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Chemotherapy in Colorectal Cancers

Introduction
Colorectal cancer also called colon or bowel cancer includes cancerous growth in colon, rectum and appendix.

Colorectal Cancers

2006 Estimated New Cancer Cases in US
Leading Sites by Sex
Leading Sites by Sex

Men
  • Prostate 33%.
  • Lung and bronchus 13%.
  • Colon and rectum 10%.
  • Urinary bladder 6%.
Women
  • 31% Breast.
  • 12% Lung and bronchus.
  • 11% Colon and rectum.
  • 6% Uterine corpus.
>55,000 Total Colorectal Cancer Deaths

Colorectal Cancer
  • Second leading cause of cancer–related death in the US.
  • 145,000 new cases diagnosed each year in the US.
  • 75% of new cases in patients with no family history of CRC or predisposing illness.
  • Between 1995–2000, 20% of patients presented with metastatic disease at initial diagnosis.
Epidemiology – In India
  • One of the Most common cancers
    • In men after Lung and Head & Neck cancer.
    • In women after breast and cervix.
  • Estimated deaths for 1998: 556,000.
Screening for Colorectal Cancer
  • Screening methods
    • Fecal occult blood testing.
    • Colonoscopy.
    • Sigmoidoscopy.
    • Double–contrast barium enema.
  • NCCN recommendation for average–risk persons
    • FOBT and flexible sigmoidoscopy every 5 years or.
    • Colonoscopy every 10 years.

Risk Factors for Colorectal Cancer
  • CRC in first–degree family member or in 2 second–degree.
  • Genetic1
    • Familial adenomatous polyposis (FAP).
    • Hereditary nonpolyposis colorectal cancer (HNPCC).
  • Nongenetic1
    • History of adenomas.
    • Endometrial or ovarian cancer before age 60.
    • Inflammatory bowel disease.
  • Lifestyle factors possibly associated with increased risk2
    • “Western diet,” Sedentary lifestyle, Alcohol, Smoking.
Impact of “Western” Diet on Clinical Outcomes in Stage III Colon Cancer
  • Exercise may reduce risk of mortality following diagnosis of stage I–III colorectal cancer [1].
  • Current prospective, observational, questionnaire–based study[2]
    • Assess impact of diet on outcomes in patients with stage III colon cancer.
    • Increasingly “Western” dietary patterns associated with significantly worse survival.
Multivariate–Adjusted HR (95% CI)
Quintile DFS Recurrence–Free Survival Overall Mortality
1 (least Western) Reference Reference Reference
2 0.95 (0.68 –1.43) 0.92 (0.63 –1.36) 0.74 (0.48 –1.17)
3 1.51 (1.05 –2.17) 1.42 (0.98 –2.07) 1.38 (0.90 –2.11)
4 1.64 (1.09 –2.46) 1.44 (0.94 –2.19) 1.66 (1.04 –2.65)
5 (most Western) 3.25 (2.04 –5.19) 2.85 (1.75 –4.63) 2.32 (1.36 –3.96)
P value for trend < .001 < .001 < .001

Gastrointestinal Cancers in the U.S.A.
Cancer Facts and Figures 2006Cancer Facts and Figures 2006

Average Stage at Diagnosis
  • 2006 Incidence of colon cancer: 106,680.
  • 2006 Incidence of rectal cancer: 41,930.
Cancer StatisticsCancer Statistics


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