COLON AND RECTAL CANCER

Cancers of the Colon and Rectum are the third most common tumors in the United States. The disease is uncommon before the age of 40, but rises sharply after the age of 55. Several risk factors have been identified including a diet high in fat content, lack of dietary fiber, alcohol consumption, some types of occupational exposures (include solvents and fuel oils), a history of inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), prior radiation treatments, uretosigmoidoscopy, and the presence of a first degree relative (mother, father, sister, brother) with the disease.

Over the past decade much has been learned about biology and genetics of colorectal cancer. It is now well established that these tumors arise from polyps. This has led to intensive efforts to reduce colorectal cancers by intensive screening. Three tests are recommended by the American Cancer Society: (1) A digital rectal exam should be performed yearly starting at the age of 40, (2) A stool test for blood should be performed yearly, and (3) a flexible sigmoidoscopy is recommended every three to five years beginning at age 50. Changes in bowel habits, abdominal pain, and blood in the stool are symptoms of colorectal disease and should be evaluated.

The prognosis of colorectal cancers is largely influenced by the degree of tumor spread (commonly referred to as Stage). For tumors localized only within the mucosa or within the wall of the colon (stage I) 5-year survival rates of 85-95% are noted. For tumors penetrating through the wall of the colon (stage II) 5-year survival rates are 30-70%. Tumors that involve lymph nodes (stage III) or have spread to distant sites (stage IV) have poorer prognosis.

Treatment of Colon Cancer starts with surgical resection. The use of early chemotherapy (such as 5-FU with levamisole) has been shown to reduce the risk of tumor spread in patients at high-risk of disease (such as Dukes stage C). In patients found to have more advanced disease (ie, tumor that has spread) chemotherapy is the preferred treatment. The most common medicine is 5-FU, either given alone or in combination with leukovorin, methotrexate, PALA, or interferon. Surgical resection of solitary metastasis and other treatments, such as intra-arterial embolization, are occasionally helpful.

Treatment Rectal Cancer also typically starts with surgery. However, in contrast to colon cancer, radiation therapy plays a major role in trying to prevent the spread of cancer among patients diagnosed early. The combination of 5-FU with radiation after surgery has been found to reduce both local and distant recurrences of disease. Patients with more advanced disease are treated with chemotherapy similar to patients with advanced colon cancer.

Colon and Rectal Cancers are not currently treated with transplantation at Hackensack University Medical Center. However, the physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. In addition, the Cancer Center is participating in a number of clinical trials for Colon and Rectal Cancers. For more information about these trials call (201) 996-5800.

The Cancer Center is evaluating:

For patients with newly diagnosed Colon Cancer without known tumor spread

  1. Randomized trial of peri-operative 5-FU after curative resection followed by 5-FU/levamisole
  2. Randomized trial of adjuvant immunotherapy with a monoclonal antibody 17-1A versus no additional therapy in Dukes B
  3. Randomized trial of Oral Uracil/Ftorafur plus leucovorin versus 5-FU plus leucovorin in surgically resected stage II and III disease
  4. Randomized trial of Panorex (monoclonal antibody 17-1A) plus 5-FU plus levamisole versus 5-FU plus levamisole in surgically resected stage III patients

For patients with advanced (metastatic) disease:

  1. Phase II trial of cryoablation for the treatment of unresectable colorectal hepatic metastasis
  2. Phase III trial of leucovorin plus 5-FU plus/minus Neutrexin in previously untreated patients with advanced colorectal cancer

For patients with newly diagnosed rectal cancer

  1. Preoperative multi-modality (5-FU, leucovorin, radiotherapy)
  2. Postoperative evaluation of 5-FU IVB versus 5-FU PVI prior to and following combined PVI plus pelvic radiation versus 5-FU IVB plus leucovorin plus levamisole prior to and following combined pelvic radiotherapy and IVB 5-FU plus leucovorin