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


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 –


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 –


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 

Watch the magic of endorphins!

Do you know that between the age of 35 – 40, we all start losing 1% of our lung capacity? Do you know that if we are engaged in regular moderate physical exercise, we tend to arrest that decline? Contrary to common believe, statistics have proven that, 45 minutes of exercise on a well-rested day, yields an extra productive effort of 68 minutes.

Exercise, not alone improves your productivity immediately post exercise, but also increases your body’s ability to handle stress in the immediate 2-3 days post exercise. Of course, there are several guidelines and recommendations that offer succinct advantage on each system of our body. Please read the exercises, their customization, ramp up and the different types of exercises to add to get a comprehensive regimen for your body.

Before establishing an overall fitness base and maximizing athletic development, one should go through step by step ramp up program with numerous exercises that safely increase coordination, flexibility, speed, strength, and endurance.

“In endurance runners’ brains have greater functional connectivity than the brains of more sedentary individuals. The runners, overall, showed greater functional connectivity — or connections between distinct brain regions — within several areas of the brain, including the frontal cortex. The frontal cortex is an important region for cognitive functions such as planning, decision-making and the ability to switch attention between tasks.(Running May Enhance Brain Connections)”


Many amongst you may be thinking, what are endorphins? Endorphins are morphine like substances secreted by brain that is bedrock of ‘feel good’ factor, driving optimism and energy as well as several aspects including immunity.

(This is part of another long term initiative I chose to drive understanding the impact and importance of this issue to our community.  Initially, I will work with a small group of folks from our community, and understanding the success factor, I will expand to bigger group. You will see me blogging on this as part of this initiative).

As you already know, the pain point with us all is motivation. We all lack the motivation to go to the Gym or simply walk up and down the rails at home or other exercise. We do take an episodic bout of exercise that lasts few days or at best occasional week. Second, the compulsions of real life are really rigorous enough to abandon our episodic enthusiasm. If that’s not the only reason, some amongst us travel and crash back to our bed on our return.

Our Sedentary (Indian) Life Style – What happens & When?

  • Lungs – Do you know that between the age of 35 – 40, we all start losing 1% of our lung capacity? Do you know that if we are engaged in regular moderate physical exercise, we tend to arrest that decline?
  • Vegetarian Meals – Do you know our carb rich vegetarian diet tend to get converted to fats in the absence of exercise? We tend to put on fat despite eating fat restricted diet?
  • No Exercise – Do you know our heart tends to lose its ejection ability (ejection fraction)? Heart too gets deconditioned not doing exercise.
  • No Exercise – Do you know, our muscles steadily lose its strength and tone and eventually, it becomes small if not atrophied?
  • Bones – Do you know, our skeletal system is highly dependent on the health of our muscles, that once these muscles get decompensated, they lose the tone and we tend to injure our joints? Some reflections are prolapse disc, radiating pain, increase wear and tear of joints due to imbalance of agonist and antagonist muscles?
  • Brain – Do you know that our brain (dendrites) loses its networking potential between the neurons and we tend to accumulate the senile plaque and other material at a faster pace due to inactivity? You may want to know what Senile Plaque are – simply speaking, we lose our memory faster with inactivity.
  • Diabetes – Do you know, in the absence of moderate to vigorous exercises, we increase peripheral resistance to glucose and eventually end up with type 2 diabetes?

Well, none of these happens overnight but the decline has already started and all of these provides a huge background to most future illnesses (of ageing or late adulthood). We all know, lack of exercise takes a daily toll on our health. American Heart Association considers lack of habitual physical activity as the fourth major risk factor for coronary heart disease. Our cardiac, respiratory, metabolic, musculoskeletal, nervous, gastrointestinal and endocrine system all need a vigorous physically active program to keep those healthy.

According to Office of Disease Prevention and Health Promotion Healthy People Guidelines, in adults and older adults, physical activity can lower the risk of:

We think, we are healthy, but –

Our life style, sedentary and food habits strongly predispose us to – 

  • Early death
  • Coronary heart disease
  • Stroke
  • High blood pressure
  • Type 2 diabetes
  • Breast and colon cancer
  • Falls
  • Depression

By adding exercise to our routine, we tend not only to slow down the decline but simultaneously build our mental health and be more optimistic and productive? While we do physical workout, we tend to not alone increase our physical health coefficient our mood and perception, as well as our ability to deal with stress and our quantitative efforts at work. This is because brain secrets, ‘feelgood’ chemicals – endorphin, oxytocin, serotonin, and dopamine that helps to rejuvenate us.

