Colon cancer recurrent

There is currently no definitive role for adjuvant radiation in colon cancer. However, patients who receive surgery for rectal cancer receive radiation therapy to reduce local tumor recurrence. Adjuvant radiation plus chemotherapy is considered standard treatment for patients with stage II or III rectal cancer after the surgical procedure is complete.17 Preoperative radiation may be used to reduce the initial size of rectal cancers in order to make the surgical procedure easier. 

Following resection of liver metastases, infusion of chemotherapy through the portal vein provides an additional adjuvant treatment approach. Historically 5-FU and floxuri-dine have been the agents used most commonly for hepatic portal vein infusion owing to their high metabolism in the liver. Although some studies demonstrate a decrease in recurrence rates, the value of portal vein infusion of chemotherapy for colon cancer remains to be determined.25 Table 88-4 summarizes adjuvant treatment recommendations for colon cancer. 

RT can be administered with curative surgical resection to prevent local recurrence of rectal cancer, before surgery to shrink a rectal tumor and make it operable, or in advanced or metastatic disease to alleviate symptoms. Adjuvant RT, however, does not have a definitive role in colon cancer because recurrences are usually extrapelvic. 

Adjuvant chemotherapy significantly decreases risk of cancer recurrence and death in stage III colon cancer and is standard of care. 

Figure 15.1 Hazard ratios and 95 per cent confidence intervals for death from any cause (panel (a)) and recurrence (panel (b)) by treatment group (Sargent DJ, Goldberg RM, Jacobson SD, MacDonald JS et al., A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. New England Journal of Medicine, 345, 1091-1097. (2001) Massachusetts Medical Society.)...

Several studies using rofecoxib or celecoxib have been contemplated or begun. Both Cox-2 inhibitors are being studied in patients with familial adenomatous polyposis, and results with celecoxib have recently been reported (Steinbach et al., 2000). Also, there are plans to evaluate the ability of Cox-2 inhibitors to reduce the recurrence of polyps in patients who have had sporadic colonic polyps surgically removed. Ultimately, one would like to determine whether therapy with Cox-2 inhibitors could be used prophylactically in high-risk patients to prevent the development or recurrence of colon cancer. 

Further investigation had confirmed a recurrence of her colon cancer, with metastatic spread to the lungs and liver. 

Adjuvant therapy differs for colon and rectal cancer because their natural history and recurrence patterns differ. Rectal cancer is more difficult to resect with wide margins, so local recurrences are more frequent than with colon cancer. Adjuvant RT plus chemotherapy is considered standard for stage 11 or 111 rectal cancer. Adjuvant chemotherapy is standard for stage 111 colon cancer and can be considered for high-risk stage II colon cancer. Adjuvant therapy is not indicated for stage I colorectal cancer because most patients are cured by surgical resection alone. 

Surgery for colon cancer generally involves complete tumor resection with an appropriate margin of tumor-free bowel and a regional lymphadenectomy. Surgery for rectal cancer depends on the area involved. Although less than 33% of these patients require permanent colostomy, frequent complications include urinary retention, incontinence, impotence, andlocoregional recurrence. 

After successful initial therapy, CEA levels decline. During remission, CEA levels are stable. Rising CEA values may indicate recurrence of disease. The lead time from CEA elevation to clinical recurrence is about 5 months. A repeat laparotomy can be performed to confirm the relapse, which is detected in 90% of cases. In the monitoring of metastatic colon cancer, CEA is useful in following patients throughout therapy and the clinical course of the disease. 

The goal for stage I, II, and III colon cancer is cure surgery should be offered to all eligible patients for this purpose. Adjuvant chemotherapy, consisting of 6 months of fluo-rouracil plus leucovorin, significantly reduces the risk of cancer recurrence and overall mortality compared to observation alone in patients with stage III disease. 

Additional prospective studies have not shown a significant decrease in adenoma recurrence at 3 years. Although calcium intake appears to be inversely related to colon cancer, its role as a chemoprevention agent is still under investigation. 

Adjuvant chemotherapy is standard therapy for patients with stage in colon cancer. The presence of lymph node involvement with tumor places patients with stage El colon cancer at high risk for relapse, and the risk of death within 5 years of surgical resection alone is as high as 70%. In this population of patients, adjuvant chemotherapy significantly decreases risk of cancer recurrence and death and is considered standard of care. 

There is currently no definitive role for adjuvant XRT in colon cancer because most recurrences are extrapelvic and occur in the abdomen. Although local recurrence and debilitating pelvic pain are uncommon, a subset of patients with T3 or T4 tumors located in the cecum, hepatic and splenic flexures, and sigmoid are at increased risk of local recurrence and may benefit from postoperative XRT and chemotherapy. Early trials using effective doses of whole abdominal XRT were limited by considerable toxicity. However, results from studies combining abdominal XRT plus fluorouracil are promising. To date, postoperative local XRT may reduce the risk of local recurrence and improve survival compared to adjuvant chemotherapy alone, but should only be considered for select patients with colon cancer. ... 

Many HATs are involved in cancer pathogenesis and several are proposed as cancer biomarkers due to correlations of expression levels with outcomes, including a positive correlation between p300 expression levels and prostate cancer recurrence, and a negative correlation between hMOF and primary breast carcinomas. A series of isothiazolone PCAF-p300 inhibitors has shown inhibition of growth of a panel of colon and ovarian tumour cell lines. ... 

Successful treatment for the IVC syndrome due to recurrence of colon cancer - chemotherapy in combination with the use of the expandable metallic stent placement. Hepatogastroenterology 48 1048-1049... 

Fig. 8.5. CT-guided ablation of recurrent colon cancer liver metastases. Contrast enhanced CT top row) shows previously treated colon cancer metastases as a hypoattenuating defect. Immediately adjacent to this lesion is an enhancing focus of recurrence (arrow). Bottom row shows successful placement of radio frequency probes within the recurrence site...

B vitamin intake or vitamin blood concentrations have also been related to various cancers. The cancer types that have been best investigated with respeet to folic acid are colon cancer and colorectal cancer. Convincing evidence from observational studies led to the initiation of randomized controlled trials with folic acid in colorectal adenomas. However, similar to cardiovascular disease, there seems to be a discrepancy between the observational epidemiological studies that reported in the majority an inverse association of folate and cancer risk, and the effect of folic acid supplementation in the randomized controlled trials, which reported no effect of folic add on recurrence of colorectal adenoma risk. 

Fig. 13.18a,b. Right hemicolectomy CT colonography reveals a second cancer in the transverse colon (arrow) and a cancer recurrence at the entero-colic anastomosis (arrowhead), which was not diagnosed by endoscopy... 

Staging of rectal cancer is relatively different from colon cancer. In fact, total mesorectal excision, with resection of the tumor together with surrounding mesorectal fat, is nowadays the surgically accepted treatment of choice for rectal cancer, as it is associated with a recurrence... 

Lurje, G., Zhang, W., Schultheis, A.M., Yang, D., Groshen, S., Hendifar, A.E., and Lenz, H.J. 2008. Polymorphisms in VEGF and IL-8 predict tumor recurrence in stage III colon cancer. Annals of Oncology Official Journal cf the European Society for Medical Oncdo /ESMO, 19(10), 1734-1741. doi 10.1093/annonc/mdn368. 

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