Colorectal Cancer Awareness

Colorectal
Cancer
Awareness
MD. FARID UDDIN SARDAR
B.Pharm, M.Pharm

Colorectal Cancer is cancer that forms
in the colon or the rectum. It usually
starts as benign polyps in the glands
in the lining of the colon and rectum,
and slowly develops into cancer.
Colorectal Cancer

What is Colorectal Cancer?
 Third most common type of cancer
and second most frequent cause of
cancer-related death
 A disease in which normal cells in
the lining of the colon or rectum
begin to change, grow without
control, and no longer die
 Usually begins as a noncancerous
polyp that can, over time, become a
cancerous tumor

What Are the Risk Factors for Colorectal Cancer?What Are the Risk Factors for Colorectal Cancer?
Certain types of diets: A diet that is high in red meats (such as
beef, pork, lamb, or liver) and processed meats (hot dogs and
some luncheon meats) can increase colorectal cancer risk.
Cooking meats at very high temperatures (frying, broiling, or
grilling) creates chemicals that might increase cancer risk.

Physical Inactivity : If you are not physically active, you have a
greater chance of developing colorectal cancer. Increasing
activity may help reduce your risk.

Obesity : If you are very overweight, your risk of developing
and dying from colorectal cancer is increased. Obesity raises
the risk of colon cancer in both men and women, but the link
seems to be stronger in men.

What Are the Risk Factors for Colorectal Cancer?
Smoking: Long-term smokers are more likely than non-
smokers to develop and die from colorectal cancer.
Smoking is a well-known cause of lung cancer, but it is
also linked to other cancers, like colorectal.

Age: Younger adults can develop colorectal cancer, but
the chances increase markedly after age 50. About 9 out
of 10 people diagnosed with colorectal cancer are at
least 50 years old.

Personal History of Colorectal Polyps or Colorectal Cancer:
If you have a history of adenomatous polyps (adenomas), you
are at increased risk of developing colorectal cancer.
If you have had colorectal cancer, even though it has been
completely removed, you are more likely to develop new
cancers in other areas of the colon and rectum.

Personal History of Inflammatory Bowel Disease:
Inflammatory bowel disease (IBD), which includes ulcerative
colitis and Crohn's disease, is a condition in which the colon
is inflamed over a long period of time. People who have had
IBD for many years often develop dysplasia. Dysplasia is a
term used to describe cells in the lining of the colon or rectum
that look abnormal (but not like true cancer cells) when seen
with a microscope. These cells can change into cancer over
time

Family History of Colorectal Cancer: Most colorectal cancers
occur in people without a family history of colorectal cancer.
Still, as many as 1 in 5 people who develop colorectal cancer
have other family members who have been affected by this
disease.

Inherited Syndromes: About 5% to 10% of people who
develop colorectal cancer have inherited gene defects
(mutations) that can cause family cancer syndromes and lead
to them getting the disease. The most common inherited
syndromes linked with colorectal cancers are familial
adenomatous polyposis (FAP) and hereditary non-polyposis
colorectal cancer (HNPCC), but other rarer syndromes can
also increase colorectal cancer risk.

Familial Adenomatous Polyposis (FAP)
FAP is caused by changes (mutations) in the APC gene that
a person inherits from his or her parents. About 1% of all
colorectal cancers are due to FAP.
The most common type of FAP causes people to develop
hundreds or thousands of polyps in their colon and rectum,
usually in their teens or early adulthood. Cancer usually
develops in 1 or more of these polyps as early as age 20.
By age 40, almost all people with this disorder will have
developed colon cancer if the colon isnt removed first to
prevent it.

Gardner syndrome is a type of FAP that also has
benign (non-cancerous) tumors of the skin, soft
tissue, and bones.

Hereditary Non-Polyposis Colon Cancer (HNPCC):
HNPCC, also known as Lynch syndrome, accounts for
about 2% to 4% of all colorectal cancers. In most
cases, this disorder is caused by an inherited defect
in either the gene MLH1or the gene MSH2, but other
genes can also cause HNPCC. The genes involved
normally help repair DNA damage.

Turcot Syndrome: This is a rare inherited condition in
which people are at increased risk of adenomatous
polyps and colorectal cancer, as well as brain
tumors. There are actually 2 types of Turcot
syndrome:
One can be caused by gene changes similar to those
seen in FAP, in which cases the brain tumors are
medulloblastomas.
The other can also be caused by gene changes similar
to those seen in HNPCC, in which cases the brain
tumors are glioblastomas.

Adenocarcinomas: More than 95% of colorectal cancers are a
type of cancer known as adenocarcinomas. These cancers
start in cells that form glands that make mucus to lubricate
the inside of the colon and rectum.
Other, less common types of tumors may also start in the colon
and rectum. : Carcinoid tumors, Gastrointestinal stromal
tumors (GISTs), Lymphomas, Sarcomas.
Types of Colon and Rectum Cancer

Carcinoid Tumors: These tumors start from specialized
hormone-producing cells in the intestine
Types of Colon and Rectum CancerTypes of Colon and Rectum Cancer

Gastrointestinal Stromal Tumors (GISTs): These tumors
start from specialized cells in the wall of the colon called the
interstitial cells of Cajal. Some are benign (non-cancerous);
others are malignant (cancerous). These tumors can be
found anywhere in the digestive tract, but they are unusual in
the colon

Lymphomas: These are cancers of immune system cells that
typically start in lymph nodes, but they may also start in the
colon, rectum, or other organs
Sarcomas: These tumors can start in blood vessels as well as
in muscle and connective tissue in the wall of the colon and
rectum. Sarcomas of the colon or rectum are rare.

