Colorectal Cancer

In July1999, I learned I was pregnant with my son. My sister was pregnant, too, and due to deliver in the fall. I was excited to share my happy news. But my father, then 65, had news of his own: he had been diagnosed with stage III colorectal cancer.

A model example of personalized cancer therapy that has demonstrated improved patient outcomes is the use of anti-HER2 treatment. Breast cancer patients screened via molecular diagnostics and identified as having amplification of the HER2 gene generally have a poorer prognosis, but show better responses to anti-HER2 treatment.

Colorectal cancer is one of the most commonly diagnosed cancers in the US, and it is the second leading cause of cancer-related deaths. The risk of developing colorectal cancer increases with age.

The use of oral bisphosphonates, typically used to treat osteoporosis and bone metastases in breast cancer, has recently been found to reduce breast cancer risk.

“How long have I had this cancer, Doctor?” This is a question that patients frequently ask their oncologist.

In their article, Patrone et al utilize a modified version of Collins’ law to estimate the age of breast, lung, and colorectal cancers. Collins’ law, which states that the period of risk for recurrence of a tumor is equal to the age of the patient at diagnosis plus 9 months, has been applied primarily to pediatric tumors, in particular embryonal tumors.[1,2] The results from the application of Collins’ law to these tumors have been reasonable, although exceptions have been reported and the law is not applicable to all cancers.[3,4] Its utilization in adults in the manner used in this paper is therefore unique.

The authors of “How Long Have I Had My Cancer, Doctor?” have addressed a question often contemplated by patients when they receive a diagnosis of cancer.

The choices that patients and clinicians make when dealing with cancer are dictated by time, whether they are arranging for screening mammography and colonoscopy, compiling treatment plans, or determining follow-up intervals and the age of freedom from follow-up.

Despite recommendations against using EGFR inhibitors in the presence of KRAS mutations, cetuximab therapy may be enhanced by the presence of the p.G13D KRAS mutation.

Like the protective plastic cap at the ends of shoelaces that prevent them from unraveling, telomeres protect the ends of chromosomes. These small strips of DNA prevent chromosome tips from fraying during cell division. But as the cells divide, the telomeres shorten and the cells age. Shortened telomeres have been linked to an increased risk of cancer development. Researchers at the Mayo Clinic in Rochester, Minn., wanted to see if telomere shortening was linked to colon cancer development at a younger age.

Selected rectal cancer patients who undergo optimal surgery with TME can still benefit from short-term preoperative radiation therapy.

CT colonography is feasible in remote health centers where optimal colonoscopy is limited, according to a study from the University of Arizona in Tucson.

The search for a magic bullet against cancer historically has glowed bright then dimmed, depending on the stage of discovery. Developments surrounding monoclonal antibodies and angiogenesis inhibitors have followed this cycle, as exuberance for their potential has bowed to the nuances that underlie the complex mechanisms on which they depend.

Take-home message from the current data is the importance of exposing patients to all potentially active agents.

A growing body of evidence supports the use of CT colonography for colon cancer screening, and a U.S. panel should reverse its decision to not endorse the procedure, according to the CT Colonography Coalition.

St. Luke’s Episcopal Hospital has established the Philip A. Salem, MD, Chair in Cancer Research.

Male sex, but not race, predicted colon polyp prevalence, suggesting that African Americans may not benefi t from earlier screening.

Despite efforts by the manufacturer to reduce the cost of Avastin, the clinical effectiveness agency for England and Wales says that it will not recommend the drug for the first-line treatment of metastatic colorectal cancer.