Folks, there is one simple thing that stops these daily aggregation of risk –


I am working on overcoming our lack of motivation using multiple approaches. One amongst those is getting a trainer for training. If the pilot runs successfully, we will book a space where we can participate in group exercises with trainer hired on an hourly basis. I have not run out of options, if these won’t work, I will be more creative and come up with more options.

However, I am strongly opposed to directly jumping on the exercise bandwagon and break whatever we have. We need to

  1. Customize as per individual body habitus
  2. Develop comprehensive plan (Endurance/Aerobics, Yoga, Resistance, Strength, Flexibility etc. I will cover individual topics eventually, watch this space!)
  3. Ramp up our exercise program.

Very few know that exercise, Yoga, Tai Chi or any other physical activities are not generic and need customization. Everybody is different and every individual is in a different state of health at different points in time. Consequently, a tailored approach is the key to success. Not all exercises from Gym are suitable for all, the same holds true about Yoga or Tai Chi. Unfortunately, our trainers are inadequately educated with medical understanding of our body to provide a customized program.  Though doctors are trained, unfortunately, they only know polar ends, normal health and diseases condition. If something is not diseased, it is normal. However, practically, very often we fall in the gray zone. Summarily, we definitely can’t rely on our trainers and our doctors don’t have time to understand the needs of our normal bodies and provide a kinesthetic plan for our wellbeing.

Second, a ramp up is equally important. Presuming we have no underlying health issue, despite we cannot suddenly start with any exercise, be it jogging, running, swimming, or any or the aerobics or resistance training. We need to ramp up gradually and we need to recruit different groups incrementally in a coordinated fashion. Before establishing an overall fitness base and maximizing athletic development, one should go through step by step ramp up program with numerous exercises that safely increase coordination, flexibility, speed, strength, and endurance.

What will motivate us and get us going into regular exercise schedule? I believe, commitment, discipline, motivation and a group fun filled activity will do that. I feel, getting a trainer will help circumvent a lot of these inertia. We still have to work with other factors like choosing right exercises customized to our own body types, gradual ramp up and adding multiple types of exercises, such as Yoga, Cardio, Resistance Training, Strengthening Small Muscle groups etc. Of course, exercise is not panacea but offers a solid beginning and foundation. Getting good sleep and eating health are other things. However, the scope of this article is restricted to exercise and I will continue talking about exercise.

I am undertaking this community initiative for zero-sum gain despite a cost to my time and efforts, simply to get us all embarked on a community exercise plan. I will do a free physical evaluation (based on guidelines from American Academy of Sports and Physical Medicine) and will provide an explanation of the best options for selecting the exercises plus the best plan to ramp up. All I need is your cooperation.

As a proof of concept, I am planning to call a trainer at home whose responsibility will be to get us going at a particular time. He/She will keep us all motivated. Initially, I will have 5-6 folks to start with. We will find a time according to mutual convenience. The venue will be my home and we will start immediately, if possible. What do you say?


PS: Watch this space as I keep updating it with different types of exercises (including videos), guidelines and how best to tailor exercises to our body’s state and needs.


Highly Recommended:

American Heart Association Recommendations for Physical Activity in Adults

2008 Physical Activity Guidelines for Americans Summary



Interesting Read:

Physical Activity (Office of Disease Prevention and Health Promotion)

Physical Activity Guidelines For Americans

Global Recommendations on Physical Activity for Health

Endorphins and exercise

US Gov Guidelines –

Physical Activity Guidelines for Americans

Chapter 4: Active Adults

Chapter 6: Safe and Active

ANABOLIC-ANDROGENIC STEROIDS: Mechanism of Action and Effects on Performance


How Exercise Beefs Up the Brain

Boost your natural ‘feelgood’ chemicals

Exercising to relax

The Hormones Of Happiness And How To Increase Them

Hormonal Response to Exercise

Why endorphins (and exercise) make you happy

The Neurochemicals of Happiness

Exercise detoxes body of depressive chemicals, scientists find


Residential Security – With Changing Political Times

Residential Security – With Changing Political Environment

Updated after incidence of hate message (Nov 24, 2016) –

  1. Don’t Panic
  2. Don’t Deal Alone, Call Law Enforcement
  3. Inform Community, Deal As A Community

Suggested Ideas:

