOBT.
Screening OptionsScreening Options
• Sigmoidoscopy:
In this test, the rectum and lower colon are examined
using a lighted instrument called a sigmoidoscope.
Precancerous and cancerous growths in the rectum
and lower colon can be found and either removed or
biopsied.
Screening OptionsScreening Options
• Colonoscopy:
The rectum and entire colon are examined using a
lighted instrument called a colonoscope.
Precancerous and cancerous growths throughout the
colon can be found and either removed or biopsied,
including growths in the upper part of the colon.
Screening OptionsScreening Options
• Virtual colonoscopy (computerized tomographic
colonography, CTC):
Special X-ray equipment is used to produce
pictures of the colon and rectum that are
assembled by a computer into detailed images
that can show polyps and other abnormalities.
Screening OptionsScreening Options
• Double contrast barium enema (DCBE):
In this test, a series of X-rays of the entire colon and
rectum are taken after the patient is given an enema
with a barium solution and air is introduced into the
colon. The barium and air help to outline the colon
and rectum on the x-rays.
Screening OptionsScreening Options
• Digital rectal exam (DRE):
In this test, a health care provider inserts a
lubricated, gloved finger into the rectum to feel for
abnormal areas. DRE allows examination of only the
lower part of the rectum. It is often performed as
part of a routine physical examination.
Screening OptionsScreening Options
• The decision to have a certain test will take into account several factors, including the following:
the person’s age, medical history, family history, and general health
the accuracy of the testthe accuracy of the test
the potential harms of the test
the preparation required for the testthe preparation required for the test
whether sedation is necessary during the test
the follow-up care after the testthe follow-up care after the test
the convenience of the test
the cost of the test and the availability of insurance coveragethe cost of the test and the availability of insurance coverage
Most Effective Screening Most Effective Screening MethodMethod
• Getting a colonoscopy can reduce the average person's risk of dying from colorectal cancer by 90%90%.
Why is colonoscopy #1?Why is colonoscopy #1?
PROS CONS
Most sensitive Perceived as invasivePerceived as invasive
Long lasting protectionLong lasting protection Highest risk
Single session diagnosis and therapy
Requires bowel Requires bowel preparationpreparation
ComfortableComfortable Imperfect sensitivity
Adherence Rates for Adherence Rates for Cancer ScreeningCancer Screening
Men are more likely to get screened for colorectal cancer Men are more likely to get screened for colorectal cancer than women.than women.
Colon Cancer ScreeningColon Cancer Screening
Just over halfJust over half of the U.S. adults aged
50+ 50+ have had a colonoscopy or
sigmoidoscopy.
Latest Screening StatsLatest Screening Stats
• The percentage of adults aged 50 years and older
who reported having had a home FOBT within
one year and/or lower endoscopy within 10 years
before the survey increased from 54 percent in
2002, 57 percent in 2004, and to 60 percent in
2006.
Latest Screening StatsLatest Screening Stats
• The percentage of adults who reported never
being screened for colorectal cancer decreased
from 34 percent in 2004, 32 percent in 2004, and
to 30 percent in 2006.
• Good news Good news – more and more people are getting
screened.
Why Low Screening Why Low Screening Rates?Rates?
1. lacked health insurance
2. those with no usual source of healthcare
3. those who reported no doctor's visits within the
preceding year.
Physicians on Low Physicians on Low Screening RatesScreening Rates
• Believe that patients don’t want screening.
• Unclear about guidelines.
• Low awareness of screening benefits.
• Lack of skills to perform screening.
• Structural issues (lack of practice “systems”).
• Low reimbursement.
• Context of visit and time.
Patients on Low Patients on Low Screening RatesScreening Rates
• Low awareness of CRC as a health threat.
• Lack of knowledge of screening benefits.
• Fear, embarrassment, discomfort.
• Time.
• Cost.
• Access.
• Physician didn’t recommend.
How is Colorectal Cancer How is Colorectal Cancer Diagnosed?Diagnosed?
DiagnosisDiagnosis
• If a patient has test results that suggest cancer
and/or has symptoms, the doctor will ask about
personal and family medical history and gives a
physical exam. Multiple screening tests may be
required.
Colon Cancer RatesColon Cancer Rates
• It is estimated that 148,810148,810 men and women
(77,250 men and 71,560 women) were diagnosed
with and 49,96049,960 men and women died of cancer
of the colon and rectum in 2008.
What Are The Treatment What Are The Treatment Options?Options?
TreatmentTreatment
• Depends mainly on the location of the tumor in the
colon or rectum and the stage of the disease.
• May involve surgery, chemotherapy, biological therapy,
or radiation therapy.
• It is important that the patients works with their
doctors to develop a plan that meets their needs.
TreatmentTreatment
• Cancer treatment is either local therapy or systemic
therapy.
TreatmentTreatment
• Local therapy: Surgery and radiation therapy are local
therapies. They remove or destroy cancer in or near
the colon or rectum. When colorectal cancer has
spread to other parts of the body, local therapy may
be used to control the disease in those specific areas.
TreatmentTreatment
• Systemic therapy: Chemotherapy and biological
therapy are systemic therapies. The drugs enter the
bloodstream and destroy or control cancer
throughout the body.
SurgerySurgery
• Surgery is the most common treatment for colorectal
cancer.
• There are three basic types of surgery: colonoscopycolonoscopy,
laparoscopy laparoscopy and open surgeryopen surgery.
ColonoscopyColonoscopy
• A small malignant polyp may be removed from the
colon or upper rectum with a colonoscope.
