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Colorectal Cancer Treatment
Susan Rein, BSN RN CCRC
Colorectal Cancer Diagnosis
Colorectal cancer includes malignant or
cancerous tumors of the colon and/or the
rectum.
Anatomy
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Anus
Rectum
Sigmoid
Descending
Transverse
Ascending
Cecum
Staging
When you’re diagnosed
with colorectal cancer,
your doctor needs to find
how advanced the
disease is, or how far it
has spread. This
important part of your
colorectal cancer
diagnosis is known as
staging.
Tests used to determine the stage of
your colorectal cancer
• Blood Tests: The level of certain substances in your blood is
checked. If you have colorectal cancer, you may have a high
carcinoembryonic antigen (CEA) level.
• Endoscopic Ultrasound (EUS): An ultrasound probe that
sends out sound waves is inserted into your rectum. A
computer-generated picture, created from the echoes of the
sound waves, shows how deep the rectal tumor has grown and
whether the cancer has spread (or metastasized) to lymph
nodes or other nearby tissues.
• Chest X-Ray: X-rays of your chest can show whether the
cancer has spread to your lungs.
Tests…
• CT Scan: An X-ray machine linked to a computer gives doctors
a detailed picture of areas inside your body. Tumors in your
liver, lungs, and other areas will show up on the CT scan.
• PET Scan: positron emission tomography – An imaging test
used to light up cancer in different parts of the body. You get an
injection of a short-lived radioactive substance before having
the scan. Cancerous tissue will build up more of the substance
and appear brighter than normal tissue on the PET images.
Other non-cancerous tissues, such as areas of inflammation,
can also sometimes “light up.”
How is colorectal cancer treated?
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Surgery
Radiation Oncology
Chemotherapy
Biological Therapy
The Team
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Medical Oncologists – Oncologists are doctors who study and treat
cancer
Radiation Oncologists – Radiation oncologists use X-rays and other
types of medical radiation to control or kill cancer cells in the body
Surgical Oncologists – Surgical oncologists are part of the
multidisciplinary cancer team who specialize in operations that remove
cancer from different areas of the body
Gastroenterologists - Doctors who specialize in the digestive system
Oncology social workers, who help you manage the stresses
associated with cancer diagnosis and treatment and help the patient
find needed resources
Alternative therapists who provide massage, acupuncture,
biofeedback and other therapies as an optional part of the treatment
program
Surgery (Primary Treatment)
• Laparoscopy: Early colon cancer may be removed
with the aid of a thin, lighted tube (laparoscope).
Three or four tiny cuts are made into your abdomen.
The surgeon sees inside your 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 your
intestine and your liver to see if the cancer has
spread.
• Open surgery: The surgeon makes a large cut into
your 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
your intestine and your liver to see if the cancer has
spread.
Common types of ostomies in intestinal
surgery
• Ileostomy
– connecting the ileal (where the small and
large bowel meet) part of the small
intestine to the abdominal wall
• Colostomy
– connecting the colon, or, large intestine to
the abdominal wall
Radiation Therapy
Radiation therapy involves using X-rays and
other types of medical radiation aimed at
specific parts of the body to:
– Kill cancer cells
– Prevent cancer cells from developing or
recurring
– Improve many of the symptoms caused by
cancer
Radiation Therapy
Radiation therapy can be:
• Used before surgery to make the operation easier
(this is called “neoadjuvant” treatment)
• Used after surgery to reduce the chances of the
cancer coming back (this is called “adjuvant
treatment”)
• Almost as effective as surgery in people who are not
fit enough for an operation
External Beam Radiation Therapy
• External beam radiation therapy involves a
series of daily outpatient treatments to
accurately deliver radiation to the area at
risk.
– Before beginning treatment, you will be scheduled for a
simulation to map out the area being treated. This will
involve having X-rays and/or a CT scan. You will also
receive tiny tattoo marks on your skin to help the therapists
precisely position you for daily treatment. Treatment is
given once a day, Monday through Friday, for about four to
six weeks.
Rectal Cancers
• Radiation can be given
either before or after
surgery
• treated by low anterior
resection or
abdominoperineal
resection
• chemotherapy before
surgery (neoadjuvant
treatment), as well as
giving adjuvant
chemotherapy after
surgery
Chemotherapy
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Chemotherapy uses anticancer drugs to kill cancer cells. The drugs
enter the bloodstream and can affect cancer cells all over the body.
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Anticancer drugs are usually given through a vein, but some may be
given by mouth. You may be treated in an outpatient part of the
hospital, at the doctor's office, or at home. Rarely, a hospital stay may
be needed.
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The side effects of chemotherapy depend mainly on the specific
drugs and the dose. The drugs can harm normal cells that divide
rapidly:
– 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.
– 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.
Chemotherapy Drugs Used for
Colorectal Cancer
5-Fluorouracil (5-FU) has been the first
choice chemotherapy drug for colorectal
cancer for many years. It is used in
combination with leucovorin (a vitamin), which
makes 5-FU more effective. 5-FU is given
intravenously.
Recently, a pill form of 5-FU has been
developed, called Xeloda, which is used for
colorectal cancer that has spread to other
organs.
FOLFOX
FOLFOX is a chemotherapy regime for
treatment of colorectal cancer, made up
of the drugs
• FOL– Folinic acid (Leucovorin)
• F – Fluororacil (5-FU)
• OX – Oxaliplatin (Eloxatin)
Monoclonal Antibodies
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These are substances produced in the laboratory that can locate and
bind to cancer cells wherever they are in the body. These antibodies
can be used to see where the tumor is in the body (detection of
cancer), or as therapy to deliver drugs, toxins, or radioactive material
directly to a tumor.
In February 2004, the U.S. Food and Drug Administration approved
the first monoclonal antibody to treat metastatic colorectal cancer,
Erbitux (Cetuximab).
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Also in February 2004, the FDA approved another first of its kind
monoclonal antibody called Avastin (Bevacizumab). This drug works
by shutting down a process called angiogenesis - the process whereby
tumors grow new blood vessels to help them receive the nutrients
needed to survive. It's approved to treat advanced colorectal cancer
that has spread to other organs.
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A third drug, Vectibix (Panitumumab), was approved in 2007.
Chemotherapy Agents
Several new chemotherapy drugs also are
used for the treatment of colorectal cancer
that has spread.
These include:
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Camptosar (Irinotecan HCL)
Eloxatin (Oxaliplatin)
Avastin (Bevacizumab)
Erbitux (Cetuximab)
Other Treatment Funding Sources
Pharmaceutical Drug Replacement
• Genentech Access to Care Foundation
–Avastin (Bevacizumab)
• PACT+ Sanofi Aventis
–Oxaliplatin (Eloxatin)
• Roche Patient Assistant Foundation
–Xeloda (Capecitabine)
Contact Information
Susan Rein BSN RN CCRC
University of Colorado Denver
303-724-1272
303-724-0964 Fax
[email protected]