THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Colon Cancer: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83350-8 1. Colon Cancer-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of colon cancer.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to colon cancer. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to colon cancer, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Adult Primary Liver Cancer
·
The Official Patient's Sourcebook on Anal Cancer
·
The Official Patient's Sourcebook on Esophageal Cancer
·
The Official Patient's Sourcebook on Extrahepatic Bile Duct Cancer
·
The Official Patient's Sourcebook on Gallbladder Cancer
·
The Official Patient's Sourcebook on Gastric Cancer
·
The Official Patient's Sourcebook on Gastrointestinal Carcinoid Tumor
·
The Official Patient's Sourcebook on Pancreatic Cancer
·
The Official Patient's Sourcebook on Rectal Cancer
·
The Official Patient's Sourcebook on Small Intestine Cancer
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON COLON CANCER: GUIDELINES ....... 9
Overview............................................................................................................... 9 What Is Colon Cancer?....................................................................................... 11 Risk Factors ........................................................................................................ 11 Symptoms ........................................................................................................... 12 Diagnosis ............................................................................................................ 12 Prognosis ............................................................................................................ 13 Staging................................................................................................................ 13 Treatment Options ............................................................................................. 15 Treatments Being Tested in Clinical Trials........................................................ 16 Treatment Options by Stage............................................................................... 17 Treatment Options for Recurrent Colon Cancer................................................ 19 To Learn More .................................................................................................... 19 About PDQ......................................................................................................... 20 More Guideline Sources ..................................................................................... 21 Vocabulary Builder............................................................................................. 30
CHAPTER 2. SEEKING GUIDANCE ....................................................... 35
Overview............................................................................................................. 35 Associations and Colon Cancer .......................................................................... 35 Finding More Associations................................................................................. 45 Cancer Support Groups...................................................................................... 47 The Cancer Information Service ......................................................................... 49 Finding Cancer Resources in Your Community................................................ 51 Finding Doctors Who Specialize in Cancer Care ............................................... 55 Selecting Your Doctor ........................................................................................ 57 Working with Your Doctor ................................................................................ 59 Finding a Cancer Treatment Facility ................................................................. 60 Additional Cancer Support Information ............................................................ 62 Vocabulary Builder............................................................................................. 62
CHAPTER 3. CLINICAL TRIALS AND COLON CANCER........................ 65
Overview............................................................................................................. 65 Recent Trials on Colon Cancer........................................................................... 68 Benefits and Risks............................................................................................... 97 Clinical Trials and Insurance Coverage ........................................................... 100
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Clinical Trials and Medicare Coverage ............................................................ 103 Increasing the Likelihood of Insurance Coverage for Trials ............................. 104 If Your Insurance Claim Is Denied after the Trial Has Begun ........................ 106 Government Initiatives to Expand Insurance Coverage for Trials .................. 109 Keeping Current on Clinical Trials.................................................................. 110 General References............................................................................................ 111 Vocabulary Builder........................................................................................... 112
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL................................................ 117 CHAPTER 4. STUDIES ON COLON CANCER ....................................... 119
Overview........................................................................................................... 119 The Combined Health Information Database ................................................... 119 Federally Funded Research on Colon Cancer ................................................... 130 E-Journals: PubMed Central ............................................................................ 135 The National Library of Medicine: PubMed .................................................... 140 Vocabulary Builder........................................................................................... 155
CHAPTER 5. PATENTS ON COLON CANCER ...................................... 163
Overview........................................................................................................... 163 Patents on Colon Cancer .................................................................................. 164 Patent Applications on Colon Cancer .............................................................. 170 Keeping Current ............................................................................................... 177 Vocabulary Builder........................................................................................... 177
CHAPTER 6. BOOKS ON COLON CANCER ......................................... 179
Overview........................................................................................................... 179 Book Summaries: Federal Agencies .................................................................. 179 The National Library of Medicine Book Index ................................................. 181 Chapters on Colon Cancer ................................................................................ 184 General Home References ................................................................................. 192 Vocabulary Builder........................................................................................... 193
CHAPTER 7. MULTIMEDIA ON COLON CANCER............................... 195
Overview........................................................................................................... 195 Video Recordings .............................................................................................. 195 Bibliography: Multimedia on Colon Cancer..................................................... 197 Vocabulary Builder........................................................................................... 200
CHAPTER 8. PERIODICALS AND NEWS ON COLON CANCER............ 203
Overview........................................................................................................... 203 News Services & Press Releases ....................................................................... 203 Newsletters on Colon Cancer ........................................................................... 214 Newsletter Articles ........................................................................................... 215 Academic Periodicals Covering Colon Cancer ................................................. 219 Vocabulary Builder........................................................................................... 221
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 223
Contents
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Overview........................................................................................................... 223 NIH Guidelines................................................................................................. 223 What Is Colon Cancer?..................................................................................... 224 Adjuvant Therapy............................................................................................. 227 Advanced Disease ............................................................................................. 228 Cellular Classification ...................................................................................... 231 Stage Information ............................................................................................. 231 Treatment Option Overview ............................................................................ 233 Recurrent Colon Cancer ................................................................................... 253 NIH Databases.................................................................................................. 262 Other Commercial Databases ........................................................................... 272 The Genome Project and Colon Cancer............................................................ 273 Specialized References....................................................................................... 277 Vocabulary Builder........................................................................................... 278
CHAPTER 10. DISSERTATIONS ON COLON CANCER ......................... 281
Overview........................................................................................................... 281 Dissertations on Colon Cancer......................................................................... 281 Keeping Current ............................................................................................... 283 Vocabulary Builder........................................................................................... 283
PART III. APPENDICES .................................................. 285 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 287
Overview........................................................................................................... 287 Your Medications: The Basics .......................................................................... 288 Learning More about Your Medications .......................................................... 289 Commercial Databases...................................................................................... 291 Drug Development and Approval .................................................................... 292 Understanding the Approval Process for New Cancer Drugs......................... 293 The Role of the Federal Drug Administration (FDA)...................................... 294 Getting Drugs to Patients Who Need Them .................................................... 298 Contraindications and Interactions (Hidden Dangers) ................................... 300 A Final Warning .............................................................................................. 301 General References............................................................................................ 301 Vocabulary Builder........................................................................................... 302
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 303
Overview........................................................................................................... 303 What Is CAM? ................................................................................................. 304 What Are the Domains of Alternative Medicine?............................................ 305 Finding CAM References on Colon Cancer ..................................................... 310 Additional Web Resources................................................................................ 320 General References............................................................................................ 335 Vocabulary Builder........................................................................................... 336
APPENDIX C. RESEARCHING NUTRITION ......................................... 339
Overview........................................................................................................... 339
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Contents
Food and Nutrition: General Principles........................................................... 340 Finding Studies on Colon Cancer..................................................................... 344 Federal Resources on Nutrition........................................................................ 347 Additional Web Resources................................................................................ 348 Vocabulary Builder........................................................................................... 354
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 357
Overview........................................................................................................... 357 Preparation ....................................................................................................... 357 Finding a Local Medical Library ...................................................................... 358 Medical Libraries Open to the Public............................................................... 358
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 365
Overview........................................................................................................... 365 Your Rights as a Patient................................................................................... 365 Patient Responsibilities .................................................................................... 369 Choosing an Insurance Plan............................................................................. 370 Medicare and Medicaid .................................................................................... 372 Financial Assistance for Cancer Care............................................................... 375 NORD’s Medication Assistance Programs ..................................................... 378 Additional Resources ........................................................................................ 379
ONLINE GLOSSARIES.................................................... 381 Online Dictionary Directories.......................................................................... 384
COLON CANCER GLOSSARY ...................................... 385 General Dictionaries and Glossaries ................................................................ 408
INDEX................................................................................... 410
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 Adapted from the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Colon Cancer
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Colon Cancer has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to colon cancer, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on colon cancer. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on colon cancer should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching colon cancer (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to colon cancer. It also gives you sources of information that can help you find a doctor in your local area specializing in treating colon cancer. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with colon cancer. Part II moves on to advanced research dedicated to colon cancer. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on colon cancer. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “freeto-use” options. Part III provides appendices of useful background reading for all patients with colon cancer or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with colon cancer. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with colon cancer.
Scope While this sourcebook covers colon cancer, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that colon cancer is often considered a synonym or a condition closely related to the following: ·
Adenocarcinoma of the Colon
·
Bowel Cancer
·
Cancer Colon
4
Colon Cancer
·
Cancer Intestine
·
Cancer of the Colon
·
Cancer of the Large Intestine
·
Carcinoma of the Colon
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Colonic Cancer
·
Colorectal Cancer
·
Intestinal Cancer
In addition to synonyms and related conditions, physicians may refer to colon cancer using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for colon cancer:4 ·
153 malignant neoplasm of colon
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to colon cancer. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with colon cancer will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with colon cancer is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of colon cancer, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on colon cancer. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of colon cancer to you or even given you a pamphlet or brochure describing colon cancer. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON COLON CANCER: GUIDELINES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on colon cancer. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on colon cancer can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on colon cancer. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with colon cancer and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Cancer Institute (NCI); guidelines available at http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtml
Among the above, the National Cancer Institute (NCI) is particularly noteworthy. The NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.6 Specifically, the Institute: ·
Supports and coordinates research projects conducted by universities, hospitals, research foundations, and businesses throughout this country and abroad through research grants and cooperative agreements.
·
Conducts research in its own laboratories and clinics.
·
Supports education and training in fundamental sciences and clinical disciplines for participation in basic and clinical research programs and treatment programs relating to cancer through career awards, training grants, and fellowships.
·
Supports research projects in cancer control.
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Supports a national network of cancer centers.
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Collaborates with voluntary organizations and other national and foreign institutions engaged in cancer research and training activities.
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Encourages and coordinates cancer research by industrial concerns where such concerns evidence a particular capability for programmatic research.
·
Collects and disseminates information on cancer.
This paragraph has been adapted from the NCI: http://www.nci.nih.gov/. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 6
Guidelines 11
·
Supports construction of laboratories, clinics, and related facilities necessary for cancer research through the award of construction grants.
The NCI, established under the National Cancer Act of 1937, is the Federal Government’s principal agency for cancer research and training. The National Cancer Act of 1971 broadened the scope and responsibilities of the NCI and created the National Cancer Program. Over the years, legislative amendments have maintained the NCI authorities and responsibilities and added new information dissemination mandates as well as a requirement to assess the incorporation of state-of-the-art cancer treatments into clinical practice. Information dissemination is made possible through the NCI Online at www.cancer.gov. Cancer.gov offers to the public and physicians up-to-date information on the latest cancer research, current and upcoming clinical trials, statistics, research programs, and research funding. The following patient guideline was recently published by the NCI on colon cancer.
What Is Colon Cancer?7 Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
Risk Factors Age and health history can affect the risk of developing colon cancer. Risk factors include: ·
Age 50 or older.
The following guidelines appeared on the NCI website on Aug. 26, 2002. The text was last modified in August 2002. The text has been adapted for this sourcebook. 7
12 Colon Cancer
·
A family history of cancer of the colon or rectum.
·
A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
·
A history of polyps (small noncancerous growths) in the colon.
·
A history of ulcerative colitis (ulcers in the lining of the large intestine).
·
Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).
Symptoms Possible signs of colon cancer include a change in bowel habits or blood in the stool. These and other symptoms may be caused by colon cancer or by other conditions. A doctor should be consulted if any of the following problems occur: ·
A change in bowel habits.
·
Blood (either bright red or very dark) in the stool.
·
Diarrhea, constipation, or feeling that the bowel does not empty completely.
·
Stools that are narrower than usual.
·
General abdominal discomfort (frequent gas pains, bloating, fullness, or cramps).
·
Weight loss with no known reason.
·
Constant tiredness.
·
Vomiting.
Diagnosis Tests that examine the rectum, rectal tissue, and blood are used to detect (find) and diagnose colon cancer. The following tests and procedures may be used:
Guidelines 13
·
Fecal occult blood test: A small stool sample is placed on a special card and returned to the doctor or lab. This test examines the stool for occult (hidden) blood.
·
Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels for lumps or abnormal areas and tests any stool for blood.
·
Barium enema: A procedure in which a liquid containing barium is put into the rectum by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray.
·
Sigmoidoscopy: An examination in which a doctor uses a sigmoidoscope (a thin, lighted instrument) to view the inside of the lower colon and rectum for polyps, tumors, or abnormal areas. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.
·
Colonoscopy: An examination of the inside of the entire colon and rectum using a colonoscope (a thin, lighted instrument) inserted into the rectum. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.
·
Biopsy: The removal of cells or tissues for examination under a microscope.
Prognosis Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether the cancer is in the inner lining of the colon only, involves the whole colon, or has spread to other places in the body) and the patient’s general health.
Staging After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body. The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the
14 Colon Cancer
staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following stages are used for colon cancer: Stage 0 (Carcinoma in Situ) In stage 0, the cancer is found in the innermost lining of the colon only. Stage 0 cancer is also called carcinoma in situ. Stage I In stage I, the cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but it has not spread to the outer wall of the colon or outside the colon. Stage I colon cancer is sometimes called Dukes’ A colon cancer. Stage II In stage II, cancer has spread outside the colon to nearby tissue, but it has not gone into the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) Stage II colon cancer is sometimes called Dukes’ B colon cancer. Stage III In stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. Stage III colon cancer is sometimes called Dukes’ C colon cancer. Stage IV In stage IV, cancer has spread to other parts of the body, such as the liver or lungs. Stage IV colon cancer is sometimes called Dukes’ D colon cancer.
Guidelines 15
Treatment Options There are different types of treatment for patients with colon cancer. Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Three types of standard treatment are used. These include the following: Surgery Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery: ·
Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging piece of tissue), the operation is called a polypectomy.
·
Resection: If the cancer is larger, the doctor will perform a colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.
·
Resection and colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. Sometimes the colostomy is needed only until the lower colon has healed,
16 Colon Cancer
and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent. Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Radiation Therapy Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Colon cancer may be treated with external radiation. After treatment, a blood test to measure carcinoembryonic antigen (CEA; a substance in the blood that may be increased when colon cancer is present) may be done along with other tests to see if the cancer has come back.
Treatments Being Tested in Clinical Trials Other types of treatment are being tested in clinical trials. These include the following: Biological Therapy Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against disease.
Guidelines 17
Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Treatment Options by Stage Stage 0 Colon Cancer (Carcinoma in Situ) Treatment of stage 0 (carcinoma in situ) may include the following types of surgery: ·
Local excision (surgery to remove the tumor without cutting through the abdominal wall) or simple polypectomy (surgery to remove the cancer from a small bulging piece of tissue).
·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon). This is done when the cancerous tissue is too large to remove by local excision.
Stage I Colon Cancer Treatment of stage I colon cancer is usually the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon).
Stage II Colon Cancer Treatment of stage II colon cancer may include the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon).
·
Clinical trials of chemotherapy, radiation therapy, or biological therapy after surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.
18 Colon Cancer
Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Stage III Colon Cancer Treatment of stage III colon cancer may include the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon), with or without chemotherapy.
·
Clinical trials of chemotherapy, radiation therapy, and/or biological therapy after surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Stage IV Colon Cancer Treatment of stage IV colon cancer may include the following: ·
Resection/anastomosis (surgery to remove the cancer and join the cut ends of the colon or to bypass the tumor).
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Surgery to remove parts of other organs such as the liver, lungs, and ovaries where the cancer may have spread.
·
Chemotherapy.
·
Clinical trials of chemotherapy or biological therapy.
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Radiation therapy may be offered to some patients as palliative therapy (to relieve symptoms).
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Guidelines 19
Treatment Options for Recurrent Colon Cancer Treatment of recurrent colon cancer depends on where the cancer has recurred (come back) and the general health of the patient. Treatment for recurrent colon cancer may include the following: ·
Surgery to remove cancer that may have spread to the liver, lungs, or ovaries.
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Surgery to remove cancer cells that have recurred (come back) in the colon.
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Radiation therapy as palliative therapy (to relieve symptoms).
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Chemotherapy as palliative therapy (to relieve symptoms).
· Clinical trials of biological therapy or chemotherapy. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
To Learn More Call For more information, U.S. residents may call the National Cancer Institute’s (NCI’s) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-4226237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-ofhearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions. Web Sites and Organizations The NCI’s Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
20 Colon Cancer
Publications The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237), TTY at 1800-332-8615.
LiveHelp The NCI’s LiveHelp service, a program available on several of the Institute’s Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer. Write For more information from the NCI, please write to this address: National Cancer Institute Office of Communications 31 Center Drive, MSC 2580 Bethesda, MD 20892-2580
About PDQ PDQ Is a Comprehensive Cancer Database Available on Cancer.gov PDQ is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov (http://cancer.gov), the NCI’s Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government’s focal point for biomedical research.
Guidelines 21
PDQ Contains Cancer Information Summaries The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-tounderstand, non-technical language. Both versions provide current and accurate cancer information. The PDQ cancer information summaries are developed by cancer experts and reviewed regularly. Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary (“Date Last Modified”) indicates the time of the most recent change.
PDQ Contains Information on Clinical Trials Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Listings of clinical trials are included in PDQ and are available online at Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
More Guideline Sources The guideline above on colon cancer is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you
22 Colon Cancer
find additional guidelines on topics related to colon cancer. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with colon cancer. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on colon cancer and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive:
Guidelines 23
·
Colon Book: A Look at Polyps and Colon Cancer, Their Treatment, and Your Prospects for Recovery. Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.25 per copy; plus shipping and handling. Summary: This patient education brochure describes colon polyps and colon cancer, their treatment, and prognosis. Written in nontechnical language, the brochure notes that it can be quite unsettling when a doctor suspects that the patient has a growth in their colon. However, most colon growths can be removed swiftly. And even if the growth is cancerous, with early medical treatment, prognosis is good. A prompt evaluation is the key to diagnosing a colon growth. A medical history, thorough exam, and diagnostic tests (including digital rectal exam, sigmoidoscopy, barium enema, and colonoscopy) help the doctor diagnose the colon problem and plan the right treatment. Surgical treatment may involve removal of the colon growth or growths; if cancer is found, further treatment (such as chemotherapy or radiation) may be needed. After recovery from surgery and any other treatments, the patient can slowly return to their daily activities. Followup exams, a healthy diet, and help from friends, family, and support groups can help the patient get back to his or her routine as quickly as possible. One section of the brochure illustrates and describes the healthy colon, how it functions, and how unhealthy growths (polyps and cancer) can occur. The brochure then describes preoperative care, the different types of colon resections that may be utilized (right hemicolectomy, transverse colectomy, left colectomy, and sigmoid colectomy), what to expect during the hospital stay, and postoperative recovery at home. The brochure is illustrated with full color line drawings and is available in English or Spanish. 12 figures.
·
Understanding Colon Cancer Screening Source: Manchester, MA: American Society for Gastrointestinal Endoscopy. 2001. [2 p.]. Contact: Available from American Society for Gastrointestinal Endoscopy. 13 Elm Street, Manchester, MA 01944. (508) 526-8330. Price: Single copy free. Summary: This brochure educates readers about colon cancer screening. The brochure offers six True or False statements about colorectal cancer (CRC) screening, then explains the correct answer for each. Topics include the incidence of CRC in men versus women; the indications for
24 Colon Cancer
testing; the time involved in a colonoscopy screening examination; the mortality associated with CRC; diagnostic tests used to screen for colon cancer; and prevention of CRC. Colorectal cancer affects an equal number of men and women. Beginning at age 50, all men and women should be screened for colorectal cancer, even if they are experiencing no problems or symptoms. Colonoscopy is almost always done on an outpatient basis; the test is safe and the procedure itself typically takes less than 30 minutes. Colorectal cancer is the third leading cause of cancer deaths in women in the United States. Tests used for screening for CRC include digital rectal exam, stool blood test, barium enema, flexible sigmoidoscopy, and colonoscopy. The brochure emphasizes that colon cancer is often preventable, so screening is very important. ·
ACG Recommendations on Colorectal Cancer Screening for Average and Higher Risk Patients in Clinical Practice Source: Arlington, VA: American College of Gastroenterology. 200x. 25 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206-1656. (703) 820-7400. Fax (703) 9314520. Price: Single copy free. Summary: This booklet outlines the preferred colorectal cancer screening recommendations of the American College of Gastroenterology (ACG) and presents an update of the ACG position on screening as outlined by the Agency for Healthcare Policy and Research (AHCPR). The AHCPR's recommendations presented a menu of options for screening average risk persons. These options have similar cost-effectiveness ratios, however, there are substantial differences between the various options regarding their effectiveness, initial costs, and to a lesser degree, risk. The ACG continues to endorse the AHCPR guideline. The update recommendation as presented in the booklet is meant to reflect trends in the rapidly changing perceptions of colorectal cancer prevention strategies among clinical gastroenterologists in both academic and private practice. The preferred screening strategy for persons over age 50 at average risk for colorectal cancer is colonoscopy every 10 years. An alternative strategy for this population (used when resources, expertise, or reimbursement for screening colonoscopy are not available) is flexible sigmoidoscopy every 5 years plus annual fecal occult blood testing. The booklet outlines other screening strategies include barium enema, and CT (computed tomography) and magnetic resonance (MR) colonography (also called virtual colonoscopy). The booklet then discusses screening for people in high risk categories, including those with a personal or family history of familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, and strong family history of colon cancer. The booklet includes
Guidelines 25
extensive tables that summarize the information and guidelines presented in the text. 2 figures. 4 tables. 142 references. ·
Now Medicare Covers a Test That Could Save Your Life: What You Should Know About New Medicare Colorectal Cancer Screening Benefit [and] Screening for Your Family Source: Arlington, VA: American College of Gastroenterology. 1998. 6 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. (800) 478-2876. Price: Single copy free. Summary: This brochure describes colorectal cancer screening and new Medicare reimbursement (payment) for its costs. Screening can prevent cancer by removing pre-cancerous growths (polyps), and early detection allows diagnosis before cancers have a chance to spread. Up to 80 percent of colon cancer deaths can be prevented by timely removal of precancerous polyps. Congress passed a new law which directed Medicare to pay for three tests for colorectal cancer screening. Fecal occult blood tests will be paid for annually; flexible sigmoidoscopy will be paid for once every four years for average risk patients; and screening colonoscopy will be paid for once every two years for high risk patients. The brochure describes each of these tests, as well as barium X-ray, noting the advantages and disadvantages of each. High risk patients are those who have a personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease (Crohn's disease or ulcerative colitis; those who have a close relative who has had colorectal cancer or an adenomatous polyp; and those who have a family history of familial adenomatous polyposis or of hereditary non-polyposis colorectal cancer. The brochure concludes with information about choosing a physician to do these screening tests. A physician's insert is provided with the brochure; the insert lists the HCPCS Codes and Guidelines for Reimbursement for colorectal cancer screening tests. (AA-M).
·
Colorectal Cancer Screening: Early Detection Source: San Ramon, CA: Health Information Network, Inc. 1996. 14 p. Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. Price: $1.95 suggested list price; professional and bulk discounts available. Order number 206. ISBN: 1885274629. Summary: This brochure provides readers with basic information about screening for colorectal cancer. The brochure defines a screening test as a type of medical examination that may find cancer early, before it causes
26 Colon Cancer
symptoms or pain. Colorectal cancer is cancer in any part of the large intestine, which includes the colon and rectum. Colorectal cancer is one of the most curable types of cancer, with a success rate of over 90 percent when found in its early stages. Written in language that is easy to read, the brochure covers the anatomy of the colon and rectum, the nature of cancer, risk factors for colorectal cancer, screening tests for colorectal cancer (fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema with air contrast examination, and digital rectal examination), symptoms of colorectal cancer, and patient followup. The brochure provides the addresses and phone numbers of the American Cancer Society and the National Cancer Institute. A brief glossary of terms is also included. ·
Colorectal Cancer: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. [2 p.]. Contact: Available from American Society for Colon and Rectal Surgeons (ASCRS). 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Website: www.fascrs.org. Price: Single copy free. Summary: This brochure describes colorectal cancer, the second most common cancer in the United States, striking 140,000 people annually and causing 60,000 deaths. The author stresses that the disease is potentially curable if diagnosed in the early stages. Risk factors include age, family history of colorectal cancer and polyps, and personal history of ulcerative colitis, colon polyps, or cancer of other organs, especially of the breast or uterus. Nearly all colon and rectal cancer begins in benign polyps; these premalignant growths occur on the bowel wall and may eventually increase in size and become cancer. The most common symptoms are rectal bleeding and changes in bowel habits, such as constipation or diarrhea. Unfortunately, many polyps and early cancers fail to produce symptoms. Therefore, routine physicals should include colorectal cancer detection procedures after age 40, including digital rectal exams, a chemical test of stool for blood, and sigmoidoscopy (the inspection of the lower bowel with a lighted tubular instrument). Colorectal cancer requires surgery in nearly all cases for a complete cure. Radiation and chemotherapy are sometimes used in addition to surgery. The brochure also outlines steps that can reduce the risk of contracting colon cancer. One way is having benign polyps removed by an outpatient procedure called colonoscopy. There is also some evidence that diet (high fiber, low fat) may play a significant role in preventing colorectal cancer. Readers are also encouraged to pay attention to changes in their bowel
Guidelines 27
habits. The brochure concludes with a brief description of the specialty of colon and rectal surgeons. 1 figure. ·
Follow Up Evaluation After Surgery for Colorectal Cancer: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1992. 4 p. Contact: Available from American Society of Colon and Rectal Surgeons. 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Fax (847) 290-9203. Price: Single copy free; bulk copies available. Summary: This patient education brochure provides information about patient follow-up evaluations after surgery for colorectal cancer. Written in a question and answer format, the brief brochure discusses the reasons why follow-up evaluations are crucial, the recommended length of a followup program, what to expect at a followup visit, and the importance of screening close family members who are at increased risk for colon and rectal cancer.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “colon cancer” or synonyms. The following was recently posted: ·
ACR Appropriateness Criteria™ for pre-treatment staging of colorectal cancer. Source: American College of Radiology.; 1996 (revised 1999); 8 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1626&sSearch_string=colon+cancer
·
ACR Appropriateness Criteria™ for screening for colorectal cancer. Source: American College of Radiology.; 1998; 7 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1639&sSearch_string=colon+cancer
28 Colon Cancer
·
Adjuvant therapy for stage II colon cancer following complete resection. Source: Cancer Care Ontario Practice Guidelines Initiative.; 1997 August 25 (updated online 2000 Apr) http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2235&sSearch_string=colon+cancer
·
Adjuvant therapy for stage III colon cancer following complete resection. Source: Cancer Care Ontario Practice Guidelines Initiative.; 1997 August 25 (updated online 2000 Apr); Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2242&sSearch_string=colon+cancer
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American Gastroenterological Association medical position statement: hereditary colorectal cancer and genetic testing. Source: American Gastroenterological Association.; 2001 April 18; 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2283&sSearch_string=colon+cancer
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American Gastroenterological Association medical position statement: impact of dietary fiber on colon cancer occurrence. Source: American Gastroenterological Association.; 1999 November 15 (reviewed 2001); 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2296&sSearch_string=colon+cancer
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Colorectal cancer screening. Source: Institute for Clinical Systems Improvement.; 1995 May (revised 2001 Jul) http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2251&sSearch_string=colon+cancer
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·
Colorectal cancer screening: clinical guidelines and rationale. Source: American Gastroenterological Association.; 1997 February (reviewed 2001); 48 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0045&sSearch_string=colon+cancer
·
Preventive health care, 2001 update: colorectal cancer screening. Source: Canadian Task Force on Preventive Health Care.; 2001; 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2120&sSearch_string=colon+cancer
·
Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Source: American Society of Clinical Oncology.; 1999 April (revised 2000 Oct); 10 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1111&sSearch_string=colon+cancer
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Frequently Asked Questions For Caregivers Summary: A series of commonly asked questions and answers provided for persons caring for patients with colon (colorectal) cancer. Source: Colon Cancer Alliance http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6073
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for
30 Colon Cancer
documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to colon cancer. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in
Guidelines 31
immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH] Biopsy: The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fineneedle aspiration. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH] CEA: Carcinoembryonic antigen. A substance that is sometimes found in an increased amount in the blood of people with certain cancers. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached
32 Colon Cancer
to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colonoscope: A thin, lighted tube used to examine the inside of the colon. [NIH]
Colonoscopy: An examination of the inside of the colon using a thin, lighted tube (called a colonoscope) inserted into the rectum. If abnormal areas are seen, tissue can be removed and examined under a microscope to determine whether disease is present. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscopy: The use of a thin, lighted tube (called an endoscope) to examine the inside of the body. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Immunotherapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also called biological therapy or biological response modifier (BRM) therapy. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH]
Guidelines 33
Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oncology: The study of cancer. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Postoperative: After surgery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Preoperative: Preceding an operation. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiology: The use of radiation (such as x-rays) or other imaging technologies (such as ultrasound and magnetic resonance imaging) to diagnose or treat disease. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sigmoidoscope: A thin, lighted tube used to view the inside of the colon. [NIH]
Sigmoidoscopy: Inspection of the lower colon using a thin, lighted tube called a sigmoidoscope. Samples of tissue or cells may be collected for examination under a microscope. Also called proctosigmoidoscopy. [NIH]
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Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH] Stomach: An organ that is part of the digestive system. It helps in the digestion of food by mixing it with digestive juices and churning it into a thin liquid. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Systemic: Affecting the entire body. [NIH] Tomography: A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an x-ray machine. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH]
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CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with colon cancer. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with colon cancer. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Colon Cancer As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
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influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American College of Surgeons Address: American College of Surgeons 633 North Saint Clair Street, Chicago, IL 60611-3211 Telephone: (312) 202-5000 Toll-free: (888) 939-3333 Fax: (312) 202-5001 Email: None. Web Site: http://www.facs.org/ Background: The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The College currently has more than 56,000 Fellows including more than 3,400 Fellows in other countries, making it the largest organization of surgeons in the world. There are presently more than 3,300 Associate Fellows. The American College of Surgeons sponsors a variety of continuing medical education (CME) programs and conducts various programs through its Commission on Cancer to improve the care of the cancer patient. Through its Committee on Trauma, ACS works to improve the care of injured and critically ill patients before, en route to, and during hospitalization. The College also monitors and analyzes socioeconomic, legislative, and regulatory issues affecting the field of surgery through its Socioeconomic Affairs Department and Washington, DC office and serves as a sponsoring organization for the Residency Review Committees for Colon and Rectal Surgery, Neurological Surgery, Otolaryngology, Plastic Surgery, Surgery, Thoracic Surgery, and Urology and supports postdoctoral education in surgery through several scholarship programs. Through its Office of Public Information, ACS provides public education services to patients with general information to help them make informed decisions about surgical care, and distributes a brochure series on frequently performed surgical procedures.
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American Society of Colon and Rectal Surgeons Address: American Society of Colon and Rectal Surgeons 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005 Telephone: (847) 290-9184 Toll-free: (888) 939-3333 Fax: (847) 290-9203 Email:
[email protected] Web Site: http://www.fascrs.org/ Background: The American Society of Colon and Rectal Surgeons (ASCRS) is a medical professional society representing more than 1,000 board certified colon and rectal surgeons and other surgeons. The Society's membership is dedicated to advancing and promoting the science and practice of the treatment of individuals with diseases and disorders affecting the colon, rectum, and anus. The Society's Standards Task Force is committed to developing practice parameters for the treatment of colon and rectal diseases and disorders including ambulatory anorectal surgery, treatment of hemorrhoids, management of anal fissure, treatment of rectal carcinoma, and detection of colorectal neoplasms. The Society's web site provides links to such practice parameters as well as to core subject updates on such topics as colonic volvulus, ostomies and stomal therapy, familial adenomatous polyposis, and colon and rectal cancer. The Society also publishes the 'Washington Report,' which offers updates on current federal legislative and regulatory actions, and provides professional publications including the 'ASCRS Newsletter' and the Society's official journal entitled 'Diseases of the Colon and Rectum.' The ASCRS also provides an email discussion group (listserv) for the benefit of ASCRS members and fellows in colon and rectal surgery. The primary purpose of the listserv is to provide a forum for the informal discussion of clinical cases and other issues of general interest to the colon and rectal surgeon community. The Society's web site also provides information on the Collaborative Group of the Americas on Inherited Colorectal Cancer. The Group was established in 1995 to improve understanding of the basic science of inherited colorectal cancer and the clinical management of affected families. Its broad aims are to promote education of physicians, allied health care professionals, patients, and their families; provide linkage to clinical and chemoprevention trials; promote the integration of molecular and clinical research at local and national levels; and serve as a resource for developing similar genetic registers. The American Society of Colon and Rectal Surgeons also provides patient information on a variety of topics including anal abscess/fistula, anal fissure, anal warts, bowel incontinence, colonoscopy, colorectal cancer, constipation, Crohn's
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disease, diverticular disease, irritable bowel syndrome, ostomy, rectal prolapse, and ulcerative colitis. ·
Canadian Cancer Society Address: Canadian Cancer Society 10 Alcorn Avenue, Suite 200, Toronto, Ontario, M4V 3B1, Canada Telephone: (416) 961-7223 Toll-free: (888) 939-3333 Fax: (416) 961-4189 Email:
[email protected] Web Site: http://www.cancer.ca/ Background: The Canadian Cancer Society (CCS) is a national, nonprofit, community-based organization that is dedicated to eradicating cancer and improving the quality of life of people living with cancer. Established in 1937, the Society currently has 350,000 volunteers, over 600 community locations, 10 provincial divisions, and one national office. The Canadian Cancer Society works to achieve its mission by promoting and supporting cancer research, educating the public, engaging in public policy advocacy efforts, and providing patient and family services. The Society is committed to funding medical research, awarding fellowships to support advanced clinical training in oncology, and funding behavioral research to help determine the best ways to promote lifestyle changes that may reduce the risk of cancer. The Society's public education programs work to promote the prevention and early detection of cancer by providing information and skill development through programs, advocacy, and collaboration. In addition, the Canadian Cancer Society works with coalitions of health, medical, research, and professional organizations to lobby Parliament and provincial legislatures concerning public policies that will promote health and prevent disease. The Society's patient services program is committed to meeting the social, emotional, informational, and spiritual needs of people with cancer and their families. Program services include the Society's Cancer Information Service, which provides affected individuals and family members with current information about all aspects of cancer; networking programs that enable individuals with cancer to communicate with trained volunteers who have also been affected by cancer; transportation to treatment centers and other practical assistance; and educational publications for affected individuals and family members.
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CancerOnline Address: Telephone: (410) 955-3875 Toll-free: (888) 939-3333 Email:
[email protected] Web Site: http://www.canceronline.org Background: CancerOnline is a nonprofit site on the Internet dedicated to providing individuals with cancer easy access to clinical information and offering extensive practical support and encouragement. CancerOnline collaborates with many different cancer care centers and organizations and provides original material contributed by cancer patients, caregivers, and cancer care specialists in private practice and a variety of cancer centers. CancerOnline's content is overseen by three advisory panels made up of oncologists, radiologists, and clinical care providers who want to help cancer patients become students of their disease; other cancer care specialists and providers of psychosocial support who want to encourage patients to participate actively in their treatment; and patients, survivors, and caregivers who want to help patients live with vitality and hope even in the face of a life-challenging illness. CancerOnline offers several major areas within its site including 'About CancerOnline,' 'Support and Encouragement,' 'Getting Information,' 'Participating in This Community,' and 'Special Features.' The site offers several sources of clinical information that can be accessed through a network of subject areas; practical advice before, during, and after treatment; stories from individuals who have triumphed over cancer; opportunities for affected individuals and families to contribute personal stories, creative expressions, commentaries, and questions; hints on how to obtain additional information on and off the Internet; dynamic linkage to additional web sites that provide information and support to those with particular types of cancer; and more. CancerOnline provides information and support to individuals with any type of cancer including Bladder Cancer, Breast Cancer, Colon and Rectal Cancer, Liver Cancer, Lymphoma, Ovarian Cancer, Prostate Cancer, Stomach Cancer, Uterine Cancer, Pediatric Cancers, Brain Tumors, Head and Neck Cancer, Leukemia, Lung Cancer, Melanoma, Pancreatic Cancer, Skin Cancer, Thyroid Cancer, and Rare Adult Cancers.
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David G. Jagelman Inherited Colorectal Cancer Registries Address: David G. Jagelman Inherited Colorectal Cancer Registries Cleveland Clinic Foundation, T10-Medical Genetics, 9500 Euclid Avenue, Cleveland, OH 44195 Telephone: (216) 444-6470 Toll-free: (800) 998-4785
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Fax: (216) 445-6935 Email:
[email protected] Background: Established in 1978, the David G. Jagelman Inherited Colorectal Cancer Registries is a not-for-profit academic medical center recognized as a National Referral Center and an international resource for diseases of the colon and rectum. Dedicated to identifying, educating, and serving affected individuals, the organization has an educational division, a research institute, and a hospital and outpatient clinic. The organization offers risk assessments and appropriate screening tests; maintains computerized registries of affected individuals and those who may be at risk (e.g., for Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colorectal Cancer, and Familial Colon Cancer). It suggests surveillance protocols and reviews surgical options for affected individuals. David G. Jagelman Inherited Colorectal Cancer Registries also provides a variety of educational and support materials including brochures, pamphlets, articles, and a newsletter called 'Family Matters.'. ·
Gastrointestinal Polyposis and Hereditary Colon Cancer Registry Address: Gastrointestinal Polyposis and Hereditary Colon Cancer Registry Center for Medical Genetics, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-4922 Telephone: (410) 955-3875 Toll-free: (888) 939-3333
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International Cancer Alliance for Research and Education Address: International Cancer Alliance for Research and Education 4853 Cordell Avenue, Suite 11, Bethesda, MD 20814 Telephone: (301) 654-7933 Toll-free: (800) 422-7361 Fax: (301) 654-8684 Email:
[email protected] Web Site: http://icare.org Background: The International Cancer Alliance for Research and Education (ICARE) is a nonprofit organization that provides focused information to individuals affected by cancer and their physicians on an ongoing, person-to-person basis. Cancer is a general term referring to a group of diseases characterized by uncontrolled cellular growth that may invade surrounding tissues and spread (metastasize) to other bodily tissues or organs. The different cancers may be classified based upon the organ and cell type involved, the nature of the malignancy, and the disease's clinical course. ICARE has developed several patient-centered
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programs through a process of collection, evaluation, and dissemination of information, bringing affected individuals into contact with physicians and scientists from around the world. The Alliance is operated by a network of scientists, clinicians, staff members, and lay volunteers, many of whom are affected by cancer themselves. The Alliance maintains the ICARE Registry, a confidential membership listing that permits ongoing dialogue between ICARE and its network members. Registry members receive a 'cancer therapy review' including a description of the specific form of cancer in question, information concerning detection and staging procedures, an overview of current treatments, a bibliography for more in-depth research, and listings of diagnostic tests, ongoing clinical trials, and second opinion centers. Registry members also receive medical, research, clinical trial, and Food and Drug Administration (FDA) updates relating to the specific form of cancer or cancer in general; regular newsletters; and access to all ICARE programs. Such programs include ICARE patient education partner centers, which provide affected individuals with access to an electronic library of cancer information and online hook-ups at the community level; private electronic support groups for individuals dealing with common types of cancer or common issues; a clinical trial matching program; and other services. ICARE provides information concerning its mission, objectives, services, and programs on its web site on the Internet. ·
Intestinal Multiple Polyposis and Colorectal Cancer Registry Address: Intestinal Multiple Polyposis and Colorectal Cancer Registry P.O. Box 11, Conyngham, PA 18219 Telephone: (717) 788-3712 Toll-free: (888) 772-6566 Fax: (717) 788-4046 Email:
[email protected] Background: The Intestinal Multiple Polyposis and Colorectal Cancer Registry, also known as IMPACC, is a not-for-profit self-help service organization that was established in 1986. The purpose of the group is to provide information and support to people affected by Multiple Polyposis or Hereditary Colorectal Cancer, their families, and their physicians. Multiple Familial Polyposis is a group of rare inherited conditions of the gastrointestinal system characterized by benign growths (adenomatous polyps) lining the mucous membrane of the intestine. Because such growths have high malignant potential, affected individuals may potentially develop cancer of the colon and/or rectum. The Registry promotes ongoing medical research into the causes, treatment, and prevention of these disorders. IMPACC also offers a
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variety of services including genetic counseling, referrals to appropriate avenues of treatment, and a quarterly newsletter. ·
Johns Hopkins Hereditary Colorectal Cancer Registry Address: Johns Hopkins Hereditary Colorectal Cancer Registry 550 North Broadway, Number 108, Baltimore, MD 21205-2011 Telephone: (410) 955-3875 Toll-free: (888) 772-6566 Fax: (410) 614-9544 Email:
[email protected] Web Site: None Background: The Johns Hopkins Hereditary Colorectal Cancer Registry is a research organization that maintains a registry of families affected by different forms of Hereditary Colorectal Cancer including Hereditary Colon Cancer, Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colorectal Cancer, Juvenile Polyposis, and Peutz-Jeghers Syndrome. Established in 1973, the Registry currently includes hundreds of families affected by these disorders. Interested individuals are offered the opportunity to participate in ongoing research studies. The Registry also offers educational materials to people affected by hereditary forms of colon cancer, their families, and physicians.
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M. D. Anderson Cancer Center Hereditary Colorectal Cancer Registry Address: M. D. Anderson Cancer Center Hereditary Colorectal Cancer Registry Universitiy of Texas, 1515 Holcombe Boulevard, Box 78, Houston, TX 77030 Telephone: (713) 792-2828 Toll-free: (800) 472-4376 Fax: (713) 745-1163 Email:
[email protected] Web Site: http://www.utmdacc.uth.tmc.edu/ Background: The University of Texas M.D. Anderson Cancer Center Hereditary Colorectal Cancer Registry is a registry organization dedicated to evaluating families in which there is a suspected or confirmed risk of a hereditary colorectal cancer syndrome. Established in 1988, the registry stafRegistry's staff makes arrangements to obtain necessary risk assessment, tests, procedures, or treatments at M.D. Anderson. Genetic testing and counseling are performed on appropriate families in order to identify persons at high risk for hereditary colorectal cancer. Individuals and their family members can also be evaluated for eligibility for other ongoing studies such as chemoprevention and
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psychosocial studies. Educational materials include a periodic newsletter entitled 'Hereditary Colon Cancer Newsletter,' a guide entitled 'Johns Hopkins Guide for Patients and Families: Familial Adenomatous Polyposis (FAP),' and 'Hereditary Non-Polyposis Colon Cancer: A Guide for Patients and Families.' Program activities include genetic counseling, educational programs, and referrals. The registry can be reached at its web site on the Internet at http://utmdacc.uth.tmc.edu. ·
OncoLink: The University of Pennsylvania Cancer Center Resource Address: The University of Pennsylvania Cancer Center Resource Web Site on the Internet, Telephone: (410) 955-3875 Toll-free: (888) 939-3333 Email:
[email protected] Web Site: http://www.oncolin.upenn.edu Background: OncoLink is a multimedia oncology information resource on the World Wide Web on the Internet. OncoLink's mission 'is consistent with that of the University of Pennsylvania Medical Center and the University of Pennsylvania Cancer Center, which have sanctioned the site's use and development. OncoLink is accessible worldwide to anyone with Internet access, and there is no charge for its use. Oncolink has been established with the following objectives: (1) dissemination of information relevant to the field of oncology; (2) education of health care personnel; (3) education of affected individuals, families, and other interested parties; and (4) rapid collection of information pertinent to the specialty. OncoLink's home page includes the following headings: Disease Oriented Headings (i.e., specific types of cancer); Medical Specialty Oriented Menus (i.e., medical specialities that deal with cancer, chemotherapy information, etc.); Psychosocial Support and Personal Experiences; Cancer Causes, Screening, and Prevention; Clinical Trials; Global Resources for Cancer Information; Cancer FAQs (frequently asked questions); Medical Supportive Care for the Cancer Patient; Conferences and Meetings; and Financial Issues for Cancer Patients.
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Roswell Park Family Cancer Registry Address: Roswell Park Family Cancer Registry Elm and Carlton Streets, Buffalo, NY 14263 Telephone: (716) 845-5815 Toll-free: (800) 685-6825 Fax: (716) 845-8980 Email:
[email protected] 44 Colon Cancer
Background: Roswell Park Family Cancer Registry is a research organization dedicated to registering families at risk of developing cancers. The Registry seeks to educate affected individuals and family members in the areas of prevention, early detection, and treatment of cancer, as well as risk assessment of such family members. Established in 1992, this research program is designed to obtain detailed medical and family history information from people who, because of their family history or other risk factors, may have an increased potential of developing cancer. To this end, the Registry takes blood and other tissue samples. This material is provided to research scientists studying cancer genes. The affected individuals or families are thus provided with updated information on genetics, genetic cancers, and testing. The Registry produces educational materials including a pamphlet entitled 'Hereditary Non-polyposis Colorectal Cancer.' The organization supports such program activities as genetic counseling, patient and general education, and research. ·
Steve Antanas Stavro Familial Gastrointestinal Cancer Registry Address: Steve Antanas Stavro Familial Gastrointestinal Cancer Registry Familial Gastrointestinal Cancer Registry, Suite 1157, Mount Sinai Hospital, 600 University Avenue, Ontario, M5G 1X5, Canada Telephone: (416) 586-8334 Fax: (416) 586-8644 Email:
[email protected] Background: The Steve Antanas Stavro Familial Gastrointestinal Cancer Registry is a professional and research center dedicated to providing professional services as well as emotional support to people affected by familial gastrointestinal cancer and their families. Established in 1980, the center conducts research studies and has an investigative team focused on innovative surgical techniques related to gastrointestinal cancer. The center also has a molecular diagnostic program and offers a screening service for family members who may be at risk for the hereditary form of the disease. Along with its scientific and medical departments, the center also has a genetic counseling department that offers advice and support to affected individuals and families. The Steve Antanas Stavro Familial Gastrointestinal Cancer Registry maintains a database of affected individuals and produces educational and support materials including pamphlets, brochures, family guides, and a biannual newsletter. The Registry relays information regarding hospital and community resources through a patient library.
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Strang-Cornell Hereditary Colon Cancer Program Address: Strang-Cornell Hereditary Colon Cancer Program 428 East 72nd Street, New York, NY 10021 Telephone: (212) 746-5656 Toll-free: (888) 939-3333 Fax: (212) 746-8765 Email:
[email protected] Web Site: http://www.strang.org Background: The Strang-Cornell Hereditary Colon Cancer Program (SCPC) is a not- for-profit organization dedicated to providing individuals with Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis Colorectal Cancer (HNPCC) clinical and educational services, as well as to foster participation in research. Colorectal cancer is a common disease in the United States. While most cases of colorectal cancer are sporadic, up to ten percent are hereditary. Hereditary colorectal cancer includes the polyposis syndromes, of which Familial Adenomatious Polyposis is the most common, and the nonpolyposis syndromes, broadly referred to as Hereditary Nonpolyposis Colorectal Cancer. Established in 1934, this program is a collaboration between the Strang Cancer Prevention Center and the New York Hospital-Cornell Medical Center. SCPC includes three divisions: registries for FAP and HNPCC, which are maintained with the assistance of a full-time registrar; clinical and pre-clinical research, including the study of predictors of malignant potential, chemoprevention of colon cancer, gastrointestinal immune function, molecular diagnostics, and dietary intervention; and clinical services, inclusive of medical and surgical treatment, with specialists in nutrition, psychological and genetic counseling. Educational materials include two pamphlets entitled 'Nutrition Consultation Program' and 'Hereditary Colon Cancer Program.' Program activities include a support group, genetic counseling, patient networking, education, and referrals. SCPC can be reached at its e-mail address at MBERTAGatmail.med.cornell.edu or its web site at www.strang.org.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
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The National Cancer Institute (NCI) The National Cancer Institute (NCI) has complied a list of national organizations that offer services to people with cancer and their families. To view the list, see the NCI fact sheet online at the following Web address: http://cis.nci.nih.gov/fact/8_1.htm. The name of each organization is accompanied by its contact information and a brief explanation of its services.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about colon cancer. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “colon cancer” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “colon cancer”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing
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with colon cancer. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “colon cancer” (or a synonym) in the search box.
Cancer Support Groups10 People diagnosed with cancer and their families face many challenges that may leave them feeling overwhelmed, afraid, and alone. It can be difficult to cope with these challenges or to talk to even the most supportive family members and friends. Often, support groups can help people affected by cancer feel less alone and can improve their ability to deal with the uncertainties and challenges that cancer brings. Support groups give people who are affected by similar diseases an opportunity to meet and discuss ways to cope with the illness. How Can Support Groups Help? People who have been diagnosed with cancer sometimes find they need assistance coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional burden of cancer is sometimes part of a patient’s treatment plan. Cancer support groups are designed to provide a confidential atmosphere where cancer patients or cancer survivors can discuss the challenges that accompany the illness with others who may have experienced the same challenges. For example, people gather to discuss the emotional needs created by cancer, to exchange information about their disease—including practical problems such as managing side effects or returning to work after treatment—and to share their feelings. Support groups have helped thousands of people cope with these and similar situations.
10
This section has been adapted from the NCI: http://cis.nci.nih.gov/fact/8_8.htm.
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Can Family Members and Friends Participate in Support Groups? Family and friends are affected when cancer touches someone they love, and they may need help in dealing with stresses such as family disruptions, financial worries, and changing roles within relationships. To help meet these needs, some support groups are designed just for family members of people diagnosed with cancer; other groups encourage families and friends to participate along with the cancer patient or cancer survivor. How Can People Find Support Groups? Many organizations offer support groups for people diagnosed with cancer and their family members or friends. The NCI fact sheet National Organizations That Offer Services to People with Cancer and Their Families lists many cancer-concerned organizations that can provide information about support groups. This fact sheet is available at http://cis.nci.nih.gov/fact/8_1.htm on the Internet, or can be ordered from the Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). Some of these organizations provide information on their Web sites about contacting support groups. Doctors, nurses, or hospital social workers who work with cancer patients may also have information about support groups, such as their location, size, type, and how often they meet. Most hospitals have social services departments that provide information about cancer support programs. Additionally, many newspapers carry a special health supplement containing information about where to find support groups.
What Types of Support Groups Are Available? Several kinds of support groups are available to meet the individual needs of people at all stages of cancer treatment, from diagnosis through follow-up care. Some groups are general cancer support groups, while more specialized groups may be for teens or young adults, for family members, or for people affected by a particular disease. Support groups may be led by a professional, such as a psychiatrist, psychologist, or social worker, or by cancer patients or survivors. In addition, support groups can vary in approach, size, and how often they meet. Many groups are free, but some require a fee (people can contact their health insurance company to find out whether their plan will cover the cost). It is important for people to find an atmosphere that is comfortable and meets their individual needs.
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Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
The Cancer Information Service11 The Cancer Information Service (CIS) is a program of the National Cancer Institute (NCI), the Nation’s lead agency for cancer research. As a resource for information and education about cancer, the CIS is a leader in helping people become active participants in their own health care by providing the latest information on cancer in understandable language. Through its network of regional offices, the CIS serves the United States, Puerto Rico, the U.S. Virgin Islands, and the Pacific Islands. For 25 years, the Cancer Information Service has provided the latest and most accurate cancer information to patients and families, the public, and health professionals by: ·
Interacting with people one-on-one through its Information Service,
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Working with organizations through its Partnership Program,
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Participating in research efforts to find the best ways to help people adopt healthier behaviors,
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Providing access to NCI information over the Internet. How Does the CIS Assist the Public?
Through the CIS toll-free telephone service (1–800–4–CANCER), callers speak with knowledgeable, caring staff who are experienced at explaining medical information in easy-to-understand terms. CIS information specialists answer calls in English and Spanish. They also provide cancer information to deaf and hard of hearing callers through the toll-free TTY number (1–800– 11
This section has been adapted from the NCI: http://cis.nci.nih.gov/fact/2_5.htm.
50 Colon Cancer
332–8615). CIS staff have access to comprehensive, accurate information from the NCI on a range of cancer topics, including the most recent advances in cancer treatment. They take as much time as each caller needs, provide thorough and personalized attention, and keep all calls confidential. The CIS also provides live, online assistance to users of NCI Web sites through LiveHelp, an instant messaging service that is available from 9:00 a.m. to 7:30 p.m. Eastern time, Monday through Friday. Through LiveHelp, information specialists provide answers to questions about cancer and help in navigating Cancer.gov, the NCI’s Web site. Through the telephone numbers or LiveHelp service, CIS users receive: ·
Answers to their questions about cancer, including ways to prevent cancer, symptoms and risks, diagnosis, current treatments, and research studies;
·
Written materials from the NCI;
·
Referrals to clinical trials and cancer-related services, such as treatment centers, mammography facilities, or other cancer organizations;
·
Assistance in quitting smoking from information specialists trained in smoking cessation counseling. What Kind of Assistance Does the CIS Partnership Program Offer?
Through its Partnership Program, the CIS collaborates with established national, state, and regional organizations to reach minority and medically underserved audiences with cancer information. Partnership Program staff provide assistance to organizations developing programs that focus on breast and cervical cancer, clinical trials, tobacco control, and cancer awareness for special populations. To reach those in need, the CIS: ·
Helps bring cancer information to people who do not traditionally seek health information or who may have difficulties doing so because of educational, financial, cultural, or language barriers;
·
Provides expertise to organizations to help strengthen their ability to inform people they serve about cancer; and
·
Links organizations with similar goals and helps them plan and evaluate programs, develop coalitions, conduct training on cancer-related topics, and use NCI resources.
Seeking Guidance 51
How Do CIS Research Efforts Assist the Public? The CIS plays an important role in research by studying the most effective ways to communicate with people about healthy lifestyles; health risks; and options for preventing, diagnosing, and treating cancer. The ability to conduct health communications research is a unique aspect of the CIS. Results from these research studies can be applied to improving the way the CIS communicates about cancer and can help other programs communicate more effectively. How Do People Reach the Cancer Information Service? ·
To speak with a CIS information specialist call 1–800–4–CANCER (1–800– 422–6237), 9:00 a.m. to 4:30 p.m. local time, Monday through Friday. Deaf or hard of hearing callers with TTY equipment may call 1–800–332–8615.
·
To obtain online assistance visit the NCI’s Cancer Information Web site at http://cancer.gov/cancer_information and click on the LiveHelp link between 9:00 a.m. and 7:30 p.m. Eastern time, Monday through Friday.
·
For information 24 hours a day, 7 days a week call 1–800–4–CANCER and select option 4 to hear recorded information at any time.
·
Visit NCI’s Web site at http://cancer.gov on the Internet.
·
Visit the CIS Web site at http://cancer.gov/cis on the Internet.
Finding Cancer Resources in Your Community12 If you have cancer or are undergoing cancer treatment, there are places in your community to turn to for help. There are many local organizations throughout the country that offer a variety of practical and support services to people with cancer. However, people often don’t know about these services or are unable to find them. National cancer organizations can assist you in finding these resources, and there are a number of things you can do for yourself. Whether you are looking for a support group, counseling, advice, financial assistance, transportation to and from treatment, or information about cancer, most neighborhood organizations, local health care providers, or area hospitals are a good place to start. Often, the hardest part of looking for help is knowing the right questions to ask. 12
Adapted from the NCI: http://cis.nci.nih.gov/fact/8_9.htm.
52 Colon Cancer
What Kind of Help Can I Get? Until now, you probably never thought about the many issues and difficulties that arise with a diagnosis of cancer. There are support services to help you deal with almost any type of problem that might occur. The first step in finding the help you need is knowing what types of services are available. The following pages describe some of these services and how to find them. ·
Information on Cancer. Most national cancer organizations provide a range of information services, including materials on different types of cancer, treatments, and treatment-related issues.
·
Counseling. While some people are reluctant to seek counseling, studies show that having someone to talk to reduces stress and helps people both mentally and physically. Counseling can also provide emotional support to cancer patients and help them better understand their illness. Different types of counseling include individual, group, family, self-help (sometimes called peer counseling), bereavement, patient-to-patient, and sexuality.
·
Medical Treatment Decisions. Often, people with cancer need to make complicated medical decisions. Many organizations provide hospital and physician referrals for second opinions and information on clinical trials (research studies with people), which may expand treatment options.
