THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Colon Cancer: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83350-8 1. Colon Cancer-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of colon cancer.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to colon cancer. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to colon cancer, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Adult Primary Liver Cancer
·
The Official Patient's Sourcebook on Anal Cancer
·
The Official Patient's Sourcebook on Esophageal Cancer
·
The Official Patient's Sourcebook on Extrahepatic Bile Duct Cancer
·
The Official Patient's Sourcebook on Gallbladder Cancer
·
The Official Patient's Sourcebook on Gastric Cancer
·
The Official Patient's Sourcebook on Gastrointestinal Carcinoid Tumor
·
The Official Patient's Sourcebook on Pancreatic Cancer
·
The Official Patient's Sourcebook on Rectal Cancer
·
The Official Patient's Sourcebook on Small Intestine Cancer
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON COLON CANCER: GUIDELINES ....... 9
Overview............................................................................................................... 9 What Is Colon Cancer?....................................................................................... 11 Risk Factors ........................................................................................................ 11 Symptoms ........................................................................................................... 12 Diagnosis ............................................................................................................ 12 Prognosis ............................................................................................................ 13 Staging................................................................................................................ 13 Treatment Options ............................................................................................. 15 Treatments Being Tested in Clinical Trials........................................................ 16 Treatment Options by Stage............................................................................... 17 Treatment Options for Recurrent Colon Cancer................................................ 19 To Learn More .................................................................................................... 19 About PDQ......................................................................................................... 20 More Guideline Sources ..................................................................................... 21 Vocabulary Builder............................................................................................. 30
CHAPTER 2. SEEKING GUIDANCE ....................................................... 35
Overview............................................................................................................. 35 Associations and Colon Cancer .......................................................................... 35 Finding More Associations................................................................................. 45 Cancer Support Groups...................................................................................... 47 The Cancer Information Service ......................................................................... 49 Finding Cancer Resources in Your Community................................................ 51 Finding Doctors Who Specialize in Cancer Care ............................................... 55 Selecting Your Doctor ........................................................................................ 57 Working with Your Doctor ................................................................................ 59 Finding a Cancer Treatment Facility ................................................................. 60 Additional Cancer Support Information ............................................................ 62 Vocabulary Builder............................................................................................. 62
CHAPTER 3. CLINICAL TRIALS AND COLON CANCER........................ 65
Overview............................................................................................................. 65 Recent Trials on Colon Cancer........................................................................... 68 Benefits and Risks............................................................................................... 97 Clinical Trials and Insurance Coverage ........................................................... 100
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Clinical Trials and Medicare Coverage ............................................................ 103 Increasing the Likelihood of Insurance Coverage for Trials ............................. 104 If Your Insurance Claim Is Denied after the Trial Has Begun ........................ 106 Government Initiatives to Expand Insurance Coverage for Trials .................. 109 Keeping Current on Clinical Trials.................................................................. 110 General References............................................................................................ 111 Vocabulary Builder........................................................................................... 112
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL................................................ 117 CHAPTER 4. STUDIES ON COLON CANCER ....................................... 119
Overview........................................................................................................... 119 The Combined Health Information Database ................................................... 119 Federally Funded Research on Colon Cancer ................................................... 130 E-Journals: PubMed Central ............................................................................ 135 The National Library of Medicine: PubMed .................................................... 140 Vocabulary Builder........................................................................................... 155
CHAPTER 5. PATENTS ON COLON CANCER ...................................... 163
Overview........................................................................................................... 163 Patents on Colon Cancer .................................................................................. 164 Patent Applications on Colon Cancer .............................................................. 170 Keeping Current ............................................................................................... 177 Vocabulary Builder........................................................................................... 177
CHAPTER 6. BOOKS ON COLON CANCER ......................................... 179
Overview........................................................................................................... 179 Book Summaries: Federal Agencies .................................................................. 179 The National Library of Medicine Book Index ................................................. 181 Chapters on Colon Cancer ................................................................................ 184 General Home References ................................................................................. 192 Vocabulary Builder........................................................................................... 193
CHAPTER 7. MULTIMEDIA ON COLON CANCER............................... 195
Overview........................................................................................................... 195 Video Recordings .............................................................................................. 195 Bibliography: Multimedia on Colon Cancer..................................................... 197 Vocabulary Builder........................................................................................... 200
CHAPTER 8. PERIODICALS AND NEWS ON COLON CANCER............ 203
Overview........................................................................................................... 203 News Services & Press Releases ....................................................................... 203 Newsletters on Colon Cancer ........................................................................... 214 Newsletter Articles ........................................................................................... 215 Academic Periodicals Covering Colon Cancer ................................................. 219 Vocabulary Builder........................................................................................... 221
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 223
Contents
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Overview........................................................................................................... 223 NIH Guidelines................................................................................................. 223 What Is Colon Cancer?..................................................................................... 224 Adjuvant Therapy............................................................................................. 227 Advanced Disease ............................................................................................. 228 Cellular Classification ...................................................................................... 231 Stage Information ............................................................................................. 231 Treatment Option Overview ............................................................................ 233 Recurrent Colon Cancer ................................................................................... 253 NIH Databases.................................................................................................. 262 Other Commercial Databases ........................................................................... 272 The Genome Project and Colon Cancer............................................................ 273 Specialized References....................................................................................... 277 Vocabulary Builder........................................................................................... 278
CHAPTER 10. DISSERTATIONS ON COLON CANCER ......................... 281
Overview........................................................................................................... 281 Dissertations on Colon Cancer......................................................................... 281 Keeping Current ............................................................................................... 283 Vocabulary Builder........................................................................................... 283
PART III. APPENDICES .................................................. 285 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 287
Overview........................................................................................................... 287 Your Medications: The Basics .......................................................................... 288 Learning More about Your Medications .......................................................... 289 Commercial Databases...................................................................................... 291 Drug Development and Approval .................................................................... 292 Understanding the Approval Process for New Cancer Drugs......................... 293 The Role of the Federal Drug Administration (FDA)...................................... 294 Getting Drugs to Patients Who Need Them .................................................... 298 Contraindications and Interactions (Hidden Dangers) ................................... 300 A Final Warning .............................................................................................. 301 General References............................................................................................ 301 Vocabulary Builder........................................................................................... 302
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 303
Overview........................................................................................................... 303 What Is CAM? ................................................................................................. 304 What Are the Domains of Alternative Medicine?............................................ 305 Finding CAM References on Colon Cancer ..................................................... 310 Additional Web Resources................................................................................ 320 General References............................................................................................ 335 Vocabulary Builder........................................................................................... 336
APPENDIX C. RESEARCHING NUTRITION ......................................... 339
Overview........................................................................................................... 339
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Contents
Food and Nutrition: General Principles........................................................... 340 Finding Studies on Colon Cancer..................................................................... 344 Federal Resources on Nutrition........................................................................ 347 Additional Web Resources................................................................................ 348 Vocabulary Builder........................................................................................... 354
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 357
Overview........................................................................................................... 357 Preparation ....................................................................................................... 357 Finding a Local Medical Library ...................................................................... 358 Medical Libraries Open to the Public............................................................... 358
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 365
Overview........................................................................................................... 365 Your Rights as a Patient................................................................................... 365 Patient Responsibilities .................................................................................... 369 Choosing an Insurance Plan............................................................................. 370 Medicare and Medicaid .................................................................................... 372 Financial Assistance for Cancer Care............................................................... 375 NORD’s Medication Assistance Programs ..................................................... 378 Additional Resources ........................................................................................ 379
ONLINE GLOSSARIES.................................................... 381 Online Dictionary Directories.......................................................................... 384
COLON CANCER GLOSSARY ...................................... 385 General Dictionaries and Glossaries ................................................................ 408
INDEX................................................................................... 410
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 Adapted from the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Colon Cancer
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Colon Cancer has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to colon cancer, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on colon cancer. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on colon cancer should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching colon cancer (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to colon cancer. It also gives you sources of information that can help you find a doctor in your local area specializing in treating colon cancer. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with colon cancer. Part II moves on to advanced research dedicated to colon cancer. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on colon cancer. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “freeto-use” options. Part III provides appendices of useful background reading for all patients with colon cancer or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with colon cancer. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with colon cancer.
Scope While this sourcebook covers colon cancer, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that colon cancer is often considered a synonym or a condition closely related to the following: ·
Adenocarcinoma of the Colon
·
Bowel Cancer
·
Cancer Colon
4
Colon Cancer
·
Cancer Intestine
·
Cancer of the Colon
·
Cancer of the Large Intestine
·
Carcinoma of the Colon
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Colonic Cancer
·
Colorectal Cancer
·
Intestinal Cancer
In addition to synonyms and related conditions, physicians may refer to colon cancer using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for colon cancer:4 ·
153 malignant neoplasm of colon
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to colon cancer. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with colon cancer will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with colon cancer is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of colon cancer, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on colon cancer. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of colon cancer to you or even given you a pamphlet or brochure describing colon cancer. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON COLON CANCER: GUIDELINES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on colon cancer. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on colon cancer can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on colon cancer. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with colon cancer and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Cancer Institute (NCI); guidelines available at http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtml
Among the above, the National Cancer Institute (NCI) is particularly noteworthy. The NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.6 Specifically, the Institute: ·
Supports and coordinates research projects conducted by universities, hospitals, research foundations, and businesses throughout this country and abroad through research grants and cooperative agreements.
·
Conducts research in its own laboratories and clinics.
·
Supports education and training in fundamental sciences and clinical disciplines for participation in basic and clinical research programs and treatment programs relating to cancer through career awards, training grants, and fellowships.
·
Supports research projects in cancer control.
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Supports a national network of cancer centers.
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Collaborates with voluntary organizations and other national and foreign institutions engaged in cancer research and training activities.
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Encourages and coordinates cancer research by industrial concerns where such concerns evidence a particular capability for programmatic research.
·
Collects and disseminates information on cancer.
This paragraph has been adapted from the NCI: http://www.nci.nih.gov/. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 6
Guidelines 11
·
Supports construction of laboratories, clinics, and related facilities necessary for cancer research through the award of construction grants.
The NCI, established under the National Cancer Act of 1937, is the Federal Government’s principal agency for cancer research and training. The National Cancer Act of 1971 broadened the scope and responsibilities of the NCI and created the National Cancer Program. Over the years, legislative amendments have maintained the NCI authorities and responsibilities and added new information dissemination mandates as well as a requirement to assess the incorporation of state-of-the-art cancer treatments into clinical practice. Information dissemination is made possible through the NCI Online at www.cancer.gov. Cancer.gov offers to the public and physicians up-to-date information on the latest cancer research, current and upcoming clinical trials, statistics, research programs, and research funding. The following patient guideline was recently published by the NCI on colon cancer.
What Is Colon Cancer?7 Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
Risk Factors Age and health history can affect the risk of developing colon cancer. Risk factors include: ·
Age 50 or older.
The following guidelines appeared on the NCI website on Aug. 26, 2002. The text was last modified in August 2002. The text has been adapted for this sourcebook. 7
12 Colon Cancer
·
A family history of cancer of the colon or rectum.
·
A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
·
A history of polyps (small noncancerous growths) in the colon.
·
A history of ulcerative colitis (ulcers in the lining of the large intestine).
·
Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).
Symptoms Possible signs of colon cancer include a change in bowel habits or blood in the stool. These and other symptoms may be caused by colon cancer or by other conditions. A doctor should be consulted if any of the following problems occur: ·
A change in 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.
·
General abdominal discomfort (frequent gas pains, bloating, fullness, or cramps).
·
Weight loss with no known reason.
·
Constant tiredness.
·
Vomiting.
Diagnosis Tests that examine the rectum, rectal tissue, and blood are used to detect (find) and diagnose colon cancer. The following tests and procedures may be used:
Guidelines 13
·
Fecal occult blood test: A small stool sample is placed on a special card and returned to the doctor or lab. This test examines the stool for occult (hidden) blood.
·
Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels for lumps or abnormal areas and tests any stool for blood.
·
Barium enema: A procedure in which a liquid containing barium is put into the rectum by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray.
·
Sigmoidoscopy: An examination in which a doctor uses a sigmoidoscope (a thin, lighted instrument) to view the inside of the lower colon and rectum for polyps, tumors, or abnormal areas. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.
·
Colonoscopy: An examination of the inside of the entire colon and rectum using a colonoscope (a thin, lighted instrument) inserted into the rectum. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.
·
Biopsy: The removal of cells or tissues for examination under a microscope.
Prognosis Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether the cancer is in the inner lining of the colon only, involves the whole colon, or has spread to other places in the body) and the patient’s general health.
Staging After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body. The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the
14 Colon Cancer
staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following stages are used for colon cancer: Stage 0 (Carcinoma in Situ) In stage 0, the cancer is found in the innermost lining of the colon only. Stage 0 cancer is also called carcinoma in situ. Stage I In stage I, the cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but it has not spread to the outer wall of the colon or outside the colon. Stage I colon cancer is sometimes called Dukes’ A colon cancer. Stage II In stage II, cancer has spread outside the colon to nearby tissue, but it has not gone into the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) Stage II colon cancer is sometimes called Dukes’ B colon cancer. Stage III In stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. Stage III colon cancer is sometimes called Dukes’ C colon cancer. Stage IV In stage IV, cancer has spread to other parts of the body, such as the liver or lungs. Stage IV colon cancer is sometimes called Dukes’ D colon cancer.
Guidelines 15
Treatment Options There are different types of treatment for patients with colon cancer. Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Three types of standard treatment are used. These include the following: Surgery Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery: ·
Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging piece of tissue), the operation is called a polypectomy.
·
Resection: If the cancer is larger, the doctor will perform a colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.
·
Resection and colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. Sometimes the colostomy is needed only until the lower colon has healed,
16 Colon Cancer
and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent. Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Radiation Therapy Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Colon cancer may be treated with external radiation. After treatment, a blood test to measure carcinoembryonic antigen (CEA; a substance in the blood that may be increased when colon cancer is present) may be done along with other tests to see if the cancer has come back.
Treatments Being Tested in Clinical Trials Other types of treatment are being tested in clinical trials. These include the following: Biological Therapy Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against disease.
Guidelines 17
Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Treatment Options by Stage Stage 0 Colon Cancer (Carcinoma in Situ) Treatment of stage 0 (carcinoma in situ) may include the following types of surgery: ·
Local excision (surgery to remove the tumor without cutting through the abdominal wall) or simple polypectomy (surgery to remove the cancer from a small bulging piece of tissue).
·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon). This is done when the cancerous tissue is too large to remove by local excision.
Stage I Colon Cancer Treatment of stage I colon cancer is usually the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon).
Stage II Colon Cancer Treatment of stage II colon cancer may include the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon).
·
Clinical trials of chemotherapy, radiation therapy, or biological therapy after surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.
18 Colon Cancer
Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Stage III Colon Cancer Treatment of stage III colon cancer may include the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon), with or without chemotherapy.
·
Clinical trials of chemotherapy, radiation therapy, and/or biological therapy after surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Stage IV Colon Cancer Treatment of stage IV colon cancer may include the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon or to bypass the tumor).
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Surgery to remove parts of other organs such as the liver, lungs, and ovaries where the cancer may have spread.
·
Chemotherapy.
·
Clinical trials of chemotherapy or biological therapy.
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Radiation therapy may be offered to some patients as palliative therapy (to relieve symptoms).
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Guidelines 19
Treatment Options for Recurrent Colon Cancer Treatment of recurrent colon cancer depends on where the cancer has recurred (come back) and the general health of the patient. Treatment for recurrent colon cancer may include the following: ·
Surgery to remove cancer that may have spread to the liver, lungs, or ovaries.
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Surgery to remove cancer cells that have recurred (come back) in the colon.
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Radiation therapy as palliative therapy (to relieve symptoms).
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Chemotherapy as palliative therapy (to relieve symptoms).
· Clinical trials of biological therapy or chemotherapy. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
To Learn More Call For more information, U.S. residents may call the National Cancer Institute’s (NCI’s) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-4226237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-ofhearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions. Web Sites and Organizations The NCI’s Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
20 Colon Cancer
Publications The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237), TTY at 1800-332-8615.
LiveHelp The NCI’s LiveHelp service, a program available on several of the Institute’s Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer. Write For more information from the NCI, please write to this address: National Cancer Institute Office of Communications 31 Center Drive, MSC 2580 Bethesda, MD 20892-2580
About PDQ PDQ Is a Comprehensive Cancer Database Available on Cancer.gov PDQ is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov (http://cancer.gov), the NCI’s Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government’s focal point for biomedical research.
Guidelines 21
PDQ Contains Cancer Information Summaries The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-tounderstand, non-technical language. Both versions provide current and accurate cancer information. The PDQ cancer information summaries are developed by cancer experts and reviewed regularly. Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary (“Date Last Modified”) indicates the time of the most recent change.
PDQ Contains Information on Clinical Trials Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Listings of clinical trials are included in PDQ and are available online at Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
More Guideline Sources The guideline above on colon cancer is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you
22 Colon Cancer
find additional guidelines on topics related to colon cancer. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with colon cancer. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on colon cancer and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive:
Guidelines 23
·
Colon Book: A Look at Polyps and Colon Cancer, Their Treatment, and Your Prospects for Recovery. Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.25 per copy; plus shipping and handling. Summary: This patient education brochure describes colon polyps and colon cancer, their treatment, and prognosis. Written in nontechnical language, the brochure notes that it can be quite unsettling when a doctor suspects that the patient has a growth in their colon. However, most colon growths can be removed swiftly. And even if the growth is cancerous, with early medical treatment, prognosis is good. A prompt evaluation is the key to diagnosing a colon growth. A medical history, thorough exam, and diagnostic tests (including digital rectal exam, sigmoidoscopy, barium enema, and colonoscopy) help the doctor diagnose the colon problem and plan the right treatment. Surgical treatment may involve removal of the colon growth or growths; if cancer is found, further treatment (such as chemotherapy or radiation) may be needed. After recovery from surgery and any other treatments, the patient can slowly return to their daily activities. Followup exams, a healthy diet, and help from friends, family, and support groups can help the patient get back to his or her routine as quickly as possible. One section of the brochure illustrates and describes the healthy colon, how it functions, and how unhealthy growths (polyps and cancer) can occur. The brochure then describes preoperative care, the different types of colon resections that may be utilized (right hemicolectomy, transverse colectomy, left colectomy, and sigmoid colectomy), what to expect during the hospital stay, and postoperative recovery at home. The brochure is illustrated with full color line drawings and is available in English or Spanish. 12 figures.
·
Understanding Colon Cancer Screening Source: Manchester, MA: American Society for Gastrointestinal Endoscopy. 2001. [2 p.]. Contact: Available from American Society for Gastrointestinal Endoscopy. 13 Elm Street, Manchester, MA 01944. (508) 526-8330. Price: Single copy free. Summary: This brochure educates readers about colon cancer screening. The brochure offers six True or False statements about colorectal cancer (CRC) screening, then explains the correct answer for each. Topics include the incidence of CRC in men versus women; the indications for
24 Colon Cancer
testing; the time involved in a colonoscopy screening examination; the mortality associated with CRC; diagnostic tests used to screen for colon cancer; and prevention of CRC. Colorectal cancer affects an equal number of men and women. Beginning at age 50, all men and women should be screened for colorectal cancer, even if they are experiencing no problems or symptoms. Colonoscopy is almost always done on an outpatient basis; the test is safe and the procedure itself typically takes less than 30 minutes. Colorectal cancer is the third leading cause of cancer deaths in women in the United States. Tests used for screening for CRC include digital rectal exam, stool blood test, barium enema, flexible sigmoidoscopy, and colonoscopy. The brochure emphasizes that colon cancer is often preventable, so screening is very important. ·
ACG Recommendations on Colorectal Cancer Screening for Average and Higher Risk Patients in Clinical Practice Source: Arlington, VA: American College of Gastroenterology. 200x. 25 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206-1656. (703) 820-7400. Fax (703) 9314520. Price: Single copy free. Summary: This booklet outlines the preferred colorectal cancer screening recommendations of the American College of Gastroenterology (ACG) and presents an update of the ACG position on screening as outlined by the Agency for Healthcare Policy and Research (AHCPR). The AHCPR's recommendations presented a menu of options for screening average risk persons. These options have similar cost-effectiveness ratios, however, there are substantial differences between the various options regarding their effectiveness, initial costs, and to a lesser degree, risk. The ACG continues to endorse the AHCPR guideline. The update recommendation as presented in the booklet is meant to reflect trends in the rapidly changing perceptions of colorectal cancer prevention strategies among clinical gastroenterologists in both academic and private practice. The preferred screening strategy for persons over age 50 at average risk for colorectal cancer is colonoscopy every 10 years. An alternative strategy for this population (used when resources, expertise, or reimbursement for screening colonoscopy are not available) is flexible sigmoidoscopy every 5 years plus annual fecal occult blood testing. The booklet outlines other screening strategies include barium enema, and CT (computed tomography) and magnetic resonance (MR) colonography (also called virtual colonoscopy). The booklet then discusses screening for people in high risk categories, including those with a personal or family history of familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, and strong family history of colon cancer. The booklet includes
Guidelines 25
extensive tables that summarize the information and guidelines presented in the text. 2 figures. 4 tables. 142 references. ·
Now Medicare Covers a Test That Could Save Your Life: What You Should Know About New Medicare Colorectal Cancer Screening Benefit [and] Screening for Your Family Source: Arlington, VA: American College of Gastroenterology. 1998. 6 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. (800) 478-2876. Price: Single copy free. Summary: This brochure describes colorectal cancer screening and new Medicare reimbursement (payment) for its costs. Screening can prevent cancer by removing pre-cancerous growths (polyps), and early detection allows diagnosis before cancers have a chance to spread. Up to 80 percent of colon cancer deaths can be prevented by timely removal of precancerous polyps. Congress passed a new law which directed Medicare to pay for three tests for colorectal cancer screening. Fecal occult blood tests will be paid for annually; flexible sigmoidoscopy will be paid for once every four years for average risk patients; and screening colonoscopy will be paid for once every two years for high risk patients. The brochure describes each of these tests, as well as barium X-ray, noting the advantages and disadvantages of each. High risk patients are those who have a personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease (Crohn's disease or ulcerative colitis; those who have a close relative who has had colorectal cancer or an adenomatous polyp; and those who have a family history of familial adenomatous polyposis or of hereditary non-polyposis colorectal cancer. The brochure concludes with information about choosing a physician to do these screening tests. A physician's insert is provided with the brochure; the insert lists the HCPCS Codes and Guidelines for Reimbursement for colorectal cancer screening tests. (AA-M).
·
Colorectal Cancer Screening: Early Detection Source: San Ramon, CA: Health Information Network, Inc. 1996. 14 p. Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. Price: $1.95 suggested list price; professional and bulk discounts available. Order number 206. ISBN: 1885274629. Summary: This brochure provides readers with basic information about screening for colorectal cancer. The brochure defines a screening test as a type of medical examination that may find cancer early, before it causes
26 Colon Cancer
symptoms or pain. Colorectal cancer is cancer in any part of the large intestine, which includes the colon and rectum. Colorectal cancer is one of the most curable types of cancer, with a success rate of over 90 percent when found in its early stages. Written in language that is easy to read, the brochure covers the anatomy of the colon and rectum, the nature of cancer, risk factors for colorectal cancer, screening tests for colorectal cancer (fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema with air contrast examination, and digital rectal examination), symptoms of colorectal cancer, and patient followup. The brochure provides the addresses and phone numbers of the American Cancer Society and the National Cancer Institute. A brief glossary of terms is also included. ·
Colorectal Cancer: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. [2 p.]. Contact: Available from American Society for Colon and Rectal Surgeons (ASCRS). 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Website: www.fascrs.org. Price: Single copy free. Summary: This brochure describes colorectal cancer, the second most common cancer in the United States, striking 140,000 people annually and causing 60,000 deaths. The author stresses that the disease is potentially curable if diagnosed in the early stages. Risk factors include age, family history of colorectal cancer and polyps, and personal history of ulcerative colitis, colon polyps, or cancer of other organs, especially of the breast or uterus. Nearly all colon and rectal cancer begins in benign polyps; these premalignant growths occur on the bowel wall and may eventually increase in size and become cancer. The most common symptoms are rectal bleeding and changes in bowel habits, such as constipation or diarrhea. Unfortunately, many polyps and early cancers fail to produce symptoms. Therefore, routine physicals should include colorectal cancer detection procedures after age 40, including digital rectal exams, a chemical test of stool for blood, and sigmoidoscopy (the inspection of the lower bowel with a lighted tubular instrument). Colorectal cancer requires surgery in nearly all cases for a complete cure. Radiation and chemotherapy are sometimes used in addition to surgery. The brochure also outlines steps that can reduce the risk of contracting colon cancer. One way is having benign polyps removed by an outpatient procedure called colonoscopy. There is also some evidence that diet (high fiber, low fat) may play a significant role in preventing colorectal cancer. Readers are also encouraged to pay attention to changes in their bowel
Guidelines 27
habits. The brochure concludes with a brief description of the specialty of colon and rectal surgeons. 1 figure. ·
Follow Up Evaluation After Surgery for Colorectal Cancer: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1992. 4 p. Contact: Available from American Society of Colon and Rectal Surgeons. 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Fax (847) 290-9203. Price: Single copy free; bulk copies available. Summary: This patient education brochure provides information about patient follow-up evaluations after surgery for colorectal cancer. Written in a question and answer format, the brief brochure discusses the reasons why follow-up evaluations are crucial, the recommended length of a followup program, what to expect at a followup visit, and the importance of screening close family members who are at increased risk for colon and rectal cancer.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “colon cancer” or synonyms. The following was recently posted: ·
ACR Appropriateness Criteria™ for pre-treatment staging of colorectal cancer. Source: American College of Radiology.; 1996 (revised 1999); 8 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1626&sSearch_string=colon+cancer
·
ACR Appropriateness Criteria™ for screening for colorectal cancer. Source: American College of Radiology.; 1998; 7 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1639&sSearch_string=colon+cancer
28 Colon Cancer
·
Adjuvant therapy for stage II colon cancer following complete resection. Source: Cancer Care Ontario Practice Guidelines Initiative.; 1997 August 25 (updated online 2000 Apr) http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2235&sSearch_string=colon+cancer
·
Adjuvant therapy for stage III colon cancer following complete resection. Source: Cancer Care Ontario Practice Guidelines Initiative.; 1997 August 25 (updated online 2000 Apr); Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2242&sSearch_string=colon+cancer
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American Gastroenterological Association medical position statement: hereditary colorectal cancer and genetic testing. Source: American Gastroenterological Association.; 2001 April 18; 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2283&sSearch_string=colon+cancer
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American Gastroenterological Association medical position statement: impact of dietary fiber on colon cancer occurrence. Source: American Gastroenterological Association.; 1999 November 15 (reviewed 2001); 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2296&sSearch_string=colon+cancer
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Colorectal cancer screening. Source: Institute for Clinical Systems Improvement.; 1995 May (revised 2001 Jul) http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2251&sSearch_string=colon+cancer
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·
Colorectal cancer screening: clinical guidelines and rationale. Source: American Gastroenterological Association.; 1997 February (reviewed 2001); 48 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0045&sSearch_string=colon+cancer
·
Preventive health care, 2001 update: colorectal cancer screening. Source: Canadian Task Force on Preventive Health Care.; 2001; 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2120&sSearch_string=colon+cancer
·
Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Source: American Society of Clinical Oncology.; 1999 April (revised 2000 Oct); 10 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1111&sSearch_string=colon+cancer
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Frequently Asked Questions For Caregivers Summary: A series of commonly asked questions and answers provided for persons caring for patients with colon (colorectal) cancer. Source: Colon Cancer Alliance http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6073
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for
30 Colon Cancer
documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to colon cancer. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in
Guidelines 31
immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH] Biopsy: The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fineneedle aspiration. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH] CEA: Carcinoembryonic antigen. A substance that is sometimes found in an increased amount in the blood of people with certain cancers. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached
32 Colon Cancer
to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colonoscope: A thin, lighted tube used to examine the inside of the colon. [NIH]
Colonoscopy: An examination of the inside of the colon using a thin, lighted tube (called a colonoscope) inserted into the rectum. If abnormal areas are seen, tissue can be removed and examined under a microscope to determine whether disease is present. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscopy: The use of a thin, lighted tube (called an endoscope) to examine the inside of the body. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Immunotherapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also called biological therapy or biological response modifier (BRM) therapy. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH]
Guidelines 33
Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oncology: The study of cancer. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Postoperative: After surgery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Preoperative: Preceding an operation. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiology: The use of radiation (such as x-rays) or other imaging technologies (such as ultrasound and magnetic resonance imaging) to diagnose or treat disease. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sigmoidoscope: A thin, lighted tube used to view the inside of the colon. [NIH]
Sigmoidoscopy: Inspection of the lower colon using a thin, lighted tube called a sigmoidoscope. Samples of tissue or cells may be collected for examination under a microscope. Also called proctosigmoidoscopy. [NIH]
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Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH] Stomach: An organ that is part of the digestive system. It helps in the digestion of food by mixing it with digestive juices and churning it into a thin liquid. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Systemic: Affecting the entire body. [NIH] Tomography: A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an x-ray machine. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH]
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CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with colon cancer. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with colon cancer. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Colon Cancer As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
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influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American College of Surgeons Address: American College of Surgeons 633 North Saint Clair Street, Chicago, IL 60611-3211 Telephone: (312) 202-5000 Toll-free: (888) 939-3333 Fax: (312) 202-5001 Email: None. Web Site: http://www.facs.org/ Background: The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The College currently has more than 56,000 Fellows including more than 3,400 Fellows in other countries, making it the largest organization of surgeons in the world. There are presently more than 3,300 Associate Fellows. The American College of Surgeons sponsors a variety of continuing medical education (CME) programs and conducts various programs through its Commission on Cancer to improve the care of the cancer patient. Through its Committee on Trauma, ACS works to improve the care of injured and critically ill patients before, en route to, and during hospitalization. The College also monitors and analyzes socioeconomic, legislative, and regulatory issues affecting the field of surgery through its Socioeconomic Affairs Department and Washington, DC office and serves as a sponsoring organization for the Residency Review Committees for Colon and Rectal Surgery, Neurological Surgery, Otolaryngology, Plastic Surgery, Surgery, Thoracic Surgery, and Urology and supports postdoctoral education in surgery through several scholarship programs. Through its Office of Public Information, ACS provides public education services to patients with general information to help them make informed decisions about surgical care, and distributes a brochure series on frequently performed surgical procedures.
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American Society of Colon and Rectal Surgeons Address: American Society of Colon and Rectal Surgeons 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005 Telephone: (847) 290-9184 Toll-free: (888) 939-3333 Fax: (847) 290-9203 Email:
[email protected] Web Site: http://www.fascrs.org/ Background: The American Society of Colon and Rectal Surgeons (ASCRS) is a medical professional society representing more than 1,000 board certified colon and rectal surgeons and other surgeons. The Society's membership is dedicated to advancing and promoting the science and practice of the treatment of individuals with diseases and disorders affecting the colon, rectum, and anus. The Society's Standards Task Force is committed to developing practice parameters for the treatment of colon and rectal diseases and disorders including ambulatory anorectal surgery, treatment of hemorrhoids, management of anal fissure, treatment of rectal carcinoma, and detection of colorectal neoplasms. The Society's web site provides links to such practice parameters as well as to core subject updates on such topics as colonic volvulus, ostomies and stomal therapy, familial adenomatous polyposis, and colon and rectal cancer. The Society also publishes the 'Washington Report,' which offers updates on current federal legislative and regulatory actions, and provides professional publications including the 'ASCRS Newsletter' and the Society's official journal entitled 'Diseases of the Colon and Rectum.' The ASCRS also provides an email discussion group (listserv) for the benefit of ASCRS members and fellows in colon and rectal surgery. The primary purpose of the listserv is to provide a forum for the informal discussion of clinical cases and other issues of general interest to the colon and rectal surgeon community. The Society's web site also provides information on the Collaborative Group of the Americas on Inherited Colorectal Cancer. The Group was established in 1995 to improve understanding of the basic science of inherited colorectal cancer and the clinical management of affected families. Its broad aims are to promote education of physicians, allied health care professionals, patients, and their families; provide linkage to clinical and chemoprevention trials; promote the integration of molecular and clinical research at local and national levels; and serve as a resource for developing similar genetic registers. The American Society of Colon and Rectal Surgeons also provides patient information on a variety of topics including anal abscess/fistula, anal fissure, anal warts, bowel incontinence, colonoscopy, colorectal cancer, constipation, Crohn's
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disease, diverticular disease, irritable bowel syndrome, ostomy, rectal prolapse, and ulcerative colitis. ·
Canadian Cancer Society Address: Canadian Cancer Society 10 Alcorn Avenue, Suite 200, Toronto, Ontario, M4V 3B1, Canada Telephone: (416) 961-7223 Toll-free: (888) 939-3333 Fax: (416) 961-4189 Email:
[email protected] Web Site: http://www.cancer.ca/ Background: The Canadian Cancer Society (CCS) is a national, nonprofit, community-based organization that is dedicated to eradicating cancer and improving the quality of life of people living with cancer. Established in 1937, the Society currently has 350,000 volunteers, over 600 community locations, 10 provincial divisions, and one national office. The Canadian Cancer Society works to achieve its mission by promoting and supporting cancer research, educating the public, engaging in public policy advocacy efforts, and providing patient and family services. The Society is committed to funding medical research, awarding fellowships to support advanced clinical training in oncology, and funding behavioral research to help determine the best ways to promote lifestyle changes that may reduce the risk of cancer. The Society's public education programs work to promote the prevention and early detection of cancer by providing information and skill development through programs, advocacy, and collaboration. In addition, the Canadian Cancer Society works with coalitions of health, medical, research, and professional organizations to lobby Parliament and provincial legislatures concerning public policies that will promote health and prevent disease. The Society's patient services program is committed to meeting the social, emotional, informational, and spiritual needs of people with cancer and their families. Program services include the Society's Cancer Information Service, which provides affected individuals and family members with current information about all aspects of cancer; networking programs that enable individuals with cancer to communicate with trained volunteers who have also been affected by cancer; transportation to treatment centers and other practical assistance; and educational publications for affected individuals and family members.
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CancerOnline Address: Telephone: (410) 955-3875 Toll-free: (888) 939-3333 Email:
[email protected] Web Site: http://www.canceronline.org Background: CancerOnline is a nonprofit site on the Internet dedicated to providing individuals with cancer easy access to clinical information and offering extensive practical support and encouragement. CancerOnline collaborates with many different cancer care centers and organizations and provides original material contributed by cancer patients, caregivers, and cancer care specialists in private practice and a variety of cancer centers. CancerOnline's content is overseen by three advisory panels made up of oncologists, radiologists, and clinical care providers who want to help cancer patients become students of their disease; other cancer care specialists and providers of psychosocial support who want to encourage patients to participate actively in their treatment; and patients, survivors, and caregivers who want to help patients live with vitality and hope even in the face of a life-challenging illness. CancerOnline offers several major areas within its site including 'About CancerOnline,' 'Support and Encouragement,' 'Getting Information,' 'Participating in This Community,' and 'Special Features.' The site offers several sources of clinical information that can be accessed through a network of subject areas; practical advice before, during, and after treatment; stories from individuals who have triumphed over cancer; opportunities for affected individuals and families to contribute personal stories, creative expressions, commentaries, and questions; hints on how to obtain additional information on and off the Internet; dynamic linkage to additional web sites that provide information and support to those with particular types of cancer; and more. CancerOnline provides information and support to individuals with any type of cancer including Bladder Cancer, Breast Cancer, Colon and Rectal Cancer, Liver Cancer, Lymphoma, Ovarian Cancer, Prostate Cancer, Stomach Cancer, Uterine Cancer, Pediatric Cancers, Brain Tumors, Head and Neck Cancer, Leukemia, Lung Cancer, Melanoma, Pancreatic Cancer, Skin Cancer, Thyroid Cancer, and Rare Adult Cancers.
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David G. Jagelman Inherited Colorectal Cancer Registries Address: David G. Jagelman Inherited Colorectal Cancer Registries Cleveland Clinic Foundation, T10-Medical Genetics, 9500 Euclid Avenue, Cleveland, OH 44195 Telephone: (216) 444-6470 Toll-free: (800) 998-4785
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Fax: (216) 445-6935 Email:
[email protected] Background: Established in 1978, the David G. Jagelman Inherited Colorectal Cancer Registries is a not-for-profit academic medical center recognized as a National Referral Center and an international resource for diseases of the colon and rectum. Dedicated to identifying, educating, and serving affected individuals, the organization has an educational division, a research institute, and a hospital and outpatient clinic. The organization offers risk assessments and appropriate screening tests; maintains computerized registries of affected individuals and those who may be at risk (e.g., for Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colorectal Cancer, and Familial Colon Cancer). It suggests surveillance protocols and reviews surgical options for affected individuals. David G. Jagelman Inherited Colorectal Cancer Registries also provides a variety of educational and support materials including brochures, pamphlets, articles, and a newsletter called 'Family Matters.'. ·
Gastrointestinal Polyposis and Hereditary Colon Cancer Registry Address: Gastrointestinal Polyposis and Hereditary Colon Cancer Registry Center for Medical Genetics, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-4922 Telephone: (410) 955-3875 Toll-free: (888) 939-3333
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International Cancer Alliance for Research and Education Address: International Cancer Alliance for Research and Education 4853 Cordell Avenue, Suite 11, Bethesda, MD 20814 Telephone: (301) 654-7933 Toll-free: (800) 422-7361 Fax: (301) 654-8684 Email:
[email protected] Web Site: http://icare.org Background: The International Cancer Alliance for Research and Education (ICARE) is a nonprofit organization that provides focused information to individuals affected by cancer and their physicians on an ongoing, person-to-person basis. Cancer is a general term referring to a group of diseases characterized by uncontrolled cellular growth that may invade surrounding tissues and spread (metastasize) to other bodily tissues or organs. The different cancers may be classified based upon the organ and cell type involved, the nature of the malignancy, and the disease's clinical course. ICARE has developed several patient-centered
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programs through a process of collection, evaluation, and dissemination of information, bringing affected individuals into contact with physicians and scientists from around the world. The Alliance is operated by a network of scientists, clinicians, staff members, and lay volunteers, many of whom are affected by cancer themselves. The Alliance maintains the ICARE Registry, a confidential membership listing that permits ongoing dialogue between ICARE and its network members. Registry members receive a 'cancer therapy review' including a description of the specific form of cancer in question, information concerning detection and staging procedures, an overview of current treatments, a bibliography for more in-depth research, and listings of diagnostic tests, ongoing clinical trials, and second opinion centers. Registry members also receive medical, research, clinical trial, and Food and Drug Administration (FDA) updates relating to the specific form of cancer or cancer in general; regular newsletters; and access to all ICARE programs. Such programs include ICARE patient education partner centers, which provide affected individuals with access to an electronic library of cancer information and online hook-ups at the community level; private electronic support groups for individuals dealing with common types of cancer or common issues; a clinical trial matching program; and other services. ICARE provides information concerning its mission, objectives, services, and programs on its web site on the Internet. ·
Intestinal Multiple Polyposis and Colorectal Cancer Registry Address: Intestinal Multiple Polyposis and Colorectal Cancer Registry P.O. Box 11, Conyngham, PA 18219 Telephone: (717) 788-3712 Toll-free: (888) 772-6566 Fax: (717) 788-4046 Email:
[email protected] Background: The Intestinal Multiple Polyposis and Colorectal Cancer Registry, also known as IMPACC, is a not-for-profit self-help service organization that was established in 1986. The purpose of the group is to provide information and support to people affected by Multiple Polyposis or Hereditary Colorectal Cancer, their families, and their physicians. Multiple Familial Polyposis is a group of rare inherited conditions of the gastrointestinal system characterized by benign growths (adenomatous polyps) lining the mucous membrane of the intestine. Because such growths have high malignant potential, affected individuals may potentially develop cancer of the colon and/or rectum. The Registry promotes ongoing medical research into the causes, treatment, and prevention of these disorders. IMPACC also offers a
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variety of services including genetic counseling, referrals to appropriate avenues of treatment, and a quarterly newsletter. ·
Johns Hopkins Hereditary Colorectal Cancer Registry Address: Johns Hopkins Hereditary Colorectal Cancer Registry 550 North Broadway, Number 108, Baltimore, MD 21205-2011 Telephone: (410) 955-3875 Toll-free: (888) 772-6566 Fax: (410) 614-9544 Email:
[email protected] Web Site: None Background: The Johns Hopkins Hereditary Colorectal Cancer Registry is a research organization that maintains a registry of families affected by different forms of Hereditary Colorectal Cancer including Hereditary Colon Cancer, Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colorectal Cancer, Juvenile Polyposis, and Peutz-Jeghers Syndrome. Established in 1973, the Registry currently includes hundreds of families affected by these disorders. Interested individuals are offered the opportunity to participate in ongoing research studies. The Registry also offers educational materials to people affected by hereditary forms of colon cancer, their families, and physicians.
