CCSN welcomed back Helene Hutchings to discuss anal and colorectal cancer in this educational webinar. Helene discussed the symptoms & risk factors of these cancers, as well as treatment options that are available. She also discussed prevention of anal and colorectal cancers and the benefits of peer-to-peer support groups.

1. ABOUT COLORECTAL and
ANAL CANCER
Information Webinar
Canadian Cancer Survivor Network
Thursday 8th March 2018
Helene Hutchings

2. WHAT WE WILL DISCUSS TODAY
Colorectal Cancer Association of Canada & Anal Cancer-
ABumRap
• Who we are
Understanding Colorectal and Anal Cancer
• Symptoms
• Risk factors
• Colorectal and Anal Cancer in Canada
• Treatment Options
• Surgery
• Chemotherapy and Radiation
• Biologics/Immunotherapy
 Preventing Colorectal and Anal Cancer
• Screening
• Lifestyle options
• The benefit of peer-to-peer support groups
 Questions/Discussion
2

3. THE COLORECTAL CANCER ASSOCIATION OF
CANADA – WHO ARE WE?
 National, non-profit organization comprised of volunteers,
members and management
 Led By a National Board of Directors
 Counseled by an expert Medical Advisory Board
Dedicated to the improvement in the quality of lives of patients
3

4. THE COLORECTAL CANCER ASSOCIATION OF
CANADA – WHO ARE WE?
Mandate
1. Promote Awareness and Education of Colorectal Cancer
2. Provide Support for Patients and Their Caregivers
3. Advocate for Primary Prevention, Screening and Equal and
Timely Access to Effective Medications to Improve Patient
Outcomes
4

5. ANAL CANCER-A BUM RAP– WHO ARE WE?
Non-profit organization comprised of volunteers
based in Canada & providing international support
Mandate
1. Promote international Awareness and Education of
Anal Cancer
2. Provide Support for Patients and Their Caregivers
3. Advocate for Primary Prevention, Screening and
Equal and Timely Access to Effective Medications
to Improve Patient Outcomes
5

6. Understanding Colorectal & Anal
cancer

7. UNDERSTANDING COLORECTAL & ANAL
CANCER
• In this section:
• What is colorectal
& anal cancer?
• Stages of
colorectal & anal
cancer
• Symptoms of
colorectal & anal
cancer
• Risk factors
• Colorectal & anal
cancer numbers in
Canada
7

8. WHAT IS COLORECTAL & ANAL CANCER?
The colo-rectum (colon + rectum) is
approximately 6 feet in length whose
function is to:
1. re-absorb water from the digested
contents
2. serves as a holding chamber for stools
until evacuation.
The anus is the opening at the end of the
large intestine through which stool (solid
waste) exits the body and includes the anal
canal (apx 4cm) & the anus
8

9. WHAT IS COLORECTAL CANCER?
• Colorectal cancer is
cancer that affects the
colon or rectum
• Also known as cancer
of the Large Intestine
or Large Bowel
9

10. WHAT IS COLORECTAL CANCER?
• Most colorectal cancers start in the cells
that line the inside of the colon or rectum
• Colorectal cancer grows slowly and is
curable when diagnosed early
• Advanced colorectal cancer is when the
cancer has grown through the entire colon
or rectum wall and into nearby tissue or
organs
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11. WHAT IS ANAL CANCER?
11
Anal cancer is cancer that affects:
• The area that marks the
transition between the rectum
and anal canal
• The anal canal
• The anus
There are a variety of anal cancers and
the prognosis of most of them is better
if caught in the early stages

12. STAGES OF COLORECTAL CANCER
• Staging describes the extent of the cancer, and is based
on:
– How many layers of the bowel wall are affected
– If lymph nodes are involved
– If there is spread to other organs
Stage I
• Cancer has
only grown
through few
wall layers
• No lymph
nodes
affected
Stage II
• Cancer has
grown into
the thick
muscular
layer
• No lymph
nodes are
affected
Stage III
• Cancer has
grown
through entire
colon/rectum
wall
• 1 or more
lymph nodes
are affected
Stage IV
• Cancer has
grown
through entire
colon/rectum
wall
• Lymph nodes
are affected
• Metastasized
into nearby
tissue and/or
distant organs
12