·
Prevention and Early Detection. While cancer prevention may never be 100 percent effective, many things (such as quitting smoking and eating healthy foods) can greatly reduce a person’s risk for developing cancer. Prevention services usually focus on smoking cessation and nutrition. Early detection services, which are designed to detect cancer when a person has no symptoms of disease, can include referrals for screening mammograms, Pap tests, or prostate exams.
·
Home Health Care. Home health care assists patients who no longer need to stay in a hospital or nursing home, but still require professional medical help. Skilled nursing care, physical therapy, social work services, and nutrition counseling are all available at home.
·
Hospice Care. Hospice is care focused on the special needs of terminally ill cancer patients. Sometimes called palliative care, it centers around providing comfort, controlling physical symptoms, and giving emotional support to patients who can no longer benefit from curative treatment. Hospice programs provide services in various settings, including the patient’s home, hospice centers, hospitals, or skilled nursing facilities. Your doctor or social worker can provide a referral for these services.
Seeking Guidance 53
·
Rehabilitation. Rehabilitation services help people adjust to the effects of cancer and its treatment. Physical rehabilitation focuses on recovery from the physical effects of surgery or the side effects associated with chemotherapy. Occupational or vocational therapy helps people readjust to everyday routines, get back to work, or find employment.
·
Advocacy. Advocacy is a general term that refers to promoting or protecting the rights and interests of a certain group, such as cancer patients. Advocacy groups may offer services to assist with legal, ethical, medical, employment, legislative, or insurance issues, among others. For instance, if you feel your insurance company has not handled your claim fairly, you may want to advocate for a review of its decision.
·
Financial. Having cancer can be a tremendous financial burden to cancer patients and their families. There are programs sponsored by the government and nonprofit organizations to help cancer patients with problems related to medical billing, insurance coverage, and reimbursement issues. There are also sources for financial assistance, and ways to get help collecting entitlements from Medicaid, Medicare, and the Social Security Administration.
·
Housing/Lodging. Some organizations provide lodging for the family of a patient undergoing treatment, especially if it is a child who is ill and the parents are required to accompany the child to treatment.
·
Children’s Services. A number of organizations provide services for children with cancer, including summer camps, make-a-wish programs, and help for parents seeking child care. How to Find These Services
Often, the services that people with cancer are looking for are right in their own neighborhood or city. The following is a list of places where you can begin your search for help. ·
The hospital, clinic, or medical center where you see your doctor, received your diagnosis, or where you undergo treatment should be able to give you information. Your doctor or nurse may be able to tell you about your specific medical condition, pain management, rehabilitation services, home nursing, or hospice care.
·
Most hospitals also have a social work, home care, or discharge planning department. This department may be able to help you find a support group, a nonprofit agency that helps people who have cancer, or the government agencies that oversee Social Security, Medicare, and
54 Colon Cancer
Medicaid. While you are undergoing treatment, be sure to ask the hospital about transportation, practical assistance, or even temporary child care. Talk to a hospital financial counselor in the business office about developing a monthly payment plan if you need help with hospital expenses. ·
The public library is an excellent source of information, as are patient libraries at many cancer centers. A librarian can help you find books and articles through a literature search.
·
A local church, synagogue, YMCA or YWCA, or fraternal order may provide financial assistance, or may have volunteers who can help with transportation and home care. Catholic Charities, the United Way, or the American Red Cross may also operate local offices. Some of these organizations may provide home care, and the United Way’s information and referral service can refer you to an agency that provides financial help. To find the United Way serving your community, visit their online directory at http://www.unitedway.org on the Internet or look in the White Pages of your local telephone book.
·
Local or county government agencies may offer low-cost transportation (sometimes called para-transit) to individuals unable to use public transportation. Most states also have an Area Agency on Aging that offers low-cost services to people over 60. Your hospital or community social worker can direct you to government agencies for entitlements, including Social Security, state disability, Medicaid, income maintenance, and food stamps. (Keep in mind that most applications to entitlement programs take some time to process.) The Federal government also runs the Hill-Burton program (1–800–638–0742), which funds certain medical facilities and hospitals to provide cancer patients with free or low-cost care if they are in financial need. Getting the Most From a Service: What To Ask
No matter what type of help you are looking for, the only way to find resources to fit your needs is to ask the right questions. When you are calling an organization for information, it is important to think about what questions you are going to ask before you call. Many people find it helpful to write out their questions in advance, and to take notes during the call. Another good tip is to ask the name of the person with whom you are speaking in case you have follow-up questions. Below are some of the questions you may want to consider if you are calling or visiting a new agency and want to learn about how they can help:
Seeking Guidance 55
·
How do I apply [for this service]?
·
Are there eligibility requirements? What are they?
·
Is there an application process? How long will it take? What information will I need to complete the application process? Will I need anything else to get the service?
·
Do you have any other suggestions or ideas about where I can find help?
The most important thing to remember is that you will rarely receive help unless you ask for it. In fact, asking can be the hardest part of getting help. Don’t be afraid or ashamed to ask for assistance. Cancer is a very difficult disease, but there are people and services that can ease your burdens and help you focus on your treatment and recovery.
Finding Doctors Who Specialize in Cancer Care13 One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with colon cancer must go through the process of selecting a physician. A common way to find a doctor who specializes in cancer care is to ask for a referral from your primary care physician. Sometimes, you may know a specialist yourself, or through the experience of a family member, coworker, or friend. The following resources may also be able to provide you with names of doctors who specialize in treating specific diseases or conditions. However, these resources may not have information about the quality of care that the doctors provide. ·
Your local hospital or its patient referral service may be able to provide you with a list of specialists who practice at that hospital.
·
Your nearest National Cancer Institute (NCI)-designated cancer center can provide information about doctors who practice at that center. The NCI fact sheet The National Cancer Institute Cancer Centers Program describes and gives contact information, including Web sites, for NCIdesignated cancer treatment centers around the country. Many of the cancer centers’ Web sites have searchable directories of physicians who practice at each facility. The NCI’s fact sheet is available at http://cis.nci.nih.gov/fact/1_2.htm on the Internet, or by calling the Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237).
13
Adapted from the NCI: http://cis.nci.nih.gov/fact/7_47.htm.
56 Colon Cancer
·
The American Board of Medical Specialties (ABMS) publishes a list of board-certified physicians. The Official ABMS Directory of Board Certified Medical Specialists lists doctors’ names along with their specialty and their educational background. This resource is available in most public libraries. The ABMS also has a Web site that can be used to verify whether a specific physician is board-certified. This free service is located at http://www.abms.org/newsearch.asp on the Internet. Verification of a physician’s board certification can also be obtained by calling the ABMS at 1–866–275–2267 (1–866–ASK–ABMS).
·
The American Medical Association (AMA) provides an online service called AMA Physician Select that offers basic professional information on virtually every licensed physician in the United States and its possessions. The database can be searched by doctor’s name or by medical specialty. The AMA Physician Select service is located at http://www.ama-assn.org/aps/amahg.htm on the Internet.
·
The American Society of Clinical Oncologists (ASCO) provides an online list of doctors who are members of ASCO. The member database has the names and affiliations of over 15,000 oncologists worldwide. It can be searched by doctor’s name, institution’s name, location, and/or type of board certification. This service is located at http://www.asco.org/people/db/html/m_db.htm on the Internet.
·
The American College of Surgeons (ACOS) Fellowship Database is an online list of surgeons who are Fellows of the ACOS. The list can be searched by doctor’s name, geographic location, or medical specialty. This service is located at http://web.facs.org/acsdir/default.htm on the Internet. The ACOS can be contacted at 633 North Saint Clair Street, Chicago, IL 60611–3211; or by telephone at 312–202–5000.
·
Local medical societies may maintain lists of doctors in each specialty.
·
Public and medical libraries may have print directories of doctors’ names, listed geographically by specialty.
·
Your local Yellow Pages may have doctors listed by specialty under “Physicians.”
The Agency for Healthcare Research and Quality (AHRQ) offers Your Guide to Choosing Quality Health Care, which has information for consumers on choosing a health plan, a doctor, a hospital, or a long-term care provider. The Guide includes suggestions and checklists that you can use to determine which doctor or hospital is best for you. This resource is available at http://www.ahrq.gov/consumer/qntool.htm on the Internet. You can also
Seeking Guidance 57
order the Guide by calling the AHRQ Publications Clearinghouse at 1–800– 358–9295. If you are a member of a health insurance plan, your choice may be limited to doctors who participate in your plan. Your insurance company can provide you with a list of participating primary care doctors and specialists. It is important to ask your insurance company if the doctor you choose is accepting new patients through your health plan. You also have the option of seeing a doctor outside your health plan and paying the costs yourself. If you have a choice of health insurance plans, you may first wish to consider which doctor or doctors you would like to use, then choose a plan that includes your chosen physician(s). The National Comprehensive Cancer Network (NCCN) Physician Directory lists specialists who practice in the NCCN’s 19 member institutions across the U.S. To access the directory, go to http://www.nccn.org/ and click on “Physician Directory“. To use this service, you will be required to scroll to the bottom of the page and select “I agree.” Enter your search criteria and select “Find” at the bottom of the page. To obtain more information on a physician or institution, contact the institution’s Physician Referral Department or the NCCN Patient Information and Referral Service at 1-888909-NCCN or
[email protected]. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor14 There are many factors to consider when choosing a doctor. To make the most informed decision, you may wish to speak with several doctors before choosing one. When you meet with each doctor, you might want to consider the following: ·
Does the doctor have the education and training to meet my needs?
·
Does the doctor use the hospital that I have chosen?
14 This
section has been adapted from the AHRQ: http://www.ahrq.gov/consumer/qntascii/qntdr.htm
58 Colon Cancer
·
Does the doctor listen to me and treat me with respect?
·
Does the doctor explain things clearly and encourage me to ask questions?
·
What are the doctor’s office hours?
·
Who covers for the doctor when he or she is unavailable? Will that person have access to my medical records?
·
How long does it take to get an appointment with the doctor?
If you are choosing a surgeon, you may wish to ask additional questions about the surgeon’s background and experience with specific procedures. These questions may include: ·
Is the surgeon board-certified?15
·
Has the surgeon been evaluated by a national professional association of surgeons, such as the American College of Surgeons (ACOS)?
·
At which treatment facility or facilities does the surgeon practice?
·
How often does the surgeon perform the type of surgery I need?
·
How many of these procedures has the surgeon performed? What was the success rate?
It is important for you to feel comfortable with the specialist that you choose, because you will be working closely with that person to make decisions about your cancer treatment. Trust your own observations and feelings when deciding on a doctor for your medical care. Other health professionals and support services may also be important during cancer treatment. The National Cancer Institute fact sheet Your Health Care Team: Your Doctor Is Only the Beginning has information about these providers and services, and how to locate them. This fact sheet is located at http://cis.nci.nih.gov/fact/8_10.htm on the Internet, or can be obtained by calling the CIS at 1–800–4–CANCER (1–800–422–6237).
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 15
Seeking Guidance 59
Working with Your Doctor16 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
16
60 Colon Cancer
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Finding a Cancer Treatment Facility17 Choosing a treatment facility is another important consideration for getting the best medical care possible. Although you may not be able to choose which hospital treats you in an emergency, you can choose a facility for scheduled and ongoing care. If you have already found a doctor for your cancer treatment, you may need to choose a facility based on where your doctor practices. Your doctor may be able to recommend a facility that provides quality care to meet your needs. You may wish to ask the following questions when considering a treatment facility: ·
Has the facility had experience and success in treating my condition?
·
Has the facility been rated by state, consumer, or other groups for its quality of care?
·
How does the facility check and work to improve its quality of care?
·
Has the facility been approved by a nationally recognized accrediting body, such as the American College of Surgeons (ACOS) and/or the Joint Commission on Accredited Healthcare Organizations (JCAHO)?
·
Does the facility explain patients’ rights and responsibilities? Are copies of this information available to patients?
·
Does the treatment facility offer support services, such as social workers and resources to help me find financial assistance if I need it?
·
Is the facility conveniently located?
If you are a member of a health insurance plan, your choice of treatment facilities may be limited to those that participate in your plan. Your Adapted from the NCI: http://cis.nci.nih.gov/fact/7_47.htm. At this Web site, information on how to find treatment facilities is also available for patients living outside the U.S. 17
Seeking Guidance 61
insurance company can provide you with a list of approved facilities. Although the costs of cancer treatment can be very high, you have the option of paying out-of-pocket if you want to use a treatment facility that is not covered by your insurance plan. If you are considering paying for treatment yourself, you may wish to discuss the potential costs with your doctor beforehand. You may also want to speak with the person who does the billing for the treatment facility. In some instances, nurses and social workers can provide you with more information about coverage, eligibility, and insurance issues. The following resources may help you find a hospital or treatment facility for your care: ·
The NCI fact sheet The National Cancer Institute Cancer Centers Program describes and gives contact information for NCI-designated cancer treatment centers around the country.
·
The ACOS accredits cancer programs at hospitals and other treatment facilities. More than 1,400 programs in the United States have been designated by the ACOS as Approved Cancer Programs. The ACOS Web site offers a searchable database of these programs at http://web.facs.org/cpm/default.htm on the Internet. The ACOS can be contacted at 633 North Saint Clair Street, Chicago, IL 60611–3211; or by telephone at 312–202–5000.
·
The JCAHO is an independent, not-for-profit organization that evaluates and accredits health care organizations and programs in the United States. It also offers information for the general public about choosing a treatment facility. The JCAHO Web site is located at http://www.jcaho.org on the Internet. The JCAHO is located at One Renaissance Boulevard, Oakbrook Terrace, IL 60181–4294. The telephone number is 630–792–5800.
·
The JCAHO offers an online Quality Check service that patients can use to determine whether a specific facility has been accredited by the JCAHO and view the organization’s performance reports. This service is located at http://www.jcaho.org/qualitycheck/directry/directry.asp on the Internet.
·
The AHRQ publication Your Guide To Choosing Quality Health Care has suggestions and checklists for choosing the treatment facility that is right for you.
62 Colon Cancer
Additional Cancer Support Information In addition to the references above, the NCI has set up guidance Web sites that offers information on issues relating to cancer. These include: ·
Facing Forward - A Guide for Cancer Survivors: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=cc93a 843-6fc0-409e-8798-5c65afc172fe
·
Taking Time: Support for People With Cancer and the People Who Care About Them: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=21a4 6445-a5c8-4fee-95a3-d9d0d665077a
·
When Cancer Recurs: Meeting the Challenge: http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=9e13 d0d2-b7de-4bd6-87da-5750300a0dab
·
Your Health Care Team: Your Doctor Is Only the Beginning: http://cis.nci.nih.gov/fact/8_10.htm
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bladder: The organ that stores urine. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Charities: Social welfare organizations with programs designed to assist individuals in times of need. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Curative: Tending to overcome disease and promote recovery. [EU]
Seeking Guidance 63
Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Lymphoma: Cancer that arises in cells of the lymphatic system. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammogram: An x-ray of the breast. [NIH] Mammography: The use of x-rays to create a picture of the breast. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Metastasize: To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pap test: The collection of cells from the cervix for examination under a microscope. It is used to detect changes that may be cancer or may lead to cancer, and can show noncancerous conditions, such as infection or
64 Colon Cancer
inflammation. Also called a Pap smear. [NIH] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Thoracic: Having to do with the chest. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH]
Clinical Trials 65
CHAPTER 3. CLINICAL TRIALS AND COLON CANCER Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning colon cancer.
What Is a Clinical Trial?18 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for colon cancer is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
18
66 Colon Cancer
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on colon cancer.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for colon cancer compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on colon cancer carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on colon cancer. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
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treatment, like a placebo, has no effect on colon cancer and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how colon cancer develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for colon cancer. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Colon Cancer The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to colon cancer.19 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Antineoplaston Therapy in Treating Patients With Metastatic or Unresectable Colon Cancer Condition(s): recurrent colon adenocarcinoma of the colon
cancer;
stage
IV
colon
cancer;
Study Status: This study is currently recruiting patients. Sponsor(s): Burzynski Research Institute Purpose - Excerpt: RATIONALE: Antineoplastons are naturally occurring substances found in urine. Antineoplastons may inhibit the growth of cancer cells. PURPOSE: Phase II trial to study the effectiveness of antineoplaston therapy in treating patients with metastatic or unresectable colon cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; Burzynski Research Institute, Houston, Texas, 77055, United States; Recruiting; Stanislaw R. Burzynski 713-335-5697. Study 19
These are listed at www.ClinicalTrials.gov.
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chairs or principal investigators: Stanislaw R. Burzynski, Study Chair; Burzynski Research Institute Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003485;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
BMS-247550 in Treating Patients With Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); UAB Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of BMS-247550 in treating patients who have metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Alabama; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, 35294-3300, United States; Recruiting; Andres Forero-Torres 205-975-2837; Georgia; Georgia Cancer Specialists, Atlanta, Georgia, 30342, United States; Recruiting; Mansoor Noorali Saleh 205-975-9025. Study chairs or principal investigators: Andres Forero-Torres, Study Chair; UAB Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00033306;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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BMS-247550 in Treating Patients With Recurrent or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Chicago Cancer Research Center
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Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of BMS-247550 in treating patients who have recurrent or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00022477;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Capecitabine and Irinotecan in Treating Patients With Locally Advanced, Recurrent, or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Hoffmann-La Roche Ltd Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combining capecitabine and irinotecan in treating patients who have locally advanced, recurrent, or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00022698;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy After Surgery in Treating Patients With Liver Metastases From Colorectal Cancer Condition(s): adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients.
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Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Surgery may be an effective therapy in treating patients with liver metastases. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining surgery with chemotherapy may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of combination chemotherapy given after surgery in treating patients who have liver metastases from colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Nancy E. Kemeny 212639-8068. Study chairs or principal investigators: Nancy E. Kemeny, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003753;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy in Treating Patients With Advanced Colorectal Cancer Condition(s): recurrent colon cancer; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. PURPOSE: Clinical trial to study the effectiveness of combination chemotherapy in treating patients who have advanced colorectal cancer. Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00039611;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy in Treating Patients With Colon Cancer Condition(s): stage III colon cancer; stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Groupe Regional d'Etudes du Cancer Colorectal - Belgium Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether the time a drug is given improves its effectiveness in treating colon cancer. PURPOSE: Randomized phase III trial to determine the best time to give carboplatin with fluorouracil and leucovorin in treating patients who have stage IIB or stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): Belgium; Centre Hospitalier Hutois, Huy, 4500, Belgium; Recruiting; Jean Bury 085--27-2005; Les Cliniques Saint-Joseph ASBL, Liege (Luik), B 4000, Belgium; Recruiting; Christian N.J. Focan 00-32-4224-8990. Study chairs or principal investigators: Christian N.J. Focan, Study Chair; Groupe Regional d'Etudes du Cancer Colorectal - Belgium Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00046995;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy in Treating Patients With Colorectal Cancer Condition(s): recurrent colon cancer; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Chronotherapy Study Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving drugs at the time of day that allows for the best drug response may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. PURPOSE: Randomized phase II trial to determine the best time to give irinotecan combined with fluorouracil, leucovorin, and oxaliplatin in treating patients who have colorectal cancer. Phase(s): Phase II
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Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00039208;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy in Metastases from Colorectal Cancer
Treating
Patients
With
Liver
Condition(s): recurrent colon cancer; stage IV rectal cancer; adenocarcinoma of the rectum; recurrent rectal cancer; liver metastases; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group; Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells. It is not yet known which chemotherapy regimen is more effective for metastatic colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of intrahepatic floxuridine, leucovorin, and dexamethasone with that of systemic fluorouracil and leucovorin in treating patients who have unresectable liver metastases from colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002716;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy Plus Trastuzumab in Treating Patients With Advanced, Recurrent, or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B
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Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy plus trastuzumab in treating patients who have advanced, recurrent, or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006015;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy With or Without Bevacizumab Compared With Bevacizumab Alone in Treating Patients With Advanced or Metastatic Colorectal Cancer That Has Been Previously Treated Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as bevacizumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining monoclonal antibody therapy with combination chemotherapy may kill more tumor cells. It is not yet known if bevacizumab is more effective with or without combination chemotherapy in treating colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of combination chemotherapy with or without bevacizumab to that of bevacizumab alone in treating patients who have advanced or metastatic colorectal cancer that has been previously treated. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00025337;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy With or Without Chemoembolization in Treating Patients With Colorectal Cancer Metastatic to the Liver Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); American College of Radiology Imaging Network Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. One way to give chemotherapy drugs is by chemoembolization, which kills tumor cells by delivering drugs directly into the tumor and then blocking the blood flow to the tumor. It is not yet known if chemoembolization is more effective than standard chemotherapy in treating metastatic cancer. PURPOSE: Phase I trial and randomized phase III trial to determine the effectiveness of chemoembolization in treating patients who have colorectal cancer metastatic to the liver. For the phase III part of the trial, patients will be randomly assigned to one of two groups. Patients in group one will receive chemotherapy once a week for 4 weeks. Treatment may be repeated every 6 weeks for as long as benefit is shown. Patients in group two will receive chemotherapy as in group one and will undergo chemoembolization on day 36. The chemotherapy may be repeated as in group one. Chemoembolization may be repeated every 6 weeks for up to four courses. Patients will be evaluated every 3 months for 2 years, every 6 months for 3 years, and once a year thereafter. Phase(s): Phase I; Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023868;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Combination Chemotherapy With or Without Cryosurgery in Treating Patients With Liver Metastases from Colorectal Cancer Condition(s): adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon
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Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Cryosurgery kills cancer cells by freezing them. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug with cryosurgery and giving drugs in different ways may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of intrahepatic and intravenous combination chemotherapy with or without cryosurgery in treating liver metastases from colorectal cancer. Phase(s): Phase I Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Nancy E. Kemeny 212639-8068. Study chairs or principal investigators: Nancy E. Kemeny, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00008294;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Combination Chemotherapy With or Without Irinotecan in Treating Patients With Stage III Colon Cancer Condition(s): stage III colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Federation Nationale des Centres de Lutte Contre le Cancer; Fondation Francaise de Cancerologie Digestive Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known if combination chemotherapy is more effective with or without irinotecan in treating colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of combination chemotherapy with or without irinotecan in treating patients who have stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005979;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Comparing Two Combination Chemotherapy Regimens in Treating Patients With Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): GERCOR Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which regimen of combination chemotherapy is more effective for metastatic colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of two combination chemotherapy regimens in treating patients who have metastatic colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): France; Hopital Saint Antoine, Paris, 75571, France; Recruiting; Aimery De Gramont 33-1-49282336. Study chairs or principal investigators: Aimery De Gramont, Study Chair; GERCOR Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006468;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Comparison of Barium Enema, Computed Tomographic Colonography, and Colonoscopy in Detecting Colon Cancer Condition(s): colon cancer; rectal cancer; screening for colorectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): Duke Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Screening tests may help doctors detect cancer cells early and plan more effective treatment for cancer. New diagnostic procedures such as computed tomographic colonography may provide a less invasive method of identifying patients who have colon cancer. PURPOSE: Diagnostic and screening trial to compare the effectiveness of barium enema, computed tomographic colonography, and colonoscopy in detecting of colon cancer.
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Study Type: Screening, Diagnostic Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00016029;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Conventional Surgery Compared With Laparoscopic-Assisted Surgery in Treating Patients With Colorectal Cancer Condition(s): stage III rectal cancer; stage IV rectal cancer; stage I rectal cancer; stage I colon cancer; stage II colon cancer; stage 0 rectal cancer; stage II rectal cancer; stage III colon cancer; stage IV colon cancer; stage 0 colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): Medical Research Council Purpose - Excerpt: RATIONALE: Laparoscopic-assisted surgery is a less invasive type of surgery for colorectal cancer and may have fewer side effects and improve recovery. It is not yet known if undergoing conventional surgery is more effective than laparoscopic-assisted surgery for colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of conventional surgery with that of laparoscopicassisted surgery in treating patients who have colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003354;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Curcumin for the Prevention of Colon Cancer Condition(s): prevention of colorectal cancer; colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Michigan Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Chemoprevention therapy is the use of certain drugs to try to prevent the development of cancer. Curcumin may be effective in preventing the development of colon cancer. PURPOSE: Phase I trial to determine the dose amount of curcumin that can be tolerated to help in preventing colon cancer in healthy men and women.
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Phase(s): Phase I Study Type: Prevention Contact(s): Michigan; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, 48109-0752, United States; Recruiting; Dean E. Brenner 734-647-1417. Study chairs or principal investigators: Dean E. Brenner, Study Chair; University of Michigan Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00027495;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Erlotinib in Treating Patients With Recurrent or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Princess Margaret Hospital Purpose - Excerpt: RATIONALE: Biological therapies such as erlotinib may interfere with the growth of tumor cells and slow the growth of the tumor. PURPOSE: Phase II trial to study the effectiveness of erlotinib in treating patients who have recurrent or metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): Canada, Ontario; Cancer Care Ontario-Hamilton Regional Cancer Centre, Hamilton, Ontario, L8V 5C2, Canada; Recruiting; Pierre Major 416-821-7610; Cancer Care Ontario-London Regional Cancer Centre, London, Ontario, N6A 4L6, Canada; Recruiting; Mark D. Vincent 519-685-8640; Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada; Recruiting; Amit M. Oza 416-946-2818. Study chairs or principal investigators: Amit M. Oza, Study Chair; Princess Margaret Hospital Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032110;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Fluorouracil and Leucovorin With or Without Irinotecan in Treating Patients Following Surgery for Stage III Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; adenocarcinoma of the colon
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Study Status: This study is currently recruiting patients. Sponsor(s): Rhone Poulenc Rorer S.A. Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug and giving them after surgery may kill more tumor cells. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil and leucovorin with or without irinotecan in treating patients who have undergone surgery for stage III colorectal cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026273;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Fluorouracil Plus Leucovorin With or Without Oxaliplatin in Treating Patients With Stage II or Stage III Colon Cancer Condition(s): stage III colon cancer; stage II colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); National Surgical Adjuvant Breast and Bowel Project Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective for colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of fluorouracil plus leucovorin with or without oxaliplatin in treating patients who have stage II or stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004931;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Fluorouracil, Phenylbutyrate, and Indomethacin in Treating Patients With Advanced Colorectal Cancer Condition(s): recurrent colon cancer; stage IV rectal cancer; adenocarcinoma of the rectum; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Mount Sinai Medical Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of fluorouracil and phenylbutyrate in treating patients with stage IV colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): New York; Mount Sinai Medical Center, NY, New York, New York, 10029, United States; Recruiting; Max W. Sung 212-241-7902. Study chairs or principal investigators: Max W. Sung, Study Chair; Mount Sinai Medical Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002796;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Gene Testing in Patients With Colon Cancer Condition(s): stage III colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Analyzing the structure of genes found in a person's cancer cells may help doctors improve methods of treating patients with colon cancer. PURPOSE: Clinical trial to study the genes of patients treated with chemotherapy for colon cancer. Study Type: Genetic Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003571;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Gene Therapy in Patients With Colon Cancer That Has Spread to the Liver Condition(s): recurrent colon cancer; liver metastases; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Gene therapy may make the body build an immune response to kill tumor cells. PURPOSE: Phase I trial to study the safety of NV1020 in patients who have colon cancer that has spread to the liver and has not responded to previous chemotherapy. Phase(s): Phase I Study Type: Treatment Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Yuman Fong 212-6392016. Study chairs or principal investigators: Yuman Fong, Study Chair; Memorial Sloan-Kettering Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012155;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Genetic Study in Patients With Stage II or Stage III Colon Cancer Condition(s): stage III colon cancer; stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); NCIC-Clinical Trials Group; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Genetic studies may help in understanding the genetic processes that cause some types of cancer. PURPOSE: Genetic trial to study certain genes of patients who have stage II or stage III colon cancer. Study Type: Genetic Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00003833;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Genetic Study of Young Patients With Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage I rectal cancer; stage I colon cancer; stage III colon cancer; stage III rectal cancer; stage II colon cancer; stage II rectal cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); American College of Surgeons Purpose - Excerpt: RATIONALE: Identifying gene mutations may allow doctors to plan effective treatment for patients who develop colorectal cancer at an early age. PURPOSE: Genetic trial to study the significance of gene mutations in helping predict the outcome of treatment in patients who develop stage I , stage II, or stage III colorectal cancer at an early age. Study Type: Genetic Contact(s): New York; Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States; Recruiting; Robert J. Downey 212639-8124. Study chairs or principal investigators: Jose G. Guillem, Study Chair; American College of Surgeons Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00044967;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Hepatic Arterial Infusion Plus Chemotherapy in Treating Patients With Colorectal Cancer Metastatic to the Liver Condition(s): adenocarcinoma of the rectum; liver metastases; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); National Surgical Adjuvant Breast and Bowel Project; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving the drugs in different combinations and different ways may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of hepatic arterial infusion plus chemotherapy in treating patients who have colorectal cancer metastatic to the liver. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026234;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
High-Dose Fluorouracil With or Without Leucovorin Compared With Standard Fluorouracil Plus Leucovorin Following Surgery in Treating Patients With Stage III Colon Cancer Condition(s): mucinous adenocarcinoma of the colon; stage III colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Gastrointestinal Tract Cancer Cooperative Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known which chemotherapy regimen is more effective for colon cancer. PURPOSE: Randomized phase III trial to study the effectiveness of high-dose fluorouracil with or without leucovorin compared with standard-dose fluorouracil plus leucovorin following surgery in treating patients who have stage III colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): Netherlands; Saint Laurentius Ziekenhuis, Roermond, 6043 CV, Netherlands; Recruiting; Jacques A. Wils 475--38-2466. Study chairs or principal investigators: Jacques A. Wils, Study Chair; EORTC Gastrointestinal Tract Cancer Cooperative Group Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004150;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Immunotherapy After Surgery in Treating Patients With Breast Cancer, Colon Cancer, or Melanoma Condition(s): stage II melanoma; recurrent colon cancer; stage II breast cancer; stage I colon cancer; recurrent melanoma; stage III colon cancer; stage I melanoma; recurrent breast cancer; stage III melanoma; stage I breast cancer; stage IIIA breast cancer; stage II colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): Centro Oncologico de Excelencia Purpose - Excerpt: RATIONALE: Immunotherapy uses different ways to stimulate the immune system and stop cancer cells from growing. Immunotherapy biological extracts may be useful as adjuvant therapy in
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treating patients who have had surgery for breast cancer, colon cancer, or melanoma. PURPOSE: Phase III trial to study the effectiveness of Corynebacterium granulosum extract as maintenance immunotherapy following surgery in treating patients with breast cancer, colon cancer, or melanoma. Phase(s): Phase III Study Type: Treatment Contact(s): Argentina, Buenos Aires; Centro Oncologico de Excelencia, Gonnet, Buenos Aires, 1987 MB, Argentina; Recruiting; Hugo Omar De Carli 021-84-3119. Study chairs or principal investigators: Hugo Omar De Carli, Study Chair; Centro Oncologico de Excelencia Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002455;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Irinotecan Compared With Combination Chemotherapy in Treating Patients With Advanced Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which chemotherapy regimen is more effective for colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of irinotecan with that of combination chemotherapy in treating patients who have advanced colorectal cancer that has not responded to previous treatment. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005036;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Irinotecan or Fluorouracil Plus Leucovorin in Treating Patients With Previously Treated Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving the drugs in different combinations may kill more tumor cells. PURPOSE: Phase II trial to compare the effectiveness of either irinotecan or fluorouracil plus leucovorin in treating patients who have metastatic colorectal cancer that has been previously treated with oxaliplatin with or without irinotecan. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00016952;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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J-107088 in Treating Patients With Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Pharmaceutical Research Associates Inc. Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase II trial to study the effectiveness of J-107088 in treating patients who have metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032071;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Laparoscopic-Assisted Surgery Compared With Open Surgery in Treating Patients With Colon Cancer Condition(s): stage III colon cancer; stage I colon cancer; adenocarcinoma of the colon; stage II colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; Radiation Therapy Oncology Group; Cancer and Leukemia Group B; NCIC-Clinical Trials Group; National Surgical Adjuvant Breast and Bowel Project; North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Less invasive types of surgery may help reduce the number of side effects and improve recovery. It is not yet known which type of surgery is more effective for colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of laparoscopic-assisted colectomy with open colectomy in treating patients who have colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002575;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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LMB-9 Immunotoxin in Treating Patients With Advanced Pancreatic, Esophageal, Stomach, Colon, or Rectal Cancer Condition(s): pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Freiburg Purpose - Excerpt: RATIONALE: LMB-9 immunotoxin can locate tumor cells and kill them without harming normal cells. This may be an effective treatment for advanced pancreatic, esophageal, stomach, colon or rectal cancer. PURPOSE: Phase I trial to study the effectiveness of LMB-9 immunotoxin in treating patients who have advanced pancreatic, esophageal, stomach, colon, or rectal cancer. Phase(s): Phase I Study Type: Treatment
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Contact(s): Germany; University of Freiburg Medical Center, Freiburg, D79106, Germany; Recruiting; Peter Hafkmeyer 011-49-761-2703401. Study chairs or principal investigators: Peter Hafkmeyer, Study Chair; University of Freiburg Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010270;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Monoclonal Antibody Therapy and/or Vaccine Therapy in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; stage II colon cancer; stage II rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Onyvax Purpose - Excerpt: RATIONALE: Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Vaccines made from cancer cells may make the body build an immune response to kill colorectal tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of monoclonal antibody therapy and/or vaccine therapy in treating patients who have locally advanced or metastatic colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): United Kingdom, England; St. George's Hospital, London, England, SW17 0QT, United Kingdom; Recruiting; Fiona Lofts 020-87250231. Study chairs or principal investigators: Fiona Lofts, Study Chair; Onyvax Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00007826;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Monoclonal Antibody Therapy Compared With No Further Therapy After Surgery in Treating Patients With Stage II Colon Cancer Condition(s): stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; North Central Cancer Treatment
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Group; EORTC Gastrointestinal Tract Cancer Cooperative Group; NCICClinical Trials Group; Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Monoclonal antibodies such as edrecolomab can locate tumor cells and either kill them or deliver tumorkilling substances to them without harming normal cells. It is not yet known whether surgery to remove colon cancer is more effect with or without monoclonal antibody therapy. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without monoclonal antibody therapy in treating patients who have stage II colon cancer. Phase(s): Phase III Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002968;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
NB1011 in Treating Patients With Metastatic or Recurrent Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): NewBiotics Incorporated Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase I/II trial to study the effectiveness of NB1011 in treating patients who have metastatic or recurrent colorectal cancer that has not responded to previous treatment. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): California; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, 90095-1781, United States; Recruiting; Mark D. Pegram 310-206-8221; USC/Norris Comprehensive Cancer Center and Hospital, Los Angeles, California, 90033-0804, United States; Recruiting; Heinz-Josef Lenz 323-865-3955. Study chairs or principal investigators: Mark D. Pegram, Study Chair; NewBiotics Incorporated Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00031616;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Oxaliplatin in Treating Patients With Previously Treated Locally Advanced or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Roswell Park Cancer Institute Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Clinical trial to study the effectiveness of oxaliplatin in treating patients who have locally advanced or metastatic colorectal cancer that has been previously treated. Study Type: Treatment Contact(s): New York; Roswell Park Cancer Institute, Buffalo, New York, 14263-0001, United States; Recruiting; Milind Javle 716-845-7614. Study chairs or principal investigators: Milind Javle, Study Chair; Roswell Park Cancer Institute Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040820;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Radiolabeled Monoclonal Antibody Therapy in Treating Patients With Recurrent or Persistent Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); UAB Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Radiolabeled monoclonal antibodies can locate tumor cells and deliver tumor-killing substances to them without harming normal cells. Radiolabeled monoclonal antibody therapy may be effective treatment for colorectal cancer. PURPOSE: Phase I trial to study the effectiveness of radiolabeled monoclonal antibody therapy in treating patients who have recurrent or persistent colorectal cancer. Phase(s): Phase I
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Study Type: Treatment Contact(s): Alabama; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, 35294-3300, United States; Recruiting; Ruby F. Meredith 205-934-2763. Study chairs or principal investigators: Ruby F. Meredith, Study Chair; UAB Comprehensive Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023933;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy and Chemotherapy With or Without Tetanus Toxoid in Treating Patients With Metastatic Colorectal Cancer Condition(s): adenocarcinoma of the rectum; stage IV rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Comprehensive Cancer Center
Institute
(NCI);
Herbert
Irving
Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Tetanus toxoid may make tumor cells more sensitive to chemotherapy and vaccine therapy. PURPOSE: Randomized phase II trial to study the effectiveness of chemotherapy and vaccine therapy with or without tetanus toxoid in treating patients who have metastatic colorectal cancer. Phase(s): Phase II Study Type: Treatment Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00027833;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy in Gastrointestinal Tract
Treating
Patients
With
Cancer
of
the
Condition(s): pancreatic cancer; gastric cancer; esophageal cancer; colorectal cancer; colon cancer; rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Texas
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Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. PURPOSE: Randomized phase II trial to compare the effectiveness of two different vaccines in treating patients who have cancer of the gastrointestinal tract. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; University of Texas Medical Branch, Galveston, Texas, 77555-0209, United States; Recruiting; Robert P. Whitehead 409-772-1164. Study chairs or principal investigators: Robert P. Whitehead, Study Chair; University of Texas Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00012246;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy in Treating Patients With Stage II or Stage III Colon Cancer That has Been Removed During Surgery Condition(s): stage III colon cancer; stage II colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): Intracel Purpose - Excerpt: RATIONALE: Vaccines made from a patient's white blood cells and tumor cells may make the body build an immune response to kill tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining vaccine therapy with chemotherapy may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of vaccine therapy combined with leucovorin and fluorouracil in treating patients who have undergone surgery to completely remove stage II or stage III colon cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): District of Columbia; Washington Hospital Center, Washington, District of Columbia, 20010, United States; Recruiting; Lee E. Smith 202-877-8484; Pennsylvania; Lehigh Valley Hospital, Allentown, Pennsylvania, 18103, United States; Recruiting; Linda L. Lapos 610-4021095; Virginia; Inova Fairfax Hospital, Fairfax, Virginia, 22031, United States; Recruiting; Thomas Patrick Wright 703-560-7788. Study chairs or principal investigators: Michael G Hanna Jr., Study Chair; Intracel
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00016133;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Vaccine Therapy With or Without Interleukin-2 in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response that will kill cancer cells. Combining vaccine therapy with interleukin-2 may be a more effective treatment for colorectal cancer. PURPOSE: Phase I/II trial to study the effectiveness of vaccine therapy with or without interleukin-2 in treating patients who have locally advanced or metastatic colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): Maryland; Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support, Bethesda, Maryland, 20892-1182, United States; Recruiting; Patient Recruitment 1-888-NCI-1937; Tennessee; VanderbiltIngram Cancer Center, Nashville, Tennessee, 37232-6838, United States; Recruiting; David P. Carbone 615-936-3524. Study chairs or principal investigators: John Edward Janik, Study Chair; National Cancer Institute (NCI) Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00019591;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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Vaccine Therapy With or Without Sargramostim in Treating Patients With Advanced or Metastatic Cancer Condition(s): lung cancer; pancreatic cancer; gastric cancer; salivary gland cancer; head and neck cancer; colorectal cancer; adult primary liver cancer; testicular cancer; ovarian epithelial cancer; colon cancer; thyroid cancer; rectal cancer; breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Fox Chase Cancer Center
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Purpose - Excerpt: RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Colony-stimulating factors such as sargramostim may increase the number of immune cells found in bone marrow or peripheral blood. Combining vaccine therapy with sargramostim may make tumor cells more sensitive to the vaccine and may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of vaccine therapy with or without sargramostim in treating patients who have advanced or metastatic cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Pennsylvania; Fox Chase Cancer Center, Philadelphia, Pennsylvania, 19111, United States; Recruiting; Margaret von Mehren 215-728-3545. Study chairs or principal investigators: Margaret von Mehren, Study Chair; Fox Chase Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00028496;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
ZD 1839 and Combination Chemotherapy in Treating Patients With Advanced Solid Tumors or Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; unspecified adult solid tumor, protocol specific; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Stanford University Purpose - Excerpt: RATIONALE: Biological therapies such as ZD 1839 may interfere with the growth of tumor cells and slow the growth of the tumor. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug with ZD 1839 may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of ZD 1839 and oxaliplatin combined with leucovorin and fluorouracil in treating patients who have advanced solid tumors or colorectal cancer. Phase(s): Phase I; Phase II Study Type: Treatment Contact(s): California; Stanford University Medical Center, Stanford, California, 94305-5408, United States; Recruiting; Branimir Ivan Sikic 650725-8233. Study chairs or principal investigators: Branimir Ivan Sikic, Study Chair; Stanford University
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00025142;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
ZD 1839 in Treating Patients With Locally Advanced or Metastatic Colorectal Cancer That Has Not Responded to Chemotherapy Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage III colon cancer; stage III rectal cancer; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); University of Texas Purpose - Excerpt: RATIONALE: Biological therapies such as ZD 1839 may interfere with the growth of tumor cells and slow the growth of colorectal cancer. PURPOSE: Phase II trial to study the effectiveness of ZD 1839 in treating patients who have locally advanced or metastatic colorectal cancer that has not responded to fluorouracil and irinotecan. Phase(s): Phase II Study Type: Treatment Contact(s): Texas; Institute for Drug Development, San Antonio, Texas, 78229, United States; Recruiting; Amita Patnaik 210-949-5069; University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78284-7811, United States; Recruiting; Chris H. Takimoto 210-567-4777. Study chairs or principal investigators: Chris H. Takimoto, Study Chair; University of Texas Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00030524;jsessionid=45AB78 3531B044FB3F235C2A3A076210
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ZD 1839 Plus Combination Chemotherapy in Treating Patients With Locally Advanced, Locally Recurrent, or Metastatic Colorectal Cancer Condition(s): recurrent colon cancer; adenocarcinoma of the rectum; stage IV rectal cancer; recurrent rectal cancer; stage IV colon cancer; adenocarcinoma of the colon Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI); Dana-Farber/Harvard Cancer Center Purpose - Excerpt: RATIONALE: Biological therapies such as ZD 1839 may interfere with the growth of tumor cells and slow the growth of the
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tumor. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining ZD 1839 with combination chemotherapy may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of ZD 1839 combined with irinotecan, leucovorin, and fluorouracil in treating patients who have locally advanced, locally recurrent, or metastatic colorectal cancer. Phase(s): Phase I Study Type: Treatment Contact(s): Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts, 02115, United States; Recruiting; Charles S. Fuchs 617-6322225; Massachusetts General Hospital Cancer Center, Boston, Massachusetts, 02114, United States; Recruiting; Jeffrey William Clark 617-726-8743. Study chairs or principal investigators: Charles S. Fuchs, Study Chair; Dana-Farber/Harvard Cancer Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026364;jsessionid=45AB78 3531B044FB3F235C2A3A076210 ·
Monoclonal Antibody Therapy in Treating Patients With Lymphoma, Colon Cancer, or Prostate Cancer That Has Not Responded to Vaccine Therapy Condition(s): recurrent colon cancer; recurrent grade III follicular large cell lymphoma; recurrent mantle cell lymphoma; recurrent grade I follicular small cleaved cell lymphoma; recurrent prostate cancer; recurrent grade II follicular mixed cell lymphoma Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Monoclonal antibodies such as CTLA-4 can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. PURPOSE: Phase II trial to study the effectiveness of monoclonal antibody CTLA-4 in treating patients who have lymphoma, colon cancer, or prostate cancer that has not responded to vaccine therapy. Phase(s): Phase II Study Type: Treatment Contact(s): John Edward Janik 301-402-2913. Study chairs or principal investigators: John Edward Janik, Study Chair; National Cancer Institute (NCI)
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00047164;jsessionid=45AB78 3531B044FB3F235C2A3A076210
Benefits and Risks20 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for colon cancer. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with colon cancer. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 20
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What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.
How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
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After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
·
Know whether you participated in the treatment group or the control group (once the study has been completed). What Should You Ask before Deciding to Join a Clinical Trial?
Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for colon cancer? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Clinical Trials and Insurance Coverage21 As you consider enrolling in a clinical trial, you will face the critical issue of how to cover the costs of care. Even if you have health insurance, your coverage may not include some or all of the patient care costs associated with a clinical trial. This is because some health plans define clinical trials as “experimental” or “investigational” procedures. Because lack of coverage for these costs can keep people from enrolling in trials, the National Cancer Institute is working with major health plans and managed care groups to find solutions. In the meantime, there are strategies that may help you deal with cost and coverage barriers. This section answers frequently asked questions about insurance coverage for clinical trial participation and directs you to additional information resources. The material here is mainly concerned with treatment clinical trials, since other types of trials (prevention, screening, etc.) are newer and generally not covered by health insurance at all. However, this guide may become more relevant for prevention and other types of trials as these trials grow more common. If you do not have any health insurance, you may find this section helpful for understanding some of the costs that trials involve.
What Costs Do Trials Involve? Who Is Usually Responsible for Paying Them? There are two types of costs associated with a trial: patient care costs and research costs. Patient care costs fall into two categories: ·
Usual care costs, such as doctor visits, hospital stays, clinical laboratory tests, x-rays, etc., which occur whether you are participating in a trial or
Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b.
21
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receiving standard treatment. These costs have usually been covered by a third-party health plan, such as Medicare or private insurance. ·
Extra care costs associated with clinical trial participation, such as the additional tests that may or may not be fully covered by the clinical trial sponsor and/or research institution.
The sponsor and the participant’s health plan need to resolve coverage of these costs for particular trials. Research costs are those associated with conducting the trial, such as data collection and management, research physician and nurse time, analysis of results, and tests purely performed for research purposes. Such costs are usually covered by the sponsoring organization, such as NCI or a pharmaceutical company.
Criteria Used by Health Plans to Make Reimbursement Decisions about Trials Health insurance companies and managed care companies decide which health care services they will pay for by developing coverage policy regarding the specific services. In general, the most important factor determining whether something is covered is a health plan’s judgment as to whether the service is established or investigational. Health plans usually designate a service as established if there is a certain amount of scientific data to show that it is safe and effective. If the health plan does not think that such data exist in sufficient quantity, the plan may label the service as investigational. Health care services delivered within the setting of a clinical trial are very often categorized as investigational and not covered. This is because the health plan thinks that the major reason to perform the clinical trial is that there is not enough data to establish the safety and effectiveness of the service being studied. Thus, for some health plans, any mention of the fact that the patient is involved in a clinical trial results in a denial of payment. Your health plan may define specific criteria that a trial must meet before extending coverage, such as the following:
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Sponsorship Some plans may only cover costs of trials sponsored by organizations whose review and oversight of the trial is careful and scientifically rigorous, according to standards set by the health plan.
Trial Phase and Type Some plans may cover patient care costs only for the clinical trials they judge to be “medically necessary” on a case-by-case basis. Trial phase may also affect coverage; for example, while a plan may be willing to cover costs associated with Phase III trials, which include treatments that have already been successful with a certain number of people, the plan may require some documentation of effectiveness before covering a Phase I or II trial. While health plans are interested in efforts to improve prevention and screening, they currently seem less likely to have a review process in place for these trials. Therefore, it may be more difficult to get coverage for the care costs associated with them. Some plans, especially smaller ones, will not cover any costs associated with a clinical trial. Policies vary widely, but in most cases your best bet is to have your doctor initiate discussions with the health plan. Cost “Neutrality” Some health plans may limit coverage to trials they consider cost-neutral (i.e., not significantly more expensive than the treatments considered standard). Lack of Standard Therapy Some plans limit coverage of trials to situations in which no standard therapy is available. Facility and Personnel Qualifications A health plan may require that the facility and medical staff meet specific qualifications to conduct a trial involving unique services, especially
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intensive therapy such as a bone marrow transplant chemotherapy with bone marrow/ stem cell rescue).
(high-dose
Clinical Trials and Medicare Coverage For up-to-date information about Medicare coverage of clinical trials, go to the Web site for the Centers for Medicaid & Medicare (http://www.hcfa.gov/coverage/8d.htm; formerly the Health Care Financing Administration). As of January 2001, the following information was accurate22: What Will Medicare Pay? ·
Anything normally covered is still covered when it is part of a clinical trial. This includes test, procedures, and doctor visits that are ordinarily covered.
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Anything normally covered even if it is a service or item associated with the experimental treatment. For example, Medicare will pay for the intravenous administration of a new chemotherapy drug being tested in a trial, including any therapy to prevent side effects from the new drug.
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Anything normally covered even if it resulted from your being in the clinical trial. For example, a test or hospitalization resulting from a side effect of the new treatment that Medicare would ordinarily cover. What Costs Are Not Covered?
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Investigational items or services being tested in a trial. Sponsors of clinical trials often provide the new drug free, but make sure you ask your doctor before you begin.
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Items or services used solely for the data collection needs of the trial.
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Anything being provided free by the sponsor of the trial.
On June 7, 2000, Present Clinton announced that Medicare would revise its payment policy to reimburse the routine patient care costs of clinical trials. The announcement is available for public viewing at the following Web address: http://www.cancer.gov/clinical_trials/doc.aspx?viewid=320DD013-BA7A-4177-A0002011089F34A0.
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What Kinds of Clinical Trials Are Covered? NCI’s Cancer Information Service has provided a fact sheet for Medicare beneficiaries at the following Web site: http://cis.nci.nih.gov/fact/8_14.htm. In general, cancer treatment and diagnosis trials are covered if: ·
They are funded by the National Cancer Institute (NCI), NCI-Designated Cancer Centers, NCI-Sponsored Clinical Trials Cooperative Groups and all other Federal agencies that fund cancer research. Other trials may be eligible for coverage and doctors can ask Medicare to pay the patients’ costs. Ask your doctor about this before you begin.
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They are designed to treat or diagnose your cancer.
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The purpose or subject of the trial is within a Medicare benefit category. For example, cancer diagnosis and treatment are Medicare benefits, so these trials are covered. Cancer prevention trials are not currently covered.
Increasing the Likelihood of Insurance Coverage for Trials23 There are several steps you can follow to deal with coverage issues up front when deciding to enter a clinical trial. Along the way, enlist the help of family members and your doctor or other health professionals. You may find the following checklist useful:
Understand the Costs Associated with the Trial Ask your doctor or the trial’s contact person about the costs that must be covered by you or your health plan. Are these costs significantly higher than those associated with standard care? Also, inquire about the experience of other patients in the trial. Have their plans paid for their care? Have there been any persistent problems with coverage? How often have the trial’s administrators been successful in getting plans to cover patient care costs?
This section has been adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b&docid=0df4397a-eccb-465f-bd33-a89e7a708c46.
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Understand Your Health Plan Be sure you know what’s in your policy; request and carefully review the actual contract language. If there’s a specific exclusion for “experimental treatment,” look closely at the policy to see how the plan defines such treatment and under what conditions it might be covered. If it is not clearly defined, call the plan’s customer service line, consult their Web site, and/or write to them. Ask for specific information about clinical trials coverage.
Work Closely with Your Doctor Talk with your doctor about the paperwork he or she submits to your health plan. If there have been problems with coverage in the past, you might ask your doctor or the hospital to send an information package to the plan that includes studies supporting the procedure’s safety, benefits, and medical appropriateness. This package might include: ·
Publications from peer-reviewed literature about the proposed therapy that demonstrate patient benefits;
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A letter that uses the insurance contract’s own language to explain why the treatment, screening method, or preventive measure should be covered;
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Letters from researchers that explain the clinical trial;
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Support letters from patient advocacy groups.
Be sure to keep your own copy of any materials that the doctor sends to your health plan for future reference. Work Closely with Your Company’s Benefits Manager This person may be helpful in enlisting the support of your employer to request coverage by the health plan. Give Your Health Plan a Deadline Ask the hospital or cancer center to set a target date for the therapy. This will help to ensure that coverage decisions are made promptly.
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Know Your Rights24 A number of state governments are addressing the question of whether insurance companies ought to cover the costs associated with patients’ participation in clinical trials. Lack of such coverage is a significant barrier to many patients who might otherwise benefit from enrolling in a trial. Lack of coverage also makes it harder for researchers to successfully conduct trials that could improve prevention and treatment options. Information on State initiatives and legislation concerning cancer-related clinical trials is available at http://www.cancer.gov/ClinicalTrials/insurancelaws. By conducting your own research and learning about your rights, you may increase the likelihood that your insurance company will cover the costs of a trial.
If Your Insurance Claim Is Denied after the Trial Has Begun If a claim is denied, read your policy to find out what steps you can follow to make an appeal. In “What Cancer Survivors Need to Know about Health Insurance”, the National Coalition for Cancer Survivorship suggests that you and your doctor demonstrate to the health plan that: ·
The therapy is not just a research study, but also a valid procedure that benefits patients;
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Your situation is similar to that of other patients who are participating in clinical trials as part of a covered benefit;
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Possible complications have been anticipated and can be handled effectively.
You also may wish to contact your state insurance counseling hotline or insurance department for more help, or write your state insurance commissioner describing the problem. Where Else Can I Turn for Assistance? It’s never easy to deal with financial issues when you or a loved one faces cancer. Unfortunately, costs can present a significant barrier to clinical trials participation. The range of insurance issues and health plan contracts makes it impossible to deal with all of them here. You may wish to consult this partial list of publications, organizations, and Web sites for more information: 24
Adapted from Cancer.gov: http://www.cancer.gov/ClinicalTrials/insurancelaws.
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Publications What Cancer Survivors Need to Know about Health Insurance National Coalition of Cancer Survivorship 1010 Wayne Avenue, 5th floor Silver Spring, MD 20910 (301) 650-8868 http://www.cansearch.org/ Cancer Treatments Your Insurance Should Cover The Association of Community Cancer Centers 11600 Nebel Street, Suite 201 Rockville, MD 20852 (301) 984-9496 http://www.accc-cancer.org/main2001.shtml The Managed Care Answer Guide Patient Advocate Foundation 739 Thimble Shoals Boulevard, Suite 704 Newport News, VA 23606 (757) 873-6668 E-mail:
[email protected] 1998 Guide to Health Insurance for People with Medicare, The Medicare Handbook Medicare Helpline: 1-800-444-4606 Health Care Financing Administration: http://www.hcfa.gov/ New Medicare site: http://www.medicare.gov/ Assistance Programs Candlelighters Childhood Cancer Foundation Ombudsman Program 910 Woodmont Avenue, #4607 Bethesda, MD 20814 (301) 657-8401; 1-800-366-2223 (toll-free) E-mail:
[email protected] http://www.candlelighters.org The Ombudsman Program helps families of children with cancer and survivors of childhood cancer resolve a range of problems, including insurance coverage difficulties. Local groups appoint a Parent Advocate who works with the treatment center on behalf of families.
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Medical Care Management Corporation 5272 River Road, Suite 650 Bethesda, MD 20816-1405 (301) 652-1818 email:
[email protected] http://www.mcman.com/ Working for a range of clients, including health plans, employers, and patients, MCMC conducts independent, objective reviews of hightechnology medical care cases to assist in decision-making. While it does charge for its services, MCMC also offers a volunteer program for those who cannot afford to pay. More Information Resources OncoLink A service of the University of Pennsylvania Cancer Center. http://www.oncolink.com/ In addition to general cancer information, this web site features a section on financial information for patients. Among the topics: viatical settlements, life insurance, a glossary of financial and medical terms, and news about billing and insurance. American Association of Health Plans 1129 20th Street, NW, Suite 600 Washington, DC 20036-3421 (202) 778-3200 http://www.aahp.org/ The Web site section “For Consumers” includes a fact sheet on clinical research that describes various health plans’ efforts to support research initiatives and collaborate with academic health centers and universities. Health Insurance Association of America 555 13th Street, NW Washington, DC 20004 (202) 824-1600 ·
Home page: http://www.hiaa.org/
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Consumer Information: http://www.hiaa.org/consumer/
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Insurance Counseling Hotlines by State: http://www.hiaa.org/consumer/insurance_counsel.cfm
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State Insurance Departments: http://www.hiaa.org/consumer/state_insurance.cfm
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Government Initiatives to Expand Insurance Coverage for Trials25 The good news is that there has been a recent effort in the U.S. to assure clinical trials coverage, with NCI involved in several new initiatives as described below: NCI-Department of Defense Agreement An innovative 1996 agreement between NCI and the Department of Defense (DoD) has given thousands of DoD cancer patients more options for care and greater access to state-of-the-art treatments. Patients who are beneficiaries of TRICARE/CHAMPUS, the DoD’s health program, are covered for NCIsponsored Phase II and Phase III clinical treatment trials. NCI and DoD are refining a system that allows physicians and patients to determine quickly what current trials meet their needs and where they are taking place. NCI-Department of Veterans Affairs Agreement A 1997 agreement with the Department of Veterans Affairs provides coverage for eligible veterans of the armed services to participate in NCIsponsored prevention, diagnosis, and treatment studies nationwide. For additional information, see the VA/DoD Beneficiaries Digest Page at http://www.va.gov/cancer.htm.
Midwest Health Plans Agreement Some NCI Cooperative Groups have reached agreements with several insurers in Wisconsin and Minnesota to provide more than 200,000 people with coverage. This coverage is allocated for patient care costs if they participate in a cooperative group-sponsored trial.
Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=1d92be79-8748-4bda-80052a56d332463b&docid=d8092601-daf9-4794-8536-3be2712eb6b9.
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Pediatric Cancer Care Network This network, a cooperative agreement among the Children’s Cancer Group, the Pediatric Oncology Group, and the Blue Cross Blue Shield System Association (BCBS) nationwide, will ensure that children of BCBS subscribers receive care at designated centers of cancer care excellence and may promote the enrollment of children in Cooperative Group clinical trials.
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “colon cancer” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Adenocarcinoma: Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antineoplastons: Substances isolated from normal human blood and urine being tested as a type of treatment for some tumors and AIDS. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Bevacizumab: A monoclonal antibody that may prevent the growth of blood vessels from surrounding tissue to a solid tumor. [NIH] Capecitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Carboplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time. [NIH] Chronotherapy: The adaptation of the administration of drugs to circadian rhythms. The concept is based on the response of biological functions to time-related events, such as the low point in epinephrine levels between 10 p.m. and 4 a.m. or the elevated histamine levels between midnight and 4 a.m. The treatment is aimed at supporting normal rhythms or modifying therapy based on known variations in body rhythms. While chronotherapy is commonly used in cancer chemotherapy, it is not restricted to cancer therapy or to chemotherapy. [NIH] Corynebacterium: A genus of asporogenous bacteria that is widely distributed in nature. Its organisms appear as straight to slightly curved rods and are known to be human and animal parasites and pathogens. [NIH] Cryosurgery: Treatment performed with an instrument that freezes and destroys abnormal tissues. This procedure is a form of cryotherapy. [NIH]
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Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Dexamethasone: A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment. [NIH] Edrecolomab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Floxuridine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Fluorouracil: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Gastric: Having to do with the stomach. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Indomethacin: A drug that belongs to the family of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin reduces pain, fever, swelling and redness. It is also being used to reduce tumorinduced suppression of the immune system and to increase the effectiveness of anticancer drugs. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Intrahepatic: Within the liver. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called
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CPT 11. [NIH] Leucovorin: A drug used to protect normal cells from high doses of the anticancer drug methotrexate. It is also used to increase the antitumor effects of fluorouracil and tegafur-uracil, an oral treatment alternative to intravenous fluorouracil. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH]
Oxaliplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Phenylbutyrate: An anticancer drug that belongs to the family of drugs called differentiating agents. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Sargramostim: A colony-stimulating factor that stimulates the production of blood cells, especially platelets, during chemotherapy. It is a cytokine that belongs to the family of drugs called hematopoietic (blood-forming) agents. Also called GM-CSF. [NIH] Testicular: Pertaining to a testis. [EU] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Trastuzumab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. Trastuzumab blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. [NIH]
Unresectable: Unable to be surgically removed. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH]
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Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on colon cancer. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on colon cancer. In Part II, as in Part I, our objective is not to interpret the latest advances on colon cancer or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with colon cancer is suggested.
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CHAPTER 4. STUDIES ON COLON CANCER Overview Every year, academic studies are published on colon cancer or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on colon cancer. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on colon cancer and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and colon cancer, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “colon cancer” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Patient Experience and Preferences Toward Colon Cancer Screening: A Comparison of Virtual Colonoscopy and Conventional Colonoscopy Source: Gastrointestinal Endoscopy. 54(3):210-315, 2001. Summary: Researchers assessed patient tolerance of virtual colonoscopy (VC) compared to conventional colonoscopy (CC), characterizing patient preferences for these techniques. People referred to a Veterans Affairs Medical Center gastrointestinal clinic for colonoscopy for any indication were recruited to undergo VC prior to receiving CC. CC was performed with the patient under conscious sedation, while VC was performed without sedation. They completed a questionnaire after the VC and again after completing both tests. The questionnaire assessed overall pain, discomfort, and lack of respect. Their preferences for VC versus CC were determined using a time tradeoff technique. To verify the stability of responses, participants completed an additional questionnaire by mail at 24 hours. At both 0 and 24 hours, participants reported more pain and discomfort and less respect after VC than after CC. They preferred CC and said they would be willing to wait longer for CC as opposed to undergoing VC. Both procedures were well-tolerated overall. The researchers conclude that improvements in patient tolerance and acceptance of VC are necessary if this test is to become competitive as an alternative screening modality. 6 figures, 3 tables, 12 references.
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Virtual Colonoscopy: A New Tool for Colorectal Cancer Screening Source: Current Opinion in Gastroenterology. 17(1):78-85, January 2001. Summary: The authors conducted a literature review on virtual colonoscopy as a screening tool for colorectal cancer, including the technique, image display, image reconstruction, clinical trial results, and feasibility. The basic technique of virtual colonoscopy involves (1) cleansing the patient's colon with standard barium enema or colonoscopy bowel preparation, colonic insufflation with room air or carbon dioxide, and (3) thin-section helical computer tomography (CT) of the abdomen and pelvis followed by computer manipulation of the CT dataset. Virtual colonoscopy requires a well prepared, cleansed colon to achieve
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appropriate sensitivity and specificity. CT scan acquisition usually involves the use of both supine and prone helical CT datasets to (1) help differentiate between mobile stool and fixed pathology such as cancers or polyps; (2) allow more even distention of the colon; and (3) improve visualization of segments of the colon obscured by intraluminal fluid. CT scanning usually takes less than 20 minutes. The radiation dose required for virtual colonoscopy is about 20 percent lower than the typical dose for double-contrast barium enema. After image acquisition, the CT data can be viewed using a variety of techniques, including (1) simple evaluation of the axial CT images at lung window settings, (2) reformatted twodimensional images at cross-sectional and orthogonal planes to the long axis of the colon, (3) three-dimensional endoluminal-simulating conventional endoscopy images, and (4) extraluminal images that simulate barium enema images. Virtual endoscopy based on threedimensional magnetic resonance imaging is also feasible and may be an alternative to CT. Preliminary results show that the accuracy of virtual colonoscopy for polyp detection exceeds barium enema and approaches conventional colonoscopy. The performance of virtual colonoscopy as a screening method has not yet been established. The authors conclude that (1) results of virtual colonoscopy studies are promising; and (2) if it proves to be an accurate, reliable, and cost-effective method for detecting polyps and early cancer, then it may improve population participation in screening programs and reduce the impact of colorectal cancer. 3 figures, 36 references. ·
Colorectal Cancer Screening: New Directions, Evolving Guidelines Source: Patient Care. 35(4):24-30, 33-34, February 28, 2001. Summary: The author reviews existing guidelines, recent study data, and the controversies concerning which screening options are best for colorectal cancer detection. While all individuals age 50 years and older should undergo screening for colorectal cancer, many primary care physicians report that they do not screen all eligible patients in their practice. Several options are offered to physicians and patients regarding colorectal screening and the physician and patient together should choose an appropriate screening regimen. Screening can prevent colorectal cancer through the detection and removal of precancerous polyps. Current views place an emphasis on total colon examination with colonoscopy in average-risk persons. Annual fecal occult blood testing combined with flexible sigmoidoscopy every 5 years is the most costeffective overall screening strategy available. Barriers to screening include patient unwillingness to discuss or have this part of the anatomy examined, physician's comfort level in discussing and performing
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colorectal screening, reimbursement, the economics of doing flexible sigmoidoscopy screening in the primary care office, and insufficient capacity to perform population-wide screening colonoscopy. 1 figure, 15 references. ·
New Test May Be More Accurate in Detecting Precancerous Polyps and Curable Colorectal Cancers Source: Primary Care and Cancer. 21(3):14-16, March 2001. Summary: According to Dr. David Ahlquist, a new, noninvasive DNA test for detecting precancerous polyps and curable colorectal cancers was 91 percent sensitive for detecting cancer throughout the colon. The researchers believe that this test, although about 2 years away from becoming widely available for public use, could significantly change the way screening for colorectal cancer is done. This new test requires a stool sample and involves analyzing DNA that is shed from the surface of colorectal cancer tumors and excreted in the stool. Precancerous polyps and early-stage cancer yield specific DNA abnormalities. This new test measures these abnormalities and results in the high accuracy of detection. This test needs to undergo another phase of clinical trials. Meanwhile, Mayo Clinic physicians encourage people age 50 years and older to continue following their physician's advice and the current recommendations for screening. The researchers believe that this new DNA test may replace the fecal occult blood test that yields as many as 5 to 10 percent false-positive results. This new test also has several patientfriendly features: (1) Patients can provide stool samples at home using a special kit that fits on the toilet seat, (2) it requires no special dietary or medication restrictions, and (3) no bowel preparation is needed. This new DNA test has the potential to significantly reduce the morbidity and mortality of colorectal cancer. 1 figure, 1 reference.
·
Virtual Colonoscopy Is a Promising Technology for Colon Cancer Screening Source: Primary Care and Cancer. 21(3):12-13, March 2001. Summary: According to Dr. Richard J. Farrell, virtual colonoscopy is an accurate screening method for colorectal cancer in lesions greater than 10 millimeters. This new screening method also has good patient tolerance. Virtual colonoscopy, or computed tomography (CT) colonoscopy, uses thin-section, helical CT to generate high-resolution two-dimensional axial images and three-dimensional endoluminal images. Physicians at the Beth Israel Deaconess Hospital in Boston recruited 100 patients at high risk for colorectal cancer and polyps. All underwent virtual colonoscopy prior to elective conventional colonoscopy. Using conventional
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colonoscopy, 45 of these patients had normal findings. In the other 55 patients, the researchers found 88 polyps and 13 masses, including 9 carcinomas. Virtual colonoscopy found (1) 12 (90 percent) of the 13 masses, all of which were greater than 20 millimeters; (2) 28 (92 percent) of 31 polyps that were greater than 10 millimeters; (3) 15 (65 percent) of 23 polyps that were 6 to 9 millimeters; and (4) 12 (35 percent) of 34 polyps that were 5 millimeters or smaller. There were 11 false-positive findings of polyps and 3 false-positive findings of masses, resulting in a specificity of 90 percent. Dr. Farrell indicated that conventional colonoscopy remains the gold standard, but virtual colonoscopy is a good diagnostic tool. 1 figure. ·
Inflammatory Bowel Disease Flare, or Colon Cancer? Source: Primary Care and Cancer. 21(1):38-41, 58, January 2001. Summary: A physician discusses the risk of colorectal cancer in patients with chronic inflammatory bowel disease (IBD) and the need for a colonoscopic surveillance program throughout their lives. While the risk of colorectal cancer has long been known in ulcerative colitis patients, only recently has the colon cancer risk of Crohn's colitis been recognized as being of similar magnitude. It is unclear whether coincident colon cancer risk factors, such as a family history of colorectal neoplasm, further heighten the cancer risk in these patients. However, other contributing factors, such as the complication of primary sclerosing cholangitis, have been recognized. Colonoscopy is the screening tool of choice in IBD rather than sigmoidoscopy. Colon cancer in IBD typically follows a premalignant dysplastic phase. The likelihood of finding colon cancer at colectomy after high-grade dysplasia has been identified is about 40 percent. Symptoms of new colon cancer in individuals may be exceedingly difficult to distinguish from an exacerbation of colitis. Symptoms such as weight loss, loss of appetite, or progressive anemia should be evaluated aggressively to allow for prompt surgical resection in response to the development of dysplasia or cancer. It may be appropriate to offer prophylactic colectomy to younger ulcerative colitis patients once their colitis has been established for a decade or more, as opposed to undergoing colonoscopy every year or two for the remainder of their lives. 3 figures, 3 tables, 10 references.
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Differing Attitudes Toward Virtual and Conventional Colonoscopy for Colorectal Cancer Screening: Surveys Among Primary Care Physicians and Potential Patients Source: American Journal of Gastroenterology. 96(3):887-893, March 2001.
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Summary: Researchers examined attitudes of primary care physicians and potential screening patients toward computed tomography colonoscopy (virtual colonoscopy) and conventional colonoscopy for colorectal cancer (CRC) screening. Investigators sent questionnaires by mail or E-mail to 1,000 physicians across the United States and 400 potential patients. Both questionnaires asked respondents about their preferences for virtual and conventional colonoscopy and the reasons for their preferences. Usable responses were received from 188 physicians (response rate 18.8 percent) and 323 potential patients (response rate 80.5 percent). On the basis of information about invasiveness, 76.6 percent of potential patients and 47.3 percent of physicians initially preferred virtual colonoscopy. When information about colon cleansing was given, the proportion of physicians and potential patients preferring virtual colonoscopy fell to 40.8 and 67.9 percent, respectively. When reminded that conventional colonoscopy, but not virtual colonoscopy, allows direct visualization of the colon, the proportion of physicians favoring virtual colonoscopy decreased further to 31.0 percent; however, the proportion of patients choosing virtual colonoscopy only dropped to 64.3 percent. When told that only conventional colonoscopy allows for the therapeutic intervention of polypectomy, the proportion of physicians favoring virtual colonoscopy dropped to 25.7 percent. The proportion of patients favoring virtual colonoscopy when given this information fell markedly to 47.0 percent. When informed that virtual colonoscopy does not require sedation, the proportion of physicians and patients favoring virtual colonoscopy rose to 51.6 and 67.4 percent, respectively. Across all questions, regardless of information provided, 60.2 percent of potential patients and 44.9 percent of physicians preferred virtual colonoscopy to conventional colonoscopy. Additionally, 82.3 percent of potential patients stated that they would comply more with recommendations for CRC screening and 61.7 percent of physicians would refer more patients for screening if virtual colonoscopy was available. Researchers conclude that potential patients preferred virtual to conventional colonoscopy, whereas physicians favored conventional colonoscopy. Physicians placed more importance on the ability of conventional colonoscopy to visualize the colonic mucosa directly and the opportunity for therapy. Potential patients were more encouraged than physicians by the availability of virtual colonoscopy to improve participation in CRC screening. 2 figures, 8 tables, 19 references. ·
Colorectal Cancer: Not an Equal Opportunity Cancer (Editorial) Source: Gastroenterology. 120(4):1043-1046, March 2001.
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Summary: The author discusses racial and ethnic variations in colorectal cancer (CRC) incidence and mortality in the United States. The discussion focuses on two issues: (1) Why it is important to understand racial and ethnic variations in CRC incidence and mortality; and (2) why Americans of every race and ethnic group are not getting screened for CRC. The discussion specifically considers (1) CRC risk associated with race and ethnicity, (2) public perception and awareness of CRC, and (3) barriers to CRC screening. Rates of participation in screening are better if it is recommended by health care providers. The communication of risk of disease and benefits of screening to ethnic minorities may be especially ineffective. The process of risk communication to minorities has received little attention despite the fact that some groups suffer disproportionately from certain diseases. If there are race/ethnicity cultural barriers to colon screening, the author notes that one must study and understand these obstacles and develop appropriate educational tools. Important barriers to screening include lack of payment by insurers and lack of access to health care. The fact that a large proportion of the medically uninsured are black and fall into a higher risk group that is most likely to benefit from colon screening highlights the importance of finding a remedy for this problem. 21 references. ·
Colon Cancer in Women Source: Association of Women's Health, Obstetric and Neonatal Nurses Lifelines. 5(3):26-32, June 2001. Summary: The author provides women's health care nurses with information on basic genetic concepts, the role of genes in the development of cancer, and cancer syndromes and cancer genetic services regarding colon cancer. Colon cancer genes are dominant, meaning that a single copy can greatly increase an individual's cancer risk. All cancers are genetic in origin, but hereditary cancer results from (1) the presence of a genetic mutation in a germ cell that is reproduced in every cell of an individual's body, (2) the somatic mutation of the other gene in that pair, and (3) additional somatic mutations in the same cell line until control of cell growth and differentiation is lost. The two most common hereditary colon cancer syndromes are hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). HNPCC is characterized by (1) the presence of syndrome cancers in many individuals within a family, (2) more than one primary cancer in an individual, (3) high incidence of colon cancers, (4) early age at onset, and (5) proximal location of most of the cancers. The risk for colon cancer in an HNPCC mutation carrier is 85 to 90 percent for males and as low as 54 percent for females. FAP is characterized by (1) the presence of hundreds
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to thousands of polyps in the colon, (2) average age at polyp onset of 15 years, and (3) 100 percent risk of colon cancer if left untreated by the fourth decade. The author provides information on managing HNPCC and FAP. When a hereditary colon cancer syndrome is diagnosed families can benefit from genetic counseling and genetic testing. The author concludes that women's health nurses are in an ideal position to promote and support the cancer screening recommendations and to help with overcoming barriers to screening among female mutation carriers. 2 figures, 2 tables, 15 references. ·
One-time Screening for Colorectal Cancer With Combined Fecal Occult-blood Testing and Examination of the Distal Colon Source: New England Journal of Medicine. 345(8):555-560, August 23, 2001. Summary: Researchers examined the effectiveness of one-time screening with the fecal occult blood test (FOBT) combined with examination of the distal colon by sigmoidoscopy (SIG) for detecting colorectal cancer (CRC). They recruited 3,121 asymptomatic patients seen at 13 Veterans Affairs centers between February 1994 and January 1997 for the study. The patients provided 3 consecutive days of stool samples on cards for FOBT testing; samples were rehydrated for interpretation. The patients then underwent colonoscopy (COL). Researchers considered examination of the rectum and sigmoid colon during COL as SIG. Of the 3,121 participants, 2,885 returned their FOBT cards before COL. The mean age of this group was 63.0 years, 96.8 percent were men, and 14.2 percent reported having a first degree relative with CRC. Results indicated that 1,319 participants (45.7 percent) had no polypoid lesions. In 472 (16.4 percent), the most advanced lesions were hyperplastic polyps or nonadenomatous polyps, and in 788 (27.3 percent), the most advanced finding was one or more tubular adenomas less than 10 millimeters in diameter. Advanced neoplasia was detected in 306 patients (10.6 percent). Of these, 182 had advanced neoplasia in the distal colon and 150 in the proximal colon. Altogether, 143 had one or more large tubular adenomas, 90 had an adenoma with villous features, 49 had an adenoma with high-grade dysplasia, and 24 had invasive cancer. Seventy-three patients (23.9 percent) with advanced neoplasia had a positive FOBT. When compared with patients who had a negative FOBT, the relative risk of advanced neoplasia in patients with a positive FOBT was 3.47. SIG identified 70.3 percent of all patients with advanced neoplasia. Combined one-time screening with FOBT and SIG identified 75.8 percent of patients with advanced neoplasia. Researchers conclude that one-time screening of asymptomatic persons with the FOBT plus SIG fails to identify about
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one quarter of those with advanced neoplasia and about half of those with advanced proximal neoplasia. Clinicians should not feel confident that advanced neoplasia can be ruled out when the results of one-time combined testing are negative. Screening programs that use FOBT plus SIG may be more effective if the tests are repeated at appropriate intervals. 4 tables, 21 references. ·
Screening for Colorectal Cancer: Developing a Preventive Healthcare Program Utilizing Nurse Endoscopists Source: Gastroenetrology Nursing. 24(1):12-19, January-February 2001. Summary: The authors discuss screening for colorectal cancer (CRC) and the development of a CRC screening program incorporating nurse endoscopists at Northwestern Memorial Hospital (NMH), Chicago, Illinois. The program was developed and implemented during the creation of the Colon Cancer Screening Center (CCSC), a component of NMH's comprehensive gastrointestinal oncology program in 1997. The goals of the CCSC's CRC screening program were to (1) provide a unique early cancer detection program in the Chicago metropolitan area, (2) become a leader in early detection of CRC through screening, (3) provide a referral service to physicians within NMH that provides screening and preventive health education, and (4) develop a clinical database to track clinical outcomes and trends in patient compliance. The authors discuss aspects of developing the program that may be useful for other institutions interested in developing a similar program, including (1) the institutional marketing research process, (2) training nurse endoscopists and developing benchmark data to evaluate their training, (3) operational planning/advertising strategies, (4) implementing a program similar to the CCSC-based program, and (5) program evaluation. To date, 745 patients age 50 to 64 years old have been screened. Of these, 14 percent were referred for colonoscopy for multiple polyps or adenomas. One rectal carcinoma was identified. There were no complications from the procedures. 4 tables, 11 references.
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Virtual Colonoscopy: A New Approach for Colorectal Cancer Screening Source: Gastroenterology Nursing. 24(1):5-11, January-February 2001. Summary: The author discusses virtual colonoscopy (VC) as a new approach for colorectal cancer (CRC) screening. The article (1) presents background information on CRC screening; (2) summarizes the American Cancer Society (ACS) guidelines for CRC screening; (3) discusses the various types of VC, including a summary of clinical studies of VC; (4) discusses safety issues of VC; (5) discusses the procedural aspects of VC;
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(6) discusses the advantages of VC relative to standard colonoscopy (SC); (7) summarizes the challenges of VC; and (8) considers future implications of CRC screening with VC. VC is a tomographic technique that can display computer images of the colon in an anatomical life-like format to facilitate image interpretation and improve diagnostic accuracy. There are three types of VC: (1) Computed tomography (CT) pneumocolonoscopy, (2) CT colography, and (3) VC. All three techniques use bowel cleansing, air insufflation, smooth muscle relaxation, and helical CT data acquisition. The differences between the procedures stem from the manner in which the data are manipulated. In CT pneumocolonoscopy, CT data are interpreted in the conventional radiologic manner. CT colography involves a CT of the colon in which a small section is examined and displayed in a two-dimensional image, supplemented with three-dimensional images. VC is the interactive realtime navigation through the colon to simulate SC. Approximately 2,000 VC examinations have been performed worldwide. VC has been reported to have a sensitivity of 80 percent for detecting CRC and polyps greater than 10 millimeter. Its specificity has been reported to be 90 percent. An advantage of VC is that it does not require sedation. No perforations have been reported with VC. VC has the potential to examine the entire colon in substantially less time than SC. Although VC is comfortable for the patient, the patient still has to undergo a bowel preparation similar to that required for SC. The amount and time of insufflation, however, is less than that of SC, producing less discomfort for the patient. The author notes that VC appears to have tremendous potential for improving patient acceptance as a screening method for CRC. VC also appears to be an excellent method for implementing the current ACS guidelines for screening men and women at average risk for CRC beginning at age 50. 3 figures, 1 table, 39 references. ·
Use of Colonoscopy to Screen Asymptomatic Adults for Colorectal Cancer Source: Gastrointestinal Endoscopy. 53(7):832-834, June 2001. Summary: The first two authors discuss the results of two large studies evaluating the reliability and accuracy of different methods of screening for colorectal cancer. The first study indicated that 2.7 percent of patients with no polyps in the portion of the colon distal to the splenic flexure had advanced proximal neoplasms. The other study found that a distal adenoma was not a reliable predictor of advanced proximal neoplasia; only 46 percent of patients with an advanced proximal lesion had a distal polyp that would have been detected by screening sigmoidoscopy. In another study on double contrast barium enema, only 48 percent of large
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adenomas found by colonoscopy were detected by barium enema. The authors conclude that the most accurate and reliable evaluation currently available is colonoscopy. In a response, Lieberman discusses issues of effectiveness, risk, cost, and resources that need to be considered before embracing colonoscopy as a primary screening tool. A response by Imperiale and Ransohoff indicates that they do not consider that the data from these studies justifies a recommendation for universal colonoscopy. Instead, the two studies should be scrutinized for strength and robustness, supplemented by an assessment of whether additional studies of colonoscopic screening are still needed. Information on risk factors should be used to stratify risk among those now considered average-risk persons. Colonoscopy could be extended to increased-risk persons, while its use among average-risk persons could be deferred. ·
Colorectal Cancer Screening in North Carolina: Community Clinicians' Perspectives Source: North Carolina Medical Journal. 62(5):292-297, SeptemberOctober, 2001. Summary: Researchers conducted a survey to assess community clinicians' perspectives on colorectal cancer screening in North Carolina. Between November 1997 and May 1998, they sent a self-administered questionnaire to family practitioners, general practitioners, and general internists who were actively practicing in primary care settings. The questionnaire assessed (1) personal characteristics, (2) practices of colon cancer screening with fecal occult blood testing (FOBT) and flexible sigmoidoscopy (FS), and (3) attitudes toward and barriers to using FS. Of 1,333 physicians contacted, 736 (55 percent) provided usable responses. Results showed that (1) most respondents were male family practitioners in group practice; (2) 97 percent recommended periodic screening with FOBT; (3) of those recommending FOBT, 35 percent said that annual screening should start at age 50 years; and (4) 79 percent thought that the proper screening interval was once a year. Other results showed that (1) 92 percent recommended screening with FS, (2) 43 percent performed FS themselves, and (3) 85 percent agreed with recommendations that screening with FS should begin at age 50 years and be repeated every 3 to 5 years. Perceived barriers to FS differed according to respondents' experience with the procedure. Among practitioners who recommended FS but did not perform this procedure themselves, barriers included time constraints, equipment costs, inadequate reimbursement, and regulatory restrictions. Half of the respondents had received training in FS as medical residents. The most common perceived patient barrier to FOBT was inconvenience, and to FS was fear of pain and discomfort. The
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researchers conclude that there is a need to find ways to encourage physicians to promote colorectal cancer screening to their patients. 4 tables, 20 references. ·
Colon Cancer Screening With Virtual Colonoscopy: Promise, Polyps, Politics Source: American Journal of Roentgenology. 177(5):975-988, November 2001. Summary: The author discusses virtual colonoscopy as a potential primary means of screening for colon cancer, which could return radiologists to a major role in the prevention of colon cancer. Research suggests that its accuracy is comparable to conventional colonoscopy in detecting polyps of significant size (greater than 10 mm), with few false positives. Virtual colonoscopy has heightened awareness of the natural history of colonic polyps, especially in terms of identifying an appropriate target size for detection in colorectal screening programs. Polyps under 10 mm are often either hyperplastic on histology or unlikely to progress to frank cancer in the patient's lifetime, so they are of little clinical significance for the average adult. The rationale for detecting and removing every colonic polyp regardless of size has come under increasing scrutiny in the context of cost-benefit analysis of various test strategies for colorectal cancer screening. Virtual colonoscopy may allow patients to receive reliable information about the status of their colonic mucosa noninvasively, therefore making more informed decisions about whether to proceed to conventional colonoscopy for polypectomy. Cancer researchers are working to improve the speed of image analysis, use of computer-assisted methods for polyp detection, magnetic resonance colonography, and oral contrast tagging of fecal contents in order to avoid the need for rigorous bowel preparation, thus improving patient compliance. 10 figures, 3 tables, 87 references.
Federally Funded Research on Colon Cancer The U.S. Government supports a variety of research studies relating to colon cancer and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.26 CRISP
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control 26
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(Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to colon cancer and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore colon cancer and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for colon cancer: ·
Project Title: Apoptosis in Colon Cancer Chemoprevention Principal Investigator & Institution: Gerner, Eugene W.; Professor; None; University of Arizona Tucson, Az 85721 Timing: Fiscal Year 2001; Project Start 1-JUL-1997; Project End 1-DEC2005 Summary: Colon cancer remains the second leading cause of cancer death in the United States of America, affecting both males and females. The major theme of this program is the study of apoptosis in colon carcinogenesis and colon cancer chemoprevention. Studies in experimental rodent models and humans indicate that genetic and intestinal luminal risk factors decrease cell turnover, in part by decreasing apoptosis, in normal and neoplastic colonic tissues. Intestinal luminal risk factors include the secondary bile acids, which are affected by both genetic and dietary factors. Our program addresses both genetic and intestinal luminal risk factors, as we hypothesize that common signaling and metabolic pathways downstream of both these factors mediate cell turnover in colonic tissues and, subsequently, colon cancer risk. A corollary of this hypothesis is that these downstream pathways are rational targets for colon cancer chemoprevention strategies in humans. To test this hypothesis, we have designed projects and cores that are interactive and complementary. One project studies biochemical effectors of genes, including the Ki-ras oncogene and the APC and p53 tumor suppressor genes, which are frequently mutated in human colon cancers. A second project focuses on the role of nitric oxide in bile acid
and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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induced apoptosis. The third project emphasizes studies of the AP-1 transcription factor, which is involved in signaling pathways mediated by both APC and bile acids. The specific aims of the projects are to determine the roles of genetic and intestinal luminal risk factors in cell turnover in colonic tissues, to describe mechanisms underlying these processes, and to investigate the consequences of specific pharmacological and/or dietary interventions on cell turnover and colon carcinogenesis. The projects will address these aims using genetically altered cell culture and rodent models of colon cancer, and a variety of biochemical, molecular and cellular biology technologies. Four cores provide support in cell and tissue pathology, breeding and maintaining genetically altered rodent models of colon carcinogenesis, biometry and administration and evaluation. The long-term goal of the Apoptosis in Colon Cancer Chemoprevention Program Project Grant is to understand mechanisms of colon carcinogenesis in humans and then to use this information to establish the rational for strategies of colon cancer prevention and/or treatment. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Biological Evaluation of ZD1839 in Colon Cancer Principal Investigator & Institution: Hidalgo, Manuel; Associate Professor of Oncology; Oncology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 9-SEP-2002; Project End 1-AUG2004 Summary: (provided by applicant): The epidermal growth factor receptor (EGFR) is a transmembrane receptor involved in the transduction of proliferative and survival signals which is overexpressed in up to 50 % of patients with colon cancer. Preclinical data suggest that pharmacological inhibition of the EGFR results in tumor growth inhibition and, therefore, the EGFR represents a potential target for cancer therapy. ZD1839 is a novel, orally available, small molecule inhibitor of the EGFR in clinical development. Important questions in the development of this agent, as well as other mechanistic based compounds are the definition of patient populations more likely to respond to the drug based on the presence and functionality of the target pathway in tumor tissues and the assessment of target inhibition in clinical trials. This proposal outlines a series of clinical, pharmacological and biological studies of ZD1839 in patients with colon cancer. Our long term goal is to develop ZD1839 for the treatment of patients with colon cancer, as well as with other EGFRdriven tumors, utilizing rationally derived biological concepts based on the putative mechanism of action of the agent. The specific aims of this
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proposal are: Specific Aim # 1: to determine the relationship between expression and activation of the EGFR receptor in malignant tissues and the activity of ZD1839 in patients with colon cancer, Specific Aim # 2: to characterize the effects of ZD1839 on the activation and signaling of the EGFR in tumor and normal tissues of patients with colon cancer who are treated with ZD1839; and, Specific Aim # 3: to relate the pharmacodynamic effects of ZD 1839 to relevant indices of clinical activity. Patients with advanced, measurable, colon cancer will be treated with ZD1839 at a dose of 500 mg/day on a protracted oral dosing schedule. Tumor tissues, normal skin tissues, and plasma will be collected at baseline and 28 days post-treatment. The expression and activation of the EGFR will be determined using validated immunohistochemical methods developed at our institutions. The result from the biological studies will be correlated with indices of drug activity. These results will provide hypothesis-generating data regarding the subset of colon cancer patients more likely to benefit from treatment with this agent as well as information regarding the biological activity of ZD1839 in colon cancer. Collectively, these data will impact in the future development of ZD1839 in patients with colon cancer as well as other tumor types. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Gene Expression Changes in Metastatic Colon Cancer Principal Investigator & Institution: Guan, Rong J.; Beth Israel Deaconess Medical Center 330 Brookline Ave Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-APR-2000; Project End 1-OCT2000 Summary: The most life-threatening aspects of colon cancer are invasion and metastasis. Genetic alterations likely play a crucial role in the pathogenesis of colon cancer metastasis. Therefore, one of the most important issues in cancer research is to understand the genetic alterations in metastasis. The goal of this application is to analyze gene expression changes in metastatic colon cancer. By using differential display, we have identified 19 genes expressed differentially between primary and metastatic colon cancer. In preliminary studies, we found that a novel gene called 055 is not expressed in metastatic colon cancer tissues or a metastatic colon cancer cell line (SW620). Overexpression of 055 in SW620 increased expression of several cell differentiation markers such as E-cadherin, CEA and alkaline phosphatase and induced morphological changes consistent with cell differentiation. The expression of 055 is upregulated by several known cell differentiation reagents. Our preliminary studies show that overexpression of 055 in
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SW620 colon cancer cells suppressed in vitro invasion into matrigel and in vivo liver metastasis in nude mice. Our workings hypothesis is that the 055 gene suppresses metastasis by inducing colon cancer cell differentiation and reversing the malignant phenotype. Therefore, we propose: (1) to investigate the expression and function of 055 protein in normal and neoplastic colonic epithelial cells. This will include studying: (a) subcellular localization of the 055 gene in colon cancer cell lines; the expression of 055 protein in normal colon tissues, adenomas, primary and metastatic colon cancers by immunohistochernistry. (b) the in vitro and in vivo adhesion and invasion properties of metastatic colon cancer cells transfected with 055 gene, or primary colon cancer cells transfected with 055 antisense DNA; (c) the mechanism of 055 in regulation of E-cadherin expression and cell differentiation. (2) to study the mechanism of aberrant regulation of 055 gene in metastaric colon cancer. This will be accomplished by: (a) nuclear run-off assay to determine the rate of transcription. Should run-off assay and promoter studies fail to detect difference in rate of transcription between primary and metastatic colon cancer cells, a mRNA decay assay to assess the mRNA stability will be performed. (B) cloning and analyzing the promoter region of the 055 gene. Chloramphenicol acetyltransferase (CAT) gene assay will be used to assess the activities of normal 055 promoter in both primary and metastatic colon cancer cells. (c) Analyzing the role of DNA methylation in regulation of 055 expression. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Gene Expression of Colon Cancers That Metastasize Principal Investigator & Institution: Markowitz, Sanford D.; Ingalls Professor of Cancer Genetics; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000; Project Start 0-AUG-2000; Project End 1-JAN2005 Summary: This proposal will test the hypothesis that differences in patterns of gene expression determine the differing biologic behaviors between colon cancers that are curable with primary surgical therapy and those that ultimately metastasize to the liver and kill. Additionally, we hypothesize that in colon cancer primary tumors, only a minority of cells will be "prometastatic", that is competent to give rise to liver metastases, and that assays of whole primary tumor lysates may thus fail to distinguish the crucial presence or absence of this "prometastatic" subpopulation. To test these hypotheses, Dr. Sanford Markowitz and his colleagues in the cancer genetics program at the Case Western Reserve University-NCI designated Comprehensive Cancer Center have forged a
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collaboration with Eos Biotechnology, Inc., a leader in gene expression array technology. The collaboration aims to establish an accurate molecular classification of colon cancer by focusing on a unique collection of surgically resected colon cancer liver metastases, all of whose cells have in vivo demonstrated metastatic ability. Using the Affymetrix human 40K GeneChip expression array technology, these investigators will generate a comprehensive description of global gene expression of these liver metastases. Comparing these liver metastases versus control nonmetastatic colon cancers, that were all cured by surgical excision, will specify a set of metastases specific genes whose expression defines a "metastatic signature." The goal of identifying those colon cancer primary tumors that can metastasize will be achieved by showing that they bear "prometastatic" cells recognizable by in situ hybridization assay of "metastatic signature" genes. Project aims are: i) To elucidate the "metastatic signature" by comparing on Affymetrix arrays colon cancer liver metastases versus non-metastatic colon cancer primary tumors. ii) To identify among metastases signature genes those specifying early metastatic events detectable by array analyses of colon cancer primary tumors that did metastasize. iii) To use in situ hybridization to confirm the metastatic signature of liver metastases arises from colon epithelial cells. iv) To use in situ hybridization to detect expression of metastatic signature genes by prometastatic cells in colon cancer primary tumors that are simultaneous with lever metastases or are precursor of liver metastases relapse. v) To use in situ hybridization to determine the areas of maximum concentration of "prometastatic" cells in colon cancer primary tumors. vi) To validate the metastatic signature and show it has prognostic power in an independent validation archive of 350 colon cancers. vii) To develop immunohistochemical assays for detection of the metastatic signature. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central27 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).28 Access Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 28 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 27
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to this growing archive of e-journals is free and unrestricted.29 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “colon cancer” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for colon cancer in the PubMed Central database: ·
Cell Cycle Regulation of Metallothionein in Human Colonic Cancer Cells by WW Nagel and BL Vallee; 1995 January 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42785
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Controversy:Population-based fecal occult blood screening for colon cancer: Will the benefits outweigh the harm? by Kenneth G. Marshall; 2000 September 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80462
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CpG island methylator phenotype in colorectal cancer by Minoru Toyota, Nita Ahuja, Mutsumi Ohe-Toyota, James G. Herman, Stephen B. Baylin, and Jean-Pierre J. Issa; 1999 July 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17576
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Cyclooxygenase-2 expression in human colon cancer cells increases metastatic potential by Masahiko Tsujii, Sunao Kawano, and Raymond N. DuBois; 1997 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20370
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De novo Decorin Gene Expression Suppresses the Malignant Phenotype in Human Colon Cancer Cells by M Santra, T Skorski, B Calabretta, EC Lattime, and RV Iozzo; 1995 July 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41462
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Distinct Hypermethylation Patterns Occur at Altered Chromosome Loci in Human Lung and Colon Cancer by M Makos, BD Nelkin, MI Lerman, F Latif, B Zbar, and SB Baylin; 1992 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=48567
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Effect of 2[prime prime or minute]-O-methyl antisense ORNs on expression of thymidylate synthase in human colon cancer RKO cells by John C. Schmitz, Dong Yu, Sudhir Agrawal, and Edward Chu; 2001 January 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29681
The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 29
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Epidermal growth factor receptor activation induces nuclear targeting of cyclooxygenase-2, basolateral release of prostaglandins, and mitogenesis in polarizing colon cancer cells by Robert J. Coffey, Chris J. Hawkey, Lars Damstrup, Ramona Graves-Deal, Vincent C. Daniel, Peter J. Dempsey, Rebecca Chinery, Susan C. Kirkland, Raymond N. DuBois, Thomas L. Jetton, and Jason D. Morrow; 1997 January 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19569
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ETS1 Suppresses Tumorigenicity of Human Colon Cancer Cells by H Suzuki, V Romano-Spica, TS Papas, and NK Bhat; 1995 May 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41960
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Fine Mapping of Colon Tumor Susceptibility (Scc) Genes in the Mouse, Different from the Genes Known to be Somatically Mutated in Colon Cancer by CJA Moen, PC Groot, AAM Hart, M Snoek, and P Demant; 1996 February 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40034
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Frameshift-mutation-derived peptides as tumor-specific antigens in inherited and spontaneous colorectal cancer by Ingvil Saeterdal, Jens Bjorheim, Kari Lislerud, Marianne K. Gjertsen, Ida K. Bukholm, Ole Christian Olsen, Jahn M. Nesland, Jon Amund Eriksen, Mona Moller, Annika Lindblom, and Gustav Gaudernack; 2001 November 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60857
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Genetic disruption of PPAR[delta] decreases the tumorigenicity of human colon cancer cells by Ben Ho Park, Bert Vogelstein, and Kenneth W. Kinzler; 2001 February 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=30184
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Hereditary nonpolyposis colon cancer by Edmond G. Lemire; 2001 November 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81612
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High Expression of the DNA Methyltransferase Gene Characterizes Human Neoplastic Cells and Progression Stages of Colon Cancer by WS El-Deiry, BD Nelkin, P Celano, RC Yen, JP Falco, SR Hamilton, and SB Baylin; 1991 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51469
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HLTF gene silencing in human colon cancer by Helen R. Moinova, WeiDong Chen, Lanlan Shen, Dominic Smiraglia, Joseph Olechnowicz, Lakshmeswari Ravi, Lakshmi Kasturi, Lois Myeroff, Christoph Plass,
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Ramon Parsons, John Minna, James K. V. Willson, Sylvan B. Green, JeanPierre Issa, and Sanford D. Markowitz; 2002 April 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=123687 ·
Human Colorectal Cancers Display Abnormal Fourier-Transform Infrared Spectra by B Rigas, S Morgello, IS Goldman, and PTT Wong; 1990 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54908
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JC virus DNA is present in the mucosa of the human colon and in colorectal cancers by Luigi Laghi, Ann E. Randolph, D. P. Chauhan, Giancarlo Marra, Eugene O. Major, James V. Neel, and C. Richard Boland; 1999 June 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22112
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Limited Up-Regulation of DNA Methyltransferase in Human Colon Cancer Reflecting Increased Cell Proliferation by PJ Lee, LL Washer, DJ Law, CR Boland, IL Horon, and AP Feinberg; 1996 September 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38390
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Liver Colonization Competence Governs Colon Cancer Metastasis by T Kuo, T Kubota, M Watanabe, T Furukawa, T Teramoto, K Ishibiki, M Kitajima, AR Moosa, S Penman, and RM Hoffman; 1995 December 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40301
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Mad-1 Is the Exclusive JC Virus Strain Present in the Human Colon, and Its Transcriptional Control Region Has a Deleted 98-Base-Pair Sequence in Colon Cancer Tissues by Luigi Ricciardiello, Dong K. Chang, Luigi Laghi, Ajay Goel, Christina L. Chang, and C. Richard Boland; 2001 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=115147
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Models of Human Metastatic Colon Cancer in Nude Mice Orthotopically Constructed by Using Histologically Intact Patient Specimens by X Fu, JM Besterman, A Monosov, and RM Hoffman; 1991 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52711
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Molecular karyotype (amplotype) of metastatic colorectal cancer by unbiased arbitrarily primed PCR DNA fingerprinting by Sergei Malkhosyan, Jun Yasuda, Jose Luis Soto, Takao Sekiya, Jun Yokota, and Manuel Perucho; 1998 August 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21480
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Nuclear Matrix Proteins in Human Colon Cancer by SK Keesee, MD Meneghini, RP Szaro, and Y Wu; 1994 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43274
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p21WAF1 is required for butyrate-mediated growth inhibition of human colon cancer cells by Sonia Y. Archer, Shufen Meng, Amy Shei, and Richard A. Hodin; 1998 June 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22637
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p53 Mutations in Colorectal Cancer by NR Rodrigues, A Rowan, MEF Smith, IB Kerr, WF Bodmer, JV Gannon, and DP Lane; 1990 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54786
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Patterns of Gene Expression that Characterize the Colonic Mucosa in Patients at Genetic Risk for Colonic Cancer by LH Augenlicht, J Taylor, L Anderson, and M Lipkin; 1991 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51431
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Potential role and chronology of abnormal expression of the Deleted in Colon Cancer (DCC) and the p53 proteins in the development of gastric cancer by Francesco Graziano, Stefano Cascinu, Maria Pia Staccioli, Vincenzo Catalano, Maria Cristina Rossi, Anna Maria Baldelli, Paolo Giordani, Pietro Muretto, and Giuseppina Catalano; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=37544
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Prostacyclin-mediated activation of peroxisome proliferator-activated receptor [delta] in colorectal cancer by Rajnish A. Gupta, Jian Tan, Wade F. Krause, Mark W. Geraci, Timothy M. Willson, Sudhansu K. Dey, and Raymond N. DuBois; 2000 November 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27215
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Prostaglandin H Synthase 2 is Expressed Abnormally in Human Colon Cancer: Evidence for a Transcriptional Effect by W Kutchera, DA Jones, N Matsunami, J Groden, TM McIntyre, GA Zimmerman, RL White, and SM Prescott; 1996 May 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39362
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Receptor protein tyrosine kinase EphB4 is up-regulated in colon cancer by Sally-Anne Stephenson, Stefan Slomka, Evelyn L. Douglas, Peter J. Hewett, and Jennifer E. Hardingham; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64642
140 Colon Cancer
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Synchronous Cardiac Myxoma and Colorectal Cancer: A Case Report by Ismael N. Nuno, Tyler Y. Kang, Hector Arroyo, and Vaughn A. Starnes; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=101182
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.30 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with colon cancer, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “colon cancer” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “colon cancer” (hyperlinks lead to article summaries): ·
#12 Limited social support or religious involvement as risk factors for colon cancer. Author(s): Kinney A, Marshall E, Dudley W, Martin C, Sandler R. Source: Annals of Epidemiology. 2002 October; 12(7): 494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12377438&dopt=Abstract
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A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Author(s): Greene FL, Stewart AK, Norton HJ. Source: Annals of Surgery. 2002 October; 236(4): 416-21; Discussion 421. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12368669&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A novel lymphatic mapping technique to improve localization and staging of early colon cancer during laparoscopic colectomy. Author(s): Tsioulias GJ, Wood TF, Spirt M, Morton DL, Bilchik AJ. Source: The American Surgeon. 2002 July; 68(7): 561-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12132733&dopt=Abstract
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Activity and properties of alpha-L-fucosidase are dependent on the state of enterocytic differentiation of HT-29 colon cancer cells. Author(s): Merino-Trigo A, Rodriguez-Berrocal FJ, de Miguel E, Paez de la Cadena M. Source: The International Journal of Biochemistry & Cell Biology. 2002 October; 34(10): 1291-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12127580&dopt=Abstract
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Adenovirus-mediated gene transfer of P16INK4/CDKN2 into baxnegative colon cancer cells induces apoptosis and tumor regression in vivo. Author(s): Tamm I, Schumacher A, Karawajew L, Ruppert V, Arnold W, Nussler AK, Neuhaus P, Dorken B, Wolff G. Source: Cancer Gene Therapy. 2002 August; 9(8): 641-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12136424&dopt=Abstract
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Adjuvant Chemotherapy in Stage III Colon Cancer with 5-Fluorouracil and Levamisole versus 5-Fluorouracil and Leucovorin. Author(s): Dencausse Y, Hartung G, Sturm J, Kopp-Schneider A, Hagmuller E, Wojatschek C, Lindemann H, Fritze D, Queisser W. Source: Onkologie. 2002 October; 25(5): 426-430. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12415196&dopt=Abstract
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Adjuvant Chemotherapy Use for Medicare Beneficiaries With Stage II Colon Cancer. Author(s): Schrag D, Rifas-Shiman S, Saltz L, Bach PB, Begg CB. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 October 1; 20(19): 3999-4005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12351597&dopt=Abstract
142 Colon Cancer
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Angiogenesis inhibitor TNP-470 suppresses growth of peritoneal disseminating foci of human colon cancer line Lovo. Author(s): Fan YF, Huang ZH. Source: World Journal of Gastroenterology : Wjg. 2002 October; 8(5): 853856. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12378629&dopt=Abstract
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Anti-tumor efficacy of a novel antisense anti-MDM2 mixed-backbone oligonucleotide in human colon cancer models: p53-dependent and p53-independent mechanisms. Author(s): Wang H, Nan L, Yu D, Lindsey JR, Agrawal S, Zhang R. Source: Molecular Medicine (Cambridge, Mass.). 2002 April; 8(4): 185-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12149568&dopt=Abstract
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Apoptosis induced by activation of peroxisome-proliferator activated receptor-gamma is associated with Bcl-2 and NF-kappaB in human colon cancer. Author(s): Chen GG, Lee JF, Wang SH, Chan UP, Ip PC, Lau WY. Source: Life Sciences. 2002 April 19; 70(22): 2631-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12269390&dopt=Abstract
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Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Author(s): Ko CY, Chang JT, Chaudhry S, Kominski G. Source: Surgery. 2002 August; 132(2): 268-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12219022&dopt=Abstract
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Base excision repair as a therapeutic target in colon cancer. Author(s): Liu L, Nakatsuru Y, Gerson SL. Source: Clinical Cancer Research: an Official Journal of the American Association for Cancer Research. 2002 September; 8(9): 2985-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12231545&dopt=Abstract
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Bile acids mimic oxidative stress induced upregulation of thioredoxin reductase in colon cancer cell lines. Author(s): Lechner S, Muller-Ladner U, Schlottmann K, Jung B, McClelland M, Ruschoff J, Welsh J, Scholmerich J, Kullmann F.
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Source: Carcinogenesis. 2002 August; 23(8): 1281-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12151345&dopt=Abstract ·
Biliary, fecal and plasma deoxycholic acid in rabbit, hamster, guinea pig, and rat: comparative study and implication in colon cancer. Author(s): Kasbo J, Saleem M, Perwaiz S, Mignault D, Lamireau T, Tuchweber B, Yousef I. Source: Biol Pharm Bull. 2002 October; 25(10): 1381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12392101&dopt=Abstract
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Bioinformatics-based discovery of a novel factor with apparent specificity to colon cancer. Author(s): De Young MP, Damania H, Scheurle D, Zylberberg C, Narayanan R. Source: In Vivo. 2002 July-August; 16(4): 239-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12224133&dopt=Abstract
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Blockade of Insulin-like Growth Factor I Receptor Function Inhibits Growth and Angiogenesis of Colon Cancer. Author(s): Reinmuth N, Liu W, Fan F, Jung YD, Ahmad SA, Stoeltzing O, Bucana CD, Radinsky R, Ellis LM. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3259-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374697&dopt=Abstract
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Cancer-related serological recognition of human colon cancer: identification of potential diagnostic and immunotherapeutic targets. Author(s): Scanlan MJ, Welt S, Gordon CM, Chen YT, Gure AO, Stockert E, Jungbluth AA, Ritter G, Jager D, Jager E, Knuth A, Old LJ. Source: Cancer Research. 2002 July 15; 62(14): 4041-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12124339&dopt=Abstract
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Capillary sodium dodecyl sulfate-DALT electrophoresis with laserinduced fluorescence detection for size-based analysis of proteins in human colon cancer cells. Author(s): Hu S, Jiang J, Cook LM, Richards DP, Horlick L, Wong B, Dovichi NJ.
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Source: Electrophoresis. 2002 September; 23(18): 3136-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12298085&dopt=Abstract ·
Characterisation of tumour-associated antigens in colon cancer. Author(s): Line A, Slucka Z, Stengrevics A, Silina K, Li G, Rees RC. Source: Cancer Immunology, Immunotherapy: Cii. 2002 December; 51(10): 574-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12384809&dopt=Abstract
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Chemoprevention of precursors to colon cancer by dehydroepiandrosterone (DHEA). Author(s): Osawa E, Nakajima A, Yoshida S, Omura M, Nagase H, Ueno N, Wada K, Matsuhashi N, Ochiai M, Nakagama H, Sekihara H. Source: Life Sciences. 2002 April 19; 70(22): 2623-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12269389&dopt=Abstract
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Co-expression of CD44v3 and heparanase is correlated with metastasis of human colon cancer. Author(s): Kuniyasu H, Chihara Y, Kubozoe T, Takahashi T. Source: International Journal of Molecular Medicine. 2002 September; 10(3): 333-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12165810&dopt=Abstract
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Colon cancer screening in the ambulatory setting. Author(s): Walsh JM, Posner SF, Perez-Stable EJ. Source: Preventive Medicine. 2002 September; 35(3): 209-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12202062&dopt=Abstract
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Colon cancer: detection and prevention. Author(s): Loren DE, Lewis J, Kochman ML. Source: Gastroenterology Clinics of North America. 2002 June; 31(2): 56586. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12134619&dopt=Abstract
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Colon cancer: prevention, diagnosis, treatment. Author(s): McCormick D, Kibbe PJ, Morgan SW.
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Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 2002 September-October; 25(5): 204-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12394397&dopt=Abstract ·
COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Author(s): Hazebroek EJ. Source: Surgical Endoscopy. 2002 June; 16(6): 949-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163961&dopt=Abstract
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Comments on E. Giovannucci, "Insulin, insulin-like growth factors and colon cancer: a review of the evidence". Author(s): Grant WB. Source: The Journal of Nutrition. 2002 August; 132(8): 2324; Discussion 2325. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163683&dopt=Abstract
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Conjugated linoleic acid (CLA) inhibits growth of Caco-2 colon cancer cells: possible mediation by oleamide. Author(s): Kim EJ, Jun JG, Park HS, Kim SM, Ha YL, Park JH. Source: Anticancer Res. 2002 July-August; 22(4): 2193-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12174903&dopt=Abstract
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Connexin 43, but not connexin 32, is mutated at advanced stages of human sporadic colon cancer. Author(s): Dubina MV, Iatckii NA, Popov DE, Vasil'ev SV, Krutovskikh VA. Source: Oncogene. 2002 July 25; 21(32): 4992-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12118378&dopt=Abstract
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Constipation, anthranoid laxatives, melanosis coli, and colon cancer: a risk assessment using aberrant crypt foci. Author(s): Nascimbeni R, Donato F, Ghirardi M, Mariani P, Villanacci V, Salerni B.
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Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2002 August; 11(8): 753-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163329&dopt=Abstract ·
Cyclooxygenase-2 inhibition augments the hepatic antitumor effect of oral Salmonella typhimurium in a model of mouse metastatic colon cancer. Author(s): Feltis BA, Sahar DA, Kim AS, Saltzman DA, Leonard AS, Sielaff TD. Source: Diseases of the Colon and Rectum. 2002 August; 45(8): 1023-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12195185&dopt=Abstract
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Cyclooxygenase-2 overexpression inhibits death receptor 5 expression and confers resistance to tumor necrosis factor-related apoptosisinducing ligand-induced apoptosis in human colon cancer cells. Author(s): Tang X, Sun YJ, Half E, Kuo MT, Sinicrope F. Source: Cancer Research. 2002 September 1; 62(17): 4903-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12208739&dopt=Abstract
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Cyclooxygenase-2 Overexpression Reduces Apoptotic Susceptibility by Inhibiting the Cytochrome c-dependent Apoptotic Pathway in Human Colon Cancer Cells. Author(s): Sun Y, Tang XM, Half E, Kuo MT, Sinicrope FA. Source: Cancer Research. 2002 November 1; 62(21): 6323-6328. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12414664&dopt=Abstract
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Decoding the cryptic origins of colon cancer. Author(s): Twombly R. Source: Environmental Health Perspectives. 2002 July; 110(7): A394-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12117656&dopt=Abstract
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Determination of histamine in the whole blood of colon cancer patients. Author(s): Previati M, Raspadori A, Bertolaso L, Parmeggiani A, Bindini
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D, Vitali C, Lanzoni I, Corbacella E, Saviano M, Fagioli F, Blo G, Capitani S. Source: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences. 2002 November 25; 780(2): 331-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12401359&dopt=Abstract ·
Diagnosis and management of hereditary colon cancer. Author(s): Cruz-Correa M, Giardiello FM. Source: Gastroenterology Clinics of North America. 2002 June; 31(2): 53749, X. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12134617&dopt=Abstract
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Effectiveness of Adjuvant Fluorouracil in Clinical Practice: A Population-Based Cohort Study of Elderly Patients With Stage III Colon Cancer. Author(s): Iwashyna TJ, Lamont EB. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 October 1; 20(19): 3992-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12351596&dopt=Abstract
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Effects of genetic blockade of the insulin-like growth factor receptor in human colon cancer cell lines. Author(s): Adachi Y, Lee CT, Coffee K, Yamagata N, Ohm JE, Park KH, Dikov MM, Nadaf SR, Arteaga CL, Carbone DP. Source: Gastroenterology. 2002 October; 123(4): 1191-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12360481&dopt=Abstract
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Efficacy of combination chemotherapy for stage IV colon cancer with extensive peritoneal dissemination and multiple liver metastases: A case report. Author(s): Mukai M, Oida Y, Mukoyama S, Okamoto Y, Ito I, Nakasaki H, Kawai K, Sato S, Makuuchi H. Source: Oncol Rep. 2002 November-December; 9(6): 1339-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12375045&dopt=Abstract
148 Colon Cancer
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Erosion of psoriatic plaques: an uncommon side-effect of neoadjuvant 5-fluorouracil treatment of colon cancer. Author(s): Wetzig T, Beckheinrich P, Rytter M, Haustein UF. Source: The British Journal of Dermatology. 2002 October; 147(4): 824-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12366448&dopt=Abstract
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Evaluation of telomerase in the development and progression of colon cancer. Author(s): Boldrini L, Faviana P, Gisfredi S, Zucconi Y, Di Quirico D, Donati V, Berti P, Spisni R, Galleri D, Materazzi G, Basolo F, Miccoli P, Pingitore R, Fontanini G. Source: International Journal of Molecular Medicine. 2002 November; 10(5): 589-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12373297&dopt=Abstract
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Evaluation of telomerase mRNA (hTERT) in colon cancer. Author(s): Boldrini L, Faviana P, Gisfredi S, Zucconi Y, Di Quirico D, Donati V, Berti P, Spisni R, Galleri D, Materazzi G, Basolo F, Miccoli P, Pingitore R, Fontanini G. Source: International Journal of Oncology. 2002 September; 21(3): 493-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12168091&dopt=Abstract
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Expression of human intestinal mucin is modulated by the betagalactoside binding protein galectin-3 in colon cancer. Author(s): Dudas SP, Yunker CK, Sternberg LR, Byrd JC, Bresalier RS. Source: Gastroenterology. 2002 September; 123(3): 817-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12198708&dopt=Abstract
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Expression of maspin in colon cancers: its relationship with p53 expression and microvessel density. Author(s): Song SY, Lee SK, Kim DH, Son HJ, Kim HJ, Lim YJ, Lee WY, Chun HK, Rhee JC. Source: Digestive Diseases and Sciences. 2002 August; 47(8): 1831-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12184537&dopt=Abstract
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Functional interaction of lithocholic acid conjugates with M3 muscarinic receptors on a human colon cancer cell line. Author(s): Cheng K, Chen Y, Zimniak P, Raufman J, Xiao Y, Frucht H. Source: Biochimica Et Biophysica Acta. 2002 October 9; 1588(1): 48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12379313&dopt=Abstract
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Further investigation of the modifying effect of various chemopreventive agents on apoptosis and cell proliferation in human colon cancer cells. Author(s): Zheng Q, Hirose Y, Yoshimi N, Murakami A, Koshimizu K, Ohigashi H, Sakata K, Matsumoto Y, Sayama Y, Mori H. Source: Journal of Cancer Research and Clinical Oncology. 2002 October; 128(10): 539-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12384797&dopt=Abstract
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Genetic and epigenetic alterations in colon cancer. Author(s): Grady WM, Markowitz SD. Source: Annual Review of Genomics and Human Genetics. 2002; 3: 10128. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12142355&dopt=Abstract
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Genetic polymorphisms in the cytochrome P450 1A1, glutathione Stransferase M1 and T1, and susceptibility to colon cancer. Author(s): Ye Z, Parry JM. Source: Teratogenesis, Carcinogenesis, and Mutagenesis. 2002; 22(5): 38592. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12210502&dopt=Abstract
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Genetic profiling of colon cancer. Author(s): Neibergs HL, Hein DW, Spratt JS. Source: Journal of Surgical Oncology. 2002 August; 80(4): 204-13. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12210035&dopt=Abstract
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Hepatic ischemia-reperfusion promotes liver metastasis of colon cancer.
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Author(s): Doi K, Horiuchi T, Uchinami M, Tabo T, Kimura N, Yokomachi J, Yoshida M, Tanaka K. Source: The Journal of Surgical Research. 2002 June 15; 105(2): 243-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12121713&dopt=Abstract ·
Huntingtin-interacting protein 1 is overexpressed in prostate and colon cancer and is critical for cellular survival. Author(s): Rao DS, Hyun TS, Kumar PD, Mizukami IF, Rubin MA, Lucas PC, Sanda MG, Ross TS. Source: The Journal of Clinical Investigation. 2002 August; 110(3): 351-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163454&dopt=Abstract
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Identification of Src transformation fingerprint in human colon cancer. Author(s): Malek RL, Irby RB, Guo QM, Lee K, Wong S, He M, Tsai J, Frank B, Liu ET, Quackenbush J, Jove R, Yeatman TJ, Lee NH. Source: Oncogene. 2002 October 17; 21(47): 7256-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12370817&dopt=Abstract
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Impact of insulin-like growth factor receptor-I function on angiogenesis, growth, and metastasis of colon cancer. Author(s): Reinmuth N, Fan F, Liu W, Parikh AA, Stoeltzing O, Jung YD, Bucana CD, Radinsky R, Gallick GE, Ellis LM. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 2002 October; 82(10): 1377-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12379772&dopt=Abstract
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In vitro and in vivo treatment of colon cancer by VIP antagonists. Author(s): Levy A, Gal R, Granoth R, Dreznik Z, Fridkin M, Gozes I. Source: Regulatory Peptides. 2002 November 15; 109(1-3): 127-133. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12409224&dopt=Abstract
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Incidental detection of colon cancer by FDG positron emission tomography in patients examined for pulmonary nodules. Author(s): Zhuang H, Hickeson M, Chacko TK, Duarte PS, Nakhoda KZ, Feng Q, Alavi A.
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Source: Clinical Nuclear Medicine. 2002 September; 27(9): 628-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12192279&dopt=Abstract ·
Increase in ceramide level alters the lysosomal targeting of cathepsin D prior to onset of apoptosis in HT-29 colon cancer cells. Author(s): De Stefanis D, Reffo P, Bonelli G, Baccino FM, Sala G, Ghidoni R, Codogno P, Isidoro C. Source: Biological Chemistry. 2002 June; 383(6): 989-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12222689&dopt=Abstract
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Inhibitory effect of a selective cyclooxygenase-2 inhibitor on liver metastasis of colon cancer. Author(s): Nagatsuka I, Yamada N, Shimizu S, Ohira M, Nishino H, Seki S, Hirakawa K. Source: International Journal of Cancer. Journal International Du Cancer. 2002 August 10; 100(5): 515-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12124799&dopt=Abstract
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Insulin-like Growth Factor 1 Induces Hypoxia-inducible Factor 1mediated Vascular Endothelial Growth Factor Expression, Which is Dependent on MAP Kinase and Phosphatidylinositol 3-Kinase Signaling in Colon Cancer Cells. Author(s): Fukuda R, Hirota K, Fan F, Jung YD, Ellis LM, Semenza GL. Source: The Journal of Biological Chemistry. 2002 October 11; 277(41): 38205-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12149254&dopt=Abstract
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Integrin alpha(v)beta6-associated ERK2 mediates MMP-9 secretion in colon cancer cells. Author(s): Gu X, Niu J, Dorahy DJ, Scott R, Agrez MV. Source: British Journal of Cancer. 2002 July 29; 87(3): 348-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12177807&dopt=Abstract
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Intraoperative radiation therapy for patients with recurrent rectal and sigmoid colon cancer in previously irradiated fields. Author(s): Pezner R, Chu D, Ellenhorn J.
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Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2002 July; 64(1): 47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12208575&dopt=Abstract ·
Intraoperative radiochromoguided mapping of sentinel lymph node in colon cancer. Author(s): Nastro P, Sodo M, Dodaro CA, Gargiulo S, Acampa W, Bracale U, Renda A. Source: Tumori. 2002 July-August; 88(4): 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12400991&dopt=Abstract
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Involvement of both extracellular signal-regulated kinase and c-jun Nterminal kinase pathways in the 12-O-tetradecanoylphorbol-13-acetateinduced upregulation of p21(Cip1) in colon cancer cells. Author(s): Lin SY, Liang YC, Ho YS, Tsai SH, Pan S, Lee WS. Source: Molecular Carcinogenesis. 2002 September; 35(1): 21-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12203364&dopt=Abstract
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Less cytotoxicity to combination therapy of 5-fluorouracil and cisplatin than 5-fluorouracil alone in human colon cancer cell lines. Author(s): Chen XX, Lai MD, Zhang YL, Huang Q. Source: World Journal of Gastroenterology : Wjg. 2002 October; 8(5): 841846. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12378627&dopt=Abstract
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Lymphocyte labile iron pool, plasma iron, transferrin saturation and ferritin levels in colon cancer patients. Author(s): Gackowski D, Kruszewsk M, Banaszkiewicz Z, Jawien A, Olinski R. Source: Acta Biochim Pol. 2002; 49(1): 269-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12136950&dopt=Abstract
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Mechanisms involved in development of resistance to adenovirusmediated proapoptotic gene therapy in DLD1 human colon cancer cell line. Author(s): Zhang L, Gu J, Lin T, Huang X, Roth JA, Fang B.
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Source: Gene Therapy. 2002 September; 9(18): 1262-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12215894&dopt=Abstract ·
Modulation of the Fas Signaling Pathway by IFN-gamma in Therapy of Colon Cancer: Phase I Trial and Correlative Studies of IFN-gamma, 5Fluorouracil, and Leucovorin. Author(s): Schwartzberg LS, Petak I, Stewart C, Turner PK, Ashley J, Tillman DM, Douglas L, Tan M, Billups C, Mihalik R, Weir A, Tauer K, Shope S, Houghton JA. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 August; 8(8): 2488-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12171874&dopt=Abstract
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Molecular screening for colon cancer in inflammatory bowel disease. Author(s): Malcomson RD, McGregor AH. Source: European Journal of Gastroenterology & Hepatology. 2002 October; 14(10): 1045-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12362091&dopt=Abstract
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Monoterpenes inhibit proliferation of human colon cancer cells by modulating cell cycle-related protein expression. Author(s): Bardon S, Foussard V, Fournel S, Loubat A. Source: Cancer Letters. 2002 July 26; 181(2): 187-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12175534&dopt=Abstract
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Multivisceral resection for colon cancer. Author(s): Luna-Perez P, Rodriguez-Ramirez SE, De la Barrera MG, Zeferino M, Labastida S. Source: Journal of Surgical Oncology. 2002 June; 80(2): 100-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12173378&dopt=Abstract
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Novel Detection and Differential Utilization of a c-myc Transcriptional Block in Colon Cancer Chemoprevention. Author(s): Wilson AJ, Velcich A, Arango D, Kurland AR, Shenoy SM, Pezo RC, Levsky JM, Singer RH, Augenlicht LH.
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Source: Cancer Research. 2002 November 1; 62(21): 6006-6010. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12414619&dopt=Abstract ·
Nr-CAM is a target gene of the beta-catenin/LEF-1 pathway in melanoma and colon cancer and its expression enhances motility and confers tumorigenesis. Author(s): Conacci-Sorrell ME, Ben-Yedidia T, Shtutman M, Feinstein E, Einat P, Ben-Ze'ev A. Source: Genes & Development. 2002 August 15; 16(16): 2058-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12183361&dopt=Abstract
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Nuclear matrix protein alterations associated with colon cancer metastasis to the liver. Author(s): Brunagel G, Schoen RE, Bauer AJ, Vietmeier BN, Getzenberg RH. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3039-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374670&dopt=Abstract
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Nuclear Matrix Proteins as Proteomic Markers of Preneoplastic and Cancer Lesions: Commentary re: G. Brunagel et al., Nuclear Matrix Protein Alterations Associated with Colon Cancer Metastasis to the Liver. Clin. Cancer Res., 8: 3039-3045, 2002. Author(s): Coffey DS. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2002 October; 8(10): 3031-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12374668&dopt=Abstract
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Nutritional chemoprevention of colon cancer. Author(s): Mason JB. Source: Semin Gastrointest Dis. 2002 July; 13(3): 143-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12230317&dopt=Abstract
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Obesity, gender, and colon cancer. Author(s): Giovannucci E.
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Source: Gut. 2002 August; 51(2): 147. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12117867&dopt=Abstract
Vocabulary Builder Abdomen: The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Alkaline: Having the reactions of an alkali. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A condition in which the number of red blood cells is below normal. [NIH] Antigens: Substances that cause the immune system to make a specific immune response. [NIH] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apoptosis: A normal series of events in a cell that leads to its death. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Azoxymethane: A potent carcinogen and neurotoxic compound. It is particularly effective in inducing colon carcinomas. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH]
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Biometry: The use of statistical methods to analyze biological observations and phenomena. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Cardiac: Having to do with the heart. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cholangitis: Inflammation of a bile duct. [EU] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cisplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
DHEA: Dehydroepiandrosterone. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH]
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Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU]
Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epithelium: A thin layer of tissue that covers organs, glands, and other structures within the body. [NIH] Extracellular: Outside a cell or cells. [EU] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glucose: Sugar. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histology: The study of tissues and cells under a microscope. [NIH]
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Hormones: Chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the actions of certain cells or organs. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Immunology: The study of the body's immune system. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulin: A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lesion: An area of abnormal tissue change. [NIH] Levamisole: An antiparasitic drug that is also being studied in cancer therapy with fluorouracil. [NIH] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Melanosis: A disorder caused by a disturbance in melanin pigmentation; melanism. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors"
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and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Necrosis: Refers to the death of living tissues. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nonmetastatic: Cancer that has not spread from the primary (original) site to other sites in the body. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Pericarditis: Inflammation of the pericardium. [EU] Peritoneal: Having to do with the peritoneum (the tissue that lines the
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abdominal wall and covers most of the organs in the abdomen). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plantago: Three different species of Plantago or plantain, P. psyllium, P. ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH]
Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Pulmonary: Relating to the lungs. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source
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including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Resected: Surgical removal of part of an organ. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Telomerase: Essential ribonucleoprotein reverse transcriptase that adds telomeric DNA to the ends of eukaryotic chromosomes. Telomerase appears to be repressed in normal human somatic tissues but reactivated in cancer, and thus may be necessary for malignant transformation. EC 2.7.7.-. [NIH]
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Thioredoxin: A hydrogen-carrying protein that participates in a variety of biochemical reactions including ribonucleotide reduction. Thioredoxin is oxidized from a dithiol to a disulfide during ribonucleotide reduction. The disulfide form is then reduced by NADPH in a reaction catalyzed by thioredoxin reductase. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Tumour: 1. swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. a new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] ZD1839: A substance that is being studied as an anticancer drug. [NIH]
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CHAPTER 5. PATENTS ON COLON CANCER Overview You can learn about innovations relating to colon cancer by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.31 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with colon cancer within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with colon cancer. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
31Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Colon Cancer By performing a patent search focusing on colon cancer, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on colon cancer: ·
Metastatic breast and colon cancer regulated genes Inventor(s): Giese; Klaus (Berlin, DE) Assignee(s): Chiron Corporation (Emeryville, CA) Patent Number: 6,468,790 Date filed: November 13, 2000 Abstract: Gene sequences as shown in SEQ ID NOS:1-85 have been found to be significantly associated with metastatic potential of cancer cells, especially breast and colon cancer cells. Methods are provided for determining the risk of metastasis of a tumor, which involve determining whether a tissue sample from a tumor expresses a polypeptide encoded by a gene as shown in SEQ ID NOS:1-85, or a substantial portion thereof. Excerpt(s): The invention thus provides the art with a number of genes and proteins, which can be used as markers of metastasis. These are useful for more rationally is prescribing the course of therapy for breast or colon cancer patients. ... Some of the polynucleotides disclosed herein represent novel genes which are differentially expressed between nonmetastatic cancer cells and cancer cells which have a potential to metastasize. SEQ ID NOS:1-63 represent novel metastatic marker genes (Table 1). SEQ ID NOS:64-85 represent known genes which have been found to be differentially expressed in metastatic relative to nonmetastatic cancer cells (Table 2). Some of the metastatic marker genes disclosed herein are expressed in metastatic cells relative to nonmetastatic cells, particularly in breast cancer cells which metastasize to bone and lung (SEQ ID NOS:1, 5, 11, 18, 20, 22, 24, 30, 33, 35, 36, 38, 45, 52, 58, 65, 66, 70, 74, 76, and 80). One metastatic marker gene (SEQ ID NO:56) is expressed in non-metastatic breast cancer cells and in colon cancer cells with low metastatic potential. Other metastatic marker genes
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are expressed in metastatic cancer cells, particularly in breast cancer cells which metastasize only to lung (SEQ ID NOS:2, 4, 9, 13, 14, 19, 26, 29, 3941, 48, 55, 57, 60, 63, 64, 72, 73, 82, and 83). Still other metastatic marker genes (SEQ ID NOS:3, 7, 8, 10, 12, 15-17, 21, 23, 28, 31, 34, 37, 42-44, 46, 47, 49, 61, 62, 67, 68, 75, 77-79, 81, 84, and 85) are expressed in cancer cells which do not typically metastasize, particularly in breast cancer cells. Identification of these relationships and markers permits the formulation of reagents and methods as further described below. Other metastatic marker genes, such as those which comprise a nucleotide sequence shown in SEQ ID NOS:6, 27, 32, and 54, can be used to identify cancerous tissue, particularly breast cancer tissue. ... Full-length metastatic marker proteins can be extracted, using standard biochemical methods, from metastatic marker protein-producing human cells, such as metastatic breast or colon cancer cells. An isolated and purified metastatic marker protein or polypeptide is separated from other compounds which normally associate with a metastatic marker protein or polypeptide in a cell, such as certain proteins, carbohydrates, lipids, or subcellular organelles. A preparation of isolated and purified metastatic marker proteins or polypeptides is at least 80% pure; preferably, the preparations are 90%, 95%, or 99% pure. Web site: http://www.delphion.com/details?pn=US06468790__ ·
Colon cancer marker Inventor(s): Wolven; Amy K. (Oakland, CA), Krasnow; Randi E. (Stanford, CA), Warren; Bridget A. (Cupertino, CA), Baughn; Mariah R. (San Leandro, CA) Assignee(s): Incyte Genomics, Inc. (Palo Alto, CA) Patent Number: 6,448,041 Date filed: December 18, 2000 Abstract: The invention provides a cDNA which encodes a colon cancer marker. It also provides for the use of the cDNA, fragments, complements, and variants thereof and of the encoded protein, portions thereof and antibodies thereto for diagnosis and treatment of colon disorders, particularly colon cancer and polyps. The invention additionally provides expression vectors and host cells for the production of the protein and a transgenic model system. Excerpt(s): This invention relates to a mammalian cDNA which encodes a colon cancer marker and to the use of the cDNA and the encoded protein in the diagnosis and treatment of colon disorders, particularly colon cancer and polyps. ... Colorectal cancer is the fourth most common cancer
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and the second most common cause of cancer death in the United States with approximately 130,000 new cases and 55,000 deaths per year. Colon and rectal cancers share many environmental risk factors and both are found in individuals with specific genetic syndromes (Potter (1999) J Natl Cancer Institute 91:916-932). Colon cancer is the only cancer that occurs with approximately equal frequency in men and women, and the fiveyear survival rate following diagnosis of colon cancer is around 55% in the United States (Ries et al. (1990) National Institutes of Health, DHHS Publ. No. (NI)90-2789). ... Colon cancer is causally related to both genes and the environment. Several molecular pathways have been linked to the development of colon cancer, and the expression of key genes in any of these pathways may be affected by inherited or acquired mutation or by hypermethylation. There is a particular need to identify genes for which changes in expression may provide an early indicator of colon cancer or a predisposition for the development of colon cancer. Web site: http://www.delphion.com/details?pn=US06448041__ ·
Diagnosis and monitoring of colon cancer patients by measurement of NCA 50/90 in blood Inventor(s): Allard; William Jeffrey (Poughquag, NY), Yeung; Kwok K. (Prospect, CT) Assignee(s): Bayer Corporation (Tarrytown, NY) Patent Number: 6,309,846 Date filed: November 22, 1996 Abstract: A method for aiding in the diagnosis of, and monitoring the progression or course of, colon cancer in a patient by measuring the amount of NCA 50/90 in a blood sample, e.g., serum sample, obtained from the patient. Measurement in a single sample of an amount of NCA 50/90 significantly higher than the mean amount of NCA 50/90 in the normal population is an indication of colon cancer in a symptomatic patient. The course of colon cancer can also be monitored by performing a series of specific immunoassays over time to determine changes in the level of NCA 50/90 in blood samples. Increases in blood NCA 50/90 levels over time are indicative of a deteriorating condition whereas decreasing levels of blood NCA 50/90 over time indicate an improving condition. Excerpt(s): The present invention relates to the diagnosis of, and monitoring the progression, course, or stage of, disease in colon cancer patients. More particularly, the invention relates to such diagnostic and monitoring methods based on measurement of cancer marker blood
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levels. ... It has now been found that NCA 50/90 can be significantly elevated in the blood of patients with colon cancer. Accordingly, the present invention provides a method for aiding in the diagnosis of colon cancer in a patient who presents with symptoms of colon cancer (i.e., a symptomatic patient), comprising the steps of determining the amount of NCA 50/90 in a blood sample obtained from said patient and comparing such measured amount of NCA 50/90 to the mean amount of NCA 50/90 in the normal population, whereby the presence of a significantly increased higher amount of NCA 50/90 in the patient's blood is an indication of colon cancer in the patient. With this and other information suggestive of colon cancer, the physician is assisted in making a diagnosis. ... The present invention also provides a method for monitoring the course or progression of colon cancer in a patient who has been diagnosed with colon cancer. A series of specific immunoassays are performed over time to determine changes in the level of NCA 50/90 in blood samples obtained from such patient, whereby changes in the NCA 50/90 blood level correlate with changes in disease status. More particularly, increases in blood NCA 50/90 levels will generally indicate a deteriorating condition while decreases in blood NCA 50/90 levels indicate an improving condition. Where the diagnosed patient has been treated for colon cancer, e.g., radiation, chemotherapy, surgery, or the like, increases in blood NCA 50/90 levels indicate recurrence of disease. Web site: http://www.delphion.com/details?pn=US06309846__ ·
Isolated nucleic acid molecules associated with colon cancer and methods for diagnosing and treating colon cancer Inventor(s): Scanlan; Matthew J. (New York, NY), Chen; Yao-Tseng (New York, NY), Stockert; Elisabeth (New York, NY), Old; Lloyd J. (New York, NY) Assignee(s): Ludwig Institute for Cancer Research (New York, NY) Patent Number: 6,043,084 Date filed: October 10, 1997 Abstract: Various molecules associated with disorders such as colon cancer are disclosed. The invention also discloses diagnostic and therapeutic methods based upon these molecules. Excerpt(s): This invention relates to the isolation of genes associated with colon cancer, methods of diagnosing colon cancer using these, as well as other genes which are known, as well as therapeutic approaches to treating such conditions. ... The SEREX methodology has now been applied to colon cancer samples. Several nucleic acid molecules have
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been newly isolated and sequenced, and are now associated with stomach cancer. Further, a pattern of expression involving these, as well as previously isolated genes has been found to be associated with colon cancer. These results are the subject of this application, which is elaborated upon in the disclosure which follows. ... Of the six clones which were identified as being reactive with autologous and allogeneic cancer serum, and not with normal serum, two were found to be identical to previously identified molecules. Four others were found to have little or no homology to known sequences. These are presented as SEQ ID NOS: 1-4. Of twenty seven allogeneic colon cancer serum samples tested, 67% reacted with at least one of these antigens. Web site: http://www.delphion.com/details?pn=US06043084__ ·
Method of preventing colon cancer with vitamin D.sub.3 analogues Inventor(s): Brasitus; Thomas A. (Olympia Fields, IL), Bissonnette; Bruce Marc (Chicago, IL), Sitrin; Michael D. (Flossmoor, IL) Assignee(s): Arch Development Corporation (Chicago, IL) Patent Number: 6,040,300 Date filed: April 7, 1995 Abstract: A method for preventing the initiation of colon cancer is disclosed. Vitamin D.sub.3 analogues prevented the development of adenomas and adenocarcinomas when administered to rats prior to, and subsequent to, chemically induced tumorigenesis. Excerpt(s): The present invention relates generally to the field of cancer prevention. In particular, the invention relates to a method of preventing colon cancer by vitamin D.sub.3 analogues. In one example, administration of 1.alpha., 25-Dihydroxy-16-ene-23-yne-26, 27hexafluorocholecalciferol reduced the incidence of colon cancer in rats. ... Colon cancer is a leading cause of death among patients with internal malignancies in the United States and, unfortunately, at the time of initial diagnosis is incurable in approximately one-half of the patients found to harbor this malignancy (Zarling and Rhodes, Int. Med. Specialist 3:72-86, 1982). Moreover, despite advances in the fields of surgery, radiotherapy and chemotherapy, the cure rate for this disease has not improved significantly (Zarling and Rhodes, 1982). Based on these considerations, the search for strategies to prevent the development of cancers in this organ has markedly intensified during the past decade. ... Although the cause of large bowel cancer is not known, most epidemiologists associate it with diet, and, in particular, the low-fiber, high-protein, high-fat content that characterizes the diet of most Americans and people in other
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urban, industrialized societies. Many observers believe that colon cancer is the first major cancer type for which available evidence is sufficient to recommend dietary changes in the general public (Willett, Nature 338:384, 1989; Greenwald, Cancer 70 (Suppl.): 1206, 1992). In this regard, the possibility of using dietary supplements as a strategy to prevent colon cancer has recently been recognized (Mukhtar and Athar, Clev. Clin. J. Med. 55:507-508, 1988). Web site: http://www.delphion.com/details?pn=US06040300__ ·
Methods of treating colon cancer utilizing tumor-specific antibodies Inventor(s): Welt; Sydney (New York, NY), Old; Lloyd J. (New York, NY), Barendswaard; Elsje (New York, NY), Montalto; Nicholas J. (New York, NY), Gure; Ali Osmay (New York, NY) Assignee(s): Ludwig Institute For Cancer Research (New York, NY) Patent Number: 5,958,412 Date filed: June 4, 1997 Abstract: This invention relates to methods of reducing the effects of colon cancer tumors. Various agents are conjugated to monoclonal antibodies which are specific for colon cancer cells. The conjugates are administered to patients having colon cancer such that the effects of the cancer are reduced. Excerpt(s): This invention relates to a method of reducing the effects of colon cancer tumors, utilizing at least one monoclonal antibody. Specifically, at least one monoclonal antibody is utilized in conjunction with an anti-tumor drug, a peptide which inhibits DNA tumor activity or a radioisotope in the treatment of colorectal carcinoma. This invention further relates to a method of delivering genetic material to DNA of tumor cells and to a method of delivering anti-cancer agents to nuclei of colon tumor cells, as well as to monoclonal antibodies which are specific for A33 antigen; an antigen found on colon cancer cells. ... It is therefore an object of this invention to provide methods for reducing the effects of colon cancers. ... It is another object of this invention to provide a method of delivering genetic material to DNA of colon cancer cells. Web site: http://www.delphion.com/details?pn=US05958412__
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Patent Applications on Colon Cancer As of December 2000, U.S. patent applications are open to public viewing.32 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to colon cancer: ·
Genes expressed in colon cancer Inventor(s): Lasek, Amy W.; (Oakland, CA), Jones, David A.; (Salt Lake City, UT) Correspondence: Incyte Genomics, Inc.; 3160 Porter Drive; Palo Alto; CA; 94304; US Patent Application Number: 20020160382 Date filed: October 11, 2001 Abstract: The present invention relates to a combination comprising a plurality of cDNAs which are differentially expressed in colon cancer, or in a precancerous condition of the colon and which may be used in their entirety or in part as to diagnose, to stage to treat or to monitor the treatment of a subject with a colon cancer. Excerpt(s): The present invention relates to a combination comprising a plurality of cDNAs which are differentially expressed in colon cancer and in premalignant conditions of the colon and which may be used entirely or in part to diagnose, to stage, to treat, or to monitor the progression or treatment of colon cancer. ... The potential application of gene expression profiling is particularly relevant to improving diagnosis, prognosis, and treatment of disease. For example, both the levels and sequences expressed in tissues from subjects with colon cancer may be compared with the levels and sequences expressed in normal tissue. ... Colorectal cancer is the fourth most common cancer and the second most common cause of cancer death in the United States with approximately 130,000 new cases and 55,000 deaths per year. Colon and rectal cancers share many environmental risk factors and both are found in individuals with specific genetic syndromes. (See Potter (1999) J Natl Cancer Institute 91:916-932 for a review of colorectal cancer.) Colon cancer is the only cancer that occurs with approximately equal frequency in men and women, and the five-year survival rate following diagnosis of colon cancer is around 55% in the United States (Ries et al. (1990) National Institutes of Health, DHHS Publ No. (NIH)90-2789). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
32
This has been a common practice outside the United States prior to December 2000.
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·
Metastatic breast and colon cancer regulated genes Inventor(s): Giese, Klaus; (San Francisco, Ca), Xin, Hong; (Emeryville, CA) Correspondence: Chiron Corporation; Intellectual Property - R440; P.O. Box 8097; Emeryville; CA; 94662-8097; US Patent Application Number: 20020068278 Date filed: December 17, 1998 Abstract: Gene sequences as shown in SEQ ID NO:1-18 have been discovered and isolated, and found to be significantly associated with metastatic spread of breast and colon cancer cells to other organs. Methods are provided for determining the risk of metastasis of a breast or colon tumor, which involve determining whether a tissue sample from a tumor expresses a polypeptide encoded by a gene as shown in SEQ ID NOS:1-18, or a substantial portion thereof. One of the gene sequences encodes a novel aspartyl protease termed CSP56, which can be used to provide reagents and methods for determining which tumors are likely to metastasize and for suppressing metastases of these tumors. Clinicians can use this information to predict which tumors will metastasize to other organs and to provide relevant therapies to appropriate patients. Excerpt(s): The invention thus provides the art with a number of genes and proteins, which can be used as markers of metastasis. These are useful for more rationally prescribing the course of therapy for cancer patients, especially those with breast or colon cancer. ... It is another discovery of the present invention that a novel aspartyl-type protease, CSP56, is over-expressed in highly metastatic cancer, particularly in breast and colon cancer, and is associated with the progression of primary tumors to a metastatic state. This information can be utilized to make diagnostic reagents specific for expression products of the CSP56 gene. It can also be used in diagnostic and prognostic methods which will help clinicians to plan appropriate treatment regimes for cancers, especially of the breast and colon. ... Biological activity of a metastatic marker protein variant, including a CSP56 variant, can be readily determined by one of skill in the art. Differential expression of the variant, for example, can be measured in cell lines which vary in metastatic potential, such as the breast cancer cell lines MDA-MB-231 (Brinkley et al., Cancer Res. 40, 3118-29, 1980), MDA-MB-435 (Brinkley et al., 1980), MCF-7, BT-20, ZR-75-1, MDA-MB-157, MDA-MB-361, MDAMB-453, Alab and MDA-MB-468, or colon cancer cell lines Km12C and Km12L4A. The MDA-MB-231 cell line was deposited at the ATCC on May 15, 1998 (ATCC CRL-12532). The Km12C cell line was deposited at the ATCC on May 15, 1998 (ATCC CRL-12533). The Km12L4A cell line
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was deposited at the ATCC on March 19, 1998 (ATCC CRL-12496). The MDA-MB-435 cell line was deposited at the ATCC on Oct. 9, 1998 (ATCC CRL 12583). The MCF-7 cell line was deposited at the ATCC on Oct. 9, 1998 (ATCC CRL-12584). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Compositions and methods of diagnosing, monitoring, staging, imaging and treating colon cancer Inventor(s): Yang, Fei ; (San Diego, CA), Piderit, Alejandra ; (Concepcion, CL), Hu, Ping ; (San Ramon, CA), Recipon, Herve E. ; (San Francisco, CA), Macina, Roberto A. ; (San Jose, CA) Correspondence: Licata & Tyrrell P.C.; 66 E. Main Street; Marlton; NJ; 08053; US Patent Application Number: 20020065396 Date filed: March 26, 2001 Abstract: The present invention provides polynucleotides and polypeptides which are diagnostic markers for colon cancer. In addition, antibodies immunospecific for these markers are provided. Vectors, hosts cells and methods for producing these markers, as well as methods and tools for using these markers in detecting, diagnosing, monitoring, staging, prognosticating, imaging and treating colon cancer are also provided. Excerpt(s): This invention relates, in part, to newly identified polynucleotides and polypeptides encoded thereby, as well as methods for producing and using these polynucleotides and polypeptides. Antibodies which are immunospecific for these polypeptides are also described. Expression of the newly identified polynucleotides and levels of the polypeptides encoded thereby are upregulated in or specific to colon cancer tissue. These new polynucleotides and polypeptides, referred to herein as Colon Cancer Specific Genes or CSGs are believed to be useful in assays for detecting, diagnosing, monitoring, staging, prognosticating, imaging and treating cancers, particularly colon cancer. ... The prognosis of colon cancer is clearly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement. These two characteristics form the basis for all staging systems developed for this disease. Treatment decisions are usually made in reference to the older Duke's or the Modified AstlerColler (MAC) classification scheme for staging. ... Bowel obstruction and bowel perforation are indicators of poor prognosis in patients with colon cancer. Elevated pretreatment serum levels of carcinoembryonic antigen
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(CEA) and of carbohydrate antigen 19-9 (CA 19-9) also have a negative prognostic significance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Compositions and methods for the therapy and diagnosis of colon cancer Inventor(s): Jiang, Yuqiu ; (Kent, WA), Hepler, William T. ; (Seattle, WA), Clapper, Jonathan D. ; (Seattle, WA), Wang, Aijun ; (Issaquah, WA), Secrist, Heather ; (Seattle, WA) Correspondence: Seed Intellectual Property Law Group PLLC; 701 Fifth Ave; Suite 6300; Seattle; WA; 98104-7092; US Patent Application Number: 20020040127 Date filed: June 8, 2001 Abstract: Compositions and methods for the therapy and diagnosis of cancer, such as colon cancer, are disclosed. Compositions may comprise one or more colon tumor proteins, immunogenic portions thereof, or polynucleotides that encode such portions. Alternatively, a therapeutic composition may comprise an antigen presenting cell that expresses a colon tumor protein, or a T cell that is specific for cells expressing such a protein. Such compositions may be used, for example, for the prevention and treatment of diseases such as colon cancer. Diagnostic methods based on detecting a colon tumor protein, or mRNA encoding such a protein, in a sample are also provided. Excerpt(s): The present invention relates generally to therapy and diagnosis of cancer, such as colon cancer. The invention is more specifically related to polypeptides comprising at least a portion of a colon tumor protein, and to polynucleotides encoding such polypeptides. Such polypeptides and polynucleotides may be used in vaccines and pharmaceutical compositions for prevention and treatment of colon malignancies, and for the diagnosis and monitoring of such cancers. ... Colon cancer is the second most frequently diagnosed malignancy in the United States as well as the second most common cause of cancer death. The five-year survival rate for patients with colorectal cancer detected in an early localized stage is 92%; unfortunately, only 37% of colorectal cancer is diagnosed at this stage. The survival rate drops to 64% if the cancer is allowed to spread to adjacent organs or lymph nodes, and to 7% in patients with distant metastases. ... The prognosis of colon cancer is directly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement, consequently early detection and treatment are especially important.
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Currently, diagnosis is aided by the use of screening assays for fecal occult blood, sigmoidoscopy, colonoscopy and double contrast barium enemas. Treatment regimens are determined by the type and stage of the cancer, and include surgery, radiation therapy and/or chemotherapy. Recurrence following surgery (the most common form of therapy) is a major problem and is often the ultimate cause of death. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method of detecting colon cancer Inventor(s): Pant, Keshab D.; (Perris, CA), McCracken, John D.; (Redlands, CA), Fagoaga, Omar; (Colton, CA), Kelln, Wayne; (Loma Linda, CA), Nehlsen-Cannarella, Sandra; (Redlands, CA) Correspondence: Knobbe Martens Olson & Bear LLP; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020009760 Date filed: July 25, 2001 Abstract: An immunological assay and kit for colon cancer screening is disclosed. Fecal glycoproteins are extracted from individual samples such that immunogenicity is maintained. The purified fecal glycoproteins are reacted with antibodies to Colon and Ovarian Tumor Antigen (COTA). The mucin antigen COTA is specifically present in colorectal cancer tissue and not in normal colons. The amount of COTA in the fecal sample is determined and used to indicate the presence of colon cancer. Excerpt(s): The present invention is directed to a method for detecting colon cancer utilizing an antibody specific for a glycoprotein found in colon cancer cells. ... Colorectal cancer is among the leading causes of cancer-related morbidity and mortality in industrialized nations. The pathogenesis is related to hereditary influences, modified by the quantity and quality of dietary fat. In 1995, the American Cancer society estimated that 135,000 new cases of colon cancer were diagnosed; 71% were in the colon and 30% were in the rectum. Patients diagnosed at an early stage, prior to lymph-node spread, are potentially cured with surgery. At present, only 41% of patients are diagnosed at an early stage. The remaining cases frequently undergo peri-operative radiation and/or chemotherapy to attempt to control the metastatic spread of disease. Ultimately, 50% of patients thought to have undergone curative resections eventually develop recurrent disease. Unfortunately, 55,000 Americans die each year due to recurrent or metastatic colon or rectal cancer. The key to enhanced survival is early diagnosis. Colon and rectal cancers are often silent and slowly progressive. Most patients exhibit
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symptoms such as rectal bleeding, pain, abdominal distension or weight loss only after the disease is advanced and not surgically curable. ... Over the past 25 years, early colorectal cancer detection has been based on the fecal occult blood test (FOBT) performed annually on asymptomatic individuals. Current recommendations adapted by several healthcare organizations, including the American Cancer Society, call for fecal occult blood testing beginning at age 50, repeated annually until such time as the patient would no longer benefit from screening. A positive FOBT leads to colonoscopic examination of the bowel; an expensive and invasive procedure, with a serious complication rate of one per 5,000 examinations. Only 12% of patients with heme positive stool are diagnosed with cancer or large polyps at the time of colonoscopy. Most studies show that FOBT screening does not improve cancer-related mortality or overall survival. Compliance with occult blood testing has been poor; less than 20 percent of the population is offered or completes FOBT as recommended. If FOBT is properly done, the patient collects a fecal sample from three consecutive bowel movements. Samples are obtained while the patient adheres to dietary guidelines and avoids medications known to induce occult gastrointestinal bleeding. In reality, physicians frequently fail to instruct patients properly, patients frequently fail to adhere to protocol, and some patients find the task of collecting fecal samples difficult or unpleasant, hence compliance with annual occult blood testing is poor. Compounding the problem of compliance, the sensitivity and specificity of FOBT to detect colon cancer is poor. In eight prospective studies where hemoccult testing was followed by colonoscopy, only 41 of 159 cancers diagnosed were detected by FOBT, yielding a screening sensitivity of 26%. FOBT sensitivity for pre-cancerous polyps was also poor. Poor test specificity leads to unnecessary colonoscopy, adding considerable expense to colon cancer screening. In the University of Minnesota trial, a large prospective hemoccult screening study, test specificity was 90%, and positive predictive value was 2%. Only one colon cancer was found in every 50 test-triggered colonoscopies performed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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·
Metastatic breast and colon cancer regulated genes Inventor(s): Giese, Klaus; (Berlin, DE) Correspondence: Chiron Corporation; Intellectual Property R338; P.O. Box 8097; Emeryville; CA; 94662-8097; US Patent Application Number: 20020009739 Date filed: April 6, 2001 Abstract: Gene sequences as shown in SEQ ID NOS: 1-85 have been found to be significantly associated with metastatic potential of cancer cells, especially breast and colon cancer cells. Methods are provided for determining the risk of metastasis of a tumor, which involve determining whether a tissue sample from a tumor expresses a polypeptide encoded by a gene as shown in SEQ ID NOS: 1-85, or a substantial portion thereof. Excerpt(s): The invention thus provides the art with a number of genes and proteins, which can be used as markers of metastasis. These are useful for more rationally prescribing the course of therapy for breast or colon cancer patients. ... Some of the polynucleotides disclosed herein represent novel genes which are differentially expressed between nonmetastatic cancer cells and cancer cells which have a potential to metastasize. SEQ ID NOS: 1-63 represent novel metastatic marker genes (Table 1). SEQ ID NOS:64-85 represent known genes which have been found to be differentially expressed in metastatic relative to nonmetastatic cancer cells (Table 2). Some of the metastatic marker genes disclosed herein are expressed in metastatic cells relative to nonmetastatic cells, particularly in breast cancer cells which metastasize to bone and lung (SEQ ID NOS:1, 5, 11, 18, 20, 22, 24, 30, 33, 35, 36, 38, 45, 52, 58, 65, 66, 70, 74, 76, and 80). One metastatic marker gene (SEQ ID NO:56) is expressed in non-metastatic breast cancer cells and in colon cancer cells with low metastatic potential. Other metastatic marker genes are expressed in metastatic cancer cells, particularly in breast cancer cells which metastasize only to lung (SEQ ID NOS:2, 4, 9, 13, 14, 19, 26, 29, 3941, 48, 55, 57, 60, 63, 64, 72. 73, 82, and 83). Still other metastatic marker genes (SEQ ID NOS:3, 7, 8, 10, 12, 15-17, 21, 23, 28, 31, 34, 37, 42-44, 46, 47, 49, 61, 62, 67, 68, 75, 77-79, 81, 84, and 85) are expressed in cancer cells which do not typically metastasize, particularly in breast cancer cells. Identification of these relationships and markers permits the formulation of reagents and methods as further described below. Other metastatic marker genes, such as those which comprise a nucleotide sequence shown in SEQ ID NOS:6, 27, 32, and 54, can be used to identify cancerous tissue, particularly breast cancer tissue. ... Full-length metastatic marker proteins can be extracted, using standard biochemical methods, from metastatic marker protein-producing human cells, such as metastatic
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breast or colon cancer cells. An isolated and purified metastatic marker protein or polypeptide is separated from other compounds which normally associate with a metastatic marker protein or polypeptide in a cell, such as certain proteins, carbohydrates, lipids, or subcellular organelles. A preparation of isolated and purified metastatic marker proteins or polypeptides is at least 80% pure; preferably, the preparations are 90%, 95%, or 99% pure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with colon cancer, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “colon cancer” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on colon cancer. You can also use this procedure to view pending patent applications concerning colon cancer. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Allogeneic: Taken from different individuals of the same species. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Lipid: Fat. [NIH]
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Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Recurrence: The return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH]
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CHAPTER 6. BOOKS ON COLON CANCER Overview This chapter provides bibliographic book references relating to colon cancer. You have many options to locate books on colon cancer. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on colon cancer include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “colon cancer” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on colon cancer: ·
Cancer Screening Source: St. Louis, MO, Mosby-Year Book, Inc., 307 p., 1996.
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Contact: Mosby-Year Book, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146. Summary: Cancer Screening is a monograph that includes articles written by experts in the field of cancer screening, who present current information and bring attention to controversial issues surrounding cancer screening. The monograph is divided into two main sections preceded by a chapter titled Principles of Cancer Screening, which defines key terms associated with screening and describes measures of validity for a screening test, major principles of cancer screening, and evaluation of a proposed screening strategy. Part I, Screening for Specific Cancers, contains chapters on (1) breast cancer as an appropriate illness for screening, mammography as an appropriate screening test, casecontrol studies and randomized controlled trials, demonstration and implementation projects, and nationwide dissemination programs and policy recommendations; (2) cervical cancer epidemiology, pathogenesis, screening, prevention of invasive cervical cancer, and future directions; (3) colon and rectal cancer etiology and prevention, screening procedures, and practice and research recommendations; (4) the prostate cancer screening debate, prostate specific antigen (PSA) screening studies, and recommendations about screening for prostate cancer; (5) lung cancer presentation, staging, treatment outcome, epidemiology, biology, genetic changes, historical screening studies, tumor markers, identification of high-risk groups, and prospects for screening approaches; (6) ovarian cancer epidemiology, efficacy of screening, genetics, molecular biology and ovarian cancer screening, and primary care guidelines; (7) skin cancer and melanoma epidemiology, definitions, screening efficacy, education, prevention and early detection activities in Europe, primary prevention, screening program pitfalls, identification of high-risk populations, skin screening, molecular biology and skin screening, guidelines for primary care, financial health policy, and outlook for the future; and (8) miscellaneous tumors associated with other cancers. Part II, General Considerations in Cancer Screening, contains chapters on (1) molecular screening and the prevention of colon cancer, (2) breast cancer genetics, (3) adherence to cancer screening, (4) issues in developing a cancer screening program, and (5) legislative efforts to fund cancer screening. ·
Cancer Control Makes Sense Source: Austin, TX, Texas Department of Health, Chronic Disease Prevention Program, 43 p., 1989. Contact: Texas Department of Health, Chronic Disease Prevention Program, 1100 West 49th Street, Austin, TX 78756. (512) 458-7534.
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Summary: Cancer Control Makes Sense, a booklet addressing cancer problems in Texas, was developed by the Texas Department of Health. Statistics, graphs, charts, and maps illustrate cancer prevalence in Texas. The booklet addresses lung cancer, breast cancer, cervical cancer, and colon cancer. Discussion of each cancer includes ethnic and regional variations and risk factors. The booklet provides recommended actions to reduce cancer rates. ·
Our Health, Our Lives: A Revolutionary Approach to Total Health Care for Women Source: New York, NY: Pocket Books. 1995. 448 p. Contact: Available from Pocket Books. 1230 Sixth Avenue, New York, NY 10020. (800) 223-2336. Price: $24. ISBN: 0671880853. Summary: In this book, the author demonstrates how medicine can function to serve women's needs and shows women how to help start that process in their own lives. Eighteen chapters are presented in four sections: the woman-centered approach; total health in context; women's life cycles; and mind and body together. Topics include becoming one's own health advocation; how the female body works; risk factors for heart disease; women's cancer; diabetes; preventing osteoporosis; bladder conditions; fatigue and the immune system; the patterns in women's lives; pregnancy and beyond; the menopause years; the emotionally healthy woman; healthy sexuality; eating problems; and substance addictions. Specific topics that address digestive diseases include risk factors for colon cancer; nutrition, including fats and fiber; eating disorders; appendicitis; cholesterol; dietary calcium; depression and the immune system; dieting and weight loss; eating habits; gallbladder disease; pregnancy and the gastrointestinal system; systemic lupus erythematosus; obesity; and vitamins. A detailed subject index concludes the book.
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “colon cancer” (or synonyms) into the search box, and select “books only.” From
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there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:33 ·
Adjuvant therapy for colon and rectum cancer: January 1985 through April 1990: 491 citations. Author: prepared by Karen Patrias, J. Michael Hamilton; Year: 1990; Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section; Washington, D.C.: Sold by the Supt. of Docs., U.S. G.P.O., [1990]
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Atlas of selective sentinal lymphadenectomy for melanoma, breast cancer, and colon cancer. Author: edited by Stanley P.L. Leong; Year: 2002; Boston: Kluwer Academic Publishers, c2002; ISBN: 1402070136 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1402070136/icongroupin terna
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Calcium, vitamin D, and prevention of colon cancer. Author: editors, Martin Lipkin, Harold L. Newmark, Gary Kelloff; planning committee, Charles W. Boone ... [et al.]; Year: 1991; Boca Raton: CRC Press, c1991; ISBN: 0849342643 http://www.amazon.com/exec/obidos/ASIN/0849342643/icongroupin terna
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Cancer of the colon and rectum; its diagnosis and treatment, by Fred W. Rankin ... and A. Stephens Graham ... Author: Rankin, Fred W. (Fred Wharton), 1886-; Year: 1939; Springfield, Ill., Baltimore, Md., C. C. Thomas [c1939]
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Cancer of the colon or rectum: research report. Author: National Cancer Institute; Year: 1981; [Bethesda, Md.]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, 1981
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Cancer of the colon, rectum, and anus. Author: editors, Alfred M. Cohen, Sidney J. Winawer; associate editors, Michael A. Friedman, Leonard L. Gunderson; Year: 1995; New York: McGraw-Hill, Health Professions Division, c1995; ISBN: 0070116016:
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/0070116016/icongroupin terna ·
Cell and molecular biology of colon cancer. Author: editor, Leonard H. Augenlicht; Year: 1989; Boca Raton, Fla.: CRC Press, c1989; ISBN: 0849347106 http://www.amazon.com/exec/obidos/ASIN/0849347106/icongroupin terna
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Colon & rectal cancer: a comprehensive guide for patients and families. Author: Lorraine Johnston,; Year: 2000; Beijing; Sebastopol, CA: O'Reilly, c2000; ISBN: 1565926331 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1565926331/icongroupin terna
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Colon and rectal cancer: a report by 63 Illinois hospitals on cases diagnosed in 1976-78. Author: Patrias, Karen; Year: 1988; Chicago: American Cancer Society, Illinois Division, c1988
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Colon and rectal cancer. Author: volume editor, Peter S. Edelstein; Year: 2000; New York: Wiley-Liss, c2000; ISBN: 0471351458 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0471351458/icongroupin terna
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Colon cancer: a report by 32 Illinois hospitals on 910 cases diagnosed in 1968. Author: Shamsuddin, Abulkalam M; Year: 1976; Chicago: American Cancer Society, Illinois Division, c1976
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Colon cancer cells. Author: edited by Mary Pat Moyer, George H. Poste; Year: 1990; San Diego: Academic Press, c1990; ISBN: 0125093756 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0125093756/icongroupin terna
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Colon cancer genetics. Author: edited by Patrick M. Lynch and Henry T. Lynch; Year: 1985; New York, N.Y.: Van Nostrand Reinhold, c1985; ISBN: 0442249187 http://www.amazon.com/exec/obidos/ASIN/0442249187/icongroupin terna
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Colon cancer prevention: dietary modulation of cellular and molecular mechanisms. Author: edited under the auspices of the American Institute for Cancer Research; Year: 1999; New York: Kluwer Academic/Plenum Publishers, c1999; ISBN: 0306462079 http://www.amazon.com/exec/obidos/ASIN/0306462079/icongroupin terna
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Colon cancer study: May 1991. Author: European Association for Gastroenterology and Endoscopy. Postgraduate Course (2000: Brussels,
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Belgium); Year: 1991; [Rockville, Md.?]: Physician Insurers Association of America, c1991 ·
Colon cancer. Author: edited by E. Grundmann; with contributions by H. Bünte ... [et al.]; Year: 1978; Stuttgart; New York: Fischer, 1978; ISBN: 3437105604
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Cost-effectiveness of alternative workup strategies in screening for colorectal cancer. Author: K. Brown, C. Burrows; Year: 1990; [Fairfield, Vic., Australia]: National Centre for Health Program Evaluation, [1990]
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Detection of colon lesions; first standardization conference ... sponsored by American College of Radiology, Ad Hoc Committee on Detection of Cancer of the Colon ... October 30-November 1, 1969. Author: National Conference on Colon Examinations (1st: 1969: Chicago); Year: 1973; Chicago, American College of Radiology, 1973
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Diagnostic assays for colon cancer. Author: Abulkalam M. Shamsuddin; Year: 1991; Boca Raton: CRC Press, c1991; ISBN: 0849365406 http://www.amazon.com/exec/obidos/ASIN/0849365406/icongroupin terna
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Diseases of the colon and rectum: with self-assessment workbook: ulcerative colitis, granulomatous colitis, diverticular diseases of colon, cancer of colon and rectum. Author: Him-che Yeung; Year: 1993; Rosemead, CA: Institute of Chinese Medicine, c1993; ISBN: 0963971506 http://www.amazon.com/exec/obidos/ASIN/0963971506/icongroupin terna
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Hereditary breast, ovarian, and colon cancer: proceedings of a workshop held at the Sheraton Washington Hotel, Washington, D.C., April 27-29, 1994. Author: sponsors, National Cancer Institute, National Center for Human Genome Research; scientific editors, Ruth; Year: 1995; Bethesda, MD: National Cancer Institute, 1995
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Update gastroenterology 2000: Barrett's esophagus, colon cancer, and tumor imaging: Postgraduate Course 2000, Brussels, November 25. Author: edited by R. Arnold, J.P. Galmiche; Year: 2000; Montrouge, France: John Libbey Eurotext, c2000; ISBN: 2742003460
Chapters on Colon Cancer Frequently, colon cancer will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with colon cancer, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and colon cancer using the “Detailed Search” option. Go directly to the
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following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on colon cancer: ·
Gastrointestinal Problems Including Colon Cancer Source: in Rosenfeld, J.A., ed. Women's Health in Primary Care. Baltimore, MD: Williams and Wilkins. 1997. p. 633-660. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-8555. Fax (800) 4478438. Price: $59.95 (paperback). ISBN: 0683073664. Summary: This chapter, from a book on women's health for primary care providers, reviews gastrointestinal problems in women. The chapter covers diseases of the upper GI tract, including gastroesophageal reflux disease (GERD), peptic ulcer disease, and gastric carcinoma; gallstones; liver diseases, including primary biliary cirrhosis, autoimmune liver disease, drug-induced liver disease, and alcoholic liver disease; and lower GI disease, including irritable bowel syndrome, inflammatory bowel disease, and colon cancer. For each disease, the author discusses incidence, risk factors, clinical symptoms, diagnosis, and treatment options. 1 figure. 8 tables. 90 references.
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Cancer of the Colon Source: in Pennsylvania Cancer Incidence and Mortality: 1994-1998. Harrisburg, PA, Pennsylvania Department of Health, pp. 52-59, June 2001. Contact: Pennsylvania Department of Health, Bureau of Health Statistics, 555 Walnut Street, 6th Floor, Harrisburg, PA 17101. (717) 783-2548. Internet/Email: www.health.state.pa.us/stats/. Summary: Cancer of the Colon, a chapter in Pennsylvania Cancer Incidence and Mortality: 1994-1998, presents colon cancer incidence and mortality data for Pennsylvania (PA) residents from 1989 through 1998. The data are stratified by race, sex, and county. In 1998, 7,339 cases of colon cancer were diagnosed among PA residents, the largest number of cases reported during the 10-year period. It was the third most common cancer site among both males and females, accounting for a little over 10 percent of all new cancer cases diagnosed in 1998. In 1998, 2,963 PA residents died from colon cancer, the second lowest annual rate during
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the period. Between 1989 and 1998, there were no evident trends in annual age-adjusted mortality rates among black males and black females; however, rates for white males and white females have been decreasing. The chapter also summarizes risk factors and American Cancer Society recommendations for the early detection of colon cancer. ·
Colorectal Cancer Source: in Cancer Screening: Theory and Practice. Kramer, B.S.; Gohagan, J.K.; Prorok, P.C.; eds. Marcel Dekker, Inc., New York, NY, pp. 219-265, 1999. Contact: Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016. (212) 696-9000. FAX: (212) 685-4540. Internet: http://www.dekker.com. Summary: Colorectal Cancer, a chapter in Cancer Screening: Theory and Practice, focuses on issues related to colorectal cancer screening. Colorectal cancer is the fourth most common nonskin cancer worldwide. Survival is dependent on the stage at which the cancer is detected. Lifestyle is a major determinant of colorectal cancer risk. Risk factors include (1) dietary animal fat and dairy products, (2) alcohol, (3) physical inactivity, (4) overweight, (5) not having given birth, (6) history of ulcerative colitis, and (7) family history. There is strong evidence that colon cancer develops from preexisting adenomas. A number of genes have been associated with colorectal cancer. Screening tests for colorectal cancer include (1) digital rectal examination (DRE), (2) fecal occult blood testing (FOBT), (3) sigmoidoscopy, (4) barium enema, (5) colonoscopy, and (6) genetic testing. Studies on the effectiveness of DRE have yielded inconclusive results. A major concern about FOBT is the lack of sensitivity, but mortality and followup studies on the effectiveness of FOBT have shown a 33 percent reduction in the mortality rate in those screened annually. Randomized trials and observational studies have shown the effectiveness of sigmoidoscopy. The main complication of endoscopic colorectal screening is bowel perforation. The risks are much greater for colonoscopy than for sigmoidoscopy. Endoscopic procedures are uncomfortable, and colonoscopy usually requires sedation. Models for assessing the cost-effectiveness of colorectal cancer screening are limited by a lack of knowledge about the efficiency of the tests, the appropriate interval between tests, and the appropriate age for starting and stopping screening. A comprehensive public education program is necessary to break down social taboos about bowel cancer. Screening recommendations from professional organizations are complex and overlapping, but for average-risk persons age 50, recommendations are (1) annual FOBT, (2) flexible sigmoidoscopy every 5 years, (3) double-
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contrast barium enema every 5 to 10 years, and (4) colonoscopy every 10 years. ·
Advances in Screening for Colorectal Cancer Source: in Advances in Cancer Screening. Miller, A.B.; ed. Boston, MA. Kluwer Academic Publishers, pp. 51-76, 1996. Contact: Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, MA 02061. Summary: Advances in Screening for Colorectal Cancer, a chapter in Advances in Cancer Screening, provides an overview of the scientific evidence on screening for colorectal cancer. Primary prevention of colorectal cancer remains speculative because there are few established etiologic factors. Secondary prevention through annual fecal occult blood testing (FOBT) has been shown to reduce colorectal cancer mortality. There have been four randomized controlled trials of FOBT's. The Minnesota trial is the only study to date that has published a mortality reduction. Through 13 years of followup, the Minnesota study showed a 33 percent mortality reduction. Preliminary results from a Danish trial have shown a 20 percent reduction. There are two prospective, nonrandomized controlled FOBT trials. One study, in New York City, New York, showed a 43 percent reduction and improved survival. Results from a study in France are pending. Results from case-control studies ranged from no mortality reduction to 57 percent reduction. Three types of FOBT's are (1) immunochemical, (2) hemeporphyrin, and (3) guaiac. Immunochemical tests detect only hemoglobin and globin, and are not affected by diet. Hemeporphyrin tests detect the broadest range of blood derivatives. Guaiac tests, such as Hemoccult, detect heme in any form. Screening with flexible sigmoidoscopy to detect adenomatous polyps has received considerable attention. The rationale for this test is that most cancers arise from polyps. The advantage of flexible sigmoidoscopy is direct visualization of adenomas. The disadvantage is that it is only useful for examining the distal portion of the colon. Colonoscopy has been suggested as a one-time screen during the sixth decade of life. The only test that has proven to be effective in reducing colorectal cancer mortality is Hemoccult conducted annually after age 50.
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Colon and Rectal Cancer Source: in Harvard Guide to Women's Health. Carlson, K.J.; Eisenstat, S.A.; Ziporyn, T. Harvard University Press, Cambridge, MA, pp. 160-164, 1996.
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Summary: Colon and Rectal Cancer, a chapter in The Harvard Guide to Women's Health, discusses the symptoms, evaluation, treatment, and prevention of colorectal cancer. Colorectal cancer is currently the third leading cause of cancer in the United States, although death rates have been dropping, especially among women. Explanations for the gender differences in colorectal cancer death rates include (1) differences in diet and exercise habits, (2) differences in alcohol consumption, and (3) hormonal differences. Family history is the most significant risk factor for colorectal cancer, with one in five cancers traced to a predisposing gene. Blacks have a slightly higher risk of developing and dying from colorectal cancer than people of other ethnic backgrounds. Having a prior history of adenamatous polyps or ulcerative colitis is also a risk factor. Symptoms include (1) rectal bleeding, (2) persistent changes in bowel habits, (3) marked change in stool shape or size, (4) abdominal pain, and (5) weight loss. Screening for colorectal cancer includes (1) digital rectal examination, (2) sigmoidoscopy, (3) fecal occult blood test (FOBT), (4) barium enema, and (5) colonoscopy. Treatment for colorectal cancer usually involves surgery, often followed by chemotherapy. There is no evidence that regular screening prevents colorectal cancer, but there is enough indirect evidence to lead several authorities to recommend that all people over age 40 have a rectal examination and all people over age 50 have an FOBT and sigmoidoscopic examination every 3 to 5 years. Prevention strategies include (1) diets high in fiber, (2) reduced alcohol intake, (3) exercise, (4) folic acid supplementation, and (5) aspirin. ·
Colorectal Cancer Screening in a Defined Population Source: in Advances in Cancer Control: Cancer Control Research and the Emergence of the Oncology Product Line. Engstrom, P.F.; Anderson, P.N.; Mortenson, L.E.; eds. New York, NY, Alan R. Liss, Inc., pp. 7-19, 1988. Contact: Alan R. Liss, Inc., 41 East 11th Street, New York, NY 10003. Summary: Colorectal Cancer Screening in a Defined Population, a chapter in Advances in Cancer Control: Cancer Control Research and the Emergence of the Oncology Product Line, focuses on a joint venture for the delivery of cancer-related medical care called US HEALTHCHECK. Developed in 1985, this collaboration resulted in the development of a breast and colorectal cancer screening and early detection program for members of a health maintenance organization (HMO) for Pennsylvania and New Jersey. The US HEALTHCHECK colorectal cancer screening program was intended to reduce morbidity and mortality from colorectal cancer among eligible HMO members by (1) detecting early stage cancer through fecal occult blood testing, (2) ensuring the provision of state-of-
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the-art care and treatment to target populations with positive findings, and (3) utilizing the expertise of a comprehensive cancer center to evaluate patterns of colon and rectum cancer patient management. These goals were to be achieved by integrating the US HEALTHCHECK program into an Individual Practice Association (IPA). The authors present details on participation in colorectal cancer screening programs and discuss the integration of colorectal cancer screening into primary physician practice. They explain the structure of the US HEALTHCHECK colorectal cancer screening program. The organizational structure of the IPA/HMO setting renders this model of physician practice an ideal setting for initiating Phase IV cancer control studies. The similarity of the IPA/HMO physician practice settings to those of solo and group fee-forservice practitioners suggests generalizability of programmatic methods and related clinical outcomes to non-HMO medical care delivery systems. Several aspects of the US HEALTHCHECK program are currently being evaluated, Including (1) population member initial participation, (2) member adherence, and (3) physician management and diagnosis of patients. ·
Colorectal Cancer Screening Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 189-202. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Colorectal cancer (CRC) is one of the most common malignancies in the developed world and the second leading cause of cancer-related death in the United States. Appropriate disease screening has the potential to prevent death from CRC. This chapter on colorectal cancer screening is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include the epidemiology of CRC; typical clinical presentations of CRC; factors that modify CRC risk; risk assessment and screening based on risk assessment; available screening tests, including fecal occult (hidden) blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema; the cost effectiveness of screening; compliance with CRC screening; interventions to encourage CRC screen; two common problems in CRC screening; and patient follow up after resected polyps and colon cancer. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. The authors
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conclude that growing public awareness of CRC and its impact, increasing evidence that CRC screening is a cost-effective method to decrease mortality, wide promulgation of screening recommendations, and greater willingness by insurers to reimburse costs of CRC screening may improve CRC screening rates. 1 figure. 5 tables. 16 references. ·
Screening for Colorectal Cancer Source: in Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force. Second Edition. US Preventive Services Task Force. Baltimore, MD, Williams and Wilkins, pp. 89-103, 1996. Contact: Williams and Wilkins, 351 West Camden Street, Baltimore, MD 21201-2436. Summary: Screening for Colorectal Cancer, a chapter in Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force, discusses the accuracy and effectiveness of various colorectal screening methods. The principal screening tests for detecting colorectal cancer in asymptomatic persons are the digital rectal examination, fecal occult blood test (FOBT), and sigmoidoscopy. The digital rectal examination is of limited value as a screening test because fewer than 10 percent of colorectal cancers can be palpated by the examining finger. The reported sensitivity and specificity of FOBT for detecting colorectal cancer in asymptomatic persons are 26-92 percent and 90-99 percent, respectively, while sigmoidoscopic screening in asymptomatic persons detects 1-4 cancers per 1,000 examinations. Important limitations to the effectiveness of these screenings are the ability of patients and clinicians to comply with testing and the cost of screening. The logistical difficulties and costs of performing FOBT and sigmoidoscopy on a large proportion of the U.S. population are significant, due to the limited accessibility of the tests and the high expense of performing screening and followup. Moreover, the tests have potential adverse effects that must be considered such as falsepositive results that lead to expensive and potentially harmful diagnostic procedures. The authors recommend colorectal cancer screening for all persons over age 50 years with annual FOBT, sigmoidoscopy, or both. Persons with a family history of hereditary syndromes associated with a high risk of colon cancer should be referred for diagnosis and management.
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Prevention and Control of Colorectal Cancer Source: in Cancer Prevention and Control. Greenwald, P.; Kramer, B.S.; Weed, D.L.; eds. New York, NY, Marcel Dekker, Inc., pp. 537-559, 1995. Contact: Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016.
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Summary: Prevention and Control of Colorectal Cancer, a chapter in Cancer Prevention and Control, discusses the role played by primary and secondary prevention in the control of colorectal cancer. Primary prevention involves the identification and avoidance of environmental factors related to carcinogenesis. Secondary prevention includes the identification and eradication of premalignant lesions and the early detection and treatment of cancer. The evidence that nutritional factors can promote or inhibit the development of colorectal cancer suggests that primary prevention may play an important part in the control of this disease. Researchers review the data from the United States and abroad on the relationship between colorectal cancer and colorectal adenomas and (1) dietary fat consumption; (2) fiber intake; (3) excessive caloric intake and body weight; and (4) intake of minerals, vitamins, and trace elements. Researchers conclude this section by discussing gene-nutrient interaction in colon carcinogenesis and dietary guidelines for the prevention of colon cancer. Researchers state that definitive evidence of the relationship between diet and cancer must await the results of prospective, randomized intervention studies in humans. The discussion of secondary prevention focuses on screening for average- and high-risk patients. Average- or standard-risk patients are at risk by virtue of age only and have no other associated risk factors. High-risk patients have conditions from which colorectal cancers are suspected to arise, including adenomatous polyps, familial syndromes, sporadic cancer, genetic abnormalities, and ulcerative colitis. The chapter details screening and followup guidelines for both sets of at-risk patients. Researchers suggest that primary prevention targeted to the general population may reduce the incidence of adenomas and thus reduce future colorectal cancer incidence and mortality. Secondary prevention strategies may help the general population over age 50, by detecting earlier-stage cancers or extirpating adenomas. Researchers also discuss their hopes for more sophisticated screening techniques and easily-implemented nutritional interventions. ·
Screening for Colorectal Cancer: State of the Art on Screening for Colorectal Cancer Source: in Cancer Screening. Miller, A.B.; Chamberlain, J.; Day, N.E.; Hakama, M.; Prorok, P.C.; eds. Cambridge, England, Cambridge University Press, pp. 81-138, 1991. Contact: Press Syndicate of the University of Cambridge, 40 West 20th Street, New York, NY 10011-4211. Summary: Screening for Colorectal Cancer: State of the Art on Screening for Colorectal Cancer, a section in Cancer Screening, reviews methods,
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trials, and studies associated with detection of colorectal cancer. The chapters in this section are: (1) Colon Cancer Control Study: Status and Current Issues; (2) An Update on the Nottingham Trial of Fecal Occult Blood Screening for Colorectal Carcinoma; (3) A Randomized Trial of Fecal Occult Blood Testing for Early Detection of Colorectal Cancer, Results of Screening and Rescreening of 51,325 Subjects; (4) Interim Report on a Randomized Trial of Screening for Colorectal Cancer with Hemoccult-II; (5) Case-control Evaluation of Colorectal Cancer Screening in the Federal Republic of Germany; and (6) Summary of the Discussion on Colorectal Cancer Screening. While the current trials will eventually reveal the effect of screening for occult blood in the stool on colorectal cancer mortality, no single trial will be definitive and most will require more time. Several more years of followup will also be required before the effect of adenoma removal on cancer incidence is determined. Meanwhile, screening for colorectal cancer or its precursors is not a justifiable public health policy.
General Home References In addition to references for colon cancer, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Cancer: 50 Essential Things to Do by Greg Anderson, O. Carl Simonton; Paperback - 184 pages; Revised & Updated edition (August 1999), Plume; ISBN: 0452280745; http://www.amazon.com/exec/obidos/ASIN/0452280745/icongroupinterna · Cancer Encyclopedia -- Collections of Anti-Cancer & Anti-Carcinogenic Agents, Chemicals, Drugs and Substances by John C. Bartone; Paperback (January 2002), ABBE Publishers Association of Washington, DC; ISBN: 0788326791; http://www.amazon.com/exec/obidos/ASIN/0788326791/icongroupinterna · Cancer Sourcebook: Basic Consumer Health Information About Major Forms and Stages of Cancer by Edward J. Prucha (Editor); Library Binding - 1100 pages, 3rd edition (August 1, 2000), Omnigraphics, Inc.; ISBN: 0780802276; http://www.amazon.com/exec/obidos/ASIN/0780802276/icongroupinterna · Cancer Supportive Care: A Comprehensive Guide for Patients and Their Families by Ernest H. Rosenbaum, M.D., Isadora Rosenbaum, M.A.;
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Paperback - 472 pages (November 5, 1998), Somerville House Books Limited; ISBN: 1894042115; http://www.amazon.com/exec/obidos/ASIN/1894042115/icongroupinterna · Cancer Symptom Management: Patient Self-Care Guides (Book with CD-ROM for Windows & Macintosh) by Connie Henke Yarbro (Editor), et al; CD-ROM - 264 pages, 2nd Book & CD-Rom edition (January 15, 2000), Jones & Bartlett Publishing; ISBN: 0763711675; http://www.amazon.com/exec/obidos/ASIN/0763711675/icongroupint erna · Diagnosis Cancer: Your Guide Through the First Few Months by Wendy Schlessel Harpham, Ann Bliss Pilcher (Illustrator); Paperback: 230 pages; Revised & Updated edition (November 1997), .W. Norton & Company; ISBN: 0393316912; http://www.amazon.com/exec/obidos/ASIN/0393316912/icongroupinterna · The Human Side of Cancer: Living with Hope, Coping with Uncertainty by Jimmie C. Holland, M.D., Sheldon Lewis; Paperback - 368 pages (October 2, 2001), Quill; ISBN: 006093042X; http://www.amazon.com/exec/obidos/ASIN/006093042X/icongroupinterna
Vocabulary Builder Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Calcium: A mineral found in teeth, bones, and other body tissues. [NIH] Carcinogenic: Producing carcinoma. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Immunosuppressive: responses. [NIH]
Describes the ability to lower immune system
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Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Menopause: The time of life when a woman's menstrual periods stop permanently. Also called "change of life." [NIH] Osteoporosis: A condition that is characterized by a decrease in bone mass and density, causing bones to become fragile. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proctitis: Inflammation of the rectum. [EU] PSA: Prostate-specific antigen. A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Taboo: Any negative tradition or behavior that is generally regarded as harmful to social welfare and forbidden within a cultural or social group. [NIH]
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CHAPTER 7. MULTIMEDIA ON COLON CANCER Overview Information on colon cancer can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on colon cancer. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on colon cancer is the Combined Health Information Database. You will need to limit your search to “video recording” and “colon cancer” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on colon cancer:
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Gastroenterology for the Primary Care Physician Source: Mount Laurel, NJ: CME Conference Video, Inc. 1994. (instructional package). Contact: Available from CME Conference Video, Inc. 2000 Crawford Place, Suite 100, Mount Laurel, NJ 08054. (800) 284-8433. Fax (800) 2845964. Price: $450 plus $12.25 shipping and handling (as of 1995); group practice package available. Program No. 153. Summary: This continuing education course is designed to update internists, family practitioners, and other primary care physicians on new developments in gastroenterology. The format of the course focuses on case presentations emphasizing important and evolving concepts in gastroenterology. The emphasis is on practical diagnostic and therapeutic choices and the development of cost effective management algorithms. Topics include hepatitis C, non-cardiac chest pain, psychopharmacologic approaches to acid reduction, peptic ulcer disease, Helicobacter pylori, risk factors for NSAID injury, Clostridium difficile, travelers' diarrhea, constipation in the elderly, pancreatitis, endoscopic ultrasound, gastroesophageal reflux disease, Barrett's esophagus, liver disease, GI manifestations in AIDS, esophagitis, fecal incontinence, diagnostic testing, irritable bowel syndrome, inflammatory bowel disease, drug therapy, chronic diarrhea, gallstone disease, colon cancer, cirrhosis, and ascites. The program offers 11 hours of AMA-PRA Category 1 credit. (AA-M).
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Ostomy Care Source: Toronto, Ontario: Medical Audio Visual Communications, Inc. 1993. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. P.O. Box 84548, 2336 Bloor Street West, Toronto, Ontario M6S 1TO Canada. (800) 757-4868 or (905) 602-1160. Fax (905) 602-8720. E-mail:
[email protected]. Price: $249.00 plus shipping and handling. Order number: MED052. Summary: This program is designed to train nurses aides or nursing assistants in the care of patients who have an ostomy. The program features two different patients, a young woman who undergoes an ileostomy for chronic ulcerative colitis and an older man who undergoes a sigmoid colostomy for colon cancer. The program first reviews the different types of ostomies, the reasons why a patient might need to have a temporary or permanent ostomy, and the different types of stomas that can be created (loop, double-barrel, and end stomas). The program then discusses the importance of the physician, enterostomal (ET) nurse, and
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patient working together to determine the type and placement of the stoma required and to develop the patient care plan. Peristomal skin care is always vital, regardless of the type of stoma. The program emphasizes that preoperative care and patient education will greatly increase the likelihood of success. The program then reviews the use of pouch appliances, the types of pouches (and indications for each), the use of pouch deodorant, and the need to resize the appliances as the stoma changes (this can take 6 to 8 weeks). The ET nurse is then shown changing the woman's ileostomy pouch in the hospital: gathering supplies (each is displayed), measuring the stoma, using skin barrier paste, placing the skin barrier, placing the pouch, and documenting the appearance of stoma and skin, the pouch contents, and the presence of flatus (gas). The program then shows a different home health care ET nurse helping the man with the colostomy irrigate his stoma. Again, the stoma supplies and the irrigation process are outlined and depicted. Two final sections of the video discuss the dietary restrictions that may be indicated for the ileostomy and for the colostomy and the problems that patients may encounter for which a health care provider needs to be contacted.
Bibliography: Multimedia on Colon Cancer The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in colon cancer (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on colon cancer. For more information, follow the hyperlink indicated: ·
Adjuvant therapy for colon and rectum cancer: NIH consensus development conference. Source: developed and produced for NIH by Gardiner-Caldwell SynerMed; Year: 1990; Format: Videorecording; Califon, N.J.: Gardiner-Caldwell SynerMed, c1990
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Aseptic ileocolostomy and resection of right colon for cancer. Source: by Fred W. Rankin; Year: 1939; Format: Motion picture; [S.l.: s.n., 1939]
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Can the GI prevent cancer?: colon cancer & Barrett's esophagus: recorded at DDW 1995 in San Diego. Source: AGA, American
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Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?] ·
Cancer of the colon and the barium enema examination. Source: Radiological Society of North America; Year: 1982; Format: Slide; [Chicago, Ill.]: RSNA, c1982
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Cancer of the colon and the gynecologist. Source: obstetrician/ presented by the Department of Gynecology/Obstetrics, Emory University, School of Medicine; Year: 1984; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, c1984
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Clinical aspects of genetic testing in colon cancer and GI disease: recorded at DDW 1995 in San Diego. Source: AGA, American Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?]
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Coding for ICD-9-CM: skin grafts and cancer of the colon. Source: AHA; Year: 1998; Format: Videorecording; [Chicago, Ill.]: American Hospital Association, c1998
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Colon cancer screening. Year: 1996; Format: Videorecording; Houston, TX: University of Texas Health Science Center, 1996
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Colon cancer. Source: [Bert Vogelstein]; Year: 1996; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1996]
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Colon cancer. Source: American College of Surgeons; Year: 1991; Format: Sound recording; [Chicago, Ill.]: The College, [1991]
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Colorectal cancer. Source: a presentation of Films for the Humanities & Sciences; Year: 1993; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1993
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Detection of asymptomatic colon cancer. Source: School of Medicine, University of North Carolina; Year: 1973; Format: Videorecording; Chapel Hill: The University, [1973]
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Diagnosis and management of cancer of the colon and rectum. Source: produced by Audio Productions, Inc; Year: 1966; Format: Motion picture; United States: American Cancer Society, c1966
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Diet and colon cancer. Source: sponsored by Department of Biochemistry, School of Medicine, State University of New York at Buffalo; Year: 1979; Format: Slide; [Buffalo, N.Y.]: The Department, 1979
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Extended surgery for cancer of the colon, cancer of the head and neck, and melanoma: indications and techniques. Source: American College of Surgeons; Year: 1978; Format: Sound recording; [Chicago]: The College, [1978]
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Genitourinary cancer : focus, testicular tumors. Source: Memorial Sloan-Kettering Cancer Center; Year: 1976; Format: Sound recording; [New York]: The Center, c1976
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Idealistic HMO: can good care survive the market? Source: a presentation of Films for the Humanities & Sciences; a production of Hedrick Smith Productions, Inc.; produced in association with South Carolina Educational Television; Year: 2000; Format: Videorecording; Princeton, N.J.: Films for the Humanities; Sciences, c2000
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Inherited colon cancer genes: recorded at DDW 1994 in New Orleans. Source: AGA; Year: 1994; Format: Sound recording; [Bethesda, Md.]: American Gastroenterology Association, [1994?]
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Local excision of colon cancer. Source: from the Film Library and the Clinical Congress of ACS; Year: 1995; Format: Videorecording; Boston, Mass.: Deaconess Hospital, c1995
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Management of colon and rectal cancer. Source: University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute; [produced by] MDA-TV; Year: 1977; Format: Videorecording; Houston: The Center, 1977
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Molecular basis of reducing colon cancer with aspirin: recorded at DDW 1995 in San Diego. Source: AGA; Year: 1995; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, [1995?]
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Multidisciplinary approaches for managing colon and rectum cancer. Source: Glenn D. Steele, Jr; Year: 1992; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1992
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Mutations in colon cancer: mechanisms and causes: recorded at DDW 1995 in San Diego. Source: AGA; Year: 1995; Format: Sound recording; [Bethesda, Md.]: American Gastroenterological Association, [1995?]
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Nursing management of the patient with colon cancer. Source: [presented by] Mosby; Samuel Merritt College, Studio Three Productions; Year: 1995; Format: Videorecording; [St. Louis, Mo.]: Mosby-Year Book, c1995
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Oncology update: colon cancer. Source: a co-production of the Regional Audio Visual Center and Physician Education & Development; Year: 1995; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1995
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Pelvic evisceration for sigmoid colon cancer: preserving the lower part of the rectum with excision of the bilateral internal iliac arteries and veins. Year: 1986; Format: Videorecording; Danbury, Conn.: Davis+Geck, distributors, 1986
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Rectal and colon cancer. Source: Memorial Sloan-Kettering Cancer Center; Year: 1976; Format: Sound recording; [New York]: The Center, c1976
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Role of the physician in long term care ; Chemotherapy for elderly colon cancer patients. Year: 2002; Format: Videorecording; Carrollton, TX: HSTN, c2002
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Screening for colon cancer. Source: [presented by] the Medical University of South Carolina, College of Medicine and the Health Communications Network; Year: 1993; Format: Videorecording; Charleston, S.C.: The University, c1993
Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Ascites: Abnormal buildup of fluid in the abdomen. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Esophagitis: Inflammation of the esophagus (the tube that carries food from the mouth to the stomach). [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hepatitis: Inflammation of the liver. [NIH] Ileostomy: An opening into the ileum, part of the small intestine, from the outside of the body. An ileostomy provides a new path for waste material to leave the body after part of the intestine has been removed. [NIH] Irrigation: Washing by a stream of water or other fluid. [EU] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism
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or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Veins: The vessels carrying blood toward the heart. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON COLON CANCER Overview Keeping up on the news relating to colon cancer can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on colon cancer. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover colon cancer beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on colon cancer is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “colon cancer” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
University of Pittsburgh Cancer Institute Investigators Discover Proteins Linked to Colon Cancer Summary: Pittsburgh, Oct. 8 /PRNewswire/ -- Findings published in this month's issue of Clinical Cancer Research and featured on the journal's cover, may bring researchers one-step closer to the development of tumor markers to detect colon cancer early, before it has had a chance to spread and when it is easier to cure, say researchers from the University of Pittsburgh Cancer Institute (UPCI). These tumor markers -- elevated levels of proteins or other substances in the blood, urine or tissue that indicate the presence of cancer -- also could help identify which patients with colon cancer are more likely to develop recurrent disease. In the study, Robert Getzenberg, Ph.D., senior author and associate professor of urology, pathology and pharmacology at the University of Pittsburgh and co-director, Prostate and Urologic Cancer Program, UPCI and colleagues analyzed cancerous tissue resulting from colon cancer that had spread to the liver -- the most common site for colon cancer to recur - and found three proteins present in the diseased liver tissue that were not present in normal liver tissue. The findings add to previous findings published earlier this year in the journal Cancer Research in which the same researchers identified four different proteins present in colon cancer tumor samples that were not found in normal colon tissue. "Identifying a specific and sensitive tumor marker that would allow reliable early detection of colon cancer and predict the potential for the cancer to spread or recur would be of great benefit to patients," said Dr. Getzenberg. "Early diagnosis of recurrent colon cancer is critical to effective treatment of the disease, however, colon cancer metastases are very difficult to pick up early. Thirty-five to 40 percent of all patients with colon cancer have recurrent disease and the majority of these patients cannot be cured and will eventually die."
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The researchers analyzed a subset of proteins in the cell nucleus called nuclear matrix proteins, or NMPs, to examine the cellular changes in tissue that occur as colon cancer grows. "NMPs appear to represent the earliest changes that occur in cells, which is why we wanted to look carefully at these proteins in both studies," explained Dr. Getzenberg. "In the first study, we looked at the specific NMPs present in cancerous colon tissue and in the second, we examined the NMPs present in liver metastases that had resulted from colon cancer. We found that there are several proteins present in the diseased tissue that are not present in the normal tissue, indicating that these proteins are specifically linked to the development of colon cancer." "These are promising results since microscopic changes indicative of liver metastasis are not currently detectable by conventional imaging studies," said Robert Schoen, M.D., M.P.H., study co-author and associate professor of medicine, division of gastroenterology, hepatology and nutrition, University of Pittsburgh and director, Colorectal Cancer Prevention Program, UPCI. "Carcinoembryonic antigen, or CEA, a tumor-associated glycoprotein, is the most commonly used blood test to survey patients treated for colorectal cancer for possible recurrence, but it is only somewhat useful since only half of colorectal cancers shed CEA levels sufficient for detection and often, by the time a rising CEA is detected, the tumor is too far advanced for effective re- treatment. Identifying the changes in NMPs that occur from colon cancer may be a more promising method to diagnosis the disease early, as well as a way to identify patients at greater risk for cancer recurrence." In subsequent studies, the researchers plan to develop antibodies against the identified proteins to detect their presence in tissue, serum and stool samples from patients. "By identifying patients who are more likely to experience cancer recurrence, based on the presence of specific proteins, we can potentially detect metastases earlier and target therapy more precisely and effectively to that patient," said Dr. Getzenberg. Colorectal cancer is a worldwide public health problem. In the United States, colorectal cancer accounts for 11 percent of all cancers with 147,300 new cases and 56,000 deaths estimated in 2002. For patients with advanced disease, five-year survival rates are 10-20 percent, however, when colon cancer is diagnosed at an early, localized stage, the five-year survival rate is 90 percent.
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The study was supported by a grant from the National Institutes of Health and in part by the A.v. Humboldt Foundation, Germany. Coauthors include Gisela Brunagel, M.D., Anthony J. Bauer, Ph.D., and Barbara N. Vietmeier, all of the University of Pittsburgh School of Medicine. This project exemplifies the innovative research into the cause, course and cure of cancer that will continue and expand as UPCI moves into the Hillman Cancer Center, a new 301,000 square-foot, $130 million state-ofthe- art clinical and research facility being dedicated on Oct. 9, 2002. UPCI is one of the nation's select National Cancer Institute-designated Comprehensive Cancer Centers and the only one in western Pennsylvania. UPCI investigators are world-renowned for their work in clinical and basic cancer research. For more information on UPCI, please contact the Cancer Information and Referral Service at 1-800-237-4724, or visit UPCI's Web site at http://www.upci.upmc.edu.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to colon cancer. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “colon cancer” (or synonyms). The following was recently listed in this archive for colon cancer: ·
COX-2 inhibitor prevents liver metastasis of colon cancer in mice Source: Reuters Industry Breifing Date: August 20, 2002 http://www.reuters.gov/archive/2002/08/20/business/links/20020820 scie005.html
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New pain meds treat spread of colon cancer in mice Source: Reuters Health eLine Date: August 15, 2002 http://www.reuters.gov/archive/2002/08/15/eline/links/20020815elin 008.html
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With similar treatment, blacks and whites with colon cancer fare equally well Source: Reuters Medical News Date: August 12, 2002 http://www.reuters.gov/archive/2002/08/12/professional/links/20020 812manc001.html
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Src upregulation disrupts cellular contacts, which may permit colon cancer spread Source: Reuters Medical News Date: August 08, 2002 http://www.reuters.gov/archive/2002/08/08/professional/links/20020 808scie001.html
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Overexpression of sialidase suppresses apoptosis in human colon cancer Source: Reuters Medical News Date: July 29, 2002 http://www.reuters.gov/archive/2002/07/29/professional/links/20020 729scie003.html
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Small study finds possible link between growth hormone, colon cancer Source: Reuters Industry Breifing Date: July 26, 2002 http://www.reuters.gov/archive/2002/07/26/business/links/20020726 clin014.html
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Possible link between growth hormone, colon cancer Source: Reuters Health eLine Date: July 26, 2002 http://www.reuters.gov/archive/2002/07/26/eline/links/20020726elin 007.html
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Obesity doubles colon cancer risk in young women Source: Reuters Health eLine Date: July 18, 2002 http://www.reuters.gov/archive/2002/07/18/eline/links/20020718elin 009.html
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Folate supplement may reduce colon cancer risk Source: Reuters Health eLine Date: July 18, 2002 http://www.reuters.gov/archive/2002/07/18/eline/links/20020718elin 010.html
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Recommendations on colon cancer screening updated Source: Reuters Health eLine Date: July 15, 2002 http://www.reuters.gov/archive/2002/07/15/eline/links/20020715elin 012.html
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Colorectal cancer screening urged for all men and women beginning at 50 Source: Reuters Medical News Date: July 15, 2002 http://www.reuters.gov/archive/2002/07/15/professional/links/20020 715publ003.html
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Excessive IGF-I may explain link between diet, colon cancer Source: Reuters Medical News Date: July 12, 2002 http://www.reuters.gov/archive/2002/07/12/professional/links/20020 712epid005.html
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US Senate committee OKs colon cancer screening bill Source: Reuters Health eLine Date: July 10, 2002 http://www.reuters.gov/archive/2002/07/10/eline/links/20020710elin 034.html
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Epigenomics, Mayo Clinic to develop early diagnostic for colorectal cancer Source: Reuters Industry Breifing Date: November 05, 2002 http://www.reuters.gov/archive/2002/11/05/business/links/20021105 inds013.html
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Women should start colon cancer screening at 50 Source: Reuters Health eLine Date: October 21, 2002 http://www.reuters.gov/archive/2002/10/21/eline/links/20021021elin 028.html
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Increased folate intake reduces colon cancer risk Source: Reuters Medical News Date: October 21, 2002 http://www.reuters.gov/archive/2002/10/21/professional/links/20021 021epid002.html
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Average-risk women should begin colorectal cancer screening at age 50 Source: Reuters Medical News Date: October 21, 2002 http://www.reuters.gov/archive/2002/10/21/professional/links/20021 021publ004.html
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Unique nuclear matrix proteins associated with colon cancer metastases to liver Source: Reuters Medical News Date: October 17, 2002 http://www.reuters.gov/archive/2002/10/17/professional/links/20021 017scie002.html
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US colon cancer screening rates slowly improving Source: Reuters Health eLine Date: October 01, 2002 http://www.reuters.gov/archive/2002/10/01/eline/links/20021001elin 024.html
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One bad copy of gene boosts colon cancer risk Source: Reuters Health eLine Date: September 20, 2002 http://www.reuters.gov/archive/2002/09/20/eline/links/20020920elin 020.html
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Simultaneous resection of colon cancer and liver metastases can be done safely Source: Reuters Medical News Date: September 05, 2002 http://www.reuters.gov/archive/2002/09/05/professional/links/20020 905clin014.html
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Laparoscopy may provide long-term survival benefit to colon cancer patients Source: Reuters Medical News Date: June 28, 2002 http://www.reuters.gov/archive/2002/06/28/professional/links/20020 628clin013.html
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Keyhole surgery better for colon cancer-study Source: Reuters Health eLine Date: June 28, 2002 http://www.reuters.gov/archive/2002/06/28/eline/links/20020628elin 007.html
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Sanofi completes NDA filing for colon cancer treatment Source: Reuters Industry Breifing Date: June 27, 2002 http://www.reuters.gov/archive/2002/06/27/business/links/20020627 rglt005.html
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Veggies slow spread--not start--of colon cancer Source: Reuters Health eLine Date: June 21, 2002 http://www.reuters.gov/archive/2002/06/21/eline/links/20020621elin 014.html
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Routine colon cancer screening should start at age 50 for most people Source: Reuters Medical News Date: June 05, 2002 http://www.reuters.gov/archive/2002/06/05/professional/links/20020 605publ001.html
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Colon cancer in under-50 group relatively rare Source: Reuters Health eLine Date: June 05, 2002 http://www.reuters.gov/archive/2002/06/05/eline/links/20020605elin 018.html
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Immunocytochemical stool test detects colon cancer Source: Reuters Industry Breifing Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/business/links/20020530 drgd008.html
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Colorectal cancer screen in risky patients studied Source: Reuters Health eLine Date: May 22, 2002 http://www.reuters.gov/archive/2002/05/22/eline/links/20020522elin 009.html
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Colonoscopy every 3 years recommended for patients at high risk for colon cancer Source: Reuters Medical News Date: May 20, 2002 http://www.reuters.gov/archive/2002/05/20/professional/links/20020 520clin018.html
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Vitamin D protects against colon cancer by inducing bile acid breakdown Source: Reuters Medical News Date: May 16, 2002 http://www.reuters.gov/archive/2002/05/16/professional/links/20020 516scie002.html
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Prognosis of stage B colon cancer improves with higher lymph node recovery Source: Reuters Medical News Date: May 15, 2002 http://www.reuters.gov/archive/2002/05/15/professional/links/20020 515clin012.html
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Colon cancer screening every 5 years may be OK Source: Reuters Health eLine Date: May 08, 2002 http://www.reuters.gov/archive/2002/05/08/eline/links/20020508elin 027.html
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Colon cancer is deadlier for poor blacks in US Source: Reuters Health eLine Date: April 30, 2002 http://www.reuters.gov/archive/2002/04/30/eline/links/20020430elin 018.html
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Cut bowel cancer risk by eating less, better: study Source: Reuters Health eLine Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/eline/links/20020423elin 001.html
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Colon cancer tied to later risk of other cancers Source: Reuters Health eLine Date: April 11, 2002 http://www.reuters.gov/archive/2002/04/11/eline/links/20020411elin 007.html
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Aspirin may help prevent colon cancer Source: Reuters Health eLine Date: April 08, 2002 http://www.reuters.gov/archive/2002/04/08/eline/links/20020408elin 023.html
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Genzyme Molecular Oncology licenses gene linked to colon cancer metastasis Source: Reuters Industry Breifing Date: April 03, 2002 http://www.reuters.gov/archive/2002/04/03/business/links/20020403 inds002.html
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New target for gastrointestinal cancers found Source: Reuters Health eLine Date: March 27, 2002 http://www.reuters.gov/archive/2002/03/27/eline/links/20020327elin 013.html
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Large study says calcium may cut colon cancer risk Source: Reuters Health eLine Date: March 20, 2002 http://www.reuters.gov/archive/2002/03/20/eline/links/20020320elin 030.html
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Moderate daily calcium intake seems to reduce risk of colon cancer Source: Reuters Medical News Date: March 19, 2002 http://www.reuters.gov/archive/2002/03/19/professional/links/20020 319epid005.html
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Family history of colon cancer? Folate may help Source: Reuters Health eLine Date: March 14, 2002 http://www.reuters.gov/archive/2002/03/14/eline/links/20020314elin 012.html
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Get screened for colon cancer, US officials urge Source: Reuters Health eLine Date: March 13, 2002 http://www.reuters.gov/archive/2002/03/13/eline/links/20020313elin 029.html
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UK agency rejects bowel cancer drugs, amid furor Source: Reuters Health eLine Date: March 07, 2002 http://www.reuters.gov/archive/2002/03/07/eline/links/20020307elin 033.html
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Clues on painkillers' role in slowing colon cancer Source: Reuters Health eLine Date: March 01, 2002 http://www.reuters.gov/archive/2002/03/01/eline/links/20020301elin 001.html
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British colon cancer deaths drop to 10-year low Source: Reuters Health eLine Date: March 01, 2002 http://www.reuters.gov/archive/2002/03/01/eline/links/20020301elin 028.html
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Gene may help suppress colorectal cancer Source: Reuters Health eLine Date: February 28, 2002 http://www.reuters.gov/archive/2002/02/28/eline/links/20020228elin 004.html
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Level of active TGF-beta-1 higher in colorectal cancer patients than controls Source: Reuters Medical News Date: February 27, 2002 http://www.reuters.gov/archive/2002/02/27/professional/links/20020 227clin003.html
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High incidence of second primary colorectal cancer reported Source: Reuters Medical News Date: February 18, 2002 http://www.reuters.gov/archive/2002/02/18/professional/links/20020 218epid004.html
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New stool test detects early signs of colon cancer Source: Reuters Health eLine Date: January 30, 2002 http://www.reuters.gov/archive/2002/01/30/eline/links/20020130elin 003.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
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Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “colon cancer” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “colon cancer” (or synonyms). If you know the name of a company that is relevant to colon cancer, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “colon cancer” (or synonyms).
Newsletters on Colon Cancer Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “colon cancer.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “colon cancer” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above:
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·
Health Benefits of Physical Activity Source: Physical Activity and Fitness Research Digest. 1(1):1-8, February 1993. Summary: The Health Benefits of Physical Activity is a newsletter issue that provides a simple summary of the benefits of physical activity. Section one, Disease Prevention and Treatment, lists the diseases for which regular physical activity can reduce risk, either of getting the disease or of dying from it, and describes how exercise reduces risk for these diseases. Diseases that can be prevented through physical activity include (1) heart disease, (2) stroke, (3) vascular disease, (4) high blood pressure, (5) diabetes, (6) colon cancer, (7) obesity, (8) depression, (9) back pain, and (10) osteoporosis. Physical activity has been shown to have a significant beneficial health effect on individuals suffering from depression. Section two, Health Promotion, discusses the Healthy People 2000 report and its health goals. While physical activity's contribution to quality of life and a personal sense of well-being is more difficult to document than its contribution to prevention and treatment of disease, evidence suggests that humans were designed to be physically active and that physical activity has great potential for enhancing quality of life. Section three, Physical Fitness, examines the relationship between physical activity and physical fitness. Physical fitness has been linked to injury prevention and is often an important factor in the level of body fat, which can affect disease risk. Regular physical activity has positive benefits for both good health and adequate physical fitness.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “colon cancer” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is
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updated every 3 months. The following is a typical result when searching for newsletter articles on colon cancer: ·
Inflammatory Bowel Diseases: Misery Needn't be the Norm Source: Mayo Clinic Health Letter. 19(10): 1-3. October 2001. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This health education newsletter article familiarizes readers with inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. The author describes the two types of IBD, and their incidence, symptoms, diagnosis, drug therapy, lifestyle treatments, and surgical options. The signs and symptoms of Crohn's disease and ulcerative colitis may develop gradually or suddenly and can be similar: chronic diarrhea, vomiting, abdominal cramping, blood in the stool, weight loss and fatigue, and fever in severe cases. In addition, people with Crohn's disease are more likely to develop open sores (ulcers) in their digestive tract. Blood tests and diagnostic imaging confirm the diagnoses of inflammatory bowel disease. Drug therapy is a key component of treating IBD. Although drugs do not offer a cure for IBD, they often help control the condition. Once the right drug or combination of drugs is determined, symptoms can often be reduced. Drugs can include anti-inflammatory drugs, immune modulators, and antibiotics. Lifestyle treatments include dietary management, adequate fluid intake, stress management (including the use of support groups), and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs). At least 70 percent of those patients with Crohn's disease will need at least one or more surgeries. One side bar reminds readers of the risk of colon cancer in people with IBD. 1 figure.
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Fiber Remains a Healthy Choice Source: Harvard Health Letter. 24(6): 5. April 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. E-mail:
[email protected]. Summary: This brief newsletter article considers recent evidence reported in the New England Journal of Medicine indicating that fiber, which has long been thought to protect against colon cancer, may not, in fact, prevent the disease. Harvard researchers tracked the eating habits of nearly 90,000 women over a 16 year time period. The women who reported eating the least amount of fiber (about 10 grams per day) were no more likely to develop colorectal malignancies or polyps than those
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who ate the most (about 25 grams daily). Nutrition experts recommend that people consume between 25 and 35 grams of fiber daily; the average American ingests about 13 grams per day. This study and another Harvard investigation of 47,000 men both relied on dietary information reported by the participants. Because participants may not have accurately recalled what they ate, scientists point out that the studies do not conclusively prove that fiber has no role in preventing colon cancer. The article concludes by noting that there is one thing readers can do to reduce their risk of developing colon cancer: curb the intake of animal (saturated) fats, because there is evidence that fatty meats and dairy products increase risk. ·
Update on the Epidemiology of IBD Source: Progress in Inflammatory Bowel Disease. 15(3): 1, 3-8. Fall 1994. Contact: Available from CCFA. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 932-2423 or (800) 343-3637 or (212) 685-3440. Summary: In this article, the authors summarize the information on the epidemiology of inflammatory bowel disease (IBD) that has been published in the past 5 years and place it in context for the practicing physician and IBD researcher. After a discussion of the epidemiological challenges of IBD, the authors cover incidence of ulcerative colitis (UC) and Crohn's disease; prevalence; mortality; morbidity; the geographic variation in IBD rates; race factors; gender; age factors; urban versus rural findings; ethnicity; diet as an etiologic factor; early life events in children with IBD; oral contraceptives as risk factors for Crohn's disease; cigarette smoking; passive smoking exposure; the use of nonsteroidal antiinflammatory drugs (NSAIDs); and colon cancer risk in patients with UC. The authors conclude with a brief discussion of the use of outcomes research in the future of research on the epidemiology of IBD. 55 references.
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Epidemiology and IBD: An Intriguing Conundrum Source: Foundation Focus. p. 3-5. July 1995. Contact: Available from Crohn's and Colitis Foundation of America, Inc. 386 Park Avenue South, New York, NY 10016-8804. (800) 932-2423 or (212) 685-3440. Summary: This newsletter article provides readers with basic information about the epidemiology of inflammatory bowel disease (IBD). Topics include the search for genetic risk factors for IBD; incidence; prevalence; geographic variation in IBD rates; rates of IBD in urban versus rural settings; dietary factors; early life events, such as breastfeeding and other
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perinatal factors; the role of oral contraceptives, cigarette smoking, and nonsteroidal anti-inflammatory drugs (NSAIDs); and ways to potentially reduce the colon cancer risk associated with IBD. 2 figures. ·
Link Between Plant-Based Diet and Lowered Risk for Colon Cancer Remains Clear, Convincing Source: AICR Science News. Issue 17, p.1-2. September 2000. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. www.aicr.org. Summary: This article makes the case that the media distorted two articles in the April 20, 2000, issue of the New England Journal of Medicine (NEJM) and gave many Americans misleading impressions about diet and cancer. The studies failed to find a link between recurrence of colon polyps and either low-fat, high-fiber diets featuring fruits and vegetables or diets that included high- fiber cereal supplements. The studies involved only short-term (four-year) adjustments to the diet. Colon cancer is a disease that can take decades to develop. Convincing epidemiological evidence suggests that a healthy diet has its greatest preventive effect as a lifelong commitment. Although it remains to be seen whether four years of fruits, vegetables, whole grains, and beans protect against cancer, there is ample and growing evidence that a lifetime of these foods will.
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Lifestyle Factors and Colon Cancer Risk Source: AICR Science News. Issue 17, p.2. September 2000. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. www.aicr.org. Summary: Researchers analyzed data from a population-based study to determine lifestyle patterns and their association with colon cancer. Data from 1,993 cases and 2,410 controls were grouped by factor analysis to describe various aspects of lifestyle patterns. Among both men and women, a lifestyle characterized by high levels of physical activity showed the strongest inverse association with colon cancer. Additional results from the study point to the importance of maintaining a healthy weight and eating a diet high in plant foods and low in animal products. The authors of the study believe that vigorous physical activity may be the most important component of a healthy lifestyle that decreases risk of colon cancer.
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IBS: More Common than You Think Source: University of California, Berkeley, Wellness Letter. 17(1):1-2. October 2000. Contact: Health Letter Associates. P.O. Box 412, Prince Street Station, New York, NY 10012-0007. Summary: Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder reported to primary care physicians. Its cause is unknown, although one theory is that the nerves lining the colon of IBS sufferers are more sensitive to bowel contractions, the passage of gas, and other digestive processes. No specific food is known to be responsible for the symptoms. The role of stress may be either the cause or the result of IBS. The article advises those over age 50 who develop chronic bowel problems to be tested to rule out colon cancer. Steps to take in order to avoid IBS symptoms are included in the article.
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Does Fiber Help Prevent Cancer? Source: American Institute for Cancer Research Newsletter. Issue 69, p.1,3. Fall 2000. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. Summary: This article explains the reasons behind recent headlines that announced that dietary fiber does not prevent colon cancer. Two studies published in the New England Journal of Medicine found that eating more fiber for several years did not prevent recurrence of colorectal polyps. These tiny growths may precede colorectal cancer. One of the studies tested a low-fat, high-fiber diet emphasizing vegetables and fruits while the other tested a wheat bran fiber supplement. In both of the studies, consumption of the fiber containing foods was lower than what it should have been. The American Institute for Cancer Research (AICR) recommends not abandoning a low-fat, high-fiber diet on the basis of these two studies. The AICR states that the scientific evidence linking consumption of high-fiber foods to cancer prevention is clear and convincing.
Academic Periodicals Covering Colon Cancer Academic periodicals can be a highly technical yet valuable source of information on colon cancer. We have compiled the following list of periodicals known to publish articles relating to colon cancer and which are currently indexed within the National Library of Medicine’s PubMed
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database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on colon cancer published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on colon cancer: ·
Biochemical Pharmacology. (Biochem Pharmacol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ochemical+Pharmacology&dispmax=20&dispstart=0
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Biological Chemistry. (Biol Chem) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ological+Chemistry&dispmax=20&dispstart=0
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British Journal of Cancer. (Br J Cancer) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bri tish+Journal+of+Cancer&dispmax=20&dispstart=0
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Cancer Research. (Cancer Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ca ncer+Research&dispmax=20&dispstart=0
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Clinical Nuclear Medicine. (Clin Nucl Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Nuclear+Medicine&dispmax=20&dispstart=0
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Gene Therapy. (Gene Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ge ne+Therapy&dispmax=20&dispstart=0
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Genes & Development. (Genes Dev) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ge nes+&+Development&dispmax=20&dispstart=0
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Journal of Gastroenterology. (J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology&dispmax=20&dispstart=0
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Journal of Surgical Oncology. (J Surg Oncol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Surgical+Oncology&dispmax=20&dispstart=0
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Journal of the National Cancer Institute. (J Natl Cancer Inst) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+the+National+Cancer+Institute&dispmax=20&dispstart=0
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Life Sciences. (Life Sci) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Lif e+Sciences&dispmax=20&dispstart=0
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Molecular Medicine (Cambridge, Mass. . (Mol Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M olecular+Medicine+(Cambridge,+Mass.+&dispmax=20&dispstart=0
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Preventive Medicine. (Prev Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Pr eventive+Medicine&dispmax=20&dispstart=0
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Regulatory Peptides. (Regul Pept) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Re gulatory+Peptides&dispmax=20&dispstart=0
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The Journal of Nutrition. (J Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Nutrition&dispmax=20&dispstart=0
Vocabulary Builder Epidemiological: Relating to, or involving epidemiology. [EU]
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Inflammation: A response of redness, swelling, pain, and a feeling of heat in certain areas which is meant to protect tissues affected by injury or disease. [NIH]
Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] NSAIDs: Nonsteroidal anti-inflammatory drugs. A group of drugs that decrease fever, swelling, pain, and redness. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtml
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In this chapter, we begin by reproducing one such guideline for colon cancer:
What Is Colon Cancer?34 Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of patients. Recurrence following surgery is a major problem and often is the ultimate cause of death. The prognosis of colon cancer is clearly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement. These 2 characteristics form the basis for all staging systems developed for this disease. Bowel obstruction and bowel perforation are indicators of poor prognosis.35 Elevated pretreatment serum levels of carcinoembryonic antigen (CEA) have a negative prognostic significance.36 Many other prognostic markers have been evaluated retrospectively in the prognosis of patients with colon cancer, although most, including allelic loss of chromosome 18q or thymidylate synthase expression, have not been prospectively validated.37 Microsatellite instability, also associated with hereditary nonpolyposis colon cancer, has been shown to be associated with improved survival independent of tumor stage in a population-based series of 607 patients less than 50 years of age with colorectal cancer.38 Age greater than 65 years at presentation is not a contraindication to standard therapies; acceptable morbidity and mortality, as well as long-term survival, are achieved in this
The following guidelines appeared on the NCI website on Aug. 26, 2002. The text was last modified in July 2002. The text has been adapted for this sourcebook. Note: Separate PDQ summaries on Screening for Colorectal Cancer and Prevention of Colorectal Cancer are also available. Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 35 Steinberg SM, Barkin JS, Kaplan RS, et al.: Prognostic indicators of colon tumors: the Gastrointestinal Tumor Study Group experience. Cancer 57(9): 1866-1870, 1986. 36 Filella X, Molina R, Grau JJ, et al.: Prognostic value of CA 19.9 levels in colorectal cancer. Annals of Surgery 216(1): 55-59, 1992. 37 McLeod HL, Murray GI: Tumour markers of prognosis in colorectal cancer. British Journal of Cancer 79(2): 191-203, 1999. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. New England Journal of Medicine 331(4): 213-221, 1994. Lanza G, Matteuzzi M, Gafa R, et al.: Chromosome 18q allelic loss and prognosis in stage II and III colon cancer. International Journal of Cancer 79(4): 390-395, 1998. 38 Gryfe R, Kim H, Hsieh ET, et al.: Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. New England Journal of Medicine 342(2): 69-77, 2000. 34
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patient population.39 Racial differences in overall survival after adjuvant therapy have been observed, without differences in disease-free survival, suggesting that comorbid conditions play a role in survival outcome in different patient populations.40 Because of the frequency of the disease, the identification of high-risk groups, the demonstrated slow growth of primary lesions, the better survival of patients with early-stage lesions, and the relative simplicity and accuracy of screening tests, screening for colon cancer should be a part of routine care for all adults starting at age 50 years, especially for those with first-degree relatives with colorectal cancer. There are groups that have a high incidence of colorectal cancer. These groups include those with hereditary conditions, such as familial polyposis, hereditary nonpolyposis colon cancer (HNPCC), Lynch I Syndrome, Lynch II Syndrome, and ulcerative colitis.41 Together they account for 10% to 15% of colorectal cancers. Patients with HNPCC reportedly have better prognoses in stage-stratified survival analysis than patients with sporadic colorectal cancer, but the retrospective nature of the studies and possibility of selection factors make this observation difficult to interpret.42 [Level of evidence: 3iiiA] More common conditions with an increased risk include: a personal history of colorectal cancer or adenomas, first degree family history of colorectal cancer or adenomas, and a personal history of ovarian, endometrial, or breast cancer.43 These high-risk groups account for only 23% of all colorectal cancers. Limiting screening or early cancer detection to only these high-risk groups would miss the majority of
Fitzgerald SD, Longo WE, Daniel GL, et al.: Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified? Diseases of the Colon and Rectum 36(2): 161166, 1993. Chiara S, Nobile MT, Vincenti M, et al.: Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemotherapy and Pharmacology 42(4): 336-340, 1998. Popescu RA, Norman A, Ross PJ, et al.: Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. Journal of Clinical Oncology 17(8): 2412-2418, 1999. 40 Dignam JJ, Colangelo L, Tian W, et al.: Outcomes among African-Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. Journal of the National Cancer Institute 91(22): 19331940, 1999. 41 Thorson AG, Knezetic JA, Lynch HT: A century of progress in hereditary nonpolyposis colorectal cancer (Lynch syndrome). Diseases of the Colon and Rectum 42(1): 1-9, 1999. 42 Watson P, Lin KM, Rodriguez-Bigas MA, et al.: Colorectal carcinoma survival among hereditary nonpolyposis colorectal carcinoma family members. Cancer 83(2): 259-266, 1998. 43 Ransohoff DF, Lang CA: Screening for colorectal cancer. New England Journal of Medicine 325(1): 37-41, 1991. Fuchs CS, Giovannucci EL, Colditz GA, et al.: A prospective study of family history and the risk of colorectal cancer. New England Journal of Medicine 331(25): 1669-1674, 1994. 39
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colorectal cancers.44 (Refer to the PDQ summaries on Screening for Colorectal Cancer and Prevention of Colorectal Cancer for more information.) Following treatment of colon cancer, periodic evaluations may lead to the earlier identification and management of recurrent disease.45 However, the impact of such monitoring on overall mortality of patients with recurrent colon cancer is limited by the relatively small proportion of patients in whom localized, potentially curable metastases are found. To date, there have been no large-scale randomized trials documenting the efficacy of a standard, postoperative monitoring program.46 CEA is a serum glycoprotein frequently used in the management of patients with colon cancer. A review of the use of this tumor marker suggests: that CEA is not a valuable screening test for colorectal cancer due to the large numbers of false-positive and false-negative reports; that postoperative CEA testing be restricted to patients who would be candidates for resection of liver or lung metastases; and that routine use of CEA alone for monitoring response to treatment not be recommended.47 However, the optimal regimen and frequency of followup examinations are not well defined, since the impact on patient survival is
Winawer SJ: Screening for colorectal cancer. Cancer: Principles and Practice of Oncology Updates 2(1): 1-16, 1987. 45 Martin EW, Minton JP, Carey LC: CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Annals of Surgery 202(1): 310-317, 1985. Bruinvels DJ, Stiggelbout AM, Kievit J, et al.: Follow-up of patients with colorectal cancer: a meta-analysis. Annals of Surgery 219(2): 174-182, 1994. Lautenbach E, Forde KA, Neugut AI: Benefits of colonoscopic surveillance after curative resection of colorectal cancer. Annals of Surgery 220(2): 206-211, 1994. Khoury DA, Opelka FG, Beck DE, et al.: Colon surveillance after colorectal cancer surgery. Diseases of the Colon and Rectum 39(3): 252-256, 1996. 46 Safi F, Link KH, Beger HG: Is follow-up of colorectal cancer patients worthwhile? Diseases of the Colon and Rectum 36(7): 636-644, 1993. Moertel CG, Fleming TR, Macdonald JS, et al.: An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA: Journal of the American Medical Association 270(8): 943-947, 1993. Rosen M, Chan L, Beart RW, et al.: Follow-up of colorectal cancer: a meta-analysis. Diseases of the Colon and Rectum 41(9): 1116-1126, 1998. Desch CE, Benson AB III, Smith TJ, et al.: Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Journal of Clinical Oncology 17(4): 1312-1321, 1999. Benson AB, Desch CE, Flynn PJ, et al.: 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. Journal of Clinical Oncology 18(20): 3586-3588, 2000. 47 American Society of Clinical Oncology: Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Journal of Clinical Oncology 14(10): 2843-2877, 1996. 44
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not clear and the quality of data is poor.48 New surveillance methods including CEA immunoscintigraphy49 and positron emission tomography are under clinical evaluation. Gastrointestinal stromal tumors can occur in the colon. (Refer to the PDQ summary on Adult Soft Tissue Sarcoma Treatment for more information.)