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M. D. Anderson Cancer Center Hereditary Colorectal Cancer Registry Address: M. D. Anderson Cancer Center Hereditary Colorectal Cancer Registry Universitiy of Texas, 1515 Holcombe Boulevard, Box 78, Houston, TX 77030 Telephone: (713) 792-2828 Toll-free: (800) 472-4376 Fax: (713) 745-1163 Email:
[email protected] Web Site: http://www.utmdacc.uth.tmc.edu/ Background: The University of Texas M.D. Anderson Cancer Center Hereditary Colorectal Cancer Registry is a registry organization dedicated to evaluating families in which there is a suspected or confirmed risk of a hereditary colorectal cancer syndrome. Established in 1988, the registry stafRegistry's staff makes arrangements to obtain necessary risk assessment, tests, procedures, or treatments at M.D. Anderson. Genetic testing and counseling are performed on appropriate families in order to identify persons at high risk for hereditary colorectal cancer. Individuals and their family members can also be evaluated for eligibility for other ongoing studies such as chemoprevention and
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psychosocial studies. Educational materials include a periodic newsletter entitled 'Hereditary Colon Cancer Newsletter,' a guide entitled 'Johns Hopkins Guide for Patients and Families: Familial Adenomatous Polyposis (FAP),' and 'Hereditary Non-Polyposis Colon Cancer: A Guide for Patients and Families.' Program activities include genetic counseling, educational programs, and referrals. The registry can be reached at its web site on the Internet at http://utmdacc.uth.tmc.edu. ·
OncoLink: The University of Pennsylvania Cancer Center Resource Address: The University of Pennsylvania Cancer Center Resource Web Site on the Internet, Telephone: (410) 955-3875 Toll-free: (888) 939-3333 Email:
[email protected] Web Site: http://www.oncolin.upenn.edu Background: OncoLink is a multimedia oncology information resource on the World Wide Web on the Internet. OncoLink's mission 'is consistent with that of the University of Pennsylvania Medical Center and the University of Pennsylvania Cancer Center, which have sanctioned the site's use and development. OncoLink is accessible worldwide to anyone with Internet access, and there is no charge for its use. Oncolink has been established with the following objectives: (1) dissemination of information relevant to the field of oncology; (2) education of health care personnel; (3) education of affected individuals, families, and other interested parties; and (4) rapid collection of information pertinent to the specialty. OncoLink's home page includes the following headings: Disease Oriented Headings (i.e., specific types of cancer); Medical Specialty Oriented Menus (i.e., medical specialities that deal with cancer, chemotherapy information, etc.); Psychosocial Support and Personal Experiences; Cancer Causes, Screening, and Prevention; Clinical Trials; Global Resources for Cancer Information; Cancer FAQs (frequently asked questions); Medical Supportive Care for the Cancer Patient; Conferences and Meetings; and Financial Issues for Cancer Patients.
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Roswell Park Family Cancer Registry Address: Roswell Park Family Cancer Registry Elm and Carlton Streets, Buffalo, NY 14263 Telephone: (716) 845-5815 Toll-free: (800) 685-6825 Fax: (716) 845-8980 Email:
[email protected]
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Background: Roswell Park Family Cancer Registry is a research organization dedicated to registering families at risk of developing cancers. The Registry seeks to educate affected individuals and family members in the areas of prevention, early detection, and treatment of cancer, as well as risk assessment of such family members. Established in 1992, this research program is designed to obtain detailed medical and family history information from people who, because of their family history or other risk factors, may have an increased potential of developing cancer. To this end, the Registry takes blood and other tissue samples. This material is provided to research scientists studying cancer genes. The affected individuals or families are thus provided with updated information on genetics, genetic cancers, and testing. The Registry produces educational materials including a pamphlet entitled 'Hereditary Non-polyposis Colorectal Cancer.' The organization supports such program activities as genetic counseling, patient and general education, and research. ·
Steve Antanas Stavro Familial Gastrointestinal Cancer Registry Address: Steve Antanas Stavro Familial Gastrointestinal Cancer Registry Familial Gastrointestinal Cancer Registry, Suite 1157, Mount Sinai Hospital, 600 University Avenue, Ontario, M5G 1X5, Canada Telephone: (416) 586-8334 Fax: (416) 586-8644 Email:
[email protected] Background: The Steve Antanas Stavro Familial Gastrointestinal Cancer Registry is a professional and research center dedicated to providing professional services as well as emotional support to people affected by familial gastrointestinal cancer and their families. Established in 1980, the center conducts research studies and has an investigative team focused on innovative surgical techniques related to gastrointestinal cancer. The center also has a molecular diagnostic program and offers a screening service for family members who may be at risk for the hereditary form of the disease. Along with its scientific and medical departments, the center also has a genetic counseling department that offers advice and support to affected individuals and families. The Steve Antanas Stavro Familial Gastrointestinal Cancer Registry maintains a database of affected individuals and produces educational and support materials including pamphlets, brochures, family guides, and a biannual newsletter. The Registry relays information regarding hospital and community resources through a patient library.
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Strang-Cornell Hereditary Colon Cancer Program Address: Strang-Cornell Hereditary Colon Cancer Program 428 East 72nd Street, New York, NY 10021 Telephone: (212) 746-5656 Toll-free: (888) 939-3333 Fax: (212) 746-8765 Email:
[email protected] Web Site: http://www.strang.org Background: The Strang-Cornell Hereditary Colon Cancer Program (SCPC) is a not- for-profit organization dedicated to providing individuals with Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis Colorectal Cancer (HNPCC) clinical and educational services, as well as to foster participation in research. Colorectal cancer is a common disease in the United States. While most cases of colorectal cancer are sporadic, up to ten percent are hereditary. Hereditary colorectal cancer includes the polyposis syndromes, of which Familial Adenomatious Polyposis is the most common, and the nonpolyposis syndromes, broadly referred to as Hereditary Nonpolyposis Colorectal Cancer. Established in 1934, this program is a collaboration between the Strang Cancer Prevention Center and the New York Hospital-Cornell Medical Center. SCPC includes three divisions: registries for FAP and HNPCC, which are maintained with the assistance of a full-time registrar; clinical and pre-clinical research, including the study of predictors of malignant potential, chemoprevention of colon cancer, gastrointestinal immune function, molecular diagnostics, and dietary intervention; and clinical services, inclusive of medical and surgical treatment, with specialists in nutrition, psychological and genetic counseling. Educational materials include two pamphlets entitled 'Nutrition Consultation Program' and 'Hereditary Colon Cancer Program.' Program activities include a support group, genetic counseling, patient networking, education, and referrals. SCPC can be reached at its e-mail address at MBERTAGatmail.med.cornell.edu or its web site at www.strang.org.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
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The National Cancer Institute (NCI) The National Cancer Institute (NCI) has complied a list of national organizations that offer services to people with cancer and their families. To view the list, see the NCI fact sheet online at the following Web address: http://cis.nci.nih.gov/fact/8_1.htm. The name of each organization is accompanied by its contact information and a brief explanation of its services.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about colon cancer. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “colon cancer” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “colon cancer”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing
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with colon cancer. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “colon cancer” (or a synonym) in the search box.
Cancer Support Groups10 People diagnosed with cancer and their families face many challenges that may leave them feeling overwhelmed, afraid, and alone. It can be difficult to cope with these challenges or to talk to even the most supportive family members and friends. Often, support groups can help people affected by cancer feel less alone and can improve their ability to deal with the uncertainties and challenges that cancer brings. Support groups give people who are affected by similar diseases an opportunity to meet and discuss ways to cope with the illness. How Can Support Groups Help? People who have been diagnosed with cancer sometimes find they need assistance coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional burden of cancer is sometimes part of a patient’s treatment plan. Cancer support groups are designed to provide a confidential atmosphere where cancer patients or cancer survivors can discuss the challenges that accompany the illness with others who may have experienced the same challenges. For example, people gather to discuss the emotional needs created by cancer, to exchange information about their disease—including practical problems such as managing side effects or returning to work after treatment—and to share their feelings. Support groups have helped thousands of people cope with these and similar situations.
10
This section has been adapted from the NCI: http://cis.nci.nih.gov/fact/8_8.htm.
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Can Family Members and Friends Participate in Support Groups? Family and friends are affected when cancer touches someone they love, and they may need help in dealing with stresses such as family disruptions, financial worries, and changing roles within relationships. To help meet these needs, some support groups are designed just for family members of people diagnosed with cancer; other groups encourage families and friends to participate along with the cancer patient or cancer survivor. How Can People Find Support Groups? Many organizations offer support groups for people diagnosed with cancer and their family members or friends. The NCI fact sheet National Organizations That Offer Services to People with Cancer and Their Families lists many cancer-concerned organizations that can provide information about support groups. This fact sheet is available at http://cis.nci.nih.gov/fact/8_1.htm on the Internet, or can be ordered from the Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). Some of these organizations provide information on their Web sites about contacting support groups. Doctors, nurses, or hospital social workers who work with cancer patients may also have information about support groups, such as their location, size, type, and how often they meet. Most hospitals have social services departments that provide information about cancer support programs. Additionally, many newspapers carry a special health supplement containing information about where to find support groups.
What Types of Support Groups Are Available? Several kinds of support groups are available to meet the individual needs of people at all stages of cancer treatment, from diagnosis through follow-up care. Some groups are general cancer support groups, while more specialized groups may be for teens or young adults, for family members, or for people affected by a particular disease. Support groups may be led by a professional, such as a psychiatrist, psychologist, or social worker, or by cancer patients or survivors. In addition, support groups can vary in approach, size, and how often they meet. Many groups are free, but some require a fee (people can contact their health insurance company to find out whether their plan will cover the cost). It is important for people to find an atmosphere that is comfortable and meets their individual needs.
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Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
The Cancer Information Service11 The Cancer Information Service (CIS) is a program of the National Cancer Institute (NCI), the Nation’s lead agency for cancer research. As a resource for information and education about cancer, the CIS is a leader in helping people become active participants in their own health care by providing the latest information on cancer in understandable language. Through its network of regional offices, the CIS serves the United States, Puerto Rico, the U.S. Virgin Islands, and the Pacific Islands. For 25 years, the Cancer Information Service has provided the latest and most accurate cancer information to patients and families, the public, and health professionals by: ·
Interacting with people one-on-one through its Information Service,
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Working with organizations through its Partnership Program,
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Participating in research efforts to find the best ways to help people adopt healthier behaviors,
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Providing access to NCI information over the Internet. How Does the CIS Assist the Public?
Through the CIS toll-free telephone service (1–800–4–CANCER), callers speak with knowledgeable, caring staff who are experienced at explaining medical information in easy-to-understand terms. CIS information specialists answer calls in English and Spanish. They also provide cancer information to deaf and hard of hearing callers through the toll-free TTY number (1–800– 11
This section has been adapted from the NCI: http://cis.nci.nih.gov/fact/2_5.htm.
50 Colon Cancer
332–8615). CIS staff have access to comprehensive, accurate information from the NCI on a range of cancer topics, including the most recent advances in cancer treatment. They take as much time as each caller needs, provide thorough and personalized attention, and keep all calls confidential. The CIS also provides live, online assistance to users of NCI Web sites through LiveHelp, an instant messaging service that is available from 9:00 a.m. to 7:30 p.m. Eastern time, Monday through Friday. Through LiveHelp, information specialists provide answers to questions about cancer and help in navigating Cancer.gov, the NCI’s Web site. Through the telephone numbers or LiveHelp service, CIS users receive: ·
Answers to their questions about cancer, including ways to prevent cancer, symptoms and risks, diagnosis, current treatments, and research studies;
·
Written materials from the NCI;
·
Referrals to clinical trials and cancer-related services, such as treatment centers, mammography facilities, or other cancer organizations;
·
Assistance in quitting smoking from information specialists trained in smoking cessation counseling. What Kind of Assistance Does the CIS Partnership Program Offer?
Through its Partnership Program, the CIS collaborates with established national, state, and regional organizations to reach minority and medically underserved audiences with cancer information. Partnership Program staff provide assistance to organizations developing programs that focus on breast and cervical cancer, clinical trials, tobacco control, and cancer awareness for special populations. To reach those in need, the CIS: ·
Helps bring cancer information to people who do not traditionally seek health information or who may have difficulties doing so because of educational, financial, cultural, or language barriers;
·
Provides expertise to organizations to help strengthen their ability to inform people they serve about cancer; and
·
Links organizations with similar goals and helps them plan and evaluate programs, develop coalitions, conduct training on cancer-related topics, and use NCI resources.
Seeking Guidance 51
How Do CIS Research Efforts Assist the Public? The CIS plays an important role in research by studying the most effective ways to communicate with people about healthy lifestyles; health risks; and options for preventing, diagnosing, and treating cancer. The ability to conduct health communications research is a unique aspect of the CIS. Results from these research studies can be applied to improving the way the CIS communicates about cancer and can help other programs communicate more effectively. How Do People Reach the Cancer Information Service? ·
To speak with a CIS information specialist call 1–800–4–CANCER (1–800– 422–6237), 9:00 a.m. to 4:30 p.m. local time, Monday through Friday. Deaf or hard of hearing callers with TTY equipment may call 1–800–332–8615.
·
To obtain online assistance visit the NCI’s Cancer Information Web site at http://cancer.gov/cancer_information and click on the LiveHelp link between 9:00 a.m. and 7:30 p.m. Eastern time, Monday through Friday.
·
For information 24 hours a day, 7 days a week call 1–800–4–CANCER and select option 4 to hear recorded information at any time.
·
Visit NCI’s Web site at http://cancer.gov on the Internet.
·
Visit the CIS Web site at http://cancer.gov/cis on the Internet.
Finding Cancer Resources in Your Community12 If you have cancer or are undergoing cancer treatment, there are places in your community to turn to for help. There are many local organizations throughout the country that offer a variety of practical and support services to people with cancer. However, people often don’t know about these services or are unable to find them. National cancer organizations can assist you in finding these resources, and there are a number of things you can do for yourself. Whether you are looking for a support group, counseling, advice, financial assistance, transportation to and from treatment, or information about cancer, most neighborhood organizations, local health care providers, or area hospitals are a good place to start. Often, the hardest part of looking for help is knowing the right questions to ask. 12
Adapted from the NCI: http://cis.nci.nih.gov/fact/8_9.htm.
52 Colon Cancer
What Kind of Help Can I Get? Until now, you probably never thought about the many issues and difficulties that arise with a diagnosis of cancer. There are support services to help you deal with almost any type of problem that might occur. The first step in finding the help you need is knowing what types of services are available. The following pages describe some of these services and how to find them. ·
Information on Cancer. Most national cancer organizations provide a range of information services, including materials on different types of cancer, treatments, and treatment-related issues.
·
Counseling. While some people are reluctant to seek counseling, studies show that having someone to talk to reduces stress and helps people both mentally and physically. Counseling can also provide emotional support to cancer patients and help them better understand their illness. Different types of counseling include individual, group, family, self-help (sometimes called peer counseling), bereavement, patient-to-patient, and sexuality.
·
Medical Treatment Decisions. Often, people with cancer need to make complicated medical decisions. Many organizations provide hospital and physician referrals for second opinions and information on clinical trials (research studies with people), which may expand treatment options.
·
Prevention and Early Detection. While cancer prevention may never be 100 percent effective, many things (such as quitting smoking and eating healthy foods) can greatly reduce a person’s risk for developing cancer. Prevention services usually focus on smoking cessation and nutrition. Early detection services, which are designed to detect cancer when a person has no symptoms of disease, can include referrals for screening mammograms, Pap tests, or prostate exams.
·
Home Health Care. Home health care assists patients who no longer need to stay in a hospital or nursing home, but still require professional medical help. Skilled nursing care, physical therapy, social work services, and nutrition counseling are all available at home.
·
Hospice Care. Hospice is care focused on the special needs of terminally ill cancer patients. Sometimes called palliative care, it centers around providing comfort, controlling physical symptoms, and giving emotional support to patients who can no longer benefit from curative treatment. Hospice programs provide services in various settings, including the patient’s home, hospice centers, hospitals, or skilled nursing facilities. Your doctor or social worker can provide a referral for these services.
Seeking Guidance 53
·
Rehabilitation. Rehabilitation services help people adjust to the effects of cancer and its treatment. Physical rehabilitation focuses on recovery from the physical effects of surgery or the side effects associated with chemotherapy. Occupational or vocational therapy helps people readjust to everyday routines, get back to work, or find employment.
·
Advocacy. Advocacy is a general term that refers to promoting or protecting the rights and interests of a certain group, such as cancer patients. Advocacy groups may offer services to assist with legal, ethical, medical, employment, legislative, or insurance issues, among others. For instance, if you feel your insurance company has not handled your claim fairly, you may want to advocate for a review of its decision.
·
Financial. Having cancer can be a tremendous financial burden to cancer patients and their families. There are programs sponsored by the government and nonprofit organizations to help cancer patients with problems related to medical billing, insurance coverage, and reimbursement issues. There are also sources for financial assistance, and ways to get help collecting entitlements from Medicaid, Medicare, and the Social Security Administration.
·
Housing/Lodging. Some organizations provide lodging for the family of a patient undergoing treatment, especially if it is a child who is ill and the parents are required to accompany the child to treatment.
·
Children’s Services. A number of organizations provide services for children with cancer, including summer camps, make-a-wish programs, and help for parents seeking child care. How to Find These Services
Often, the services that people with cancer are looking for are right in their own neighborhood or city. The following is a list of places where you can begin your search for help. ·
The hospital, clinic, or medical center where you see your doctor, received your diagnosis, or where you undergo treatment should be able to give you information. Your doctor or nurse may be able to tell you about your specific medical condition, pain management, rehabilitation services, home nursing, or hospice care.
·
Most hospitals also have a social work, home care, or discharge planning department. This department may be able to help you find a support group, a nonprofit agency that helps people who have cancer, or the government agencies that oversee Social Security, Medicare, and
54 Colon Cancer
Medicaid. While you are undergoing treatment, be sure to ask the hospital about transportation, practical assistance, or even temporary child care. Talk to a hospital financial counselor in the business office about developing a monthly payment plan if you need help with hospital expenses. ·
The public library is an excellent source of information, as are patient libraries at many cancer centers. A librarian can help you find books and articles through a literature search.
·
A local church, synagogue, YMCA or YWCA, or fraternal order may provide financial assistance, or may have volunteers who can help with transportation and home care. Catholic Charities, the United Way, or the American Red Cross may also operate local offices. Some of these organizations may provide home care, and the United Way’s information and referral service can refer you to an agency that provides financial help. To find the United Way serving your community, visit their online directory at http://www.unitedway.org on the Internet or look in the White Pages of your local telephone book.
·
Local or county government agencies may offer low-cost transportation (sometimes called para-transit) to individuals unable to use public transportation. Most states also have an Area Agency on Aging that offers low-cost services to people over 60. Your hospital or community social worker can direct you to government agencies for entitlements, including Social Security, state disability, Medicaid, income maintenance, and food stamps. (Keep in mind that most applications to entitlement programs take some time to process.) The Federal government also runs the Hill-Burton program (1–800–638–0742), which funds certain medical facilities and hospitals to provide cancer patients with free or low-cost care if they are in financial need. Getting the Most From a Service: What To Ask
No matter what type of help you are looking for, the only way to find resources to fit your needs is to ask the right questions. When you are calling an organization for information, it is important to think about what questions you are going to ask before you call. Many people find it helpful to write out their questions in advance, and to take notes during the call. Another good tip is to ask the name of the person with whom you are speaking in case you have follow-up questions. Below are some of the questions you may want to consider if you are calling or visiting a new agency and want to learn about how they can help:
Seeking Guidance 55
·
How do I apply [for this service]?
·
Are there eligibility requirements? What are they?
·
Is there an application process? How long will it take? What information will I need to complete the application process? Will I need anything else to get the service?
·
Do you have any other suggestions or ideas about where I can find help?
The most important thing to remember is that you will rarely receive help unless you ask for it. In fact, asking can be the hardest part of getting help. Don’t be afraid or ashamed to ask for assistance. Cancer is a very difficult disease, but there are people and services that can ease your burdens and help you focus on your treatment and recovery.
Finding Doctors Who Specialize in Cancer Care13 One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with colon cancer must go through the process of selecting a physician. A common way to find a doctor who specializes in cancer care is to ask for a referral from your primary care physician. Sometimes, you may know a specialist yourself, or through the experience of a family member, coworker, or friend. The following resources may also be able to provide you with names of doctors who specialize in treating specific diseases or conditions. However, these resources may not have information about the quality of care that the doctors provide. ·
Your local hospital or its patient referral service may be able to provide you with a list of specialists who practice at that hospital.
·
Your nearest National Cancer Institute (NCI)-designated cancer center can provide information about doctors who practice at that center. The NCI fact sheet The National Cancer Institute Cancer Centers Program describes and gives contact information, including Web sites, for NCIdesignated cancer treatment centers around the country. Many of the cancer centers’ Web sites have searchable directories of physicians who practice at each facility. The NCI’s fact sheet is available at http://cis.nci.nih.gov/fact/1_2.htm on the Internet, or by calling the Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237).
13
Adapted from the NCI: http://cis.nci.nih.gov/fact/7_47.htm.
56 Colon Cancer
·
The American Board of Medical Specialties (ABMS) publishes a list of board-certified physicians. The Official ABMS Directory of Board Certified Medical Specialists lists doctors’ names along with their specialty and their educational background. This resource is available in most public libraries. The ABMS also has a Web site that can be used to verify whether a specific physician is board-certified. This free service is located at http://www.abms.org/newsearch.asp on the Internet. Verification of a physician’s board certification can also be obtained by calling the ABMS at 1–866–275–2267 (1–866–ASK–ABMS).
·
The American Medical Association (AMA) provides an online service called AMA Physician Select that offers basic professional information on virtually every licensed physician in the United States and its possessions. The database can be searched by doctor’s name or by medical specialty. The AMA Physician Select service is located at http://www.ama-assn.org/aps/amahg.htm on the Internet.
·
The American Society of Clinical Oncologists (ASCO) provides an online list of doctors who are members of ASCO. The member database has the names and affiliations of over 15,000 oncologists worldwide. It can be searched by doctor’s name, institution’s name, location, and/or type of board certification. This service is located at http://www.asco.org/people/db/html/m_db.htm on the Internet.
·
The American College of Surgeons (ACOS) Fellowship Database is an online list of surgeons who are Fellows of the ACOS. The list can be searched by doctor’s name, geographic location, or medical specialty. This service is located at http://web.facs.org/acsdir/default.htm on the Internet. The ACOS can be contacted at 633 North Saint Clair Street, Chicago, IL 60611–3211; or by telephone at 312–202–5000.
·
Local medical societies may maintain lists of doctors in each specialty.
·
Public and medical libraries may have print directories of doctors’ names, listed geographically by specialty.
·
Your local Yellow Pages may have doctors listed by specialty under “Physicians.”
The Agency for Healthcare Research and Quality (AHRQ) offers Your Guide to Choosing Quality Health Care, which has information for consumers on choosing a health plan, a doctor, a hospital, or a long-term care provider. The Guide includes suggestions and checklists that you can use to determine which doctor or hospital is best for you. This resource is available at http://www.ahrq.gov/consumer/qntool.htm on the Internet. You can also
Seeking Guidance 57
order the Guide by calling the AHRQ Publications Clearinghouse at 1–800– 358–9295. If you are a member of a health insurance plan, your choice may be limited to doctors who participate in your plan. Your insurance company can provide you with a list of participating primary care doctors and specialists. It is important to ask your insurance company if the doctor you choose is accepting new patients through your health plan. You also have the option of seeing a doctor outside your health plan and paying the costs yourself. If you have a choice of health insurance plans, you may first wish to consider which doctor or doctors you would like to use, then choose a plan that includes your chosen physician(s). The National Comprehensive Cancer Network (NCCN) Physician Directory lists specialists who practice in the NCCN’s 19 member institutions across the U.S. To access the directory, go to http://www.nccn.org/ and click on “Physician Directory“. To use this service, you will be required to scroll to the bottom of the page and select “I agree.” Enter your search criteria and select “Find” at the bottom of the page. To obtain more information on a physician or institution, contact the institution’s Physician Referral Department or the NCCN Patient Information and Referral Service at 1-888909-NCCN or
[email protected]. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor14 There are many factors to consider when choosing a doctor. To make the most informed decision, you may wish to speak with several doctors before choosing one. When you meet with each doctor, you might want to consider the following: ·
Does the doctor have the education and training to meet my needs?
·
Does the doctor use the hospital that I have chosen?
14 This
section has been adapted from the AHRQ: http://www.ahrq.gov/consumer/qntascii/qntdr.htm
58 Colon Cancer
·
Does the doctor listen to me and treat me with respect?
·
Does the doctor explain things clearly and encourage me to ask questions?
·
What are the doctor’s office hours?
·
Who covers for the doctor when he or she is unavailable? Will that person have access to my medical records?
·
How long does it take to get an appointment with the doctor?
If you are choosing a surgeon, you may wish to ask additional questions about the surgeon’s background and experience with specific procedures. These questions may include: ·
Is the surgeon board-certified?15
·
Has the surgeon been evaluated by a national professional association of surgeons, such as the American College of Surgeons (ACOS)?
·
At which treatment facility or facilities does the surgeon practice?
·
How often does the surgeon perform the type of surgery I need?
·
How many of these procedures has the surgeon performed? What was the success rate?
It is important for you to feel comfortable with the specialist that you choose, because you will be working closely with that person to make decisions about your cancer treatment. Trust your own observations and feelings when deciding on a doctor for your medical care. Other health professionals and support services may also be important during cancer treatment. The National Cancer Institute fact sheet Your Health Care Team: Your Doctor Is Only the Beginning has information about these providers and services, and how to locate them. This fact sheet is located at http://cis.nci.nih.gov/fact/8_10.htm on the Internet, or can be obtained by calling the CIS at 1–800–4–CANCER (1–800–422–6237).
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 15
Seeking Guidance 59
Working with Your Doctor16 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
16
60 Colon Cancer
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Finding a Cancer Treatment Facility17 Choosing a treatment facility is another important consideration for getting the best medical care possible. Although you may not be able to choose which hospital treats you in an emergency, you can choose a facility for scheduled and ongoing care. If you have already found a doctor for your cancer treatment, you may need to choose a facility based on where your doctor practices. Your doctor may be able to recommend a facility that provides quality care to meet your needs. You may wish to ask the following questions when considering a treatment facility: ·
Has the facility had experience and success in treating my condition?
·
Has the facility been rated by state, consumer, or other groups for its quality of care?
·
How does the facility check and work to improve its quality of care?
·
Has the facility been approved by a nationally recognized accrediting body, such as the American College of Surgeons (ACOS) and/or the Joint Commission on Accredited Healthcare Organizations (JCAHO)?
·
Does the facility explain patients’ rights and responsibilities? Are copies of this information available to patients?
·
Does the treatment facility offer support services, such as social workers and resources to help me find financial assistance if I need it?
·
Is the facility conveniently located?
If you are a member of a health insurance plan, your choice of treatment facilities may be limited to those that participate in your plan. Your Adapted from the NCI: http://cis.nci.nih.gov/fact/7_47.htm. At this Web site, information on how to find treatment facilities is also available for patients living outside the U.S. 17
Seeking Guidance 61
insurance company can provide you with a list of approved facilities. Although the costs of cancer treatment can be very high, you have the option of paying out-of-pocket if you want to use a treatment facility that is not covered by your insurance plan. If you are considering paying for treatment yourself, you may wish to discuss the potential costs with your doctor beforehand. You may also want to speak with the person who does the billing for the treatment facility. In some instances, nurses and social workers can provide you with more information about coverage, eligibility, and insurance issues. The following resources may help you find a hospital or treatment facility for your care: ·
The NCI fact sheet The National Cancer Institute Cancer Centers Program describes and gives contact information for NCI-designated cancer treatment centers around the country.
·
The ACOS accredits cancer programs at hospitals and other treatment facilities. More than 1,400 programs in the United States have been designated by the ACOS as Approved Cancer Programs. The ACOS Web site offers a searchable database of these programs at http://web.facs.org/cpm/default.htm on the Internet. The ACOS can be contacted at 633 North Saint Clair Street, Chicago, IL 60611–3211; or by telephone at 312–202–5000.
·
The JCAHO is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs in the United States. It also offers information for the general public about choosing a treatment facility. The JCAHO Web site is located at http://www.jcaho.org on the Internet. The JCAHO is located at One Renaissance Boulevard, Oakbrook Terrace, IL 60181–4294. The telephone number is 630–792–5800.
·
The JCAHO offers an online Quality Check service that patients can use to determine whether a specific facility has been accredited by the JCAHO and view the organization’s performance reports. This service is located at http://www.jcaho.org/qualitycheck/directry/directry.asp on the Internet.
·
The AHRQ publication Your Guide To Choosing Quality Health Care has suggestions and checklists for choosing the treatment facility that is right for you.
62 Colon Cancer
Additional Cancer Support Information In addition to the references above, the NCI has set up guidance Web sites that offers information on issues relating to cancer. These include: ·
Facing Forward - A Guide for Cancer Survivors: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=cc93a 843-6fc0-409e-8798-5c65afc172fe
·
Taking Time: Support for People With Cancer and the People Who Care About Them: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=21a4 6445-a5c8-4fee-95a3-d9d0d665077a
·
When Cancer Recurs: Meeting the Challenge: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=9e13 d0d2-b7de-4bd6-87da-5750300a0dab
·
Your Health Care Team: Your Doctor Is Only the Beginning: http://cis.nci.nih.gov/fact/8_10.htm
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bladder: The organ that stores urine. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Charities: Social welfare organizations with programs designed to assist individuals in times of need. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Curative: Tending to overcome disease and promote recovery. [EU]
Seeking Guidance 63
Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Lymphoma: Cancer that arises in cells of the lymphatic system. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammogram: An x-ray of the breast. [NIH] Mammography: The use of x-rays to create a picture of the breast. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Metastasize: To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pap test: The collection of cells from the cervix for examination under a microscope. It is used to detect changes that may be cancer or may lead to cancer, and can show noncancerous conditions, such as infection or
64 Colon Cancer
inflammation. Also called a Pap smear. [NIH] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Thoracic: Having to do with the chest. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH]
Clinical Trials 65
CHAPTER 3. CLINICAL TRIALS AND COLON CANCER Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning colon cancer.
What Is a Clinical Trial?18 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for colon cancer is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
18
66 Colon Cancer
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on colon cancer.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for colon cancer compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on colon cancer carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on colon cancer. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
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treatment, like a placebo, has no effect on colon cancer and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how colon cancer develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for colon cancer. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Colon Cancer The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to colon cancer.19 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Antineoplaston Therapy in Treating Patients With Metastatic or Unresectable Colon Cancer Condition(s): recurrent colon adenocarcinoma of the colon
cancer;
stage
IV
colon
cancer;
Study Status: This study is currently recruiting patients. Sponsor(s): Burzynski Research Institute Purpose - Excerpt: RATIONALE: Antineoplastons are naturally occurring substances found in urine. Antineoplastons may inhibit the growth of cancer cells. PURPOSE: Phase II trial to study the effectiveness of antineoplaston therapy in treating patients with metastatic or unresectable colon cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; Burzynski Research Institute, Houston, Texas, 77055, United States; Recruiting; Stanislaw R. Burzynski 713-335-5697. Study 19
These are listed at www.ClinicalTrials.gov.
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chairs or principal investigators: Stanislaw R. Burzynski, Study Chair; Burzynski Research Institute Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003485;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
BMS-247550 in Treating Patients With Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); UAB Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of BMS-247550 in treating patients who have metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Alabama; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, 35294-3300, United States; Recruiting; Andres Forero-Torres 205-975-2837; Georgia; Georgia Cancer Specialists, Atlanta, Georgia, 30342, United States; Recruiting; Mansoor Noorali Saleh 205-975-9025. Study chairs or principal investigators: Andres Forero-Torres, Study Chair; UAB Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00033306;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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BMS-247550 in Treating Patients With Recurrent or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Chicago Cancer Research Center
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Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of BMS-247550 in treating patients who have recurrent or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00022477;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Capecitabine and Irinotecan in Treating Patients With Locally Advanced, Recurrent, or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Hoffmann-La Roche Ltd Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combining capecitabine and irinotecan in treating patients who have locally advanced, recurrent, or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00022698;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy After Surgery in Treating Patients With Liver Metastases From Colorectal Cancer Condition(s): adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients.
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Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Surgery may be an effective therapy in treating patients with liver metastases. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining surgery with chemotherapy may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of combination chemotherapy given after surgery in treating patients who have liver metastases from colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Nancy E. Kemeny 212639-8068. Study chairs or principal investigators: Nancy E. Kemeny, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003753;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy in Treating Patients With Advanced Colorectal Cancer Condition(s): recurrent colon cancer; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. PURPOSE: Clinical trial to study the effectiveness of combination chemotherapy in treating patients who have advanced colorectal cancer. Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00039611;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy in Treating Patients With Colon Cancer Condition(s): stage III colon cancer; stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Groupe Regional d'Etudes du Cancer Colorectal - Belgium Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether the time a drug is given improves its effectiveness in treating colon cancer. PURPOSE: Randomized phase III trial to determine the best time to give carboplatin with fluorouracil and leucovorin in treating patients who have stage IIB or stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): Belgium; Centre Hospitalier Hutois, Huy, 4500, Belgium; Recruiting; Jean Bury 085--27-2005; Les Cliniques Saint-Joseph ASBL, Liege (Luik), B 4000, Belgium; Recruiting; Christian N.J. Focan 00-32-4224-8990. Study chairs or principal investigators: Christian N.J. Focan, Study Chair; Groupe Regional d'Etudes du Cancer Colorectal - Belgium Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00046995;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy in Treating Patients With Colorectal Cancer Condition(s): recurrent colon cancer; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Chronotherapy Study Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving drugs at the time of day that allows for the best drug response may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. PURPOSE: Randomized phase II trial to determine the best time to give irinotecan combined with fluorouracil, leucovorin, and oxaliplatin in treating patients who have colorectal cancer. Phase(s): Phase II
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Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00039208;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy in Metastases from Colorectal Cancer
Treating
Patients
With
Liver
Condition(s): recurrent colon cancer; stage IV rectal cancer; adenocarcinoma of the rectum; recurrent rectal cancer; liver metastases; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group; Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells. It is not yet known which chemotherapy regimen is more effective for metastatic colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of intrahepatic floxuridine, leucovorin, and dexamethasone with that of systemic fluorouracil and leucovorin in treating patients who have unresectable liver metastases from colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002716;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy Plus Trastuzumab in Treating Patients With Advanced, Recurrent, or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B
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Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy plus trastuzumab in treating patients who have advanced, recurrent, or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006015;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy With or Without Bevacizumab Compared With Bevacizumab Alone in Treating Patients With Advanced or Metastatic Colorectal Cancer That Has Been Previously Treated Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as bevacizumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining monoclonal antibody therapy with combination chemotherapy may kill more tumor cells. It is not yet known if bevacizumab is more effective with or without combination chemotherapy in treating colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of combination chemotherapy with or without bevacizumab to that of bevacizumab alone in treating patients who have advanced or metastatic colorectal cancer that has been previously treated. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00025337;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy With or Without Chemoembolization in Treating Patients With Colorectal Cancer Metastatic to the Liver Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); American College of Radiology Imaging Network Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. One way to give chemotherapy drugs is by chemoembolization, which kills tumor cells by delivering drugs directly into the tumor and then blocking the blood flow to the tumor. It is not yet known if chemoembolization is more effective than standard chemotherapy in treating metastatic cancer. PURPOSE: Phase I trial and randomized phase III trial to determine the effectiveness of chemoembolization in treating patients who have colorectal cancer metastatic to the liver. For the phase III part of the trial, patients will be randomly assigned to one of two groups. Patients in group one will receive chemotherapy once a week for 4 weeks. Treatment may be repeated every 6 weeks for as long as benefit is shown. Patients in group two will receive chemotherapy as in group one and will undergo chemoembolization on day 36. The chemotherapy may be repeated as in group one. Chemoembolization may be repeated every 6 weeks for up to four courses. Patients will be evaluated every 3 months for 2 years, every 6 months for 3 years, and once a year thereafter. Phase(s): Phase I; Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023868;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy With or Without Cryosurgery in Treating Patients With Liver Metastases from Colorectal Cancer Condition(s): adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon
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Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Cryosurgery kills cancer cells by freezing them. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug with cryosurgery and giving drugs in different ways may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of intrahepatic and intravenous combination chemotherapy with or without cryosurgery in treating liver metastases from colorectal cancer. Phase(s): Phase I Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Nancy E. Kemeny 212639-8068. Study chairs or principal investigators: Nancy E. Kemeny, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00008294;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy With or Without Irinotecan in Treating Patients With Stage III Colon Cancer Condition(s): stage III colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Federation Nationale des Centres de Lutte Contre le Cancer; Fondation Francaise de Cancerologie Digestive Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known if combination chemotherapy is more effective with or without irinotecan in treating colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of combination chemotherapy with or without irinotecan in treating patients who have stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005979;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Comparing Two Combination Chemotherapy Regimens in Treating Patients With Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): GERCOR Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which regimen of combination chemotherapy is more effective for metastatic colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of two combination chemotherapy regimens in treating patients who have metastatic colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): France; Hopital Saint Antoine, Paris, 75571, France; Recruiting; Aimery De Gramont 33-1-49282336. Study chairs or principal investigators: Aimery De Gramont, Study Chair; GERCOR Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006468;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Comparison of Barium Enema, Computed Tomographic Colonography, and Colonoscopy in Detecting Colon Cancer Condition(s): colon cancer; rectal cancer; screening for colorectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): Duke Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Screening tests may help doctors detect cancer cells early and plan more effective treatment for cancer. New diagnostic procedures such as computed tomographic colonography may provide a less invasive method of identifying patients who have colon cancer. PURPOSE: Diagnostic and screening trial to compare the effectiveness of barium enema, computed tomographic colonography, and colonoscopy in detecting of colon cancer.
