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Colon Cancer - PowerPoint PPT Presentation


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COLON CANCER. A MAJOR ISSUE IN ALASKA. A common malignancy. 200,000 cases in the U. S. in 2008 Greater than 50 new cases each year in Alaska Natives . RISK FACTORS. Age Family history Genetic predisposition Adenomatous polyps History of other gastrointestinal malignancies. Screening.

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colon cancer

COLON CANCER

A MAJOR ISSUE IN ALASKA

a common malignancy
A common malignancy
  • 200,000 cases in the U. S. in 2008
  • Greater than 50 new cases each year in Alaska Natives
risk factors
RISK FACTORS
  • Age
  • Family history
    • Genetic predisposition
  • Adenomatous polyps
  • History of other gastrointestinal malignancies
screening
Screening
  • FOBT
    • Problematic in our patient population because of H. pylori
    • Cannot differentiate upper from lower bleeds
      • A new test being studied possibly can
  • Sigmoidoscopy
  • Colonoscopy
diagnosis
Diagnosis
  • Tissue biopsy
staging
Staging
  • I confined to the mucosa
  • II into the muscularis
  • III involving the lymph nodes
  • IV distant metastases
special considerations
Special considerations
  • Colon versus Rectum
    • A different approach for rectal cancer both before and after surgery
treatment
Treatment
  • Surgery is the primary curative therapy
  • Pre-op chemotherapy-radiotherapy for rectal cancer unless the lesion is superficial
  • For patients with metastastic disease who are or may soon become obstructed
slide9
CEA
  • Good to have a baseline CEA, for both follow up and to follow for recurrence or progression
chemotherapy
Chemotherapy
  • Adjuvant
    • For Stage III
    • For high risk stage II (T4 N0)
      • Obstruction
      • Perforation
      • circumferential
    • For pre-op in rectal lesions, then post op
radiation for rectal cancers
Radiation for rectal cancers
  • Pre-Op
  • Stage III
  • High risk stage II
  • After trans-anal resection of lesions greater than T2
agents
Agents
  • FOLFOX
  • XELOX
  • Irinotecan
  • Avastin
  • Cetuximab
  • Penitumumab
unusual side effects
Unusual side effects
  • Hand-Foot syndrome
  • Cold-induced neuropathy
  • Cholera syndrome
  • Skin rash
  • Perforation (bowel, lung, wound)
  • Accelerated hypertension
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