Colon Cancer. Etiology Prevention Screening Symptoms Treatment. Presenter: Catherine Azar, MD

Transcription

1 Colon Cancer Etiology Prevention Screening Symptoms Treatment

2 Disclosure I have no disclosures

3 Learning Objectives Discuss what age should colonoscopy screenings start. Discuss lifestyle changes to help prevent colon cancer. Discuss common side effects can a patient who is receiving chemotherapy present with.

4 Risk Factors Age: risk increases as a person gets older Having had colorectal cancer or premalignant polyps before Having a history of ulcerative colitis or Crohn s disease Family history of colorectal cancer Race or ethnic background, such as being African American or Ashkenazi Type 2 diabetes Certain family syndromes, like familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC, also called Lynch syndrome)

5 Lynch Syndrome People with Lynch syndrome may experience: Colon cancer that occurs at a younger age, especially before age 50 A family history of colon cancer that occurs at a young age A family history of endometrial cancer

6 Lynch Syndrome A family history of other related cancers, including ovarian cancer, kidney cancer, stomach cancer, small intestine cancer, liver cancer, sweat gland cancer (sebaceous carcinoma) and other cancers Lynch Syndrome is a hereditary disorder caused by a mutation in a mismatch repair gene The defects in the genes disallow repair of DNA mistakes and as cells divide, errors stack and uncontrollable cell growth may result in cancer.

7 Personal Risks Certain types of diets: one that is high in red meats and processed meats can increase your colorectal cancer risk, nitrate Cooking meats at very high heat (frying, broiling, or grilling) can create chemicals that might increase cancer risk??? Nitrates Lack of exercise Being obese Smoking Heavy ETOH use

8 Prevention Low fat, high fiber diet Exercise ASA QD, NSAID s??? Stop smoking Weight loss Vitamin D supplementation Decrease ETOH

9 Cancers linked to smoking Lung Head & Neck Bladder Colorectal Esophagus Stomach AML?Breast

10 SEER DATA Estimated New Cases in 2015: 132,700 % of All New Cancer Cases: 8.0% Estimated Deaths in 2015: 49,700 % of All Cancer Deaths: 8.4% Percent Surviving 5 Years: 64.9% From 2005 to 2011

11 SEER DATA Number of New Cases and Deaths per 100,000: The number of new cases of colon and rectum cancer was 42.4 per 100,000 men and women per year. The number of deaths was 15.5 per 100,000 men and women per year. These rates are age-adjusted and based on cases and deaths. Lifetime Risk of Developing Cancer: Approximately 4.5 percent of men and women will be diagnosed with colon and rectum cancer at some point during their lifetime, based on data. Prevalence of This Cancer: In 2012, there were an estimated 1,168,929 people living with colon and rectum cancer in the United States.

12 CDC Recommendations High-sensitivity fecal occult blood test (FOBT): should be done every year. Flexible sigmoidoscopy: should be done every five years with FOBT every three years. Colonoscopy : should be done every ten years.

13 USPSTF Recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. Recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient Recommends against screening for colorectal cancer in adults older than age 85 years.

14 COLON CANCER SYMPTOMS No signs or symptoms at all A change of bowel habits Blood (either bright red or very dark) in the stool Diarrhea, constipation, or feeling that the bowel does not empty completely Stools that are narrower than usual Frequent gas pains, bloating, fullness, or cramps Weight loss for no known reason Feeling very tired

15 Treatment Surgery even if there is metastatic disease For quality of life so that patient can eat To avoid infection To avoid perforation To avoid bleeding

16 Chemotherapy Almost all agents cause diarrhea-dehydration and electrolyte abnormalities 5-FU Xeloda Oxaliplatin Irinotecan

17 Side Effects Mucositis Hand-foot syndrome Low counts

18 Biological agents Erbitux Vectibix Patients must be KRAS wild type not mutant to use these agents The most reliable way to predict whether a colorectal cancer patient will respond to one of the EGFR-inhibiting drugs is to test for certain activating mutations in the gene that encodes KRAS, which occurs in 30%-50% of colorectal cancers. Studies show patients whose tumors express the mutated version of the KRAS gene will not respond to Erbitux or Vectibix Approved only for MCRC

19 KRAS-MUTANT V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog 30%-50% of colorectal cancers More aggressive disease Less treatment options

20 Side effects Rash Hypomagnesaemia Hypercoagulability Allergic reaction Cardiopulmonary Arrest-Erbitux Pulmonary fibrosis, interstitial disease

21 Other biologic agents Avastin, 1 st LINE Zaltrap, 2nd LINE Stivarga, 2nd LINE All block VEGF receptors- vascular endothelial growth factor

22 Side Effects Bleeding Poor healing Hypertension Hypercoagulability Perforation Worsens toxicity of chemotherapy in combination

23 PD-1 Inhibitors Programmed death-1 (PD-1) is expressed on the surface of activated Tcells. Programmed death ligand-1 (PD-L1) is expressed on cancer cells. When PD-1 and PD-L1 bind, they form a biochemical response suppressing the immune system from recognizing tumor cells. PD-1 inhibitors are monoclonal antibodies that inhibit PD-1 and may enhance the ability of the body s immune system to recognize cancer cells. Once recognized, they may stimulate the body s immune system to fight the cancer.

24 PD-1 Inhibitors They are currently approved in some countries for unresectable and metastatic melanoma, and in the United States for metastatic squamous non-small cell lung cancer (NSCLC) with progression on or after platinumbased chemotherapy. Some agents in development are associated with a biomarker test for PDL1 expression to identify patients more likely to benefit from therapy. PD-1 inhibitors are administered as an intravenous infusion over minutes every 2-3 weeks (ranges due to differences between specific PD-1 agents).

25 PD-1 Inhibitors Keytruda, Pembrolizumab Opdivo, nivolumab Multiple other agents by different manufacturers in development

26 Side Effects Fatigue Anorexia Pruritus Infusion related reactions Immune mediated pneumonitis, colitis, hepatitis, nephritis, hypo/hyperthyrodism

27 QUESTIONS At what age should colonoscopy start? Name lifestyle changes to prevent colon cancer. What common side effects can a patient who is receiving chemotherapy present with?

28 How to contact me: Green Valley Office: River Road Office: (520) Cell Phone: