Colorectal cancer for

A 1993 review by La Vecchia73 concluded that there were many inconsistencies in the results of the association between coffee and colorectal cancers. For tea, in 1997 Kohlmeier and associates74 after an in-depth review of tea studies concluded that there appeared to be some protective effect of green tea on colon cancer, while they found that the data for black tea was not clear since some studies showed no association and others found increased risk with regular use. 

Following the synthesis of 5-FU in 1957 this drug remained the gold standard therapy, albeit with limited benefits, for metastatic colorectal cancer for the next 4 decades. Variations on the 5-FU theme such... 

In the study on colorectal cancer (Table 20.4), a reduced risk was found for increasing intake of anthocyanidins (OR, 0.67 for the highest versus the lowest quintile,p-trend, 0.001), flavonols (OR, 0.64,p-trend < 0.001), flavones (OR, 0.78, p-trend, 0.004), and isoflavones (OR, 0.76, p-trend, 0.001). [Rossi et al., 2006], The estimates did not substantially differ for colon and rectal cancers. After allowance for fruit and vegetable consumption, for dietary fiber, or for micronutrients previously associated to this tumor including vitamin C, the associations with flavonoids did not change by more than 10%. A recent case-control study of 1456 pairs of cases and controls conducted in Sweden confirmed a significant decrease in risk of colorectal cancer for intake of anthocyanidins and flavonols [Theodoratou et al., 2007], but there was no relation for isoflavones and flavones. However, the results on isoflavones and flavones are questionable due to the unusually and generally low intakes of the populations studied. In the Italian population, anthocyanidins were derived mainly from wine, red fruit, and onions, and flavonols from apples or pears, wine, and mixed salads. 

The mainstay of treatment for the treatment of metastatic colorectal cancer for the last 40 years has been intravenous 5-fluorouracil (5-FU). It has been... 

The results of this effort were a detailed pattern of structure-activity relationships (Figure 16.2), and the production of two compounds, topotecan 3[8] and irinotecan 4[9], which were approved for clinical use in 1996, the main indications being ovarian and small-cell lung cancer for the former and metastatic colorectal cancer for the latter. Irinotecan is a water-soluble prodrug of the active compound SN-38 (5) Figure 16.3). Several reviews of this phase of research have been published [10-12]. 

Leen, E., Goldberg, J.A., Angerson, W.J., McArdle, C.S. Potential role of Doppler perfusion index in selection of patients with colorectal cancer for adjuvant chemotherapy. Lancet 2000 355 34-37... 

Capecitabine is approved by the FDA for the treatment of (1) metastatic breast cancer in patients who have not responded to a regimen of paclitaxel and an anthracycline antibiotic (2) metastatic breast cancer when used in combination with docetaxel in patients who have had a prior anthracycline-containing regimen and (3) metastatic colorectal cancer for patients in whom fluoropyrimidine monotherapy is preferred. The recommended dose is 2500 mg/m daily, given orally in two divided doses with food, for 2 weeks followed by a rest period of 1 week. This cycle is then repeated two more times. 

In lung cancer, treated only by surgery, about 10% of patients survive for 5 years. In colorectal cancer, for which surgery is the principal treatment, the cure rate is about 50%. 

Figure 42.4 Adjusted relative risks of colorectal cancer for the highest vs. lowest categories of vitamin Be intake or blood PLP level. Source Larsson et al. (2010), cited with permission of The Journal of the American Medical Association. The size of each square is proportional to the study s weight (inverse of variance). "The range is the dilference in the midpoint between the highest and lowest categories of exposure. Exclusion of the study by de Vogel et al. which appeared to explain the study heterogeneity, yielded a pooled relative risk of 0.80 (95% Cl, 0.69-0.92) with no heterogeneity among studies (P = 0.23 12 = 24% 95% Cl, 0- %).

Parenteral nutrition was a susceptibility factor for central venous catheter-related bloodstream infections in 109 patients who received chemotherapy after surgery for colorectal cancer for a total of 5558 catheter-days in a retrospective database evaluation (OR = 13 95% Cl = 2.5, 62). 

ADCC. Cetuximab is approved for treatment of metastatic colorectal cancer (CRC) and squamous cell carcinoma of the head and neck (SCCHN). Interestingly, an adverse event, acneiform rash seems to correlate with a better response to cetuximab, while there is no such correlation with expression levels of EGFR assessed by immunohistochemistry. Further side effects are rare infusion reactions and hypomagnesia. Two other anti-EGFR antibodies approved for clinical use are the fully human antibody panitumumab (Vectibix)... 

The clinical trial that resulted in FDA approval of bevacizumab (February 2004) was a randomized, double-blind, phase III study in which bevacizumab was administered in combination with bolus-IFL (irinotecan, 5FU, leucovorin) chemotherapy as first-line therapy for previously untreated metastatic colorectal cancer [3]. Median survival was increased from 15.6 months in the bolus-IFL + placebo arm to 20.3 months in the bolus-IFL + bevacizumab arm. 

Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovor-in for metastatic colorectal cancer. N Engl J Med 350 2335-2342... 

Mafila, N. et al.. Dietary and serum alpha-tocopherol, beta-carotene and retinol, and risk for colorectal cancer in male smokers, Eur. J. Clin. Nutr, 56, 615, 2002. 

Colorectal cancer is a well-established complication of ulcerative colitis (Lennard-Jones era/., 1990 Ekbom et al., 1990). It has been shown that inflammation enhances the formation of colonic tumours in experimental animals given known carcint ens (Chester etal., 1986) and it is tempting to speculate that the longterm inflammatory response is respronsible for the increased risk of malignancy in ulcerative colitis. However, there is very little direct evidence to support this. It has also been postulated that free radicals may play a part in the development of sporadic cancers (Babbs,... 

In summary, combined estrogen plus progestin should not be used for the prevention of chronic diseases because it increases the risk of CHD, stroke, breast cancer, and venous thromboembolism. However, colorectal cancer and rates of fracture were reduced with combined hormonal treatment. 

TABLE 85-2. TNM Staging Classification System for Colorectal Cancer... 

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