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May 2016 Webinar:: Rectal Cancer 101
This webinar discusses rectal cancer. It begins with introducing the speaker and providing objectives for the webinar. It then covers topics such as prevalence and risk factors of rectal cancer, methods of diagnosis, determining the cancer stage, standard treatment options including surgery, radiation, chemotherapy and targeted therapy. Treatment is discussed in relation to cancer stage. The webinar also touches on survivorship issues and future research regarding rectal cancer.
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May 2016 Webinar:: Rectal Cancer 101
- 1. Rectal Cancer 101 Ourwebinar will begin shortly. WELCOME!
- 2. • Speaker(s): MaryMulkerin, RN, OCN • Archived Webinars: FightColorectalCancer.org/Webinars • AFTER THE WEBINAR: Expect an email with links to the material & a survey. If you fill it out, we’ll send you an “I booty” bracelet. • Ask a question in the panel on the RIGHT SIDE of your screen • Follow along via Twitter – use the hashtag #CRCWebinar Today’s Webinar:
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- 4. Disclaimer : The information andservices provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses or treatment. If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room. Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.
- 5. Speaker: Mary Mulkerin, RN,OCN is the Gastrointestinal Oncology Nurse Coordinator at University of Wisconsin Carbone Cancer Center, coordinating multi- disciplinary patient care and leading a Gilda’s Club support group. She obtained her BSN from the University of Wisconsin-Madison and has practiced in Oncology for the last 31years. She is currently completing her MS in Nursing Education at Edgewood College to pursue her research interests in survivorship and patient and staff education, in addition to developing a patient education app that would make patient’s management of their care more accessible and user-friendly.
- 6. MARY MULKERIN, RN,BSN, OCN UNIVERSITY OF WISCONSIN CARBONE CANCER CENTER MAY 25, 2016 Rectal Cancer 101
- 7. Objectives Discuss: Prevalence,risk factors and diagnosis of rectal cancer Staging of rectal cancer Types of treatment and treatment by stage Survivorship Future research
- 8. Rectal Cancer Malignant(cancer cells) form in the tissues of the rectum The rectum is about 6 inches – temporary storehouse for feces Coccyx Tumor Rectum Bladder Image retrieved from: aibolita.com
- 9. Prevalence Colorectal Cancer(CRC) – 3rd most common diagnosed cancer 39,220 new cases per year – slightly more prevalent in men than women About 5% or 1 in 20 people of the general population 90% of cases are diagnosed over age 50 Rates are decreasing over time There are more than 1 million CRC survivors! American Cancer Society, 2016
- 10. Increased Prevalence inYounger Adults Incidence increasing in people under age 40 Between 1984-2005, rate increased by 3.8% - doubled Approximately 18% rectal cancer cases are in people <50, 11% for colon cancer Of these, 20% are caused by familial syndromes Cause unknown, but possibly related to lifestyle behaviors and environmental factors Malik, M., 2016
- 11. Who’s at risk? Age 40 or older Certain hereditary conditions Having a parent, sibling, or child with a history of colorectal cancer Behavioral risk factors Personal history of: Colorectal cancer Polyps Cancer of the ovary, endometrium or breast Cleveland Clinic, 2016
- 12. Symptoms Change inbowel habits Diarrhea/Constipation Narrow stools Feeling like the bowel does not empty completely Blood in the stool Abdominal discomfort Change in appetite Unintentional weight loss Fatigue Anemia Cleveland Clinic, 2016
- 13. Detection Physical examand history Digital rectal exam Proctoscopy Colonoscopy Biopsy Carcinoembryonic antigen (CEA) – tumor marker Cleveland Clinic, 2016
- 14. Factors Affecting Prognosisand Treatment Stage of the cancer Whether the tumor has spread into or through the bowel wall Where the cancer is located in the rectum Whether the bowel is blocked or has a hole in it Whether all of the tumor can be removed by surgery General health of the person New diagnosis vs. recurrence Cleveland Clinic, 2016
- 15. Determining Cancer Stage Chest x-ray CT scan MRI (magnetic resonance imaging) Endoscopic ultrasound (EUS) PET scan Cleveland Clinic, 2016
- 16. How Does CancerSpread? Through tissue – cancer invades the surrounding normal tissue Through the lymph system – cancer invades the lymph nodes then travels Through the blood – Capillaries and veins are invaded by cancer Metastasis – cancer cells spread from the primary tumor and form another tumor in another site Cleveland Clinic, 2016