• Some small tumors in the lower rectum can be
removed through the anus without a colonoscope.
LaparoscopyLaparoscopy
• Early colon cancer may be removed with the aid of a thin,
lighted tube (laparoscope).
• The surgeon sees inside the abdomen with the laparoscope.
The tumor and part of the healthy colon are removed. Nearby
lymph nodes also may be removed.
• The surgeon checks the rest of the intestine and liver to see if
the cancer has spread.
Open SurgeryOpen Surgery
• The surgeon makes a large cut into the abdomen to
remove the tumor and part of the healthy colon or
rectum.
• Some nearby lymph nodes are also removed. The
surgeon checks the rest of the intestine and the liver
to see if the cancer has spread.
ChemotherapyChemotherapy
• Chemotherapy uses anticancer drugs to kill cancer
cells.
• The drugs enter the bloodstream and can affect
cancer cells all over the body; they are usually
given through a vein, but some may be given by
mouth.
Chemo Side EffectsChemo Side Effects
• The side effects of chemotherapy depend mainly
on the specific drugs and the dose. The drugs can
harm normal cells that divide rapidly.
Chemo Side EffectsChemo Side Effects
• Blood cells: These cells fight infection, help blood to
clot, and carry oxygen to all parts of your body.
When drugs affect your blood cells, you are more
likely to get infections, bruise or bleed easily, and
feel very weak and tired.
Chemo Side EffectsChemo Side Effects
• Cells in hair roots: Chemotherapy can cause hair
loss. Your hair will grow back, but it may be
somewhat different in color and texture.
• Cells that line the digestive tract: Chemotherapy
can cause poor appetite, nausea and vomiting,
diarrhea, or mouth and lip sores.
Chemo Side EffectsChemo Side Effects
• Skin cells: Chemotherapy for colorectal cancer can
cause the skin on the palms of the hands and
bottoms of the feet to become red and painful. The
skin may peel off.
Biological TherapyBiological Therapy
• Some people with colorectal cancer that has
spread receive a monoclonal antibody, a type of
biological therapy.
• The monoclonal antibodies bind to colorectal
cancer cells inhibiting cancer cell growth and the
spread of cancer.
Radiation TherapyRadiation Therapy
• Radiation therapy (also called radiotherapy) uses
high-energy rays to kill cancer cells. It affects cancer
cells only in the treated area.
• Doctors use different types of radiation therapy to
treat cancer. Sometimes people receive two types.
Radiation TherapyRadiation Therapy
• External radiation: The radiation comes from a
machine. The most common type of machine used
for radiation therapy is called a linear accelerator.
Most patients go to the hospital or clinic for their
treatment, generally 5 days a week for several weeks.
Radiation TherapyRadiation Therapy
• Internal radiation (implant radiation or
brachytherapy): The radiation comes from
radioactive material placed in thin tubes put
directly into or near the tumor. The patient stays
in the hospital, and the implants generally remain
in place for several days.
Radiation TherapyRadiation Therapy
• Intraoperative radiation therapy (IORT): In some
cases, radiation is given during surgery.
Radiation Side EffectsRadiation Side Effects
• Side effects Side effects depend mainly on the amount of
radiation given and the part of the body that is
treated.
• They may include: nauseanausea, vomitingvomiting, diarrheadiarrhea, bloody bloody
stoolsstools, urgent bowel movementsurgent bowel movements, urinary problems urinary problems
and red, dry and tender skinred, dry and tender skin.
Treatment for Colon Treatment for Colon CancerCancer
• Most patients with colon cancer are treated with
surgery. Some people have both surgery and
chemotherapy. Some with advanced disease get
biological therapy.
• A colostomy is seldom needed for people with colon
cancer.
Treatment for Rectal CancerTreatment for Rectal Cancer
• For all stages of rectal cancer, surgery is the most
common treatment. Some patients receive surgery,
radiation therapy, and chemotherapy. Some with
advanced disease get biological therapy.
• About 11 out of 8 8 people with rectal cancer needs a
permanent colostomy.
How Can Colorectal Cancer Be How Can Colorectal Cancer Be Prevented?Prevented?
Prevention Prevention
• Get screened.Get screened.
• Know your family history.Know your family history.
• Stay active; exercise regularly.Stay active; exercise regularly.
• Eat a balanced diet with more fruits and vegetables Eat a balanced diet with more fruits and vegetables
and less meat.and less meat.
• Maintain a healthy weight.Maintain a healthy weight.
• Avoid smoking and excessive drinking.Avoid smoking and excessive drinking.
How Can You Help?How Can You Help?
Get InvolvedGet Involved
• Become a member of the CCABecome a member of the CCA
• Join the Online Colorectal Cancer CommunityJoin the Online Colorectal Cancer Community
• Become a Voices Coordinator or Ambassador Become a Voices Coordinator or Ambassador
• Join the Buddy Support ProgramJoin the Buddy Support Program
• Participate in an Undy 5000 walk/run Participate in an Undy 5000 walk/run
Get InvolvedGet Involved
• Attend a regional seminarAttend a regional seminar
• Create a Blue Star Tribute Page Create a Blue Star Tribute Page
• Make a donationMake a donation
• Volunteer with your local communityVolunteer with your local community
• Talk about colorectal cancer with family and friends.Talk about colorectal cancer with family and friends.
Colorectal Cancer:Colorectal Cancer:
Preventable. Treatable. Beatable!Preventable. Treatable. Beatable!
Toll-Free Helpline: 877-422-2030Toll-Free Helpline: 877-422-2030
www.CCAlliance.orgwww.CCAlliance.org