22.11.2013

What is the treatment for colon and rectal cancer 5k

It's very important to meet with your colorectal surgeon and have your screening colonoscopy as soon as you reach age 50.
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Stage 0 colon cancer may be treated with a local exicision of the lesion, often via a colonoscopy. Almost all patients with stage III colon cancer, after surgery, should receive chemotherapy (adjuvant chemotherapy) with a drug known as 5-fluorouracil given for approximately 8 months.
Chemotherapy is also used for patients with stage IV disease in order to shrink the tumor, lengthen life, and improve quality of life. Radiation therapy is occasionally used in patients with colon cancer, but this is relatively uncommon. Stages of colorectal cancer - The staging of a carcinoma has to do with the size of the tumor, and the degree to which it has penetrated. ABSTRACT: The use of adjuvant chemotherapy following resection for all patients with stage III colon cancer is now part of the standard of care around the world.
Adjuvant therapy is defined as any treatment administered after surgical resection of a primary tumor with the intent of improving the patient’s outcome by eliminating any occult, viable tumor cells that may have remained after surgery. The decision of whether to use adjuvant chemotherapy is based on a patient’s risk of recurrence, which is determined in large measure by the disease stage (Table 1) and the risk reduction expected with treatment. The use of adjuvant chemotherapy in colon cancer dates back to 1990, when it was demonstrated that fluorouracil (5-FU) and the antihelminthic agent levamisole improved overall survival after resection—a finding that was repeated in 1994 in a study combining 5-FU with leucovorin (LV). The benefit of adjuvant chemotherapy for stage III colon cancer has been established and refined over several decades of clinical trials. A 70-year-old man with hypertension presented to his primary care physician with anemia and fatigue, prompting a colonoscopy, which demonstrated a nonobstructing sigmoid adenocarcinoma. The largest trial to date involving stage II patients is the Quick and Simple and Reliable (QUASAR) 1 study, which randomized colon and rectal cancer patients with an unclear indication for adjuvant chemotherapy to 5-FU and leucovorin or observation. With the introduction of oxaliplatin into adjuvant regimens, an additional question of benefit for stage II patients has been raised.
Given the potential absolute benefit of 4% seen in the QUASAR study, a definitive trial to demonstrate a benefit for adjuvant chemotherapy for stage II patients would require 4,700 patients to be adequately powered.[20] As a result, the question of benefit in this population lends itself to meta-analysis. One of the initial meta-analyses combined the outcomes of 4,000 colorectal cancer patients who received portal vein infusion of 5-FU as adjuvant therapy and demonstrated a statistically significant reduction in the 5-year mortality rate despite no change in the incidence of subsequent liver metastases.[21] This improved 5-year overall survival rate was also seen in the Dukes’ B subset of approximately 1,400 patients, with a 6% absolute risk reduction compared to observation alone. These discrepant results were repeated in two meta-analyses published concurrently in the Journal of Clinical Oncology.
However, a second and arguably more instructive goal was to compare the efficacy of adjuvant therapy in stage II and III tumors, with the hypothesis that if the biology of these tumors is similar,the relative benefit of any given chemotherapy regimen should also be similar. The pain associated with an anal fissure occurs during or after a bowel movement and may feel like a tearing, burning, or ripping sensation. Bleeding with anal fissures is usually mild and consists of small amounts of spotting on toilet paper or streaking the surface of stool. The aim of treatment for anal fissures involves relieving the pain and sphincter spasm which will promote healing of the fissure. There is always the possibility of fissure recurrence, and it is quite common for a healed fissure to recur after a hard bowel movement.
Surgical treatment of anal fissures is generally reserved for those patients who have not healed their fissure after at least three months of medical therapy.
What We DoEach patient is evaluated using a multidisciplinary approach and a team of cancer experts. Nearly 95% of those deaths are unnecessary and completely preventable with regular screenings.
If colon cancer runs in your family, you may need your screening colonoscopy at an earlier age.