Install Home (Perimeter) and Community Cameras

HOA to install signs stating community under surveillance

Often we have solicitors or vendors, either setting flyers or actively selling some products in residential community. Ideally, you should have access control for your community. Just in case, you don’t have one, here are few tips to consider, just in case someone missed something, here are few things –

  1. First, politely decline without opening the door. If in case, you open the door, step outside and talk. If you see them face to face, politely decline with a smile that you may not be interested at this time.
  1. Complaint to HOA or Local Security Service. Don’t compliant to solicitors or vendors that they are not allowed in the community. You do have a right to complaint to Local Security or HOA or if thresholds are crossed, to local law enforcement authority. Despite, be very polite and decline. HOA or Local Security can display signs if vendors are not allowed in your community.
  1. Neighborhood Watch – The idea is old but using latest messaging apps is new. Communicate with neighbors (before or after an interaction). We have a WA (What’sUp) group in our community where we share messages. Don’t be isolated – Connect as a community, Develop Collective norms, Deter & Deny as a community and when required, Report.

Messaging groups are very effective and fast but there is a downside to messaging groups, build your own community norms to serve your community.  Florida International University researchers found the following statistics within the combined 11 neighborhoods. Burglaries decreased 33 percent; Robberies decreased 24 percent and Thefts decreased 9 percent. If possible, display Neighborhood Watch using WA under use.

  1. Install Security Cameras (& motion sensor lights). Security cameras (on the perimeter) and motion sensor lights are cheap and easy to install. Ensure that the data is backed up on cloud. Install cameras in location from where they can capture face and morphology in different steps. Either have night vision on the cameras or adequate lighting to capture images. PTZ cameras with Digital Recorders are best. My experience has been very satisfactory using those as deterrence. This is in line with Crime prevention through environmental design (CPTED) to reduce crime. Installing community perimeter security cameras with PTZ and cloud backed up capabilities are best. Cameras and Lights should be away from vandalism and destruction.
  1. Record DL and Company Id. Every home owner should insist on DL of the person working within their home and or community. While most offer a company ID, we hardly track and trace if those are authentic and valid. Keeping a record of DL should provide long term deterrence from intrusion or crime. Often, these vendors or ‘House Cleaners’, most are good but we cannot discern the bad, they may be indirectly doing a surveillance and reporting into their ecosystem. If DL or address is maintained, they are likely to be traced or tracked. Knowing that you maintain a DL on them, should help in building more deterrence.

One thing is certain – if you see a vendor or someone soliciting, don’t be arrogant, decline politely. Why?

  1. They are trying to make a living
  2. You may be targeted, especially if you are rude or impolite

In these changing political environment and circumstances, our success as immigrants may be a red sore in the eyes of few nativists. Let us not get targeted. Let them think this is a nice community.

Again, I am not proposing we need to buy, I am not saying, we shouldn’t report. All I am saying is BE POLITE, ESPECIALLY WHILE DECLINING SERVICES OR VENDORS.


Selected links –

GUIDELINES FOR PUBLIC VIDEO SURVEILLANCE: A guide to protecting communities and preserving civil liberties guidelines-for-public-video-surveillance

An example of Camera Policies from University of Wisconsin at Green Bay camera-policies-from-university-of-wisconsin

Code of practice: A guide to the 12 principles (This does not apply to US scenario but it offers good understanding of issues to consider)

Camera Types from Brick House Security (Offers an understanding of different types of cameras)

Principles of Design for Operational Risk Reduction principles-of-design-for-operational-risk-reduction

Top Ten Security Mistakes Home Owner Associations (HOAs) Make!

Christmas is Coming and SO ARE THE CROOKS!

Prevention of Crime: An Overview of Gated Communities and Neighborhood Watch

Best Practices for Residential Security