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Colorectal Cancer

Background

Colorectal cancer is the third most commonly diagnosed cancer in the United States, and the third most frequent cause of cancer mortality with an estimated 56,300 deaths. More than 150 patients with newly-diagnosed colorectal cancer are managed by physicians at Hoag Hospital each year in the Colorectal Cancer Program.

Patient Care

Hoag physicians are among the most knowledgeable and skilled in the world. The management of colorectal cancers typically involves a variety of specialists including colon surgeons, rectal surgeons, radiation oncologists, medical oncologists, pathologists, radiologists, and gastroenterologists. More than 150 patients with newly-diagnosed colon or rectal cancer are managed by Hoag physicians each year.

Hereditary Screening

Although hereditary colon cancer is rare, there are several known family syndromes associated with hereditary colon cancer. Screening for hereditary colon cancer is available through the Richard J. Flamson Hereditary Screening Program (click-on). This computer-based program can help determine the likelihood that an individual may have or be at risk for hereditary or familial cancer. Genetic testing for this predisposition will likely be available in the near future. Genetic counseling is available for individuals with a family history suggestive of hereditary colon cancer.

Prevention

Early colectomy (surgical resection of the entire colon) or frequent colonoscopy with polypectomy are the best preventive measures for hereditary colon cancer. For the general population, endoscopic visual surveillance of the bowel with removal of polyps, the precursor to colorectal cancers, helps prevent colorectal cancer. Hoag has several board-certified gastroenterologists and surgeons who are expert at performing colonoscopy to evaluate the entire large bowel. There is no standard non-invasive measure that is effective for preventing colorectal cancer in the general population. However, a high-fiber diet has been associated with a lower risk of colorectal cancer, and some studies suggest that aspirin and other anti-inflammatory agents, and estrogen replacement therapy decrease the risk of developing colorectal cancer. High intake of calcium is also being tested for a possible role in prevention. Hoag physicians and staff are knowledgeable in helping individuals understand their risk of developing colorectal cancer, and preventive approaches.

Early Detection

Colonoscopic evaluation of the entire large bowel including the rectum, is the best way to detect colon cancer early. Sigmoidoscopy (evaluation of the lower two feet of the colon and rectum) is useful for detecting rectal cancer, cancer in the lower part of the bowel, and cancer precursor growths known as polyps. A radiologic test known as a barium enema is another way to examine the entire bowel, but suspicious lesions would need to be visualized and biopsied endoscopically. When detected early, the 5-year relative survival rate for colorectal cancers is 90%. It has been established that screening for colorectal cancer in the general population reduces the cancer death rate from colorectal cancer. Since the incidence of colorectal cancers increases after the age of 50, screening for people of average risk should begin at that age.

Treatment

Because the optimum treatment of colorectal cancers involves coordination of several treatment modalities, a multidisciplinary Colorectal Cancer Program was initiated at Hoag in 1997. Between 1982-1997, the proportion of colorectal cancer patients treated at Hoag with surgery alone decreased from 54% to 40% as more patients with colorectal cancer began to receive radiation therapy and/or chemotherapy in addition to surgery. Associated with this change in treatment, the 5-year relative survival rate for rectal cancer increased from 43% to 79%, and for colon cancer it increased from 51% to 65%. During 1989-1995, Hoag survival for rectal cancer exceeded the national figure by 20% and the survival for colon cancer was 3% higher.

Surgery

Hoag surgeons operate on more than 130 newly-diagnosed colorectal cancer patients each year. One of the greatest advances for patients with rectal cancer has been "spincter-sparing surgery," the ability to preserve the rectum and its sphincter for voluntary defecation to prevent the need for a permanent colostomy in most patients with rectal cancer. In colon cancer, Hoag surgeons are adept at resecting large numbers of lymph nodes which is not only important in the staging of disease, but appears to be associated with improved survival. The 5-year relative survival rate for Hoag patients with localized colon cancer is greater than 90%, and for patients with regionally advanced disease it is greater than 75%!

Radiation Therapy

Radiation therapy, given either before or after surgery, has become an important part of the management of patients with rectal cancer. With four board-certified radiation oncologists and three state-of –art linear accelerators, Hoag offers the highest quality radiation therapy. With the addition of chemotherapy and radiation therapy to surgery, Hoag patients now have relative 5-year survival rates of 90% for localized rectal cancer, and 70% regional extension of disease!

Systemic Therapy

This includes chemotherapy and biotherapy agents. Hoag physicians have adopted an aggressive approach to colorectal cancer treatment in an effort to enhance cure rates. Chemotherapy is now a standard part of the treatment of most patients with tumor involvement of lymph nodes and/or penetration of their cancer through the bowel wall.

Clinical Trials and Investigational Therapy

Unfortunately, the relative 5-year survival rate for colorectal cancer patients who have metastatic disease at diagnosis is less than 10%. For this reason better systemic treatment is needed. Hoag Cancer Center tries to maintain a number of active clinical trials that offer patients access to promising new therapy and/or address important questions regarding the treatment of colorectal cancer. At times the Hoag Cell Biology laboratory offers unique patient-specific approaches utilizing a patient’s own cancer cells as a vaccine, and/or immune cell therapies.

Tumor Board Presentations

Although cases may be presented at any of the weekly tumor boards, every two months one Hoag tumor board is dedicated to presentation of colorectal cancer cases. These multidisciplinary case conferences offer the opportunity for oncologists, gastroenterologists, surgeons, radiation oncologists, pathologists, radiologists and support staff to come together to plan treatment for patients with newly- diagnosed colorectal cancers.

Education

Community and medical staff education programs are regularly conducted to increase awareness of screening guidelines and the latest advances in the treatment of colorectal cancer. Written educational materials are available in the resource library in the Hoag Cancer Center.

Enterostomal management

Unfortunately, it is sometime medically necessary for some patients with colorectal cancer to have a temporary or permanent colostomy. Hoag has an enterostomal therapist to assist patients and loved ones with the adjustment to this development.

Integrative Complementary Care

Patients with colorectal cancers can benefit from the many programs that are available at Hoag. Interventions such as support groups, journaling instruction, aerobic exercise, yoga, visual imagery and meditation are effective additions to the medical plan of care. These programs provide an added dimension of care for the body, mind and spirit of the patient undergoing cancer treatment.

Support Programs

A number of support services are in place which can benefit patients with colorectal cancers. They include individual counseling, General Cancer Support Group, Family $ Friends Support Group Relaxation & Visualization Workshop, Brighter Image, Look Good…Feel Better Classes, Fitter Image, and A Healing Journey Through Journaling Workshop.

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