Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Colon Cancer
Etiology
Prevention
Screening
Symptoms
Treatment
Presenter: Catherine Azar, MD
Disclosure
I have no disclosures
Presenter: Catherine Azar, MD
Learning Objectives Discuss what age should colonoscopy
screenings start.
Discuss lifestyle changes to help prevent colon cancer.
Discuss common side effects can a patient who is receiving chemotherapy present with.
Presenter: Catherine Azar, MD
Risk Factors Age: risk increases as a person gets older
Having had colorectal cancer or premalignant polyps before
Having a history of ulcerative colitis or Crohn’s disease
Family history of colorectal cancer
Race or ethnic background, such as being African American or Ashkenazi
Type 2 diabetes
Certain family syndromes, like familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC, also called Lynch syndrome)
Presenter: Catherine Azar, MD
Lynch Syndrome People with Lynch syndrome may experience:
Colon cancer that occurs at a younger age, especially before age 50
A family history of colon cancer that occurs at a young age
A family history of endometrial cancer
Presenter: Catherine Azar, MD
Lynch Syndrome A family history of other related cancers, including ovarian cancer,
kidney cancer, stomach cancer, small intestine cancer, liver cancer, sweat gland cancer (sebaceous carcinoma) and other cancers
Lynch Syndrome is a hereditary disorder caused by a mutation in a mismatch repair gene
The defects in the genes disallow repair of DNA mistakes and as cells divide, errors stack and uncontrollable cell growth may result in cancer.
Presenter: Catherine Azar, MD
Personal Risks Certain types of diets: one that is high in red meats and processed
meats can increase your colorectal cancer risk, nitrate
Cooking meats at very high heat (frying, broiling, or grilling) can create chemicals that might increase cancer risk??? Nitrates
Lack of exercise
Being obese
Smoking
Heavy ETOH use
Presenter: Catherine Azar, MD
Prevention
Low fat, high fiber diet
Exercise
ASA QD, NSAID’s???
Decrease ETOH
Stop smoking
Weight loss
Vitamin D supplementation
Presenter: Catherine Azar, MD
Cancers linked to smoking
Lung
Head & Neck
Bladder
Colorectal
Esophagus
Stomach
AML
?Breast
Presenter: Catherine Azar, MD
SEER DATA
Estimated New Cases in 2015: 132,700
% of All New Cancer Cases: 8.0%
Estimated Deaths in 2015: 49,700
% of All Cancer Deaths: 8.4%
Percent Surviving 5 Years: 64.9% From 2005 to 2011 Presenter: Catherine Azar, MD
SEER DATA Number of New Cases and Deaths per 100,000: The number of new cases
of colon and rectum cancer was 42.4 per 100,000 men and women per year. The number of deaths was 15.5 per 100,000 men and women per year. These rates are age-adjusted and based on 2008-2012 cases and deaths.
Lifetime Risk of Developing Cancer: Approximately 4.5 percent of men and women will be diagnosed with colon and rectum cancer at some point during their lifetime, based on 2010-2012 data.
Prevalence of This Cancer: In 2012, there were an estimated 1,168,929 people living with colon and rectum cancer in the United States.
Presenter: Catherine Azar, MD
CDC Recommendations
High-sensitivity fecal occult blood test (FOBT): should be done every year.
Flexible sigmoidoscopy: should be done every five years with FOBT every three years.
Colonoscopy :
should be done every ten years.
Presenter: Catherine Azar, MD
USPSTF Recommends screening for colorectal cancer using fecal occult blood
testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years.
Recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient
Recommends against screening for colorectal cancer in adults older than age 85 years.
Presenter: Catherine Azar, MD
COLON CANCER SYMPTOMS No signs or symptoms at all
A change of bowel habits
Blood (either bright red or very dark) in the stool
Diarrhea, constipation, or feeling that the bowel does not empty completely
Stools that are narrower than usual
Frequent gas pains, bloating, fullness, or cramps
Weight loss for no known reason
Feeling very tired
Presenter: Catherine Azar, MD
Treatment Surgery even if there is metastatic disease
For quality of life so that patient can eat
To avoid infection
To avoid perforation
To avoid bleeding
Presenter: Catherine Azar, MD
Chemotherapy
Almost all agents cause diarrhea-dehydration and electrolyte abnormalities
5-FU
Xeloda
Oxaliplatin
Irinotecan
Presenter: Catherine Azar, MD
Side Effects
Mucositis
Hand-foot syndrome
Low counts
Presenter: Catherine Azar, MD
Biological agents Erbitux
Patients must be KRAS wild type not mutant to use these agents
The most reliable way to predict whether a colorectal cancer patient will respond to one of the EGFR-inhibiting drugs is to test for certain “activating” mutations in the gene that encodes KRAS, which occurs in 30%-50% of colorectal cancers. Studies show patients whose tumors express the mutated version of the KRAS gene will not respond to Erbitux or Vectibix
Approved only for MCRC
Vectibix
Presenter: Catherine Azar, MD
KRAS-MUTANT
V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog
30%-50% of colorectal cancers
More aggressive disease
Less treatment options
Presenter: Catherine Azar, MD
Side effects Rash
Hypomagnesaemia
Hypercoagulability
Allergic reaction
Cardiopulmonary Arrest-Erbitux
Pulmonary fibrosis, interstitial disease
Presenter: Catherine Azar, MD
Other biologic agents
Avastin, 1st LINE
Zaltrap, 2nd LINE
Stivarga, 2nd LINE
All block VEGF receptors- vascular endothelial growth factor
Presenter: Catherine Azar, MD
Side Effects Bleeding
Poor healing
Hypertension
Hypercoagulability
Perforation
Worsens toxicity of chemotherapy in combination
Presenter: Catherine Azar, MD
PD-1 Inhibitors Programmed death-1 (PD-1) is expressed on the surface of activated
Tcells. Programmed death ligand-1 (PD-L1) is expressed on cancer cells. When PD-1 and PD-L1 bind, they form a biochemical response suppressing the immune system from recognizing tumor cells.
PD-1 inhibitors are monoclonal antibodies that inhibit PD-1 and may enhance the ability of the body’s immune system to recognize cancer cells. Once recognized, they may stimulate the body’s immune system
to fight the cancer.
Presenter: Catherine Azar, MD
PD-1 Inhibitors They are currently approved in some countries for unresectable and
metastatic melanoma, and in the United States for metastatic squamous non-small cell lung cancer (NSCLC) with progression on or after platinumbased chemotherapy.
Some agents in development are associated with a biomarker test for PDL1 expression to identify patients more likely to benefit from therapy.
PD-1 inhibitors are administered as an intravenous infusion over 30-60 minutes every 2-3 weeks (ranges due to differences between specific PD-1 agents).
Presenter: Catherine Azar, MD
PD-1 Inhibitors
Keytruda, Pembrolizumab
Opdivo, nivolumab
Multiple other agents by different manufacturers in development
Presenter: Catherine Azar, MD
Side Effects
Fatigue
Anorexia
Pruritus
Infusion related reactions
Immune‐mediated pneumonitis, colitis, hepatitis, nephritis, hypo/hyperthyrodism
Presenter: Catherine Azar, MD
QUESTIONS
At what age should colonoscopy start?
Name lifestyle changes to prevent colon cancer.
What common side effects can a patient who is receiving chemotherapy present with?
Presenter: Catherine Azar, MD
How to contact me:
Green Valley Office: 520-625-6600
River Road Office: (520) 529-2031
Cell Phone: 520-599-0812
Presenter: Catherine Azar, MD