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Study Type: Screening, Diagnostic Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00016029;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Conventional Surgery Compared With Laparoscopic-Assisted Surgery in Treating Patients With Colorectal Cancer Condition(s): stage III rectal cancer; stage IV rectal cancer; stage I rectal cancer; stage I colon cancer; stage II colon cancer; stage 0 rectal cancer; stage II rectal cancer; stage III colon cancer; stage IV colon cancer; stage 0 colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): Medical Research Council Purpose - Excerpt: RATIONALE: Laparoscopic-assisted surgery is a less invasive type of surgery for colorectal cancer and may have fewer side effects and improve recovery. It is not yet known if undergoing conventional surgery is more effective than laparoscopic-assisted surgery for colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of conventional surgery with that of laparoscopicassisted surgery in treating patients who have colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003354;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Curcumin for the Prevention of Colon Cancer Condition(s): prevention of colorectal cancer; colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Michigan Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Chemoprevention therapy is the use of certain drugs to try to prevent the development of cancer. Curcumin may be effective in preventing the development of colon cancer. PURPOSE: Phase I trial to determine the dose amount of curcumin that can be tolerated to help in preventing colon cancer in healthy men and women.
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Phase(s): Phase I Study Type: Prevention Contact(s): Michigan; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, 48109-0752, United States; Recruiting; Dean E. Brenner 734-647-1417. Study chairs or principal investigators: Dean E. Brenner, Study Chair; University of Michigan Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00027495;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Erlotinib in Treating Patients With Recurrent or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Princess Margaret Hospital Purpose - Excerpt: RATIONALE: Biological therapies such as erlotinib may interfere with the growth of tumor cells and slow the growth of the tumor. PURPOSE: Phase II trial to study the effectiveness of erlotinib in treating patients who have recurrent or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Canada, Ontario; Cancer Care Ontario-Hamilton Regional Cancer Centre, Hamilton, Ontario, L8V 5C2, Canada; Recruiting; Pierre Major 416-821-7610; Cancer Care Ontario-London Regional Cancer Centre, London, Ontario, N6A 4L6, Canada; Recruiting; Mark D. Vincent 519-685-8640; Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada; Recruiting; Amit M. Oza 416-946-2818. Study chairs or principal investigators: Amit M. Oza, Study Chair; Princess Margaret Hospital Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032110;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Fluorouracil and Leucovorin With or Without Irinotecan in Treating Patients Following Surgery for Stage III Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; adenocarcinoma of the colon
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Study Status: This study is currently recruiting patients. Sponsor(s): Rhone Poulenc Rorer S.A. Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug and giving them after surgery may kill more tumor cells. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil and leucovorin with or without irinotecan in treating patients who have undergone surgery for stage III colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026273;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Fluorouracil Plus Leucovorin With or Without Oxaliplatin in Treating Patients With Stage II or Stage III Colon Cancer Condition(s): stage III colon cancer; stage II colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); National Surgical Adjuvant Breast and Bowel Project Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective for colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil plus leucovorin with or without oxaliplatin in treating patients who have stage II or stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004931;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Fluorouracil, Phenylbutyrate, and Indomethacin in Treating Patients With Advanced Colorectal Cancer Condition(s): recurrent colon cancer; stage IV rectal cancer; adenocarcinoma of the rectum; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Mount Sinai Medical Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of fluorouracil and phenylbutyrate in treating patients with stage IV colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): New York; Mount Sinai Medical Center, NY, New York, New York, 10029, United States; Recruiting; Max W. Sung 212-241-7902. Study chairs or principal investigators: Max W. Sung, Study Chair; Mount Sinai Medical Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002796;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Gene Testing in Patients With Colon Cancer Condition(s): stage III colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Analyzing the structure of genes found in a person's cancer cells may help doctors improve methods of treating patients with colon cancer. PURPOSE: Clinical trial to study the genes of patients treated with chemotherapy for colon cancer. Study Type: Genetic Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003571;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Gene Therapy in Patients With Colon Cancer That Has Spread to the Liver Condition(s): recurrent colon cancer; liver metastases; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Gene therapy may make the body build an immune response to kill tumor cells. PURPOSE: Phase I trial to study the safety of NV1020 in patients who have colon cancer that has spread to the liver and has not responded to previous chemotherapy. Phase(s): Phase I Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Yuman Fong 212-6392016. Study chairs or principal investigators: Yuman Fong, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012155;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Genetic Study in Patients With Stage II or Stage III Colon Cancer Condition(s): stage III colon cancer; stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); NCIC-Clinical Trials Group; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Genetic studies may help in understanding the genetic processes that cause some types of cancer. PURPOSE: Genetic trial to study certain genes of patients who have stage II or stage III colon cancer. Study Type: Genetic Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003833;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Genetic Study of Young Patients With Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage I rectal cancer; stage I colon cancer; stage III colon cancer; stage III rectal cancer; stage II colon cancer; stage II rectal cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); American College of Surgeons Purpose - Excerpt: RATIONALE: Identifying gene mutations may allow doctors to plan effective treatment for patients who develop colorectal cancer at an early age. PURPOSE: Genetic trial to study the significance of gene mutations in helping predict the outcome of treatment in patients who develop stage I , stage II, or stage III colorectal cancer at an early age. Study Type: Genetic Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Robert J. Downey 212639-8124. Study chairs or principal investigators: Jose G. Guillem, Study Chair; American College of Surgeons Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00044967;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Hepatic Arterial Infusion Plus Chemotherapy in Treating Patients With Colorectal Cancer Metastatic to the Liver Condition(s): adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); National Surgical Adjuvant Breast and Bowel Project; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving the drugs in different combinations and different ways may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of hepatic arterial infusion plus chemotherapy in treating patients who have colorectal cancer metastatic to the liver. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026234;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
High-Dose Fluorouracil With or Without Leucovorin Compared With Standard Fluorouracil Plus Leucovorin Following Surgery in Treating Patients With Stage III Colon Cancer Condition(s): mucinous adenocarcinoma of the colon; stage III colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Gastrointestinal Tract Cancer Cooperative Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known which chemotherapy regimen is more effective for colon cancer. PURPOSE: Randomized phase III trial to study the effectiveness of high-dose fluorouracil with or without leucovorin compared with standard-dose fluorouracil plus leucovorin following surgery in treating patients who have stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): Netherlands; Saint Laurentius Ziekenhuis, Roermond, 6043 CV, Netherlands; Recruiting; Jacques A. Wils 475--38-2466. Study chairs or principal investigators: Jacques A. Wils, Study Chair; EORTC Gastrointestinal Tract Cancer Cooperative Group Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004150;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Immunotherapy After Surgery in Treating Patients With Breast Cancer, Colon Cancer, or Melanoma Condition(s): stage II melanoma; recurrent colon cancer; stage II breast cancer; stage I colon cancer; recurrent melanoma; stage III colon cancer; stage I melanoma; recurrent breast cancer; stage III melanoma; stage I breast cancer; stage IIIA breast cancer; stage II colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): Centro Oncologico de Excelencia Purpose - Excerpt: RATIONALE: Immunotherapy uses different ways to stimulate the immune system and stop cancer cells from growing. Immunotherapy biological extracts may be useful as adjuvant therapy in
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treating patients who have had surgery for breast cancer, colon cancer, or melanoma. PURPOSE: Phase III trial to study the effectiveness of Corynebacterium granulosum extract as maintenance immunotherapy following surgery in treating patients with breast cancer, colon cancer, or melanoma. Phase(s): Phase III Study Type: Treatment Contact(s): Argentina, Buenos Aires; Centro Oncologico de Excelencia, Gonnet, Buenos Aires, 1987 MB, Argentina; Recruiting; Hugo Omar De Carli 021-84-3119. Study chairs or principal investigators: Hugo Omar De Carli, Study Chair; Centro Oncologico de Excelencia Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002455;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Irinotecan Compared With Combination Chemotherapy in Treating Patients With Advanced Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which chemotherapy regimen is more effective for colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of irinotecan with that of combination chemotherapy in treating patients who have advanced colorectal cancer that has not responded to previous treatment. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005036;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Irinotecan or Fluorouracil Plus Leucovorin in Treating Patients With Previously Treated Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving the drugs in different combinations may kill more tumor cells. PURPOSE: Phase II trial to compare the effectiveness of either irinotecan or fluorouracil plus leucovorin in treating patients who have metastatic colorectal cancer that has been previously treated with oxaliplatin with or without irinotecan. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00016952;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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J-107088 in Treating Patients With Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Pharmaceutical Research Associates Inc. Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of J-107088 in treating patients who have metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032071;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Laparoscopic-Assisted Surgery Compared With Open Surgery in Treating Patients With Colon Cancer Condition(s): stage III colon cancer; stage I colon cancer; adenocarcinoma of the colon; stage II colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; Radiation Therapy Oncology Group; Cancer and Leukemia Group B; NCIC-Clinical Trials Group; National Surgical Adjuvant Breast and Bowel Project; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Less invasive types of surgery may help reduce the number of side effects and improve recovery. It is not yet known which type of surgery is more effective for colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of laparoscopic-assisted colectomy with open colectomy in treating patients who have colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002575;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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LMB-9 Immunotoxin in Treating Patients With Advanced Pancreatic, Esophageal, Stomach, Colon, or Rectal Cancer Condition(s): pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Freiburg Purpose - Excerpt: RATIONALE: LMB-9 immunotoxin can locate tumor cells and kill them without harming normal cells. This may be an effective treatment for advanced pancreatic, esophageal, stomach, colon or rectal cancer. PURPOSE: Phase I trial to study the effectiveness of LMB-9 immunotoxin in treating patients who have advanced pancreatic, esophageal, stomach, colon, or rectal cancer. Phase(s): Phase I Study Type: Treatment
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Contact(s): Germany; University of Freiburg Medical Center, Freiburg, D79106, Germany; Recruiting; Peter Hafkmeyer 011-49-761-2703401. Study chairs or principal investigators: Peter Hafkmeyer, Study Chair; University of Freiburg Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010270;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Monoclonal Antibody Therapy and/or Vaccine Therapy in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; stage II colon cancer; stage II rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Onyvax Purpose - Excerpt: RATIONALE: Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Vaccines made from cancer cells may make the body build an immune response to kill colorectal tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of monoclonal antibody therapy and/or vaccine therapy in treating patients who have locally advanced or metastatic colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): United Kingdom, England; St. George's Hospital, London, England, SW17 0QT, United Kingdom; Recruiting; Fiona Lofts 020-87250231. Study chairs or principal investigators: Fiona Lofts, Study Chair; Onyvax Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00007826;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Monoclonal Antibody Therapy Compared With No Further Therapy After Surgery in Treating Patients With Stage II Colon Cancer Condition(s): stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; North Central Cancer Treatment
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Group; EORTC Gastrointestinal Tract Cancer Cooperative Group; NCICClinical Trials Group; Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Monoclonal antibodies such as edrecolomab can locate tumor cells and either kill them or deliver tumorkilling substances to them without harming normal cells. It is not yet known whether surgery to remove colon cancer is more effect with or without monoclonal antibody therapy. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without monoclonal antibody therapy in treating patients who have stage II colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002968;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
NB1011 in Treating Patients With Metastatic or Recurrent Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): NewBiotics Incorporated Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase I/II trial to study the effectiveness of NB1011 in treating patients who have metastatic or recurrent colorectal cancer that has not responded to previous treatment. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): California; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, 90095-1781, United States; Recruiting; Mark D. Pegram 310-206-8221; USC/Norris Comprehensive Cancer Center and Hospital, Los Angeles, California, 90033-0804, United States; Recruiting; Heinz-Josef Lenz 323-865-3955. Study chairs or principal investigators: Mark D. Pegram, Study Chair; NewBiotics Incorporated Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00031616;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Oxaliplatin in Treating Patients With Previously Treated Locally Advanced or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Roswell Park Cancer Institute Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Clinical trial to study the effectiveness of oxaliplatin in treating patients who have locally advanced or metastatic colorectal cancer that has been previously treated. Study Type: Treatment Contact(s): New York; Roswell Park Cancer Institute, Buffalo, New York, 14263-0001, United States; Recruiting; Milind Javle 716-845-7614. Study chairs or principal investigators: Milind Javle, Study Chair; Roswell Park Cancer Institute Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040820;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Radiolabeled Monoclonal Antibody Therapy in Treating Patients With Recurrent or Persistent Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); UAB Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Radiolabeled monoclonal antibodies can locate tumor cells and deliver tumor-killing substances to them without harming normal cells. Radiolabeled monoclonal antibody therapy may be effective treatment for colorectal cancer. PURPOSE: Phase I trial to study the effectiveness of radiolabeled monoclonal antibody therapy in treating patients who have recurrent or persistent colorectal cancer. Phase(s): Phase I
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Study Type: Treatment Contact(s): Alabama; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, 35294-3300, United States; Recruiting; Ruby F. Meredith 205-934-2763. Study chairs or principal investigators: Ruby F. Meredith, Study Chair; UAB Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023933;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy and Chemotherapy With or Without Tetanus Toxoid in Treating Patients With Metastatic Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Comprehensive Cancer Center
Institute
(NCI);
Herbert
Irving
Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Tetanus toxoid may make tumor cells more sensitive to chemotherapy and vaccine therapy. PURPOSE: Randomized phase II trial to study the effectiveness of chemotherapy and vaccine therapy with or without tetanus toxoid in treating patients who have metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00027833;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy in Gastrointestinal Tract
Treating
Patients
With
Cancer
of
the
Condition(s): pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Texas
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Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. PURPOSE: Randomized phase II trial to compare the effectiveness of two different vaccines in treating patients who have cancer of the gastrointestinal tract. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; University of Texas Medical Branch, Galveston, Texas, 77555-0209, United States; Recruiting; Robert P. Whitehead 409-772-1164. Study chairs or principal investigators: Robert P. Whitehead, Study Chair; University of Texas Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012246;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy in Treating Patients With Stage II or Stage III Colon Cancer That has Been Removed During Surgery Condition(s): stage III colon cancer; stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Intracel Purpose - Excerpt: RATIONALE: Vaccines made from a patient's white blood cells and tumor cells may make the body build an immune response to kill tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining vaccine therapy with chemotherapy may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of vaccine therapy combined with leucovorin and fluorouracil in treating patients who have undergone surgery to completely remove stage II or stage III colon cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): District of Columbia; Washington Hospital Center, Washington, District of Columbia, 20010, United States; Recruiting; Lee E. Smith 202-877-8484; Pennsylvania; Lehigh Valley Hospital, Allentown, Pennsylvania, 18103, United States; Recruiting; Linda L. Lapos 610-4021095; Virginia; Inova Fairfax Hospital, Fairfax, Virginia, 22031, United States; Recruiting; Thomas Patrick Wright 703-560-7788. Study chairs or principal investigators: Michael G Hanna Jr., Study Chair; Intracel
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00016133;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy With or Without Interleukin-2 in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response that will kill cancer cells. Combining vaccine therapy with interleukin-2 may be a more effective treatment for colorectal cancer. PURPOSE: Phase I/II trial to study the effectiveness of vaccine therapy with or without interleukin-2 in treating patients who have locally advanced or metastatic colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): Maryland; Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support, Bethesda, Maryland, 20892-1182, United States; Recruiting; Patient Recruitment 1-888-NCI-1937; Tennessee; VanderbiltIngram Cancer Center, Nashville, Tennessee, 37232-6838, United States; Recruiting; David P. Carbone 615-936-3524. Study chairs or principal investigators: John Edward Janik, Study Chair; National Cancer Institute (NCI) Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00019591;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Vaccine Therapy With or Without Sargramostim in Treating Patients With Advanced or Metastatic Cancer Condition(s): lung cancer; pancreatic cancer; gastric cancer; salivary gland cancer; head and neck cancer; colorectal cancer; adult primary liver cancer; testicular cancer; ovarian epithelial cancer; colon cancer; thyroid cancer; rectal cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Fox Chase Cancer Center
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Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Colony-stimulating factors such as sargramostim may increase the number of immune cells found in bone marrow or peripheral blood. Combining vaccine therapy with sargramostim may make tumor cells more sensitive to the vaccine and may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of vaccine therapy with or without sargramostim in treating patients who have advanced or metastatic cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Pennsylvania; Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, United States; Recruiting; Margaret von Mehren 215-728-3545. Study chairs or principal investigators: Margaret von Mehren, Study Chair; Fox Chase Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00028496;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
ZD 1839 and Combination Chemotherapy in Treating Patients With Advanced Solid Tumors or Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; unspecified adult solid tumor, protocol specific; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Stanford University Purpose - Excerpt: RATIONALE: Biological therapies such as ZD 1839 may interfere with the growth of tumor cells and slow the growth of the tumor. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug with ZD 1839 may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of ZD 1839 and oxaliplatin combined with leucovorin and fluorouracil in treating patients who have advanced solid tumors or colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): California; Stanford University Medical Center, Stanford, California, 94305-5408, United States; Recruiting; Branimir Ivan Sikic 650725-8233. Study chairs or principal investigators: Branimir Ivan Sikic, Study Chair; Stanford University
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00025142;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
ZD 1839 in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer That Has Not Responded to Chemotherapy Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Texas Purpose - Excerpt: RATIONALE: Biological therapies such as ZD 1839 may interfere with the growth of tumor cells and slow the growth of colorectal cancer. PURPOSE: Phase II trial to study the effectiveness of ZD 1839 in treating patients who have locally advanced or metastatic colorectal cancer that has not responded to fluorouracil and irinotecan. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; Institute for Drug Development, San Antonio, Texas, 78229, United States; Recruiting; Amita Patnaik 210-949-5069; University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78284-7811, United States; Recruiting; Chris H. Takimoto 210-567-4777. Study chairs or principal investigators: Chris H. Takimoto, Study Chair; University of Texas Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00030524;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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ZD 1839 Plus Combination Chemotherapy in Treating Patients With Locally Advanced, Locally Recurrent, or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Dana-Farber/Harvard Cancer Center Purpose - Excerpt: RATIONALE: Biological therapies such as ZD 1839 may interfere with the growth of tumor cells and slow the growth of the
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tumor. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining ZD 1839 with combination chemotherapy may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of ZD 1839 combined with irinotecan, leucovorin, and fluorouracil in treating patients who have locally advanced, locally recurrent, or metastatic colorectal cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts, 02115, United States; Recruiting; Charles S. Fuchs 617-6322225; Massachusetts General Hospital Cancer Center, Boston, Massachusetts, 02114, United States; Recruiting; Jeffrey William Clark 617-726-8743. Study chairs or principal investigators: Charles S. Fuchs, Study Chair; Dana-Farber/Harvard Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026364;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Monoclonal Antibody Therapy in Treating Patients With Lymphoma, Colon Cancer, or Prostate Cancer That Has Not Responded to Vaccine Therapy Condition(s): recurrent colon cancer; recurrent grade III follicular large cell lymphoma; recurrent mantle cell lymphoma; recurrent grade I follicular small cleaved cell lymphoma; recurrent prostate cancer; recurrent grade II follicular mixed cell lymphoma Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Monoclonal antibodies such as CTLA-4 can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. PURPOSE: Phase II trial to study the effectiveness of monoclonal antibody CTLA-4 in treating patients who have lymphoma, colon cancer, or prostate cancer that has not responded to vaccine therapy. Phase(s): Phase II Study Type: Treatment Contact(s): John Edward Janik 301-402-2913. Study chairs or principal investigators: John Edward Janik, Study Chair; National Cancer Institute (NCI)
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00047164;jsessionid=45AB78 3531B044FB3F235C2A3A076210
Benefits and Risks20 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for colon cancer. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with colon cancer. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 20
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What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.
How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
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After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
·
Know whether you participated in the treatment group or the control group (once the study has been completed). What Should You Ask before Deciding to Join a Clinical Trial?
Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for colon cancer? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Clinical Trials and Insurance Coverage21 As you consider enrolling in a clinical trial, you will face the critical issue of how to cover the costs of care. Even if you have health insurance, your coverage may not include some or all of the patient care costs associated with a clinical trial. This is because some health plans define clinical trials as “experimental” or “investigational” procedures. Because lack of coverage for these costs can keep people from enrolling in trials, the National Cancer Institute is working with major health plans and managed care groups to find solutions. In the meantime, there are strategies that may help you deal with cost and coverage barriers. This section answers frequently asked questions about insurance coverage for clinical trial participation and directs you to additional information resources. The material here is mainly concerned with treatment clinical trials, since other types of trials (prevention, screening, etc.) are newer and generally not covered by health insurance at all. However, this guide may become more relevant for prevention and other types of trials as these trials grow more common. If you do not have any health insurance, you may find this section helpful for understanding some of the costs that trials involve.
What Costs Do Trials Involve? Who Is Usually Responsible for Paying Them? There are two types of costs associated with a trial: patient care costs and research costs. Patient care costs fall into two categories: ·
Usual care costs, such as doctor visits, hospital stays, clinical laboratory tests, x-rays, etc., which occur whether you are participating in a trial or
Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b.
21
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receiving standard treatment. These costs have usually been covered by a third-party health plan, such as Medicare or private insurance. ·
Extra care costs associated with clinical trial participation, such as the additional tests that may or may not be fully covered by the clinical trial sponsor and/or research institution.
The sponsor and the participant’s health plan need to resolve coverage of these costs for particular trials. Research costs are those associated with conducting the trial, such as data collection and management, research physician and nurse time, analysis of results, and tests purely performed for research purposes. Such costs are usually covered by the sponsoring organization, such as NCI or a pharmaceutical company.
Criteria Used by Health Plans to Make Reimbursement Decisions about Trials Health insurance companies and managed care companies decide which health care services they will pay for by developing coverage policy regarding the specific services. In general, the most important factor determining whether something is covered is a health plan’s judgment as to whether the service is established or investigational. Health plans usually designate a service as established if there is a certain amount of scientific data to show that it is safe and effective. If the health plan does not think that such data exist in sufficient quantity, the plan may label the service as investigational. Health care services delivered within the setting of a clinical trial are very often categorized as investigational and not covered. This is because the health plan thinks that the major reason to perform the clinical trial is that there is not enough data to establish the safety and effectiveness of the service being studied. Thus, for some health plans, any mention of the fact that the patient is involved in a clinical trial results in a denial of payment. Your health plan may define specific criteria that a trial must meet before extending coverage, such as the following:
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Sponsorship Some plans may only cover costs of trials sponsored by organizations whose review and oversight of the trial is careful and scientifically rigorous, according to standards set by the health plan.
Trial Phase and Type Some plans may cover patient care costs only for the clinical trials they judge to be “medically necessary” on a case-by-case basis. Trial phase may also affect coverage; for example, while a plan may be willing to cover costs associated with Phase III trials, which include treatments that have already been successful with a certain number of people, the plan may require some documentation of effectiveness before covering a Phase I or II trial. While health plans are interested in efforts to improve prevention and screening, they currently seem less likely to have a review process in place for these trials. Therefore, it may be more difficult to get coverage for the care costs associated with them. Some plans, especially smaller ones, will not cover any costs associated with a clinical trial. Policies vary widely, but in most cases your best bet is to have your doctor initiate discussions with the health plan. Cost “Neutrality” Some health plans may limit coverage to trials they consider cost-neutral (i.e., not significantly more expensive than the treatments considered standard). Lack of Standard Therapy Some plans limit coverage of trials to situations in which no standard therapy is available. Facility and Personnel Qualifications A health plan may require that the facility and medical staff meet specific qualifications to conduct a trial involving unique services, especially
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intensive therapy such as a bone marrow transplant chemotherapy with bone marrow/ stem cell rescue).
(high-dose
Clinical Trials and Medicare Coverage For up-to-date information about Medicare coverage of clinical trials, go to the Web site for the Centers for Medicaid & Medicare (http://www.hcfa.gov/coverage/8d.htm; formerly the Health Care Financing Administration). As of January 2001, the following information was accurate22: What Will Medicare Pay? ·
Anything normally covered is still covered when it is part of a clinical trial. This includes test, procedures, and doctor visits that are ordinarily covered.
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Anything normally covered even if it is a service or item associated with the experimental treatment. For example, Medicare will pay for the intravenous administration of a new chemotherapy drug being tested in a trial, including any therapy to prevent side effects from the new drug.
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Anything normally covered even if it resulted from your being in the clinical trial. For example, a test or hospitalization resulting from a side effect of the new treatment that Medicare would ordinarily cover. What Costs Are Not Covered?
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Investigational items or services being tested in a trial. Sponsors of clinical trials often provide the new drug free, but make sure you ask your doctor before you begin.
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Items or services used solely for the data collection needs of the trial.
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Anything being provided free by the sponsor of the trial.
On June 7, 2000, Present Clinton announced that Medicare would revise its payment policy to reimburse the routine patient care costs of clinical trials. The announcement is available for public viewing at the following Web address: http://www.cancer.gov/clinical_trials/doc.aspx?viewid=320DD013-BA7A-4177-A0002011089F34A0.
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What Kinds of Clinical Trials Are Covered? NCI’s Cancer Information Service has provided a fact sheet for Medicare beneficiaries at the following Web site: http://cis.nci.nih.gov/fact/8_14.htm. In general, cancer treatment and diagnosis trials are covered if: ·
They are funded by the National Cancer Institute (NCI), NCI-Designated Cancer Centers, NCI-Sponsored Clinical Trials Cooperative Groups and all other Federal agencies that fund cancer research. Other trials may be eligible for coverage and doctors can ask Medicare to pay the patients’ costs. Ask your doctor about this before you begin.
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They are designed to treat or diagnose your cancer.
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The purpose or subject of the trial is within a Medicare benefit category. For example, cancer diagnosis and treatment are Medicare benefits, so these trials are covered. Cancer prevention trials are not currently covered.
Increasing the Likelihood of Insurance Coverage for Trials23 There are several steps you can follow to deal with coverage issues up front when deciding to enter a clinical trial. Along the way, enlist the help of family members and your doctor or other health professionals. You may find the following checklist useful:
Understand the Costs Associated with the Trial Ask your doctor or the trial’s contact person about the costs that must be covered by you or your health plan. Are these costs significantly higher than those associated with standard care? Also, inquire about the experience of other patients in the trial. Have their plans paid for their care? Have there been any persistent problems with coverage? How often have the trial’s administrators been successful in getting plans to cover patient care costs?
This section has been adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b&docid=0df4397a-eccb-465f-bd33-a89e7a708c46.
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Understand Your Health Plan Be sure you know what’s in your policy; request and carefully review the actual contract language. If there’s a specific exclusion for “experimental treatment,” look closely at the policy to see how the plan defines such treatment and under what conditions it might be covered. If it is not clearly defined, call the plan’s customer service line, consult their Web site, and/or write to them. Ask for specific information about clinical trials coverage.
Work Closely with Your Doctor Talk with your doctor about the paperwork he or she submits to your health plan. If there have been problems with coverage in the past, you might ask your doctor or the hospital to send an information package to the plan that includes studies supporting the procedure’s safety, benefits, and medical appropriateness. This package might include: ·
Publications from peer-reviewed literature about the proposed therapy that demonstrate patient benefits;
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A letter that uses the insurance contract’s own language to explain why the treatment, screening method, or preventive measure should be covered;
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Letters from researchers that explain the clinical trial;
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Support letters from patient advocacy groups.
Be sure to keep your own copy of any materials that the doctor sends to your health plan for future reference. Work Closely with Your Company’s Benefits Manager This person may be helpful in enlisting the support of your employer to request coverage by the health plan. Give Your Health Plan a Deadline Ask the hospital or cancer center to set a target date for the therapy. This will help to ensure that coverage decisions are made promptly.
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Know Your Rights24 A number of state governments are addressing the question of whether insurance companies ought to cover the costs associated with patients’ participation in clinical trials. Lack of such coverage is a significant barrier to many patients who might otherwise benefit from enrolling in a trial. Lack of coverage also makes it harder for researchers to successfully conduct trials that could improve prevention and treatment options. Information on State initiatives and legislation concerning cancer-related clinical trials is available at http://www.cancer.gov/ClinicalTrials/insurancelaws. By conducting your own research and learning about your rights, you may increase the likelihood that your insurance company will cover the costs of a trial.
If Your Insurance Claim Is Denied after the Trial Has Begun If a claim is denied, read your policy to find out what steps you can follow to make an appeal. In “What Cancer Survivors Need to Know about Health Insurance”, the National Coalition for Cancer Survivorship suggests that you and your doctor demonstrate to the health plan that: ·
The therapy is not just a research study, but also a valid procedure that benefits patients;
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Your situation is similar to that of other patients who are participating in clinical trials as part of a covered benefit;
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Possible complications have been anticipated and can be handled effectively.
You also may wish to contact your state insurance counseling hotline or insurance department for more help, or write your state insurance commissioner describing the problem. Where Else Can I Turn for Assistance? It’s never easy to deal with financial issues when you or a loved one faces cancer. Unfortunately, costs can present a significant barrier to clinical trials participation. The range of insurance issues and health plan contracts makes it impossible to deal with all of them here. You may wish to consult this partial list of publications, organizations, and Web sites for more information: 24
Adapted from Cancer.gov: http://www.cancer.gov/ClinicalTrials/insurancelaws.
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Publications What Cancer Survivors Need to Know about Health Insurance National Coalition of Cancer Survivorship 1010 Wayne Avenue, 5th floor Silver Spring, MD 20910 (301) 650-8868 http://www.cansearch.org/ Cancer Treatments Your Insurance Should Cover The Association of Community Cancer Centers 11600 Nebel Street, Suite 201 Rockville, MD 20852 (301) 984-9496 http://www.accc-cancer.org/main2001.shtml The Managed Care Answer Guide Patient Advocate Foundation 739 Thimble Shoals Boulevard, Suite 704 Newport News, VA 23606 (757) 873-6668 E-mail:
[email protected] 1998 Guide to Health Insurance for People with Medicare, The Medicare Handbook Medicare Helpline: 1-800-444-4606 Health Care Financing Administration: http://www.hcfa.gov/ New Medicare site: http://www.medicare.gov/ Assistance Programs Candlelighters Childhood Cancer Foundation Ombudsman Program 910 Woodmont Avenue, #4607 Bethesda, MD 20814 (301) 657-8401; 1-800-366-2223 (toll-free) E-mail:
[email protected] http://www.candlelighters.org The Ombudsman Program helps families of children with cancer and survivors of childhood cancer resolve a range of problems, including insurance coverage difficulties. Local groups appoint a Parent Advocate who works with the treatment center on behalf of families.
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Medical Care Management Corporation 5272 River Road, Suite 650 Bethesda, MD 20816-1405 (301) 652-1818 email:
[email protected] http://www.mcman.com/ Working for a range of clients, including health plans, employers, and patients, MCMC conducts independent, objective reviews of hightechnology medical care cases to assist in decision-making. While it does charge for its services, MCMC also offers a volunteer program for those who cannot afford to pay. More Information Resources OncoLink A service of the University of Pennsylvania Cancer Center. http://www.oncolink.com/ In addition to general cancer information, this web site features a section on financial information for patients. Among the topics: viatical settlements, life insurance, a glossary of financial and medical terms, and news about billing and insurance. American Association of Health Plans 1129 20th Street, NW, Suite 600 Washington, DC 20036-3421 (202) 778-3200 http://www.aahp.org/ The Web site section “For Consumers” includes a fact sheet on clinical research that describes various health plans’ efforts to support research initiatives and collaborate with academic health centers and universities. Health Insurance Association of America 555 13th Street, NW Washington, DC 20004 (202) 824-1600 ·
Home page: http://www.hiaa.org/
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Consumer Information: http://www.hiaa.org/consumer/
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Insurance Counseling Hotlines by State: http://www.hiaa.org/consumer/insurance_counsel.cfm
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State Insurance Departments: http://www.hiaa.org/consumer/state_insurance.cfm
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Government Initiatives to Expand Insurance Coverage for Trials25 The good news is that there has been a recent effort in the U.S. to assure clinical trials coverage, with NCI involved in several new initiatives as described below: NCI-Department of Defense Agreement An innovative 1996 agreement between NCI and the Department of Defense (DoD) has given thousands of DoD cancer patients more options for care and greater access to state-of-the-art treatments. Patients who are beneficiaries of TRICARE/CHAMPUS, the DoD’s health program, are covered for NCIsponsored Phase II and Phase III clinical treatment trials. NCI and DoD are refining a system that allows physicians and patients to determine quickly what current trials meet their needs and where they are taking place. NCI-Department of Veterans Affairs Agreement A 1997 agreement with the Department of Veterans Affairs provides coverage for eligible veterans of the armed services to participate in NCIsponsored prevention, diagnosis, and treatment studies nationwide. For additional information, see the VA/DoD Beneficiaries Digest Page at http://www.va.gov/cancer.htm.
Midwest Health Plans Agreement Some NCI Cooperative Groups have reached agreements with several insurers in Wisconsin and Minnesota to provide more than 200,000 people with coverage. This coverage is allocated for patient care costs if they participate in a cooperative group-sponsored trial.
Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b&docid=d8092601-daf9-4794-8536-3be2712eb6b9.
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Pediatric Cancer Care Network This network, a cooperative agreement among the Children’s Cancer Group, the Pediatric Oncology Group, and the Blue Cross Blue Shield System Association (BCBS) nationwide, will ensure that children of BCBS subscribers receive care at designated centers of cancer care excellence and may promote the enrollment of children in Cooperative Group clinical trials.
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “colon cancer” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Adenocarcinoma: Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antineoplastons: Substances isolated from normal human blood and urine being tested as a type of treatment for some tumors and AIDS. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Bevacizumab: A monoclonal antibody that may prevent the growth of blood vessels from surrounding tissue to a solid tumor. [NIH] Capecitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Carboplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time. [NIH] Chronotherapy: The adaptation of the administration of drugs to circadian rhythms. The concept is based on the response of biological functions to time-related events, such as the low point in epinephrine levels between 10 p.m. and 4 a.m. or the elevated histamine levels between midnight and 4 a.m. The treatment is aimed at supporting normal rhythms or modifying therapy based on known variations in body rhythms. While chronotherapy is commonly used in cancer chemotherapy, it is not restricted to cancer therapy or to chemotherapy. [NIH] Corynebacterium: A genus of asporogenous bacteria that is widely distributed in nature. Its organisms appear as straight to slightly curved rods and are known to be human and animal parasites and pathogens. [NIH] Cryosurgery: Treatment performed with an instrument that freezes and destroys abnormal tissues. This procedure is a form of cryotherapy. [NIH]
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Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Dexamethasone: A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment. [NIH] Edrecolomab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Floxuridine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Fluorouracil: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Gastric: Having to do with the stomach. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Indomethacin: A drug that belongs to the family of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin reduces pain, fever, swelling and redness. It is also being used to reduce tumorinduced suppression of the immune system and to increase the effectiveness of anticancer drugs. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Intrahepatic: Within the liver. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called
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CPT 11. [NIH] Leucovorin: A drug used to protect normal cells from high doses of the anticancer drug methotrexate. It is also used to increase the antitumor effects of fluorouracil and tegafur-uracil, an oral treatment alternative to intravenous fluorouracil. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH]
Oxaliplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Phenylbutyrate: An anticancer drug that belongs to the family of drugs called differentiating agents. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Sargramostim: A colony-stimulating factor that stimulates the production of blood cells, especially platelets, during chemotherapy. It is a cytokine that belongs to the family of drugs called hematopoietic (blood-forming) agents. Also called GM-CSF. [NIH] Testicular: Pertaining to a testis. [EU] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Trastuzumab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. Trastuzumab blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. [NIH]
Unresectable: Unable to be surgically removed. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH]
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Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on colon cancer. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on colon cancer. In Part II, as in Part I, our objective is not to interpret the latest advances on colon cancer or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with colon cancer is suggested.
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CHAPTER 4. STUDIES ON COLON CANCER Overview Every year, academic studies are published on colon cancer or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on colon cancer. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on colon cancer and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and colon cancer, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “colon cancer” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Patient Experience and Preferences Toward Colon Cancer Screening: A Comparison of Virtual Colonoscopy and Conventional Colonoscopy Source: Gastrointestinal Endoscopy. 54(3):210-315, 2001. Summary: Researchers assessed patient tolerance of virtual colonoscopy (VC) compared to conventional colonoscopy (CC), characterizing patient preferences for these techniques. People referred to a Veterans Affairs Medical Center gastrointestinal clinic for colonoscopy for any indication were recruited to undergo VC prior to receiving CC. CC was performed with the patient under conscious sedation, while VC was performed without sedation. They completed a questionnaire after the VC and again after completing both tests. The questionnaire assessed overall pain, discomfort, and lack of respect. Their preferences for VC versus CC were determined using a time tradeoff technique. To verify the stability of responses, participants completed an additional questionnaire by mail at 24 hours. At both 0 and 24 hours, participants reported more pain and discomfort and less respect after VC than after CC. They preferred CC and said they would be willing to wait longer for CC as opposed to undergoing VC. Both procedures were well-tolerated overall. The researchers conclude that improvements in patient tolerance and acceptance of VC are necessary if this test is to become competitive as an alternative screening modality. 6 figures, 3 tables, 12 references.
