II. Epidemiology
- Accounts for 8.5% of all new cancer cases
- Third most common cancer in the U.S.
- In U.S. (2014)
- Prevalence: 1.2 Million
- Incidence: 137,000/year
- Mortality: 50,000/year
- Highest Incidence of Colon Cancer
- North America
- Western Europe
- Australia and New Zealand
- Japan
III. Risk Factors
IV. Management: Non-resectable hepatic metastases
- Radiofrequency Ablation
- Small trials suggest prolonged survival or cure
- Wong (2001) Am J Surg 182:552-7 [PubMed]
V. Prevention
- Primary prevention
- Secondary prevention
- Routine screening for other cancers
- Tobacco Cessation
- Obesity Management and Healthy Diet (Colorectal Cancer risk factors)
- Exercise improves quality of life and decreases overall mortality (goal: 150 min/week)
- Daily low dose Aspirin
VI. Course
- Five-year survival: 65%
- Recurrence risk
- Highest risk within first 5 years post-resection (17 to 42%)
VII. Complications: General
- Colorectal Cancer recurrence (typically in first 5 years after treatment)
- Second primary Colorectal Cancer
- Urinary symptoms
- Stress Incontinence
- Urge Incontinence
- Urology Consultation indications
- Persistent Urinary Retention (pelvic nerve injury is common in initial post-operative period)
- Persistent Hematuria
- Neuropsychiatric
- Cognitive dysfunction (Chemotherapy associated)
- Typically mild and transient
- Major Depression
- Anxiety Disorder
- Insomnia
- Sexual Dysfunction
- Vaginal Dryness and Dyspareunia in women
- Erectile Dysfunction (pelvic radiation, platinum-based Chemotherapy)
- Ostomy-related concerns
- Neuropathy (esp. platinum-based Chemotherapy such as oxaliplatin)
- Fatigue
- Common in Colorectal Cancer survivors
- Consider evaluating for alternative Fatigue cause (e.g Anemia, Hypothyroidism)
- Cognitive dysfunction (Chemotherapy associated)
VIII. Complications: Gastrointestinal adverse effects
- Ostomy care
-
Diarrhea
- Dietary Fiber supplementation
- Probiotic supplementation
- Periodic Loperamide (Imodium) use
-
Fecal Incontinence
- Periodic Loperamide (Imodium) use
- Methylcellulose and Dietary Fiber
- Biofeedback
- Radiation Proctitis (Diarrhea, bleeding)
- Endoscopic argon plasma coagulation
- Sucralfate enemas
- Hanson (2012) Dis Colon Rectum 55(10): 1081-95 [PubMed]
-
Abdominal Pain
- Acute pain (esp. RUQ Pain, Pelvic Pain)
- Evaluate for cancer recurrence
-
Chronic Pain
- Radiation Proctitis
- Incisional Hernia
- Acute pain (esp. RUQ Pain, Pelvic Pain)
-
Pelvic Fracture
- Higher risk in women who undergo pelvic radiation
IX. Protocol: Monitoring post-resection
- See Cancer Survivor Care
- Oncology may often establish a survivorship care plan
- Follow-up visits (starting 4-5 weeks after curative resection)
- Visit every 3-6 months for 2-3 years, then every 6 months until 5 years post-resection
- Focus areas
- Ostomy problems or Stool Incontinence
- Radiation Proctitis
- Bowel adhesions
-
Carcinoembryonic Antigen (CEA-125)
- Perform at each visit (every 3-6 months for 2-3 years, then every 6 months until 5 years post-resection)
- May avoid in Stage I at low risk of recurrence
- Other labs (e.g. CBC, Comprehensive panel) are not routinely indicated (unless other concerns)
-
Colonoscopy
- Perform at one year post resection and resect new polyps
- Normal Colonoscopy
- Repeat at 3 years post-resection, and then every 5 years
- Advanced adenomatous polyp (>1 cm, high grade dysplasia or villous component)
- Repeat Colonoscopy in 1 year
- Rectal cancer at risk of recurrence
- Flexible Sigmoidoscopy every 3-6 months for first 2-3 years post-resection
- Imaging