13. STAGES OF ANAL CANCER
• Stage 0 (Carcinoma in Situ) - abnormal cells are found in the innermost lining of
the anus. These abnormal cells may become cancer cells and spread into nearby
normal tissue. An Anal PAP test (same as a cervical PAP) would detect this.
• Stage I - cancer has formed. Tumour is 2 centimeters or smaller in size.
• Stage II - tumour is larger than 2 centimeters.
• Stage IIIA - tumour can be any size, and has spread to either the lymph nodes
near the rectum, or into nearby organs, such as the vagina, urethra, and bladder.
• Stage IIIB - tumour can be any size, and has spread 1) into nearby organs and to
lymph nodes near the rectum, or 2) to lymph nodes on one side of the pelvis
and/or groin, and may have spread to nearby organs, or 3) to lymph nodes near
the rectum and in the groin, and/or to lymph nodes on both sides of the pelvis
and/or groin, and may have spread into nearby organs.
• Stage IV - tumour can be any size and cancer may have spread to lymph nodes or
nearby organs, and has spread to more distant organs or tissues.
13

14. SYMPTOMS OF COLORECTAL & ANAL CANCER
COLORECTAL
& ANAL
CANCER
CONSTIPATION
ABDOMINAL
CRAMPS
BLOODY
STOOLS
UNEXPLAINED
WEIGHT LOSS
LOSS OF
APPETITE
NAUSEA &
VOMITING
GAS &
BLOATING
FATIGUE
ITCHING
FEEL A
LUMP
• Symptoms may not be
present in early stages
• If or when symptoms appear,
they will vary depending on
the cancer’s size and location
• NOTE: The most COMMON
misdiagnosis in anal (and
some rectal) cancers is the
patient &/or the Primary
Care Physician/GP thinking
that the cancer is “just
hemorrhoids”!
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15. RISK FACTORS OF COLORECTAL CANCER
Age
Patient’s History of
polyps/cancer or
inflammatory bowel disease
Family history
of colorectal
cancer
Genetic
syndromes
Racial/ethnic
background
Lifestyle-
related risk
factors
15

16. RISK FACTORS OF ANAL CANCER
16
There are several factors which may increase the risk of developing the most common type of
anal cancer – squamous cell carcinoma (SCC). These include the following:
• Age
• Frequent anal redness, swelling, and soreness; Inflammatory bowel disease (IBD)
• Having anal fistulas (abnormal openings)
• Lowered Immunity (i.e. people living with HIV, organ transplants, immunosuppressive
drugs)
• HPV (Human Papilloma Virus) infection
• Having multiple sexual partners
• Having receptive anal intercourse (anal sex)
• Smoking cigarettes
Some people may not have any risk factors at all and will still develop anal cancer. This type of
anal cancer is rising significantly amongst heterosexual, HIV negative women.
Other anal cancers include: Adenocarcinoma, Melanoma, Lymphoma, Neuroendocrine,
Sarcoma

17. COLORECTAL CANCER IN CANADA
Approximately
26,800
Canadians were
diagnosed with
colorectal cancer
in 2017
Screening rates are
low, despite
provincial screening
programs
Affects men and
women almost
equally.
17

18. ANAL CANCER IN CANADA
• Anal cancer is a rare disease
• There were approximately 1000 cases in Canada in
2015
• Anal cancer numbers are high amongst the Men
having Sex with Men (MSM) and HIV+
population…specifically squamous cell carcinoma
(SCC), 80-90% of which are associated with HPV
• HOWEVER SCC anal cancer numbers are steadily
increasing in the heterosexual, HIV negative
population, especially for women over 40
18

19. TODAY’S TREATMENT OPTIONS
• In this section
• Today’s treatment
options:
• Surgery
• Chemotherapy &
Radiation
• Biologics
*Always talk to your doctor to
understand the risks and benefits
of any treatment
19