Adjuvant Therapy The current generation of large prospective randomized trials has demonstrated consistent evidence of benefit for systemic adjuvant chemotherapy employing fluorouracil (5-FU) plus either levamisole or leucovorin. In 1990, a large intergroup trial of 5-FU/levamisole reported prolonged disease-free and overall survival in patients with stage III colon cancer, compared to patients who received no treatment after surgery.50 This benefit has persisted with continued follow-up.51 The National Surgical Adjuvant Breast and Bowel Project (NSABP) then reported a trial for stage II and III patients comparing the fluorouracil/semustine/ vincristine regimen to a weekly regimen of 5-FU plus high-dose leucovorin. This demonstrated a statistically significant benefit for 5-FU/leucovorin in both overall and disease-free survival.52 Adjuvant 5-FU plus leucovorin (in different treatment schedules) was also compared to surgery alone in 4 large randomized trials that closed Rosen M, Chan L, Beart RW, et al.: Follow-up of colorectal cancer: a meta-analysis. Diseases of the Colon and Rectum 41(9): 1116-1126, 1998. Desch CE, Benson AB III, Smith TJ, et al.: Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Journal of Clinical Oncology 17(4): 1312-1321, 1999. Benson AB, Desch CE, Flynn PJ, et al.: 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. Journal of Clinical Oncology 18(20): 3586-3588, 2000. 49 Lechner P, Lind P, Goldenberg DM: Can postoperative surveillance with serial CEA immunoscintigraphy detect resectable rectal cancer recurrence and potentially improve tumor-free survival? Journal of the American College of Surgeons 191(5): 511-518, 2000. 50 Moertel CG, Fleming TR, Macdonald JS, et al.: Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. New England Journal of Medicine 322(6): 352-358, 1990. 51 Moertel CG, Fleming TR, Macdonald JS, et al.: Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Annals of Internal Medicine 122(5): 321-326, 1995. 52 Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. Journal of Clinical Oncology 11(10): 18791887, 1993. 48
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prematurely in the early 1990s when surgery alone control arms were no longer felt to represent standard care for stage III patients. Three of these trials, conducted in Canada, France, and Italy, have had their primary data pooled and analyzed together. The 3-year recurrence-free and overall survival rates were also statistically significantly improved in this analysis.53 Taken together, about 4,000 patients have participated in the positive randomized trials comparing adjuvant chemotherapy to surgery alone with a reduction in mortality of between 22% and 33%. These results are quite clear in stage III patients but uncertain in stage II patients. Adjuvant treatment of stage III colon cancer appears to be cost-effective when costs of treatment and quality-of-life measures are taken into account.54 At this time, patients with stage III (Dukes’ C) colon cancer should be considered for adjuvant therapy with 5-FU/leucovorin for 6 to 8 months.55
Advanced Disease For locally advanced disease, the role of radiation therapy with chemotherapy in colon cancer is under clinical evaluation. Palliation may be achieved in approximately 10% to 20% of patients with 5-FU. Several studies suggest an advantage when leucovorin is added to 5-FU in terms of response rate and palliation of symptoms, but not always in terms of survival.56 Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 345(8955): 939944, 1995. O’Connell M, Mailliard J, Macdonald J, et al.: An intergroup trial of intensive course 5FU and low dose leucovorin as surgical adjuvant therapy for high risk colon cancer. Proceedings of the American Society of Clinical Oncology 12: A-552, 190, 1993. 54 Brown ML, Nayfield SG, Shibley LM: Adjuvant therapy for stage III colon cancer: economics returns to research and cost-effectiveness of treatment. Journal of the National Cancer Institute 86(6): 424-430, 1994. 55 NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA: Journal of the American Medical Association 264(11): 1444-1450, 1990. Wolmark N, Rockette H, Mamounas E, et al.: Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin, and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project C-04. Journal of Clinical Oncology 17(11): 35533559, 1999. 56 Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. Erlichman C, Fine S, Wong A, et al.: A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. Journal of Clinical Oncology 6(3): 469-475, 1988. Doroshow JH, Multhauf P, Leong L, et al.: Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. Journal of Clinical Oncology 8(3): 491-501, 1990. 53
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Irinotecan (CPT-11) has been approved by the Food and Drug Administration for the treatment of patients whose tumors are refractory to 5-FU.57 Participation in clinical trials is appropriate. A number of other drugs are undergoing evaluation for the treatment of colon cancer.58 Oxaliplatin, alone or combined with 5-FU and leucovorin, has also shown activity in 5FU refractory patients.59 Some retrospective studies suggest that perioperative blood transfusions impair prognosis of patients with colorectal cancer.60 A small, singlePoon MA, O’Connell MJ, Wieand HS, et al.: Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. Journal of Clinical Oncology 9(11): 1967-1972, 1991. Valone FH, Friedman MA, Wittlinger PS, et al.: Treatment of patients with advanced colorectal carcinomas with fluorouracil alone, high-dose leucovorin plus fluorouracil, or sequential methotrexate, fluorouracil, and leucovorin: a randomized trial of the Northern California Oncology Group. Journal of Clinical Oncology 7(10): 1427-1436, 1989. Borner MM, Castiglione M, Bacchi M, et al.: The impact of adding low-dose leucovorin to monthly 5-fluorouracil in advanced colorectal carcinoma: results of a phase III trial. Annals of Oncology 9(5): 535-541, 1998. Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. Advanced Colorectal Cancer Meta-Analysis Project. Journal of Clinical Oncology 10(6): 896-903, 1992. 57 Rothenberg ML, Eckardt JR, Kuhn JG, et al.: Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. Journal of Clinical Oncology 14(4): 11281135, 1996. Conti JA, Kemeny NE, Saltz LB, et al.: Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(3): 709-715, 1996. Rougier P, Van Cutsem E, Bajetta E, et al.: Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352(9138): 1407-1412, 1998. Cunningham D, Pyrhonen S, James RD, et al.: Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138): 1413-1418, 1998. 58 Von Hoff DD: Promising new agents for treatment of patients with colorectal cancer. Seminars in Oncology 25(5, suppl 11): 47-52, 1998. 59 de Gramont A, Vignoud J, Tournigand C, et al.: Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer. European Journal of Cancer 33(2): 214-219, 1997. Bleiberg H, de Gramont A: Oxaliplatin plus 5-fluorouracil: clinical experience in patients with advanced colorectal cancer. Seminars in Oncology 25(2 suppl 5): 32-39, 1998. Cvitkovic E, Bekradda M: Oxaliplatin: a new therapeutic option in colorectal cancer. Seminars in Oncology 26(6): 647-662, 1999. Giacchetti S, Perpoint B, Zidani R, et al.: Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer. Journal of Clinical Oncology 18(1): 136-147, 2000. 60 Stephenson KR, Steinberg SM, Hughes KS, et al.: Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Annals of Surgery 208(6): 679-687, 1988.
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institution, prospective randomized trial found the need for allogeneic transfusions following resection of colorectal cancer was an independent predictor of tumor recurrence.61 This finding was not confirmed by a large, multi-institutional, prospective randomized trial which demonstrated no benefit for autologous blood transfusions when compared to allogeneic transfusions.62 Both studies established that patients who do not require any blood transfusion have a reduced risk of recurrence, but it would be premature to change transfusion procedures based on these results as other studies have not confirmed this finding.63 There are a large number of studies correlating various clinical, pathological, and molecular parameters with prognosis, but none of these parameters has been demonstrated to be as important as pathologic stage, and none yet has a major impact on choice of, or outcome from, therapy.64
Voogt PJ, Van de Velde CJ, Brand A, et al.: Perioperative blood transfusion and cancer prognosis: different effects of blood transfusion on prognosis of colon and breast cancer patients. Cancer 59(4): 836-843, 1987. 61 Heiss MM, Mempel W, Delanoff C, et al.: Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. Journal of Clinical Oncology 12(9): 1859-1867, 1994. 62 Busch OR, Hop WC, Hoynck van Papendrecht MA, et al.: Blood transfusions and prognosis in colorectal cancer. New England Journal of Medicine 328(19): 1372-1376, 1993. 63 Donohue JH, Williams S, Cha S, et al.: Perioperative blood transfusions do not affect disease recurrence of patients undergoing curative resection of colorectal carcinoma: a Mayo/North Central Cancer Treatment Group study. Journal of Clinical Oncology 13(7): 1671-1678, 1995. 64 McLeod HL, Murray GI: Tumour markers of prognosis in colorectal cancer. British Journal of Cancer 79(2): 191-203, 1999. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. New England Journal of Medicine 331(4): 213-221, 1994. Griffin MR, Bergstralh EJ, Coffey RJ, et al.: Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 60(9): 2318-2324, 1987. Johnston PG, Fisher ER, Rockette HE, et al.: The role of thymidylate synthase expression in prognosis and outcome of adjuvant chemotherapy in patients with rectal cancer. Journal of Clinical Oncology 12(12): 2640-2647, 1994. Shibata D, Reale MA, Lavin P, et al.: The DCC protein and prognosis in colorectal cancer. New England Journal of Medicine 335(23): 1727-1732, 1996. Bauer KD, Lincoln ST, Vera-Roman JM, et al.: Prognostic implications of proliferative activity and DNA aneuploidy in colonic adenocarcinomas. Laboratory Investigation 57(3): 329-335, 1987. Bauer KD, Bagwell CB, Giaretti W, et al.: Consensus review of the clinical utility of DNA flow cytometry in colorectal cancer. Cytometry 14(5): 486-491, 1993. Sun XF, Carstensen JM, Zhang H, et al.: Prognostic significance of cytoplasmic p53 oncoprotein in colorectal adenocarcinoma. Lancet 340(8832): 1369-1373, 1992. Roth JA: p53 prognostication: pardigm or paradox? Clinical Cancer Research 5(11): 3345, 1999.
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Cellular Classification Adenocarcinoma (majority of cases): ·
Mucinous (colloid) adenocarcinoma
·
Signet ring adenocarcinoma
Scirrhous tumors: ·
Neuroendocrine:65 Tumors with neuroendocrine differentiation typically have a poorer prognosis than pure adenocarcinoma variants.
Stage Information Treatment decisions should be made with reference to the TNM classification,66 rather than the older Dukes’ or the Modified Astler-Coller (MAC) classification schema. The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.67
TNM Definitions Primary tumor (T): ·
TX: Primary tumor cannot be assessed
·
T0: No evidence of primary tumor
·
Tis: Carcinoma in situ: intraepithelial or invasion of the lamina propria68
·
T1: Tumor invades submucosa
·
T2: Tumor invades muscularis propria
·
T3: Tumor invades through the muscularis propria into the subserosa, or into nonperitonealized pericolic or perirectal tissues
Saclarides TJ, Szeluga D, Staren ED: Neuroendocrine cancers of the colon and rectum: results of a ten-year experience. Diseases of the Colon and Rectum 37(7): 635-642, 1994. 66 Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 83-90. 67 Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 83-90. 68 Note: Tis includes cancer cells confined within the glandular basement membrane (intraepithelial) or lamina propria (intramucosal) with no extension through the muscularis mucosae into the submucosa. 65
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·
T4: Tumor directly invades other organs or structures, and/or perforates visceral peritoneum69
Regional lymph nodes (N): ·
NX: Regional nodes cannot be assessed
·
N0: No regional lymph node metastasis
·
N1: Metastasis in 1 to 3 regional lymph nodes
·
N2: Metastasis in 4 or more regional lymph nodes
A tumor nodule greater than 3 mm in diameter in the perirectal or pericolic fat without histologic evidence of a residual node in the nodule is classified as regional perirectal or pericolic lymph node metastasis. A tumor nodule 3 mm or less in diameter is classified in the T category as a noncontiguous extension, that is T3.70 Distant metastasis (M): ·
MX: Distant metastasis cannot be assessed
·
M0: No distant metastasis
·
M1: Distant metastasis
Stage 0 ·
Tis, N0, M0
Stage I ·
T1, N0, M0
·
T2, N0, M0
Stage II ·
T3, N0, M0
·
T4, N0, M0
Note: Direct invasion in T4 includes invasion of other segments of the colorectum by way of the serosa; for example, invasion of the sigmoid colon by a carcinoma of the cecum. 70 Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 83-90. 69
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Stage III ·
Any T, N1, M0
·
Any T, N2, M0
Stage IV ·
Any T, Any N, M1
Treatment Option Overview71 Standard treatment of colon cancer has been open surgical resection of the primary and regional lymph nodes for localized disease. The role of laparoscopic techniques72 in the treatment of colon cancer is under evaluation in a prospective randomized trial comparing laparoscopic colectomy to open colectomy.73 When resection can be performed with clear margins, patients whose tumors extend through the bowel wall and to adjacent structures have no worse prognosis than similarly staged patients without such invasion. Surgery is also curative in 20% of patients who develop resectable metastases in the liver. Many early trials of adjuvant chemotherapy failed to show a significant improvement in either overall or disease-free survival for patients receiving treatment compared to
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 72 Bokey EL, Moore JW, Chapuis PH, et al.: Morbidity and mortality following laparoscopicassisted right hemicolectomy for cancer. Diseases of the Colon and Rectum 39(10, Suppl): S24-S28, 1996. Franklin ME, Rosenthal D, Abrego-Medina D, et al.: Prospective comparison of open vs. laparoscopic colon surgery for carcinoma: five-year results. Diseases of the Colon and Rectum 39(10, Suppl): S35-S46, 1996. Fleshman JW, Nelson H, Peters WR, et al.: Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Diseases of the Colon and Rectum 39(10, Suppl): S53-S58, 1996. Marchesa P, Milsom JW, Hale JC, et al.: Intraoperative laparoscopic liver ultrasonography for staging of colorectal cancer. Diseases of the Colon and Rectum 39(10, Suppl): S73-S78, 1996. 73 Nelson H, North Central Cancer Treatment Group: NCI HIGH PRIORITY CLINICAL TRIAL --- Phase III Randomized Study of Laparoscopic-Assisted Colectomy Versus Open Colectomy for Colon Cancer (Summary Last Modified 03/2002), NCCTG-934653, clinical trial, active, 08/15/1994. 71
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concurrently randomized control patients receiving no adjuvant therapy.74 These trials employed fluorouracil (5-FU) alone or 5-FU plus semustine (methyl-CCNU). The North Central Cancer Treatment Group (NCCTG) conducted a randomized trial comparing surgical resection alone with postoperative levamisole or 5-FU/levamisole.75 [Level of evidence: 1iiA] A significant improvement in disease-free survival was observed for patients with stage III (Dukes’ C) colon cancer who received 5-FU/levamisole, but overall survival benefits were of borderline statistical significance. A survival benefit of approximately 12% (49% versus 37%) was seen in patients with stage III disease treated with 5-FU/levamisole. In a large, confirmatory intergroup trial, 5-FU/levamisole prolonged disease-free and overall survival in patients with stage III colon cancer, compared to patients who received no treatment after surgery.76 [Level of evidence: 1iiA] Levamisole alone did not confer these benefits. In 1990, a National Institutes of Health Consensus Panel recommended that adjuvant therapy with 5-FU/levamisole be considered for patients with stage III (Dukes’ C) colon cancer.77 A study comparing 5-FU and leucovorin with fluorouracil/semustine/vincristine has demonstrated a statistically significant benefit in both survival and disease-free survival for the 5FU/leucovorin arm.78 [Level of evidence: 1iiA] The National Surgical Adjuvant Breast and Bowel Project (NSABP) regimen used 5-FU at 500 Panettiere FJ, Goodman PJ, Costanzi JJ, et al.: Adjuvant therapy in large bowel adenocarcinoma: long-term results of a Southwest Oncology Group study. Journal of Clinical Oncology 6(6): 947-954, 1988. Gastrointestinal Tumor Study Group: Adjuvant therapy of colon cancer: results of a prospectively randomized trial. New England Journal of Medicine 310(12): 737-743, 1984. Higgins GA, Amadeo JH, McElhinney J, et al.: Efficacy of prolonged intermittent therapy with combined 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel: a Veterans Administration Surgical Oncology Group report. Cancer 53(1): 1-8, 1984. Buyse M, Zeleniuch-Jacquotte A, Chalmers TC: Adjuvant therapy of colorectal cancer: why we still don’t know. JAMA: Journal of the American Medical Association 259(24): 35713578, 1988. 75 Laurie JA, Moertel CG, Fleming TR, et al.: Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. Journal of Clinical Oncology 7(10): 1447-1456, 1989. 76 Moertel CG, Fleming TR, Macdonald JS, et al.: Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. New England Journal of Medicine 322(6): 352-358, 1990. 77 NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA: Journal of the American Medical Association 264(11): 1444-1450, 1990. 78 Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. Journal of Clinical Oncology 11(10): 18791887, 1993. 74
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milligrams per square meter daily and high-dose leucovorin at 500 milligrams per square meter daily, both administered every seventh day for 6 weeks out of every 8 weeks for 1 year. A controlled trial of postoperative 5FU plus leucovorin compared to surgery alone has also demonstrated a disease-free and overall survival advantage for the NCCTG regimen of 5-FU at 425 milligrams per square meter daily and low-dose leucovorin at 20 milligrams per square meter daily for 5 days repeated every 4 to 5 weeks for 6 months of chemotherapy.79 [Level of evidence: 1iiA] Investigators from the International Multicentre Pooled Analysis of Colon Cancer Trials have combined data from 3 other trials for patients with stages II and III (Dukes’ B and C) colon cancer using either no postoperative therapy or 5-FU at 370 to 400 milligrams per square meter plus intermediate-dose leucovorin at 200 milligrams per square meter daily for 5 days every 28 days for 6 cycles.80 A statistically significant improvement in disease-free and overall survival was demonstrated in all patients receiving adjuvant therapy. The NCCTG performed a trial comparing 6 months to 12 months of treatment using either 5-FU and levamisole or 5-FU, levamisole, and leucovorin for patients with stages II and III (Dukes’ B and C or MAC B2, B3, and C1-3) colon cancer.81 [Level of evidence: 1iiA] The trial showed that for equivalent survival benefit, the 5-FU plus levamisole regimen must be given for 12 months, while the 3-drug regimen could be administered over just 6 months. An intergroup trial with 4 treatment arms, including 5-FU plus levamisole, 5-FU plus low-dose leucovorin (the NCCTG regimen), 5-FU plus high-dose leucovorin (the NSABP regimen), or 5-FU plus leucovorin plus levamisole, has been reported in preliminary fashion.82 [Level of evidence: 1iiA] This study also demonstrated that 6 months of 5-FU plus leucovorin is at least as effective as 12 months of 5-FU/levamisole. The NSABP C-04 study found equivalent results in overall survival for 1 year of 5-FU plus high-dose leucovorin when compared to 1 year of 5-FU plus levamisole.83 The addition O’Connell MJ, Mailliard JA, Kahn MJ, et al.: Controlled trial of fluorouracil and low-dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer. Journal of Clinical Oncology 15(1): 246-250, 1997. 80 Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators. Journal of Clinical Oncology 17(5): 1356-1363, 1999. 81 O’Connell MJ, Laurie JA, Kahn M, et al.: Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. Journal of Clinical Oncology 16(1): 295-300, 1998. 82 Haller DG, Catalano PJ, Macdonald JS, et al.: Fluorouracil (FU), leucovorin (LV) and levamisole (LEV) adjuvant therapy for colon cancer: five-year final report of INT-0089. Proceedings of the American Society of Clinical Oncology 17: A982, 256a, 1998. 83 Wolmark N, Rockette H, Mamounas E, et al.: Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin, and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National 79
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of levamisole to 5-FU and leucovorin did not improve disease-free or overall survival. Mature data from NSABP C-05 suggest no survival benefit from the addition of interferon alfa-2a to 5-FU and high-dose leucovorin, but did note a substantial increase in grade 3 or higher toxic effects.84 Based on the outcomes of all of these trials, a recommendation was made at the 1997 American Society of Clinical Oncology meeting that any 1 of 3 regimens could be considered for postoperative treatment of patients with stage III colon cancer, all of which have resulted in a survival advantage over no postoperative chemotherapy. These include the NCCTG regimens of 5-FU and levamisole for 1 year, or 5-FU and low-dose leucovorin for 6 months, or the NSABP regimen of 5-FU and high-dose leucovorin for 6 months. At this time, there are insufficient data to determine if there is any advantage to the 3-drug combination of 5-FU and leucovorin and levamisole over any of the previously noted 2-drug regimens. There is also insufficient data to distinguish whether high-, intermediate-, or low-dose leucovorin is most advantageous as a modulator of 5-FU. Based on survival benefits from an early trial of adjuvant portal-vein 5-FU infusion in patients with colon cancer, a number of confirmatory trials were conducted.85 The preliminary results of these studies have failed to demonstrate a significant benefit for hepatic-directed adjuvant therapy in the reduction of liver recurrences.86 However, a meta-analysis has shown a modest improvement in overall survival when patients are treated with
Surgical Adjuvant Breast and Bowel Project C-04. Journal of Clinical Oncology 17(11): 35533559, 1999. 84 Wolmark N, Bryant J, Smith R, et al.: Adjuvant 5-fluorouracil and leucovorin with or without interferon alfa-2a in colon carcinoma: National Surgical Adjuvant Breast and Bowel Project protocol C-05. Journal of the National Cancer Institute 90(23): 1810-1816, 1998. 85 Taylor I, Machin D, Mullee M, et al.: A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer. British Journal of Surgery 72(5): 359-363, 1985. 86 Wolmark N, Rockette H, Wickerham DL, et al.: Adjuvant therapy of Dukes’ A, B, and C adenocarcinoma of the colon with portal-vein fluorouracil hepatic infusion: preliminary results of National Surgical Adjuvant Breast and Bowel Project Protocol C-02. Journal of Clinical Oncology 8(9): 1466-1475, 1990. Beart RW, Moertel CG, Wieand HS, et al.: Adjuvant therapy for resectable colorectal carcinoma with fluorouracil administered by portal vein infusion: a study of the Mayo Clinic and the North Central Cancer Treatment Group. Archives of Surgery 125(7): 897-901, 1990. Fielding LP, Hittinger R, Grace RH, et al.: Randomised controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectal adenocarcinoma. Lancet 340(8818): 502-506, 1992. Rougier P, Sahmoud T, Nitti D, et al.: Adjuvant portal-vein infusion of fluorouracil and heparin in colorectal cancer: a randomised trial. Lancet 351(9117): 1677-1681, 1998.
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portal-vein 5-FU infusion as compared to no postoperative therapy.87 This technique for adjuvant therapy is therefore of some historical interest and should generally not be employed because of more effective systemic adjuvant regimens administered by the more convenient peripheral intravenous route. A randomized trial by the Swiss Group for Clinical Cancer Research revealed no survival difference between systemic 5-FU versus portal-vein 5-FU infusion versus surgery alone in 769 patients with resected colon or rectal cancer.88 However, the Intergroup currently has an open trial that tests the hypothesis of perioperative systemic delivery of 5-FU chemotherapy.89 The potential value of adjuvant therapy for patients with stage II (Dukes’ B or MAC B2 or B3) colon cancer also remains a controversial issue. Investigators from the NSABP have indicated that the reduction in the risk of recurrence by adjuvant therapy in patients with stage II disease is of similar magnitude to the benefit seen in patients with stage III disease treated with adjuvant therapy, although an overall survival advantage has not been established.90 However, a randomized trial of post-operative 5-FU plus levamisole compared to surgery alone showed no survival advantage to postoperative adjuvant chemotherapy.91 A meta-analysis of 1000 stage II patients whose experience was amalgamated from a series of trials indicates a 2% advantage in disease-free survival at 5 years when adjuvant therapy treated patients treated with 5-FU/leucovorin are compared to untreated controls.92 [Level of evidence: 1iiiDi];93 Patients with stage II colon cancer Piedbois P, Buyse M, Gray R, et al.: Portal vein infusion is an effective adjuvant treatment for patients with colorectal cancer. Proceedings of the American Society of Clinical Oncology 14: A-444, 192, 1995. 88 Laffer U, Maibach R, Metzger U, et al.: Randomized trial of adjuvant perioperative chemotherapy in radically resected colorectal cancer (SAKK 40/87). Proceedings of the American Society of Clinical Oncology 17: A983, 256a, 1998. 89 Kemeny MM, Eastern Cooperative Oncology Group: Phase III Randomized Study of Curative Colon Resection With or Without Perioperative Fluorouracil in Patients with Stage IIB, IIC, or III Colon Cancer, Followed by Fluorouracil and Leucovorin Calcium for Stage IIC or III Patients (Summary Last Modified 09/2001), E-1292, clinical trial, closed, 05/19/2000. 90 Mamounas E, Wieand S, Wolmark N, et al.: Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). Journal of Clinical Oncology 17(5): 1349-1355, 1999. 91 Moertel CG, Fleming TR, Macdonald JS, et al.: Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. Journal of Clinical Oncology 13(12): 2936-2943, 1995. 92 Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators. Journal of Clinical Oncology 17(5): 1356-1363, 1999. 93 Harrington DP: The tea leaves of small trials. Journal of Clinical Oncology 17(5): 13361338, 1999. 87
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remain candidates for clinical trials in which either surgery alone or 5FU/leucovorin represents standard therapy.94 Chemotherapy trials, typically with 5-FU-based regimens, have demonstrated increased numbers of partial responses and prolongation of the time to progression of disease,95 as well as improved survival and quality of life for patients receiving chemotherapy compared to best supportive care.96 Several trials have analyzed the activity and toxic effects of various 5FU plus leucovorin regimens in patients 70 years of age or older as compared to younger patients. Similar quantitative and qualitative toxic effects of therapeutic outcomes have been observed for patients of all ages.97 [Level of evidence: 2A,C];98 [Level of evidence: 2A,C] Patients should be considered candidates for clinical trials evaluating new approaches to Colacchio TA, Cancer and Leukemia Group B: Phase III Randomized Study of Adjuvant Edrecolomab Versus No Adjuvant Therapy After Resection in Patients With Stage II Adenocarcinoma of the Colon (Summary Last Modified 05/2002), CLB-9581, clinical trial, active, 08/20/1997. Pazdur R, National Surgical Adjuvant Breast and Bowel Project: Phase III Randomized Study of Oral Uracil/Tegafur (UFT) with Leucovorin vs Fluorouracil with Leucovorin Following Resection for Stage II/III Adenocarcinoma of the Colon (Summary Last Modified 05/1999), NSABP-C-06, clinical trial, closed, 03/31/1999. Poplin EA, Southwest Oncology Group: Phase III Randomized Study of Bolus Fluorouracil and Leucovorin Calcium with Levamisole vs Continuous Infusion Fluorouracil with Levamisole as Adjuvant Therapy in Patients with High Risk Colon Cancer (Summary Last Modified 04/2000), SWOG-9415, clinical trial, closed, 12/15/1999. 95 Petrelli N, Herrera L, Rustum Y, et al.: A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma. Journal of Clinical Oncology 5(10): 1559-1565, 1987. Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. 96 Scheithauer W, Rosen H, Kornek GV, et al.: Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. British Medical Journal 306(6880): 752-755, 1993. Nordic Gastrointestinal Tumor Adjuvant Therapy Group: Expectancy or primary chemotherapy in patients with advanced asymptomatic colorectal cancer: a randomized trial. Journal of Clinical Oncology 10(6): 904-911, 1992. Buyse M, Thirion P, Carlson RW, et al.: Relation between tumour response to first-line chemotherapy and survival in advanced colorectal cancer: a meta-analysis. Lancet 356(9227): 373-378, 2000. 97 Chiara S, Nobile MT, Vincenti M, et al.: Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemotherapy and Pharmacology 42(4): 336-340, 1998. 98 Goldberg RM, Hatfield AK, Kahn M, et al.: Prospectively randomized North Central Cancer Treatment Group trial of intensive-course fluorouracil combined with the l-isomer of intravenous leucovorin, oral leucovorin, or intravenous leucovorin for the treatment of advanced colorectal cancer. Journal of Clinical Oncology 15(11) : 3320-3329, 1997. 94
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treatment.99 Irinotecan (CPT-11) is a topoisomerase-I inhibitor with a 10% to 20% partial response rate in patients with metastatic colon cancer, in patients who have received no prior chemotherapy, and in patients progressing on 5FU therapy.100 It has been approved by the Food and Drug Administration for the treatment of patients with metastatic disease that is refractory to 5FU. The designations in PDQ that treatments are “standard” or “under clinical evaluation” are not to be used as a basis for reimbursement determinations. Stage 0 Colon Cancer Stage 0 colon cancer is the most superficial of all the lesions and is limited to the mucosa without invasion of the lamina propria. Because of its superficial nature, the surgical procedure may be limited. Standard treatment options: ·
Local excision or simple polypectomy with clear margins.
·
Colon resection for larger lesions not amenable to local excision.
Stage I Colon Cancer101 Because of its localized nature, stage I has a high cure rate.
Poon MA, O’Connell MJ, Wieand HS, et al.: Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. Journal of Clinical Oncology 9(11): 1967-1972, 1991. Moertel CG: Chemotherapy for colorectal cancer. New England Journal of Medicine 330(16): 1136-1142, 1994. 100 Rothenberg ML, Eckardt JR, Kuhn JG, et al.: Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. Journal of Clinical Oncology 14(4): 11281135, 1996. Conti JA, Kemeny NE, Saltz LB, et al.: Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(3): 709-715, 1996. Rougier P, Van Cutsem E, Bajetta E, et al.: Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352(9138): 1407-1412, 1998. Cunningham D, Pyrhonen S, James RD, et al.: Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138): 1413-1418, 1998. 101 Old Staging: Dukes’ A or Modified Astler-Coller A and B1 99
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Standard treatment options: ·
Wide surgical resection and anastomosis.
Stage II Colon Cancer102 Standard treatment options: ·
Wide surgical resection and anastomosis.
·
Following surgery, patients should be considered for entry into carefully controlled clinical trials evaluating the use of systemic or regional chemotherapy,103 radiation therapy, or biologic therapy.104 Information about ongoing clinical trials is available from the NCI (http://cancer.gov/clinical_trials). Adjuvant therapy is not indicated for most patients unless they are entered into a clinical trial.
Although subgroups of patients with stage II colon cancer may be at higher than average risk for recurrence (including those with anatomic features such as tumor adherence to adjacent structures, perforation, complete obstruction, or with biologic characteristics such as aneuploidy, high S-phase analysis, or deletion of 18q),105 there is no consistent evidence that adjuvant 5-fluorouracil-based chemotherapy is associated with an overall improved survival compared with surgery alone.106 In some trials, subset analysis of adjuvant chemotherapy has demonstrated benefits in disease-free and overall survival compared with surgery alone,107 but such treatment has not Old Staging: Dukes’ B or Modified Astler-Coller B2 and B3 Pazdur R, National Surgical Adjuvant Breast and Bowel Project: Phase III Randomized Study of Oral Uracil/Tegafur (UFT) with Leucovorin vs Fluorouracil with Leucovorin Following Resection for Stage II/III Adenocarcinoma of the Colon (Summary Last Modified 05/1999), NSABP-C-06, clinical trial, closed, 03/31/1999. 104 Colacchio TA, Cancer and Leukemia Group B: Phase III Randomized Study of Adjuvant Edrecolomab Versus No Adjuvant Therapy After Resection in Patients With Stage II Adenocarcinoma of the Colon (Summary Last Modified 05/2002), CLB-9581, clinical trial, active, 08/20/1997. 105 Lanza G, Matteuzzi M, Gafa R, et al.: Chromosome 18q allelic loss and prognosis in stage II and III colon cancer. International Journal of Cancer 79(4): 390-395, 1998. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. New England Journal of Medicine 331(4): 213-221, 1994. 106 Moertel CG, Fleming TR, Macdonald JS, et al.: Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. Journal of Clinical Oncology 13(12): 2936-2943, 1995. 107 Wolmark N, Rockette H, Fisher B, et al.: The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. Journal of Clinical Oncology 11(10): 18791887, 1993. 102 103
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been considered standard for all stage II patients. Improved local control with postoperative radiation therapy has been suggested in patients with T3 and T4 tumors; an intergroup clinical trial designed to explore the role of adjuvant combined chemotherapy and radiation therapy compared with postoperative chemotherapy alone for selected patients with this high-risk stage II colon cancer was closed because of low accrual.108 However, preliminary results, published only in abstract form, have not suggested a survival advantage from routine postoperative adjuvant radiation therapy in this subgroup of patients.109 Stage III Colon Cancer110 Stage III colon cancer denotes lymph node involvement. Studies have indicated that the number of lymph nodes involved affects prognosis: patients with 1 to 3 involved nodes have a significantly better survival than those with 4 or more involved nodes. Improved local control with postoperative radiation therapy has been suggested in patients with adherence or fixation to adjacent structures.111 An Intergroup trial designed to explore the role of adjuvant combined chemotherapy and radiation therapy compared with post-operative chemotherapy alone for selected patients with stage II and III colon cancer was closed early because of low accrual. However, preliminary results, published only in abstract form, have not suggested a survival advantage from routine postoperative adjuvant
Moertel CG: Chemotherapy for colorectal cancer. New England Journal of Medicine 330(16): 1136-1142, 1994. 108 Willett CG, Fung CY, Kaufman DS, et al.: Postoperative radiation therapy for high-risk colon carcinoma. Journal of Clinical Oncology 11(6): 1112-1117, 1993. Martenson JA, North Central Cancer Treatment Group: NCI HIGH PRIORITY CLINICAL TRIAL --- Phase III Randomized Trial of Adjuvant 5-FU/LEV with vs without Radiotherapy in Patients with Completely Resected Adenocarcinoma of the Colon at High Risk of Locoregional Recurrence (Summary Last Modified 03/97), NCCTG-914652, clinical trial, closed, 12/16/1996. 109 Martenson J, Willett C, Sargent D, et al.: A phase III study of adjuvant radiation therapy (RT), 5-fluorouracil (5-FU), and levamisole (LEV) vs 5-FU and LEV in selected patients with resected high risk colon cancer: initial results of Int 0130. Proceedings of the American Society of Clinical Oncology 18: A904, 235a, 1999. 110 Old Staging: Dukes’ C or Modified Astler-Coller C1-C3. Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 111 Willett CG, Fung CY, Kaufman DS, et al.: Postoperative radiation therapy for high-risk colon carcinoma. Journal of Clinical Oncology 11(6): 1112-1117, 1993.
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radiation therapy in this subgroup of patients.112 Intraoperative electron beam radiation therapy, to the site of residual microscopic or gross residual disease following surgical extirpation, has also been reported to improve local control when combined with external beam radiation therapy and chemotherapy.113 [Level of evidence: 3iiiDi];114 (Refer to the discussion of adjuvant therapy in the treatment option overview section of this summary.) In the late 1980s, a passive immunotherapy approach to adjuvant treatment of stage III colorectal cancer demonstrated encouraging results in a single randomized trial.115 This trial compared postoperative administration of a murine monoclonal antibody to 17-1A antigen (MOAB 17-1A), a cell surface glycoprotein of uncertain function expressed on both normal and malignant epithelial cells, to surgery alone. Treated patients appeared to have a survival benefit comparable to that seen in adjuvant chemotherapy trials, with a relative reduction in mortality of 32% (95% confidence interval (CI), 851).116 [Level of evidence: 1iiA] However, the small size of this trial was associated with a wide CI for the observed benefit. Therefore, this result remains to be confirmed in ongoing trials of chemotherapy with or without MOAB 17-1A in North America and chemotherapy versus MOAB 17-1A in Europe.117 Other adjuvant immunotherapeutic approaches, including autologous tumor vaccines,118 are also under clinical evaluation. Standard treatment options: Martenson JA, Willett C, Sargent D, et al.: A phase III study of adjuvant radiation therapy (RT), 5-flourouracil (5-FU), and levamisole (LEV) vs 5-FU and LEV in selected patients with resected high risk colon cancer. Proceedings of the American Society of Clinical Oncology 18: A904, 235a, 1999. 113 Schild SE, Gunderson LL, Haddock MG, et al.: The treatment of locally advanced colon cancer. International Journal of Radiation Oncology, Biology, Physics 37(1): 51-58, 1997. 114 Valentini V, Morganti AG, De Franco A, et al.: Chemoradiation with or without intraoperative radiation therapy in patients with locally recurrent rectal carcinoma. Prognostic factors and long term outcome. Cancer 86(12): 2612-2624, 1999. 115 Riethmuller G, Holz E, Schlimok G, et al.: Monoclonal antibody therapy for resected Dukes’ C colorectal cancer: seven-year outcome of a multicenter randomized trial. Journal of Clinical Oncology 16(5): 1788-1794, 1998. 116 Riethmuller G, Holz E, Schlimok G, et al.: Monoclonal antibody therapy for resected Dukes’ C colorectal cancer: seven-year outcome of a multicenter randomized trial. Journal of Clinical Oncology 16(5): 1788-1794, 1998. 117 Pazdur R, GlaxoSmithkline: Phase III Randomized Study of Adjuvant MOAB 17-1A plus 5-FU-Based Chemotherapy vs 5-FU-Based Chemotherapy Alone for Surgically Resected Stage III Adenocarcinoma of the Colon (Summary Last Modified 08/1999), GW-157-001, clinical trial, closed, 07/06/1999. 118 Benson AB, Eastern Cooperative Oncology Group: Phase III Comparison of Adjuvant 5FU/LEV vs 5-FU/LEV plus Autologous Tumor Cell Vaccination in Patients with Potentially Curatively Resected Stage C1-3 Adenocarcinoma of the Colon (Summary Last Modified 11/94), E-1290, clinical trial, closed, 01/03/1996. 112
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·
Wide surgical resection and anastomosis. For patients who are not candidates for clinical trials, postoperative chemotherapy with fluorouracil (5-FU)/leucovorin for 6 months. 5-FU/levamisole for 12 months may also be considered, although at least 1 trial has shown this to be inferior in survival to 6 months of 5-FU plus high-dose leucovorin.119 Levamisole does not appear to be a mandatory component of adjuvant therapy.120
Moertel CG, Fleming TR, Macdonald JS, et al.: Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Annals of Internal Medicine 122(5): 321-326, 1995. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA: Journal of the American Medical Association 264(11): 1444-1450, 1990. Wolmark N, National Surgical Adjuvant Breast and Bowel Project: Phase III Randomized Comparison of 5-FU/CF vs 5-FU/LEV vs 5-FU/CF/LEV as Adjuvant Therapy Following Potentially Curative Resection of Dukes’ B and C Carcinoma of the Colon (Summary Last Modified 06/89), NSABP-C-04, clinical trial, closed, 12/31/1990. Moertel CG: Chemotherapy for colorectal cancer. New England Journal of Medicine 330(16): 1136-1142, 1994. Wolmark N, Rockette H, Wickerham DL, et al.: Adjuvant therapy of Dukes’ A, B, and C adenocarcinoma of the colon with portal-vein fluorouracil hepatic infusion: preliminary results of National Surgical Adjuvant Breast and Bowel Project Protocol C-02. Journal of Clinical Oncology 8(9): 1466-1475, 1990. Beart RW, Moertel CG, Wieand HS, et al.: Adjuvant therapy for resectable colorectal carcinoma with fluorouracil administered by portal vein infusion: a study of the Mayo Clinic and the North Central Cancer Treatment Group. Archives of Surgery 125(7): 897-901, 1990. Fielding LP, Hittinger R, Grace RH, et al.: Randomised controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectal adenocarcinoma. Lancet 340(8818): 502-506, 1992. Piedbois P, Buyse M, Gray R, et al.: Portal vein infusion is an effective adjuvant treatment for patients with colorectal cancer. Proceedings of the American Society of Clinical Oncology 14: A-444, 192, 1995. Petrelli N, Herrera L, Rustum Y, et al.: A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma. Journal of Clinical Oncology 5(10): 1559-1565, 1987. 120 Wolmark N, National Surgical Adjuvant Breast and Bowel Project: Phase III Randomized Comparison of 5-FU/CF vs 5-FU/LEV vs 5-FU/CF/LEV as Adjuvant Therapy Following Potentially Curative Resection of Dukes’ B and C Carcinoma of the Colon (Summary Last Modified 06/89), NSABP-C-04, clinical trial, closed, 12/31/1990. Piedbois P, Buyse M, Gray R, et al.: Portal vein infusion is an effective adjuvant treatment for patients with colorectal cancer. Proceedings of the American Society of Clinical Oncology 14: A-444, 192, 1995. Petrelli N, Herrera L, Rustum Y, et al.: A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma. Journal of Clinical Oncology 5(10): 1559-1565, 1987. Haller DG, Eastern Cooperative Oncology Group: NCI HIGH PRIORITY CLINICAL TRIAL --- Phase III Randomized Comparison of Adjuvant Low-Dose CF/5-FU vs High-Dose CF/5119
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·
Eligible patients should be considered for entry into carefully controlled clinical trials comparing various postoperative chemotherapy regimens, postoperative radiation therapy, or biological therapy, alone or in combination.121 Information about ongoing clinical trials is available from the NCI (http://cancer.gov/clinical_trials). Stage IV Colon Cancer122
Stage IV colon cancer denotes distant metastatic disease. Local regional approaches to treating liver metastases include hepatic resection and/or intra-arterial administration of chemotherapy with implantable infusion ports or pumps. For patients with limited (3 or less) hepatic metastases, resection may be considered with 5-year survival rates of 20% to 40%.123 For those patients with hepatic metastases deemed unresectable (due to factors such as location, distribution, excessive number), cryosurgical ablation has
FU vs Low-Dose CF/5-FU/LEV vs 5-FU/LEV Following Curative Resection in Selected Patients with Dukes’ B2 and C Carcinoma of the Colon (Summary Last Modified 06/97), EST-2288, clinical trial, closed, 07/13/1992. 121 Pazdur R, GlaxoSmithkline: Phase III Randomized Study of Adjuvant MOAB 17-1A plus 5-FU-Based Chemotherapy vs 5-FU-Based Chemotherapy Alone for Surgically Resected Stage III Adenocarcinoma of the Colon (Summary Last Modified 08/1999), GW-157-001, clinical trial, closed, 07/06/1999. Rougier P, Nordlinger B: Large scale trial for adjuvant treatment in high risk resected colorectal cancers: rationale to test the combination of loco-regional and systemic chemotherapy and to compare l-leucovorin + 5-FU to levamisole + 5-FU. Annals of Oncology 4(Suppl 2): S21-S28, 1993. 122 Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 123 Scheele J, Stangl R, Altendorf-Hofmann A: Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. British Journal of Surgery 77(11): 12411246, 1990. Steele G, Bleday R, Mayer RJ, et al.: A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group protocol 6584. Journal of Clinical Oncology 9(7): 1105-1112, 1991. Scheele J, Stangl R, Altendorf-Hofmann A, et al.: Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110(1): 13-29, 1991. Pedersen IK, Burcharth F, Roikjaer O, et al.: Resection of liver metastases from colorectal cancer: indications and results. Diseases of the Colon and Rectum 37(11): 1078-1082, 1994. Harmon KE, Ryan JA Jr, Biehl TR, et al.: Benefits and safety of hepatic resection for colorectal metastases. American Journal of Surgery 177(5), 402-404, 1999. Fong Y, Cohen AM, Fortner JG, et al.: Liver resection for colorectal metastases. Journal of Clinical Oncology 15(3): 938-946, 1997.
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been associated with long-term tumor control.124 Prognostic variables that predict a favorable outcome for cryotherapy are similar to those for hepatic resection and include low preoperative carcinoembryonic antigen level, absence of extrahepatic disease, negative margin, and lymph node negative primary.125 [Level of evidence: 3iiiA] Other local ablative techniques that have been used to manage liver metastases include embolization and interstitial radiation therapy.126 Limited pulmonary metastases may also be considered for surgical resection, with 5year survival possible in highly selected patients.127 The role of additional systemic therapy after potentially curative resection of liver metastases is uncertain. A trial of hepatic arterial floxuridine plus systemic fluorouracil (5FU) plus leucovorin was shown to result in improved 2-year disease-free and overall survival (86% versus 72%, P=.03), but did not show a significant statistical difference in median survival, compared to systemic 5-FU therapy alone.128 [Level of evidence: 1iiA] Further studies are required to confirm these findings and to determine whether more effective combination chemotherapy alone may provide similar results compared to hepatic intraarterial therapy plus systemic treatment. Hepatic intra-arterial chemotherapy with floxuridine for liver metastases has produced higher overall response rates but no consistent improvement in survival when compared to systemic chemotherapy.129 Controversy
Jarnagin WR, Fong Y, Ky A, et al.: Liver resection for metastatic colorectal cancer: assessing the risk of occult irresectable disease. Journal of the American College of Surgeons 188(1): 33-42, 1999. Ravikumar TS, Kaleya R, Kishinevsky A: Surgical ablative therapy of liver tumors. Cancer: Principles and Practice of Oncology Updates 14(3): 1-12, 2000. 125 Seifert JK, Morris DL: Prognostic factors after cryotherapy for hepatic metastases from colorectal cancer. Annals of Surgery 228(2): 201-208, 1998. 126 Thomas DS, Nauta RJ, Rodgers JE, et al.: Intraoperative high-dose rate interstitial irradiation of hepatic metastases from colorectal carcinoma. Cancer 71(6): 1977-1981, 1993. Ravikumar TS: Interstitial therapies for liver tumors. Surgical Oncology Clinics of North America 5(2): 365-377, 1996. 127 Girard P, Ducreux M, Baldeyrou P, et al.: Surgery for lung metastases from colorectal cancer: analysis of prognostic factors. Journal of Clinical Oncology 14(7): 2047-2053, 1996. McAfee MK, Allen MS, Trastek VF, et al.: Colorectal lung metastases: results of surgical excision. Annals of Thoracic Surgery 53(5): 780-786, 1992. 128 Kemeny N, Huang Y, Cohen AM, et al.: Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. New England Journal of Medicine 341(27): 2039-2048, 1999. 129 Wagman LD, Kemeny MM, Leong L, et al.: A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver. Journal of Clinical Oncology 8(11): 1885-1893, 1990. 124
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regarding the efficacy of regional chemotherapy has led to initiation of a large multicenter phase III trial (CALGB-9481) of hepatic arterial infusion versus systemic chemotherapy. The use of the combination of intraarterial chemotherapy with hepatic irradiation, especially employing focal radiation of metastatic lesions, is under evaluation.130 Several studies show increased local toxic effects with hepatic infusional therapy, including liver function abnormalities and fatal biliary sclerosis. In stage IV and recurrent colon cancer, chemotherapy has been used for palliation, with 5-FU-based treatment considered to be standard.131 5-FU has been shown to be more cytotoxic, with increased response rates but with variable effects on survival, when modulated by leucovorin132 or Kemeny N, Daly J, Reichman B, et al.: Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. Annals of Internal Medicine 107(4): 459-465, 1987. Chang AE, Schneider PD, Sugarbaker PH, et al.: A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Annals of Surgery 206(6): 685-693, 1987. Rougier P, Laplanche A, Huguier M, et al.: Hepatic arterial infusion floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. Journal of Clinical Oncology 10(7): 1112-1118, 1992. Kemeny N, Cohen A, Seiter K, et al.: Randomized trial of hepatic arterial floxuridine, mitomycin, and carmustine versus floxuridine alone in previously treated patients with liver metastases from colorectal cancer. Journal of Clinical Oncology 11(2): 330-335, 1993. Meta-Analysis Group in Cancer: Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. Journal of the National Cancer Institute 88(5): 252-258, 1996. 130 McGinn CJ, Lawrence TS: Clinical results of the combination of radiation and fluoropyrimidines in the treatment of intrahepatic cancer. Seminars in Radiation Oncology 7(4): 313-323, 1997. 131 Moertel CG: Chemotherapy for colorectal cancer. New England Journal of Medicine 330(16): 1136-1142, 1994. Schmoll HJ, Buchele T, Grothey A, et al.: Where do we stand with 5-fluorouracil? Seminars in Oncology 26(6): 589-605, 1999. 132 Valone FH, Friedman MA, Wittlinger PS, et al.: Treatment of patients with advanced colorectal carcinomas with fluorouracil alone, high-dose leucovorin plus fluorouracil, or sequential methotrexate, fluorouracil, and leucovorin: a randomized trial of the Northern California Oncology Group. Journal of Clinical Oncology 7(10): 1427-1436, 1989. Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. Erlichman C, Fine S, Wong A, et al.: A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. Journal of Clinical Oncology 6(3): 469-475, 1988. Doroshow JH, Multhauf P, Leong L, et al.: Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. Journal of Clinical Oncology 8(3): 491-501, 1990.
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methotrexate.133 Randomized clinical trials show that interferon alfa appears to add toxic effects but no clinical benefit to 5-FU therapy.134 Continuousinfusion or intermittent continuous-infusion 5-FU regimens have also resulted in decreased toxic effects and in increased response rates in some studies, with a modest benefit in median survival.135 The benefits of continuous infusion 5-FU compared to bolus regimens have been summarized in a meta-analysis.136 Oral fluoropyrimidines are also being
Poon MA, O’Connell MJ, Wieand HS, et al.: Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. Journal of Clinical Oncology 9(11): 1967-1972, 1991. Buroker TR, O’Connell MJ, Wieand HS, et al.: Randomized comparison of two schedules of fluorouracil and leucovorin in the treatment of advanced colorectal cancer. Journal of Clinical Oncology 12(1): 14-20, 1994. Jager E, Heike M, Bernhard H, et al.: Weekly high-dose leucovorin versus low-dose leucovorin combined with fluorouracil in advanced colorectal cancer: results of a randomized multicenter trial. Journal of Clinical Oncology 14(8): 2274-2279, 1996. 133 The Advanced Colorectal Cancer Meta-Analysis Project: Meta-analysis of randomized trials testing the biochemical modulation of fluorouracil by methotrexate in metastatic colorectal cancer. Journal of Clinical Oncology 12(5): 960-969, 1994. Blijham G, Wagener T, Wils J, et al.: Modulation of high-dose infusional fluorouracil by lowdose methotrexate in patients with advanced or metastatic colorectal cancer: final results of a randomized European Organization for Research and Treatment of Cancer study. Journal of Clinical Oncology 14(8): 2266-2273, 1996. 134 Kosmidis PA, Tsavaris N, Skarlos D, et al.: Fluorouracil and leucovorin with or without interferon alfa-2b in advanced colorectal cancer: analysis of a prospective randomized phase III trial. Journal of Clinical Oncology 14(10): 2682-2687, 1996. Greco FA, Figlin R, York M, et al.: Phase III randomized study to compare interferon alfa-2a in combination with fluorouracil versus fluorouracil alone in patients with advanced colorectal cancer. Journal of Clinical Oncology 14(10): 2674-2681, 1996. O’Dwyer PJ, Manola J, Valone FH, et al.: Fluorouracil modulation in colorectal cancer: lack of improvement with N-phosphonoacetyl-l-aspartic acid or oral leucovorin or interferon, but enhanced therapeutic index with weekly 24-hour infusion schedule--an ECOG/CALGB study. Journal of Clinical Oncology 19(9): 2413-2421, 2001. 135 O’Dwyer PJ, Manola J, Valone FH, et al.: Fluorouracil modulation in colorectal cancer: lack of improvement with N-phosphonoacetyl-l-aspartic acid or oral leucovorin or interferon, but enhanced therapeutic index with weekly 24-hour infusion schedule--an ECOG/CALGB study. Journal of Clinical Oncology 19(9): 2413-2421, 2001. Hansen RM, Ryan L, Anderson T, et al: Phase III study of bolus versus infusion fluorouracil with or without cisplatin in advanced colorectal cancer. Journal of the National Cancer Institute 88(10): 668-674, 1996. Aranda E, Diaz-Rubio E, Cervantes A, et al.: Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with weekly high-dose 48-hour continuous-infusion fluorouracil for advanced colorectal cancer: a Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD) study. Annals of Oncology 9(7): 727-731, 1998. 136 Meta-analysis Group in Cancer: Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. Journal of Clinical Oncology 16(1): 301-308, 1998.