Screening Methods for Colorectal Cancer
 Colonoscopy (currently the best way to
prevent and detect colorectal cancer)
 Virtual colonography
 Sigmoidoscopy
 Fecal occult blood test
 Double contrast barium enema
 Digital rectal examination

What Are the Symptoms of Colorectal Cancer?
 A change in bowel habits: diarrhea, constipation, or
a feeling that the bowel does not empty completely

What Are the Symptoms of Colorectal Cancer?
A feeling that you need to have a bowel movement
that's not relieved by having one
Rectal bleeding with bright red blood
Blood in the stool, which may make the stool look
dark
Cramping or abdominal (belly) pain
Weakness and fatiague
Unintended weight loss

StageStage 00 Colorectal CancerColorectal Cancer
 Known as “cancer in situ,”
meaning the cancer is located
in the mucosa (moist tissue
lining the colon or rectum)
 Removal of the polyp
(polypectomy) is the usual
treatment

Stage I Colorectal CancerStage I Colorectal Cancer
 The cancer has grown through the
mucosa and invaded the
muscularis (muscular coat)
 Treatment is surgery to remove
the tumor and some surrounding
lymph nodes

Stage II Colorectal CancerStage II Colorectal Cancer
 The cancer has grown
beyond the muscularis of
the colon or rectum but has
not spread to the lymph
nodes
 Stage II colon cancer is
treated with surgery and, in
some cases, chemotherapy
after surgery
 Stage II rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy

Stage III Colorectal CancerStage III Colorectal Cancer
 The cancer has spread to the
regional lymph nodes (lymph nodes
near the colon and rectum)
 Stage III colon cancer is treated
with surgery and chemotherapy
 Stage III rectal cancer is treated
with surgery, radiation therapy, and
chemotherapy

Stage IV Colorectal CancerStage IV Colorectal Cancer
 The cancer has spread outside of the
colon or rectum to other areas of the
body
 Stage IV cancer is treated with
chemotherapy. Surgery to remove the
colon or rectal tumor may or may not
be done
 Additional surgery to remove
metastases may also be done in
carefully selected patients

Treatment: SurgeryTreatment: Surgery
 Foundation of curative therapy
 The tumor, along with the adjacent healthy colon or rectum and
lymph nodes, is typically removed to offer the best chance for
cure
 May require temporary or (rarely) permanent colostomy
(surgical opening in abdomen that provides a place for waste
to exit the body)

 Adjuvant chemotherapy is given after surgery to maximize a
patient’s chance for cure
 Neoadjuvant chemotherapy is given before surgery
 Palliative chemotherapy is given to patients whose cancer cannot
be removed to delay or reverse cancer-related symptoms and
substantially improve quality and length of life
Treatment: ChemotherapyTreatment: Chemotherapy
Types of Chemotherapy

Treatment: ChemotherapyTreatment: Chemotherapy
 Drugs used to kill cancer cells
 Typical medications include fluorouracil (5-FU), oxaliplatin
(Eloxatin), irinotecan (Camptosar), and capecitabine (Xeloda)
 A combination of medications is often used
 Chemotherapy regimens are 5-FU + Folinic Acid, Oxaliplatin
(Eloxatin) monotherapy, FOLFOX - 4, FOLFOX - 6, FOLFOX - 7,
FLOX, Irinotecan monotherapy, FOLFIRI, FOLFIRI 3, FOLFOXFIRI,
Capecitabine monotherapy, XELOX
 Monoclonal Antibodies – Targeted Therapies

Vascular Endothelial Growth Factor (VEGF)Vascular Endothelial Growth Factor (VEGF)
receptor Antibody - Antiangiogenesis Therapyreceptor Antibody - Antiangiogenesis Therapy
 “Starves” the tumor by disrupting its blood supply
 This therapy is given along with chemotherapy
 Bevacizumab (Avastin) was approved by the U.S. Food and
Drug Administration (FDA) in 2004 for the treatment of
colorectal cancer

Anti Epidermal growth factor (EGF) receptorAnti Epidermal growth factor (EGF) receptor
antibodiesantibodies
 Treatment designed to target cancer cells while minimizing
damage to healthy cells
 Cetuximab (Erbitux) was approved by the FDA in 2004 for
the treatment of advanced colorectal cancer

When standard protocol becomes
refractory than salvage therapy is used
with second or third line drugs.
Salvage ChemotherapySalvage Chemotherapy

Cancer Treatment: Radiation TherapyCancer Treatment: Radiation Therapy
 The use of high-energy x-rays or
other particles to destroy cancer
cell
 Used to treat rectal cancer, either
before or after surgery
 Different methods of delivery
 External-beam: outside the body
 Intraoperative: one dose during
surgery

TAKE HOME MESSEGETAKE HOME MESSEGE
Stay a Healthy Weight
Be Active : at least 150 minutes of moderate or 75
minutes of vigorous intensity activity per week or an
equivalent combination, preferably spread throughout the
week.

Eat Right: Choose foods and beverages in amounts that
help you get to and stay at a healthy weight. Eat at least
2½ cups of vegetables and fruits each day Choose
whole grains.
Limit red meats (like beef, pork, or lamb) and processed
meats (like hot dogs or luncheon meats)

Don’t Smoke.
If you have any family history of cancer please
contact with physician.
Colonoscopy at least one time in a year.

If you are age 45 or older and at average risk, get
tested for colorectal cancer.
Screening tests offer the best way to prevent CRC or
find it early. Finding cancer early gives you a better
chance for successful treatment.
Early CRC usually has no symptoms. Don’t wait for
symptoms to occur.
Again —treatment is most effective when CRC is
found early.

Colorectal Cancer Awareness

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