20. SURGERY
• Surgery remains the primary treatment for colorectal
cancer and may be an option for anal cancers
• In the very early stages, surgeries can involve
removing a polyp during a colonoscopy or, in the case
of anal cancer, a small lesion if surgical removal will
not impair sphincter function
• In advanced surgeries, such as a colectomy, a section
of the colon and/or rectum can be removed. In the
case of anal cancer, advanced surgery includes the
removal of the lower part of the rectum & anus
• If possible, the remaining parts of the colon & rectum
are reconnected to create a functioning colon, or a
stoma is created. The removal of the anal canal & anus
results in a permanent stoma
20

21. CHEMOTHERAPY & RADIATION
 Chemotherapy
• Stop the growth of cancer cells, either by destroying them or
stopping them from dividing; it may also be used to reduce the
size of metastases
• Drugs are administered via the bloodstream, usually through the
vein, or may be administered orally
 Radiation therapy
• Radiation damages the genetic material within cancer cells,
thereby limiting their ability to divide
• Normal cells are also affected by radiation, but they are able to
repair themselves in a way that cancer cells cannot
21

22. BIOLOGICS
– Biologic therapy targets parts of cancer cells, which make them
different from normal cells, without harming those normal cells
• They are a man-made version of an immune system protein
that fits like a lock and key with a particular protein
• They lock on to those cells or proteins and stops their
activity which helps stop cancer cells from growing and
dividing
– These personalized medicines identify genetic differences in
individuals that affect the way people respond to drugs
• This is done through identifying Biomarkers - biological
molecules found in blood, body fluids, tissues or the tumour
itself
• Cutting edge cancer research for many cancers, including
anal cancer, is being carried out in Ottawa which is having a
global impact on cancer treatment
22

23. Side Effects of Pelvic Radiation for Anal Cancer
Radiotherapy (Radiation) is highly effective in the treatment
of anal cancers and there have been huge improvements
in radiotherapy techniques and equipment over recent
years. But because of the very nature of the treatment,
radiotherapy can affect tissue and other organs in the
pelvic region. Sometimes these are called ‘late effects’,
although some symptoms may occur at anytime from
during treatment to many years later. These can include:
• Sexual function issues including vaginal stenosis & erectile
dysfunction
• Anal stenosis
• Bladder issues
• Joint pain especially lower back, hips & upper thighs
• Rectal/Anal bleeding
• Loss of fertility in women
23

24. PREVENTING COLORECTAL &
ANAL CANCER
• Screening
• Healthy Lifestyle; HPV Vaccination
•The benefits of peer-to-peer anal cancer
patient support

25. COLORECTAL CANCER SCREENING
Average Risk Person
The CCAC recommends that the average risk person start screening for
crc at the age of 50 through the use of Fecal Occult Blood Tests (FOBT) or
Fecal Immunochemical Test (FIT) at least once every two years
25

26. COLORECTAL CANCER SCREENING
High Risk Person
A high risk person is someone who has a family history of colorectal cancer in a
first degree relative (parent, sibling or child) or is someone who is symptomatic.
The CCAC recommends that the high risk person start diagnostic screening for
colorectal cancer through a colonoscopy once they become symptomatic or 10
years before the age of onset of the disease in their first degree relative.
26

27. ANAL CANCER SCREENING
There are no national guidelines for general population anal
cancer screening.
At present, anal cancer screening is mainly carried out for the
high risk population (organ transplant recipients, HIV positive,
MSM) or past anal cancer patients.
Screening includes:
• Digital Anal Rectal Exam (DARE)
• High Resolution Anoscopy (HRA) & Colonoscopy
• Anal PAP & HPV testing
• Pre-cancerous anal neoplasia can be treated at this stage;
anal neoplasia is similar to cervical neoplasia
27

