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Treatment options depend on the following: The stage of the cancer PowerPoint PPT Presentation


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Treatment options depend on the following: The stage of the cancer Whether the cancer has recurred The patient’s general health. Surgical Management. Total resection of tumor optimal treatment. Pre-operative Procedure. Intraoperative Procedure. Postoperative Procedures.

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Treatment options depend on the following: The stage of the cancer

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Treatment options depend on the following the stage of the cancer

  • Treatment options depend on the following:

    • The stage of the cancer

    • Whether the cancer has recurred

    • The patient’s general health


Surgical management

Surgical Management

  • Total resection of tumor

    • optimal treatment


Pre operative procedure

Pre-operative Procedure


Intraoperative procedure

Intraoperative Procedure


Postoperative procedures

Postoperative Procedures


Postoperative procedures1

Postoperative Procedures


Chemotherapy

Chemotherapy

  • 5-FU

    • 15-20% of patients have partial response

    • Backbone of treatment

    • IV or oral (capecitabine)

      • Similar efficacy

    • Radiosensitizer- when given with radiotherapy

  • 5-FU + folinic acid (leucovirin)

    • Improves efficacy

    • Enhances binding to thymidylatesynthase

    • Three-fold improvement in partial response

    • 6 mos. after resection (stage III)

      • 40% decrease in recurrence rates

      • 30% improvement in survival


Chemotherapy1

Chemotherapy

  • 5-FU + LV + Irinotecan (FOLFIRI regimen)

    • Topoisomerase 1 inhibitor

    • Improves response rates and survival of patients with metastatic disease

    • Diarrhea

  • 5-FU + LV + Oxiplatin (FOLFOX regimen)

    • Platinum analogue

    • Improves response rate

    • Dose-dependent neuropathy, resolves following cessation of therapy

  • FOLFIRI = FOLFOX


Chemotherapy2

Chemotherapy

  • Monoclonal antibodies

    • Effective for advanced colorectal cancer

    • Cetuximab and Panitumumab

      • Directed against EGFR

      • Benefit previously treated patients

      • cetuximab – reverse cellular resistance to cytotoxic chemotherapy

      • Acne-like rash

    • Bevacizumab

      • Directed against VEGF

      • Anti-angiogenesis

      • HPN, proteinuria, increased likelihood of thromboembolic events


Treatment by stage of colon cancer

Treatment by Stage of Colon Cancer

  • Stage 0

    • cancer has not grown beyond the inner lining of the colon

    • polypectomyor local excision through the colonoscope

    • Colon resection may be necessary if the tumor is too big to be removed by local excision

  • Stage I

    • cancer has grown through several layers of the colon, but has not spread outside the colon wall

    • Surgical resection

  • American cancer society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_by_Stage_of_Colon_Cancer.asp

  • National Cancer Institute

  • http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1


Treatment by stage of colon cancer1

Treatment by Stage of Colon Cancer

  • Stage II

    • cancer has grown through the wall of the colon and may extend into nearby tissue

    • has not yet spread to the lymph nodes

    • Surgical resection is usually the only treatment needed

    • if cancer is likely to recur, radiation or chemotherapy may be recommended

    • Clinical trials of chemotherapy, radiation therapy, or monoclonal antibody therapy after surgery

  • Stage III

    • more advanced stage

    • cancer has spread to nearby lymph nodes, but has not yet spread to other parts of the body

    • Surgical resection is the first treatment

    • Adjuvant chemotherapy with 5-FU and leucovorin

    • Radiation therapy: if cancer was large enough to grow into adjacent tissues

  • American cancer society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_by_Stage_of_Colon_Cancer.asp

  • National Cancer Institute

  • http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1


Treatment by stage of colon cancer2

Treatment by Stage of Colon Cancer

  • Stage IV and Recurrent Colon Cancer

    • cancer has spread to distant organs and tissues such as the liver, lung, peritoneum, or ovary

    • segmental resection or diverting colostomy

      • relieve or prevent blockage of the colon and to prevent other local complications

    • Surgery to remove parts of other organs, where the cancer may have recurred or spread

    • Radiation therapy or chemotherapy

      • palliative therapy to relieve symptoms and improve quality of life

    • Clinical trials of chemotherapy and/or monoclonal antibody therapy

    • locally recurrent colon cancer: local excision

    • Liver recurrence

      • Chemotherapy followed by resection

      • Radiofrequency ablation or cryosurgery.

      • Clinical trials of hepatic chemoembolization with radiation therapy

  • American cancer society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_by_Stage_of_Colon_Cancer.asp

  • National Cancer Institute

  • http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1


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