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Virtual Colonoscopy: A New Tool for Colorectal Cancer Screening Source: Current Opinion in Gastroenterology. 17(1):78-85, January 2001. Summary: The authors conducted a literature review on virtual colonoscopy as a screening tool for colorectal cancer, including the technique, image display, image reconstruction, clinical trial results, and feasibility. The basic technique of virtual colonoscopy involves (1) cleansing the patient's colon with standard barium enema or colonoscopy bowel preparation, colonic insufflation with room air or carbon dioxide, and (3) thin-section helical computer tomography (CT) of the abdomen and pelvis followed by computer manipulation of the CT dataset. Virtual colonoscopy requires a well prepared, cleansed colon to achieve
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appropriate sensitivity and specificity. CT scan acquisition usually involves the use of both supine and prone helical CT datasets to (1) help differentiate between mobile stool and fixed pathology such as cancers or polyps; (2) allow more even distention of the colon; and (3) improve visualization of segments of the colon obscured by intraluminal fluid. CT scanning usually takes less than 20 minutes. The radiation dose required for virtual colonoscopy is about 20 percent lower than the typical dose for double-contrast barium enema. After image acquisition, the CT data can be viewed using a variety of techniques, including (1) simple evaluation of the axial CT images at lung window settings, (2) reformatted twodimensional images at cross-sectional and orthogonal planes to the long axis of the colon, (3) three-dimensional endoluminal-simulating conventional endoscopy images, and (4) extraluminal images that simulate barium enema images. Virtual endoscopy based on threedimensional magnetic resonance imaging is also feasible and may be an alternative to CT. Preliminary results show that the accuracy of virtual colonoscopy for polyp detection exceeds barium enema and approaches conventional colonoscopy. The performance of virtual colonoscopy as a screening method has not yet been established. The authors conclude that (1) results of virtual colonoscopy studies are promising; and (2) if it proves to be an accurate, reliable, and cost-effective method for detecting polyps and early cancer, then it may improve population participation in screening programs and reduce the impact of colorectal cancer. 3 figures, 36 references. ·
Colorectal Cancer Screening: New Directions, Evolving Guidelines Source: Patient Care. 35(4):24-30, 33-34, February 28, 2001. Summary: The author reviews existing guidelines, recent study data, and the controversies concerning which screening options are best for colorectal cancer detection. While all individuals age 50 years and older should undergo screening for colorectal cancer, many primary care physicians report that they do not screen all eligible patients in their practice. Several options are offered to physicians and patients regarding colorectal screening and the physician and patient together should choose an appropriate screening regimen. Screening can prevent colorectal cancer through the detection and removal of precancerous polyps. Current views place an emphasis on total colon examination with colonoscopy in average-risk persons. Annual fecal occult blood testing combined with flexible sigmoidoscopy every 5 years is the most costeffective overall screening strategy available. Barriers to screening include patient unwillingness to discuss or have this part of the anatomy examined, physician's comfort level in discussing and performing
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colorectal screening, reimbursement, the economics of doing flexible sigmoidoscopy screening in the primary care office, and insufficient capacity to perform population-wide screening colonoscopy. 1 figure, 15 references. ·
New Test May Be More Accurate in Detecting Precancerous Polyps and Curable Colorectal Cancers Source: Primary Care and Cancer. 21(3):14-16, March 2001. Summary: According to Dr. David Ahlquist, a new, noninvasive DNA test for detecting precancerous polyps and curable colorectal cancers was 91 percent sensitive for detecting cancer throughout the colon. The researchers believe that this test, although about 2 years away from becoming widely available for public use, could significantly change the way screening for colorectal cancer is done. This new test requires a stool sample and involves analyzing DNA that is shed from the surface of colorectal cancer tumors and excreted in the stool. Precancerous polyps and early-stage cancer yield specific DNA abnormalities. This new test measures these abnormalities and results in the high accuracy of detection. This test needs to undergo another phase of clinical trials. Meanwhile, Mayo Clinic physicians encourage people age 50 years and older to continue following their physician's advice and the current recommendations for screening. The researchers believe that this new DNA test may replace the fecal occult blood test that yields as many as 5 to 10 percent false-positive results. This new test also has several patientfriendly features: (1) Patients can provide stool samples at home using a special kit that fits on the toilet seat, (2) it requires no special dietary or medication restrictions, and (3) no bowel preparation is needed. This new DNA test has the potential to significantly reduce the morbidity and mortality of colorectal cancer. 1 figure, 1 reference.
·
Virtual Colonoscopy Is a Promising Technology for Colon Cancer Screening Source: Primary Care and Cancer. 21(3):12-13, March 2001. Summary: According to Dr. Richard J. Farrell, virtual colonoscopy is an accurate screening method for colorectal cancer in lesions greater than 10 millimeters. This new screening method also has good patient tolerance. Virtual colonoscopy, or computed tomography (CT) colonoscopy, uses thin-section, helical CT to generate high-resolution two-dimensional axial images and three-dimensional endoluminal images. Physicians at the Beth Israel Deaconess Hospital in Boston recruited 100 patients at high risk for colorectal cancer and polyps. All underwent virtual colonoscopy prior to elective conventional colonoscopy. Using conventional
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colonoscopy, 45 of these patients had normal findings. In the other 55 patients, the researchers found 88 polyps and 13 masses, including 9 carcinomas. Virtual colonoscopy found (1) 12 (90 percent) of the 13 masses, all of which were greater than 20 millimeters; (2) 28 (92 percent) of 31 polyps that were greater than 10 millimeters; (3) 15 (65 percent) of 23 polyps that were 6 to 9 millimeters; and (4) 12 (35 percent) of 34 polyps that were 5 millimeters or smaller. There were 11 false-positive findings of polyps and 3 false-positive findings of masses, resulting in a specificity of 90 percent. Dr. Farrell indicated that conventional colonoscopy remains the gold standard, but virtual colonoscopy is a good diagnostic tool. 1 figure. ·
Inflammatory Bowel Disease Flare, or Colon Cancer? Source: Primary Care and Cancer. 21(1):38-41, 58, January 2001. Summary: A physician discusses the risk of colorectal cancer in patients with chronic inflammatory bowel disease (IBD) and the need for a colonoscopic surveillance program throughout their lives. While the risk of colorectal cancer has long been known in ulcerative colitis patients, only recently has the colon cancer risk of Crohn's colitis been recognized as being of similar magnitude. It is unclear whether coincident colon cancer risk factors, such as a family history of colorectal neoplasm, further heighten the cancer risk in these patients. However, other contributing factors, such as the complication of primary sclerosing cholangitis, have been recognized. Colonoscopy is the screening tool of choice in IBD rather than sigmoidoscopy. Colon cancer in IBD typically follows a premalignant dysplastic phase. The likelihood of finding colon cancer at colectomy after high-grade dysplasia has been identified is about 40 percent. Symptoms of new colon cancer in individuals may be exceedingly difficult to distinguish from an exacerbation of colitis. Symptoms such as weight loss, loss of appetite, or progressive anemia should be evaluated aggressively to allow for prompt surgical resection in response to the development of dysplasia or cancer. It may be appropriate to offer prophylactic colectomy to younger ulcerative colitis patients once their colitis has been established for a decade or more, as opposed to undergoing colonoscopy every year or two for the remainder of their lives. 3 figures, 3 tables, 10 references.
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Differing Attitudes Toward Virtual and Conventional Colonoscopy for Colorectal Cancer Screening: Surveys Among Primary Care Physicians and Potential Patients Source: American Journal of Gastroenterology. 96(3):887-893, March 2001.
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Summary: Researchers examined attitudes of primary care physicians and potential screening patients toward computed tomography colonoscopy (virtual colonoscopy) and conventional colonoscopy for colorectal cancer (CRC) screening. Investigators sent questionnaires by mail or E-mail to 1,000 physicians across the United States and 400 potential patients. Both questionnaires asked respondents about their preferences for virtual and conventional colonoscopy and the reasons for their preferences. Usable responses were received from 188 physicians (response rate 18.8 percent) and 323 potential patients (response rate 80.5 percent). On the basis of information about invasiveness, 76.6 percent of potential patients and 47.3 percent of physicians initially preferred virtual colonoscopy. When information about colon cleansing was given, the proportion of physicians and potential patients preferring virtual colonoscopy fell to 40.8 and 67.9 percent, respectively. When reminded that conventional colonoscopy, but not virtual colonoscopy, allows direct visualization of the colon, the proportion of physicians favoring virtual colonoscopy decreased further to 31.0 percent; however, the proportion of patients choosing virtual colonoscopy only dropped to 64.3 percent. When told that only conventional colonoscopy allows for the therapeutic intervention of polypectomy, the proportion of physicians favoring virtual colonoscopy dropped to 25.7 percent. The proportion of patients favoring virtual colonoscopy when given this information fell markedly to 47.0 percent. When informed that virtual colonoscopy does not require sedation, the proportion of physicians and patients favoring virtual colonoscopy rose to 51.6 and 67.4 percent, respectively. Across all questions, regardless of information provided, 60.2 percent of potential patients and 44.9 percent of physicians preferred virtual colonoscopy to conventional colonoscopy. Additionally, 82.3 percent of potential patients stated that they would comply more with recommendations for CRC screening and 61.7 percent of physicians would refer more patients for screening if virtual colonoscopy was available. Researchers conclude that potential patients preferred virtual to conventional colonoscopy, whereas physicians favored conventional colonoscopy. Physicians placed more importance on the ability of conventional colonoscopy to visualize the colonic mucosa directly and the opportunity for therapy. Potential patients were more encouraged than physicians by the availability of virtual colonoscopy to improve participation in CRC screening. 2 figures, 8 tables, 19 references. ·
Colorectal Cancer: Not an Equal Opportunity Cancer (Editorial) Source: Gastroenterology. 120(4):1043-1046, March 2001.
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Summary: The author discusses racial and ethnic variations in colorectal cancer (CRC) incidence and mortality in the United States. The discussion focuses on two issues: (1) Why it is important to understand racial and ethnic variations in CRC incidence and mortality; and (2) why Americans of every race and ethnic group are not getting screened for CRC. The discussion specifically considers (1) CRC risk associated with race and ethnicity, (2) public perception and awareness of CRC, and (3) barriers to CRC screening. Rates of participation in screening are better if it is recommended by health care providers. The communication of risk of disease and benefits of screening to ethnic minorities may be especially ineffective. The process of risk communication to minorities has received little attention despite the fact that some groups suffer disproportionately from certain diseases. If there are race/ethnicity cultural barriers to colon screening, the author notes that one must study and understand these obstacles and develop appropriate educational tools. Important barriers to screening include lack of payment by insurers and lack of access to health care. The fact that a large proportion of the medically uninsured are black and fall into a higher risk group that is most likely to benefit from colon screening highlights the importance of finding a remedy for this problem. 21 references. ·
Colon Cancer in Women Source: Association of Women's Health, Obstetric and Neonatal Nurses Lifelines. 5(3):26-32, June 2001. Summary: The author provides women's health care nurses with information on basic genetic concepts, the role of genes in the development of cancer, and cancer syndromes and cancer genetic services regarding colon cancer. Colon cancer genes are dominant, meaning that a single copy can greatly increase an individual's cancer risk. All cancers are genetic in origin, but hereditary cancer results from (1) the presence of a genetic mutation in a germ cell that is reproduced in every cell of an individual's body, (2) the somatic mutation of the other gene in that pair, and (3) additional somatic mutations in the same cell line until control of cell growth and differentiation is lost. The two most common hereditary colon cancer syndromes are hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). HNPCC is characterized by (1) the presence of syndrome cancers in many individuals within a family, (2) more than one primary cancer in an individual, (3) high incidence of colon cancers, (4) early age at onset, and (5) proximal location of most of the cancers. The risk for colon cancer in an HNPCC mutation carrier is 85 to 90 percent for males and as low as 54 percent for females. FAP is characterized by (1) the presence of hundreds
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to thousands of polyps in the colon, (2) average age at polyp onset of 15 years, and (3) 100 percent risk of colon cancer if left untreated by the fourth decade. The author provides information on managing HNPCC and FAP. When a hereditary colon cancer syndrome is diagnosed families can benefit from genetic counseling and genetic testing. The author concludes that women's health nurses are in an ideal position to promote and support the cancer screening recommendations and to help with overcoming barriers to screening among female mutation carriers. 2 figures, 2 tables, 15 references. ·
One-time Screening for Colorectal Cancer With Combined Fecal Occult-blood Testing and Examination of the Distal Colon Source: New England Journal of Medicine. 345(8):555-560, August 23, 2001. Summary: Researchers examined the effectiveness of one-time screening with the fecal occult blood test (FOBT) combined with examination of the distal colon by sigmoidoscopy (SIG) for detecting colorectal cancer (CRC). They recruited 3,121 asymptomatic patients seen at 13 Veterans Affairs centers between February 1994 and January 1997 for the study. The patients provided 3 consecutive days of stool samples on cards for FOBT testing; samples were rehydrated for interpretation. The patients then underwent colonoscopy (COL). Researchers considered examination of the rectum and sigmoid colon during COL as SIG. Of the 3,121 participants, 2,885 returned their FOBT cards before COL. The mean age of this group was 63.0 years, 96.8 percent were men, and 14.2 percent reported having a first degree relative with CRC. Results indicated that 1,319 participants (45.7 percent) had no polypoid lesions. In 472 (16.4 percent), the most advanced lesions were hyperplastic polyps or nonadenomatous polyps, and in 788 (27.3 percent), the most advanced finding was one or more tubular adenomas less than 10 millimeters in diameter. Advanced neoplasia was detected in 306 patients (10.6 percent). Of these, 182 had advanced neoplasia in the distal colon and 150 in the proximal colon. Altogether, 143 had one or more large tubular adenomas, 90 had an adenoma with villous features, 49 had an adenoma with high-grade dysplasia, and 24 had invasive cancer. Seventy-three patients (23.9 percent) with advanced neoplasia had a positive FOBT. When compared with patients who had a negative FOBT, the relative risk of advanced neoplasia in patients with a positive FOBT was 3.47. SIG identified 70.3 percent of all patients with advanced neoplasia. Combined one-time screening with FOBT and SIG identified 75.8 percent of patients with advanced neoplasia. Researchers conclude that one-time screening of asymptomatic persons with the FOBT plus SIG fails to identify about
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one quarter of those with advanced neoplasia and about half of those with advanced proximal neoplasia. Clinicians should not feel confident that advanced neoplasia can be ruled out when the results of one-time combined testing are negative. Screening programs that use FOBT plus SIG may be more effective if the tests are repeated at appropriate intervals. 4 tables, 21 references. ·
Screening for Colorectal Cancer: Developing a Preventive Healthcare Program Utilizing Nurse Endoscopists Source: Gastroenetrology Nursing. 24(1):12-19, January-February 2001. Summary: The authors discuss screening for colorectal cancer (CRC) and the development of a CRC screening program incorporating nurse endoscopists at Northwestern Memorial Hospital (NMH), Chicago, Illinois. The program was developed and implemented during the creation of the Colon Cancer Screening Center (CCSC), a component of NMH's comprehensive gastrointestinal oncology program in 1997. The goals of the CCSC's CRC screening program were to (1) provide a unique early cancer detection program in the Chicago metropolitan area, (2) become a leader in early detection of CRC through screening, (3) provide a referral service to physicians within NMH that provides screening and preventive health education, and (4) develop a clinical database to track clinical outcomes and trends in patient compliance. The authors discuss aspects of developing the program that may be useful for other institutions interested in developing a similar program, including (1) the institutional marketing research process, (2) training nurse endoscopists and developing benchmark data to evaluate their training, (3) operational planning/advertising strategies, (4) implementing a program similar to the CCSC-based program, and (5) program evaluation. To date, 745 patients age 50 to 64 years old have been screened. Of these, 14 percent were referred for colonoscopy for multiple polyps or adenomas. One rectal carcinoma was identified. There were no complications from the procedures. 4 tables, 11 references.
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Virtual Colonoscopy: A New Approach for Colorectal Cancer Screening Source: Gastroenterology Nursing. 24(1):5-11, January-February 2001. Summary: The author discusses virtual colonoscopy (VC) as a new approach for colorectal cancer (CRC) screening. The article (1) presents background information on CRC screening; (2) summarizes the American Cancer Society (ACS) guidelines for CRC screening; (3) discusses the various types of VC, including a summary of clinical studies of VC; (4) discusses safety issues of VC; (5) discusses the procedural aspects of VC;
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(6) discusses the advantages of VC relative to standard colonoscopy (SC); (7) summarizes the challenges of VC; and (8) considers future implications of CRC screening with VC. VC is a tomographic technique that can display computer images of the colon in an anatomical life-like format to facilitate image interpretation and improve diagnostic accuracy. There are three types of VC: (1) Computed tomography (CT) pneumocolonoscopy, (2) CT colography, and (3) VC. All three techniques use bowel cleansing, air insufflation, smooth muscle relaxation, and helical CT data acquisition. The differences between the procedures stem from the manner in which the data are manipulated. In CT pneumocolonoscopy, CT data are interpreted in the conventional radiologic manner. CT colography involves a CT of the colon in which a small section is examined and displayed in a two-dimensional image, supplemented with three-dimensional images. VC is the interactive realtime navigation through the colon to simulate SC. Approximately 2,000 VC examinations have been performed worldwide. VC has been reported to have a sensitivity of 80 percent for detecting CRC and polyps greater than 10 millimeter. Its specificity has been reported to be 90 percent. An advantage of VC is that it does not require sedation. No perforations have been reported with VC. VC has the potential to examine the entire colon in substantially less time than SC. Although VC is comfortable for the patient, the patient still has to undergo a bowel preparation similar to that required for SC. The amount and time of insufflation, however, is less than that of SC, producing less discomfort for the patient. The author notes that VC appears to have tremendous potential for improving patient acceptance as a screening method for CRC. VC also appears to be an excellent method for implementing the current ACS guidelines for screening men and women at average risk for CRC beginning at age 50. 3 figures, 1 table, 39 references. ·
Use of Colonoscopy to Screen Asymptomatic Adults for Colorectal Cancer Source: Gastrointestinal Endoscopy. 53(7):832-834, June 2001. Summary: The first two authors discuss the results of two large studies evaluating the reliability and accuracy of different methods of screening for colorectal cancer. The first study indicated that 2.7 percent of patients with no polyps in the portion of the colon distal to the splenic flexure had advanced proximal neoplasms. The other study found that a distal adenoma was not a reliable predictor of advanced proximal neoplasia; only 46 percent of patients with an advanced proximal lesion had a distal polyp that would have been detected by screening sigmoidoscopy. In another study on double contrast barium enema, only 48 percent of large
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adenomas found by colonoscopy were detected by barium enema. The authors conclude that the most accurate and reliable evaluation currently available is colonoscopy. In a response, Lieberman discusses issues of effectiveness, risk, cost, and resources that need to be considered before embracing colonoscopy as a primary screening tool. A response by Imperiale and Ransohoff indicates that they do not consider that the data from these studies justifies a recommendation for universal colonoscopy. Instead, the two studies should be scrutinized for strength and robustness, supplemented by an assessment of whether additional studies of colonoscopic screening are still needed. Information on risk factors should be used to stratify risk among those now considered average-risk persons. Colonoscopy could be extended to increased-risk persons, while its use among average-risk persons could be deferred. ·
Colorectal Cancer Screening in North Carolina: Community Clinicians' Perspectives Source: North Carolina Medical Journal. 62(5):292-297, SeptemberOctober, 2001. Summary: Researchers conducted a survey to assess community clinicians' perspectives on colorectal cancer screening in North Carolina. Between November 1997 and May 1998, they sent a self-administered questionnaire to family practitioners, general practitioners, and general internists who were actively practicing in primary care settings. The questionnaire assessed (1) personal characteristics, (2) practices of colon cancer screening with fecal occult blood testing (FOBT) and flexible sigmoidoscopy (FS), and (3) attitudes toward and barriers to using FS. Of 1,333 physicians contacted, 736 (55 percent) provided usable responses. Results showed that (1) most respondents were male family practitioners in group practice; (2) 97 percent recommended periodic screening with FOBT; (3) of those recommending FOBT, 35 percent said that annual screening should start at age 50 years; and (4) 79 percent thought that the proper screening interval was once a year. Other results showed that (1) 92 percent recommended screening with FS, (2) 43 percent performed FS themselves, and (3) 85 percent agreed with recommendations that screening with FS should begin at age 50 years and be repeated every 3 to 5 years. Perceived barriers to FS differed according to respondents' experience with the procedure. Among practitioners who recommended FS but did not perform this procedure themselves, barriers included time constraints, equipment costs, inadequate reimbursement, and regulatory restrictions. Half of the respondents had received training in FS as medical residents. The most common perceived patient barrier to FOBT was inconvenience, and to FS was fear of pain and discomfort. The
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researchers conclude that there is a need to find ways to encourage physicians to promote colorectal cancer screening to their patients. 4 tables, 20 references. ·
Colon Cancer Screening With Virtual Colonoscopy: Promise, Polyps, Politics Source: American Journal of Roentgenology. 177(5):975-988, November 2001. Summary: The author discusses virtual colonoscopy as a potential primary means of screening for colon cancer, which could return radiologists to a major role in the prevention of colon cancer. Research suggests that its accuracy is comparable to conventional colonoscopy in detecting polyps of significant size (greater than 10 mm), with few false positives. Virtual colonoscopy has heightened awareness of the natural history of colonic polyps, especially in terms of identifying an appropriate target size for detection in colorectal screening programs. Polyps under 10 mm are often either hyperplastic on histology or unlikely to progress to frank cancer in the patient's lifetime, so they are of little clinical significance for the average adult. The rationale for detecting and removing every colonic polyp regardless of size has come under increasing scrutiny in the context of cost-benefit analysis of various test strategies for colorectal cancer screening. Virtual colonoscopy may allow patients to receive reliable information about the status of their colonic mucosa noninvasively, therefore making more informed decisions about whether to proceed to conventional colonoscopy for polypectomy. Cancer researchers are working to improve the speed of image analysis, use of computer-assisted methods for polyp detection, magnetic resonance colonography, and oral contrast tagging of fecal contents in order to avoid the need for rigorous bowel preparation, thus improving patient compliance. 10 figures, 3 tables, 87 references.
Federally Funded Research on Colon Cancer The U.S. Government supports a variety of research studies relating to colon cancer and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.26 CRISP
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control 26
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(Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to colon cancer and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore colon cancer and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for colon cancer: ·
Project Title: Apoptosis in Colon Cancer Chemoprevention Principal Investigator & Institution: Gerner, Eugene W.; Professor; None; University of Arizona Tucson, Az 85721 Timing: Fiscal Year 2001; Project Start 1-JUL-1997; Project End 1-DEC2005 Summary: Colon cancer remains the second leading cause of cancer death in the United States of America, affecting both males and females. The major theme of this program is the study of apoptosis in colon carcinogenesis and colon cancer chemoprevention. Studies in experimental rodent models and humans indicate that genetic and intestinal luminal risk factors decrease cell turnover, in part by decreasing apoptosis, in normal and neoplastic colonic tissues. Intestinal luminal risk factors include the secondary bile acids, which are affected by both genetic and dietary factors. Our program addresses both genetic and intestinal luminal risk factors, as we hypothesize that common signaling and metabolic pathways downstream of both these factors mediate cell turnover in colonic tissues and, subsequently, colon cancer risk. A corollary of this hypothesis is that these downstream pathways are rational targets for colon cancer chemoprevention strategies in humans. To test this hypothesis, we have designed projects and cores that are interactive and complementary. One project studies biochemical effectors of genes, including the Ki-ras oncogene and the APC and p53 tumor suppressor genes, which are frequently mutated in human colon cancers. A second project focuses on the role of nitric oxide in bile acid
and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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induced apoptosis. The third project emphasizes studies of the AP-1 transcription factor, which is involved in signaling pathways mediated by both APC and bile acids. The specific aims of the projects are to determine the roles of genetic and intestinal luminal risk factors in cell turnover in colonic tissues, to describe mechanisms underlying these processes, and to investigate the consequences of specific pharmacological and/or dietary interventions on cell turnover and colon carcinogenesis. The projects will address these aims using genetically altered cell culture and rodent models of colon cancer, and a variety of biochemical, molecular and cellular biology technologies. Four cores provide support in cell and tissue pathology, breeding and maintaining genetically altered rodent models of colon carcinogenesis, biometry and administration and evaluation. The long-term goal of the Apoptosis in Colon Cancer Chemoprevention Program Project Grant is to understand mechanisms of colon carcinogenesis in humans and then to use this information to establish the rational for strategies of colon cancer prevention and/or treatment. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Biological Evaluation of ZD1839 in Colon Cancer Principal Investigator & Institution: Hidalgo, Manuel; Associate Professor of Oncology; Oncology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 9-SEP-2002; Project End 1-AUG2004 Summary: (provided by applicant): The epidermal growth factor receptor (EGFR) is a transmembrane receptor involved in the transduction of proliferative and survival signals which is overexpressed in up to 50 % of patients with colon cancer. Preclinical data suggest that pharmacological inhibition of the EGFR results in tumor growth inhibition and, therefore, the EGFR represents a potential target for cancer therapy. ZD1839 is a novel, orally available, small molecule inhibitor of the EGFR in clinical development. Important questions in the development of this agent, as well as other mechanistic based compounds are the definition of patient populations more likely to respond to the drug based on the presence and functionality of the target pathway in tumor tissues and the assessment of target inhibition in clinical trials. This proposal outlines a series of clinical, pharmacological and biological studies of ZD1839 in patients with colon cancer. Our long term goal is to develop ZD1839 for the treatment of patients with colon cancer, as well as with other EGFRdriven tumors, utilizing rationally derived biological concepts based on the putative mechanism of action of the agent. The specific aims of this
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proposal are: Specific Aim # 1: to determine the relationship between expression and activation of the EGFR receptor in malignant tissues and the activity of ZD1839 in patients with colon cancer, Specific Aim # 2: to characterize the effects of ZD1839 on the activation and signaling of the EGFR in tumor and normal tissues of patients with colon cancer who are treated with ZD1839; and, Specific Aim # 3: to relate the pharmacodynamic effects of ZD 1839 to relevant indices of clinical activity. Patients with advanced, measurable, colon cancer will be treated with ZD1839 at a dose of 500 mg/day on a protracted oral dosing schedule. Tumor tissues, normal skin tissues, and plasma will be collected at baseline and 28 days post-treatment. The expression and activation of the EGFR will be determined using validated immunohistochemical methods developed at our institutions. The result from the biological studies will be correlated with indices of drug activity. These results will provide hypothesis-generating data regarding the subset of colon cancer patients more likely to benefit from treatment with this agent as well as information regarding the biological activity of ZD1839 in colon cancer. Collectively, these data will impact in the future development of ZD1839 in patients with colon cancer as well as other tumor types. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Gene Expression Changes in Metastatic Colon Cancer Principal Investigator & Institution: Guan, Rong J.; Beth Israel Deaconess Medical Center 330 Brookline Ave Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-APR-2000; Project End 1-OCT2000 Summary: The most life-threatening aspects of colon cancer are invasion and metastasis. Genetic alterations likely play a crucial role in the pathogenesis of colon cancer metastasis. Therefore, one of the most important issues in cancer research is to understand the genetic alterations in metastasis. The goal of this application is to analyze gene expression changes in metastatic colon cancer. By using differential display, we have identified 19 genes expressed differentially between primary and metastatic colon cancer. In preliminary studies, we found that a novel gene called 055 is not expressed in metastatic colon cancer tissues or a metastatic colon cancer cell line (SW620). Overexpression of 055 in SW620 increased expression of several cell differentiation markers such as E-cadherin, CEA and alkaline phosphatase and induced morphological changes consistent with cell differentiation. The expression of 055 is upregulated by several known cell differentiation reagents. Our preliminary studies show that overexpression of 055 in
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SW620 colon cancer cells suppressed in vitro invasion into matrigel and in vivo liver metastasis in nude mice. Our workings hypothesis is that the 055 gene suppresses metastasis by inducing colon cancer cell differentiation and reversing the malignant phenotype. Therefore, we propose: (1) to investigate the expression and function of 055 protein in normal and neoplastic colonic epithelial cells. This will include studying: (a) subcellular localization of the 055 gene in colon cancer cell lines; the expression of 055 protein in normal colon tissues, adenomas, primary and metastatic colon cancers by immunohistochernistry. (b) the in vitro and in vivo adhesion and invasion properties of metastatic colon cancer cells transfected with 055 gene, or primary colon cancer cells transfected with 055 antisense DNA; (c) the mechanism of 055 in regulation of E-cadherin expression and cell differentiation. (2) to study the mechanism of aberrant regulation of 055 gene in metastaric colon cancer. This will be accomplished by: (a) nuclear run-off assay to determine the rate of transcription. Should run-off assay and promoter studies fail to detect difference in rate of transcription between primary and metastatic colon cancer cells, a mRNA decay assay to assess the mRNA stability will be performed. (B) cloning and analyzing the promoter region of the 055 gene. Chloramphenicol acetyltransferase (CAT) gene assay will be used to assess the activities of normal 055 promoter in both primary and metastatic colon cancer cells. (c) Analyzing the role of DNA methylation in regulation of 055 expression. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Gene Expression of Colon Cancers That Metastasize Principal Investigator & Institution: Markowitz, Sanford D.; Ingalls Professor of Cancer Genetics; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000; Project Start 0-AUG-2000; Project End 1-JAN2005 Summary: This proposal will test the hypothesis that differences in patterns of gene expression determine the differing biologic behaviors between colon cancers that are curable with primary surgical therapy and those that ultimately metastasize to the liver and kill. Additionally, we hypothesize that in colon cancer primary tumors, only a minority of cells will be "prometastatic", that is competent to give rise to liver metastases, and that assays of whole primary tumor lysates may thus fail to distinguish the crucial presence or absence of this "prometastatic" subpopulation. To test these hypotheses, Dr. Sanford Markowitz and his colleagues in the cancer genetics program at the Case Western Reserve University-NCI designated Comprehensive Cancer Center have forged a
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collaboration with Eos Biotechnology, Inc., a leader in gene expression array technology. The collaboration aims to establish an accurate molecular classification of colon cancer by focusing on a unique collection of surgically resected colon cancer liver metastases, all of whose cells have in vivo demonstrated metastatic ability. Using the Affymetrix human 40K GeneChip expression array technology, these investigators will generate a comprehensive description of global gene expression of these liver metastases. Comparing these liver metastases versus control nonmetastatic colon cancers, that were all cured by surgical excision, will specify a set of metastases specific genes whose expression defines a "metastatic signature." The goal of identifying those colon cancer primary tumors that can metastasize will be achieved by showing that they bear "prometastatic" cells recognizable by in situ hybridization assay of "metastatic signature" genes. Project aims are: i) To elucidate the "metastatic signature" by comparing on Affymetrix arrays colon cancer liver metastases versus non-metastatic colon cancer primary tumors. ii) To identify among metastases signature genes those specifying early metastatic events detectable by array analyses of colon cancer primary tumors that did metastasize. iii) To use in situ hybridization to confirm the metastatic signature of liver metastases arises from colon epithelial cells. iv) To use in situ hybridization to detect expression of metastatic signature genes by prometastatic cells in colon cancer primary tumors that are simultaneous with lever metastases or are precursor of liver metastases relapse. v) To use in situ hybridization to determine the areas of maximum concentration of "prometastatic" cells in colon cancer primary tumors. vi) To validate the metastatic signature and show it has prognostic power in an independent validation archive of 350 colon cancers. vii) To develop immunohistochemical assays for detection of the metastatic signature. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central27 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).28 Access Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 28 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 27
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to this growing archive of e-journals is free and unrestricted.29 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “colon cancer” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for colon cancer in the PubMed Central database: ·
Cell Cycle Regulation of Metallothionein in Human Colonic Cancer Cells by WW Nagel and BL Vallee; 1995 January 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42785
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Controversy:Population-based fecal occult blood screening for colon cancer: Will the benefits outweigh the harm? by Kenneth G. Marshall; 2000 September 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80462
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CpG island methylator phenotype in colorectal cancer by Minoru Toyota, Nita Ahuja, Mutsumi Ohe-Toyota, James G. Herman, Stephen B. Baylin, and Jean-Pierre J. Issa; 1999 July 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17576
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Cyclooxygenase-2 expression in human colon cancer cells increases metastatic potential by Masahiko Tsujii, Sunao Kawano, and Raymond N. DuBois; 1997 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20370
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De novo Decorin Gene Expression Suppresses the Malignant Phenotype in Human Colon Cancer Cells by M Santra, T Skorski, B Calabretta, EC Lattime, and RV Iozzo; 1995 July 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41462
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Distinct Hypermethylation Patterns Occur at Altered Chromosome Loci in Human Lung and Colon Cancer by M Makos, BD Nelkin, MI Lerman, F Latif, B Zbar, and SB Baylin; 1992 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=48567
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Effect of 2[prime prime or minute]-O-methyl antisense ORNs on expression of thymidylate synthase in human colon cancer RKO cells by John C. Schmitz, Dong Yu, Sudhir Agrawal, and Edward Chu; 2001 January 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29681
The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 29
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Epidermal growth factor receptor activation induces nuclear targeting of cyclooxygenase-2, basolateral release of prostaglandins, and mitogenesis in polarizing colon cancer cells by Robert J. Coffey, Chris J. Hawkey, Lars Damstrup, Ramona Graves-Deal, Vincent C. Daniel, Peter J. Dempsey, Rebecca Chinery, Susan C. Kirkland, Raymond N. DuBois, Thomas L. Jetton, and Jason D. Morrow; 1997 January 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19569
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ETS1 Suppresses Tumorigenicity of Human Colon Cancer Cells by H Suzuki, V Romano-Spica, TS Papas, and NK Bhat; 1995 May 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41960
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Fine Mapping of Colon Tumor Susceptibility (Scc) Genes in the Mouse, Different from the Genes Known to be Somatically Mutated in Colon Cancer by CJA Moen, PC Groot, AAM Hart, M Snoek, and P Demant; 1996 February 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40034
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Frameshift-mutation-derived peptides as tumor-specific antigens in inherited and spontaneous colorectal cancer by Ingvil Saeterdal, Jens Bjorheim, Kari Lislerud, Marianne K. Gjertsen, Ida K. Bukholm, Ole Christian Olsen, Jahn M. Nesland, Jon Amund Eriksen, Mona Moller, Annika Lindblom, and Gustav Gaudernack; 2001 November 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60857
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Genetic disruption of PPAR[delta] decreases the tumorigenicity of human colon cancer cells by Ben Ho Park, Bert Vogelstein, and Kenneth W. Kinzler; 2001 February 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=30184
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Hereditary nonpolyposis colon cancer by Edmond G. Lemire; 2001 November 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81612
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High Expression of the DNA Methyltransferase Gene Characterizes Human Neoplastic Cells and Progression Stages of Colon Cancer by WS El-Deiry, BD Nelkin, P Celano, RC Yen, JP Falco, SR Hamilton, and SB Baylin; 1991 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51469
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HLTF gene silencing in human colon cancer by Helen R. Moinova, WeiDong Chen, Lanlan Shen, Dominic Smiraglia, Joseph Olechnowicz, Lakshmeswari Ravi, Lakshmi Kasturi, Lois Myeroff, Christoph Plass,
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Ramon Parsons, John Minna, James K. V. Willson, Sylvan B. Green, JeanPierre Issa, and Sanford D. Markowitz; 2002 April 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=123687 ·
Human Colorectal Cancers Display Abnormal Fourier-Transform Infrared Spectra by B Rigas, S Morgello, IS Goldman, and PTT Wong; 1990 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54908
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JC virus DNA is present in the mucosa of the human colon and in colorectal cancers by Luigi Laghi, Ann E. Randolph, D. P. Chauhan, Giancarlo Marra, Eugene O. Major, James V. Neel, and C. Richard Boland; 1999 June 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22112
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Limited Up-Regulation of DNA Methyltransferase in Human Colon Cancer Reflecting Increased Cell Proliferation by PJ Lee, LL Washer, DJ Law, CR Boland, IL Horon, and AP Feinberg; 1996 September 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38390
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Liver Colonization Competence Governs Colon Cancer Metastasis by T Kuo, T Kubota, M Watanabe, T Furukawa, T Teramoto, K Ishibiki, M Kitajima, AR Moosa, S Penman, and RM Hoffman; 1995 December 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40301
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Mad-1 Is the Exclusive JC Virus Strain Present in the Human Colon, and Its Transcriptional Control Region Has a Deleted 98-Base-Pair Sequence in Colon Cancer Tissues by Luigi Ricciardiello, Dong K. Chang, Luigi Laghi, Ajay Goel, Christina L. Chang, and C. Richard Boland; 2001 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=115147
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Models of Human Metastatic Colon Cancer in Nude Mice Orthotopically Constructed by Using Histologically Intact Patient Specimens by X Fu, JM Besterman, A Monosov, and RM Hoffman; 1991 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52711
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Molecular karyotype (amplotype) of metastatic colorectal cancer by unbiased arbitrarily primed PCR DNA fingerprinting by Sergei Malkhosyan, Jun Yasuda, Jose Luis Soto, Takao Sekiya, Jun Yokota, and Manuel Perucho; 1998 August 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21480
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Nuclear Matrix Proteins in Human Colon Cancer by SK Keesee, MD Meneghini, RP Szaro, and Y Wu; 1994 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43274
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p21WAF1 is required for butyrate-mediated growth inhibition of human colon cancer cells by Sonia Y. Archer, Shufen Meng, Amy Shei, and Richard A. Hodin; 1998 June 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22637
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p53 Mutations in Colorectal Cancer by NR Rodrigues, A Rowan, MEF Smith, IB Kerr, WF Bodmer, JV Gannon, and DP Lane; 1990 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54786
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Patterns of Gene Expression that Characterize the Colonic Mucosa in Patients at Genetic Risk for Colonic Cancer by LH Augenlicht, J Taylor, L Anderson, and M Lipkin; 1991 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51431
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Potential role and chronology of abnormal expression of the Deleted in Colon Cancer (DCC) and the p53 proteins in the development of gastric cancer by Francesco Graziano, Stefano Cascinu, Maria Pia Staccioli, Vincenzo Catalano, Maria Cristina Rossi, Anna Maria Baldelli, Paolo Giordani, Pietro Muretto, and Giuseppina Catalano; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=37544
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Prostacyclin-mediated activation of peroxisome proliferator-activated receptor [delta] in colorectal cancer by Rajnish A. Gupta, Jian Tan, Wade F. Krause, Mark W. Geraci, Timothy M. Willson, Sudhansu K. Dey, and Raymond N. DuBois; 2000 November 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27215
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Prostaglandin H Synthase 2 is Expressed Abnormally in Human Colon Cancer: Evidence for a Transcriptional Effect by W Kutchera, DA Jones, N Matsunami, J Groden, TM McIntyre, GA Zimmerman, RL White, and SM Prescott; 1996 May 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39362
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Receptor protein tyrosine kinase EphB4 is up-regulated in colon cancer by Sally-Anne Stephenson, Stefan Slomka, Evelyn L. Douglas, Peter J. Hewett, and Jennifer E. Hardingham; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64642
140 Colon Cancer
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Synchronous Cardiac Myxoma and Colorectal Cancer: A Case Report by Ismael N. Nuno, Tyler Y. Kang, Hector Arroyo, and Vaughn A. Starnes; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=101182
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.30 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with colon cancer, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “colon cancer” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “colon cancer” (hyperlinks lead to article summaries): ·
#12 Limited social support or religious involvement as risk factors for colon cancer. Author(s): Kinney A, Marshall E, Dudley W, Martin C, Sandler R. Source: Annals of Epidemiology. 2002 October; 12(7): 494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12377438&dopt=Abstract
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A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Author(s): Greene FL, Stewart AK, Norton HJ. Source: Annals of Surgery. 2002 October; 236(4): 416-21; Discussion 421. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12368669&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A novel lymphatic mapping technique to improve localization and staging of early colon cancer during laparoscopic colectomy. Author(s): Tsioulias GJ, Wood TF, Spirt M, Morton DL, Bilchik AJ. Source: The American Surgeon. 2002 July; 68(7): 561-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12132733&dopt=Abstract
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Activity and properties of alpha-L-fucosidase are dependent on the state of enterocytic differentiation of HT-29 colon cancer cells. Author(s): Merino-Trigo A, Rodriguez-Berrocal FJ, de Miguel E, Paez de la Cadena M. Source: The International Journal of Biochemistry & Cell Biology. 2002 October; 34(10): 1291-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12127580&dopt=Abstract
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Adenovirus-mediated gene transfer of P16INK4/CDKN2 into baxnegative colon cancer cells induces apoptosis and tumor regression in vivo. Author(s): Tamm I, Schumacher A, Karawajew L, Ruppert V, Arnold W, Nussler AK, Neuhaus P, Dorken B, Wolff G. Source: Cancer Gene Therapy. 2002 August; 9(8): 641-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12136424&dopt=Abstract
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Adjuvant Chemotherapy in Stage III Colon Cancer with 5-Fluorouracil and Levamisole versus 5-Fluorouracil and Leucovorin. Author(s): Dencausse Y, Hartung G, Sturm J, Kopp-Schneider A, Hagmuller E, Wojatschek C, Lindemann H, Fritze D, Queisser W. Source: Onkologie. 2002 October; 25(5): 426-430. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12415196&dopt=Abstract
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Adjuvant Chemotherapy Use for Medicare Beneficiaries With Stage II Colon Cancer. Author(s): Schrag D, Rifas-Shiman S, Saltz L, Bach PB, Begg CB. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 October 1; 20(19): 3999-4005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12351597&dopt=Abstract
142 Colon Cancer
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Angiogenesis inhibitor TNP-470 suppresses growth of peritoneal disseminating foci of human colon cancer line Lovo. Author(s): Fan YF, Huang ZH. Source: World Journal of Gastroenterology : Wjg. 2002 October; 8(5): 853856. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12378629&dopt=Abstract
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Anti-tumor efficacy of a novel antisense anti-MDM2 mixed-backbone oligonucleotide in human colon cancer models: p53-dependent and p53-independent mechanisms. Author(s): Wang H, Nan L, Yu D, Lindsey JR, Agrawal S, Zhang R. Source: Molecular Medicine (Cambridge, Mass.). 2002 April; 8(4): 185-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12149568&dopt=Abstract
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Apoptosis induced by activation of peroxisome-proliferator activated receptor-gamma is associated with Bcl-2 and NF-kappaB in human colon cancer. Author(s): Chen GG, Lee JF, Wang SH, Chan UP, Ip PC, Lau WY. Source: Life Sciences. 2002 April 19; 70(22): 2631-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12269390&dopt=Abstract
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Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Author(s): Ko CY, Chang JT, Chaudhry S, Kominski G. Source: Surgery. 2002 August; 132(2): 268-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12219022&dopt=Abstract
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Base excision repair as a therapeutic target in colon cancer. Author(s): Liu L, Nakatsuru Y, Gerson SL. Source: Clinical Cancer Research: an Official Journal of the American Association for Cancer Research. 2002 September; 8(9): 2985-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12231545&dopt=Abstract
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Bile acids mimic oxidative stress induced upregulation of thioredoxin reductase in colon cancer cell lines. Author(s): Lechner S, Muller-Ladner U, Schlottmann K, Jung B, McClelland M, Ruschoff J, Welsh J, Scholmerich J, Kullmann F.
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Source: Carcinogenesis. 2002 August; 23(8): 1281-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12151345&dopt=Abstract ·
Biliary, fecal and plasma deoxycholic acid in rabbit, hamster, guinea pig, and rat: comparative study and implication in colon cancer. Author(s): Kasbo J, Saleem M, Perwaiz S, Mignault D, Lamireau T, Tuchweber B, Yousef I. Source: Biol Pharm Bull. 2002 October; 25(10): 1381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12392101&dopt=Abstract
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Bioinformatics-based discovery of a novel factor with apparent specificity to colon cancer. Author(s): De Young MP, Damania H, Scheurle D, Zylberberg C, Narayanan R. Source: In Vivo. 2002 July-August; 16(4): 239-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12224133&dopt=Abstract
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Blockade of Insulin-like Growth Factor I Receptor Function Inhibits Growth and Angiogenesis of Colon Cancer. Author(s): Reinmuth N, Liu W, Fan F, Jung YD, Ahmad SA, Stoeltzing O, Bucana CD, Radinsky R, Ellis LM. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3259-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374697&dopt=Abstract
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Cancer-related serological recognition of human colon cancer: identification of potential diagnostic and immunotherapeutic targets. Author(s): Scanlan MJ, Welt S, Gordon CM, Chen YT, Gure AO, Stockert E, Jungbluth AA, Ritter G, Jager D, Jager E, Knuth A, Old LJ. Source: Cancer Research. 2002 July 15; 62(14): 4041-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12124339&dopt=Abstract
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Capillary sodium dodecyl sulfate-DALT electrophoresis with laserinduced fluorescence detection for size-based analysis of proteins in human colon cancer cells. Author(s): Hu S, Jiang J, Cook LM, Richards DP, Horlick L, Wong B, Dovichi NJ.
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Source: Electrophoresis. 2002 September; 23(18): 3136-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12298085&dopt=Abstract ·
Characterisation of tumour-associated antigens in colon cancer. Author(s): Line A, Slucka Z, Stengrevics A, Silina K, Li G, Rees RC. Source: Cancer Immunology, Immunotherapy: Cii. 2002 December; 51(10): 574-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12384809&dopt=Abstract
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Chemoprevention of precursors to colon cancer by dehydroepiandrosterone (DHEA). Author(s): Osawa E, Nakajima A, Yoshida S, Omura M, Nagase H, Ueno N, Wada K, Matsuhashi N, Ochiai M, Nakagama H, Sekihara H. Source: Life Sciences. 2002 April 19; 70(22): 2623-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12269389&dopt=Abstract
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Co-expression of CD44v3 and heparanase is correlated with metastasis of human colon cancer. Author(s): Kuniyasu H, Chihara Y, Kubozoe T, Takahashi T. Source: International Journal of Molecular Medicine. 2002 September; 10(3): 333-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12165810&dopt=Abstract
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Colon cancer screening in the ambulatory setting. Author(s): Walsh JM, Posner SF, Perez-Stable EJ. Source: Preventive Medicine. 2002 September; 35(3): 209-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12202062&dopt=Abstract
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Colon cancer: detection and prevention. Author(s): Loren DE, Lewis J, Kochman ML. Source: Gastroenterology Clinics of North America. 2002 June; 31(2): 56586. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12134619&dopt=Abstract
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Colon cancer: prevention, diagnosis, treatment. Author(s): McCormick D, Kibbe PJ, Morgan SW.
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Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 2002 September-October; 25(5): 204-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12394397&dopt=Abstract ·
COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Author(s): Hazebroek EJ. Source: Surgical Endoscopy. 2002 June; 16(6): 949-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163961&dopt=Abstract
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Comments on E. Giovannucci, "Insulin, insulin-like growth factors and colon cancer: a review of the evidence". Author(s): Grant WB. Source: The Journal of Nutrition. 2002 August; 132(8): 2324; Discussion 2325. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163683&dopt=Abstract
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Conjugated linoleic acid (CLA) inhibits growth of Caco-2 colon cancer cells: possible mediation by oleamide. Author(s): Kim EJ, Jun JG, Park HS, Kim SM, Ha YL, Park JH. Source: Anticancer Res. 2002 July-August; 22(4): 2193-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12174903&dopt=Abstract
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Connexin 43, but not connexin 32, is mutated at advanced stages of human sporadic colon cancer. Author(s): Dubina MV, Iatckii NA, Popov DE, Vasil'ev SV, Krutovskikh VA. Source: Oncogene. 2002 July 25; 21(32): 4992-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12118378&dopt=Abstract
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Constipation, anthranoid laxatives, melanosis coli, and colon cancer: a risk assessment using aberrant crypt foci. Author(s): Nascimbeni R, Donato F, Ghirardi M, Mariani P, Villanacci V, Salerni B.
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Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2002 August; 11(8): 753-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163329&dopt=Abstract ·
Cyclooxygenase-2 inhibition augments the hepatic antitumor effect of oral Salmonella typhimurium in a model of mouse metastatic colon cancer. Author(s): Feltis BA, Sahar DA, Kim AS, Saltzman DA, Leonard AS, Sielaff TD. Source: Diseases of the Colon and Rectum. 2002 August; 45(8): 1023-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12195185&dopt=Abstract
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Cyclooxygenase-2 overexpression inhibits death receptor 5 expression and confers resistance to tumor necrosis factor-related apoptosisinducing ligand-induced apoptosis in human colon cancer cells. Author(s): Tang X, Sun YJ, Half E, Kuo MT, Sinicrope F. Source: Cancer Research. 2002 September 1; 62(17): 4903-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12208739&dopt=Abstract
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Cyclooxygenase-2 Overexpression Reduces Apoptotic Susceptibility by Inhibiting the Cytochrome c-dependent Apoptotic Pathway in Human Colon Cancer Cells. Author(s): Sun Y, Tang XM, Half E, Kuo MT, Sinicrope FA. Source: Cancer Research. 2002 November 1; 62(21): 6323-6328. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12414664&dopt=Abstract
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Decoding the cryptic origins of colon cancer. Author(s): Twombly R. Source: Environmental Health Perspectives. 2002 July; 110(7): A394-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12117656&dopt=Abstract
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Determination of histamine in the whole blood of colon cancer patients. Author(s): Previati M, Raspadori A, Bertolaso L, Parmeggiani A, Bindini
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D, Vitali C, Lanzoni I, Corbacella E, Saviano M, Fagioli F, Blo G, Capitani S. Source: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences. 2002 November 25; 780(2): 331-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12401359&dopt=Abstract ·
Diagnosis and management of hereditary colon cancer. Author(s): Cruz-Correa M, Giardiello FM. Source: Gastroenterology Clinics of North America. 2002 June; 31(2): 53749, X. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12134617&dopt=Abstract
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Effectiveness of Adjuvant Fluorouracil in Clinical Practice: A Population-Based Cohort Study of Elderly Patients With Stage III Colon Cancer. Author(s): Iwashyna TJ, Lamont EB. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 October 1; 20(19): 3992-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12351596&dopt=Abstract
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Effects of genetic blockade of the insulin-like growth factor receptor in human colon cancer cell lines. Author(s): Adachi Y, Lee CT, Coffee K, Yamagata N, Ohm JE, Park KH, Dikov MM, Nadaf SR, Arteaga CL, Carbone DP. Source: Gastroenterology. 2002 October; 123(4): 1191-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12360481&dopt=Abstract
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Efficacy of combination chemotherapy for stage IV colon cancer with extensive peritoneal dissemination and multiple liver metastases: A case report. Author(s): Mukai M, Oida Y, Mukoyama S, Okamoto Y, Ito I, Nakasaki H, Kawai K, Sato S, Makuuchi H. Source: Oncol Rep. 2002 November-December; 9(6): 1339-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12375045&dopt=Abstract
148 Colon Cancer
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Erosion of psoriatic plaques: an uncommon side-effect of neoadjuvant 5-fluorouracil treatment of colon cancer. Author(s): Wetzig T, Beckheinrich P, Rytter M, Haustein UF. Source: The British Journal of Dermatology. 2002 October; 147(4): 824-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12366448&dopt=Abstract
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Evaluation of telomerase in the development and progression of colon cancer. Author(s): Boldrini L, Faviana P, Gisfredi S, Zucconi Y, Di Quirico D, Donati V, Berti P, Spisni R, Galleri D, Materazzi G, Basolo F, Miccoli P, Pingitore R, Fontanini G. Source: International Journal of Molecular Medicine. 2002 November; 10(5): 589-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12373297&dopt=Abstract
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Evaluation of telomerase mRNA (hTERT) in colon cancer. Author(s): Boldrini L, Faviana P, Gisfredi S, Zucconi Y, Di Quirico D, Donati V, Berti P, Spisni R, Galleri D, Materazzi G, Basolo F, Miccoli P, Pingitore R, Fontanini G. Source: International Journal of Oncology. 2002 September; 21(3): 493-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12168091&dopt=Abstract
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Expression of human intestinal mucin is modulated by the betagalactoside binding protein galectin-3 in colon cancer. Author(s): Dudas SP, Yunker CK, Sternberg LR, Byrd JC, Bresalier RS. Source: Gastroenterology. 2002 September; 123(3): 817-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12198708&dopt=Abstract
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Expression of maspin in colon cancers: its relationship with p53 expression and microvessel density. Author(s): Song SY, Lee SK, Kim DH, Son HJ, Kim HJ, Lim YJ, Lee WY, Chun HK, Rhee JC. Source: Digestive Diseases and Sciences. 2002 August; 47(8): 1831-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12184537&dopt=Abstract
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Functional interaction of lithocholic acid conjugates with M3 muscarinic receptors on a human colon cancer cell line. Author(s): Cheng K, Chen Y, Zimniak P, Raufman J, Xiao Y, Frucht H. Source: Biochimica Et Biophysica Acta. 2002 October 9; 1588(1): 48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12379313&dopt=Abstract
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Further investigation of the modifying effect of various chemopreventive agents on apoptosis and cell proliferation in human colon cancer cells. Author(s): Zheng Q, Hirose Y, Yoshimi N, Murakami A, Koshimizu K, Ohigashi H, Sakata K, Matsumoto Y, Sayama Y, Mori H. Source: Journal of Cancer Research and Clinical Oncology. 2002 October; 128(10): 539-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12384797&dopt=Abstract
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Genetic and epigenetic alterations in colon cancer. Author(s): Grady WM, Markowitz SD. Source: Annual Review of Genomics and Human Genetics. 2002; 3: 10128. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12142355&dopt=Abstract
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Genetic polymorphisms in the cytochrome P450 1A1, glutathione Stransferase M1 and T1, and susceptibility to colon cancer. Author(s): Ye Z, Parry JM. Source: Teratogenesis, Carcinogenesis, and Mutagenesis. 2002; 22(5): 38592. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12210502&dopt=Abstract
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Genetic profiling of colon cancer. Author(s): Neibergs HL, Hein DW, Spratt JS. Source: Journal of Surgical Oncology. 2002 August; 80(4): 204-13. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12210035&dopt=Abstract
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Hepatic ischemia-reperfusion promotes liver metastasis of colon cancer.
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Author(s): Doi K, Horiuchi T, Uchinami M, Tabo T, Kimura N, Yokomachi J, Yoshida M, Tanaka K. Source: The Journal of Surgical Research. 2002 June 15; 105(2): 243-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12121713&dopt=Abstract ·
Huntingtin-interacting protein 1 is overexpressed in prostate and colon cancer and is critical for cellular survival. Author(s): Rao DS, Hyun TS, Kumar PD, Mizukami IF, Rubin MA, Lucas PC, Sanda MG, Ross TS. Source: The Journal of Clinical Investigation. 2002 August; 110(3): 351-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163454&dopt=Abstract
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Identification of Src transformation fingerprint in human colon cancer. Author(s): Malek RL, Irby RB, Guo QM, Lee K, Wong S, He M, Tsai J, Frank B, Liu ET, Quackenbush J, Jove R, Yeatman TJ, Lee NH. Source: Oncogene. 2002 October 17; 21(47): 7256-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12370817&dopt=Abstract
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Impact of insulin-like growth factor receptor-I function on angiogenesis, growth, and metastasis of colon cancer. Author(s): Reinmuth N, Fan F, Liu W, Parikh AA, Stoeltzing O, Jung YD, Bucana CD, Radinsky R, Gallick GE, Ellis LM. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 2002 October; 82(10): 1377-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12379772&dopt=Abstract
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In vitro and in vivo treatment of colon cancer by VIP antagonists. Author(s): Levy A, Gal R, Granoth R, Dreznik Z, Fridkin M, Gozes I. Source: Regulatory Peptides. 2002 November 15; 109(1-3): 127-133. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12409224&dopt=Abstract
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Incidental detection of colon cancer by FDG positron emission tomography in patients examined for pulmonary nodules. Author(s): Zhuang H, Hickeson M, Chacko TK, Duarte PS, Nakhoda KZ, Feng Q, Alavi A.
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Source: Clinical Nuclear Medicine. 2002 September; 27(9): 628-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12192279&dopt=Abstract ·
Increase in ceramide level alters the lysosomal targeting of cathepsin D prior to onset of apoptosis in HT-29 colon cancer cells. Author(s): De Stefanis D, Reffo P, Bonelli G, Baccino FM, Sala G, Ghidoni R, Codogno P, Isidoro C. Source: Biological Chemistry. 2002 June; 383(6): 989-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12222689&dopt=Abstract
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Inhibitory effect of a selective cyclooxygenase-2 inhibitor on liver metastasis of colon cancer. Author(s): Nagatsuka I, Yamada N, Shimizu S, Ohira M, Nishino H, Seki S, Hirakawa K. Source: International Journal of Cancer. Journal International Du Cancer. 2002 August 10; 100(5): 515-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12124799&dopt=Abstract
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Insulin-like Growth Factor 1 Induces Hypoxia-inducible Factor 1mediated Vascular Endothelial Growth Factor Expression, Which is Dependent on MAP Kinase and Phosphatidylinositol 3-Kinase Signaling in Colon Cancer Cells. Author(s): Fukuda R, Hirota K, Fan F, Jung YD, Ellis LM, Semenza GL. Source: The Journal of Biological Chemistry. 2002 October 11; 277(41): 38205-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12149254&dopt=Abstract
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Integrin alpha(v)beta6-associated ERK2 mediates MMP-9 secretion in colon cancer cells. Author(s): Gu X, Niu J, Dorahy DJ, Scott R, Agrez MV. Source: British Journal of Cancer. 2002 July 29; 87(3): 348-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12177807&dopt=Abstract
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Intraoperative radiation therapy for patients with recurrent rectal and sigmoid colon cancer in previously irradiated fields. Author(s): Pezner R, Chu D, Ellenhorn J.
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Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2002 July; 64(1): 47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12208575&dopt=Abstract ·
Intraoperative radiochromoguided mapping of sentinel lymph node in colon cancer. Author(s): Nastro P, Sodo M, Dodaro CA, Gargiulo S, Acampa W, Bracale U, Renda A. Source: Tumori. 2002 July-August; 88(4): 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12400991&dopt=Abstract
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Involvement of both extracellular signal-regulated kinase and c-jun Nterminal kinase pathways in the 12-O-tetradecanoylphorbol-13-acetateinduced upregulation of p21(Cip1) in colon cancer cells. Author(s): Lin SY, Liang YC, Ho YS, Tsai SH, Pan S, Lee WS. Source: Molecular Carcinogenesis. 2002 September; 35(1): 21-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12203364&dopt=Abstract
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Less cytotoxicity to combination therapy of 5-fluorouracil and cisplatin than 5-fluorouracil alone in human colon cancer cell lines. Author(s): Chen XX, Lai MD, Zhang YL, Huang Q. Source: World Journal of Gastroenterology : Wjg. 2002 October; 8(5): 841846. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12378627&dopt=Abstract
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Lymphocyte labile iron pool, plasma iron, transferrin saturation and ferritin levels in colon cancer patients. Author(s): Gackowski D, Kruszewsk M, Banaszkiewicz Z, Jawien A, Olinski R. Source: Acta Biochim Pol. 2002; 49(1): 269-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12136950&dopt=Abstract
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Mechanisms involved in development of resistance to adenovirusmediated proapoptotic gene therapy in DLD1 human colon cancer cell line. Author(s): Zhang L, Gu J, Lin T, Huang X, Roth JA, Fang B.
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Source: Gene Therapy. 2002 September; 9(18): 1262-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12215894&dopt=Abstract ·
Modulation of the Fas Signaling Pathway by IFN-gamma in Therapy of Colon Cancer: Phase I Trial and Correlative Studies of IFN-gamma, 5Fluorouracil, and Leucovorin. Author(s): Schwartzberg LS, Petak I, Stewart C, Turner PK, Ashley J, Tillman DM, Douglas L, Tan M, Billups C, Mihalik R, Weir A, Tauer K, Shope S, Houghton JA. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 August; 8(8): 2488-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12171874&dopt=Abstract
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Molecular screening for colon cancer in inflammatory bowel disease. Author(s): Malcomson RD, McGregor AH. Source: European Journal of Gastroenterology & Hepatology. 2002 October; 14(10): 1045-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12362091&dopt=Abstract
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Monoterpenes inhibit proliferation of human colon cancer cells by modulating cell cycle-related protein expression. Author(s): Bardon S, Foussard V, Fournel S, Loubat A. Source: Cancer Letters. 2002 July 26; 181(2): 187-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12175534&dopt=Abstract
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Multivisceral resection for colon cancer. Author(s): Luna-Perez P, Rodriguez-Ramirez SE, De la Barrera MG, Zeferino M, Labastida S. Source: Journal of Surgical Oncology. 2002 June; 80(2): 100-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12173378&dopt=Abstract
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Novel Detection and Differential Utilization of a c-myc Transcriptional Block in Colon Cancer Chemoprevention. Author(s): Wilson AJ, Velcich A, Arango D, Kurland AR, Shenoy SM, Pezo RC, Levsky JM, Singer RH, Augenlicht LH.
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Source: Cancer Research. 2002 November 1; 62(21): 6006-6010. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12414619&dopt=Abstract ·
Nr-CAM is a target gene of the beta-catenin/LEF-1 pathway in melanoma and colon cancer and its expression enhances motility and confers tumorigenesis. Author(s): Conacci-Sorrell ME, Ben-Yedidia T, Shtutman M, Feinstein E, Einat P, Ben-Ze'ev A. Source: Genes & Development. 2002 August 15; 16(16): 2058-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12183361&dopt=Abstract
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Nuclear matrix protein alterations associated with colon cancer metastasis to the liver. Author(s): Brunagel G, Schoen RE, Bauer AJ, Vietmeier BN, Getzenberg RH. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3039-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374670&dopt=Abstract
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Nuclear Matrix Proteins as Proteomic Markers of Preneoplastic and Cancer Lesions: Commentary re: G. Brunagel et al., Nuclear Matrix Protein Alterations Associated with Colon Cancer Metastasis to the Liver. Clin. Cancer Res., 8: 3039-3045, 2002. Author(s): Coffey DS. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3031-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374668&dopt=Abstract
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Nutritional chemoprevention of colon cancer. Author(s): Mason JB. Source: Semin Gastrointest Dis. 2002 July; 13(3): 143-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12230317&dopt=Abstract
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Obesity, gender, and colon cancer. Author(s): Giovannucci E.
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Source: Gut. 2002 August; 51(2): 147. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12117867&dopt=Abstract
Vocabulary Builder Abdomen: The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Alkaline: Having the reactions of an alkali. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A condition in which the number of red blood cells is below normal. [NIH] Antigens: Substances that cause the immune system to make a specific immune response. [NIH] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apoptosis: A normal series of events in a cell that leads to its death. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Azoxymethane: A potent carcinogen and neurotoxic compound. It is particularly effective in inducing colon carcinomas. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH]
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Biometry: The use of statistical methods to analyze biological observations and phenomena. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Cardiac: Having to do with the heart. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cholangitis: Inflammation of a bile duct. [EU] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cisplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
DHEA: Dehydroepiandrosterone. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH]
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Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU]
Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epithelium: A thin layer of tissue that covers organs, glands, and other structures within the body. [NIH] Extracellular: Outside a cell or cells. [EU] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glucose: Sugar. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histology: The study of tissues and cells under a microscope. [NIH]
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Hormones: Chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the actions of certain cells or organs. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Immunology: The study of the body's immune system. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulin: A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lesion: An area of abnormal tissue change. [NIH] Levamisole: An antiparasitic drug that is also being studied in cancer therapy with fluorouracil. [NIH] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Melanosis: A disorder caused by a disturbance in melanin pigmentation; melanism. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors"
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and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Necrosis: Refers to the death of living tissues. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nonmetastatic: Cancer that has not spread from the primary (original) site to other sites in the body. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Pericarditis: Inflammation of the pericardium. [EU] Peritoneal: Having to do with the peritoneum (the tissue that lines the
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abdominal wall and covers most of the organs in the abdomen). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plantago: Three different species of Plantago or plantain, P. psyllium, P. ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH]
Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Pulmonary: Relating to the lungs. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source
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including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Resected: Surgical removal of part of an organ. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Telomerase: Essential ribonucleoprotein reverse transcriptase that adds telomeric DNA to the ends of eukaryotic chromosomes. Telomerase appears to be repressed in normal human somatic tissues but reactivated in cancer, and thus may be necessary for malignant transformation. EC 2.7.7.-. [NIH]
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Thioredoxin: A hydrogen-carrying protein that participates in a variety of biochemical reactions including ribonucleotide reduction. Thioredoxin is oxidized from a dithiol to a disulfide during ribonucleotide reduction. The disulfide form is then reduced by NADPH in a reaction catalyzed by thioredoxin reductase. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Tumour: 1. swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. a new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] ZD1839: A substance that is being studied as an anticancer drug. [NIH]
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CHAPTER 5. PATENTS ON COLON CANCER Overview You can learn about innovations relating to colon cancer by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.31 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with colon cancer within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with colon cancer. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
31Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Colon Cancer By performing a patent search focusing on colon cancer, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on colon cancer: ·
Metastatic breast and colon cancer regulated genes Inventor(s): Giese; Klaus (Berlin, DE) Assignee(s): Chiron Corporation (Emeryville, CA) Patent Number: 6,468,790 Date filed: November 13, 2000 Abstract: Gene sequences as shown in SEQ ID NOS:1-85 have been found to be significantly associated with metastatic potential of cancer cells, especially breast and colon cancer cells. Methods are provided for determining the risk of metastasis of a tumor, which involve determining whether a tissue sample from a tumor expresses a polypeptide encoded by a gene as shown in SEQ ID NOS:1-85, or a substantial portion thereof. Excerpt(s): The invention thus provides the art with a number of genes and proteins, which can be used as markers of metastasis. These are useful for more rationally is prescribing the course of therapy for breast or colon cancer patients. ... Some of the polynucleotides disclosed herein represent novel genes which are differentially expressed between nonmetastatic cancer cells and cancer cells which have a potential to metastasize. SEQ ID NOS:1-63 represent novel metastatic marker genes (Table 1). SEQ ID NOS:64-85 represent known genes which have been found to be differentially expressed in metastatic relative to nonmetastatic cancer cells (Table 2). Some of the metastatic marker genes disclosed herein are expressed in metastatic cells relative to nonmetastatic cells, particularly in breast cancer cells which metastasize to bone and lung (SEQ ID NOS:1, 5, 11, 18, 20, 22, 24, 30, 33, 35, 36, 38, 45, 52, 58, 65, 66, 70, 74, 76, and 80). One metastatic marker gene (SEQ ID NO:56) is expressed in non-metastatic breast cancer cells and in colon cancer cells with low metastatic potential. Other metastatic marker genes
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are expressed in metastatic cancer cells, particularly in breast cancer cells which metastasize only to lung (SEQ ID NOS:2, 4, 9, 13, 14, 19, 26, 29, 3941, 48, 55, 57, 60, 63, 64, 72, 73, 82, and 83). Still other metastatic marker genes (SEQ ID NOS:3, 7, 8, 10, 12, 15-17, 21, 23, 28, 31, 34, 37, 42-44, 46, 47, 49, 61, 62, 67, 68, 75, 77-79, 81, 84, and 85) are expressed in cancer cells which do not typically metastasize, particularly in breast cancer cells. Identification of these relationships and markers permits the formulation of reagents and methods as further described below. Other metastatic marker genes, such as those which comprise a nucleotide sequence shown in SEQ ID NOS:6, 27, 32, and 54, can be used to identify cancerous tissue, particularly breast cancer tissue. ... Full-length metastatic marker proteins can be extracted, using standard biochemical methods, from metastatic marker protein-producing human cells, such as metastatic breast or colon cancer cells. An isolated and purified metastatic marker protein or polypeptide is separated from other compounds which normally associate with a metastatic marker protein or polypeptide in a cell, such as certain proteins, carbohydrates, lipids, or subcellular organelles. A preparation of isolated and purified metastatic marker proteins or polypeptides is at least 80% pure; preferably, the preparations are 90%, 95%, or 99% pure. Web site: http://www.delphion.com/details?pn=US06468790__ ·
Colon cancer marker Inventor(s): Wolven; Amy K. (Oakland, CA), Krasnow; Randi E. (Stanford, CA), Warren; Bridget A. (Cupertino, CA), Baughn; Mariah R. (San Leandro, CA) Assignee(s): Incyte Genomics, Inc. (Palo Alto, CA) Patent Number: 6,448,041 Date filed: December 18, 2000 Abstract: The invention provides a cDNA which encodes a colon cancer marker. It also provides for the use of the cDNA, fragments, complements, and variants thereof and of the encoded protein, portions thereof and antibodies thereto for diagnosis and treatment of colon disorders, particularly colon cancer and polyps. The invention additionally provides expression vectors and host cells for the production of the protein and a transgenic model system. Excerpt(s): This invention relates to a mammalian cDNA which encodes a colon cancer marker and to the use of the cDNA and the encoded protein in the diagnosis and treatment of colon disorders, particularly colon cancer and polyps. ... Colorectal cancer is the fourth most common cancer
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and the second most common cause of cancer death in the United States with approximately 130,000 new cases and 55,000 deaths per year. Colon and rectal cancers share many environmental risk factors and both are found in individuals with specific genetic syndromes (Potter (1999) J Natl Cancer Institute 91:916-932). Colon cancer is the only cancer that occurs with approximately equal frequency in men and women, and the fiveyear survival rate following diagnosis of colon cancer is around 55% in the United States (Ries et al. (1990) National Institutes of Health, DHHS Publ. No. (NI)90-2789). ... Colon cancer is causally related to both genes and the environment. Several molecular pathways have been linked to the development of colon cancer, and the expression of key genes in any of these pathways may be affected by inherited or acquired mutation or by hypermethylation. There is a particular need to identify genes for which changes in expression may provide an early indicator of colon cancer or a predisposition for the development of colon cancer. Web site: http://www.delphion.com/details?pn=US06448041__ ·
Diagnosis and monitoring of colon cancer patients by measurement of NCA 50/90 in blood Inventor(s): Allard; William Jeffrey (Poughquag, NY), Yeung; Kwok K. (Prospect, CT) Assignee(s): Bayer Corporation (Tarrytown, NY) Patent Number: 6,309,846 Date filed: November 22, 1996 Abstract: A method for aiding in the diagnosis of, and monitoring the progression or course of, colon cancer in a patient by measuring the amount of NCA 50/90 in a blood sample, e.g., serum sample, obtained from the patient. Measurement in a single sample of an amount of NCA 50/90 significantly higher than the mean amount of NCA 50/90 in the normal population is an indication of colon cancer in a symptomatic patient. The course of colon cancer can also be monitored by performing a series of specific immunoassays over time to determine changes in the level of NCA 50/90 in blood samples. Increases in blood NCA 50/90 levels over time are indicative of a deteriorating condition whereas decreasing levels of blood NCA 50/90 over time indicate an improving condition. Excerpt(s): The present invention relates to the diagnosis of, and monitoring the progression, course, or stage of, disease in colon cancer patients. More particularly, the invention relates to such diagnostic and monitoring methods based on measurement of cancer marker blood
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levels. ... It has now been found that NCA 50/90 can be significantly elevated in the blood of patients with colon cancer. Accordingly, the present invention provides a method for aiding in the diagnosis of colon cancer in a patient who presents with symptoms of colon cancer (i.e., a symptomatic patient), comprising the steps of determining the amount of NCA 50/90 in a blood sample obtained from said patient and comparing such measured amount of NCA 50/90 to the mean amount of NCA 50/90 in the normal population, whereby the presence of a significantly increased higher amount of NCA 50/90 in the patient's blood is an indication of colon cancer in the patient. With this and other information suggestive of colon cancer, the physician is assisted in making a diagnosis. ... The present invention also provides a method for monitoring the course or progression of colon cancer in a patient who has been diagnosed with colon cancer. A series of specific immunoassays are performed over time to determine changes in the level of NCA 50/90 in blood samples obtained from such patient, whereby changes in the NCA 50/90 blood level correlate with changes in disease status. More particularly, increases in blood NCA 50/90 levels will generally indicate a deteriorating condition while decreases in blood NCA 50/90 levels indicate an improving condition. Where the diagnosed patient has been treated for colon cancer, e.g., radiation, chemotherapy, surgery, or the like, increases in blood NCA 50/90 levels indicate recurrence of disease. Web site: http://www.delphion.com/details?pn=US06309846__ ·
Isolated nucleic acid molecules associated with colon cancer and methods for diagnosing and treating colon cancer Inventor(s): Scanlan; Matthew J. (New York, NY), Chen; Yao-Tseng (New York, NY), Stockert; Elisabeth (New York, NY), Old; Lloyd J. (New York, NY) Assignee(s): Ludwig Institute for Cancer Research (New York, NY) Patent Number: 6,043,084 Date filed: October 10, 1997 Abstract: Various molecules associated with disorders such as colon cancer are disclosed. The invention also discloses diagnostic and therapeutic methods based upon these molecules. Excerpt(s): This invention relates to the isolation of genes associated with colon cancer, methods of diagnosing colon cancer using these, as well as other genes which are known, as well as therapeutic approaches to treating such conditions. ... The SEREX methodology has now been applied to colon cancer samples. Several nucleic acid molecules have
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been newly isolated and sequenced, and are now associated with stomach cancer. Further, a pattern of expression involving these, as well as previously isolated genes has been found to be associated with colon cancer. These results are the subject of this application, which is elaborated upon in the disclosure which follows. ... Of the six clones which were identified as being reactive with autologous and allogeneic cancer serum, and not with normal serum, two were found to be identical to previously identified molecules. Four others were found to have little or no homology to known sequences. These are presented as SEQ ID NOS: 1-4. Of twenty seven allogeneic colon cancer serum samples tested, 67% reacted with at least one of these antigens. Web site: http://www.delphion.com/details?pn=US06043084__ ·
Method of preventing colon cancer with vitamin D.sub.3 analogues Inventor(s): Brasitus; Thomas A. (Olympia Fields, IL), Bissonnette; Bruce Marc (Chicago, IL), Sitrin; Michael D. (Flossmoor, IL) Assignee(s): Arch Development Corporation (Chicago, IL) Patent Number: 6,040,300 Date filed: April 7, 1995 Abstract: A method for preventing the initiation of colon cancer is disclosed. Vitamin D.sub.3 analogues prevented the development of adenomas and adenocarcinomas when administered to rats prior to, and subsequent to, chemically induced tumorigenesis. Excerpt(s): The present invention relates generally to the field of cancer prevention. In particular, the invention relates to a method of preventing colon cancer by vitamin D.sub.3 analogues. In one example, administration of 1.alpha., 25-Dihydroxy-16-ene-23-yne-26, 27hexafluorocholecalciferol reduced the incidence of colon cancer in rats. ... Colon cancer is a leading cause of death among patients with internal malignancies in the United States and, unfortunately, at the time of initial diagnosis is incurable in approximately one-half of the patients found to harbor this malignancy (Zarling and Rhodes, Int. Med. Specialist 3:72-86, 1982). Moreover, despite advances in the fields of surgery, radiotherapy and chemotherapy, the cure rate for this disease has not improved significantly (Zarling and Rhodes, 1982). Based on these considerations, the search for strategies to prevent the development of cancers in this organ has markedly intensified during the past decade. ... Although the cause of large bowel cancer is not known, most epidemiologists associate it with diet, and, in particular, the low-fiber, high-protein, high-fat content that characterizes the diet of most Americans and people in other
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urban, industrialized societies. Many observers believe that colon cancer is the first major cancer type for which available evidence is sufficient to recommend dietary changes in the general public (Willett, Nature 338:384, 1989; Greenwald, Cancer 70 (Suppl.): 1206, 1992). In this regard, the possibility of using dietary supplements as a strategy to prevent colon cancer has recently been recognized (Mukhtar and Athar, Clev. Clin. J. Med. 55:507-508, 1988). Web site: http://www.delphion.com/details?pn=US06040300__ ·
Methods of treating colon cancer utilizing tumor-specific antibodies Inventor(s): Welt; Sydney (New York, NY), Old; Lloyd J. (New York, NY), Barendswaard; Elsje (New York, NY), Montalto; Nicholas J. (New York, NY), Gure; Ali Osmay (New York, NY) Assignee(s): Ludwig Institute For Cancer Research (New York, NY) Patent Number: 5,958,412 Date filed: June 4, 1997 Abstract: This invention relates to methods of reducing the effects of colon cancer tumors. Various agents are conjugated to monoclonal antibodies which are specific for colon cancer cells. The conjugates are administered to patients having colon cancer such that the effects of the cancer are reduced. Excerpt(s): This invention relates to a method of reducing the effects of colon cancer tumors, utilizing at least one monoclonal antibody. Specifically, at least one monoclonal antibody is utilized in conjunction with an anti-tumor drug, a peptide which inhibits DNA tumor activity or a radioisotope in the treatment of colorectal carcinoma. This invention further relates to a method of delivering genetic material to DNA of tumor cells and to a method of delivering anti-cancer agents to nuclei of colon tumor cells, as well as to monoclonal antibodies which are specific for A33 antigen; an antigen found on colon cancer cells. ... It is therefore an object of this invention to provide methods for reducing the effects of colon cancers. ... It is another object of this invention to provide a method of delivering genetic material to DNA of colon cancer cells. Web site: http://www.delphion.com/details?pn=US05958412__
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Patent Applications on Colon Cancer As of December 2000, U.S. patent applications are open to public viewing.32 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to colon cancer: ·
Genes expressed in colon cancer Inventor(s): Lasek, Amy W.; (Oakland, CA), Jones, David A.; (Salt Lake City, UT) Correspondence: Incyte Genomics, Inc.; 3160 Porter Drive; Palo Alto; CA; 94304; US Patent Application Number: 20020160382 Date filed: October 11, 2001 Abstract: The present invention relates to a combination comprising a plurality of cDNAs which are differentially expressed in colon cancer, or in a precancerous condition of the colon and which may be used in their entirety or in part as to diagnose, to stage to treat or to monitor the treatment of a subject with a colon cancer. Excerpt(s): The present invention relates to a combination comprising a plurality of cDNAs which are differentially expressed in colon cancer and in premalignant conditions of the colon and which may be used entirely or in part to diagnose, to stage, to treat, or to monitor the progression or treatment of colon cancer. ... The potential application of gene expression profiling is particularly relevant to improving diagnosis, prognosis, and treatment of disease. For example, both the levels and sequences expressed in tissues from subjects with colon cancer may be compared with the levels and sequences expressed in normal tissue. ... Colorectal cancer is the fourth most common cancer and the second most common cause of cancer death in the United States with approximately 130,000 new cases and 55,000 deaths per year. Colon and rectal cancers share many environmental risk factors and both are found in individuals with specific genetic syndromes. (See Potter (1999) J Natl Cancer Institute 91:916-932 for a review of colorectal cancer.) Colon cancer is the only cancer that occurs with approximately equal frequency in men and women, and the five-year survival rate following diagnosis of colon cancer is around 55% in the United States (Ries et al. (1990) National Institutes of Health, DHHS Publ No. (NIH)90-2789). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
32
This has been a common practice outside the United States prior to December 2000.
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·
Metastatic breast and colon cancer regulated genes Inventor(s): Giese, Klaus; (San Francisco, Ca), Xin, Hong; (Emeryville, CA) Correspondence: Chiron Corporation; Intellectual Property - R440; P.O. Box 8097; Emeryville; CA; 94662-8097; US Patent Application Number: 20020068278 Date filed: December 17, 1998 Abstract: Gene sequences as shown in SEQ ID NO:1-18 have been discovered and isolated, and found to be significantly associated with metastatic spread of breast and colon cancer cells to other organs. Methods are provided for determining the risk of metastasis of a breast or colon tumor, which involve determining whether a tissue sample from a tumor expresses a polypeptide encoded by a gene as shown in SEQ ID NOS:1-18, or a substantial portion thereof. One of the gene sequences encodes a novel aspartyl protease termed CSP56, which can be used to provide reagents and methods for determining which tumors are likely to metastasize and for suppressing metastases of these tumors. Clinicians can use this information to predict which tumors will metastasize to other organs and to provide relevant therapies to appropriate patients. Excerpt(s): The invention thus provides the art with a number of genes and proteins, which can be used as markers of metastasis. These are useful for more rationally prescribing the course of therapy for cancer patients, especially those with breast or colon cancer. ... It is another discovery of the present invention that a novel aspartyl-type protease, CSP56, is over-expressed in highly metastatic cancer, particularly in breast and colon cancer, and is associated with the progression of primary tumors to a metastatic state. This information can be utilized to make diagnostic reagents specific for expression products of the CSP56 gene. It can also be used in diagnostic and prognostic methods which will help clinicians to plan appropriate treatment regimes for cancers, especially of the breast and colon. ... Biological activity of a metastatic marker protein variant, including a CSP56 variant, can be readily determined by one of skill in the art. Differential expression of the variant, for example, can be measured in cell lines which vary in metastatic potential, such as the breast cancer cell lines MDA-MB-231 (Brinkley et al., Cancer Res. 40, 3118-29, 1980), MDA-MB-435 (Brinkley et al., 1980), MCF-7, BT-20, ZR-75-1, MDA-MB-157, MDA-MB-361, MDAMB-453, Alab and MDA-MB-468, or colon cancer cell lines Km12C and Km12L4A. The MDA-MB-231 cell line was deposited at the ATCC on May 15, 1998 (ATCC CRL-12532). The Km12C cell line was deposited at the ATCC on May 15, 1998 (ATCC CRL-12533). The Km12L4A cell line
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was deposited at the ATCC on March 19, 1998 (ATCC CRL-12496). The MDA-MB-435 cell line was deposited at the ATCC on Oct. 9, 1998 (ATCC CRL 12583). The MCF-7 cell line was deposited at the ATCC on Oct. 9, 1998 (ATCC CRL-12584). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Compositions and methods of diagnosing, monitoring, staging, imaging and treating colon cancer Inventor(s): Yang, Fei ; (San Diego, CA), Piderit, Alejandra ; (Concepcion, CL), Hu, Ping ; (San Ramon, CA), Recipon, Herve E. ; (San Francisco, CA), Macina, Roberto A. ; (San Jose, CA) Correspondence: Licata & Tyrrell P.C.; 66 E. Main Street; Marlton; NJ; 08053; US Patent Application Number: 20020065396 Date filed: March 26, 2001 Abstract: The present invention provides polynucleotides and polypeptides which are diagnostic markers for colon cancer. In addition, antibodies immunospecific for these markers are provided. Vectors, hosts cells and methods for producing these markers, as well as methods and tools for using these markers in detecting, diagnosing, monitoring, staging, prognosticating, imaging and treating colon cancer are also provided. Excerpt(s): This invention relates, in part, to newly identified polynucleotides and polypeptides encoded thereby, as well as methods for producing and using these polynucleotides and polypeptides. Antibodies which are immunospecific for these polypeptides are also described. Expression of the newly identified polynucleotides and levels of the polypeptides encoded thereby are upregulated in or specific to colon cancer tissue. These new polynucleotides and polypeptides, referred to herein as Colon Cancer Specific Genes or CSGs are believed to be useful in assays for detecting, diagnosing, monitoring, staging, prognosticating, imaging and treating cancers, particularly colon cancer. ... The prognosis of colon cancer is clearly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement. These two characteristics form the basis for all staging systems developed for this disease. Treatment decisions are usually made in reference to the older Duke's or the Modified AstlerColler (MAC) classification scheme for staging. ... Bowel obstruction and bowel perforation are indicators of poor prognosis in patients with colon cancer. Elevated pretreatment serum levels of carcinoembryonic antigen
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(CEA) and of carbohydrate antigen 19-9 (CA 19-9) also have a negative prognostic significance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Compositions and methods for the therapy and diagnosis of colon cancer Inventor(s): Jiang, Yuqiu ; (Kent, WA), Hepler, William T. ; (Seattle, WA), Clapper, Jonathan D. ; (Seattle, WA), Wang, Aijun ; (Issaquah, WA), Secrist, Heather ; (Seattle, WA) Correspondence: Seed Intellectual Property Law Group PLLC; 701 Fifth Ave; Suite 6300; Seattle; WA; 98104-7092; US Patent Application Number: 20020040127 Date filed: June 8, 2001 Abstract: Compositions and methods for the therapy and diagnosis of cancer, such as colon cancer, are disclosed. Compositions may comprise one or more colon tumor proteins, immunogenic portions thereof, or polynucleotides that encode such portions. Alternatively, a therapeutic composition may comprise an antigen presenting cell that expresses a colon tumor protein, or a T cell that is specific for cells expressing such a protein. Such compositions may be used, for example, for the prevention and treatment of diseases such as colon cancer. Diagnostic methods based on detecting a colon tumor protein, or mRNA encoding such a protein, in a sample are also provided. Excerpt(s): The present invention relates generally to therapy and diagnosis of cancer, such as colon cancer. The invention is more specifically related to polypeptides comprising at least a portion of a colon tumor protein, and to polynucleotides encoding such polypeptides. Such polypeptides and polynucleotides may be used in vaccines and pharmaceutical compositions for prevention and treatment of colon malignancies, and for the diagnosis and monitoring of such cancers. ... Colon cancer is the second most frequently diagnosed malignancy in the United States as well as the second most common cause of cancer death. The five-year survival rate for patients with colorectal cancer detected in an early localized stage is 92%; unfortunately, only 37% of colorectal cancer is diagnosed at this stage. The survival rate drops to 64% if the cancer is allowed to spread to adjacent organs or lymph nodes, and to 7% in patients with distant metastases. ... The prognosis of colon cancer is directly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement, consequently early detection and treatment are especially important.
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Currently, diagnosis is aided by the use of screening assays for fecal occult blood, sigmoidoscopy, colonoscopy and double contrast barium enemas. Treatment regimens are determined by the type and stage of the cancer, and include surgery, radiation therapy and/or chemotherapy. Recurrence following surgery (the most common form of therapy) is a major problem and is often the ultimate cause of death. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method of detecting colon cancer Inventor(s): Pant, Keshab D.; (Perris, CA), McCracken, John D.; (Redlands, CA), Fagoaga, Omar; (Colton, CA), Kelln, Wayne; (Loma Linda, CA), Nehlsen-Cannarella, Sandra; (Redlands, CA) Correspondence: Knobbe Martens Olson & Bear LLP; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020009760 Date filed: July 25, 2001 Abstract: An immunological assay and kit for colon cancer screening is disclosed. Fecal glycoproteins are extracted from individual samples such that immunogenicity is maintained. The purified fecal glycoproteins are reacted with antibodies to Colon and Ovarian Tumor Antigen (COTA). The mucin antigen COTA is specifically present in colorectal cancer tissue and not in normal colons. The amount of COTA in the fecal sample is determined and used to indicate the presence of colon cancer. Excerpt(s): The present invention is directed to a method for detecting colon cancer utilizing an antibody specific for a glycoprotein found in colon cancer cells. ... Colorectal cancer is among the leading causes of cancer-related morbidity and mortality in industrialized nations. The pathogenesis is related to hereditary influences, modified by the quantity and quality of dietary fat. In 1995, the American Cancer society estimated that 135,000 new cases of colon cancer were diagnosed; 71% were in the colon and 30% were in the rectum. Patients diagnosed at an early stage, prior to lymph-node spread, are potentially cured with surgery. At present, only 41% of patients are diagnosed at an early stage. The remaining cases frequently undergo peri-operative radiation and/or chemotherapy to attempt to control the metastatic spread of disease. Ultimately, 50% of patients thought to have undergone curative resections eventually develop recurrent disease. Unfortunately, 55,000 Americans die each year due to recurrent or metastatic colon or rectal cancer. The key to enhanced survival is early diagnosis. Colon and rectal cancers are often silent and slowly progressive. Most patients exhibit
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symptoms such as rectal bleeding, pain, abdominal distension or weight loss only after the disease is advanced and not surgically curable. ... Over the past 25 years, early colorectal cancer detection has been based on the fecal occult blood test (FOBT) performed annually on asymptomatic individuals. Current recommendations adapted by several healthcare organizations, including the American Cancer Society, call for fecal occult blood testing beginning at age 50, repeated annually until such time as the patient would no longer benefit from screening. A positive FOBT leads to colonoscopic examination of the bowel; an expensive and invasive procedure, with a serious complication rate of one per 5,000 examinations. Only 12% of patients with heme positive stool are diagnosed with cancer or large polyps at the time of colonoscopy. Most studies show that FOBT screening does not improve cancer-related mortality or overall survival. Compliance with occult blood testing has been poor; less than 20 percent of the population is offered or completes FOBT as recommended. If FOBT is properly done, the patient collects a fecal sample from three consecutive bowel movements. Samples are obtained while the patient adheres to dietary guidelines and avoids medications known to induce occult gastrointestinal bleeding. In reality, physicians frequently fail to instruct patients properly, patients frequently fail to adhere to protocol, and some patients find the task of collecting fecal samples difficult or unpleasant, hence compliance with annual occult blood testing is poor. Compounding the problem of compliance, the sensitivity and specificity of FOBT to detect colon cancer is poor. In eight prospective studies where hemoccult testing was followed by colonoscopy, only 41 of 159 cancers diagnosed were detected by FOBT, yielding a screening sensitivity of 26%. FOBT sensitivity for pre-cancerous polyps was also poor. Poor test specificity leads to unnecessary colonoscopy, adding considerable expense to colon cancer screening. In the University of Minnesota trial, a large prospective hemoccult screening study, test specificity was 90%, and positive predictive value was 2%. Only one colon cancer was found in every 50 test-triggered colonoscopies performed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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·
Metastatic breast and colon cancer regulated genes Inventor(s): Giese, Klaus; (Berlin, DE) Correspondence: Chiron Corporation; Intellectual Property R338; P.O. Box 8097; Emeryville; CA; 94662-8097; US Patent Application Number: 20020009739 Date filed: April 6, 2001 Abstract: Gene sequences as shown in SEQ ID NOS: 1-85 have been found to be significantly associated with metastatic potential of cancer cells, especially breast and colon cancer cells. Methods are provided for determining the risk of metastasis of a tumor, which involve determining whether a tissue sample from a tumor expresses a polypeptide encoded by a gene as shown in SEQ ID NOS: 1-85, or a substantial portion thereof. Excerpt(s): The invention thus provides the art with a number of genes and proteins, which can be used as markers of metastasis. These are useful for more rationally prescribing the course of therapy for breast or colon cancer patients. ... Some of the polynucleotides disclosed herein represent novel genes which are differentially expressed between nonmetastatic cancer cells and cancer cells which have a potential to metastasize. SEQ ID NOS: 1-63 represent novel metastatic marker genes (Table 1). SEQ ID NOS:64-85 represent known genes which have been found to be differentially expressed in metastatic relative to nonmetastatic cancer cells (Table 2). Some of the metastatic marker genes disclosed herein are expressed in metastatic cells relative to nonmetastatic cells, particularly in breast cancer cells which metastasize to bone and lung (SEQ ID NOS:1, 5, 11, 18, 20, 22, 24, 30, 33, 35, 36, 38, 45, 52, 58, 65, 66, 70, 74, 76, and 80). One metastatic marker gene (SEQ ID NO:56) is expressed in non-metastatic breast cancer cells and in colon cancer cells with low metastatic potential. Other metastatic marker genes are expressed in metastatic cancer cells, particularly in breast cancer cells which metastasize only to lung (SEQ ID NOS:2, 4, 9, 13, 14, 19, 26, 29, 3941, 48, 55, 57, 60, 63, 64, 72. 73, 82, and 83). Still other metastatic marker genes (SEQ ID NOS:3, 7, 8, 10, 12, 15-17, 21, 23, 28, 31, 34, 37, 42-44, 46, 47, 49, 61, 62, 67, 68, 75, 77-79, 81, 84, and 85) are expressed in cancer cells which do not typically metastasize, particularly in breast cancer cells. Identification of these relationships and markers permits the formulation of reagents and methods as further described below. Other metastatic marker genes, such as those which comprise a nucleotide sequence shown in SEQ ID NOS:6, 27, 32, and 54, can be used to identify cancerous tissue, particularly breast cancer tissue. ... Full-length metastatic marker proteins can be extracted, using standard biochemical methods, from metastatic marker protein-producing human cells, such as metastatic
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breast or colon cancer cells. An isolated and purified metastatic marker protein or polypeptide is separated from other compounds which normally associate with a metastatic marker protein or polypeptide in a cell, such as certain proteins, carbohydrates, lipids, or subcellular organelles. A preparation of isolated and purified metastatic marker proteins or polypeptides is at least 80% pure; preferably, the preparations are 90%, 95%, or 99% pure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with colon cancer, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “colon cancer” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on colon cancer. You can also use this procedure to view pending patent applications concerning colon cancer. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Allogeneic: Taken from different individuals of the same species. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Lipid: Fat. [NIH]
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Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Recurrence: The return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH]
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CHAPTER 6. BOOKS ON COLON CANCER Overview This chapter provides bibliographic book references relating to colon cancer. You have many options to locate books on colon cancer. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on colon cancer include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “colon cancer” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on colon cancer: ·
Cancer Screening Source: St. Louis, MO, Mosby-Year Book, Inc., 307 p., 1996.
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Contact: Mosby-Year Book, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146. Summary: Cancer Screening is a monograph that includes articles written by experts in the field of cancer screening, who present current information and bring attention to controversial issues surrounding cancer screening. The monograph is divided into two main sections preceded by a chapter titled Principles of Cancer Screening, which defines key terms associated with screening and describes measures of validity for a screening test, major principles of cancer screening, and evaluation of a proposed screening strategy. Part I, Screening for Specific Cancers, contains chapters on (1) breast cancer as an appropriate illness for screening, mammography as an appropriate screening test, casecontrol studies and randomized controlled trials, demonstration and implementation projects, and nationwide dissemination programs and policy recommendations; (2) cervical cancer epidemiology, pathogenesis, screening, prevention of invasive cervical cancer, and future directions; (3) colon and rectal cancer etiology and prevention, screening procedures, and practice and research recommendations; (4) the prostate cancer screening debate, prostate specific antigen (PSA) screening studies, and recommendations about screening for prostate cancer; (5) lung cancer presentation, staging, treatment outcome, epidemiology, biology, genetic changes, historical screening studies, tumor markers, identification of high-risk groups, and prospects for screening approaches; (6) ovarian cancer epidemiology, efficacy of screening, genetics, molecular biology and ovarian cancer screening, and primary care guidelines; (7) skin cancer and melanoma epidemiology, definitions, screening efficacy, education, prevention and early detection activities in Europe, primary prevention, screening program pitfalls, identification of high-risk populations, skin screening, molecular biology and skin screening, guidelines for primary care, financial health policy, and outlook for the future; and (8) miscellaneous tumors associated with other cancers. Part II, General Considerations in Cancer Screening, contains chapters on (1) molecular screening and the prevention of colon cancer, (2) breast cancer genetics, (3) adherence to cancer screening, (4) issues in developing a cancer screening program, and (5) legislative efforts to fund cancer screening. ·
Cancer Control Makes Sense Source: Austin, TX, Texas Department of Health, Chronic Disease Prevention Program, 43 p., 1989. Contact: Texas Department of Health, Chronic Disease Prevention Program, 1100 West 49th Street, Austin, TX 78756. (512) 458-7534.
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Summary: Cancer Control Makes Sense, a booklet addressing cancer problems in Texas, was developed by the Texas Department of Health. Statistics, graphs, charts, and maps illustrate cancer prevalence in Texas. The booklet addresses lung cancer, breast cancer, cervical cancer, and colon cancer. Discussion of each cancer includes ethnic and regional variations and risk factors. The booklet provides recommended actions to reduce cancer rates. ·
Our Health, Our Lives: A Revolutionary Approach to Total Health Care for Women Source: New York, NY: Pocket Books. 1995. 448 p. Contact: Available from Pocket Books. 1230 Sixth Avenue, New York, NY 10020. (800) 223-2336. Price: $24. ISBN: 0671880853. Summary: In this book, the author demonstrates how medicine can function to serve women's needs and shows women how to help start that process in their own lives. Eighteen chapters are presented in four sections: the woman-centered approach; total health in context; women's life cycles; and mind and body together. Topics include becoming one's own health advocation; how the female body works; risk factors for heart disease; women's cancer; diabetes; preventing osteoporosis; bladder conditions; fatigue and the immune system; the patterns in women's lives; pregnancy and beyond; the menopause years; the emotionally healthy woman; healthy sexuality; eating problems; and substance addictions. Specific topics that address digestive diseases include risk factors for colon cancer; nutrition, including fats and fiber; eating disorders; appendicitis; cholesterol; dietary calcium; depression and the immune system; dieting and weight loss; eating habits; gallbladder disease; pregnancy and the gastrointestinal system; systemic lupus erythematosus; obesity; and vitamins. A detailed subject index concludes the book.
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “colon cancer” (or synonyms) into the search box, and select “books only.” From
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there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:33 ·
Adjuvant therapy for colon and rectum cancer: January 1985 through April 1990: 491 citations. Author: prepared by Karen Patrias, J. Michael Hamilton; Year: 1990; Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section; Washington, D.C.: Sold by the Supt. of Docs., U.S. G.P.O., [1990]
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Atlas of selective sentinal lymphadenectomy for melanoma, breast cancer, and colon cancer. Author: edited by Stanley P.L. Leong; Year: 2002; Boston: Kluwer Academic Publishers, c2002; ISBN: 1402070136 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1402070136/icongroupin terna
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Calcium, vitamin D, and prevention of colon cancer. Author: editors, Martin Lipkin, Harold L. Newmark, Gary Kelloff; planning committee, Charles W. Boone ... [et al.]; Year: 1991; Boca Raton: CRC Press, c1991; ISBN: 0849342643 http://www.amazon.com/exec/obidos/ASIN/0849342643/icongroupin terna
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Cancer of the colon and rectum; its diagnosis and treatment, by Fred W. Rankin ... and A. Stephens Graham ... Author: Rankin, Fred W. (Fred Wharton), 1886-; Year: 1939; Springfield, Ill., Baltimore, Md., C. C. Thomas [c1939]
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Cancer of the colon or rectum: research report. Author: National Cancer Institute; Year: 1981; [Bethesda, Md.]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, 1981
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Cancer of the colon, rectum, and anus. Author: editors, Alfred M. Cohen, Sidney J. Winawer; associate editors, Michael A. Friedman, Leonard L. Gunderson; Year: 1995; New York: McGraw-Hill, Health Professions Division, c1995; ISBN: 0070116016:
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/0070116016/icongroupin terna ·
Cell and molecular biology of colon cancer. Author: editor, Leonard H. Augenlicht; Year: 1989; Boca Raton, Fla.: CRC Press, c1989; ISBN: 0849347106 http://www.amazon.com/exec/obidos/ASIN/0849347106/icongroupin terna
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Colon & rectal cancer: a comprehensive guide for patients and families. Author: Lorraine Johnston,; Year: 2000; Beijing; Sebastopol, CA: O'Reilly, c2000; ISBN: 1565926331 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1565926331/icongroupin terna
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Colon and rectal cancer: a report by 63 Illinois hospitals on cases diagnosed in 1976-78. Author: Patrias, Karen; Year: 1988; Chicago: American Cancer Society, Illinois Division, c1988
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Colon and rectal cancer. Author: volume editor, Peter S. Edelstein; Year: 2000; New York: Wiley-Liss, c2000; ISBN: 0471351458 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0471351458/icongroupin terna
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Colon cancer: a report by 32 Illinois hospitals on 910 cases diagnosed in 1968. Author: Shamsuddin, Abulkalam M; Year: 1976; Chicago: American Cancer Society, Illinois Division, c1976
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Colon cancer cells. Author: edited by Mary Pat Moyer, George H. Poste; Year: 1990; San Diego: Academic Press, c1990; ISBN: 0125093756 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0125093756/icongroupin terna
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Colon cancer genetics. Author: edited by Patrick M. Lynch and Henry T. Lynch; Year: 1985; New York, N.Y.: Van Nostrand Reinhold, c1985; ISBN: 0442249187 http://www.amazon.com/exec/obidos/ASIN/0442249187/icongroupin terna
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Colon cancer prevention: dietary modulation of cellular and molecular mechanisms. Author: edited under the auspices of the American Institute for Cancer Research; Year: 1999; New York: Kluwer Academic/Plenum Publishers, c1999; ISBN: 0306462079 http://www.amazon.com/exec/obidos/ASIN/0306462079/icongroupin terna
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Colon cancer study: May 1991. Author: European Association for Gastroenterology and Endoscopy. Postgraduate Course (2000: Brussels,
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Belgium); Year: 1991; [Rockville, Md.?]: Physician Insurers Association of America, c1991 ·
Colon cancer. Author: edited by E. Grundmann; with contributions by H. Bünte ... [et al.]; Year: 1978; Stuttgart; New York: Fischer, 1978; ISBN: 3437105604
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Cost-effectiveness of alternative workup strategies in screening for colorectal cancer. Author: K. Brown, C. Burrows; Year: 1990; [Fairfield, Vic., Australia]: National Centre for Health Program Evaluation, [1990]
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Detection of colon lesions; first standardization conference ... sponsored by American College of Radiology, Ad Hoc Committee on Detection of Cancer of the Colon ... October 30-November 1, 1969. Author: National Conference on Colon Examinations (1st: 1969: Chicago); Year: 1973; Chicago, American College of Radiology, 1973
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Diagnostic assays for colon cancer. Author: Abulkalam M. Shamsuddin; Year: 1991; Boca Raton: CRC Press, c1991; ISBN: 0849365406 http://www.amazon.com/exec/obidos/ASIN/0849365406/icongroupin terna
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Diseases of the colon and rectum: with self-assessment workbook: ulcerative colitis, granulomatous colitis, diverticular diseases of colon, cancer of colon and rectum. Author: Him-che Yeung; Year: 1993; Rosemead, CA: Institute of Chinese Medicine, c1993; ISBN: 0963971506 http://www.amazon.com/exec/obidos/ASIN/0963971506/icongroupin terna
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Hereditary breast, ovarian, and colon cancer: proceedings of a workshop held at the Sheraton Washington Hotel, Washington, D.C., April 27-29, 1994. Author: sponsors, National Cancer Institute, National Center for Human Genome Research; scientific editors, Ruth; Year: 1995; Bethesda, MD: National Cancer Institute, 1995
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Update gastroenterology 2000: Barrett's esophagus, colon cancer, and tumor imaging: Postgraduate Course 2000, Brussels, November 25. Author: edited by R. Arnold, J.P. Galmiche; Year: 2000; Montrouge, France: John Libbey Eurotext, c2000; ISBN: 2742003460
Chapters on Colon Cancer Frequently, colon cancer will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with colon cancer, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and colon cancer using the “Detailed Search” option. Go directly to the
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following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on colon cancer: ·
Gastrointestinal Problems Including Colon Cancer Source: in Rosenfeld, J.A., ed. Women's Health in Primary Care. Baltimore, MD: Williams and Wilkins. 1997. p. 633-660. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-8555. Fax (800) 4478438. Price: $59.95 (paperback). ISBN: 0683073664. Summary: This chapter, from a book on women's health for primary care providers, reviews gastrointestinal problems in women. The chapter covers diseases of the upper GI tract, including gastroesophageal reflux disease (GERD), peptic ulcer disease, and gastric carcinoma; gallstones; liver diseases, including primary biliary cirrhosis, autoimmune liver disease, drug-induced liver disease, and alcoholic liver disease; and lower GI disease, including irritable bowel syndrome, inflammatory bowel disease, and colon cancer. For each disease, the author discusses incidence, risk factors, clinical symptoms, diagnosis, and treatment options. 1 figure. 8 tables. 90 references.
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Cancer of the Colon Source: in Pennsylvania Cancer Incidence and Mortality: 1994-1998. Harrisburg, PA, Pennsylvania Department of Health, pp. 52-59, June 2001. Contact: Pennsylvania Department of Health, Bureau of Health Statistics, 555 Walnut Street, 6th Floor, Harrisburg, PA 17101. (717) 783-2548. Internet/Email: www.health.state.pa.us/stats/. Summary: Cancer of the Colon, a chapter in Pennsylvania Cancer Incidence and Mortality: 1994-1998, presents colon cancer incidence and mortality data for Pennsylvania (PA) residents from 1989 through 1998. The data are stratified by race, sex, and county. In 1998, 7,339 cases of colon cancer were diagnosed among PA residents, the largest number of cases reported during the 10-year period. It was the third most common cancer site among both males and females, accounting for a little over 10 percent of all new cancer cases diagnosed in 1998. In 1998, 2,963 PA residents died from colon cancer, the second lowest annual rate during
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the period. Between 1989 and 1998, there were no evident trends in annual age-adjusted mortality rates among black males and black females; however, rates for white males and white females have been decreasing. The chapter also summarizes risk factors and American Cancer Society recommendations for the early detection of colon cancer. ·
Colorectal Cancer Source: in Cancer Screening: Theory and Practice. Kramer, B.S.; Gohagan, J.K.; Prorok, P.C.; eds. Marcel Dekker, Inc., New York, NY, pp. 219-265, 1999. Contact: Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016. (212) 696-9000. FAX: (212) 685-4540. Internet: http://www.dekker.com. Summary: Colorectal Cancer, a chapter in Cancer Screening: Theory and Practice, focuses on issues related to colorectal cancer screening. Colorectal cancer is the fourth most common nonskin cancer worldwide. Survival is dependent on the stage at which the cancer is detected. Lifestyle is a major determinant of colorectal cancer risk. Risk factors include (1) dietary animal fat and dairy products, (2) alcohol, (3) physical inactivity, (4) overweight, (5) not having given birth, (6) history of ulcerative colitis, and (7) family history. There is strong evidence that colon cancer develops from preexisting adenomas. A number of genes have been associated with colorectal cancer. Screening tests for colorectal cancer include (1) digital rectal examination (DRE), (2) fecal occult blood testing (FOBT), (3) sigmoidoscopy, (4) barium enema, (5) colonoscopy, and (6) genetic testing. Studies on the effectiveness of DRE have yielded inconclusive results. A major concern about FOBT is the lack of sensitivity, but mortality and followup studies on the effectiveness of FOBT have shown a 33 percent reduction in the mortality rate in those screened annually. Randomized trials and observational studies have shown the effectiveness of sigmoidoscopy. The main complication of endoscopic colorectal screening is bowel perforation. The risks are much greater for colonoscopy than for sigmoidoscopy. Endoscopic procedures are uncomfortable, and colonoscopy usually requires sedation. Models for assessing the cost-effectiveness of colorectal cancer screening are limited by a lack of knowledge about the efficiency of the tests, the appropriate interval between tests, and the appropriate age for starting and stopping screening. A comprehensive public education program is necessary to break down social taboos about bowel cancer. Screening recommendations from professional organizations are complex and overlapping, but for average-risk persons age 50, recommendations are (1) annual FOBT, (2) flexible sigmoidoscopy every 5 years, (3) double-
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contrast barium enema every 5 to 10 years, and (4) colonoscopy every 10 years. ·
Advances in Screening for Colorectal Cancer Source: in Advances in Cancer Screening. Miller, A.B.; ed. Boston, MA. Kluwer Academic Publishers, pp. 51-76, 1996. Contact: Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, MA 02061. Summary: Advances in Screening for Colorectal Cancer, a chapter in Advances in Cancer Screening, provides an overview of the scientific evidence on screening for colorectal cancer. Primary prevention of colorectal cancer remains speculative because there are few established etiologic factors. Secondary prevention through annual fecal occult blood testing (FOBT) has been shown to reduce colorectal cancer mortality. There have been four randomized controlled trials of FOBT's. The Minnesota trial is the only study to date that has published a mortality reduction. Through 13 years of followup, the Minnesota study showed a 33 percent mortality reduction. Preliminary results from a Danish trial have shown a 20 percent reduction. There are two prospective, nonrandomized controlled FOBT trials. One study, in New York City, New York, showed a 43 percent reduction and improved survival. Results from a study in France are pending. Results from case-control studies ranged from no mortality reduction to 57 percent reduction. Three types of FOBT's are (1) immunochemical, (2) hemeporphyrin, and (3) guaiac. Immunochemical tests detect only hemoglobin and globin, and are not affected by diet. Hemeporphyrin tests detect the broadest range of blood derivatives. Guaiac tests, such as Hemoccult, detect heme in any form. Screening with flexible sigmoidoscopy to detect adenomatous polyps has received considerable attention. The rationale for this test is that most cancers arise from polyps. The advantage of flexible sigmoidoscopy is direct visualization of adenomas. The disadvantage is that it is only useful for examining the distal portion of the colon. Colonoscopy has been suggested as a one-time screen during the sixth decade of life. The only test that has proven to be effective in reducing colorectal cancer mortality is Hemoccult conducted annually after age 50.
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Colon and Rectal Cancer Source: in Harvard Guide to Women's Health. Carlson, K.J.; Eisenstat, S.A.; Ziporyn, T. Harvard University Press, Cambridge, MA, pp. 160-164, 1996.
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Summary: Colon and Rectal Cancer, a chapter in The Harvard Guide to Women's Health, discusses the symptoms, evaluation, treatment, and prevention of colorectal cancer. Colorectal cancer is currently the third leading cause of cancer in the United States, although death rates have been dropping, especially among women. Explanations for the gender differences in colorectal cancer death rates include (1) differences in diet and exercise habits, (2) differences in alcohol consumption, and (3) hormonal differences. Family history is the most significant risk factor for colorectal cancer, with one in five cancers traced to a predisposing gene. Blacks have a slightly higher risk of developing and dying from colorectal cancer than people of other ethnic backgrounds. Having a prior history of adenamatous polyps or ulcerative colitis is also a risk factor. Symptoms include (1) rectal bleeding, (2) persistent changes in bowel habits, (3) marked change in stool shape or size, (4) abdominal pain, and (5) weight loss. Screening for colorectal cancer includes (1) digital rectal examination, (2) sigmoidoscopy, (3) fecal occult blood test (FOBT), (4) barium enema, and (5) colonoscopy. Treatment for colorectal cancer usually involves surgery, often followed by chemotherapy. There is no evidence that regular screening prevents colorectal cancer, but there is enough indirect evidence to lead several authorities to recommend that all people over age 40 have a rectal examination and all people over age 50 have an FOBT and sigmoidoscopic examination every 3 to 5 years. Prevention strategies include (1) diets high in fiber, (2) reduced alcohol intake, (3) exercise, (4) folic acid supplementation, and (5) aspirin. ·
Colorectal Cancer Screening in a Defined Population Source: in Advances in Cancer Control: Cancer Control Research and the Emergence of the Oncology Product Line. Engstrom, P.F.; Anderson, P.N.; Mortenson, L.E.; eds. New York, NY, Alan R. Liss, Inc., pp. 7-19, 1988. Contact: Alan R. Liss, Inc., 41 East 11th Street, New York, NY 10003. Summary: Colorectal Cancer Screening in a Defined Population, a chapter in Advances in Cancer Control: Cancer Control Research and the Emergence of the Oncology Product Line, focuses on a joint venture for the delivery of cancer-related medical care called US HEALTHCHECK. Developed in 1985, this collaboration resulted in the development of a breast and colorectal cancer screening and early detection program for members of a health maintenance organization (HMO) for Pennsylvania and New Jersey. The US HEALTHCHECK colorectal cancer screening program was intended to reduce morbidity and mortality from colorectal cancer among eligible HMO members by (1) detecting early stage cancer through fecal occult blood testing, (2) ensuring the provision of state-of-
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the-art care and treatment to target populations with positive findings, and (3) utilizing the expertise of a comprehensive cancer center to evaluate patterns of colon and rectum cancer patient management. These goals were to be achieved by integrating the US HEALTHCHECK program into an Individual Practice Association (IPA). The authors present details on participation in colorectal cancer screening programs and discuss the integration of colorectal cancer screening into primary physician practice. They explain the structure of the US HEALTHCHECK colorectal cancer screening program. The organizational structure of the IPA/HMO setting renders this model of physician practice an ideal setting for initiating Phase IV cancer control studies. The similarity of the IPA/HMO physician practice settings to those of solo and group fee-forservice practitioners suggests generalizability of programmatic methods and related clinical outcomes to non-HMO medical care delivery systems. Several aspects of the US HEALTHCHECK program are currently being evaluated, Including (1) population member initial participation, (2) member adherence, and (3) physician management and diagnosis of patients. ·
Colorectal Cancer Screening Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 189-202. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Colorectal cancer (CRC) is one of the most common malignancies in the developed world and the second leading cause of cancer-related death in the United States. Appropriate disease screening has the potential to prevent death from CRC. This chapter on colorectal cancer screening is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include the epidemiology of CRC; typical clinical presentations of CRC; factors that modify CRC risk; risk assessment and screening based on risk assessment; available screening tests, including fecal occult (hidden) blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema; the cost effectiveness of screening; compliance with CRC screening; interventions to encourage CRC screen; two common problems in CRC screening; and patient follow up after resected polyps and colon cancer. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. The authors
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conclude that growing public awareness of CRC and its impact, increasing evidence that CRC screening is a cost-effective method to decrease mortality, wide promulgation of screening recommendations, and greater willingness by insurers to reimburse costs of CRC screening may improve CRC screening rates. 1 figure. 5 tables. 16 references. ·
Screening for Colorectal Cancer Source: in Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force. Second Edition. US Preventive Services Task Force. Baltimore, MD, Williams and Wilkins, pp. 89-103, 1996. Contact: Williams and Wilkins, 351 West Camden Street, Baltimore, MD 21201-2436. Summary: Screening for Colorectal Cancer, a chapter in Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force, discusses the accuracy and effectiveness of various colorectal screening methods. The principal screening tests for detecting colorectal cancer in asymptomatic persons are the digital rectal examination, fecal occult blood test (FOBT), and sigmoidoscopy. The digital rectal examination is of limited value as a screening test because fewer than 10 percent of colorectal cancers can be palpated by the examining finger. The reported sensitivity and specificity of FOBT for detecting colorectal cancer in asymptomatic persons are 26-92 percent and 90-99 percent, respectively, while sigmoidoscopic screening in asymptomatic persons detects 1-4 cancers per 1,000 examinations. Important limitations to the effectiveness of these screenings are the ability of patients and clinicians to comply with testing and the cost of screening. The logistical difficulties and costs of performing FOBT and sigmoidoscopy on a large proportion of the U.S. population are significant, due to the limited accessibility of the tests and the high expense of performing screening and followup. Moreover, the tests have potential adverse effects that must be considered such as falsepositive results that lead to expensive and potentially harmful diagnostic procedures. The authors recommend colorectal cancer screening for all persons over age 50 years with annual FOBT, sigmoidoscopy, or both. Persons with a family history of hereditary syndromes associated with a high risk of colon cancer should be referred for diagnosis and management.
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Prevention and Control of Colorectal Cancer Source: in Cancer Prevention and Control. Greenwald, P.; Kramer, B.S.; Weed, D.L.; eds. New York, NY, Marcel Dekker, Inc., pp. 537-559, 1995. Contact: Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016.
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Summary: Prevention and Control of Colorectal Cancer, a chapter in Cancer Prevention and Control, discusses the role played by primary and secondary prevention in the control of colorectal cancer. Primary prevention involves the identification and avoidance of environmental factors related to carcinogenesis. Secondary prevention includes the identification and eradication of premalignant lesions and the early detection and treatment of cancer. The evidence that nutritional factors can promote or inhibit the development of colorectal cancer suggests that primary prevention may play an important part in the control of this disease. Researchers review the data from the United States and abroad on the relationship between colorectal cancer and colorectal adenomas and (1) dietary fat consumption; (2) fiber intake; (3) excessive caloric intake and body weight; and (4) intake of minerals, vitamins, and trace elements. Researchers conclude this section by discussing gene-nutrient interaction in colon carcinogenesis and dietary guidelines for the prevention of colon cancer. Researchers state that definitive evidence of the relationship between diet and cancer must await the results of prospective, randomized intervention studies in humans. The discussion of secondary prevention focuses on screening for average- and high-risk patients. Average- or standard-risk patients are at risk by virtue of age only and have no other associated risk factors. High-risk patients have conditions from which colorectal cancers are suspected to arise, including adenomatous polyps, familial syndromes, sporadic cancer, genetic abnormalities, and ulcerative colitis. The chapter details screening and followup guidelines for both sets of at-risk patients. Researchers suggest that primary prevention targeted to the general population may reduce the incidence of adenomas and thus reduce future colorectal cancer incidence and mortality. Secondary prevention strategies may help the general population over age 50, by detecting earlier-stage cancers or extirpating adenomas. Researchers also discuss their hopes for more sophisticated screening techniques and easily-implemented nutritional interventions. ·
Screening for Colorectal Cancer: State of the Art on Screening for Colorectal Cancer Source: in Cancer Screening. Miller, A.B.; Chamberlain, J.; Day, N.E.; Hakama, M.; Prorok, P.C.; eds. Cambridge, England, Cambridge University Press, pp. 81-138, 1991. Contact: Press Syndicate of the University of Cambridge, 40 West 20th Street, New York, NY 10011-4211. Summary: Screening for Colorectal Cancer: State of the Art on Screening for Colorectal Cancer, a section in Cancer Screening, reviews methods,
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trials, and studies associated with detection of colorectal cancer. The chapters in this section are: (1) Colon Cancer Control Study: Status and Current Issues; (2) An Update on the Nottingham Trial of Fecal Occult Blood Screening for Colorectal Carcinoma; (3) A Randomized Trial of Fecal Occult Blood Testing for Early Detection of Colorectal Cancer, Results of Screening and Rescreening of 51,325 Subjects; (4) Interim Report on a Randomized Trial of Screening for Colorectal Cancer with Hemoccult-II; (5) Case-control Evaluation of Colorectal Cancer Screening in the Federal Republic of Germany; and (6) Summary of the Discussion on Colorectal Cancer Screening. While the current trials will eventually reveal the effect of screening for occult blood in the stool on colorectal cancer mortality, no single trial will be definitive and most will require more time. Several more years of followup will also be required before the effect of adenoma removal on cancer incidence is determined. Meanwhile, screening for colorectal cancer or its precursors is not a justifiable public health policy.
General Home References In addition to references for colon cancer, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Cancer: 50 Essential Things to Do by Greg Anderson, O. Carl Simonton; Paperback - 184 pages; Revised & Updated edition (August 1999), Plume; ISBN: 0452280745; http://www.amazon.com/exec/obidos/ASIN/0452280745/icongroupinterna · Cancer Encyclopedia -- Collections of Anti-Cancer & Anti-Carcinogenic Agents, Chemicals, Drugs and Substances by John C. Bartone; Paperback (January 2002), ABBE Publishers Association of Washington, DC; ISBN: 0788326791; http://www.amazon.com/exec/obidos/ASIN/0788326791/icongroupinterna · Cancer Sourcebook: Basic Consumer Health Information About Major Forms and Stages of Cancer by Edward J. Prucha (Editor); Library Binding - 1100 pages, 3rd edition (August 1, 2000), Omnigraphics, Inc.; ISBN: 0780802276; http://www.amazon.com/exec/obidos/ASIN/0780802276/icongroupinterna · Cancer Supportive Care: A Comprehensive Guide for Patients and Their Families by Ernest H. Rosenbaum, M.D., Isadora Rosenbaum, M.A.;
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Paperback - 472 pages (November 5, 1998), Somerville House Books Limited; ISBN: 1894042115; http://www.amazon.com/exec/obidos/ASIN/1894042115/icongroupinterna · Cancer Symptom Management: Patient Self-Care Guides (Book with CD-ROM for Windows & Macintosh) by Connie Henke Yarbro (Editor), et al; CD-ROM - 264 pages, 2nd Book & CD-Rom edition (January 15, 2000), Jones & Bartlett Publishing; ISBN: 0763711675; http://www.amazon.com/exec/obidos/ASIN/0763711675/icongroupint erna · Diagnosis Cancer: Your Guide Through the First Few Months by Wendy Schlessel Harpham, Ann Bliss Pilcher (Illustrator); Paperback: 230 pages; Revised & Updated edition (November 1997), .W. Norton & Company; ISBN: 0393316912; http://www.amazon.com/exec/obidos/ASIN/0393316912/icongroupinterna · The Human Side of Cancer: Living with Hope, Coping with Uncertainty by Jimmie C. Holland, M.D., Sheldon Lewis; Paperback - 368 pages (October 2, 2001), Quill; ISBN: 006093042X; http://www.amazon.com/exec/obidos/ASIN/006093042X/icongroupinterna
Vocabulary Builder Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Calcium: A mineral found in teeth, bones, and other body tissues. [NIH] Carcinogenic: Producing carcinoma. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Immunosuppressive: responses. [NIH]
Describes the ability to lower immune system
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Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Menopause: The time of life when a woman's menstrual periods stop permanently. Also called "change of life." [NIH] Osteoporosis: A condition that is characterized by a decrease in bone mass and density, causing bones to become fragile. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proctitis: Inflammation of the rectum. [EU] PSA: Prostate-specific antigen. A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Taboo: Any negative tradition or behavior that is generally regarded as harmful to social welfare and forbidden within a cultural or social group. [NIH]
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CHAPTER 7. MULTIMEDIA ON COLON CANCER Overview Information on colon cancer can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on colon cancer. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on colon cancer is the Combined Health Information Database. You will need to limit your search to “video recording” and “colon cancer” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on colon cancer:
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Gastroenterology for the Primary Care Physician Source: Mount Laurel, NJ: CME Conference Video, Inc. 1994. (instructional package). Contact: Available from CME Conference Video, Inc. 2000 Crawford Place, Suite 100, Mount Laurel, NJ 08054. (800) 284-8433. Fax (800) 2845964. Price: $450 plus $12.25 shipping and handling (as of 1995); group practice package available. Program No. 153. Summary: This continuing education course is designed to update internists, family practitioners, and other primary care physicians on new developments in gastroenterology. The format of the course focuses on case presentations emphasizing important and evolving concepts in gastroenterology. The emphasis is on practical diagnostic and therapeutic choices and the development of cost effective management algorithms. Topics include hepatitis C, non-cardiac chest pain, psychopharmacologic approaches to acid reduction, peptic ulcer disease, Helicobacter pylori, risk factors for NSAID injury, Clostridium difficile, travelers' diarrhea, constipation in the elderly, pancreatitis, endoscopic ultrasound, gastroesophageal reflux disease, Barrett's esophagus, liver disease, GI manifestations in AIDS, esophagitis, fecal incontinence, diagnostic testing, irritable bowel syndrome, inflammatory bowel disease, drug therapy, chronic diarrhea, gallstone disease, colon cancer, cirrhosis, and ascites. The program offers 11 hours of AMA-PRA Category 1 credit. (AA-M).
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Ostomy Care Source: Toronto, Ontario: Medical Audio Visual Communications, Inc. 1993. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. P.O. Box 84548, 2336 Bloor Street West, Toronto, Ontario M6S 1TO Canada. (800) 757-4868 or (905) 602-1160. Fax (905) 602-8720. E-mail:
[email protected]. Price: $249.00 plus shipping and handling. Order number: MED052. Summary: This program is designed to train nurses aides or nursing assistants in the care of patients who have an ostomy. The program features two different patients, a young woman who undergoes an ileostomy for chronic ulcerative colitis and an older man who undergoes a sigmoid colostomy for colon cancer. The program first reviews the different types of ostomies, the reasons why a patient might need to have a temporary or permanent ostomy, and the different types of stomas that can be created (loop, double-barrel, and end stomas). The program then discusses the importance of the physician, enterostomal (ET) nurse, and
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patient working together to determine the type and placement of the stoma required and to develop the patient care plan. Peristomal skin care is always vital, regardless of the type of stoma. The program emphasizes that preoperative care and patient education will greatly increase the likelihood of success. The program then reviews the use of pouch appliances, the types of pouches (and indications for each), the use of pouch deodorant, and the need to resize the appliances as the stoma changes (this can take 6 to 8 weeks). The ET nurse is then shown changing the woman's ileostomy pouch in the hospital: gathering supplies (each is displayed), measuring the stoma, using skin barrier paste, placing the skin barrier, placing the pouch, and documenting the appearance of stoma and skin, the pouch contents, and the presence of flatus (gas). The program then shows a different home health care ET nurse helping the man with the colostomy irrigate his stoma. Again, the stoma supplies and the irrigation process are outlined and depicted. Two final sections of the video discuss the dietary restrictions that may be indicated for the ileostomy and for the colostomy and the problems that patients may encounter for which a health care provider needs to be contacted.
Bibliography: Multimedia on Colon Cancer The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in colon cancer (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on colon cancer. For more information, follow the hyperlink indicated: ·
Adjuvant therapy for colon and rectum cancer: NIH consensus development conference. Source: developed and produced for NIH by Gardiner-Caldwell SynerMed; Year: 1990; Format: Videorecording; Califon, N.J.: Gardiner-Caldwell SynerMed, c1990
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Aseptic ileocolostomy and resection of right colon for cancer. Source: by Fred W. Rankin; Year: 1939; Format: Motion picture; [S.l.: s.n., 1939]
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Can the GI prevent cancer?: colon cancer & Barrett's esophagus: recorded at DDW 1995 in San Diego. Source: AGA, American
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Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?] ·
Cancer of the colon and the barium enema examination. Source: Radiological Society of North America; Year: 1982; Format: Slide; [Chicago, Ill.]: RSNA, c1982
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Cancer of the colon and the gynecologist. Source: obstetrician/ presented by the Department of Gynecology/Obstetrics, Emory University, School of Medicine; Year: 1984; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, c1984
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Clinical aspects of genetic testing in colon cancer and GI disease: recorded at DDW 1995 in San Diego. Source: AGA, American Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?]
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Coding for ICD-9-CM: skin grafts and cancer of the colon. Source: AHA; Year: 1998; Format: Videorecording; [Chicago, Ill.]: American Hospital Association, c1998
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Colon cancer screening. Year: 1996; Format: Videorecording; Houston, TX: University of Texas Health Science Center, 1996
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Colon cancer. Source: [Bert Vogelstein]; Year: 1996; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1996]
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Colon cancer. Source: American College of Surgeons; Year: 1991; Format: Sound recording; [Chicago, Ill.]: The College, [1991]
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Colorectal cancer. Source: a presentation of Films for the Humanities & Sciences; Year: 1993; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1993
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Detection of asymptomatic colon cancer. Source: School of Medicine, University of North Carolina; Year: 1973; Format: Videorecording; Chapel Hill: The University, [1973]
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Diagnosis and management of cancer of the colon and rectum. Source: produced by Audio Productions, Inc; Year: 1966; Format: Motion picture; United States: American Cancer Society, c1966
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Diet and colon cancer. Source: sponsored by Department of Biochemistry, School of Medicine, State University of New York at Buffalo; Year: 1979; Format: Slide; [Buffalo, N.Y.]: The Department, 1979
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Extended surgery for cancer of the colon, cancer of the head and neck, and melanoma: indications and techniques. Source: American College of Surgeons; Year: 1978; Format: Sound recording; [Chicago]: The College, [1978]
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Genitourinary cancer : focus, testicular tumors. Source: Memorial Sloan-Kettering Cancer Center; Year: 1976; Format: Sound recording; [New York]: The Center, c1976
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Idealistic HMO: can good care survive the market? Source: a presentation of Films for the Humanities & Sciences; a production of Hedrick Smith Productions, Inc.; produced in association with South Carolina Educational Television; Year: 2000; Format: Videorecording; Princeton, N.J.: Films for the Humanities; Sciences, c2000
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Inherited colon cancer genes: recorded at DDW 1994 in New Orleans. Source: AGA; Year: 1994; Format: Sound recording; [Bethesda, Md.]: American Gastroenterology Association, [1994?]
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Local excision of colon cancer. Source: from the Film Library and the Clinical Congress of ACS; Year: 1995; Format: Videorecording; Boston, Mass.: Deaconess Hospital, c1995
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Management of colon and rectal cancer. Source: University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute; [produced by] MDA-TV; Year: 1977; Format: Videorecording; Houston: The Center, 1977
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Molecular basis of reducing colon cancer with aspirin: recorded at DDW 1995 in San Diego. Source: AGA; Year: 1995; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, [1995?]
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Multidisciplinary approaches for managing colon and rectum cancer. Source: Glenn D. Steele, Jr; Year: 1992; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1992
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Mutations in colon cancer: mechanisms and causes: recorded at DDW 1995 in San Diego. Source: AGA; Year: 1995; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, [1995?]
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Nursing management of the patient with colon cancer. Source: [presented by] Mosby; Samuel Merritt College, Studio Three Productions; Year: 1995; Format: Videorecording; [St. Louis, Mo.]: Mosby-Year Book, c1995
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Oncology update: colon cancer. Source: a co-production of the Regional Audio Visual Center and Physician Education & Development; Year: 1995; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1995
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Pelvic evisceration for sigmoid colon cancer: preserving the lower part of the rectum with excision of the bilateral internal iliac arteries and veins. Year: 1986; Format: Videorecording; Danbury, Conn.: Davis+Geck, distributors, 1986
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Rectal and colon cancer. Source: Memorial Sloan-Kettering Cancer Center; Year: 1976; Format: Sound recording; [New York]: The Center, c1976
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Role of the physician in long term care ; Chemotherapy for elderly colon cancer patients. Year: 2002; Format: Videorecording; Carrollton, TX: HSTN, c2002
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Screening for colon cancer. Source: [presented by] the Medical University of South Carolina, College of Medicine and the Health Communications Network; Year: 1993; Format: Videorecording; Charleston, S.C.: The University, c1993
Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Ascites: Abnormal buildup of fluid in the abdomen. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Esophagitis: Inflammation of the esophagus (the tube that carries food from the mouth to the stomach). [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hepatitis: Inflammation of the liver. [NIH] Ileostomy: An opening into the ileum, part of the small intestine, from the outside of the body. An ileostomy provides a new path for waste material to leave the body after part of the intestine has been removed. [NIH] Irrigation: Washing by a stream of water or other fluid. [EU] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism
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or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Veins: The vessels carrying blood toward the heart. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON COLON CANCER Overview Keeping up on the news relating to colon cancer can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on colon cancer. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover colon cancer beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on colon cancer is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “colon cancer” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
University of Pittsburgh Cancer Institute Investigators Discover Proteins Linked to Colon Cancer Summary: Pittsburgh, Oct. 8 /PRNewswire/ -- Findings published in this month's issue of Clinical Cancer Research and featured on the journal's cover, may bring researchers one-step closer to the development of tumor markers to detect colon cancer early, before it has had a chance to spread and when it is easier to cure, say researchers from the University of Pittsburgh Cancer Institute (UPCI). These tumor markers -- elevated levels of proteins or other substances in the blood, urine or tissue that indicate the presence of cancer -- also could help identify which patients with colon cancer are more likely to develop recurrent disease. In the study, Robert Getzenberg, Ph.D., senior author and associate professor of urology, pathology and pharmacology at the University of Pittsburgh and co-director, Prostate and Urologic Cancer Program, UPCI and colleagues analyzed cancerous tissue resulting from colon cancer that had spread to the liver -- the most common site for colon cancer to recur - and found three proteins present in the diseased liver tissue that were not present in normal liver tissue. The findings add to previous findings published earlier this year in the journal Cancer Research in which the same researchers identified four different proteins present in colon cancer tumor samples that were not found in normal colon tissue. "Identifying a specific and sensitive tumor marker that would allow reliable early detection of colon cancer and predict the potential for the cancer to spread or recur would be of great benefit to patients," said Dr. Getzenberg. "Early diagnosis of recurrent colon cancer is critical to effective treatment of the disease, however, colon cancer metastases are very difficult to pick up early. Thirty-five to 40 percent of all patients with colon cancer have recurrent disease and the majority of these patients cannot be cured and will eventually die."
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The researchers analyzed a subset of proteins in the cell nucleus called nuclear matrix proteins, or NMPs, to examine the cellular changes in tissue that occur as colon cancer grows. "NMPs appear to represent the earliest changes that occur in cells, which is why we wanted to look carefully at these proteins in both studies," explained Dr. Getzenberg. "In the first study, we looked at the specific NMPs present in cancerous colon tissue and in the second, we examined the NMPs present in liver metastases that had resulted from colon cancer. We found that there are several proteins present in the diseased tissue that are not present in the normal tissue, indicating that these proteins are specifically linked to the development of colon cancer." "These are promising results since microscopic changes indicative of liver metastasis are not currently detectable by conventional imaging studies," said Robert Schoen, M.D., M.P.H., study co-author and associate professor of medicine, division of gastroenterology, hepatology and nutrition, University of Pittsburgh and director, Colorectal Cancer Prevention Program, UPCI. "Carcinoembryonic antigen, or CEA, a tumor-associated glycoprotein, is the most commonly used blood test to survey patients treated for colorectal cancer for possible recurrence, but it is only somewhat useful since only half of colorectal cancers shed CEA levels sufficient for detection and often, by the time a rising CEA is detected, the tumor is too far advanced for effective re- treatment. Identifying the changes in NMPs that occur from colon cancer may be a more promising method to diagnosis the disease early, as well as a way to identify patients at greater risk for cancer recurrence." In subsequent studies, the researchers plan to develop antibodies against the identified proteins to detect their presence in tissue, serum and stool samples from patients. "By identifying patients who are more likely to experience cancer recurrence, based on the presence of specific proteins, we can potentially detect metastases earlier and target therapy more precisely and effectively to that patient," said Dr. Getzenberg. Colorectal cancer is a worldwide public health problem. In the United States, colorectal cancer accounts for 11 percent of all cancers with 147,300 new cases and 56,000 deaths estimated in 2002. For patients with advanced disease, five-year survival rates are 10-20 percent, however, when colon cancer is diagnosed at an early, localized stage, the five-year survival rate is 90 percent.
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The study was supported by a grant from the National Institutes of Health and in part by the A.v. Humboldt Foundation, Germany. Coauthors include Gisela Brunagel, M.D., Anthony J. Bauer, Ph.D., and Barbara N. Vietmeier, all of the University of Pittsburgh School of Medicine. This project exemplifies the innovative research into the cause, course and cure of cancer that will continue and expand as UPCI moves into the Hillman Cancer Center, a new 301,000 square-foot, $130 million state-ofthe- art clinical and research facility being dedicated on Oct. 9, 2002. UPCI is one of the nation's select National Cancer Institute-designated Comprehensive Cancer Centers and the only one in western Pennsylvania. UPCI investigators are world-renowned for their work in clinical and basic cancer research. For more information on UPCI, please contact the Cancer Information and Referral Service at 1-800-237-4724, or visit UPCI's Web site at http://www.upci.upmc.edu.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to colon cancer. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “colon cancer” (or synonyms). The following was recently listed in this archive for colon cancer: ·
COX-2 inhibitor prevents liver metastasis of colon cancer in mice Source: Reuters Industry Breifing Date: August 20, 2002 http://www.reuters.gov/archive/2002/08/20/business/links/20020820 scie005.html
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New pain meds treat spread of colon cancer in mice Source: Reuters Health eLine Date: August 15, 2002 http://www.reuters.gov/archive/2002/08/15/eline/links/20020815elin 008.html
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With similar treatment, blacks and whites with colon cancer fare equally well Source: Reuters Medical News Date: August 12, 2002 http://www.reuters.gov/archive/2002/08/12/professional/links/20020 812manc001.html
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Src upregulation disrupts cellular contacts, which may permit colon cancer spread Source: Reuters Medical News Date: August 08, 2002 http://www.reuters.gov/archive/2002/08/08/professional/links/20020 808scie001.html
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Overexpression of sialidase suppresses apoptosis in human colon cancer Source: Reuters Medical News Date: July 29, 2002 http://www.reuters.gov/archive/2002/07/29/professional/links/20020 729scie003.html
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Small study finds possible link between growth hormone, colon cancer Source: Reuters Industry Breifing Date: July 26, 2002 http://www.reuters.gov/archive/2002/07/26/business/links/20020726 clin014.html
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Possible link between growth hormone, colon cancer Source: Reuters Health eLine Date: July 26, 2002 http://www.reuters.gov/archive/2002/07/26/eline/links/20020726elin 007.html
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Obesity doubles colon cancer risk in young women Source: Reuters Health eLine Date: July 18, 2002 http://www.reuters.gov/archive/2002/07/18/eline/links/20020718elin 009.html
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Folate supplement may reduce colon cancer risk Source: Reuters Health eLine Date: July 18, 2002 http://www.reuters.gov/archive/2002/07/18/eline/links/20020718elin 010.html
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Recommendations on colon cancer screening updated Source: Reuters Health eLine Date: July 15, 2002 http://www.reuters.gov/archive/2002/07/15/eline/links/20020715elin 012.html
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Colorectal cancer screening urged for all men and women beginning at 50 Source: Reuters Medical News Date: July 15, 2002 http://www.reuters.gov/archive/2002/07/15/professional/links/20020 715publ003.html
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Excessive IGF-I may explain link between diet, colon cancer Source: Reuters Medical News Date: July 12, 2002 http://www.reuters.gov/archive/2002/07/12/professional/links/20020 712epid005.html
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US Senate committee OKs colon cancer screening bill Source: Reuters Health eLine Date: July 10, 2002 http://www.reuters.gov/archive/2002/07/10/eline/links/20020710elin 034.html
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Epigenomics, Mayo Clinic to develop early diagnostic for colorectal cancer Source: Reuters Industry Breifing Date: November 05, 2002 http://www.reuters.gov/archive/2002/11/05/business/links/20021105 inds013.html
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Women should start colon cancer screening at 50 Source: Reuters Health eLine Date: October 21, 2002 http://www.reuters.gov/archive/2002/10/21/eline/links/20021021elin 028.html
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Increased folate intake reduces colon cancer risk Source: Reuters Medical News Date: October 21, 2002 http://www.reuters.gov/archive/2002/10/21/professional/links/20021 021epid002.html
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Average-risk women should begin colorectal cancer screening at age 50 Source: Reuters Medical News Date: October 21, 2002 http://www.reuters.gov/archive/2002/10/21/professional/links/20021 021publ004.html
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Unique nuclear matrix proteins associated with colon cancer metastases to liver Source: Reuters Medical News Date: October 17, 2002 http://www.reuters.gov/archive/2002/10/17/professional/links/20021 017scie002.html
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US colon cancer screening rates slowly improving Source: Reuters Health eLine Date: October 01, 2002 http://www.reuters.gov/archive/2002/10/01/eline/links/20021001elin 024.html
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One bad copy of gene boosts colon cancer risk Source: Reuters Health eLine Date: September 20, 2002 http://www.reuters.gov/archive/2002/09/20/eline/links/20020920elin 020.html
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Simultaneous resection of colon cancer and liver metastases can be done safely Source: Reuters Medical News Date: September 05, 2002 http://www.reuters.gov/archive/2002/09/05/professional/links/20020 905clin014.html
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Laparoscopy may provide long-term survival benefit to colon cancer patients Source: Reuters Medical News Date: June 28, 2002 http://www.reuters.gov/archive/2002/06/28/professional/links/20020 628clin013.html
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Keyhole surgery better for colon cancer-study Source: Reuters Health eLine Date: June 28, 2002 http://www.reuters.gov/archive/2002/06/28/eline/links/20020628elin 007.html
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Sanofi completes NDA filing for colon cancer treatment Source: Reuters Industry Breifing Date: June 27, 2002 http://www.reuters.gov/archive/2002/06/27/business/links/20020627 rglt005.html
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Veggies slow spread--not start--of colon cancer Source: Reuters Health eLine Date: June 21, 2002 http://www.reuters.gov/archive/2002/06/21/eline/links/20020621elin 014.html
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Routine colon cancer screening should start at age 50 for most people Source: Reuters Medical News Date: June 05, 2002 http://www.reuters.gov/archive/2002/06/05/professional/links/20020 605publ001.html
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Colon cancer in under-50 group relatively rare Source: Reuters Health eLine Date: June 05, 2002 http://www.reuters.gov/archive/2002/06/05/eline/links/20020605elin 018.html
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Immunocytochemical stool test detects colon cancer Source: Reuters Industry Breifing Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/business/links/20020530 drgd008.html
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Colorectal cancer screen in risky patients studied Source: Reuters Health eLine Date: May 22, 2002 http://www.reuters.gov/archive/2002/05/22/eline/links/20020522elin 009.html
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Colonoscopy every 3 years recommended for patients at high risk for colon cancer Source: Reuters Medical News Date: May 20, 2002 http://www.reuters.gov/archive/2002/05/20/professional/links/20020 520clin018.html
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Vitamin D protects against colon cancer by inducing bile acid breakdown Source: Reuters Medical News Date: May 16, 2002 http://www.reuters.gov/archive/2002/05/16/professional/links/20020 516scie002.html
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Prognosis of stage B colon cancer improves with higher lymph node recovery Source: Reuters Medical News Date: May 15, 2002 http://www.reuters.gov/archive/2002/05/15/professional/links/20020 515clin012.html
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Colon cancer screening every 5 years may be OK Source: Reuters Health eLine Date: May 08, 2002 http://www.reuters.gov/archive/2002/05/08/eline/links/20020508elin 027.html
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Colon cancer is deadlier for poor blacks in US Source: Reuters Health eLine Date: April 30, 2002 http://www.reuters.gov/archive/2002/04/30/eline/links/20020430elin 018.html
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Cut bowel cancer risk by eating less, better: study Source: Reuters Health eLine Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/eline/links/20020423elin 001.html
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Colon cancer tied to later risk of other cancers Source: Reuters Health eLine Date: April 11, 2002 http://www.reuters.gov/archive/2002/04/11/eline/links/20020411elin 007.html
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Aspirin may help prevent colon cancer Source: Reuters Health eLine Date: April 08, 2002 http://www.reuters.gov/archive/2002/04/08/eline/links/20020408elin 023.html
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Genzyme Molecular Oncology licenses gene linked to colon cancer metastasis Source: Reuters Industry Breifing Date: April 03, 2002 http://www.reuters.gov/archive/2002/04/03/business/links/20020403 inds002.html
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New target for gastrointestinal cancers found Source: Reuters Health eLine Date: March 27, 2002 http://www.reuters.gov/archive/2002/03/27/eline/links/20020327elin 013.html
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Large study says calcium may cut colon cancer risk Source: Reuters Health eLine Date: March 20, 2002 http://www.reuters.gov/archive/2002/03/20/eline/links/20020320elin 030.html
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Moderate daily calcium intake seems to reduce risk of colon cancer Source: Reuters Medical News Date: March 19, 2002 http://www.reuters.gov/archive/2002/03/19/professional/links/20020 319epid005.html
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Family history of colon cancer? Folate may help Source: Reuters Health eLine Date: March 14, 2002 http://www.reuters.gov/archive/2002/03/14/eline/links/20020314elin 012.html
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Get screened for colon cancer, US officials urge Source: Reuters Health eLine Date: March 13, 2002 http://www.reuters.gov/archive/2002/03/13/eline/links/20020313elin 029.html
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UK agency rejects bowel cancer drugs, amid furor Source: Reuters Health eLine Date: March 07, 2002 http://www.reuters.gov/archive/2002/03/07/eline/links/20020307elin 033.html
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Clues on painkillers' role in slowing colon cancer Source: Reuters Health eLine Date: March 01, 2002 http://www.reuters.gov/archive/2002/03/01/eline/links/20020301elin 001.html
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British colon cancer deaths drop to 10-year low Source: Reuters Health eLine Date: March 01, 2002 http://www.reuters.gov/archive/2002/03/01/eline/links/20020301elin 028.html
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Gene may help suppress colorectal cancer Source: Reuters Health eLine Date: February 28, 2002 http://www.reuters.gov/archive/2002/02/28/eline/links/20020228elin 004.html
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Level of active TGF-beta-1 higher in colorectal cancer patients than controls Source: Reuters Medical News Date: February 27, 2002 http://www.reuters.gov/archive/2002/02/27/professional/links/20020 227clin003.html
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High incidence of second primary colorectal cancer reported Source: Reuters Medical News Date: February 18, 2002 http://www.reuters.gov/archive/2002/02/18/professional/links/20020 218epid004.html
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New stool test detects early signs of colon cancer Source: Reuters Health eLine Date: January 30, 2002 http://www.reuters.gov/archive/2002/01/30/eline/links/20020130elin 003.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
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Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “colon cancer” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “colon cancer” (or synonyms). If you know the name of a company that is relevant to colon cancer, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “colon cancer” (or synonyms).
Newsletters on Colon Cancer Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “colon cancer.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “colon cancer” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above:
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·
Health Benefits of Physical Activity Source: Physical Activity and Fitness Research Digest. 1(1):1-8, February 1993. Summary: The Health Benefits of Physical Activity is a newsletter issue that provides a simple summary of the benefits of physical activity. Section one, Disease Prevention and Treatment, lists the diseases for which regular physical activity can reduce risk, either of getting the disease or of dying from it, and describes how exercise reduces risk for these diseases. Diseases that can be prevented through physical activity include (1) heart disease, (2) stroke, (3) vascular disease, (4) high blood pressure, (5) diabetes, (6) colon cancer, (7) obesity, (8) depression, (9) back pain, and (10) osteoporosis. Physical activity has been shown to have a significant beneficial health effect on individuals suffering from depression. Section two, Health Promotion, discusses the Healthy People 2000 report and its health goals. While physical activity's contribution to quality of life and a personal sense of well-being is more difficult to document than its contribution to prevention and treatment of disease, evidence suggests that humans were designed to be physically active and that physical activity has great potential for enhancing quality of life. Section three, Physical Fitness, examines the relationship between physical activity and physical fitness. Physical fitness has been linked to injury prevention and is often an important factor in the level of body fat, which can affect disease risk. Regular physical activity has positive benefits for both good health and adequate physical fitness.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is
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updated every 3 months. The following is a typical result when searching for newsletter articles on colon cancer: ·
Inflammatory Bowel Diseases: Misery Needn't be the Norm Source: Mayo Clinic Health Letter. 19(10): 1-3. October 2001. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This health education newsletter article familiarizes readers with inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. The author describes the two types of IBD, and their incidence, symptoms, diagnosis, drug therapy, lifestyle treatments, and surgical options. The signs and symptoms of Crohn's disease and ulcerative colitis may develop gradually or suddenly and can be similar: chronic diarrhea, vomiting, abdominal cramping, blood in the stool, weight loss and fatigue, and fever in severe cases. In addition, people with Crohn's disease are more likely to develop open sores (ulcers) in their digestive tract. Blood tests and diagnostic imaging confirm the diagnoses of inflammatory bowel disease. Drug therapy is a key component of treating IBD. Although drugs do not offer a cure for IBD, they often help control the condition. Once the right drug or combination of drugs is determined, symptoms can often be reduced. Drugs can include anti-inflammatory drugs, immune modulators, and antibiotics. Lifestyle treatments include dietary management, adequate fluid intake, stress management (including the use of support groups), and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs). At least 70 percent of those patients with Crohn's disease will need at least one or more surgeries. One side bar reminds readers of the risk of colon cancer in people with IBD. 1 figure.
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Fiber Remains a Healthy Choice Source: Harvard Health Letter. 24(6): 5. April 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. E-mail:
[email protected]. Summary: This brief newsletter article considers recent evidence reported in the New England Journal of Medicine indicating that fiber, which has long been thought to protect against colon cancer, may not, in fact, prevent the disease. Harvard researchers tracked the eating habits of nearly 90,000 women over a 16 year time period. The women who reported eating the least amount of fiber (about 10 grams per day) were no more likely to develop colorectal malignancies or polyps than those
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who ate the most (about 25 grams daily). Nutrition experts recommend that people consume between 25 and 35 grams of fiber daily; the average American ingests about 13 grams per day. This study and another Harvard investigation of 47,000 men both relied on dietary information reported by the participants. Because participants may not have accurately recalled what they ate, scientists point out that the studies do not conclusively prove that fiber has no role in preventing colon cancer. The article concludes by noting that there is one thing readers can do to reduce their risk of developing colon cancer: curb the intake of animal (saturated) fats, because there is evidence that fatty meats and dairy products increase risk. ·
Update on the Epidemiology of IBD Source: Progress in Inflammatory Bowel Disease. 15(3): 1, 3-8. Fall 1994. Contact: Available from CCFA. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 932-2423 or (800) 343-3637 or (212) 685-3440. Summary: In this article, the authors summarize the information on the epidemiology of inflammatory bowel disease (IBD) that has been published in the past 5 years and place it in context for the practicing physician and IBD researcher. After a discussion of the epidemiological challenges of IBD, the authors cover incidence of ulcerative colitis (UC) and Crohn's disease; prevalence; mortality; morbidity; the geographic variation in IBD rates; race factors; gender; age factors; urban versus rural findings; ethnicity; diet as an etiologic factor; early life events in children with IBD; oral contraceptives as risk factors for Crohn's disease; cigarette smoking; passive smoking exposure; the use of nonsteroidal antiinflammatory drugs (NSAIDs); and colon cancer risk in patients with UC. The authors conclude with a brief discussion of the use of outcomes research in the future of research on the epidemiology of IBD. 55 references.
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Epidemiology and IBD: An Intriguing Conundrum Source: Foundation Focus. p. 3-5. July 1995. Contact: Available from Crohn's and Colitis Foundation of America, Inc. 386 Park Avenue South, New York, NY 10016-8804. (800) 932-2423 or (212) 685-3440. Summary: This newsletter article provides readers with basic information about the epidemiology of inflammatory bowel disease (IBD). Topics include the search for genetic risk factors for IBD; incidence; prevalence; geographic variation in IBD rates; rates of IBD in urban versus rural settings; dietary factors; early life events, such as breastfeeding and other
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perinatal factors; the role of oral contraceptives, cigarette smoking, and nonsteroidal anti-inflammatory drugs (NSAIDs); and ways to potentially reduce the colon cancer risk associated with IBD. 2 figures. ·
Link Between Plant-Based Diet and Lowered Risk for Colon Cancer Remains Clear, Convincing Source: AICR Science News. Issue 17, p.1-2. September 2000. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. www.aicr.org. Summary: This article makes the case that the media distorted two articles in the April 20, 2000, issue of the New England Journal of Medicine (NEJM) and gave many Americans misleading impressions about diet and cancer. The studies failed to find a link between recurrence of colon polyps and either low-fat, high-fiber diets featuring fruits and vegetables or diets that included high- fiber cereal supplements. The studies involved only short-term (four-year) adjustments to the diet. Colon cancer is a disease that can take decades to develop. Convincing epidemiological evidence suggests that a healthy diet has its greatest preventive effect as a lifelong commitment. Although it remains to be seen whether four years of fruits, vegetables, whole grains, and beans protect against cancer, there is ample and growing evidence that a lifetime of these foods will.
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Lifestyle Factors and Colon Cancer Risk Source: AICR Science News. Issue 17, p.2. September 2000. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. www.aicr.org. Summary: Researchers analyzed data from a population-based study to determine lifestyle patterns and their association with colon cancer. Data from 1,993 cases and 2,410 controls were grouped by factor analysis to describe various aspects of lifestyle patterns. Among both men and women, a lifestyle characterized by high levels of physical activity showed the strongest inverse association with colon cancer. Additional results from the study point to the importance of maintaining a healthy weight and eating a diet high in plant foods and low in animal products. The authors of the study believe that vigorous physical activity may be the most important component of a healthy lifestyle that decreases risk of colon cancer.
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IBS: More Common than You Think Source: University of California, Berkeley, Wellness Letter. 17(1):1-2. October 2000. Contact: Health Letter Associates. P.O. Box 412, Prince Street Station, New York, NY 10012-0007. Summary: Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder reported to primary care physicians. Its cause is unknown, although one theory is that the nerves lining the colon of IBS sufferers are more sensitive to bowel contractions, the passage of gas, and other digestive processes. No specific food is known to be responsible for the symptoms. The role of stress may be either the cause or the result of IBS. The article advises those over age 50 who develop chronic bowel problems to be tested to rule out colon cancer. Steps to take in order to avoid IBS symptoms are included in the article.
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Does Fiber Help Prevent Cancer? Source: American Institute for Cancer Research Newsletter. Issue 69, p.1,3. Fall 2000. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. Summary: This article explains the reasons behind recent headlines that announced that dietary fiber does not prevent colon cancer. Two studies published in the New England Journal of Medicine found that eating more fiber for several years did not prevent recurrence of colorectal polyps. These tiny growths may precede colorectal cancer. One of the studies tested a low-fat, high-fiber diet emphasizing vegetables and fruits while the other tested a wheat bran fiber supplement. In both of the studies, consumption of the fiber containing foods was lower than what it should have been. The American Institute for Cancer Research (AICR) recommends not abandoning a low-fat, high-fiber diet on the basis of these two studies. The AICR states that the scientific evidence linking consumption of high-fiber foods to cancer prevention is clear and convincing.
Academic Periodicals Covering Colon Cancer Academic periodicals can be a highly technical yet valuable source of information on colon cancer. We have compiled the following list of periodicals known to publish articles relating to colon cancer and which are currently indexed within the National Library of Medicine’s PubMed
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database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on colon cancer published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on colon cancer: ·
Biochemical Pharmacology. (Biochem Pharmacol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ochemical+Pharmacology&dispmax=20&dispstart=0
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Biological Chemistry. (Biol Chem) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ological+Chemistry&dispmax=20&dispstart=0
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British Journal of Cancer. (Br J Cancer) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bri tish+Journal+of+Cancer&dispmax=20&dispstart=0
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Cancer Research. (Cancer Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ca ncer+Research&dispmax=20&dispstart=0
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Clinical Nuclear Medicine. (Clin Nucl Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Nuclear+Medicine&dispmax=20&dispstart=0
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Gene Therapy. (Gene Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ge ne+Therapy&dispmax=20&dispstart=0
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Genes & Development. (Genes Dev) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ge nes+&+Development&dispmax=20&dispstart=0
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Journal of Gastroenterology. (J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology&dispmax=20&dispstart=0
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Journal of Surgical Oncology. (J Surg Oncol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Surgical+Oncology&dispmax=20&dispstart=0
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Journal of the National Cancer Institute. (J Natl Cancer Inst) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+the+National+Cancer+Institute&dispmax=20&dispstart=0
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Life Sciences. (Life Sci) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Lif e+Sciences&dispmax=20&dispstart=0
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Molecular Medicine (Cambridge, Mass. . (Mol Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M olecular+Medicine+(Cambridge,+Mass.+&dispmax=20&dispstart=0
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Preventive Medicine. (Prev Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Pr eventive+Medicine&dispmax=20&dispstart=0
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Regulatory Peptides. (Regul Pept) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Re gulatory+Peptides&dispmax=20&dispstart=0
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The Journal of Nutrition. (J Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Nutrition&dispmax=20&dispstart=0
Vocabulary Builder Epidemiological: Relating to, or involving epidemiology. [EU]
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Inflammation: A response of redness, swelling, pain, and a feeling of heat in certain areas which is meant to protect tissues affected by injury or disease. [NIH]
Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] NSAIDs: Nonsteroidal anti-inflammatory drugs. A group of drugs that decrease fever, swelling, pain, and redness. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtml
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In this chapter, we begin by reproducing one such guideline for colon cancer:
What Is Colon Cancer?34 Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of patients. Recurrence following surgery is a major problem and often is the ultimate cause of death. The prognosis of colon cancer is clearly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement. These 2 characteristics form the basis for all staging systems developed for this disease. Bowel obstruction and bowel perforation are indicators of poor prognosis.35 Elevated pretreatment serum levels of carcinoembryonic antigen (CEA) have a negative prognostic significance.36 Many other prognostic markers have been evaluated retrospectively in the prognosis of patients with colon cancer, although most, including allelic loss of chromosome 18q or thymidylate synthase expression, have not been prospectively validated.37 Microsatellite instability, also associated with hereditary nonpolyposis colon cancer, has been shown to be associated with improved survival independent of tumor stage in a population-based series of 607 patients less than 50 years of age with colorectal cancer.38 Age greater than 65 years at presentation is not a contraindication to standard therapies; acceptable morbidity and mortality, as well as long-term survival, are achieved in this
The following guidelines appeared on the NCI website on Aug. 26, 2002. The text was last modified in July 2002. The text has been adapted for this sourcebook. Note: Separate PDQ summaries on Screening for Colorectal Cancer and Prevention of Colorectal Cancer are also available. Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 35 Steinberg SM, Barkin JS, Kaplan RS, et al.: Prognostic indicators of colon tumors: the Gastrointestinal Tumor Study Group experience. Cancer 57(9): 1866-1870, 1986. 36 Filella X, Molina R, Grau JJ, et al.: Prognostic value of CA 19.9 levels in colorectal cancer. Annals of Surgery 216(1): 55-59, 1992. 37 McLeod HL, Murray GI: Tumour markers of prognosis in colorectal cancer. British Journal of Cancer 79(2): 191-203, 1999. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. New England Journal of Medicine 331(4): 213-221, 1994. Lanza G, Matteuzzi M, Gafa R, et al.: Chromosome 18q allelic loss and prognosis in stage II and III colon cancer. International Journal of Cancer 79(4): 390-395, 1998. 38 Gryfe R, Kim H, Hsieh ET, et al.: Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. New England Journal of Medicine 342(2): 69-77, 2000. 34
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patient population.39 Racial differences in overall survival after adjuvant therapy have been observed, without differences in disease-free survival, suggesting that comorbid conditions play a role in survival outcome in different patient populations.40 Because of the frequency of the disease, the identification of high-risk groups, the demonstrated slow growth of primary lesions, the better survival of patients with early-stage lesions, and the relative simplicity and accuracy of screening tests, screening for colon cancer should be a part of routine care for all adults starting at age 50 years, especially for those with first-degree relatives with colorectal cancer. There are groups that have a high incidence of colorectal cancer. These groups include those with hereditary conditions, such as familial polyposis, hereditary nonpolyposis colon cancer (HNPCC), Lynch I Syndrome, Lynch II Syndrome, and ulcerative colitis.41 Together they account for 10% to 15% of colorectal cancers. Patients with HNPCC reportedly have better prognoses in stage-stratified survival analysis than patients with sporadic colorectal cancer, but the retrospective nature of the studies and possibility of selection factors make this observation difficult to interpret.42 [Level of evidence: 3iiiA] More common conditions with an increased risk include: a personal history of colorectal cancer or adenomas, first degree family history of colorectal cancer or adenomas, and a personal history of ovarian, endometrial, or breast cancer.43 These high-risk groups account for only 23% of all colorectal cancers. Limiting screening or early cancer detection to only these high-risk groups would miss the majority of
Fitzgerald SD, Longo WE, Daniel GL, et al.: Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified? Diseases of the Colon and Rectum 36(2): 161166, 1993. Chiara S, Nobile MT, Vincenti M, et al.: Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemotherapy and Pharmacology 42(4): 336-340, 1998. Popescu RA, Norman A, Ross PJ, et al.: Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. Journal of Clinical Oncology 17(8): 2412-2418, 1999. 40 Dignam JJ, Colangelo L, Tian W, et al.: Outcomes among African-Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. Journal of the National Cancer Institute 91(22): 19331940, 1999. 41 Thorson AG, Knezetic JA, Lynch HT: A century of progress in hereditary nonpolyposis colorectal cancer (Lynch syndrome). Diseases of the Colon and Rectum 42(1): 1-9, 1999. 42 Watson P, Lin KM, Rodriguez-Bigas MA, et al.: Colorectal carcinoma survival among hereditary nonpolyposis colorectal carcinoma family members. Cancer 83(2): 259-266, 1998. 43 Ransohoff DF, Lang CA: Screening for colorectal cancer. New England Journal of Medicine 325(1): 37-41, 1991. Fuchs CS, Giovannucci EL, Colditz GA, et al.: A prospective study of family history and the risk of colorectal cancer. New England Journal of Medicine 331(25): 1669-1674, 1994. 39
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colorectal cancers.44 (Refer to the PDQ summaries on Screening for Colorectal Cancer and Prevention of Colorectal Cancer for more information.) Following treatment of colon cancer, periodic evaluations may lead to the earlier identification and management of recurrent disease.45 However, the impact of such monitoring on overall mortality of patients with recurrent colon cancer is limited by the relatively small proportion of patients in whom localized, potentially curable metastases are found. To date, there have been no large-scale randomized trials documenting the efficacy of a standard, postoperative monitoring program.46 CEA is a serum glycoprotein frequently used in the management of patients with colon cancer. A review of the use of this tumor marker suggests: that CEA is not a valuable screening test for colorectal cancer due to the large numbers of false-positive and false-negative reports; that postoperative CEA testing be restricted to patients who would be candidates for resection of liver or lung metastases; and that routine use of CEA alone for monitoring response to treatment not be recommended.47 However, the optimal regimen and frequency of followup examinations are not well defined, since the impact on patient survival is
Winawer SJ: Screening for colorectal cancer. Cancer: Principles and Practice of Oncology Updates 2(1): 1-16, 1987. 45 Martin EW, Minton JP, Carey LC: CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Annals of Surgery 202(1): 310-317, 1985. Bruinvels DJ, Stiggelbout AM, Kievit J, et al.: Follow-up of patients with colorectal cancer: a meta-analysis. Annals of Surgery 219(2): 174-182, 1994. Lautenbach E, Forde KA, Neugut AI: Benefits of colonoscopic surveillance after curative resection of colorectal cancer. Annals of Surgery 220(2): 206-211, 1994. Khoury DA, Opelka FG, Beck DE, et al.: Colon surveillance after colorectal cancer surgery. Diseases of the Colon and Rectum 39(3): 252-256, 1996. 46 Safi F, Link KH, Beger HG: Is follow-up of colorectal cancer patients worthwhile? Diseases of the Colon and Rectum 36(7): 636-644, 1993. Moertel CG, Fleming TR, Macdonald JS, et al.: An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA: Journal of the American Medical Association 270(8): 943-947, 1993. Rosen M, Chan L, Beart RW, et al.: Follow-up of colorectal cancer: a meta-analysis. Diseases of the Colon and Rectum 41(9): 1116-1126, 1998. Desch CE, Benson AB III, Smith TJ, et al.: Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Journal of Clinical Oncology 17(4): 1312-1321, 1999. Benson AB, Desch CE, Flynn PJ, et al.: 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. Journal of Clinical Oncology 18(20): 3586-3588, 2000. 47 American Society of Clinical Oncology: Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Journal of Clinical Oncology 14(10): 2843-2877, 1996. 44
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not clear and the quality of data is poor.48 New surveillance methods including CEA immunoscintigraphy49 and positron emission tomography are under clinical evaluation. Gastrointestinal stromal tumors can occur in the colon. (Refer to the PDQ summary on Adult Soft Tissue Sarcoma Treatment for more information.)
Adjuvant Therapy The current generation of large prospective randomized trials has demonstrated consistent evidence of benefit for systemic adjuvant chemotherapy employing fluorouracil (5-FU) plus either levamisole or leucovorin. In 1990, a large intergroup trial of 5-FU/levamisole reported prolonged disease-free and overall survival in patients with stage III colon cancer, compared to patients who received no treatment after surgery.50 This benefit has persisted with continued follow-up.51 The National Surgical Adjuvant Breast and Bowel Project (NSABP) then reported a trial for stage II and III patients comparing the fluorouracil/semustine/ vincristine regimen to a weekly regimen of 5-FU plus high-dose leucovorin. This demonstrated a statistically significant benefit for 5-FU/leucovorin in both overall and disease-free survival.52 Adjuvant 5-FU plus leucovorin (in different treatment schedules) was also compared to surgery alone in 4 large randomized trials that closed Rosen M, Chan L, Beart RW, et al.: Follow-up of colorectal cancer: a meta-analysis. Diseases of the Colon and Rectum 41(9): 1116-1126, 1998. Desch CE, Benson AB III, Smith TJ, et al.: Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Journal of Clinical Oncology 17(4): 1312-1321, 1999. Benson AB, Desch CE, Flynn PJ, et al.: 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. Journal of Clinical Oncology 18(20): 3586-3588, 2000. 49 Lechner P, Lind P, Goldenberg DM: Can postoperative surveillance with serial CEA immunoscintigraphy detect resectable rectal cancer recurrence and potentially improve tumor-free survival? Journal of the American College of Surgeons 191(5): 511-518, 2000. 50 Moertel CG, Fleming TR, Macdonald JS, et al.: Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. New England Journal of Medicine 322(6): 352-358, 1990. 51 Moertel CG, Fleming TR, Macdonald JS, et al.: Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Annals of Internal Medicine 122(5): 321-326, 1995. 52 Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. Journal of Clinical Oncology 11(10): 18791887, 1993. 48
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prematurely in the early 1990s when surgery alone control arms were no longer felt to represent standard care for stage III patients. Three of these trials, conducted in Canada, France, and Italy, have had their primary data pooled and analyzed together. The 3-year recurrence-free and overall survival rates were also statistically significantly improved in this analysis.53 Taken together, about 4,000 patients have participated in the positive randomized trials comparing adjuvant chemotherapy to surgery alone with a reduction in mortality of between 22% and 33%. These results are quite clear in stage III patients but uncertain in stage II patients. Adjuvant treatment of stage III colon cancer appears to be cost-effective when costs of treatment and quality-of-life measures are taken into account.54 At this time, patients with stage III (Dukes’ C) colon cancer should be considered for adjuvant therapy with 5-FU/leucovorin for 6 to 8 months.55
Advanced Disease For locally advanced disease, the role of radiation therapy with chemotherapy in colon cancer is under clinical evaluation. Palliation may be achieved in approximately 10% to 20% of patients with 5-FU. Several studies suggest an advantage when leucovorin is added to 5-FU in terms of response rate and palliation of symptoms, but not always in terms of survival.56 Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 345(8955): 939944, 1995. O’Connell M, Mailliard J, Macdonald J, et al.: An intergroup trial of intensive course 5FU and low dose leucovorin as surgical adjuvant therapy for high risk colon cancer. Proceedings of the American Society of Clinical Oncology 12: A-552, 190, 1993. 54 Brown ML, Nayfield SG, Shibley LM: Adjuvant therapy for stage III colon cancer: economics returns to research and cost-effectiveness of treatment. Journal of the National Cancer Institute 86(6): 424-430, 1994. 55 NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA: Journal of the American Medical Association 264(11): 1444-1450, 1990. Wolmark N, Rockette H, Mamounas E, et al.: Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin, and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project C-04. Journal of Clinical Oncology 17(11): 35533559, 1999. 56 Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. Erlichman C, Fine S, Wong A, et al.: A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. Journal of Clinical Oncology 6(3): 469-475, 1988. Doroshow JH, Multhauf P, Leong L, et al.: Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. Journal of Clinical Oncology 8(3): 491-501, 1990. 53
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Irinotecan (CPT-11) has been approved by the Food and Drug Administration for the treatment of patients whose tumors are refractory to 5-FU.57 Participation in clinical trials is appropriate. A number of other drugs are undergoing evaluation for the treatment of colon cancer.58 Oxaliplatin, alone or combined with 5-FU and leucovorin, has also shown activity in 5FU refractory patients.59 Some retrospective studies suggest that perioperative blood transfusions impair prognosis of patients with colorectal cancer.60 A small, singlePoon MA, O’Connell MJ, Wieand HS, et al.: Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. Journal of Clinical Oncology 9(11): 1967-1972, 1991. Valone FH, Friedman MA, Wittlinger PS, et al.: Treatment of patients with advanced colorectal carcinomas with fluorouracil alone, high-dose leucovorin plus fluorouracil, or sequential methotrexate, fluorouracil, and leucovorin: a randomized trial of the Northern California Oncology Group. Journal of Clinical Oncology 7(10): 1427-1436, 1989. Borner MM, Castiglione M, Bacchi M, et al.: The impact of adding low-dose leucovorin to monthly 5-fluorouracil in advanced colorectal carcinoma: results of a phase III trial. Annals of Oncology 9(5): 535-541, 1998. Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. Advanced Colorectal Cancer Meta-Analysis Project. Journal of Clinical Oncology 10(6): 896-903, 1992. 57 Rothenberg ML, Eckardt JR, Kuhn JG, et al.: Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. Journal of Clinical Oncology 14(4): 11281135, 1996. Conti JA, Kemeny NE, Saltz LB, et al.: Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(3): 709-715, 1996. Rougier P, Van Cutsem E, Bajetta E, et al.: Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352(9138): 1407-1412, 1998. Cunningham D, Pyrhonen S, James RD, et al.: Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138): 1413-1418, 1998. 58 Von Hoff DD: Promising new agents for treatment of patients with colorectal cancer. Seminars in Oncology 25(5, suppl 11): 47-52, 1998. 59 de Gramont A, Vignoud J, Tournigand C, et al.: Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer. European Journal of Cancer 33(2): 214-219, 1997. Bleiberg H, de Gramont A: Oxaliplatin plus 5-fluorouracil: clinical experience in patients with advanced colorectal cancer. Seminars in Oncology 25(2 suppl 5): 32-39, 1998. Cvitkovic E, Bekradda M: Oxaliplatin: a new therapeutic option in colorectal cancer. Seminars in Oncology 26(6): 647-662, 1999. Giacchetti S, Perpoint B, Zidani R, et al.: Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer. Journal of Clinical Oncology 18(1): 136-147, 2000. 60 Stephenson KR, Steinberg SM, Hughes KS, et al.: Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Annals of Surgery 208(6): 679-687, 1988.
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institution, prospective randomized trial found the need for allogeneic transfusions following resection of colorectal cancer was an independent predictor of tumor recurrence.61 This finding was not confirmed by a large, multi-institutional, prospective randomized trial which demonstrated no benefit for autologous blood transfusions when compared to allogeneic transfusions.62 Both studies established that patients who do not require any blood transfusion have a reduced risk of recurrence, but it would be premature to change transfusion procedures based on these results as other studies have not confirmed this finding.63 There are a large number of studies correlating various clinical, pathological, and molecular parameters with prognosis, but none of these parameters has been demonstrated to be as important as pathologic stage, and none yet has a major impact on choice of, or outcome from, therapy.64
Voogt PJ, Van de Velde CJ, Brand A, et al.: Perioperative blood transfusion and cancer prognosis: different effects of blood transfusion on prognosis of colon and breast cancer patients. Cancer 59(4): 836-843, 1987. 61 Heiss MM, Mempel W, Delanoff C, et al.: Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. Journal of Clinical Oncology 12(9): 1859-1867, 1994. 62 Busch OR, Hop WC, Hoynck van Papendrecht MA, et al.: Blood transfusions and prognosis in colorectal cancer. New England Journal of Medicine 328(19): 1372-1376, 1993. 63 Donohue JH, Williams S, Cha S, et al.: Perioperative blood transfusions do not affect disease recurrence of patients undergoing curative resection of colorectal carcinoma: a Mayo/North Central Cancer Treatment Group study. Journal of Clinical Oncology 13(7): 1671-1678, 1995. 64 McLeod HL, Murray GI: Tumour markers of prognosis in colorectal cancer. British Journal of Cancer 79(2): 191-203, 1999. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. New England Journal of Medicine 331(4): 213-221, 1994. Griffin MR, Bergstralh EJ, Coffey RJ, et al.: Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 60(9): 2318-2324, 1987. Johnston PG, Fisher ER, Rockette HE, et al.: The role of thymidylate synthase expression in prognosis and outcome of adjuvant chemotherapy in patients with rectal cancer. Journal of Clinical Oncology 12(12): 2640-2647, 1994. Shibata D, Reale MA, Lavin P, et al.: The DCC protein and prognosis in colorectal cancer. New England Journal of Medicine 335(23): 1727-1732, 1996. Bauer KD, Lincoln ST, Vera-Roman JM, et al.: Prognostic implications of proliferative activity and DNA aneuploidy in colonic adenocarcinomas. Laboratory Investigation 57(3): 329-335, 1987. Bauer KD, Bagwell CB, Giaretti W, et al.: Consensus review of the clinical utility of DNA flow cytometry in colorectal cancer. Cytometry 14(5): 486-491, 1993. Sun XF, Carstensen JM, Zhang H, et al.: Prognostic significance of cytoplasmic p53 oncoprotein in colorectal adenocarcinoma. Lancet 340(8832): 1369-1373, 1992. Roth JA: p53 prognostication: pardigm or paradox? Clinical Cancer Research 5(11): 3345, 1999.
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Cellular Classification Adenocarcinoma (majority of cases): ·
Mucinous (colloid) adenocarcinoma
·
Signet ring adenocarcinoma
Scirrhous tumors: ·
Neuroendocrine:65 Tumors with neuroendocrine differentiation typically have a poorer prognosis than pure adenocarcinoma variants.
Stage Information Treatment decisions should be made with reference to the TNM classification,66 rather than the older Dukes’ or the Modified Astler-Coller (MAC) classification schema. The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.67
TNM Definitions Primary tumor (T): ·
TX: Primary tumor cannot be assessed
·
T0: No evidence of primary tumor
·
Tis: Carcinoma in situ: intraepithelial or invasion of the lamina propria68
·
T1: Tumor invades submucosa
·
T2: Tumor invades muscularis propria
·
T3: Tumor invades through the muscularis propria into the subserosa, or into nonperitonealized pericolic or perirectal tissues
Saclarides TJ, Szeluga D, Staren ED: Neuroendocrine cancers of the colon and rectum: results of a ten-year experience. Diseases of the Colon and Rectum 37(7): 635-642, 1994. 66 Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 83-90. 67 Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 83-90. 68 Note: Tis includes cancer cells confined within the glandular basement membrane (intraepithelial) or lamina propria (intramucosal) with no extension through the muscularis mucosae into the submucosa. 65
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·
T4: Tumor directly invades other organs or structures, and/or perforates visceral peritoneum69
Regional lymph nodes (N): ·
NX: Regional nodes cannot be assessed
·
N0: No regional lymph node metastasis
·
N1: Metastasis in 1 to 3 regional lymph nodes
·
N2: Metastasis in 4 or more regional lymph nodes
A tumor nodule greater than 3 mm in diameter in the perirectal or pericolic fat without histologic evidence of a residual node in the nodule is classified as regional perirectal or pericolic lymph node metastasis. A tumor nodule 3 mm or less in diameter is classified in the T category as a noncontiguous extension, that is T3.70 Distant metastasis (M): ·
MX: Distant metastasis cannot be assessed
·
M0: No distant metastasis
·
M1: Distant metastasis
Stage 0 ·
Tis, N0, M0
Stage I ·
T1, N0, M0
·
T2, N0, M0
Stage II ·
T3, N0, M0
·
T4, N0, M0
Note: Direct invasion in T4 includes invasion of other segments of the colorectum by way of the serosa; for example, invasion of the sigmoid colon by a carcinoma of the cecum. 70 Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 83-90. 69
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Stage III ·
Any T, N1, M0
·
Any T, N2, M0
Stage IV ·
Any T, Any N, M1
Treatment Option Overview71 Standard treatment of colon cancer has been open surgical resection of the primary and regional lymph nodes for localized disease. The role of laparoscopic techniques72 in the treatment of colon cancer is under evaluation in a prospective randomized trial comparing laparoscopic colectomy to open colectomy.73 When resection can be performed with clear margins, patients whose tumors extend through the bowel wall and to adjacent structures have no worse prognosis than similarly staged patients without such invasion. Surgery is also curative in 20% of patients who develop resectable metastases in the liver. Many early trials of adjuvant chemotherapy failed to show a significant improvement in either overall or disease-free survival for patients receiving treatment compared to
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 72 Bokey EL, Moore JW, Chapuis PH, et al.: Morbidity and mortality following laparoscopicassisted right hemicolectomy for cancer. Diseases of the Colon and Rectum 39(10, Suppl): S24-S28, 1996. Franklin ME, Rosenthal D, Abrego-Medina D, et al.: Prospective comparison of open vs. laparoscopic colon surgery for carcinoma: five-year results. Diseases of the Colon and Rectum 39(10, Suppl): S35-S46, 1996. Fleshman JW, Nelson H, Peters WR, et al.: Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Diseases of the Colon and Rectum 39(10, Suppl): S53-S58, 1996. Marchesa P, Milsom JW, Hale JC, et al.: Intraoperative laparoscopic liver ultrasonography for staging of colorectal cancer. Diseases of the Colon and Rectum 39(10, Suppl): S73-S78, 1996. 73 Nelson H, North Central Cancer Treatment Group: NCI HIGH PRIORITY CLINICAL TRIAL --- Phase III Randomized Study of Laparoscopic-Assisted Colectomy Versus Open Colectomy for Colon Cancer (Summary Last Modified 03/2002), NCCTG-934653, clinical trial, active, 08/15/1994. 71
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concurrently randomized control patients receiving no adjuvant therapy.74 These trials employed fluorouracil (5-FU) alone or 5-FU plus semustine (methyl-CCNU). The North Central Cancer Treatment Group (NCCTG) conducted a randomized trial comparing surgical resection alone with postoperative levamisole or 5-FU/levamisole.75 [Level of evidence: 1iiA] A significant improvement in disease-free survival was observed for patients with stage III (Dukes’ C) colon cancer who received 5-FU/levamisole, but overall survival benefits were of borderline statistical significance. A survival benefit of approximately 12% (49% versus 37%) was seen in patients with stage III disease treated with 5-FU/levamisole. In a large, confirmatory intergroup trial, 5-FU/levamisole prolonged disease-free and overall survival in patients with stage III colon cancer, compared to patients who received no treatment after surgery.76 [Level of evidence: 1iiA] Levamisole alone did not confer these benefits. In 1990, a National Institutes of Health Consensus Panel recommended that adjuvant therapy with 5-FU/levamisole be considered for patients with stage III (Dukes’ C) colon cancer.77 A study comparing 5-FU and leucovorin with fluorouracil/semustine/vincristine has demonstrated a statistically significant benefit in both survival and disease-free survival for the 5FU/leucovorin arm.78 [Level of evidence: 1iiA] The National Surgical Adjuvant Breast and Bowel Project (NSABP) regimen used 5-FU at 500 Panettiere FJ, Goodman PJ, Costanzi JJ, et al.: Adjuvant therapy in large bowel adenocarcinoma: long-term results of a Southwest Oncology Group study. Journal of Clinical Oncology 6(6): 947-954, 1988. Gastrointestinal Tumor Study Group: Adjuvant therapy of colon cancer: results of a prospectively randomized trial. New England Journal of Medicine 310(12): 737-743, 1984. Higgins GA, Amadeo JH, McElhinney J, et al.: Efficacy of prolonged intermittent therapy with combined 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel: a Veterans Administration Surgical Oncology Group report. Cancer 53(1): 1-8, 1984. Buyse M, Zeleniuch-Jacquotte A, Chalmers TC: Adjuvant therapy of colorectal cancer: why we still don’t know. JAMA: Journal of the American Medical Association 259(24): 35713578, 1988. 75 Laurie JA, Moertel CG, Fleming TR, et al.: Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. Journal of Clinical Oncology 7(10): 1447-1456, 1989. 76 Moertel CG, Fleming TR, Macdonald JS, et al.: Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. New England Journal of Medicine 322(6): 352-358, 1990. 77 NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA: Journal of the American Medical Association 264(11): 1444-1450, 1990. 78 Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. Journal of Clinical Oncology 11(10): 18791887, 1993. 74
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milligrams per square meter daily and high-dose leucovorin at 500 milligrams per square meter daily, both administered every seventh day for 6 weeks out of every 8 weeks for 1 year. A controlled trial of postoperative 5FU plus leucovorin compared to surgery alone has also demonstrated a disease-free and overall survival advantage for the NCCTG regimen of 5-FU at 425 milligrams per square meter daily and low-dose leucovorin at 20 milligrams per square meter daily for 5 days repeated every 4 to 5 weeks for 6 months of chemotherapy.79 [Level of evidence: 1iiA] Investigators from the International Multicentre Pooled Analysis of Colon Cancer Trials have combined data from 3 other trials for patients with stages II and III (Dukes’ B and C) colon cancer using either no postoperative therapy or 5-FU at 370 to 400 milligrams per square meter plus intermediate-dose leucovorin at 200 milligrams per square meter daily for 5 days every 28 days for 6 cycles.80 A statistically significant improvement in disease-free and overall survival was demonstrated in all patients receiving adjuvant therapy. The NCCTG performed a trial comparing 6 months to 12 months of treatment using either 5-FU and levamisole or 5-FU, levamisole, and leucovorin for patients with stages II and III (Dukes’ B and C or MAC B2, B3, and C1-3) colon cancer.81 [Level of evidence: 1iiA] The trial showed that for equivalent survival benefit, the 5-FU plus levamisole regimen must be given for 12 months, while the 3-drug regimen could be administered over just 6 months. An intergroup trial with 4 treatment arms, including 5-FU plus levamisole, 5-FU plus low-dose leucovorin (the NCCTG regimen), 5-FU plus high-dose leucovorin (the NSABP regimen), or 5-FU plus leucovorin plus levamisole, has been reported in preliminary fashion.82 [Level of evidence: 1iiA] This study also demonstrated that 6 months of 5-FU plus leucovorin is at least as effective as 12 months of 5-FU/levamisole. The NSABP C-04 study found equivalent results in overall survival for 1 year of 5-FU plus high-dose leucovorin when compared to 1 year of 5-FU plus levamisole.83 The addition O’Connell MJ, Mailliard JA, Kahn MJ, et al.: Controlled trial of fluorouracil and low-dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer. Journal of Clinical Oncology 15(1): 246-250, 1997. 80 Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators. Journal of Clinical Oncology 17(5): 1356-1363, 1999. 81 O’Connell MJ, Laurie JA, Kahn M, et al.: Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. Journal of Clinical Oncology 16(1): 295-300, 1998. 82 Haller DG, Catalano PJ, Macdonald JS, et al.: Fluorouracil (FU), leucovorin (LV) and levamisole (LEV) adjuvant therapy for colon cancer: five-year final report of INT-0089. Proceedings of the American Society of Clinical Oncology 17: A982, 256a, 1998. 83 Wolmark N, Rockette H, Mamounas E, et al.: Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin, and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National 79
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of levamisole to 5-FU and leucovorin did not improve disease-free or overall survival. Mature data from NSABP C-05 suggest no survival benefit from the addition of interferon alfa-2a to 5-FU and high-dose leucovorin, but did note a substantial increase in grade 3 or higher toxic effects.84 Based on the outcomes of all of these trials, a recommendation was made at the 1997 American Society of Clinical Oncology meeting that any 1 of 3 regimens could be considered for postoperative treatment of patients with stage III colon cancer, all of which have resulted in a survival advantage over no postoperative chemotherapy. These include the NCCTG regimens of 5-FU and levamisole for 1 year, or 5-FU and low-dose leucovorin for 6 months, or the NSABP regimen of 5-FU and high-dose leucovorin for 6 months. At this time, there are insufficient data to determine if there is any advantage to the 3-drug combination of 5-FU and leucovorin and levamisole over any of the previously noted 2-drug regimens. There is also insufficient data to distinguish whether high-, intermediate-, or low-dose leucovorin is most advantageous as a modulator of 5-FU. Based on survival benefits from an early trial of adjuvant portal-vein 5-FU infusion in patients with colon cancer, a number of confirmatory trials were conducted.85 The preliminary results of these studies have failed to demonstrate a significant benefit for hepatic-directed adjuvant therapy in the reduction of liver recurrences.86 However, a meta-analysis has shown a modest improvement in overall survival when patients are treated with
Surgical Adjuvant Breast and Bowel Project C-04. Journal of Clinical Oncology 17(11): 35533559, 1999. 84 Wolmark N, Bryant J, Smith R, et al.: Adjuvant 5-fluorouracil and leucovorin with or without interferon alfa-2a in colon carcinoma: National Surgical Adjuvant Breast and Bowel Project protocol C-05. Journal of the National Cancer Institute 90(23): 1810-1816, 1998. 85 Taylor I, Machin D, Mullee M, et al.: A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer. British Journal of Surgery 72(5): 359-363, 1985. 86 Wolmark N, Rockette H, Wickerham DL, et al.: Adjuvant therapy of Dukes’ A, B, and C adenocarcinoma of the colon with portal-vein fluorouracil hepatic infusion: preliminary results of National Surgical Adjuvant Breast and Bowel Project Protocol C-02. Journal of Clinical Oncology 8(9): 1466-1475, 1990. Beart RW, Moertel CG, Wieand HS, et al.: Adjuvant therapy for resectable colorectal carcinoma with fluorouracil administered by portal vein infusion: a study of the Mayo Clinic and the North Central Cancer Treatment Group. Archives of Surgery 125(7): 897-901, 1990. Fielding LP, Hittinger R, Grace RH, et al.: Randomised controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectal adenocarcinoma. Lancet 340(8818): 502-506, 1992. Rougier P, Sahmoud T, Nitti D, et al.: Adjuvant portal-vein infusion of fluorouracil and heparin in colorectal cancer: a randomised trial. Lancet 351(9117): 1677-1681, 1998.
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portal-vein 5-FU infusion as compared to no postoperative therapy.87 This technique for adjuvant therapy is therefore of some historical interest and should generally not be employed because of more effective systemic adjuvant regimens administered by the more convenient peripheral intravenous route. A randomized trial by the Swiss Group for Clinical Cancer Research revealed no survival difference between systemic 5-FU versus portal-vein 5-FU infusion versus surgery alone in 769 patients with resected colon or rectal cancer.88 However, the Intergroup currently has an open trial that tests the hypothesis of perioperative systemic delivery of 5-FU chemotherapy.89 The potential value of adjuvant therapy for patients with stage II (Dukes’ B or MAC B2 or B3) colon cancer also remains a controversial issue. Investigators from the NSABP have indicated that the reduction in the risk of recurrence by adjuvant therapy in patients with stage II disease is of similar magnitude to the benefit seen in patients with stage III disease treated with adjuvant therapy, although an overall survival advantage has not been established.90 However, a randomized trial of post-operative 5-FU plus levamisole compared to surgery alone showed no survival advantage to postoperative adjuvant chemotherapy.91 A meta-analysis of 1000 stage II patients whose experience was amalgamated from a series of trials indicates a 2% advantage in disease-free survival at 5 years when adjuvant therapy treated patients treated with 5-FU/leucovorin are compared to untreated controls.92 [Level of evidence: 1iiiDi];93 Patients with stage II colon cancer Piedbois P, Buyse M, Gray R, et al.: Portal vein infusion is an effective adjuvant treatment for patients with colorectal cancer. Proceedings of the American Society of Clinical Oncology 14: A-444, 192, 1995. 88 Laffer U, Maibach R, Metzger U, et al.: Randomized trial of adjuvant perioperative chemotherapy in radically resected colorectal cancer (SAKK 40/87). Proceedings of the American Society of Clinical Oncology 17: A983, 256a, 1998. 89 Kemeny MM, Eastern Cooperative Oncology Group: Phase III Randomized Study of Curative Colon Resection With or Without Perioperative Fluorouracil in Patients with Stage IIB, IIC, or III Colon Cancer, Followed by Fluorouracil and Leucovorin Calcium for Stage IIC or III Patients (Summary Last Modified 09/2001), E-1292, clinical trial, closed, 05/19/2000. 90 Mamounas E, Wieand S, Wolmark N, et al.: Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). Journal of Clinical Oncology 17(5): 1349-1355, 1999. 91 Moertel CG, Fleming TR, Macdonald JS, et al.: Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. Journal of Clinical Oncology 13(12): 2936-2943, 1995. 92 Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators. Journal of Clinical Oncology 17(5): 1356-1363, 1999. 93 Harrington DP: The tea leaves of small trials. Journal of Clinical Oncology 17(5): 13361338, 1999. 87
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remain candidates for clinical trials in which either surgery alone or 5FU/leucovorin represents standard therapy.94 Chemotherapy trials, typically with 5-FU-based regimens, have demonstrated increased numbers of partial responses and prolongation of the time to progression of disease,95 as well as improved survival and quality of life for patients receiving chemotherapy compared to best supportive care.96 Several trials have analyzed the activity and toxic effects of various 5FU plus leucovorin regimens in patients 70 years of age or older as compared to younger patients. Similar quantitative and qualitative toxic effects of therapeutic outcomes have been observed for patients of all ages.97 [Level of evidence: 2A,C];98 [Level of evidence: 2A,C] Patients should be considered candidates for clinical trials evaluating new approaches to Colacchio TA, Cancer and Leukemia Group B: Phase III Randomized Study of Adjuvant Edrecolomab Versus No Adjuvant Therapy After Resection in Patients With Stage II Adenocarcinoma of the Colon (Summary Last Modified 05/2002), CLB-9581, clinical trial, active, 08/20/1997. Pazdur R, National Surgical Adjuvant Breast and Bowel Project: Phase III Randomized Study of Oral Uracil/Tegafur (UFT) with Leucovorin vs Fluorouracil with Leucovorin Following Resection for Stage II/III Adenocarcinoma of the Colon (Summary Last Modified 05/1999), NSABP-C-06, clinical trial, closed, 03/31/1999. Poplin EA, Southwest Oncology Group: Phase III Randomized Study of Bolus Fluorouracil and Leucovorin Calcium with Levamisole vs Continuous Infusion Fluorouracil with Levamisole as Adjuvant Therapy in Patients with High Risk Colon Cancer (Summary Last Modified 04/2000), SWOG-9415, clinical trial, closed, 12/15/1999. 95 Petrelli N, Herrera L, Rustum Y, et al.: A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma. Journal of Clinical Oncology 5(10): 1559-1565, 1987. Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. 96 Scheithauer W, Rosen H, Kornek GV, et al.: Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. British Medical Journal 306(6880): 752-755, 1993. Nordic Gastrointestinal Tumor Adjuvant Therapy Group: Expectancy or primary chemotherapy in patients with advanced asymptomatic colorectal cancer: a randomized trial. Journal of Clinical Oncology 10(6): 904-911, 1992. Buyse M, Thirion P, Carlson RW, et al.: Relation between tumour response to first-line chemotherapy and survival in advanced colorectal cancer: a meta-analysis. Lancet 356(9227): 373-378, 2000. 97 Chiara S, Nobile MT, Vincenti M, et al.: Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemotherapy and Pharmacology 42(4): 336-340, 1998. 98 Goldberg RM, Hatfield AK, Kahn M, et al.: Prospectively randomized North Central Cancer Treatment Group trial of intensive-course fluorouracil combined with the l-isomer of intravenous leucovorin, oral leucovorin, or intravenous leucovorin for the treatment of advanced colorectal cancer. Journal of Clinical Oncology 15(11) : 3320-3329, 1997. 94
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treatment.99 Irinotecan (CPT-11) is a topoisomerase-I inhibitor with a 10% to 20% partial response rate in patients with metastatic colon cancer, in patients who have received no prior chemotherapy, and in patients progressing on 5FU therapy.100 It has been approved by the Food and Drug Administration for the treatment of patients with metastatic disease that is refractory to 5FU. The designations in PDQ that treatments are “standard” or “under clinical evaluation” are not to be used as a basis for reimbursement determinations. Stage 0 Colon Cancer Stage 0 colon cancer is the most superficial of all the lesions and is limited to the mucosa without invasion of the lamina propria. Because of its superficial nature, the surgical procedure may be limited. Standard treatment options: ·
Local excision or simple polypectomy with clear margins.
·
Colon resection for larger lesions not amenable to local excision.
Stage I Colon Cancer101 Because of its localized nature, stage I has a high cure rate.
Poon MA, O’Connell MJ, Wieand HS, et al.: Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. Journal of Clinical Oncology 9(11): 1967-1972, 1991. Moertel CG: Chemotherapy for colorectal cancer. New England Journal of Medicine 330(16): 1136-1142, 1994. 100 Rothenberg ML, Eckardt JR, Kuhn JG, et al.: Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. Journal of Clinical Oncology 14(4): 11281135, 1996. Conti JA, Kemeny NE, Saltz LB, et al.: Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(3): 709-715, 1996. Rougier P, Van Cutsem E, Bajetta E, et al.: Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352(9138): 1407-1412, 1998. Cunningham D, Pyrhonen S, James RD, et al.: Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138): 1413-1418, 1998. 101 Old Staging: Dukes’ A or Modified Astler-Coller A and B1 99
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Standard treatment options: ·
Wide surgical resection and anastomosis.
Stage II Colon Cancer102 Standard treatment options: ·
Wide surgical resection and anastomosis.
·
Following surgery, patients should be considered for entry into carefully controlled clinical trials evaluating the use of systemic or regional chemotherapy,103 radiation therapy, or biologic therapy.104 Information about ongoing clinical trials is available from the NCI (http://cancer.gov/clinical_trials). Adjuvant therapy is not indicated for most patients unless they are entered into a clinical trial.
Although subgroups of patients with stage II colon cancer may be at higher than average risk for recurrence (including those with anatomic features such as tumor adherence to adjacent structures, perforation, complete obstruction, or with biologic characteristics such as aneuploidy, high S-phase analysis, or deletion of 18q),105 there is no consistent evidence that adjuvant 5-fluorouracil-based chemotherapy is associated with an overall improved survival compared with surgery alone.106 In some trials, subset analysis of adjuvant chemotherapy has demonstrated benefits in disease-free and overall survival compared with surgery alone,107 but such treatment has not Old Staging: Dukes’ B or Modified Astler-Coller B2 and B3 Pazdur R, National Surgical Adjuvant Breast and Bowel Project: Phase III Randomized Study of Oral Uracil/Tegafur (UFT) with Leucovorin vs Fluorouracil with Leucovorin Following Resection for Stage II/III Adenocarcinoma of the Colon (Summary Last Modified 05/1999), NSABP-C-06, clinical trial, closed, 03/31/1999. 104 Colacchio TA, Cancer and Leukemia Group B: Phase III Randomized Study of Adjuvant Edrecolomab Versus No Adjuvant Therapy After Resection in Patients With Stage II Adenocarcinoma of the Colon (Summary Last Modified 05/2002), CLB-9581, clinical trial, active, 08/20/1997. 105 Lanza G, Matteuzzi M, Gafa R, et al.: Chromosome 18q allelic loss and prognosis in stage II and III colon cancer. International Journal of Cancer 79(4): 390-395, 1998. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. New England Journal of Medicine 331(4): 213-221, 1994. 106 Moertel CG, Fleming TR, Macdonald JS, et al.: Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. Journal of Clinical Oncology 13(12): 2936-2943, 1995. 107 Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. Journal of Clinical Oncology 11(10): 18791887, 1993. 102 103
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been considered standard for all stage II patients. Improved local control with postoperative radiation therapy has been suggested in patients with T3 and T4 tumors; an intergroup clinical trial designed to explore the role of adjuvant combined chemotherapy and radiation therapy compared with postoperative chemotherapy alone for selected patients with this high-risk stage II colon cancer was closed because of low accrual.108 However, preliminary results, published only in abstract form, have not suggested a survival advantage from routine postoperative adjuvant radiation therapy in this subgroup of patients.109 Stage III Colon Cancer110 Stage III colon cancer denotes lymph node involvement. Studies have indicated that the number of lymph nodes involved