Irinotecan and 5-fluorouracil are the two most commonly used drugs, given either individually or in combination. When the tumor is small and has not penetrated the mucosal layer, it is said to be stage I cancer. Recent trials have led to changes in the standard regimens, which now include the use of oxaliplatin (Eloxatin) for most patients with stage III colon cancer.
For adjuvant chemotherapy to be considered in any disease, the agents used should effectively eradicate the type of tumor cells present in that disease, and the risk-to-benefit ratio for the adjuvant treatment must be favorable, since some, if not most, patients who receive adjuvant treatment are already cured by the surgical procedure. The now-standard TNM staging system is based on tumor penetration through the bowel wall (T) and the presence of regional lymph node (N) and distant metastases (M). Patients with stage II disease represent approximately one-quarter of the patients diagnosed with colon cancer and have a good prognosis, with a 5-year survival rate of approximately 80%. The relevant historical trials focusing on stage III patients have been extensively reviewed.[2-4] Despite the fact that patients with stage II disease have been included in many of these adjuvant trials, the benefit of chemotherapy after resection in these patients has still not been definitively established. He underwent a left hemicolectomy, which identified a moderately differentiated adenocarcinoma invading through the muscularis propria (T3) without lymphovascular invasion.
It may represent inadequate surgical resection, incomplete pathologic evaluation, or a paucity of pericolonic regional lymph nodes in this patient. Several “high-risk” features have been proposed, including inadequate sampling of the lymph nodes, with varying amounts of supporting data. This trial enrolled 1,247 patients; however, it was underpowered to answer the question of benefit in stage II patients, as only 318 with this diagnosis were studied. Patients with high-risk stage II disease, which was defined by the presence of obstruction, perforation, or invasion of adjacent structures at the time of diagnosis, accounted for 20% of the study enrollment. However, this study included rectal cancer patients (29%), some of whom also received adjuvant or neoadjuvant radiation therapy. Unfortunately, the meta-analyses performed thus far have also been discordant and controversial. This did not, however, reach statistical significance, although Dukes’ B patients had the same relative risk reduction with treatment as was seen in Dukes’ C patients (18%). The mortality reduction in stage II patients occurred irrespective of the presence or absence of the adverse prognostic factors of obstruction, perforation, and invasion into adjacent structures.
This was indeed suggested by the results of the analysis, as the relative benefit of the more effective treatment arm in each trial was similar in stage II and III patients, with a trend towards a greater relative benefit for stage II patients. Once a fissure develops, the painful symptoms may accompany every bowel movement thereafter. However, even the slightest amount of blood in the toilet bowl may discolor the toilet water, and give the appearance of heavy bleeding. Even after the pain and bleeding has disappeared one should maintain good bowel habits and adhere to a high fiber diet or fiber supplement regimen.
Surgical treatment for anal fissures is highly effective and recurrence rates after surgery are low. Minimally invasive surgical techniques are used to decrease post-operative pain and speed up recovery. There are very few cases where people have a genetic type of colon cancer that presents at a very young age.
Ameer Kabour to learn more about colon cancer, prevention, screening, and treatment options. For stages I, II, and III cancer, removal of a segment of colon containing the tumor and reattachment of the colon is necessary. There is some debate as to whether patients with stage II colon cancer should receive chemotherapy after surgery and patients should discuss this with their oncologist.
A new drug, oxaliplatin, is also useful in these patients, but has not yet been approved by the FDA.


Recent declines in mortality rates from colorectal cancer in the United States have been attributed to the increased utilization of surveillance and improvements in adjuvant chemotherapy.
Patients with stage I disease have a high probability of cure after resection, and adjuvant chemotherapy is unlikely to add much benefit. This review addresses the current debate over the use of adjuvant chemotherapy in stage II colon cancer, describing relevant concepts for critiquing the available data in the literature and attempting to place the potential benefits in a framework appropriate for discussion with patients. The following review of the past 20 years of trials provides a background for understanding the current controversy in this field.
The four arms of the study included combinations of 5-FU with and without leucovorin or levamisole.
Fissures are quite common, but are often confused with other causes of pain and bleeding, such as hemorrhoids. Therefore, initial management of anal fissures is directed at controlling constipation, softening stools, and reducing anal sphincter spasm.
The procedure usually involves cutting a portion of the internal anal sphincter muscle and is termed a lateral internal sphincterotomy. Individualized care is offered based on the patient's comorbid conditions, their tumor type, and its location. Unfortunately, no adequately powered trial has determined whether adjuvant chemotherapy is beneficial for stage II patients, and its use is much more controversial. Adjuvant therapy is not an option for patients with stage IV (metastatic) cancer, although the term is frequently used to identify chemotherapy given after resection of localized metastasis.[1] Therefore, only patients with stage II or III disease are generally considered eligible for adjuvant chemotherapy.
Current trials in stage III colorectal cancer are exploring the integration of capecitabine into combination regimens and the addition of monoclonal antibodies to adjuvant therapies. Often times patients may try to avoid defecation in fear of experiencing the intense rectal pain.
Acute fissures are typically managed with non-operative treatments and roughly 90% will heal without surgery. In select cases, genetic analysis of the tumor is performed to search for drugs that can block important signaling pathways and thereby slow growth and kill cancer cells. Most investigators agree that adjuvant chemotherapy has some activity against stage II disease. Once a fissure develops, the internal anal sphincter typically goes into spasm, which causes a decrease in blood flow to the area of the fissure and leads to further separation of the tear, impairing healing and causing pain. A high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids help relieve constipation, promote soft bowel movements, and aid in the healing process.
Despite the lack of data, there is growing acceptance of an informal classification system, which stratifies stage II patients by risk on the basis of clinical data, as a guide for deciding whether to use adjuvant therapy. Anal fissures present for less than six weeks are described as acute, while those present for over six weeks are described as chronic fissures. Warm water sitz baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles, which can also help healing. The only phase III clinical trial for stage II patients currently ongoing in the United States uses molecular classification as the basis for patient randomization. Chronic fissures often have a small external skin tag associated with the tear called a sentinel pile.
Some patients will experience almost immediate relief of their pain following the procedure.



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