- 17. Stages of RectalCancer
- 18. Standard Treatment ofRectal Cancer Surgery Radiation Therapy Chemotherapy Targeted Therapy Cleveland Clinic, 2016
- 19. Surgery Surgery isthe most common treatment for all stages Radiation therapy or chemotherapy may be given before surgery – neoadjuvant therapy After surgery, chemotherapy or radiation may be given – adjuvant therapy Cleveland Clinic, 2016
- 20. Types of Surgery Type of surgery depends on the stage and overall health of the person Types Polypectomy Cryosurgery Local excision - TAMIS Resection Radiofrequency ablation Pelvic exenteration Cleveland Clinic, 2016
- 21. Surgical Resection LowAnterior Resection (LAR) – Tumor is in the upper part of the rectum. May have a temporary ostomy. Proctectomy with colo-anal anastomosis – Tumor is in the mid to lower third. Entire rectum removed and colon is attached to the anus Abdominoperineal resection (APR) – Tumor is in the lower rectum. Permanent ostomy American Cancer Society, 2016
- 22. Radiation Therapy High-energyx-rays or other types of radiation is used to kill cancer cells 2 types of radiation: External beam Internal radiation – uses needles seeds, wires or catheters Type of treatment chosen and length of treatment depends on stage Cleveland Clinic, 2016
- 23. Chemotherapy – Anti-CancerDrugs Chemotherapy is give at different times during treatment – before or after surgery and for stage IV cancer Chemotherapy is given is different ways: Systemic chemotherapy – IV or orally Regional chemotherapy – given directly into an artery that leads to a part of the body with a tumor. Examples: Hepatic artery infusion, Chemoembolization American Cancer Society, 2016
- 24. Embolization Substances areinjected into the hepatic artery to try and block or reduce the blood flow to cancer cells in the liver 3 main types of embolization: Arterial embolization Chemoembolization (TACE) Radioembolization American Cancer Society, 2016
- 25. Targeted Therapy Drugsthat attack specific genes or proteins in a cancer Often have different and less severe side effects May be given alone or with chemotherapy Examples: Drugs that target blood vessel formation Drugs that target Epidermal Growth Factor Receptor – Test tumor for KRAS Mutation/Molecular Profiling Kinase inhibitors – block signals to the cancer cell’s control center American Cancer Society, 2016
- 26. Treatment of RectalCancer by Stage Stage 0 – Removal of the polyp only Stage I Local excision Resection Resection with radiation therapy and chemotherapy usually before surgery but may be after Stage II Resection plus chemotherapy and radiation Resection with or without chemotherapy after surgery Cleveland Clinic, 2016
- 27. Treatment of RectalCancer by Stage Stage III Resection plus chemotherapy and radiation usually before surgery Resection with or without chemotherapy after surgery Stage IV and Recurrent Rectal Cancer Resection with or without chemoradiation before surgery Resection or pelvic exenteration as palliation Palliative radiation and/or chemotherapy Chemotherapy with or without targeted therapy Placement of a rectal stent/diverting ostomy Tumor Molecular Profiling Cleveland Clinic, 2016
- 28. Treatment of RectalCancer by Stage Treatment of liver metastasis Cryosurgery of Radiofrequency Ablation Chemoembolization or systemic chemotherapy Internal radiation therapy Surgery to remove the tumor Treatment of lung metastasis Cryosurgery or Radiofrequency Ablation Surgery Cleveland Clinic, 2016
- 29. Living as aRectal Cancer Survivor A cancer survivor is anyone who has been diagnosed with cancer – from the time of diagnosis and for the balance of his or her life Survivorship Care Plan Treatment summary Suggested schedule for follow-up exams and tests Long-term effects from treatment – management and when to call the doctor Surveillance for recurrence and secondary cancers Healthy lifestyle suggestions American Cancer Society, 2016
- 30. Survivorship Follow-up Doctorvisits Colonoscopy CT Scans or other imaging CEA Some side effects linger after treatment or may develop months or years later American Cancer Society, 2016
- 31. Long-Term Treatment Effects Fatigue Keep a diary for 1 week and use the diary to plan your schedule Make a daily schedule with rest breaks Keep naps to < 30 minutes Be active 3 Ps: Prioritize, Plan and Pace Neuropathy Take practical steps to make your environment safer May take months or years to improve Full recovery sometimes is not possible
