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Anal & Colorectal Cancer


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For Colorectal Cancer Awareness Month, 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.

There was a Q&A session following the webinar.

Published in: Healthcare
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Anal & Colorectal Cancer

  1. 1. ABOUT COLORECTAL and ANAL CANCER Information Webinar Canadian Cancer Survivor Network Thursday 21st March 2019 Helene Hutchings
  2. 2. WHAT WE WILL DISCUSS TODAY Colorectal Cancer 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. 3. COLORECTAL CANCER CANADA  National, non-profit organization comprised of volunteers, members and management  Led By a National Board of Directors  Counseled by an expert Medical Advisory Board  The Colorectal Cancer Association of Canada (CCAC) is dedicated to increasing awareness of colorectal cancer, supporting patients, and advocating for population-based screening and timely access to effective treatments. Dedicated to the improvement in the quality of lives of patients 3
  4. 4. 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 4
  5. 5. Understanding Colorectal & Anal cancer
  6. 6. 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 6
  7. 7. 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 7
  8. 8. 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 8
  9. 9. 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 9
  10. 10. WHAT IS ANAL CANCER? 10 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 Note: Tumors of the anal margin (below the anal verge and involving the perianal hair-bearing skin) are classified with skin tumors.
  11. 11. STAGES OF COLORECTAL CANCER • There are various staging techniques but in summary 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 11
  12. 12. 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 IIA - tumour is between 2-5 centimeters. • Stage IIB – Tumour is over 5 centimetres. • Stage IIIA - tumour up to 5 centimetres, and has spread to nearby lymph nodes • Stage IIIB - Tumor of any size invading adjacent organ(s), such as the vagina, urethra, or bladder but NOT the lymph nodes • Stage III– EITHER a tumour larger than 5cm with spread to near by lymph nodes OR Tumor of any size invading adjacent organ(s), such as the vagina, urethra, or bladder PLUS near by lymph nodes • Stage IV - tumour can be any size and cancer may have spread to lymph nodes or nearby organs, and has ALSO spread to more distant organs or tissues. • Note: The AJCC has designated staging by TNM (tumor, node, metastasis) classification to define anal cancer. 12
  13. 13. 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”! 13
  14. 14. 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 14
  15. 15. RISK FACTORS OF ANAL CANCER 15 There are several factors which may increase the risk of developing the most common type of anal cancer – squamous cell (epidermoid) carcinomas (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 rarer anal cancers include: Adenocarcinoma, Melanoma, Lymphoma, Neuroendocrine, Sarcoma
  16. 16. 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. 16
  17. 17. 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 17
  18. 18. 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 18
  19. 19. 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 19
  20. 20. 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 20
  21. 21. 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 21
  22. 22. 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 22
  23. 23. PREVENTING COLORECTAL & ANAL CANCER • Screening • Healthy Lifestyle; HPV Vaccination •The benefits of peer-to-peer anal cancer patient support
  24. 24. 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 24
  25. 25. 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. 25
  26. 26. 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 26
  27. 27. 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 27
  28. 28. 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 can contact Helene for more info
  29. 29. Testimonials for Peer-to-Peer Support: 29 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.
  30. 30. Testimonials for Peer-to-Peer Support 30 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.
  31. 31. 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. 31
  32. 32. THANK YOU! QUESTIONS?.... 32
  33. 33. 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 Web site Blog: Twitter: @survivornetca Facebook: Pinterest: