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ColorectalCancer,1,Whatisit?,2,ItisthethirdmostfrequentlydiagnosedcancerinmenandwomenandthesecondhighestcauseofcancerdeathsintheU.S.Yet,whenfoundearly,itishighlycurable.Thistypeofcanceroccurswhenabnormalcellsgrowintheliningofthelargeintestine(colon)orrectum.Learnmoreaboutwhogetscolorectalcancer,howitisdetected,andwhatthelatesttreatmentscanaccomplish.,3,Howitstarts?,4,Itoftenbeginaspolypsbenigngrowthsonthesurfaceofthecolon.Thetwomostcommontypesofintestinalpolypsareadenomasandhyperplasicpolyps.Theydevelopwhenthereareerrorsinthewaycellsgrowandrepairtheliningofthecolon.Mostpolypsremainbenign,butsomehavethepotentialtoturncancerous.Removingthemearlypreventscolorectalcancer.,5,RiskFactorsYouCantControl,6,genetics&lifestyle.Agemostpatientsareolderthan50PolypsorinflammatoryboweldiseaseFamilyhistoryofcolorectalcancerHistoryofovarianorbreastcancer,7,RiskFactorsYouCanControl,8,Diethighinred,processed,orheavilycookedmeatsBeingoverweight(excessfataroundthewaist)ExercisingtoolittleSmokingordrinkingalcohol,9,ItswarningSigns,10,Thereareusuallynoearlywarningsignsforcolorectalcancer.Forthisreasonitsimportanttogetscreened.Detectingcancerearlymeansitsmorecurable.Asthediseaseprogresses,patientsmaynoticebloodinthestool,abdominalpain,achangeinbowelhabits(suchasconstipationordiarrhea),unexplainedweightloss,orfatigue.Bythetimethesesymptomsappear,tumorstendtobelargerandmoredifficulttotreat.,11,Screening,12,Becausecolorectalcancerisstealthy,screeningsarethekeytoearlydetection.Beginningatage50,mostpeopleshouldhaveacolonoscopyevery10years.Thisprocedureusesatinycameratoexaminetheentirecolonandrectum.Thesetestsnotonlyfindtumorsearly,butcanactuallypreventcolorectalcancerbyremovingpolyps(shownhere).,13,VirtualColonoscopy,14,ThereisnowanalternativetocolonoscopythatusesCTscanimagestoconstructa3-Dmodelofyourcolon.Calledvirtualcolonoscopy,theprocedurecanrevealpolypsorotherabnormalitieswithoutactuallyinsertingacamerainsideyourbody.Themaindisadvantageisthatifpolypsarefound,arealcolonoscopywillstillbeneededtoremoveandevaluatethem.,15,X-RaysoftheColon(LowerGI),X-Raysofthecolon-usingachalkyliquidknownasbariumasacontrastagent-allowyourdoctoraglimpseattheinteriorofthecolonandrectum,offeringanotherwaytodetectpolyps,tumors,andchangesintheintestinaltissue.Shownhereisanapplecoretumorconstrictingthecolon.Likethevirtualcolonoscopy,anyabnormalitiesthatappearontheX-rayswillneedtobefollowedupwithaconventionalcolonoscopy.,16,DiagnosingColorectalCancer,Iftestingrevealsapossibletumor,thenextstepisabiopsy.Duringacolonoscopy,yourdoctorwillremovepolypsandtaketissuesamplesfromanypartsofthecolonthatlookunusual.Thistissueisexaminedunderamicroscopetodeterminewhetherornotitiscancerous.Shownhereisacolor-enhanced,magnifiedviewofcoloncancercells.,17,StagingColorectalCancer,Ifcancerisdetected,itwillbestaged,aprocessoffindingouthowfarthecancerhasspread.Tumorsizemaynotcorrelatewiththestageofcancer.Stagingalsoenablesyourdoctortodeterminewhattypeoftreatmentyouwillreceive.,18,ICancerhasnotspreadbeyondtheinsideofthecolonorrectumIICancerhasspreadintothemusclelayerofthecolonorrectumIII-CancerhasspreadtooneormorelymphnodesintheareaIVCancerhasspreadtootherpartsofthebody,suchastheliver,lung,orbones.ThisstagedoesNOTdependonhowdeepthetumorhaspenetratedorifthediseasehasspreadtothelymphnodesnearthetumor.,19,ColorectalCancerSurvivalRates,Theoutlookforyourrecoverydependsonthestageofyourcancer,withhigherstagesmeaningmoreseriouscancer.Thefive-yearsurvivalratereferstothepercentageofpatientswholiveatleastfiveyearsafterbeingdiagnosed.StageIhasa93%five-yearsurvivalratewhilestageIVhasafive-yearsurvivalrateofonly8%.,20,ColorectalCancerSurgery,Inallbutthelaststageofcolorectalcancer,theusualtreatmentissurgerytoremovethetumorandsurroundingtissue.Inthecaseoflargertumors,itmaybenecessarytotakeoutanentiresectionofthecolonand/orrectum.Thegoodnewsisthatsurgeryhasaveryhighcurerateintheearlystages.Ifthecancerhasspreadtotheliver,lungs,orotherorgans,surgeryisnotlikelytoofferacure-butremovingtheadditionaltumors,whenpossible,mayreducesymptoms.,21,TreatingAdvancedColorectalCancer,Whencolorectalcancerhasspreadtooneormorelymphnodes(stageIII),itcanstillbecured.Treatmenttypicallyinvolvesacombinationofsurgery,radiation(beingadministeredhere),andchemotherapy.Ifthecancercomesbackafterinitialtreatmentorspreadstootherorgans,itbecomesmuchmoredifficulttocure.Butradiationandchemotherapycanstillrelievesymptomsandhelppatientslivelonger.,22,CopingWithChemotherapy,Chemotherapyhascomealongwayfromthedaysofturningpeoplesstomachs.Newerdrugsarelesslikelytocausethisproblem,andtherearealsomedicationstocontrolnauseaifitdoesoccur.Clinicaltrialscontinuetosearchforchemotherapydrugsthataremoreeffectiveandtolerable.,23,RadiofrequencyAblation,Radiofrequencyablation(RFA)usesintenseheattoburnawaytumors.GuidedbyaCTscan,adoctorinsertsaneedle-likedevicethatdeliversheatdirectlytoatumorandthesurroundingarea.Thisoffersanalternativefordestroyingtumorsthatcannotbesurgicallyremoved.Inpatientswithalimitednumberoflivermetastasesthatcannotberemovedbysurgery,chemotherapyissometimescombinedwithRFAfortumordestruction.,24,PreventingColorectalCancer,25,eatinganutritiousdietTheNationalCancerInstituterecommendsalow-fatdietthatincludesplentyoffiberandatleastfiveservingsoffruitsandvegetablesperday.,26,gettingenoughexercisePhysicalactivityappearstobeapow