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evaluated in phase II-III trials.137 Oral regimens using prodrugs of 5-FU or inhibitors of dihydropyrimidine dehydrogenase (DPD) (GW 776C85) pharmacologically simulate continuous infusion and are under clinical evaluation.138 The choice of a 5-FU-based chemotherapy regimen for an individual patient should be based on known response rates and the toxic effects profile of the chosen regimen, as well as cost and quality-of-life issues.139 In a meta-analysis of 1219 patients in randomized trials where patients were assigned to receive 5-FU with or without leucovorin via either continuous infusion or bolus, neutropenia was noted in 4% of patients who received continuous infusion versus 31% of patients who received bolus and hand-foot syndrome was found in 34% of patients who received continuous infusion versus 13% of patients who received bolus. All other toxic effects were noted with similar frequency and severity, regardless of continuousinfusion or bolus administration.140 DPD is the rate-limiting enzyme in the degradation pathway for 5-FU. While genetic polymorphism commonly results in considerable individual variability in levels of this enzyme, between 0.5% and 3% of the population are severely DPD deficient. Severe mucositis, neutropenia, diarrhea, and cerebellar dysfunction can result in toxic deaths among patients who are DPD deficient. Standard testing for DPD is not widely available, but one study found that patients with a pretreatment ratio of dihydrouracil to uracil of 1.8 or less were at risk of increased 5-FU toxic effects.141 Irinotecan (CPT-11) is a topoisomerase-I inhibitor with a 10% to 20% partial response rate in patients with metastatic colon cancer, in patients who have Pazdur R: Phase II study of UFT plus leucovorin in colorectal cancer. Oncology 54(Suppl 1): 19-23, 1997. Baron MG, Feliu J, Giron CG, et al.: UFT modulated with leucovorin in advanced colorectal cancer: Oncopaz experience. Oncology 54(Suppl 1): 24-29, 1997. 138 Hoff PM, Royce M, Medgyesy D, et al.: Oral fluoropyrimidines. Seminars in Oncology 26(6): 640-646, 1999. 139 Leichman CG, Fleming TR, Muggia FM, et al.: Phase II study of fluorouracil and its modulation in advanced colorectal cancer: a Southwest Oncology Group study. Journal of Clinical Oncology 13(6): 1303-1311, 1995. 140 Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors. Meta-Analysis Group in Cancer. Journal of Clinical Oncology 16(11): 3537-3541, 1998. 141 Gamelin E, Boisdron-Celle M, Guerin-Meyer V, et al.: Correlation between uracil and dihydrouracil plasma ratio, fluorouracil (5-FU) pharmacokinetic parameters, and tolerance in patients with advanced colorectal cancer: a potential interest for predicting 5-FU toxicity and determining optimal 5-FU dosage. Journal of Clinical Oncology 17(4): 1105-1110, 1999. Morrison GB, Bastian A, Dela Rosa T, et al.: Dihydropyrimidine dehydrogenase deficiency: a pharmacogenetic defect causing severe adverse reactions to 5-fluorouracil-based chemotherapy. Oncology Nursing Forum 24(1): 83-88, 1997. Diasio RB: Clinical implications of dihydropyrimidine dehydrogenase inhibition. Oncology (Huntington NY) 13(7 suppl 3): 17-21, 1999. 137
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received no prior chemotherapy, and in patients progressing on 5-FU therapy.142 It is now considered standard therapy for patients with stage IV disease who do not respond to or progress on 5-FU.143 CPT-11 has been compared to either retreatment with 5-FU or best supportive care in a pair of randomized European trials of patients with colorectal cancer refractory to 5-FU. In both trials, there was a survival and quality-of-life advantage for patients treated with CPT-11 over 5-FU or supportive care.144 [Levels of evidence: 1iiA,1iiC];145 [Levels of evidence: 1iiA,1iiC] Two phase III prospective randomized, controlled trials were designed to evaluate the combination of 5-FU, leucovorin, and CPT-11 to 5-FU and leucovorin alone. The first of these trials compared the bolus 5-FU, leucovorin, and CPT-11 to bolus 5-FU and leucovorin alone and to CPT-11; the primary endpoint was progression-free survival.146 The trial demonstrated significant benefit in terms of confirmed response rates, timeto-tumor progression, and overall survival.147 [Level of evidence: 1iiA] The combination treatment showed confirmed responses in 39% of patients, compared with 21% in patients treated with 5-FU and leucovorin alone and 18% in patients treated with CPT-11. This benefit was highly significant in favor of the combination. In addition, time-to-tumor progression was significantly prolonged with the combination (7.0 versus 4.3 months, P=.004). Median survival was also improved with the combination; median Rothenberg ML, Eckardt JR, Kuhn JG, et al.: Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. Journal of Clinical Oncology 14(4): 11281135, 1996. Conti JA, Kemeny NE, Saltz LB, et al.: Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(3): 709-715, 1996. 143 Cunningham D, Pyrhonen S, James RD, et al.: A phase III multicenter randomized study of CPT-11 versus supportive care (SC) alone in patients (Pts) with 5FU-resistant metastatic colorectal cancer (MCRC). Proceedings of the American Society of Clinical Oncology 17: A1, 1a, 1998. 144 Rougier P, Van Cutsem E, Bajetta E, et al.: Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352(9138): 1407-1412, 1998. 145 Cunningham D, Pyrhonen S, James RD, et al.: Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138): 1413-1418, 1998. 146 Saltz LB, Cox JV, et al. for the Irinotecan Study Group: Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. New England Journal of Medicine 343(13): 905914, 2000. 147 Saltz LB, Cox JV, et al. for the Irinotecan Study Group: Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. New England Journal of Medicine 343(13): 905914, 2000. 142
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survival was 14.8 months for patients on the combination arm and 12.6 months for patients on the 5-FU and leucovorin arm (P=.042). The second pivotal trial of combination chemotherapy with CPT-11 compared 2 different regimens of infusional 5-FU and folinic acid (either the AIO [Arbeitsgemeinschaft Internische Onkologie] or the deGramont regimen).148 Either weekly or biweekly CPT-11 was administered according to the schedule of the infusional 5-FU. This trial also demonstrated improvements in response rate, time-to-tumor progression, and median survival. For the most important endpoint, median survival, the combination arm was associated with a median survival of 17.4 months, compared with 14.1 months for the 5-FU and folinic acid arm (P=.032).149 [Level of evidence: 1iiA] A combined analysis of the survival advantages seen in these 2 trials was presented at the 2000 American Society of Clinical Oncology meeting.150 The combined survival for the combination of CPT-11, 5-FU, and leucovorin was 15.9 months, compared to 13.3 months for the non-CPT-11 regimen (P=.003). This represents a survival hazard ratio of 0.79. Another drug, Tomudex, is a specific thymidylate synthase inhibitor which has demonstrated activity similar to that of bolus 5-FU and leucovorin.151 [Level of evidence: 1iiA];152 A number of other drugs are undergoing evaluation for the treatment of colon cancer.153 Capecitabine, an oral fluoropyrimidine carbamate, has been compared to 5FU plus leucovorin in a phase III study.154 The drug has a response rate Douillard JY, Cunningham D, Roth AD, et al.: Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209): 1041-1047, 2000. 149 Douillard JY, Cunningham D, Roth AD, et al.: Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209): 1041-1047, 2000. 150 Saltz LB, Douillard J, Pirotta N, et al.: Combined analysis of two phase III randomized trials comparing irinotecan (C), fluorouracil (F), leucovorin (L) vs F alone as first-line therapy of previously untreated metastatic colorectal cancer (MCRC). Proceedings of the American Society of Clinical Oncology 19: A938, 242a, 2000. 151 Cunningham D: Mature results from three large controlled studies with raltitrexed (‘Tomudex’). British Journal of Cancer 77(Suppl 2): 15-21, 1998. 152 Cocconi G, Cunningham D, Van Cutsem E, et al.: Open, randomized, multicenter trial of raltitrexed versus fluorouracil plus high-dose leucovorin in patients with advanced colorectal cancer. Journal of Clinical Oncology 16(9): 2943-2952, 1998. 153 Von Hoff DD: Promising new agents for treatment of patients with colorectal cancer. Seminars in Oncology 25(5, suppl 11): 47-52, 1998. 154 Hoff PM, Ansari R, Batist G, et al.: Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. Journal of Clinical Oncology 19(8): 22822292, 2001. 148
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higher than 5-FU plus leucovorin in metastatic colon cancer, although survival, duration of response, and time-to-disease progression were similar in the 2 treatment arms. Toxic effects were less in the capecitabine group. There was less stomatitis, nausea, and neutropenia with neutropenic fever. In the capecitabine group, hand-foot syndrome was more frequent and severe diarrhea requiring hospitalization was increased. Drug doses of capecitabine used in the study were high, which may account for its toxic effects. It may serve to substitute for 5-FU plus leucovorin as a less toxic single agent or in combinations.155 [Level of evidence: 1iiDiii] Oxaliplatin, alone or combined with 5-FU and leucovorin, has shown promising activity in previously treated and untreated patients with metastatic colorectal cancer and in patients with 5-FU refractory disease.156 One multicenter trial reported a response rate of 21%, a median progressionfree survival of 5 months, and a median survival of 11 months.157 Overall survival from the start of first-line chemotherapy was 19 months. In this trial, oxaliplatin was given first, followed by 48-hour infusion of 5-FU, with short leucovorin infusion. The data and safety monitoring committees of the cooperative groups conducting studies comparing the value of 5-FU/leucovorin/CPT-11 to 5FU/leucovorin in the adjuvant setting and to 5-FU/leucovorin/oxaliplatin or oxaliplatin/CPT-11 in the advanced disease setting have suspended accrual to these trials due to an unexpectedly high death rate on the 5FU/leucovorin/CPT-11 arms.158 This 3 drug regimen appears to be more Hoff PM, Ansari R, Batist G, et al.: Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. Journal of Clinical Oncology 19(8): 22822292, 2001. 156 de Gramont A, Vignoud J, Tournigand C, et al.: Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer. European Journal of Cancer 33(2): 214-219, 1997. Bleiberg H, de Gramont A: Oxaliplatin plus 5-fluorouracil: clinical experience in patients with advanced colorectal cancer. Seminars in Oncology 25(2 suppl 5): 32-39, 1998. Giacchetti S, Perpoint B, Zidani R, et al.: Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer. Journal of Clinical Oncology 18(1): 136-147, 2000. Cvitkovic E, Bekradda M: Oxaliplatin: a new therapeutic option in colorectal cancer. Seminars in Oncology 26(6): 647-662, 1999. 157 Andre T, Bensmaine MA, Louvet C, et al.: Multicenter phase II study of bimonthly highdose leucovorin, fluorouracil infusion, and oxaliplatin for metastatic colorectal cancer resistant to the same leucovorin and fluorouracil regimen. Journal of Clinical Oncology 17(11): 3560-3568, 1999. 158 Sargent DJ, Niedzwiecki D, O’Connell MJ, et al.: Recommendation for caution with irinotecan, fluorouracil, and leucovorin for colorectal cancer. New England Journal of Medicine 345(2): 144-145; discussion 146, 2001. 155
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toxic than initially reported. The majority of deaths in both studies were observed in the first 60 days, usually during the first chemotherapy cycle. This may imply increased sensitivity in a minority of patients, possibly based on genetic differences in key steps in the metabolic activation/deactivation of irinotecan, 5-FU, or both agents. Additional analyses may provide guidance in dose adjustment for the initial cycle and/or in patient selection. For the present, the use of this regimen should be accompanied by careful attention to early signs of diarrhea, dehydration, neutropenia, or other toxic effects, especially during the first chemotherapy cycle. Standard treatment options: ·
Surgical resection/anastomosis or bypass of obstructing or bleeding primary lesions in selected cases.
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Surgical resection of isolated metastases (liver, lung, ovaries).159
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Chemotherapy.
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Clinical trials evaluating new drugs and biologic therapy.
·
Radiation therapy to the primary tumor to palliate bleeding, obstruction, or pain. Palliative radiation therapy may also be targeted to other sites of metastases for similar indications.
Scheele J, Stangl R, Altendorf-Hofmann A: Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. British Journal of Surgery 77(11): 12411246, 1990. Scheele J, Stangl R, Altendorf-Hofmann A, et al.: Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110(1): 13-29, 1991. Girard P, Ducreux M, Baldeyrou P, et al.: Surgery for lung metastases from colorectal cancer: analysis of prognostic factors. Journal of Clinical Oncology 14(7): 2047-2053, 1996. Wagman LD, Kemeny MM, Leong L, et al.: A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver. Journal of Clinical Oncology 8(11): 1885-1893, 1990. Adson MA, van Heerden JA, Wagner JS, et al.: Resection of hepatic metastases from colorectal cancer. Archives of Surgery 119(6): 647-651, 1984. Coppa GF, Eng K, Ranson JH, et al.: Hepatic resection for metastatic colon and rectal cancer. Annals of Surgery 202(2): 203-208, 1985. Jaeck D, Bachellier P, Guiguet M, et al.: Long-term survival following resection of colorectal hepatic metastases. British Journal of Surgery 84(7): 977-980, 1997. Taylor M, Forster J, Langer B, et al.: A study of prognostic factors for hepatic resection for colorectal metastases. American Journal of Surgery 173(6): 467-471, 1997. 159
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Recurrent Colon Cancer160 Treatment of recurrent colon cancer depends on the sites of recurrent disease demonstrable by physical examination and/or radiographic studies. In addition to standard radiographic procedures, radioimmunoscintography may add clinical information which may affect management.161 However, such approaches have not led to improvements in long-term outcome measures such as survival. Unique approaches to treating liver metastases include resection of metastases, cryotherapy, and/or intra-arterial chemotherapy using improved implantable infusion ports and pumps.162 Hepatic intra-arterial chemotherapy with floxuridine has produced a higher overall response rate but no consistent improvement in survival, even when combined with resection of hepatic metastases.163 Several studies show increased local toxic effects, including liver function abnormalities and fatal biliary sclerosis.164 Local ablative techniques for elimination of liver Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) 161 Serafini AN, Klein JL, Wolff BG, et al.: Radioimmunoscintigraphy of recurrent, metastatic, or occult colorectal cancer with technetium 99m-labled totally human monoclonal antibody 88BV59: results of pivotal, phase III multicenter studies. Journal of Clinical Oncology 16(5): 1777-1787, 1998. 162 Wagman LD, Kemeny MM, Leong L, et al.: A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver. Journal of Clinical Oncology 8(11): 1885-1893, 1990. Kemeny N, Cohen A, Seiter K, et al.: Randomized trial of hepatic arterial floxuridine, mitomycin, and carmustine versus floxuridine alone in previously treated patients with liver metastases from colorectal cancer. Journal of Clinical Oncology 11(2): 330-335, 1993. Pedersen IK, Burcharth F, Roikjaer O, et al.: Resection of liver metastases from colorectal cancer: indications and results. Diseases of the Colon and Rectum 37(11): 1078-1082, 1994. Korpan NN: Hepatic cryosurgery for liver metastases: long-term follow-up. Annals of Surgery 225(2): 193-201, 1997. Adam R, Akpinar E, Johann M, et al.: Place of cryosurgery in the treatment of malignant liver tumors. Annals of Surgery 225(1): 39-50, 1997. 163 Wagman LD, Kemeny MM, Leong L, et al.: A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver. Journal of Clinical Oncology 8(11): 1885-1893, 1990. Meta-Analysis Group in Cancer: Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. Journal of the National Cancer Institute 88(5): 252-258, 1996. 164 Chang AE, Schneider PD, Sugarbaker PH, et al.: A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Annals of Surgery 206(6): 685-693, 1987. Kemeny N, Daly J, Reichman B, et al.: Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. Annals of Internal Medicine 107(4): 459-465, 1987. 160
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metastases have been used, including cryosurgery, embolization, and ultrasound techniques.165 However, some evidence suggests that survival may be enhanced in some patients if resection results in no remaining measurable tumor.166 For those patients with hepatic metastases deemed unresectable (due to factors such as location, distribution, excessive number), cryosurgical ablation has been associated with long term tumor control.167 Prognostic variables that predict a favorable outcome for cryotherapy are similar to those for hepatic resection and include low preoperative carcinoembryonic antigen level, absence of extrahepatic disease, negative margin, and lymph node negative primary).168 [Level of evidence: 3iiiA] Locally recurrent colon cancer, such as a suture line recurrence, may be resectable, particularly if an inadequate prior operation was performed. Limited pulmonary metastases may also be considered for surgical resection, with 5-year survival possible in highly selected patients.169 In stage IV and recurrent colon cancer, chemotherapy has been used for palliation, with fluorouracil (5-FU)-based treatment considered to be standard.170 5-FU has been shown to be more cytotoxic, with increased response rates but with variable effects on survival, when modulated by Rougier P, Laplanche A, Huguier M, et al.: Hepatic arterial infusion floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. Journal of Clinical Oncology 10(7): 1112-1118, 1992. 165 Ravikumar TS, Steele G, Kane R, et al.: Experimental and clinical observations on hepatic cryosurgery for colorectal metastases. Cancer Research 51(23, Part 1): 6323-6327, 1991. Thomas DS, Nauta RJ, Rodgers JE, et al.: Intraoperative high-dose rate interstitial irradiation of hepatic metastases from colorectal carcinoma. Cancer 71(6): 1977-1981, 1993. 166 Scheele J, Stangl R, Altendorf-Hofmann A: Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. British Journal of Surgery 77(11): 12411246, 1990. Steele G, Bleday R, Mayer RJ, et al.: A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group protocol 6584. Journal of Clinical Oncology 9(7): 1105-1112, 1991. Scheele J, Stangl R, Altendorf-Hofmann A, et al.: Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110(1): 13-29, 1991. 167 Ravikumar TS, Kaleya R, Kishinevsky A: Surgical ablative therapy of liver tumors. Cancer: Principles and Practice of Oncology Updates 14(3): 1-12, 2000. 168 Seifert JK, Morris DL: Prognostic factors after cryotherapy for hepatic metastases from colorectal cancer. Annals of Surgery 228(2): 201-208, 1998. 169 McAfee MK, Allen MS, Trastek VF, et al.: Colorectal lung metastases: results of surgical excision. Annals of Thoracic Surgery 53(5): 780-786, 1992. Girard P, Ducreux M, Baldeyrou P, et al.: Surgery for lung metastases from colorectal cancer: analysis of prognostic factors. Journal of Clinical Oncology 14(7): 2047-2053, 1996. 170 Moertel CG: Chemotherapy for colorectal cancer. New England Journal of Medicine 330(16): 1136-1142, 1994. Schmoll HJ, Buchele T, Grothey A, et al.: Where do we stand with 5-fluorouracil? Seminars in Oncology 26(6): 589-605, 1999.
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leucovorin,171 methotrexate,172 or other agents.173 Interferon alfa appears to add toxic effects but no clinical benefit to 5-FU therapy.174 ContinuousValone FH, Friedman MA, Wittlinger PS, et al.: Treatment of patients with advanced colorectal carcinomas with fluorouracil alone, high-dose leucovorin plus fluorouracil, or sequential methotrexate, fluorouracil, and leucovorin: a randomized trial of the Northern California Oncology Group. Journal of Clinical Oncology 7(10): 1427-1436, 1989. Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. Erlichman C, Fine S, Wong A, et al.: A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. Journal of Clinical Oncology 6(3): 469-475, 1988. Doroshow JH, Multhauf P, Leong L, et al.: Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. Journal of Clinical Oncology 8(3): 491-501, 1990. Poon MA, O’Connell MJ, Wieand HS, et al.: Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. Journal of Clinical Oncology 9(11): 1967-1972, 1991. Buroker TR, O’Connell MJ, Wieand HS, et al.: Randomized comparison of two schedules of fluorouracil and leucovorin in the treatment of advanced colorectal cancer. Journal of Clinical Oncology 12(1): 14-20, 1994. Jager E, Heike M, Bernhard H, et al.: Weekly high-dose leucovorin versus low-dose leucovorin combined with fluorouracil in advanced colorectal cancer: results of a randomized multicenter trial. Journal of Clinical Oncology 14(8): 2274-2279, 1996. 172 The Advanced Colorectal Cancer Meta-Analysis Project: Meta-analysis of randomized trials testing the biochemical modulation of fluorouracil by methotrexate in metastatic colorectal cancer. Journal of Clinical Oncology 12(5): 960-969, 1994. 173 Wadler S, Lembersky B, Atkins M, et al.: Phase II trial of fluorouracil and recombinant interferon alfa-2a in patients with advanced colorectal carcinoma: an Eastern Cooperative Oncology Group Study. Journal of Clinical Oncology 9(10): 1806-1810, 1991. Kemeny N, Younes A, Seiter K, et al.: Interferon alpha-2a and 5-fluorouracil for advanced colorectal carcinoma: assessment of activity and toxicity. Cancer 66(12): 2470-2475, 1990. Pazdur R, Ajani JA, Patt YZ, et al.: Phase II study of fluorouracil and recombinant interferon alfa-2a in previously untreated advanced colorectal carcinoma. Journal of Clinical Oncology 8(12): 2027-2031, 1990. The Corfu-A Study Group: Phase III randomized study of two fluorouracil combinations with either interferon alfa-2a or leucovorin for advanced colorectal cancer. Journal of Clinical Oncology 13(4): 921-928, 1995. Hill M, Norman A, Cunningham D, et al.: Royal Marsden phase III trial of fluorouracil with or without interferon alfa-2b in advanced colorectal cancer. Journal of Clinical Oncology 13(6): 1297-1302, 1995. 174 Kosmidis PA, Tsavaris N, Skarlos D, et al.: Fluorouracil and leucovorin with or without interferon alfa-2b in advanced colorectal cancer: analysis of a prospective randomized phase III trial. Journal of Clinical Oncology 14(10): 2682-2687, 1996. Greco FA, Figlin R, York M, et al.: Phase III randomized study to compare interferon alfa-2a in combination with fluorouracil versus fluorouracil alone in patients with advanced colorectal cancer. Journal of Clinical Oncology 14(10): 2674-2681, 1996. O’Dwyer PJ, Manola J, Valone FH, et al.: Fluorouracil modulation in colorectal cancer: lack of improvement with N-phosphonoacetyl-l-aspartic acid or oral leucovorin or interferon, 171
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infusion or intermittent continuous-infusion 5-FU regimens have also resulted in decreased toxic effects and in increased response rates in some studies, with a modest benefit in median survival.175 The benefits of continuous-infusion 5-FU compared to bolus regimens have been summarized in a meta-analysis.176 Oral regimens using prodrugs of 5-FU or inhibitors of DPD (GW 776C85) pharmacologically simulate continuous infusion and are under clinical evaluation.177 The choice of a 5-FU-based chemotherapy regimen for an individual patient should be based on known response rates and the toxic effects profile of the chosen regimen, as well as cost and quality-of-life issues.178 Innovative ways of altering toxic effects patterns, and potentially improving clinical benefit, include chronomodulated therapy, in which drug doses are varied throughout the day to allow for greater dose intensity without increased toxic effects.179 In a meta-analysis of 1219 patients in randomized trials where patients were assigned to receive 5-FU with or without leucovorin via either continuous infusion or bolus, neutropenia was noted in 4% of patients who received continuous infusion versus 31% of patients who received bolus and handfoot syndrome was found in 34% of patients who received continuous infusion versus 13% of patients who received bolus. All other toxic effects but enhanced therapeutic index with weekly 24-hour infusion schedule--an ECOG/CALGB study. Journal of Clinical Oncology 19(9): 2413-2421, 2001. 175 O’Dwyer PJ, Manola J, Valone FH, et al.: Fluorouracil modulation in colorectal cancer: lack of improvement with N-phosphonoacetyl-l-aspartic acid or oral leucovorin or interferon, but enhanced therapeutic index with weekly 24-hour infusion schedule--an ECOG/CALGB study. Journal of Clinical Oncology 19(9): 2413-2421, 2001. Hansen RM, Ryan L, Anderson T, et al: Phase III study of bolus versus infusion fluorouracil with or without cisplatin in advanced colorectal cancer. Journal of the National Cancer Institute 88(10): 668-674, 1996. Aranda E, Diaz-Rubio E, Cervantes A, et al.: Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with weekly high-dose 48-hour continuous-infusion fluorouracil for advanced colorectal cancer: a Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD) study. Annals of Oncology 9(7): 727-731, 1998. 176 Meta-analysis Group in Cancer: Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. Journal of Clinical Oncology 16(1): 301-308, 1998. 177 Hoff PM, Royce M, Medgyesy D, et al.: Oral fluoropyrimidines. Seminars in Oncology 26(6): 640-646, 1999. 178 Leichman CG, Fleming TR, Muggia FM, et al.: Phase II study of fluorouracil and its modulation in advanced colorectal cancer: a Southwest Oncology Group study. Journal of Clinical Oncology 13(6): 1303-1311, 1995. 179 Levi FA, Zidani R, Vannetzel J, et al.: Chronomodulated versus fixed-infusion-rate delivery of ambulatory chemotherapy with oxaliplatin, fluorouracil, and folinic acid (Leucovorin) in patients with colorectal cancer metastases: a randomized multi-institutional trial. Journal of the National Cancer Institute 86(21): 1608-1617, 1994. Bertheault-Cvitkovic F, Jami A, Ithzaki M, et al.: Biweekly intensified ambulatory chronomodulated chemotherapy with oxaliplatin, fluorouracil, and leucovorin in patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(11): 2950-2958, 1996.
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were noted with similar frequency and severity, regardless of continuousinfusion or bolus administration.180 Irinotecan (CPT-11) is a topoisomerase-I inhibitor with a 10% to 20% partial response rate in patients with metastatic colon cancer, in patients who have received no prior chemotherapy, and in patients progressing on 5-FU therapy.181 It is now considered standard therapy for patients with stage IV disease who do not respond to or progress on 5-FU.182 CPT-11 has been compared to either retreatment with 5-FU or best supportive care in a pair of randomized European trials of patients with colorectal cancer refractory to 5-FU. In both trials, there was a survival and quality-of-life advantage for patients treated with CPT-11 over 5-FU or supportive care.183 [Levels of evidence: 1iiA,1iiC];184 [Levels of evidence: 1iiA,1iiC] Two phase III prospective randomized, controlled trials were designed to evaluate the combination of 5-FU, leucovorin, and CPT-11 to 5-FU and leucovorin alone. The first of these trials compared the bolus 5-FU, leucovorin, and CPT-11 to bolus 5-FU and leucovorin alone and to CPT-11; the primary endpoint was progression-free survival.185 The trial demonstrated significant benefit in terms of confirmed response rates, time-
Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors. Meta-Analysis Group in Cancer. Journal of Clinical Oncology 16(11): 3537-3541, 1998. 181 Rothenberg ML, Eckardt JR, Kuhn JG, et al.: Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. Journal of Clinical Oncology 14(4): 11281135, 1996. Conti JA, Kemeny NE, Saltz LB, et al.: Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. Journal of Clinical Oncology 14(3): 709-715, 1996. 182 Cunningham D, Pyrhonen S, James RD, et al.: A phase III multicenter randomized study of CPT-11 versus supportive care (SC) alone in patients (Pts) with 5FU-resistant metastatic colorectal cancer (MCRC). Proceedings of the American Society of Clinical Oncology 17: A1, 1a, 1998. 183 Rougier P, Van Cutsem E, Bajetta E, et al.: Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352(9138): 1407-1412, 1998. 184 Cunningham D, Pyrhonen S, James RD, et al.: Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352(9138): 1413-1418, 1998. 185 Saltz LB, Cox JV, et al. for the Irinotecan Study Group: Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. New England Journal of Medicine 343(13): 905914, 2000. 180
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to-tumor progression, and overall survival.186 [Level of evidence: 1iiA] The combination treatment showed confirmed responses in 39% of patients, compared with 21% in patients treated with 5-FU and leucovorin alone and 18% in patients treated with CPT-11. This benefit was highly significant in favor of the combination. In addition, time-to-tumor progression was significantly prolonged with the combination (7.0 versus 4.3 months, P=.004). Median survival was also improved with the combination; median survival was 14.8 months for patients on the combination arm and 12.6 months for patients on the 5-FU and leucovorin arm (P=.042). The second pivotal trial of combination chemotherapy with CPT-11 compared 2 different regimens of infusional 5-FU and folinic acid (either the AIO [Arbeitsgemeinschaft Internische Onkologie] or the deGramont regimen).187 Either weekly or biweekly CPT-11 was administered according to the schedule of the infusional 5-FU. This trial also demonstrated improvements in response rate, time-to-tumor progression, and median survival. For the most important endpoint, median survival, the combination arm was associated with a median survival of 17.4 months, compared with 14.1 months for the 5-FU and folinic acid arm (P=.032).188 [Level of evidence: 1iiA] A combined analysis of the survival advantages seen in these 2 trials was presented at the 2000 American Society of Clinical Oncology meeting.189 The combined survival for the combination of CPT-11, 5-FU, and leucovorin was 15.9 months, compared to 13.3 months for the non-CPT-11 regimen (P=.003). This represents a survival hazard ratio of 0.79. Another drug, Tomudex, is a specific thymidylate synthase inhibitor which has demonstrated activity similar to that of bolus 5-FU and leucovorin.190
186 Saltz LB, Cox JV, et al. for the Irinotecan Study Group: Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. New England Journal of Medicine 343(13): 905914, 2000. 187 Douillard JY, Cunningham D, Roth AD, et al.: Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209): 1041-1047, 2000. 188 Douillard JY, Cunningham D, Roth AD, et al.: Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209): 1041-1047, 2000. 189 Saltz LB, Douillard J, Pirotta N, et al.: Combined analysis of two phase III randomized trials comparing irinotecan (C), fluorouracil (F), leucovorin (L) vs F alone as first-line therapy of previously untreated metastatic colorectal cancer (MCRC). Proceedings of the American Society of Clinical Oncology 19: A938, 242a, 2000. 190 Cunningham D: Mature results from three large controlled studies with raltitrexed (‘Tomudex’). British Journal of Cancer 77(Suppl 2): 15-21, 1998.
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[Level of evidence: 1iiA]191 A number of other drugs are undergoing evaluation for the treatment of colon cancer.192 Capecitabine, an oral fluoropyrimidine carbamate, has been compared to 5FU plus leucovorin in a phase III study.193 The drug has a response rate higher than 5-FU plus leucovorin in metastatic colon cancer, although survival, duration of response, and time-to-disease progression were similar in the 2 treatment arms. Toxic effects were less in the capecitabine group. There was less stomatitis, nausea, and neutropenia with neutropenic fever. In the capecitabine group, hand-foot syndrome was more frequent and severe diarrhea requiring hospitalization was increased. Drug doses of capecitabine used in the study were high, which may account for its toxic effects. It may serve to substitute for 5-FU plus leucovorin as a less toxic single agent or in combinations.194 [Level of evidence: 1iiDiii] Oxaliplatin, alone or combined with 5-FU and leucovorin, has shown promising activity in previously treated and previously untreated patients with metastatic colorectal cancer and in patients with 5-FU refractory disease.195 One multicenter trial reported a response rate of 21%, a median progression-free survival of 5 months, and a median survival of 11 months.196 Cocconi G, Cunningham D, Van Cutsem E, et al.: Open, randomized, multicenter trial of raltitrexed versus fluorouracil plus high-dose leucovorin in patients with advanced colorectal cancer. Journal of Clinical Oncology 16(9): 2943-2952, 1998. 192 Von Hoff DD: Promising new agents for treatment of patients with colorectal cancer. Seminars in Oncology 25(5, suppl 11): 47-52, 1998. 193 Hoff PM, Ansari R, Batist G, et al.: Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. Journal of Clinical Oncology 19(8): 22822292, 2001. 194 Hoff PM, Ansari R, Batist G, et al.: Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. Journal of Clinical Oncology 19(8): 22822292, 2001. 195 de Gramont A, Vignoud J, Tournigand C, et al.: Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer. European Journal of Cancer 33(2): 214-219, 1997. Bleiberg H, de Gramont A: Oxaliplatin plus 5-fluorouracil: clinical experience in patients with advanced colorectal cancer. Seminars in Oncology 25(2 suppl 5): 32-39, 1998. Giacchetti S, Perpoint B, Zidani R, et al.: Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer. Journal of Clinical Oncology 18(1): 136-147, 2000. Cvitkovic E, Bekradda M: Oxaliplatin: a new therapeutic option in colorectal cancer. Seminars in Oncology 26(6): 647-662, 1999. 196 Andre T, Bensmaine MA, Louvet C, et al.: Multicenter phase II study of bimonthly highdose leucovorin, fluorouracil infusion, and oxaliplatin for metastatic colorectal cancer resistant to the same leucovorin and fluorouracil regimen. Journal of Clinical Oncology 17(11): 3560-3568, 1999. 191
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Overall survival from the start of first-line chemotherapy was 19 months. In this trial, oxaliplatin was given first, followed by 48-hour infusion of 5-FU, with short leucovorin infusion. The data and safety monitoring committees of the cooperative groups conducting studies comparing the value of 5-FU/leucovorin/CPT-11 to 5FU/leucovorin in the adjuvant setting and to 5-FU/leucovorin/oxaliplatin or oxaliplatin/CPT-11 in the advanced disease setting have suspended accrual to these trials due to an unexpectedly high death rate on the 5FU/leucovorin/CPT-11 arms.197 This 3 drug regimen appears to be more toxic than initially reported. The majority of deaths in both studies were observed in the first 60 days, usually during the first chemotherapy cycle. This may imply increased sensitivity in a minority of patients, possibly based on genetic differences in key steps in the metabolic activation/deactivation of irinotecan, 5-FU, or both agents. Additional analyses may provide guidance in dose adjustment for the initial cycle and/or in patient selection. For the present, the use of this regimen should be accompanied by careful attention to early signs of diarrhea, dehydration, neutropenia, or other toxic effects, especially during the first chemotherapy cycle. Patients with advanced colon cancer who have relapsed after either adjuvant therapy or treatment for advanced disease with 5-FU and leucovorin may be considered for additional therapy. A number of approaches have been used in the treatment of such patients, including retreatment with 5-FU and treatment with CPT-11.198 Patients retreated with bolus or infusional 5-FU following adjuvant 5-FU therapy or discontinuation of 5-FU in responding patients with metastatic disease have response rates and response durations similar to previously untreated patients.199 [Level of evidence: 2B] Standard treatment options: ·
Resection of liver metastases in selected patients (5-year cure rate for resection of solitary or combination metastases exceeds 20%).200
Sargent DJ, Niedzwiecki D, O’Connell MJ, et al.: Recommendation for caution with irinotecan, fluorouracil, and leucovorin for colorectal cancer. New England Journal of Medicine 345(2): 144-145; discussion 146, 2001. 198 Goldberg RM: Is repeated treatment with a 5-fluorouracil-based regimen useful in colorectal cancer? Seminars in Oncology 25(5, suppl 11): 21-28, 1998. 199 Goldberg RM: Is repeated treatment with a 5-fluorouracil-based regimen useful in colorectal cancer? Seminars in Oncology 25(5, suppl 11): 21-28, 1998. 200 Wagman LD, Kemeny MM, Leong L, et al.: A prospective, randomized evaluation of the treatment of colorectal cancer metastatic to the liver. Journal of Clinical Oncology 8(11): 1885-1893, 1990. 197
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Resection of isolated pulmonary or ovarian metastases.
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Surgical resection of locally recurrent cancer.
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Palliative radiation therapy.
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Palliative chemotherapy.201
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Clinical trials evaluating biological therapy.
Scheele J, Stangl R, Altendorf-Hofmann A: Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. British Journal of Surgery 77(11): 12411246, 1990. Scheele J, Stangl R, Altendorf-Hofmann A, et al.: Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110(1): 13-29, 1991. Adson MA, van Heerden JA, Wagner JS, et al.: Resection of hepatic metastases from colorectal cancer. Archives of Surgery 119(6): 647-651, 1984. Coppa GF, Eng K, Ranson JH, et al.: Hepatic resection for metastatic colon and rectal cancer. Annals of Surgery 202(2): 203-208, 1985. Gayowski TJ, Iwatsuki S, Madariaga JR, et al.: Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 116(4): 703-711, 1994. Fernandez-Trigo V, Shamsa F, Sugarbaker PH, et al.: Repeat liver resections from colorectal metastasis. Surgery 117(3): 296-304, 1995. Jaeck D, Bachellier P, Guiguet M, et al.: Long-term survival following resection of colorectal hepatic metastases. British Journal of Surgery 84(7): 977-980, 1997. Taylor M, Forster J, Langer B, et al.: A study of prognostic factors for hepatic resection for colorectal metastases. American Journal of Surgery 173(6): 467-471, 1997. Elias D, Cavalcanti A, Sabourin JC, et al.: Resection of liver metastases from colorectal cancer: the real impact of the surgical margin. European Journal of Surgical Oncology 24(3): 174-179, 1998. 201 Valone FH, Friedman MA, Wittlinger PS, et al.: Treatment of patients with advanced colorectal carcinomas with fluorouracil alone, high-dose leucovorin plus fluorouracil, or sequential methotrexate, fluorouracil, and leucovorin: a randomized trial of the Northern California Oncology Group. Journal of Clinical Oncology 7(10): 1427-1436, 1989. Petrelli N, Douglass HO, Herrera L, et al.: The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Journal of Clinical Oncology 7(10): 1419-1426, 1989. Erlichman C, Fine S, Wong A, et al.: A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma. Journal of Clinical Oncology 6(3): 469-475, 1988. Doroshow JH, Multhauf P, Leong L, et al.: Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. Journal of Clinical Oncology 8(3): 491-501, 1990. Buroker TR, O’Connell MJ, Wieand HS, et al.: Randomized comparison of two schedules of fluorouracil and leucovorin in the treatment of advanced colorectal cancer. Journal of Clinical Oncology 12(1): 14-20, 1994. Poon MA, O’Connell MJ, Moertel CG, et al.: Biochemical modulation of fluorouracil: evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. Journal of Clinical Oncology 7(10): 1407-1418, 1989.
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·
Chemotherapy phase I and II clinical trials, mostly relating to biochemical modulation of fluoropyridines and continuous-infusion schedules, or oral fluoropyrimidine programs simulating continuous infusion.202
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.203 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:204 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html.
Wadler S, Wiernik PH: Clinical update on the role of fluorouracil and recombinant interferon alfa-2a in the treatment of colorectal carcinoma. Seminars in Oncology 17(1, Suppl 1): 16-21, 1990. Grem JL, Jordan E, Robson ME, et al.: Phase II study of fluorouracil, leucovorin, and interferon alfa-2a in metastatic colorectal carcinoma. Journal of Clinical Oncology 11(9): 1737-1745, 1993. Pazdur R, Lassere Y, Rhodes V, et al.: Phase II trial of uracil and tegafur plus oral leucovorin: an effective oral regimen in the treatment of metastatic colorectal carcinoma. Journal of Clinical Oncology 12(11): 2296-2300, 1994. Diasio RB: Improving 5-FU with a novel dihydropyrimidine dehydrogenase inactivator. Oncology 12(3 Suppl 4): 51-56, 1998. Shirasaka T, Shimamato Y, Ohshimo H, et al.: Development of a novel form of an oral 5fluorouracil derivative (S-1) directed to the potentiation of the tumor selective cytotoxicity of 5-fluorouracil by two biochemical modulators. Anti-Cancer Drugs 7(5): 548-557, 1996. 203 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 204 See http://www.nlm.nih.gov/databases/databases.html. 202
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Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html ·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat colon cancer, the following are particularly noteworthy.
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The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and colon cancer using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “colon cancer” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with colon cancer. The following is a sample result: ·
Levamisole Contact: AIDS Project Los Angeles, 3550 Wilshire Blvd Ste 300, Los Angeles, CA, 90010-2404, (213) 201-1600, http://www.apla.org. Summary: This compilation of articles focuses on Levamisole, a synthetic drug originally approved for veterinary use, which has proven effective as adjunct therapy with 5-fluorouracil (5-FU) to treat colon cancer. Levamisole shows immunomodulatory effects like enhancement and restoration of immunity, although the mechanism is unknown. Preclinical and clinical studies discussed show diverse results on various cancers, and one clinical trial concludes Levamisole has no beneficial effect on HIV-infected patients. Buyers' clubs offer Levamisole as an AIDS treatment, but this paper suggests more clinical research is needed prior to the clinical use of Levamisole in AIDS patients.
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Cancer Facts and Figures: Pennsylvania, 2001 Source: Harrisburg, PA, Pennsylvania Department of Health, 18 p., September 2001. Contact: Pennsylvania Department of Health, Bureau of Health Statistics, 555 Walnut Street, 6th Floor, Harrisburg, PA 17101-1900. (717) 783-2548. FAX: (717) 772-3258. Internet/Email: www.health.state.pa.us/stats/. Summary: Cancer Facts and Figures: Pennsylvania, 2001 presents forecasted cancer incidence and mortality statistics for Pennsylvania. Data for this report are from the Pennsylvania Cancer Registry. This report provides (1) an average day of cancer cases and deaths; (2) basic facts about cancer in Pennsylvania; (3) cancer trends by sex and race; (4) risk factors; (5) trends in breast, lung, prostate, and colon cancer; (6) 2001 projected cancer case and deaths by site, sex, and county; (7) guidelines
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for early detection; and (8) Cancer Control Program initiatives of the Pennsylvania Department of Health. About 75,700 Pennsylvanians are projected to be diagnosed with cancer in 2001, and about 30,045 are projected to die from cancer. The number of cancer cases are increasing because of a larger percentage of early stage diagnoses, an aging population, and better public awareness of symptoms. Total cancer death rates have been declining since 1993. In 1988, the cancer incidence rate for blacks was only 6 percent higher than that for whites, but by 1998, the difference increased to 18.1 percent. The cancer mortality rate for blacks in Pennsylvania has remained 40 to 50 percent higher than the rate for whites. The Pennsylvania Department of Health Cancer Control Program supports and funds special cancer awareness, screening, and research initiatives, with an emphasis on breast, cervical, colorectal, prostate, and skin cancers. ·
Understanding GI Bleeding: A Consumer Education Brochure Source: Arlington, VA: American College of Gastroenterology. 200x. 13 p. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206-1656. (703) 820-7400. Fax (703) 9314520. Price: Single copy free. Also available for free at http://www.acg.gi.org/acg-dev/patientinfo/frame_gibleeding.html. Summary: This consumer education brochure outlines the symptoms, causes and treatment of gastrointestinal (GI) bleeding. Bleeding in the gastrointestinal tract means that some part of the GI tract (esophagus, stomach, small intestine, large intestine, and rectum) is bleeding internally, either slightly (which may or may not be very serious) or heavily (which may have serious health consequences). The symptoms of GI bleeding vary, depending on which part of the digestive tract is involved. Symptoms can include vomiting blood, vomiting dark material that looks like coffee grounds, passing black tarry stools, or passing pure blood or blood mixed in stool. Cause of GI bleeding include ulcers, varices, liver disease, gastritis, tumors, colon cancer, polyps, colitis, diverticular disease, and hemorrhoids. The brochure focuses on ulcers and their causes (usually Helicobacter pylori infection) and treatment. The brochure also explores the use of nonsteroidal antiinflammatory drugs (NSAIDs) and the need to balance pain relief and concerns with side effects of these drugs (including GI bleeding). Conventional treatments for ulcers (H2 blockers and proton pump inhibitors) have been found to have a beneficial effect in treating NSAID induced ulcers and in preventing GI bleeding. The brochure concludes by encouraging ongoing monitoring of the patient taking NSAIDs, since problems with GI bleeding can arise with few, if any, symptoms. 2 figures. 2 tables.
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Fiber Facts Source: Fort Worth, TX: Konsyl Pharmaceuticals, Inc. 1999. [2 p.]. Contact: Available from Konsyl Pharmaceuticals, Inc. 4200 South Hulen Street, Suite 513, Fort Worth, TX 76109-4912. (800) 356-6795 or (817) 7638011. Fax (817) 731-9389. Website: www.konsyl.com. Price: Single copy free. Summary: This brochure provides basic information about dietary fiber, defined as the part of the plant that cannot be digested by humans. Fiber is found in grains, cereals, fruits, vegetables, nuts, seeds, and legumes (dried beans, peas, and lentils). There are two kinds of fiber and most sources of fiber contain a mixture of both types. Soluble fiber absorbs water and promotes good intestinal health by increasing bowel motility which enhances transit through the intestinal tract. Insoluble fiber absorbs little water but is still important because it improves the transit time necessary to move fecal material through the colon. The National Cancer Institute has recommended eating 25 to 35 grams of fiber a day as a step toward preventing colon cancer. Most Americans consume only 10 to 15 grams of fiber per day. The brochure reviews strategies that readers can implement to increase their fiber intake, but notes that it is important to increase the level slowly. A chart is provided for readers to determine their present level of dietary fiber intake. The author discusses the use of fiber supplements, such as Konsyl (the manufacturer of which is the producer of this brochure). The brochure summarizes how increased fiber will benefit each of six disease areas: constipation, hemorrhoids, diverticular disease, irritable bowel syndrome (IBS), colon cancer, and cardiovascular disease. The brochure is illustrated with full color drawings and photographs. 1 table. 4 figures.
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Taking Care of Your Colon Source: Santa Cruz, CA: ETR Associates. 1999. 6 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. Price: $16.00 for 50 copies plus shipping and handling, bulk copies available. Order number R362. Summary: This educational brochure offers information about the role of the colon (large intestine) and strategies for maintaining colon health. The colon reabsorbs most of the water from undigested food, then moves solid waste out of the body. Most colon problems have clear symptoms, such as cramps, constipation, or diarrhea. The brochure briefly defines some common problems, including diverticulosis (colon pockets), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), colon
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polyps, and infections of the colon. The brochure then focuses on prevention of problems, with an emphasis on including enough dietary fiber and fluids in one's daily intake. Fiber in the diet promotes regular bowel movements, makes constipation and cramping less likely, reduces the time that waste remains in the colon, eases diverticulosis and IBS, may reduce the risk of colon cancer and some other cancers, and lowers levels of low density cholesterol (LDL). The brochure recommends that readers avoid laxatives, high fat foods, colonics or enemas, and too much caffeine or alcohol. The brochure offers suggestions for treating minor problems with diarrhea and constipation, then concludes with a discussion of colon cancer and the screening tests used to diagnose colon cancer (including a digital rectal exam, a stool blood test, a flexible sigmoidoscopy, and colonoscopy). 1 figure. 1 table. ·
Colonoscopy: Diagnosing Problems of the Lower Digestive Tract Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $ 0.80 plus shipping and handling; bulk copies available. Order number 5007. Summary: This brochure describes colonoscopy, a nonsurgical procedure that allows the health care provider to see directly inside the patient's lower digestive tract (colon and rectum). The brochure describes the use of the colonoscope, an instrument consisting of a thin, flexible tube that is moved through the colon. The tube has several openings through which instruments can be passed (for taking biopsies). The tube also has fiber optics to beam light inside the colon and a camera to pass images to the health care provider's screen. Colonoscopy is used to diagnose colon abnormalities, such as bleeding or an area of inflammation, and to prescribe the best treatment for them. Colonoscopy is also used to screen for colon cancer. Colonoscopy can detect problems in their earliest, most treatable stages. The brochure explains the preprocedure care that patients should follow, including a special diet and the use of colon preparations such as laxatives. The brochure outlines what the patient can expect during the test itself and during recovery. Within a few hours after patients return home, most of them are able to eat normally and resume most normal activities, unless otherwise directed. Results of the colonoscopy are usually given before the patient leaves for home, or within a few days. The brochure is illustrated with black and white line drawings illustrating patients and the colonoscopy procedure, and full color illustrations of the anatomy of the colon and rectum. 9 figures.
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Lower GI Endoscopy: Viewing Your Colon. [Endoscopia de la Parte Baja del Tracto Gastrointestinal: Examen Visual del Colon] Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $ 17.95 for 50 copies; plus shipping and handling; bulk copies available. Order number 9785 for English; 9796 for Spanish. Summary: This brochure describes lower gastrointestinal (GI) endoscopy, a special examination that uses a long, narrow, flexible tube called an endoscope. Lower GI endoscopy can examine the entire colon and rectum (colonoscopy) or just the rectum and sigmoid colon (sigmoidoscopy). This instrument contains a strong light and a video camera, allowing the GI tract to be viewed on a video screen. The brochure provides information for patients about what to do before the exam, what to expect during the procedure itself, and what to expect after the procedure. The brochure also briefly describes lower GI anatomy and the types of problems that can be diagnosed with endoscopy, including inflammation of the colon (colitis), growths (polyps), and colon cancer. Patients may be given results of the procedure before they leave the office or hospital; additional results may take several days. The brochure cautions readers to contact their physician if they experience pain in the abdomen, fever, or rectal bleeding during their recovery time. The brochure is illustrated with full color line drawings of the colorectal anatomy and the procedure. The brochure is available in English or Spanish. 4 figures.
·
Laparoscopic Colon Surgery: Using Smaller Incisions for Less Pain and a Faster Recovery Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.95 plus shipping and handling; bulk copies available. Order number 11109. Summary: This brochure outlines the use of laparoscopy for colon surgery. With laparoscopy, the doctor makes a few small incisions rather than a single large one. A laparoscope (a thin, telescope like tube) is then placed into one of the small incisions. This allows the doctor to view the colon on a video monitor. Surgical tools are placed into the other incisions. The benefits of a laparoscopic approach over open surgery include less scarring, less pain, faster recovery, shorter hospital stay, and quicker return to normal activity. The brochure reviews the anatomy and
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physiology of the colon, then summarizes common colon problems, including large polyps, diverticulosis and diverticulitis, inflammatory bowel disease (IBD), and colon cancer. Diagnostic tests that may be used to evaluate and diagnose colon problems include the medical history, physical exam, barium enema, endoscopy, and sigmoidoscopy. The brochure details the preoperative steps that patients should follow before laparoscopic treatment and what patients can expect during and immediately after the surgical procedure. Common laparoscopic procedures include segmental resection, right hemicolectomy, left hemicolectomy, sigmoid colectomy, and colostomy surgery; each type is illustrated. The brochure also reviews postoperative care in the hospital and at home. The brochure concludes with a reminder of the steps toward long term colon health, including good nutrition and physical activity. The brochure is illustrated with full color line drawings. 30 figures. ·
Laser Ablation of Tumors Source: Nutley, NJ: Roche Laboratories. 1990. 3 p. Contact: Available from Maria L. Bergamo, MD. Roche Laboratories. 340 Kingsland Street, Nutley, NJ 07110. (201) 235-5000. Summary: This brochure discusses laser ablation therapy for tumors. Although radical surgery is usually still the treatment of choice in patients with potentially curable rectal cancers, endoscopic laser ablation has become increasingly popular as a palliative measure, particularly in cases of advanced metastatic disease or in patients whose age or concomitant medical conditions make surgery an unacceptably high risk. Focusing on the Nd-YAG laser, this brochure discusses the power, potential and problems of lasers; the cost-effectiveness of laser surgery; and use of lasers for total tumor removal. A report on one clinical study of 35 surgical patients is included. Two color photographs illustrate laser ablation of colonic adenomas and Nd-YAG laser palliation of obstructing colon cancer. 4 references.
·
Wisconsin Colorectal Cancer Source: Wisconsin Department of Health and Family Services, Bureau of Health Information, Division of Health Care Financing, 19 p., March 2001. Contact: Wisconsin Department of Health and Family Services, Bureau of Health Information, Division of Health Care Financing, P.O. Box 309, Madison, WI 53701-0309. INTERNET/EMAIL:
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http://www.dhfs.state.wi.us/wcrs/pdf/ WisconsinColorectalCancer.pdf. Summary: Wisconsin Colorectal Cancer provides information on the incidence and mortality of colorectal cancer in Wisconsin based on data from the Wisconsin Cancer Reporting System. Information is also included concerning the national incidence and mortality cancer statistics, risk factors, screening guidelines, current cancer research, and sources for additional information. The purpose of this report is to integrate statistical and general educational information in a summary format that is useful to a general audience. The Wisconsin Cancer Reporting System has collected cancer incidence data on Wisconsin residents since 1976. The Wisconsin Behavioral Risk Factor Survey is a representative, statewide telephone survey of Wisconsin household residents age 18 years and over. Known risk factors for colorectal cancer include (1) increasing age, (2) diet high in fat from animal food sources, (3) physical inactivity, (4) obesity, (5) smoking, (6) personal medical history of certain cancers, (7) intestinal polyps, (8) inflammatory bowel disease, and (9) family medical history of certain cancer and genetic conditions. Survival is usually increased when colorectal cancer is identified early and appropriate treatment is received. From 1990 to 1997 in Wisconsin both colorectal cancer incidence rates and mortality rates have declined. Screening tests for colorectal cancer include (1) rectal examination, (2) fecal occult blood test, (3) sigmoidoscopy, (4) colonoscopy, and (5) double contrast barium enema. Women taking hormone replacement therapy (HRT) had a 46 percent lower incidence of colon cancer than those not taking HRT after menopause. A list provides additional sources of information. 2 figures, 5 tables, 44 references.
The NLM Gateway205 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.206 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 205 206
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This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.207 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “colon cancer” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 350750 Books / Periodicals / Audio Visual 2585 Consumer Health 294 Meeting Abstracts 2575 Other Collections 87 Total 356291
HSTAT208 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.209 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.210 Simply search by “colon cancer” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 208 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 209 The HSTAT URL is http://hstat.nlm.nih.gov/. 210 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS 207
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Coffee Break: Tutorials for Biologists211 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.212 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.213 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic
Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 211 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 212 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 213 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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medical record system; see the following Web http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
site:
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Colon Cancer With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to colon cancer. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).214 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, http://www.ncbi.nlm.nih.gov/Omim/searchomim.html.
go Type
to “colon
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
214
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cancer” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for colon cancer: ·
Colon Cancer, Familial Nonpolyposis, Type 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?120435
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Colon Cancer, Familial Nonpolyposis, Type 2 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?120436
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Colorectal Cancer, Hereditary Nonpolyposis Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?114500
·
Leukemia, Acute Myelocytic, with Polyposis Coli and Colon Cancer Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?246470
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Cancer: Uncontrolled cell division. Examples: Breast And Ovarian Cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html
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Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in
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the drop box next to “Search.” In the box next to “for,” enter “colon cancer” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database215 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database216 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 216 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 215
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“colon cancer” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in colon cancer (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Advanced and Critical Care Oncology Nursing: Managing Primary Complications by Cynthia C. Chernecky (Editor), et al; Paperback - 736 pages (September 18, 1997), W B Saunders Co; ISBN: 0721668607; http://www.amazon.com/exec/obidos/ASIN/0721668607/icongroupinterna · Cancer: Etiology, Diagnosis, and Treatment by Walter J. Burdette; Paperback - 287 pages, 1st edition (January 15, 1998), McGraw Hill Text; ISBN: 0070089922; http://www.amazon.com/exec/obidos/ASIN/0070089922/icongroupinterna · Cancer Management: A Multidisciplinary Approach: Medical, Surgical & Radiation by Richard Pazdur (Editor), et al; Paperback - 982 pages, 5th edition (June 15, 2001), Publisher Research & Representation, Inc.; ISBN: 1891483080; http://www.amazon.com/exec/obidos/ASIN/1891483080/icongroupinterna · Familial Cancer and Prevention: Molecular Epidemiology: A New Strategy Toward Cancer Control by Joji Utsunomiya (Editor), et al; Hardcover (April 1999), Wiley-Liss; ISBN: 0471249378; http://www.amazon.com/exec/obidos/ASIN/0471249378/icongroupinterna · Fundamentals of Cancer Epidemiology by Philip C. Nasca, Ph.D. (Editor), Pastides Harris, Ph.D., MPH (Editor); Hardcover - 368 pages, 1st edition (February 15, 2001), Aspen Publishers, Inc.; ISBN: 0834217767; http://www.amazon.com/exec/obidos/ASIN/0834217767/icongroupinterna · Helping Cancer Patients Cope: A Problem-Solving Approach by Arthur M. Nezu (Editor), et al; Hardcover - 314 pages (December 15, 1998), American Psychological Association (APA); ISBN: 1557985332; http://www.amazon.com/exec/obidos/ASIN/1557985332/icongroupinterna
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· Quantitative Estimation and Prediction of Human Cancer Risks (Iarc Scientific Publications, 131) by Suresh H. Moolgavkar (Editor), et al; Paperback (September 1999), Oxford University Press; ISBN: 9283221311; http://www.amazon.com/exec/obidos/ASIN/9283221311/icongroupinterna · Textbook of Cancer Epidemiology by ADAMI, et al; Hardcover - 385 pages, 1st edition (July 15, 2002), Oxford University Press; ISBN: 0195109694; http://www.amazon.com/exec/obidos/ASIN/0195109694/icongroupint erna
Vocabulary Builder Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Gastritis: Inflammation of the stomach. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunoscintigraphy: An imaging procedure in which antibodies labeled with radioactive substances are given to the person. A picture is taken of sites in the body where the antibody localizes. [NIH]
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Incision: A cut made in the body during surgery. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and -gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Methotrexate: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Milligram: A measure of weight. A milligram is approximately 450,000times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH]
Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH]
Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peritoneum: The tissue that lines the abdominal wall and covers most of the organs in the abdomen. [NIH] Prodrugs: A compound that, on administration, must undergo chemical conversion by metabolic processes before becoming the pharmacologically active drug for which it is a prodrug. [NIH] Refractory: Not readily yielding to treatment. [EU] Sarcoma: A cancer of the bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue. [NIH]
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Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Semustine: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH]
Dissertations 281
CHAPTER 10. DISSERTATIONS ON COLON CANCER Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to colon cancer. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Colon Cancer ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to colon cancer. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with colon cancer: ·
An Investigation of the Relationship of Selected Dietary Factors and Colon Cancer by Wolczuk, Patricia Dianne; PhD from the University of British Columbia (Canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK66846
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·
Analysis of the Post-transitional Modifications Ofp53 from a Human Colon Cancer Cell Line by Busby, Scott Allen; PhD from State University of New York at Stony Brook, 2001, 153 pages http://wwwlib.umi.com/dissertations/fullcit/3051058
·
Characterization of Human Insulin-like Growth Factor Binding Protein (igfbp) -4 Gene Promoter and Its Regulation in Colon Cancer Cell Line Caco2 Cells by Shen, Qiang; PhD from the University of Texas Graduate Sch. of Biomedical Sci. at Galveston, 2001, 205 pages http://wwwlib.umi.com/dissertations/fullcit/3030112
·
Comparing Exact Tests and Asymptotic Tests with Colorectal Cancer Variables Within the National Health and Nutrition Examination Survey III by Musial, Joseph Leonard, III; PhD from Wayne State University, 1999, 60 pages http://wwwlib.umi.com/dissertations/fullcit/9954538
·
Consumption of Black Beans and Navy Beans Reduced Azoxymethane Induced Colon Cancer in Rats by Hangen, Laura; MS from Michigan State University, 2001, 89 pages http://wwwlib.umi.com/dissertations/fullcit/1403868
·
Effects of Liposome-encapsulated Tnf-alpha and Radiation against Colon Cancer by Kim, Dong Won; PhD from Loma Linda University, 2001, 259 pages http://wwwlib.umi.com/dissertations/fullcit/3026995
·
Epidemiologic Studies of Coffee Consumption, Dietary Patterns, and Body Weight: Implications for Colorectal Cancer Prevention by Terry, Paul Daniel; PhD from Columbia University, 2002, 175 pages http://wwwlib.umi.com/dissertations/fullcit/3037763
·
Exposure to Heterocyclic Amines, Benzo(a)pyrene, and Mutagenicity from Meat Intake Characterized by Cooking Methods and Doneness, Genetic Susceptibility at the N-acetyltransferase 1 and 2 Loci, and Association with Colon Cancer in a Population-based S by Butler, Lesley Mary; PhD from the University of North Carolina at Chapel Hill, 2001, 378 pages http://wwwlib.umi.com/dissertations/fullcit/3031807
·
The Effect of Pre- and Probiotics and Components of Beef on Colon Cancer Risk in Rats by Khil, Jinmo; PhD from University of Minnesota, 2001, 151 pages http://wwwlib.umi.com/dissertations/fullcit/9994515
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·
The Effects of Freeze-dried Black Raspberries on Colon Cancer in the F344 Rat by Harris, Gabriel Keith; PhD from the Ohio State University, 2001, 143 pages http://wwwlib.umi.com/dissertations/fullcit/3011068
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to colon cancer is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH] Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU]
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with colon cancer and related conditions.
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APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with colon cancer. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for colon cancer. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of colon cancer. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics217 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of colon cancer. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with colon cancer take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
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Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for colon cancer. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
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How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
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If you can get a refill, and how often.
217
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
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·
About any terms or directions you do not understand.
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What to do if you miss a dose.
