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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 - 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
    • Whether the cancer has recurred
    • The patient’s general health
surgical management
Surgical Management
  • Total resection of tumor
    • optimal treatment
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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