Advancements in Rectal Cancer Treatments
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Welcome!
Advancements in Treating Rectal Cancer
Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series
Our webinar will begin shortly
www.FightColorectalCancer.org
877-427-2111
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Fight Colorectal Cancer
1. Tonight’s speaker: Dr. Deborah Schrag, MD
2. Archived webinars: Link.FightCRC.org/Webinars
3. Follow up survey to come via email. Get a free Blue Star of
Hope pin when you tell us how we did tonight.
4. Ask a question in the panel on the right side of your screen and
look for hyperlinks during throughout the presentation.
5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111
www.FightColorectalCancer.org
877-427-2111
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Fight Colorectal Cancer
Disclaimer
The information and services provided by Fight Colorectal
Cancer are for general informational purposes only.
The information and services are not intended to be substitutes
for professional medical advice, diagnosis, or treatment.
If you are ill, or suspect that you are ill, see a doctor
immediately. In an emergency, call 911 or go to the nearest
emergency room.
Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition. www.FightColorectalCancer.org
877-427-2111
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Fight Colorectal Cancer
Up coming webinar
Wednesday, June 19th
8pm-9pm EST
Colorectal Cancer:
What's New and What's on the Horizon?
In Collaboration with the Colon Cancer Alliance
www.FightColorectalCancer.org
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Fight Colorectal Cancer
www.FightColorectalCancer.org
877-427-2111
Dr. Deborah Schrag, MD, MPH Dana Farber Cancer Institute
Associate Professor of Medicine, Harvard Medical School
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Deborah Schrag MD MPH
Dana-Farber Cancer Institute
Boston, MA
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American Cancer Society estimates 40,340
new cases of rectal cancer in 2013
Colon/Rectal cancer is the 3rd leading cause of
cancer-related death in US
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The death rate from rectal cancer has been
dropping for 20+ years.
>1 million colorectal cancer survivors in US
Advancements:
Screening & early detection
Improvements in treatment
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Detection
Workup
Staging
Treatment
Surveillance
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Screening (typically starts at age 50)
Colonoscopy (camera)
CT (scan)
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Procedure What is it? Why do it?
Biopsy & Pathology
Review
Remove tumor tissue &
examine it under a
microscope
To discover the
presence, cause or
extent disease.
Colonoscopy &
Proctoscopy
Examine colon & rectum
with a camera
To discover the
presence, cause or
extent disease.
CT of
chest/abdomen/pelvis An x-ray scan (image)
To see if the cancer has
spread beyond the
rectum.
CEA Blood test Carcinoembryonic antigen
(CEA) is a protein
associated with tumors.
ERUS or MRI Medical imaging that
examines soft tissue
To discover the
presence, cause or
extent disease.
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Stage
describes the extent of the cancer in the body
how far the main tumor has grown into nearby areas
extent of spread to nearby lymph nodes
whether the cancer has spread (metastasized) to other
organs of the body
is an important factor in determining prognosis &
treatment options
based on the results of physical exam, biopsies, &
imaging tests
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Surgery
Radiation Therapy
Chemotherapy
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Surgery is usually the main treatment for rectal
cancer, although radiation and chemotherapy
will often be given before and/or after surgery.
Surgeon removes tumor and surrounding
tissues (extent of resection depends on extent
of tumor)
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Advances in techniques, equipment, and
surgical specialization
More precise excision
Availability of stapling devices
J pouch and coloplasty pouch
Attention to cancer clearance - Total mesorectal
excision has reduced local recurrence following
surgery
Microsurgery
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High-energy rays or particles destroy cancer
cells
Radiation may
Lower the risk that the tumor will come back
Improve operability
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External-beam radiation therapy
Similar experience to getting an x-ray
Endocavitary radiation therapy
Small device inserted to deliver radiation
Brachytherapy (internal radiation therapy)
Small pellets of radioactive material placed next to
tumor
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May be administered before and/or after
surgery
Drugs used to treat rectal cancer
5-Fluorouracil
Capecitabing
Irinotecan
Oxaliplatin
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Regimens (combinations of drugs) used to treat rectal cancer FOLFOX = 5-FU + leucovorin + oxaliplatin
FOLFIRI = 5-FU + leucovorin + irinotecan
FOLFOXIRI = leucovorin + 5-FU + oxali + irinotecan
CapeOx = capecitabine + oxaliplatin
Addition of biologic agents Bevacizumab
Cetuximab
Panitumumab
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Periodic screening & tests to see if the cancer
has come back.
History/Physical
CT Scan
Colonoscopy
Blood Tests
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This research study is being done to see if
radiation can be avoided for a select group of
rectal cancer patients who have a good
response to 6 treatments with a chemotherapy
combination regimen known as FOLFOX.
The proposed study does not use new agents
or procedures, but rather sequences existing
well established treatment strategies in a
different way.
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Stage II & III rectal cancer is treated in 3 phases:
1. Chemotherapy and radiation given together over 5.5 weeks –”chemoradiation”
Why? To prevent the tumor from coming back in the same location in the pelvis
2. Surgery to remove the tumor
3. Chemotherapy with a drug combination called “FOLFOX” given every 2 weeks over about 4 months
Why? To prevent the cancer from coming back in a distant organ such as the liver
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With modern surgical techniques, chemotherapy advances, and MRIs it is possible that some patients can avoid radiation to the pelvis
Because chemoradiation has side effects, it would be valuable to avoid it for patients who can achieve good results without it
Rectal cancer specialists hope that FOLFOX chemotherapy before surgery will enable some rectal cancer patients to avoid chemoradiation
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Radiation treatment is time consuming….daily visits
Radiation often has long term effects on bowel bladder and sexual function
Radiation in previous clinical trials does not improve overall survival rates, but does decrease the local recurrence rates
Radiation treatment may be unnecessary for some patients with early stage rectal cancer
Better imaging techniques, better surgical techniques have made it easier to carefully stage patients
We do not know the best way to treat this disease until we carefully compare these approaches.
We need your help!
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Chemotherapy
for 3-4 months Surgery
5.5 weeks
of radiation
with 5FU
chemotherapy
(5FUCMT)
4-6 weeks
Recovery
4-6 weeks
Recovery
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Chemo
for 3-4
Months*
Surgery
If tumor
responds to
chemotherapy
If tumor
does not
respond to
chemo
5.5 weeks
of radiation
with 5FU
chemo
(5FUCMT)
Surgery
Chemo
for 3-4
months
Re-
evaluation
3 mo. of
chemo
(6 FOLFOX
treatments)
4-6
we
eks re
co
ve
ry
4-6
we
eks re
co
ve
ry
4-6
we
eks re
co
ve
ry
4-6
we
eks re
co
ve
ry
*If the pathologist or surgeon find evidence of more extensive disease, it is
possible that postoperative 5FUCMT could also be recommended
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The National Cancer Institute at:
1-800-4-CANCER (1-800-422-6237)
http://cancer.gov/clinicaltrials/
http://cancer.gov/cancerinfo/
For more information about the PROSPECT trial
(N1048):
http://www.cancer.gov/clinicaltrials/search/view?cdrid=715321&
protocolsearchid=10158136&version=patient
The lead investigator for this trial, Dr. Deborah Schrag, at
The protocol coordinator for this trial, John Taylor, at
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Fight Colorectal Cancer
CONTACT US
Fight Colorectal Cancer 1414 Prince Street, Suite 204
Alexandria, VA 22314
(703) 548-1225
Toll-Free Answer Line: 1-877-427-2111
www.FightColorectalCancer.org
Email us: [email protected]