28. PREVENTING COLORECTAL-ANAL CANCER
HEALTHY LIFESTYLE TIPS
*Be aware that sometimes there is just NO apparent reason for why people
get ColoRectal-Anal Cancer
Always talk to your doctor before engaging in physical activity
Speak to your Doctor about the HPV vaccination in regards to HPV related
cancer prevention.
Maintain a
healthy weight
Engage in moderate
exercise
Diet – eat more fruits and
vegetables, whole grains, lean
protein, healthy fats & fibre
Limit alcohol & red/processed
meat consumption; stop
smoking
28

29. The Benefits of Peer-to Peer Support
for ColoRectal-Anal Cancer Patients
• In addition to the advice & support of your medical team, the availability
of support for cancer patients from other cancer patients who have or
had the same cancer as you is extremely important...especially for rare
and highly stigmatized cancers such as Anal Cancer
• There are many international support organizations that provide face to
face, email, telephone and/or on-line forum support
• These organizations offer support in many ways including:
– Emotional
– advice for dealing with treatment side effects both in the short &
long term
– Information on clinical trials
• There are specific Anal Cancer support organizations as well as
ColoRectal-Anal Support ones....you can contact Helene for more info

30. Testimonials for Peer-to-Peer Support:
30
Carmen B.
(Rectal Cancer) I can tell you that I don't know what I would have done without ...all the support and
advice I have gotten there. Since this cancer is still considered rare, there are very few actual person to
person support groups and often one must turn to the internet to find people going through the same
experiences. I have found that many of my supporters and fellow survivors frequently know much more
about certain issues than my oncology team has and they have given me very specific advice and
suggestions on how to deal with long term side effects and the psychosocial aspects of recovery. The
support has been priceless to me!
Barb R
(Anal Melanoma) I found myself on the beginning wanting to be private about my Cancer but was
interested in hearing about other people trials with their surgeries and treatments. My Cancer was so rare I
do have trouble trying to relate with others. I could certainly give encouragement when others were down.
I have trouble understanding most of the lingo as I only had a colostomy and no further treatments of any
kind. I do enjoy talking and listening to other Cancer patients and sharing in their joys and sharing their
struggles and their prays.

31. Testimonials for Peer-to-Peer Support
31
Nancy CB
(Squamous cell anal ca)
• It's important to me, because people who have not had cancer or this type of cancer and the
treatments have no idea what we are dealing with.
• It's important, because you may hear of a different treatment that worked for someone else that you
can run past your doctor.
• It's important, because when we give bad news, people are understanding and sympathetic and
someone may say, "Hey that happened to me, and I'm still here, because I did blah,blah,blah. You'll be
fine!" And when we give good news, our buddies here will cheer us on and make us feel great.
• It's important, because we don't feel alone and different from everyone in the world.
• It's important, because with anal cancer, we don't have to be embarrassed to talk about our poop and
how often we do it and what it looks like when we talk to our group.
• It's important, because the people here can make us laugh and we need to laugh more than ever. We
can ask questions that we may be afraid to ask our doctor. We can talk about something new that's
going on with our body and people will tell us if that happened to them, and what they think we should
do about it.
• It's important for those of us who are anal cancer survivors/patients, because this is a rare cancer, and
we're not likely to run into a lot of people who have/have had it, and here we can find a whole bunch
of people to commiserate with.

32. March is Colo-Rectal & Anal Cancer Awareness Month
• 21st March: Anal Cancer Awareness Day
Anal Cancer numbers are increasing globally, yet anal cancer
is still one of the least talked about and most stigmatized of
all cancers. By creating an Anal Cancer Awareness Day and
having that day within March, Colo-Rectal Cancer Awareness
Month, we hope to increase awareness, lessen stigma....and
get more people to talk to their doctors about their butt
concerns!
Talk about it
Break the silence
Lose the stigma!
…and save more lives.
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33. THANK YOU!
QUESTIONS?....
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34. Canadian Cancer Survivor Network
Contact Info
Canadian Cancer Survivor Network
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail info@survivornet.ca
Web site www.survivornet.ca
Blog: http://jackiemanthornescancerblog.blogspot.com/
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Pinterest: http://pinterest.com/survivornetwork/