- 32. Long Term TreatmentEffects Changes in bowel function Imodium, Stool bulking agents Pelvic floor exercises Diet Phantom rectal sensation/pain – common, resolves spontaneously in most cases Ice packs/warm baths Anti-depressant medications Pelvic floor exercises, yoga Relaxation techniques
- 33. Emotional Challenges Senseof relief Sadness, sense of loss Worry, irritability and anxiety Fear of recurrence Unexpected emotions Losing the “safety net” Role changes Changes in social support Changes in relationships with family, friends & coworkers Unmet expectations about returning to normal, “new normal”
- 34. Additional Concerns Changesin sexual function Infertility Returning to work Financial issues Genetic counseling
- 35. Lowering Risk ofRecurrence Healthy weight Being active Eating a healthy diet Aspirin Alcohol Quitting smoking American Cancer Society, 2016
- 36. What’s New inRectal Cancer Research Prospect Clinical Trial – awaiting data analysis. 4 months of IV chemotherapy is given prior to surgery instead of chemotherapy and radiation TNT – Total neoadjuvant therapy. IV chemotherapy followed by chemotherapy and radiation, then surgery. No further treatment after surgery. Traditionally, only 68% of patients complete all of their adjuvant therapy
- 37. References American CancerSociety. (2016). Retrieved from http://www.cancer.org/cancer/colonandrectumcanc er/detailed guide Cleveland Clinic. (2016). Retrieved from http://my.clevelandclinic.org/health/diseases_condi tions/hic-colorectal-cancer Malik, M., (2015). Rising rates of sporadic colorectal cancer in young adults: a possible environmental link. Retrieved from http://am.asco.org/rising-rates- sporadic-colorectal-cancer-young adults-possible- environmental-link
- 38. Question & Answer: SNAPA #STRONGARMSELFIE Bayer HealthCare will donate $1 for every photo posted (up to $25,000). Flex a “strong arm” & post it to Twitter or Instagram! (Use the hashtag!)
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Editor's Notes
- #10 Median age for men is 63, women 65 Rated decreasing 1% per year Increased survival related to increased screening and better treatments
- #12 Hereditary – familial adenomatous polyposis (FAP), Lynch Syndrome Behavioral Risk Factors – Activity (may decrease risk by up to 25%), Diet, weight, smoking, alcohol
- #13 Abdominal discomfort – bloating, cramps, gas, fullness
- #14 Biopsy – may check for gene mutations, Lynch syndrome, special immunohistochemical stains
- #18 Stage 0 – Carcinoma in situ – abnormal cell are found in the innermost (mucosa) lining of the rectum Stage I – cancer formed in the mucosa of the rectal wall and has spread to the submucosa and possibly to the muscle layer Stage II – Cancer has spread through the muscle layer and possibly through the serosa, and possibly nearby organs. No lymph nodes involved. Stage III – Cancer has spread to the mucosa and possibly through the submucosa, serosa and muscle wall. Cancer has spread to nearby lymph nodes. Stage IV – Cancer has spread through the muscle wall and may have spread to nearby organs and lymph nodes. Cancer has spread to one or more organs not near the rectum, such as liver or lung.
- #20 Neoadjuvant therapy – makes it easier to remove the tumor with clean margins, lessens problems with bowel control after surgery
- #21 Cryosurgery – Instrument is used to freeze and destroy abnormal tissue. Carcinoma in situ or stage 0 Local excision – Cancer has not spread to the wall of the rectum Trans Anal Minimally Invasive Surgery Resection – Cancer has spread to the wall. Portion or all of the rectum is removed. Lymph nodes removed. Will cover more later. RFA – High – energy radio waves. Probe through the skin, uses and electric current. Used on liver/lung Pelvic Exenteration – Cancer has spread to nearby organs. Lower colon, bladder, and lymph nodes are removed. In women, the cervix , vagina and ovaries are removed. In men, the prostate is removed.
- #22 Needs to be done in a high volume center with a dedicated colorectal surgeon – better outcomes LAR – part of the rectum is removed and the reattached to the remaining part of the rectum wither right away or later
- #24 Chemo – Capecitabine, FOLFOX
- #25 Arterial embolization – catheter is inserted in the femoral artery to the hepatic artery and small particles are injected to block up the artery Radioembolization – small beads (microspheres) coated with radioactive ytrium-90 in the hepatic artery
- #26 4 in 10 patients are KRAS mutations
- #27 Stage I – 5 year survival rate 87% Stage IIA 80%, IIB 49%
- #28 Stage IIIA 84%, IIIB 71%, IIIC 58% Stage IV 12%
- #34 Take care of emotions, express thoughts and feelings, time to heal, communicate, find ways to relax, use min-body approaches, focus on solutions