Primary surgery with an abdominoperineal resection (APR) was historically the standard of care for localized anal squamous cell carcinoma. APR achieved 40%-70% survival rates at five years, with local failures from 27%-47%.[1,2] With modern technology and radiation dose escalation, external beam radiation therapy (EBRT) studies have improved complete response rates, decreased morbidity, and improved sphincter preservation rates. Nigro et al added 5-fluorouracil (5FU) and mitomycin C (MMC) to concurrent EBRT [3,4] and impressive complete response rates inspired other groups to investigate the role of chemotherapy as a component of sphincter-preserving therapy. The European Organization for Research and Treatment of Cancer (EORTC) and United Kingdom Coordinating Committee on Cancer Research (UKCCCR) studies reported improved local control and colostomy-free survival when chemotherapy (5FU/MMC) was administered in conjunction with radiation.[5,6] The five-year survival rate for patients receiving standard chemoradiation approaches 70%; however, 20%-40% experience grade 3-4 toxicity, and administration with MMC causes profound hematologic toxicity.

The treatment of cancer of the anal canal has changed significantly over the past several decades. Although the abdominoperineal resection (APR) was the historical standard of care, a therapeutic paradigm shift occurred with the seminal work of Nigro, who reported that anal canal cancer could be treated with definitive chemoradiation, with APR reserved for salvage therapy only. This remains an attractive approach for patients and physicians alike and the standard of care in this disease. Now, nearly four decades later, a similar approach continues to be utilized, albeit with higher radiation doses; however, this strategy remains fraught with considerable treatment-related morbidities. With the advent of intensity-modulated radiation therapy (IMRT), many oncologists are beginning to utilize this technology in the treatment of anal cancer in order to decrease these toxicities while maintaining similar treatment efficacy. This article reviews the relevant literature leading up to the modern treatment of anal canal cancer, and discusses IMRT-related toxicity and disease-related outcomes in the context of outcomes of conventionally treated anal cancer.

Investigators at Memorial-Sloan Kettering plan to tease out exactly how much vitamin D is enough to improve survival prospects.

Patients saw improvements in progression-free survival, while oncologists saw benefit of evidence-driven medicine at work.

Current guidelines may be inadequate in at-risk African-American and Latino populations.

Early detection of cancer and novel chemotherapy agents have resulted in longer survival following a colorectal cancer diagnosis.

Metabolic inhibition by chemotherapeutic drugs most likely hampers imaging results.

Every year in the United States, approximately 160,000 cases of colorectal cancer (CRC) are diagnosed, and about 57,000 patients die of the disease, making it the second leading cause of death from cancer among adults.

In this ASCO podcast, Dr. Goldberg, Distinguished Professor, Hematology/Oncology, at the University of North Carolina Lineberger Comprehensive Cancer Center and the Physician-in-Chief of the North Carolina Cancer Hospital, spoke about the new developments in advanced colorectal cancer since his ASCO 2003 practice-changing presentation.

A high intake of dietary polyamines, which are commonly found in orange juice, corn, red meat, peas, and nuts, has been linked to the size and grade of colorectal adenomas found on screening colonoscopy.

Confusion over important prognostic indicator may lead to unnecessary treatment.

The combination of oxaliplatin plus fluorouracil/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for colorectal cancer (CRC), both as adjuvant therapy and as treatment for metastatic disease. Unfortunately, platinum-based chemotherapies also produce neurotoxicity as a side effect. Neurotoxicity is the most common dose-limiting toxicity of oxaliplatin, and it is one of the major causes for patients to stop receiving chemotherapy. It can manifest as either of two distinct syndromes: a transient, acute syndrome that can appear during or shortly after the infusion (~1%–2% of patients), and a dose-limiting, cumulative sensory neuropathy. Calcium/magnesium (Ca/Mg) infusions have been used to decrease the incidence of oxaliplatin-induced neuropathy. The actual utility of Ca/Mg infusions in this setting has been an interesting and controversial topic. They may reduce the severity of neurotoxicity, but some investigators have questioned whether they also will alter the efficacy of these chemotherapy regimens. In this paper, we review the clinical data concerning the usefulness of Ca/Mg infusions in reducing the incidence of oxaliplatin-induced neuropathy as well as their effect on responsiveness to chemotherapy.