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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 l.jpg

COLON CANCER

A MAJOR ISSUE IN ALASKA


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A common malignancy

  • 200,000 cases in the U. S. in 2008

  • Greater than 50 new cases each year in Alaska Natives


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RISK FACTORS

  • Age

  • Family history

    • Genetic predisposition

  • Adenomatous polyps

  • History of other gastrointestinal malignancies


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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


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Diagnosis

  • Tissue biopsy


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Staging

  • I confined to the mucosa

  • II into the muscularis

  • III involving the lymph nodes

  • IV distant metastases


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Special considerations

  • Colon versus Rectum

    • A different approach for rectal cancer both before and after surgery


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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


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CEA

  • Good to have a baseline CEA, for both follow up and to follow for recurrence or progression


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Chemotherapy

  • Adjuvant

    • For Stage III

    • For high risk stage II (T4 N0)

      • Obstruction

      • Perforation

      • circumferential

    • For pre-op in rectal lesions, then post op


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Radiation for rectal cancers

  • Pre-Op

  • Stage III

  • High risk stage II

  • After trans-anal resection of lesions greater than T2


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Agents

  • FOLFOX

  • XELOX

  • Irinotecan

  • Avastin

  • Cetuximab

  • Penitumumab


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Unusual side effects

  • Hand-Foot syndrome

  • Cold-induced neuropathy

  • Cholera syndrome

  • Skin rash

  • Perforation (bowel, lung, wound)

  • Accelerated hypertension


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