Surgical and Chemotherapy Options for Treating Advanced CRC

Basic understanding on Colorectal Cancer

If you want to learn basic anatomy and gather understanding on CRC and the different options, below sites have helpful information –

Introduction and review of anatomy of colon cancer

You may also visit

Selected Animations of Colorectal Cancer (CRC)

Above site has great animations and offers succinctly information on current Treatment Strategies –

  • Surgery
  • Radiation
  • Chemotherapy
  • Targeted Therapy

For Understanding the different molecular laboratory test required for colorectal cancer, you may click here.

Chemotherapy and Targeted Therapy Options (please click hyperlink)

Different options are given and you may want to discuss these with your Oncologists

TREATMENT FOR STAGE IV, METASTATIC CANCER OR RECURRENT CRC

Site helps us understand that it is a worthwhile effort to manage this, never a futile effort.

  1. Your metastatic tumors are limited enough to be removed surgically (resectable) and might be curable
  2. Your tumors are not resectable now, but with adjuvant treatment might become resectable and converted to a curable situation
  3. Your cancer is widespread and unlikely to become resectable and should be treated palliatively with the goal of extending your quality of life for as long as possible

I also saw other interesting content worth reading on this same site –

  • QUESTIONS TO ASK IF YOU HAVE STAGE IV OR RECURRENT CRC
  • EXAMPLES OF TREATMENT OPTIONS COMBINED TO TREAT METASTATIC DISEASE OVER TIME
  • CHEMOTHERAPY COMBINATIONS
  • TARGETED THERAPIES

Chemo drugs for treating CRC

Current Options for Third-Line Treatment of Metastatic Colorectal Cancer

Surgical Options – Colorectal Cancer: Treatment Options

Approved by the Cancer.Net Editorial Board, 06/2016

You may want to consider chemo options per your case. Another Interesting Site that indicates Chemo Options per Stage

  • Stage I – No adjuvant treatment is recommended for stage I colon cancer.
  • Stage II & III – Adjuvant therapy is recommended for stage III and high-risk stage II colon cancer patients.
  • Stage IV – Treatment for stage IV colon cancer is generally palliative. There are many new cytotoxic chemotherapy and targeted agents available for treating metastatic colon cancer, such as 5-FU, oxaliplatin, irinotecan, cetuximab, and bevacizumab.

What is the cancer cells have seeded to peritoneum (abdominal cavity)?

Options for treating CRC that has spread to peritoneum are –

  • Old Traditional method such as
  • Newer Option such as

However, before we chose the options, we have to measure the baseline with scores. Socres are counted using two scales, Peritoneal Cancer Index (PCI ) and Peritoneal Surface Disease Severity Score (PSDSS). The scales compute information from three distinct parameters –

  1. Patient’s symptoms
  2. Location and
  3. CRC tumor burden (Size)
  • Older Methods – removal of the omentum, systemic and/or palliative chemotherapy, and palliative surgery.
  • Newer Regimen – cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and intraperitoneal chemotherapy.

Survival benefit –

Note: Older systemic chemotherapy regimens such as 5-flurouracil (5FU) and leucovorin offer a limited survival benefit of approximately 7 months, whereas, if Oxiplatin or irinotecan are added, survival can be extended to approximately 2 years.

Newer Regimens such as CRS and HIPEC have survival benefit of approximately 63 months with a 5-year survival near 50%. To say it simply, 50% patients will survive beyond 5 years.

The scales help in understanding the 5 years survival more objectively –

  • PCI 10 or less – 50% 5-year survival
  • PCI of 11 to 20 – 20% 5-year survival
  • PCI more than 20 – 0% 5-year survival

For Information on Gene Expression Profiling, you may visit following site –

Disclaimer:

The information available is for information purpose only. These are not recommendations. You are advised to consult your oncologist to get the recommendations for managing CRC patients.  The above site has all relevant references hyperlinked to the subtopics. The author holds no responsibility for any information mentioned herein.

 

CRC – Gene Expression Profiling

Molecular profiling changes the management of Colorectal Cancer significantly. This blog lists all relevant molecular markers associated with prognostic, response to chemotherapy, survival and recurrence of Colon Cancer.

Molecular profiling changes the management of Colorectal Cancer significantly.  This blog lists all relevant molecular markers associated with prognostic, response to chemotherapy, survival and recurrence of Colon Cancer.

The markers are chosen based on the basis of gene expression profile on colon cancer. As the cancer advances, it accumulates several genetic aberrations. Spread of cancer, response to treatment, survival to treatment and recurrence are all associated with different molecular markers.

These markers have been shortlisted from existing literature, experience with patients and the outcome. However, this is based upon my understanding and experience with patients and any decision based upon this blog need to be approved by your treating physician. I take no responsibility for decisions and or outcome based on these markers.

Many Molecular markers have been used for prediction and prognosis. Key amongst those are –

  1. MSI – Microsatellite Instability with the mismatch repair MMR system, MSI-H, MSI , MLH1, MsH2, MsH3, MsH6 and PMs2
  2. EGFR –
  3. VEGF
  4. KRAS mutation in Codon 12, 13, 61
  5. PTEN mutation
  6. PIK3CA Mutation
  7. BRAF V600E (Exon 15)
  8. p53

 

CEA – Carcinoembryonic antigen – CEA is separated from other molecular markers since CEA helps in understanding tumor burden and is also required for regular follow up.

 

Tissue Sampling:

The tissues should be immediately placed into liquid nitrogen upon excision and meticulously selected  pathologist for molecular profiling. Samples both from primary and secondaries (Lymph nodes) are required. Remember, to submit normal tissue along with the disease sample.

Dry Ice can be used as a media only for selected tests.

This page is under construction. I will update the markers as well as the references.

For Understanding the different surgical and chemotherapy options, you may visit –

Surgical and Chemotherapy options for Treating Advanced CRC, click here