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COLON CANCER

COLON CANCER. A MAJOR ISSUE IN ALASKA. A common malignancy. 200,000 cases in the U. S. in 2008 Greater than 50 new cases each year in Alaska Natives . RISK FACTORS. Age Family history Genetic predisposition Adenomatous polyps History of other gastrointestinal malignancies. Screening.

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COLON CANCER

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  1. COLON CANCER A MAJOR ISSUE IN ALASKA

  2. A common malignancy • 200,000 cases in the U. S. in 2008 • Greater than 50 new cases each year in Alaska Natives

  3. RISK FACTORS • Age • Family history • Genetic predisposition • Adenomatous polyps • History of other gastrointestinal malignancies

  4. Screening • FOBT • Problematic in our patient population because of H. pylori • Cannot differentiate upper from lower bleeds • A new test being studied possibly can • Sigmoidoscopy • Colonoscopy

  5. Diagnosis • Tissue biopsy

  6. Staging • I confined to the mucosa • II into the muscularis • III involving the lymph nodes • IV distant metastases

  7. Special considerations • Colon versus Rectum • A different approach for rectal cancer both before and after surgery

  8. Treatment • Surgery is the primary curative therapy • Pre-op chemotherapy-radiotherapy for rectal cancer unless the lesion is superficial • For patients with metastastic disease who are or may soon become obstructed

  9. CEA • Good to have a baseline CEA, for both follow up and to follow for recurrence or progression

  10. Chemotherapy • Adjuvant • For Stage III • For high risk stage II (T4 N0) • Obstruction • Perforation • circumferential • For pre-op in rectal lesions, then post op

  11. Radiation for rectal cancers • Pre-Op • Stage III • High risk stage II • After trans-anal resection of lesions greater than T2

  12. Agents • FOLFOX • XELOX • Irinotecan • Avastin • Cetuximab • Penitumumab

  13. Unusual side effects • Hand-Foot syndrome • Cold-induced neuropathy • Cholera syndrome • Skin rash • Perforation (bowel, lung, wound) • Accelerated hypertension

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