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If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for colon cancer). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
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Reason taken
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Dosage
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Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for colon cancer. One such
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source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.218 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of colon cancer. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to colon cancer: Capecitabine ·
Systemic - U.S. Brands: Xeloda http://www.nlm.nih.gov/medlineplus/druginfo/capecitabinesyst emic203548.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm. 218
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Carmustine ·
Systemic - U.S. Brands: BiCNU http://www.nlm.nih.gov/medlineplus/druginfo/carmustinesyste mic202117.html
Fluorouracil ·
Systemic - U.S. Brands: Adrucil http://www.nlm.nih.gov/medlineplus/druginfo/fluorouracilsyst emic202245.html
Irinotecan ·
Systemic - U.S. Brands: Camptosar http://www.nlm.nih.gov/medlineplus/druginfo/irinotecansyste mic203051.html
Leucovorin ·
Systemic - U.S. Brands: Wellcovorin http://www.nlm.nih.gov/medlineplus/druginfo/leucovorinsyste mic202321.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information.
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Information can be obtained at the following http://www.genrx.com/Mosby/PhyGenRx/group.html.
hyperlink:
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Drug Development and Approval The following Web sites can be valuable resources when conducting research on the development and approval of new cancer drugs: ·
FDA Home Page: Search for drugs currently in development or those which have been recently approved by the FDA. http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/
·
Cancer Liaison Program: Answers questions from the public about drug approval processes, cancer clinical trials, and access to investigational therapies. http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/oashi/c ancer/cancer.html
·
Center for Drug Evaluation and Research http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/cder/
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·
Drug Approvals by Cancer Indications (Alphabetical List) http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/oashi/c ancer/cdrugalpha.html
·
Drug Approvals by Cancer Indications (Cancer Type) http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/oashi/c ancer/cdrugind.html
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Electronic Orange Book of Approved Drug Products http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/cder/ob /default.htm
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Guidance Documents for Industry: Contains an archive of documents describing FDA policies on specific topics. http://redir.nci.nih.gov/cgibin/redir.pl?section=Cancerinfo&destURI=http://www.fda.gov/cder/gu idance/index.htm
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Industry Collaboration: Provides information to industry on the process for getting new drugs into clinical trials. http://ctep.cancer.gov/industry/index.html
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Investigator’s Handbook: Provides information to investigators on specific procedures related to clinical trial development. http://ctep.cancer.gov/handbook/index.html
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Questions and Answers About NCI’s Natural Products Branch: A fact sheet that describes the functions of this branch, which collects and analyzes specimens of plant, marine, and microbial origin for possible anticancer properties. http://cis.nci.nih.gov/fact/7_33.htm
Understanding the Approval Process for New Cancer Drugs219 Since June 1996, about 80 new cancer-related drugs, or new uses for drugs already on the market, have been approved by the U.S. Food and Drug Administration (FDA), the division of the U.S. Department of Health and Human Services charged with ensuring the safety and effectiveness of new drugs before they can go on the market. (The FDA maintains an annotated Adapted from the NCI: http://www.cancer.gov/clinical_trials/doc_header.aspx?viewid=d94cbfac-e478-4704-9052d8e8a3372b56. 219
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online list of drugs approved for use with cancer since 1996.) Some of these drugs treat cancer, some alleviate pain and other symptoms, and, in one case, reduce the risk of invasive cancer in people who are considered highrisk. The FDA relied on the results of clinical trials in making every one of these approvals. Without reliable information about a drug’s effects on humans, it would be impossible to approve any drug for widespread use. When considering a new drug, the FDA faces two challenges: ·
First, making sure that the drug is safe and effective before it is made widely available;
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Second, ensuring that drugs which show promise are made available as quickly as possible to the people they can help.
To deal with these challenges, the FDA maintains a rigorous review process but also has measures in place to make some drugs available in special cases. This aim of this section is to acquaint you with the drug approval process and point you to other resources for learning more about it.
The Role of the Federal Drug Administration (FDA) Approval is only one step in the drug development process. In fact, the FDA estimates that, on average, it takes eight and a half years to study and test a new drug before it can be approved for the general public. That includes early laboratory and animal testing, as well as the clinical trials that evaluate the drugs in humans. The FDA plays a key role at three main points in this process: ·
Determining whether or not a new drug shows enough promise to be given to people in clinical trials
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Once clinical trials begin, deciding whether or not they should continue, based on reports of efficacy and adverse reactions
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When clinical trials are completed, deciding whether or not the drug can be sold to the public and what its label should say about directions for use, side effects, warnings, and the like.
To make these decisions, the FDA must review studies submitted by the drug’s sponsor (usually the manufacturer), evaluate any adverse reports from preclinical studies and clinical trials (that is, reports of side effects or complications), and review the adequacy of the chemistry and manufacturing. This process is lengthy, but it is meant to ensure that only beneficial drugs with acceptable side effects will make their way into the
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hands of the public. At the same time, recent legislative mandates and streamlined procedures within the FDA have accelerated the approval of effective drugs, especially for serious illnesses such as cancer. In addition, specific provisions make some drugs available to patients with special needs even before the approval process is complete.
From Lab to Patient Care By law, the Food and Drug Administration (FDA) must review all test results for new drugs to ensure that products are safe and effective for specific uses. “Safe” does not mean that the drug is free of possible adverse side effects; rather, it means that the potential benefits have been determined to outweigh any risks. The testing process begins long before the first person takes the drug, with preliminary research and animal testing. If a drug proves promising in the lab, the drug company or sponsor must apply for FDA approval to test it in clinical trials involving people. For drugs, the application, called an Investigational New Drug (IND) Application, is sent through the Center for Drug Evaluation and Research’s (CDER) IND Review Process; for biological agents, the IND is sent to the Center for Biologics Evaluation and Research (CBER). Once the IND is approved by CDER or CBER, clinical trials can begin. If the drug makes it through the clinical trials process—that is, the studies show that it is superior to current drugs—the manufacturer must submit a New Drug Application (NDA) or (for biological agents) a Biologics License Application (BLA) to the FDA. (Biological agents, such as serums, vaccines, and cloned proteins, are manufactured from substances taken from living humans or animals.) This application must include: ·
The exact chemical makeup of the drug or biologic and the mechanisms by which it is effective
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Results of animal studies
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Results of clinical trials
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How the drug or biologic is manufactured, processed, and packaged
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Quality control standards
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Samples of the product in the form(s) in which it is to be administered.
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Once the FDA receives the NDA or BLA from the manufacturer or developer, the formal New Drug Application Review Process or Biologics/Product License Application Review Process begins. For an overview of the entire process from start to finish, see the CDER’s visual representation of The New Drug Development Process: Steps from Test Tube to New Drug Application Review, which is available for public viewing at the following Web address: http://www.fda.gov/cder/handbook/develop.htm.
Speed versus Safety in the Approval Process The FDA’s current goal is that no more than ten months will pass between the time that a complete application is submitted and the FDA takes action on it. But the process is not always smooth. Sometimes FDA’s external advisory panels call for additional research or data. In other cases, the FDA staff asks for more information or revised studies. Some new drug approvals have taken as little as 42 days; other more difficult NDAs have spent years in the approval process.
Setting Priorities The order in which NDAs are assessed by the FDA is determined by a classification system designed to give priority to drugs with the greatest potential benefits. All drugs that offer significant medical advances over existing therapies for any disease are considered “priority” drugs in the approval process. NDAs for cancer treatment drugs are reviewed for this status primarily by the Division of Oncology Drug Products in the FDA’s Center for Drug Evaluation and Research (CDER). For Biologic License Applications (vaccines, blood products, and medicines made from animal products), the Center for Biologics Evaluation and Research (CBER) provides additional regulation and oversight.
Expert Advice The FDA relies on a system of independent advisory committees, made up of professionals from outside the agency, for expert advice and guidance in making sound decisions about drug approval. Each committee meets as needed to weigh available evidence and assess the safety, effectiveness, and appropriate use of products considered for approval. In addition, these
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committees provide advice about general criteria for evaluation and scientific issues not related to specific products. The Oncologic Drugs Advisory Committee (ODAC) meets regularly to provide expert advice on cancer-related treatments and preventive drugs. Each committee is composed of representatives from the research science and medical fields. At least one member on every advisory committee must represent the consumer perspective.
Final Approval As the FDA looks at all the data submitted and the results of its own review, it applies two benchmark questions to each application for drug approval: ·
Do the results of well-controlled studies provide substantial evidence of effectiveness?
·
Do the results show the product is safe under the conditions of use in the proposed labeling? In this context, “safe” means that potential benefits have been determined to outweigh any risks.
Continued Vigilance The FDA’s responsibility for new drug treatments does not stop with final approval. The Office of Compliance in the Center for Drug Evaluation and Research (CDER) implements and tracks programs to make sure manufacturers comply with current standards and practice regulations. CDER’s Office of Drug Marketing, Advertising, and Communication monitors new drug advertising to make sure it is truthful and complete. At the Center for Biologic Evaluation and Research, biologics are followed with the same vigilance after approval. And through a system called MedWatch, the FDA gets feedback from health professionals and consumers on how the new drugs are working, any adverse reactions, and potential problems in labeling and dosage.
Online FDA Resources The following information from the FDA should help you better understand the drug approval process: ·
Center for Drug Evaluation http://www.fda.gov/cder/handbook
and
Research:
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·
From Test Tube to Patient: New Drug Development in the U.S. – a special January 1995 issue of the magazine FDA Consumer: http://www.fda.gov/fdac/special/newdrug/ndd_toc.html
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Milestones in U.S. Food and Drug Law History: http://www.fda.gov/opacom/backgrounders/miles.html
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Drug Approvals for Cancer Indications: http://www.fda.gov/oashi/cancer/cdrug.html
Getting Drugs to Patients Who Need Them Clinical trials provide the most important information used by the FDA in determining whether a new drug shows “substantial evidence of effectiveness,” or whether an already-approved drug can be used effectively in new ways (for example, to treat or prevent other types of cancer, or at a different dosage). The FDA must certify that a drug has shown promise in laboratory and animal trials before human testing can begin. The trials process includes three main stages and involves continuous review, which ensures that the sponsor can stop the study early if major problems develop or unexpected levels of treatment benefit are found. As with all clinical trials, benefits and risks must be carefully weighed by the researchers conducting the study and the patients who decide to participate. Not everyone is eligible to participate in a clinical trial. Some patients do not fit the exact requirements for studies, some have rare forms of cancer for which only a limited number of studies are underway, and others are too ill to participate. Working with the NCI and other sponsors, the FDA has established special conditions under which a patient and his or her physician can apply to receive cancer drugs that have not yet been through the approval process. In the past, these special case applications for new drugs were grouped under the name “compassionate uses.” More recently, such uses have expanded to include more patients and more categories of investigational drugs.
Access to Investigational Drugs The process of new drug development has many parts. In the United States, until a drug has been approved by the FDA, it can generally be obtained only through several mechanisms: enrollment in a clinical trial studying the drug, an expanded access program or special exemption/compassionate use programs. For more information about investigational drugs, see “Questions
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and Answers: Access to Investigational Drugs“ at http://www.cancer.gov/cancer_information/doc_img.aspx?viewid=74b62d8 4-e135-451f-9bc9-d54358ede947. “Group C” Drugs In the 1970s, researchers from the NCI became concerned about the lag between the date when an investigational drug was found to have antitumor activity and the time that drug became available on the market. Working with the FDA, the NCI established the “Group C” classification to allow access to drugs with reproducible activity. Group C drugs are provided to properly trained physicians who have registered using a special form to assure that their patient qualifies under guideline protocols for the drug. Each Group C drug protocol specifies patient eligibility, reporting methodology, and drug use. Not only does Group C designation (now called Group C/Treatment INDs) speed new drugs to patients who need them most, but the process also allows the NCI to gather important information on the safety as well as activity of the drugs in the settings in which they will be most used after final FDA approval. Drugs are placed in the Group C category by agreement between the FDA and the NCI. Group C drugs are always provided free of charge, and the Health Care Financing Administration provides coverage for care associated with Group C therapy.
Treatment INDs In 1987, the FDA began authorizing the use of new drugs still in the development process to treat certain seriously ill patients. In these cases, the process is referred to as a treatment investigational new drug application (Treatment IND). Clinical trials of the new drug must already be underway and have demonstrated positive results that are reproducible. The FDA sets guidelines about what constitutes serious and life-threatening illnesses, how much must already be known about a drug’s side effects and benefits, and where physicians can obtain the drug for treatment. For many seriously ill patients, the risks associated with taking a not-yet-completely proven drug are outweighed by the possible benefits.
Accelerated Approval “Accelerated approval” is the short-hand term for the FDA’s new review system which, in the 1990s, has been used to ensure rapid approval while at
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the same time putting new safeguards into place. Accelerated approval is based on “surrogate endpoint” judgments: FDA can grant marketing approval to drugs and treatments that, according to certain indicators, prove they are likely to have beneficial effects on a disease or condition, even before such direct benefits have been shown clinically. Accelerated approval does NOT mean that additional clinical trials are not needed or that FDA stops gathering information about the effects of the drug; a follow-up study is required to demonstrate activity by more conventional endpoints.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with colon cancer--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat colon cancer or potentially create deleterious side effects in patients with colon cancer. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
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A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with colon cancer. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with colon cancer. The FDA warns patients to watch out for220: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Antifolate Drugs in Cancer Therapy (Cancer Drug Discovery and Development) by Ann L. Jackman (Editor); Hardcover: 480 pages; (March 1999), Humana Press; ISBN: 0896035964; http://www.amazon.com/exec/obidos/ASIN/0896035964/icongroupinterna
·
Consumers Guide to Cancer Drugs by Gail M. Wilkes, et al; Paperback 448 pages, 1st edition (January 15, 2000), Jones & Bartlett Publishing; ISBN: 0763711705; http://www.amazon.com/exec/obidos/ASIN/0763711705/icongroupinterna
220
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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·
Patient Education Guide to Oncology Drugs (Book with CD-ROM) by Gail M. Wilkes, et al; CD-ROM - 447 pages, 1st edition (January 15, 2000), Jones & Bartlett Publishing; ISBN: 076371173X; http://www.amazon.com/exec/obidos/ASIN/076371173X/icongroupinterna
·
The Role of Multiple Intensification in Medical Oncology by M. S. Aapro (Editor), D. Maraninchi (Editor); Hardcover (June 1998), Springer Verlag; ISBN: 3540635432; http://www.amazon.com/exec/obidos/ASIN/3540635432/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Carmustine: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview221 Research indicates that the use of complementary and alternative therapies is increasing. A large-scale study published in the November 11, 1998, issue of the Journal of the American Medical Association found that CAM use among the general public increased from 34 percent in 1990 to 42 percent in 1997. Several surveys of CAM use by cancer patients have been conducted with small numbers of patients. One study published in the February 2000 issue of the journal Cancer reported that 37 percent of 46 patients with prostate cancer used one or more CAM therapies as part of their cancer treatment. These therapies included herbal remedies, old-time remedies, vitamins, and special diets. A larger study of CAM use in patients with different types of cancer was published in the July 2000 issue of the Journal of Clinical Oncology . That study found that 83 percent of 453 cancer patients had used at least one CAM therapy as part of their cancer treatment. The study included CAM therapies such as special diets, psychotherapy, spiritual practices, and vitamin supplements. When psychotherapy and spiritual practices were excluded, 69 percent of patients had used at least one CAM therapy in their cancer treatment. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to colon cancer. Finally, at the conclusion of this chapter, we will provide a list of readings on colon cancer from various authors. We will begin, however, with the National Center for
221Adapted
from the NCI: http://cis.nci.nih.gov/fact/9_14.htm.
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Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?222 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture. Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. 222
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
What Are the Domains of Alternative Medicine?223 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic
223
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology. Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
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Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues. Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch.
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Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields. Research indicates that the use of complementary and alternative therapies is increasing. A large-scale study published in the November 11, 1998, issue of the Journal of the American Medical Association found that CAM use among the general public increased from 34 percent in 1990 to 42 percent in 1997. Several surveys of CAM use by cancer patients have been conducted with small numbers of patients. One study published in the February 2000 issue of the journal Cancer reported that 37 percent of 46 patients with prostate cancer used one or more CAM therapies as part of their cancer treatment. These therapies included herbal remedies, old-time remedies, vitamins, and special diets. A larger study of CAM use in patients with different types of cancer was published in the July 2000 issue of the Journal of Clinical Oncology . That study found that 83 percent of 453 cancer patients had used at least one CAM therapy as part of their cancer treatment. The study included CAM therapies such as special diets, psychotherapy, spiritual practices, and vitamin supplements. When psychotherapy and spiritual practices were excluded, 69 percent of patients had used at least one CAM therapy in their cancer treatment.
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How Are Complementary and Alternative Approaches Evaluated?224 It is important that the same scientific evaluation which is used to assess conventional approaches be used to evaluate complementary and alternative therapies. A number of medical centers are evaluating complementary and alternative therapies by developing clinical trials (research studies with people) to test them. Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process, including clinical trials with large numbers of patients. Often, less is known about the safety and effectiveness of complementary and alternative methods. Some of these complementary and alternative therapies have not undergone rigorous evaluation. Others, once considered unorthodox, are finding a place in cancer treatment—not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. Some approaches, such as laetrile, have been studied and found ineffective or potentially harmful.
NCI-Sponsored Clinical Trials in Complementary and Alternative Medicine The NCI is currently sponsoring several clinical trials (research studies with patients) that study complementary and alternative treatments for cancer. Current trials include enzyme therapy with nutritional support for the treatment of inoperable pancreatic cancer, shark cartilage therapy for the treatment of non-small cell lung cancer, and studies of the effects of diet on prostate and breast cancers. Some of these trials compare alternative therapies with conventional treatments, while others study the effects of complementary approaches used in addition to conventional treatments. Patients who are interested in taking part in these or any clinical trials should talk with their doctor. More information about clinical trials sponsored by the NCI can be obtained from NCCAM (http://nccam.nih.gov, 1-888-644-6226), OCCAM
224Adapted
from the NCI: http://cis.nci.nih.gov/fact/9_14.htm
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(http://occam.nci.nih.gov), and the NCI’s Cancer Information Service (CIS) (http://cis.nci.nih.gov, 1-800-4-CANCER).
Questions to Ask Your Healthcare Provider about CAM When considering complementary and alternative therapies, ask your healthcare provider the following questions: ·
What benefits can be expected from this therapy?
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What are the risks associated with this therapy?
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Do the known benefits outweigh the risks?
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What side effects can be expected?
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Will the therapy interfere with conventional treatment?
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Is this therapy part of a clinical trial? If so, who is sponsoring the trial?
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Will the therapy be covered by health insurance?
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How can patients and their health care providers learn more about complementary and alternative therapies?
Finding CAM References on Colon Cancer Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for colon cancer. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to colon cancer and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “colon cancer” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of
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complementary and alternative medicine (CAM) that are related to colon cancer: ·
A diet containing alpha-cellulose and fish oil reduces aberrant crypt foci formation and modulates other possible markers for colon cancer risk in azoxymethane-treated rats. Author(s): Coleman LJ, Landstrom EK, Royle PJ, Bird AR, McIntosh GH. Source: The Journal of Nutrition. 2002 August; 132(8): 2312-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12163681&dopt=Abstract
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A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. Author(s): Sargent DJ, Goldberg RM, Jacobson SD, Macdonald JS, Labianca R, Haller DG, Shepherd LE, Seitz JF, Francini G. Source: The New England Journal of Medicine. 2001 October 11; 345(15): 1091-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11596588&dopt=Abstract
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Adjuvant chemotherapy for colon cancer. Author(s): Ducreux M, Boige V. Source: Best Practice & Research. Clinical Gastroenterology. 2002 April; 16(2): 283-98. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11969239&dopt=Abstract
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Adjuvant chemotherapy for colon cancer. Author(s): Kumar SK, Goldberg RM. Source: Current Oncology Reports. 2001 March; 3(2): 94-101. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11177740&dopt=Abstract
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Adjuvant chemotherapy for colon cancer: the US experience. Author(s): Haller DG. Source: Tumori. 2001 January-February; 87(1 Suppl 1): S86-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11300040&dopt=Abstract
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Adjuvant therapy for colon cancer: the European experience. Author(s): Wils J.
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Source: Tumori. 2001 January-February; 87(1 Suppl 1): S85. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11300039&dopt=Abstract ·
Adjuvant therapy in high-risk colon cancer. Author(s): Bleiberg H. Source: Seminars in Oncology. 2000 October; 27(5 Suppl 10): 48-59. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11049033&dopt=Abstract
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Adjuvant therapy of colon cancer. Author(s): Macdonald JS. Source: Ca: a Cancer Journal for Clinicians. 1999 July-August; 49(4): 20219. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11198882&dopt=Abstract
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Adjuvant therapy of colon cancer. Author(s): Macdonald JS, Astrow AB. Source: Seminars in Oncology. 2001 February; 28(1): 30-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11254865&dopt=Abstract
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Antiproliferative effects of S-allylmercaptocysteine on colon cancer cells when tested alone or in combination with sulindac sulfide. Author(s): Shirin H, Pinto JT, Kawabata Y, Soh JW, Delohery T, Moss SF, Murty V, Rivlin RS, Holt PR, Weinstein IB. Source: Cancer Research. 2001 January 15; 61(2): 725-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11212275&dopt=Abstract
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Antitumorigenic effects of several food proteins in a rat model with colon cancer and their reverse correlation with plasma bile acid concentration. Author(s): Azuma N, Suda H, Iwasaki H, Yamagata N, Saeki T, Kanamoto R, Iwami K. Source: J Nutr Sci Vitaminol (Tokyo). 2000 April; 46(2): 91-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10885796&dopt=Abstract
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Augmentation of apoptosis and tumor regression by flavopiridol in the presence of CPT-11 in Hct116 colon cancer monolayers and xenografts. Author(s): Motwani M, Jung C, Sirotnak FM, She Y, Shah MA, Gonen M, Schwartz GK. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2001 December; 7(12): 4209-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11751522&dopt=Abstract
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Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: patient and provider perspectives. Author(s): Eakin EG, Strycker LA. Source: Psycho-Oncology. 2001 March-April; 10(2): 103-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11268137&dopt=Abstract
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Bax induction activates apoptotic cascade via mitochondrial cytochrome c release and Bax overexpression enhances apoptosis induced by chemotherapeutic agents in DLD-1 colon cancer cells. Author(s): Kobayashi T, Sawa H, Morikawa J, Zhang W, Shiku H. Source: Japanese Journal of Cancer Research : Gann. 2000 December; 91(12): 1264-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11123425&dopt=Abstract
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Carotenoids and colon cancer. Author(s): Slattery ML, Benson J, Curtin K, Ma KN, Schaeffer D, Potter JD. Source: The American Journal of Clinical Nutrition. 2000 February; 71(2): 575-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10648274&dopt=Abstract
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Caspase-8 activation independent of CD95/CD95-L interaction during paclitaxel-induced apoptosis in human colon cancer cells (HT29-D4). Author(s): Goncalves A, Braguer D, Carles G, Andre N, Prevot C, Briand C. Source: Biochemical Pharmacology. 2000 December 1; 60(11): 1579-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11077039&dopt=Abstract
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Colon cancer chemoprevention with ginseng and other botanicals. Author(s): Wargovich MJ. Source: Journal of Korean Medical Science. 2001 December; 16 Suppl: S816. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11748382&dopt=Abstract
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Combination of oxaliplatin and irinotecan on human colon cancer cell lines: activity in vitro and in vivo. Author(s): Guichard S, Arnould S, Hennebelle I, Bugat R, Canal P. Source: Anti-Cancer Drugs. 2001 October; 12(9): 741-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11593056&dopt=Abstract
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Comparative analysis of the effects of flavonoids on proliferation, cytotoxicity, and apoptosis in human colon cancer cell lines. Author(s): Kuntz S, Wenzel U, Daniel H. Source: European Journal of Nutrition. 1999 June; 38(3): 133-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10443335&dopt=Abstract
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Comparative efficacy of adjuvant chemotherapy in patients with Dukes' B versus Dukes' C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C02, C-03, and C-04) Author(s): Mamounas E, Wieand S, Wolmark N, Bear HD, Atkins JN, Song K, Jones J, Rockette H. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1999 May; 17(5): 1349-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10334518&dopt=Abstract
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Coriandrum sativum--effect on lipid metabolism in 1,2-dimethyl hydrazine induced colon cancer. Author(s): Chithra V, Leelamma S. Source: Journal of Ethnopharmacology. 2000 August; 71(3): 457-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10940583&dopt=Abstract
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Dietary soy reduces colon carcinogenesis in human and rats. Soy and colon cancer. Author(s): Bennink MR.
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Source: Advances in Experimental Medicine and Biology. 2001; 492: 11-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11480660&dopt=Abstract ·
Differentiation of human colon cancer cells changes the expression of beta-tubulin isotypes and MAPs. Author(s): Carles G, Braguer D, Dumontet C, Bourgarel V, Goncalves A, Sarrazin M, Rognoni JB, Briand C. Source: British Journal of Cancer. 1999 June; 80(8): 1162-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10376967&dopt=Abstract
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Double cancer (lung and colon cancer) that showed complete remission with irinotecan and cisplatin combined chemotherapy. Author(s): Kaneki T, Koizumi T, Kawashima A, Tsushima K, Kubo K, Fujimoto K, Honda T, Akamatsu T. Source: Journal of Gastroenterology. 2000; 35(11): 864-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11085497&dopt=Abstract
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Drg1, a novel target for modulating sensitivity to CPT-11 in colon cancer cells. Author(s): Motwani M, Sirotnak FM, She Y, Commes T, Schwartz GK. Source: Cancer Research. 2002 July 15; 62(14): 3950-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12124325&dopt=Abstract
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Edrecolomab alone or in combination with fluorouracil and folinic acid in the adjuvant treatment of stage III colon cancer: a randomised study. Author(s): Punt CJ, Nagy A, Douillard JY, Figer A, Skovsgaard T, Monson J, Barone C, Fountzilas G, Riess H, Moylan E, Jones D, Dethling J, Colman J, Coward L, MacGregor S. Source: Lancet. 2002 August 31; 360(9334): 671-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12241873&dopt=Abstract
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Effect of folate supplementation on mucosal cell proliferation in high risk patients for colon cancer. Author(s): Khosraviani K, Weir HP, Hamilton P, Moorehead J, Williamson K.
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Source: Gut. 2002 August; 51(2): 195-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12117879&dopt=Abstract ·
Effects of folate supplementation on two provisional molecular markers of colon cancer: a prospective, randomized trial. Author(s): Kim YI, Baik HW, Fawaz K, Knox T, Lee YM, Norton R, Libby E, Mason JB. Source: The American Journal of Gastroenterology. 2001 January; 96(1): 184-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11197251&dopt=Abstract
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Effects of increased ambient pressure on colon cancer cell adhesion. Author(s): Basson MD, Yu CF, Herden-Kirchoff O, Ellermeier M, Sanders MA, Merrell RC, Sumpio BE. Source: Journal of Cellular Biochemistry. 2000 April; 78(1): 47-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10797565&dopt=Abstract
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Effects of lyophilized black raspberries on azoxymethane-induced colon cancer and 8-hydroxy-2'-deoxyguanosine levels in the Fischer 344 rat. Author(s): Harris GK, Gupta A, Nines RG, Kresty LA, Habib SG, Frankel WL, LaPerle K, Gallaher DD, Schwartz SJ, Stoner GD. Source: Nutrition and Cancer. 2001; 40(2): 125-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11962247&dopt=Abstract
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Efficacy of adjuvant fluorouracil and leucovorin in stage B2 and C colon cancer. International Multicenter Pooled Analysis of Colon Cancer Trials Investigators. Author(s): Marsoni S. Source: Seminars in Oncology. 2001 February; 28(1 Suppl 1): 14-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11273584&dopt=Abstract
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Efficient induction of apoptosis by ONYX-015 adenovirus in human colon cancer cell lines regardless of p53 status. Author(s): Petit T, Davidson KK, Cerna C, Lawrence RA, Von Hoff DD, Heise C, Kirn D, Izbicka E.
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Source: Anti-Cancer Drugs. 2002 January; 13(1): 47-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11914640&dopt=Abstract ·
Enhanced clearance of topoisomerase I inhibitors from human colon cancer cells by glucuronidation. Author(s): Cummings J, Boyd G, Ethell BT, Macpherson JS, Burchell B, Smyth JF, Jodrell DI. Source: Biochemical Pharmacology. 2002 February 15; 63(4): 607-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11992628&dopt=Abstract
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Estrogen receptor beta mRNA in colon cancer cells: growth effects of estrogen and genistein. Author(s): Arai N, Strom A, Rafter JJ, Gustafsson JA. Source: Biochemical and Biophysical Research Communications. 2000 April 13; 270(2): 425-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10753641&dopt=Abstract
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Estrogen synthesis in human colon cancer epithelial cells. Author(s): Fiorelli G, Picariello L, Martineti V, Tonelli F, Brandi ML. Source: The Journal of Steroid Biochemistry and Molecular Biology. 1999 December 31; 71(5-6): 223-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10704911&dopt=Abstract
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FDG PET evaluation of residual masses and regrowth of abdominal lymph node metastases from colon cancer compared with CT during chemotherapy. Author(s): Yoshioka T, Fukuda H, Fujiwara T, Iwata R, Ido T, Murakawa Y, Gamo M, Ishioka C, Kanamaru R. Source: Clinical Nuclear Medicine. 1999 April; 24(4): 261-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10466523&dopt=Abstract
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Fluorouracil and leucovorin with or without interferon alfa-2a as adjuvant treatment, in patients with high-risk colon cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group. Author(s): Fountzilas G, Zisiadis A, Dafni U, Konstantaras C, Hatzitheoharis G, Papavramidis S, Bousoulegas A, Basdanis G,
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Giannoulis E, Dokmetzioglou J, Katsohis C, Nenopoulou E, Karvounis N, Briassoulis E, Aravantinos G, Kosmidis P, Skarlos D, Pavlidis N. Source: Oncology. 2000 April; 58(3): 227-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10765125&dopt=Abstract ·
Fluorouracil plus leucovorin as effective adjuvant chemotherapy in curatively resected stage III colon cancer: results of the trial adjCCA-01. Author(s): Porschen R, Bermann A, Loffler T, Haack G, Rettig K, Anger Y, Strohmeyer G. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2001 March 15; 19(6): 1787-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11251010&dopt=Abstract
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Genistein induces apoptosis and topoisomerase II-mediated DNA breakage in colon cancer cells. Author(s): Salti GI, Grewal S, Mehta RR, Das Gupta TK, Boddie AW Jr, Constantinou AI. Source: European Journal of Cancer (Oxford, England : 1990). 2000 April; 36(6): 796-802. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10762754&dopt=Abstract
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Health behavior changes after colon cancer: a comparison of findings from face-to-face and on-line focus groups. Author(s): Kramish Campbell M, Meier A, Carr C, Enga Z, James AS, Reedy J, Zheng B. Source: Family & Community Health. 2001 October; 24(3): 88-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11563947&dopt=Abstract
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Homocamptothecin, an E-ring-modified camptothecin, exerts more potent antiproliferative activity than other topoisomerase I inhibitors in human colon cancers obtained from surgery and maintained in vitro under histotypical culture conditions. Author(s): Philippart P, Harper L, Chaboteaux C, Decaestecker C, Bronckart Y, Gordover L, Lesueur-Ginot L, Malonne H, Lavergne O, Bigg DC, da Costa PM, Kiss R.
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Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2000 April; 6(4): 1557-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10778989&dopt=Abstract ·
Inhibition by berberine of cyclooxygenase-2 transcriptional activity in human colon cancer cells. Author(s): Fukuda K, Hibiya Y, Mutoh M, Koshiji M, Akao S, Fujiwara H. Source: Journal of Ethnopharmacology. 1999 August; 66(2): 227-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10433483&dopt=Abstract
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Inhibition of azoxymethane-induced colon cancer by orange juice. Author(s): Miyagi Y, Om AS, Chee KM, Bennink MR. Source: Nutrition and Cancer. 2000; 36(2): 224-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10890034&dopt=Abstract
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Inhibitory effects of evodiamine on in vitro invasion and experimental lung metastasis of murine colon cancer cells. Author(s): Ogasawara M, Matsubara T, Suzuki H. Source: Biol Pharm Bull. 2001 August; 24(8): 917-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11510485&dopt=Abstract
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Intensified regression of colon cancer liver metastases in mice treated with irinotecan and the immunomodulator JBT 3002. Author(s): Shinohara H, Bucana CD, Killion JJ, Fidler IJ. Source: Journal of Immunotherapy (Hagerstown, Md. : 1997). 2000 MayJune; 23(3): 321-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10838661&dopt=Abstract
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Irinotecan-based combinations for the adjuvant treatment of stage III colon cancer. Author(s): Saltz L. Source: Oncology (Huntingt). 2000 December; 14(12 Suppl 14): 47-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11200149&dopt=Abstract
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Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians' Network. Author(s): Alberts DS, Martinez ME, Roe DJ, Guillen-Rodriguez JM, Marshall JR, van Leeuwen JB, Reid ME, Ritenbaugh C, Vargas PA, Bhattacharyya AB, Earnest DL, Sampliner RE. Source: The New England Journal of Medicine. 2000 April 20; 342(16): 1156-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10770980&dopt=Abstract
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Modification of the sensitivity to cisplatin with c-myc over-expression or down-regulation in colon cancer cells. Author(s): Funato T, Kozawa K, Kaku M, Sasaki T. Source: Anti-Cancer Drugs. 2001 November; 12(10): 829-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11707650&dopt=Abstract
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Monthly 5-days 5-fluorouracil and low-dose leucovorin for adjuvant chemotherapy in colon cancer. Author(s): Ahn JB, Shim KY, Jeung HC, Rha SY, Yoo NC, Kim NK, Roh JK, Min JS, Kim BS, Chung HC. Source: Cancer Letters. 2001 June 26; 167(2): 215-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11369143&dopt=Abstract
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Multiple factors other than p53 influence colon cancer sensitivity to paclitaxel. Author(s): Sharma N, Ramachandran S, Bowers M, Yegappan M, Brown R, Aziz S, Chapman R, Yu BW. Source: Cancer Chemotherapy and Pharmacology. 2000; 46(4): 329-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11052631&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to colon cancer; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Breast Cancer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Breast.ht m Breast Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Can cerBreastcc.html
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Cancer Prevention (Reducing the Risk) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000272.html Cancer Prevention and Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Diet.htm Cancer, Breast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Can cerBreastcc.html Cancer, Colorectal Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Can cerColorectalcc.html Colon Cancer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Colon.htm Colorectal Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Can cerColorectalcc.html Colorectal cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/ colorectalcancer.html
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Constipation Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Crohn's Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cro hnsDiseasecc.html Diverticular Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Div erticularDiseasecc.html Immune Function Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Immune_Function .htm Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulc erativeColitiscc.html Inflammatory Bowel Disease, Crohn's Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cro hnsDiseasecc.html Iron-Deficiency Anemia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Iron_Deficiency.ht m
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Lung Cancer Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Lung.htm Menopause Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Me nopausecc.html Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obe sitycc.html Ulcerative Colitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Ulcerative_Colitis. htm Ulcerative Colitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ulc erativeColitiscc.html ·
Alternative Therapy Colon therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 682,00.html
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Nutrition Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Nutr itioncm.html ·
Herbs and Supplements Acidophilus and Other Probiotics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000089.html Aminoglycosides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsAminoglycosidescl.html Antibiotic Combination: Sulfa Drugs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsSulfaDrugscl.html Barbiturates Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti convulsantMedicationsBarbituratescl.html Biguanides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti diabeticMedicationsBiguanidescl.html
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Bile Acid Sequestrants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cho lesterolLoweringMedicationsBileAcidSequestrantscl.html Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Calcitrol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Cephalosporins Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsCephalosporinscl.html Chemotherapy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Chemotherapy.htm Chitosan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Chitosan.htm
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Cholecalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Curcuma Alternative names: Turmeric; Curcuma longa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Cyclophosphamide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cyclophosphamide.h tm DHA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/D ocosahexaenoicAcidDHAcs.html Docetaxel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Docetaxel.htm Docosahexaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHA.htm Docosahexaenoic Acid (DHA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/D ocosahexaenoicAcidDHAcs.html
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Echinacea Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Echinacea Alternative names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea, Purple Coneflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Echinacea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 775,00.html Echinacea angustifolia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Echinacea pallida Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Echinacea purpurea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html
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Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ei cosapentaenoicAcidEPAcs.html Electrolytes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Car diovascularMedicationsElectrolytescl.html EPA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ei cosapentaenoicAcidEPAcs.html Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Fiber.htm Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Fi bercs.html
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Fiber, insoluble Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 998,00.html Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Flavonoids.htm Fluorouracil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Fluorouracil.htm Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gl utaminecs.html Glutathione Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glutathione.htm Greater Celandine Alternative names: Chelidonium majus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Greater_Celandine.ht m Green Tea Alternative names: Camellia sinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Green_Tea.htm
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Histamine H2 Antagonists Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Ulce rMedicationsHistamineH2Antagonistscl.html Inhalant, Systemic, and Topical Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti inflammatoryMedicationsInhalantSystemicandTopicalCorticosteroids cl.html IP-6 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/IP-6.htm Ispaghula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps ylliumcs.html Lycopene Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 803,00.html Macrolides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsMacrolidescl.html Melatonin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Melatonin.htm
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Methotrexate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Methotrexate.htm Monophasic, Biphasic, and Triphasic Preparations Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Birt hControlMedicationscl.html Musa Banana Alternative names: Plantain, Banana; Musa sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ N-Acetyl Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/N_Acetyl_Cysteine.ht m Paclitaxel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Paclitaxel.htm Penicillin Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsPenicillinDerivativescl.html Phosphorus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P hosphoruscs.html
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Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps ylliumcs.html Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Proton Pump Inhibitors (Gastric Acid Secretion Inhibitors) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Ulce rMedicationsProtonPumpInhibitorscl.html Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps ylliumcs.html Purple Coneflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Quinolones Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsQuinolonescl.html
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Sambucus Alternative names: Black Elderberry; Sambucus nigra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Stevia Alternative names: Sweetleaf; Stevia rebaudiana Bertoni Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Sulfasalazine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sulfasalazine.htm Sulindac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sulindac.htm Tetracycline Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsTetracyclineDerivativescl.html Uricosuric Agents Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: Uricosuric Agents Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine Definitive Guide to Cancer by W. John Diamond, et al; Hardcover - 1120 pages Package edition (March 18, 1997), Alternativemedicine.Com Books; ISBN: 1887299017; http://www.amazon.com/exec/obidos/ASIN/1887299017/icongroupinterna · Beating Cancer With Nutrition - Revised by Patrick Quillin, Noreen Quillin (Contributor); Paperback - 352 pages; Book & CD edition (January 1, 2001), Bookworld Services; ISBN: 0963837281; http://www.amazon.com/exec/obidos/ASIN/0963837281/icongroupinterna · Cancer: Increasing Your Odds for Survival - A Resource Guide for Integrating Mainstream, Alternative and Complementary Therapies by David Bognar, Walter Cronkite; Paperback (August 1998), Hunter House; ISBN: 0897932471; http://www.amazon.com/exec/obidos/ASIN/0897932471/icongroupinterna · Choices in Healing by Michael Lerner; Paperback - 696 pages; (February 28, 1996), MIT Press; ISBN: 0262621045; http://www.amazon.com/exec/obidos/ASIN/0262621045/icongroupinterna · The Gerson Therapy: The Amazing Nutritional Program for Cancer and Other Illnesses by Charlotte Gerson, Morton Walker, D.P.M.; Paperback 448 pages (October 2001), Kensington Publishing Corp.; ISBN: 1575666286; http://www.amazon.com/exec/obidos/ASIN/1575666286/icongroupinterna · Natural Compounds in Cancer Therapy by John C. Boik; Paperback - 520 pages (March 2001), Oregon Medical Press; ISBN: 0964828014; http://www.amazon.com/exec/obidos/ASIN/0964828014/icongroupinterna · There’s No Place Like Hope: A Guide to Beating Cancer in Mind-Sized Bites by Vickie Girard, Dan Zadra (Editor); Hardcover - 161 pages (April 2001), Compendium Inc.; ISBN: 1888387416; http://www.amazon.com/exec/obidos/ASIN/1888387416/icongroupinterna
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· Your Life in Your Hands by Jane A. Plant, Ph.D; Hardcover - 272 pages (December 13, 2000), St. Martins Press (Trade); ISBN: 0312275617; http://www.amazon.com/exec/obidos/ASIN/0312275617/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Berberine: An alkaloid from Hydrastis canadensis L., Berberidaceae. It is also found in many other plants. It is relatively toxic parenterally, but has been used orally for various parasitic and fungal infections and as antidiarrheal. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Cephalosporins: A family of antibiotic drugs that is used to treat a wide variety of bacterial infections. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cyclophosphamide: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Deoxyguanosine: A nucleoside consisting of the base guanine and the sugar deoxyribose. [NIH] Docetaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH] Echinacea:
A genus of perennial herbs used topically and internally. It
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contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Flavopiridol: Belongs to the family of anticancer drugs called flavinols. [NIH] Ginseng: An herb with a root that has been used in some cultures to treat certain medical problems. It may have anticancer effects. [NIH] Glutamine: An amino acid used in nutrition therapy. It is also being studied for the treatment of diarrhea caused by radiation therapy to the pelvis. [NIH] Inoperable: Not suitable to be operated upon. [EU] Lycopene: A red pigment found in tomatoes and some fruits. [NIH] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] Paclitaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Sulindac: A nonsteroidal anti-inflammatory drug that is being studied as a treatment for cancer. [NIH] Tetracycline: An antibiotic drug used to treat infection. [NIH] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of
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approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [NIH] Uricosuric: 1. pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. an agent that promotes uricosuria. [EU] Xenograft: The cells of one species transplanted to another species. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with colon cancer. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with colon cancer may be given different recommendations. Some recommendations may be directly related to colon cancer, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of colon cancer. We will then show you how to find studies dedicated specifically to nutrition and colon cancer.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
·
Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
·
Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:225 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
225
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 343
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?226
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”227 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.228 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 227 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 228 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 226
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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Colon Cancer The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.229 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
229
Researching Nutrition 345
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “colon cancer” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on colon cancer: ·
How to prevent colon cancer: new research updates old theories. Source: Antinoro, L. Environmental-nutrition (USA). (January 1999). volume 22(1) page 1, 6. intestines neoplasms human nutrition research dietary fibres diet fats body weight folic acid calcium alcoholic beverages 0893-4452 Summary: intestin neoplasme nutrition humaine recherche fibre alimentaire regime alimentaire corps gras poids corporel acide folique calcium boisson alcoolisee
Additional consumer oriented references include: ·
1. Is colon cancer really linked to a daily diet of red meat. Source: Conning, D.M. B-N-F-Nutr-Bull-Br-Nutr-Found. London : The Foundation. May 1991. volume 16 (2) page 60-61. 0141-9684
·
By the way, doctor...I've had small amounts of blood in my bowel movements from time to time for years. My doctor has done a pretty thorough evaluation and has ruled out colon cancer or anything serious: what I have is plain old hemorrhoids. I've heard of an operation using rubber bands that can get rid of them. Should I go ahead and have this procedure done? Source: Lee, T H Harv-Health-Lett. 2000 June; 25(8): 8 1052-1577
·
Calcium and vitamin D intakes influence the risk of bowel cancer in men. Source: Nutrition-reviews (USA). (June 1985). volume 43(6) page 170-172. vitamin d carcinoma intestines calcium 0029-6643
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Clues to colon cancer. Source: Liebman, B. Nutr-Action-Health-Lett. Washington, D.C. : Center for Science in the Public Interest. March 1990. volume 17 (2) page 1, 5-7. 0199-5510
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Colon cancer and fibre: ! or. Source: Arens, U. BNF-nutr-bull. London : The British Nutrition Foundation. Spring 1999. volume 24 (86) page 4-7. 0141-9684
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·
Colon cancer prevention. Worth the trouble. Source: Anonymous Harv-Health-Lett. 1999 November; 25(1): 1-2 10521577
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Diet and colon cancer. Source: Orta, J. Nutr-M-D. Van Nuys, Calif. : The Journal. April 1989. volume 15 (4) page 1-2. 0732-0167
·
Diet, lifestyle and colorectal cancer: is hyperinsulinemia the missing link? Author(s): University of Toronto, Ontario, Canada. Source: Kim, Y.I. Nutrition-reviews (USA). (September 1998). volume 56(9) page 275-279. intestines neoplasms diet insulin metabolic disorders diabetes risk men women 0029-6643
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Dietary fiber and colorectal cancer: what is appropriate advice? Author(s): Department of Foods & Nutrition, Purdue University, West Lafayette, IN 47907-1260, USA. Source: Story, J A Savaiano, D A Nutr-Revolume 2001 March; 59(3 Pt 1): 84-6 0029-6643
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Dietary habits affect colon cancer risk. Source: Anonymous Health-News. 1998 August 15; 4(10): 5 1081-5880
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Effect of wheat fiber and vitamins C and E supplements on rectal polyps in patients at high risk for colon cancer. Source: Anonymous Nutr-Revolume 1990 May; 48(5): 218-20 0029-6643
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Epidemiology and mechanisms relating diet to risk of colorectal cancer. Source: Mathews, F. Nutr-res-rev. Cambridge [England] ; New York : Cambridge University Press, c1988-. 1996. volume 9 page 197-239. 09544224
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Fiber and colon cancer: does the current evidence justify a preventive policy? Author(s): USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111. Source: Ausman, L M Nutr-Revolume 1993 February; 51(2): 57-63 00296643
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Fiber helps diabetes ... but not colon cancer? Source: Anonymous Health-News. 2000 June; 6(6): 5 1081-5880
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Fish-oil supplementation reduces intestinal hyperproliferation in persons at risk for colon cancer. Source: Anonymous Nutr-Revolume 1993 August; 51(8): 241-3 0029-6643
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Folate, alcohol, methionine, and colon cancer risk: is there a unifying theme? Source: Anonymous Nutr-Revolume 1994 January; 52(1): 18-20 0029-6643
Researching Nutrition 347
·
Iron and colorectal cancer risk: human studies. Author(s): Department of Surgery, University of Illinois at Chicago, 60612, USA. Source: Nelson, R L Nutr-Revolume 2001 May; 59(5): 140-8 0029-6643
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Is meat involved in colon cancer. Source: Nestle, M. BNF-nutr-bull. London : The British Nutrition Foundation. Spring 1998. volume 23 (83) page 79-83. 0141-9684
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Meat consumption and colorectal cancer: a review of epidemiologic evidence. Author(s): Unit of Nutrition and Cancer, International Agency for Research on Cancer, Lyon, France. Source: Norat, T Riboli, E Nutr-Revolume 2001 February; 59(2): 37-47 0029-6643
·
Nutrition classics. Cancer, July 1971: Epidemiology of cancer of the colon and rectum. By Denis P. Burkitt. Source: Anonymous Nutr-Revolume 1987 July; 45(7): 212-4 0029-6643
The following information is typical of that found when using the “Full IBIDS Database” when searching using “colon cancer” (or a synonym): ·
Energy intake, overweight, physical exercise and colorectal cancer risk. Author(s): Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
[email protected] Source: Giacosa, A Franceschi, S La Vecchia, C Favero, A Andreatta, R Eur-J-Cancer-Prevolume 1999 December; 8 Suppl 1S53-60 0959-8278
·
Nutrients and food groups and large bowel cancer in Europe. Author(s): Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano (PN), Italy. Source: Franceschi, S Eur-J-Cancer-Prevolume 1999 December; 8 Suppl 1S49-52 0959-8278
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to colon cancer; please note that any particular subject below may indicate either a therapeutic use, or a
Researching Nutrition 349
contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Folic_Acid.htm Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm Vitamin C Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 904,00.html Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_D.htm Vitamin D Alternative names: Calciferol, Calcitrol, Cholecalciferol, Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Vitamin D Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000129.html
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Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 905,00.html Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_E.htm Vitamin E Alternative names: Alpha-Tocopherol, Beta-Tocopherol, D-AlphaTocopherol, Delta-Tocopherol, Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html ·
Minerals Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Beta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html
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Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Calcium.htm Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C alciumcs.html Calcium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000113.html Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 884,00.html Cisplatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cisplatin.htm D-Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Delta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html
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Folate Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000161.html Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Iron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Iron.htm Selenium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Selenium.htm Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000233.html ·
Food and Diet Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Garlic.htm Garlic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000164.html Garlic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,21,00. html
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Hazelnuts Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,307,0 0.html High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/High_Fiber_Diet.htm Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Salt_Diet.htm Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/O mega3FattyAcidscs.html Omega-3 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 992,00.html Soy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Soy.htm Soy Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000185.html Vegetarian Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Vegetarian_Diet.htm
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Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Wheat.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Bacteria: A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium. [NIH]
Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Phosphorous: Having to do with or containing the element phosphorus. [NIH]
Potassium: A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heart beat. [NIH]
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Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An essential dietary mineral. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 357
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.230
230
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
358 Colon Cancer
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):231 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
231
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 359
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library, http://planetreesanjose.org/
·
California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 361
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
·
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
·
Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 363
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
·
Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 365
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with colon cancer faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.232 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
232Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 367
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
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·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 369
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.233
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”234 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 234 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 233
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.235 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.236 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 236 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 235
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 373
contact information on how to find more in-depth information about Medicaid.237
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp. 237
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 375
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
Financial Assistance for Cancer Care238 Cancer imposes heavy economic burdens on both patients and their families. For many people, a portion of medical expenses is paid by their health insurance plan. For individuals who do not have health insurance or who need financial assistance to cover health care costs, resources are available,
238
Adapted from the NCI: http://cis.nci.nih.gov/fact/8_3.htm.
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including government-sponsored programs and services supported by voluntary organizations. Cancer patients and their families should discuss any concerns they may have about health care costs with their physician, medical social worker, or the business office of their hospital or clinic. The organizations and resources listed below may offer financial assistance. Organizations that provide publications in Spanish or have Spanishspeaking staff have been identified. ·
The American Cancer Society (ACS) office can provide the telephone number of the local ACS office serving your area. The local ACS office may offer reimbursement for expenses related to cancer treatment including transportation, medicine, and medical supplies. The ACS also offers programs that help cancer patients, family members, and friends cope with the emotional challenges they face. Some publications are available in Spanish. Spanish-speaking staff are available. Telephone: 1– 800–ACS–2345 (1–800–227–2345). Web site: http://www.cancer.org
·
The AVONCares Program for Medically Underserved Women provides financial assistance and relevant education and support to low income, under- and uninsured, underserved women throughout the country in need of diagnostic and/or related services (transportation, child care, and social support) for the treatment of breast, cervical, and ovarian cancers. Telephone: 1–800–813–HOPE (1–800–813–4673). Web site: http://www.cancercare.org.
Community voluntary agencies and service organizations such as the Salvation Army, Lutheran Social Services, Jewish Social Services, Catholic Charities, and the Lions Club may offer help. These organizations are listed in your local phone directory. Some churches and synagogues may provide financial help or services to their members. Fundraising is another mechanism to consider. Some patients find that friends, family, and community members are willing to contribute financially if they are aware of a difficult situation. Contact your local library for information about how to organize fundraising efforts. General assistance programs provide food, housing, prescription drugs, and other medical expenses for those who are not eligible for other programs. Funds are often limited. Information can be obtained by contacting your state or local Department of Social Services; this number is found in the local telephone directory.
Your Rights and Insurance 377
Hill-Burton is a program through which hospitals receive construction funds from the Federal Government. Hospitals that receive Hill-Burton funds are required by law to provide some services to people who cannot afford to pay for their hospitalization. Information about which facilities are part of this program is available by calling the toll-free number or visiting the Web site shown below. A brochure about the program is available in Spanish. Telephone: 1–800–638–0742. Web site: http://www.hrsa.gov/osp/dfcr/obtain/consfaq.htm.
Income Tax Deductions Medical costs that are not covered by insurance policies sometimes can be deducted from annual income before taxes. Examples of tax deductible expenses might include mileage for trips to and from medical appointments, out-of-pocket costs for treatment, prescription drugs or equipment, and the cost of meals during lengthy medical visits. The local Internal Revenue Service office, tax consultants, or certified public accountants can determine medical costs that are tax deductible. These telephone numbers are available in the local telephone directory. Web site: http://www.irs.ustreas.gov.
The Patient Advocate Foundation The Patient Advocate Foundation (PAF) is a national nonprofit organization that provides education, legal counseling, and referrals to cancer patients and survivors concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters. Telephone: 1–800–532–5274. Web site: http://www.patientadvocate.org. Patient Assistance Programs are offered by some pharmaceutical manufacturers to help pay for medications. To learn whether a specific drug might be available at reduced cost through such a program, talk with a physician or a medical social worker.
Transportation There are nonprofit organizations that arrange free or reduced cost air transportation for cancer patients going to or from cancer treatment centers. Financial need is not always a requirement. To find out about these programs, talk with a medical social worker. Ground transportation services
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may be offered or mileage reimbursed through the local ACS or your state or local Department of Social Services.
Veterans Benefits Eligible veterans and their dependents may receive cancer treatment at a Veterans Administration Medical Center. Treatment for service-connected conditions is provided, and treatment for other conditions may be available based on the veteran’s financial need. Some publications are available in Spanish. Spanish-speaking staff are available in some offices. Telephone: 1– 877–222–VETS. Web site: http://www.va.gov/vbs/health.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.239 NORD programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
239
Your Rights and Insurance 379
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:240 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
240 You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
Online Glossaries 381
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
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Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to colon cancer and keep them on file. The NIH, in particular, suggests that patients with colon cancer visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Colon Cancer Colon cancer Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000262.htm Colon cancer screening Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002071.htm
·
Signs & Symptoms for Colon Cancer Abdominal fullness, gaseous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003124.htm Abdominal pain and tenderness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Blood in the stool Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm
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Tiredness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm ·
Diagnostics and Tests for Colon Cancer Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Colonoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003886.htm Fecal Occult Blood Test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003393.htm Sigmoidoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm Stool guaiac Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003393.htm
·
Nutrition for Colon Cancer High-fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm
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Background Topics for Colon Cancer Cancer - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002166.htm
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Chemotherapy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm Metastasis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002260.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Radiation therapy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001918.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 385
COLON CANCER GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Adenocarcinoma: Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Allogeneic: Taken from different individuals of the same species. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A condition in which the number of red blood cells is below normal. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH] Antibody: A type of protein made by certain white blood cells in response
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to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigens: Substances that cause the immune system to make a specific immune response. [NIH] Antineoplastons: Substances isolated from normal human blood and urine being tested as a type of treatment for some tumors and AIDS. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apoptosis: A normal series of events in a cell that leads to its death. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Ascites: Abnormal buildup of fluid in the abdomen. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Azoxymethane: A potent carcinogen and neurotoxic compound. It is particularly effective in inducing colon carcinomas. [NIH] Bacteria: A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium. [NIH]
Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH]
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Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH] Berberine: An alkaloid from Hydrastis canadensis L., Berberidaceae. It is also found in many other plants. It is relatively toxic parenterally, but has been used orally for various parasitic and fungal infections and as antidiarrheal. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bevacizumab: A monoclonal antibody that may prevent the growth of blood vessels from surrounding tissue to a solid tumor. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biometry: The use of statistical methods to analyze biological observations and phenomena. [NIH] Biopsy: The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fineneedle aspiration. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bladder: The organ that stores urine. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcium: A mineral found in teeth, bones, and other body tissues. [NIH] Capecitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH]
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Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carboplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carmustine: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] CEA: Carcinoembryonic antigen. A substance that is sometimes found in an increased amount in the blood of people with certain cancers. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Cephalosporins: A family of antibiotic drugs that is used to treat a wide variety of bacterial infections. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Charities: Social welfare organizations with programs designed to assist individuals in times of need. [NIH]
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Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Cholangitis: Inflammation of a bile duct. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronotherapy: The adaptation of the administration of drugs to circadian rhythms. The concept is based on the response of biological functions to time-related events, such as the low point in epinephrine levels between 10 p.m. and 4 a.m. or the elevated histamine levels between midnight and 4 a.m. The treatment is aimed at supporting normal rhythms or modifying therapy based on known variations in body rhythms. While chronotherapy is commonly used in cancer chemotherapy, it is not restricted to cancer therapy or to chemotherapy. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Cisplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH]
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Colonoscope: A thin, lighted tube used to examine the inside of the colon. [NIH]
Colonoscopy: An examination of the inside of the colon using a thin, lighted tube (called a colonoscope) inserted into the rectum. If abnormal areas are seen, tissue can be removed and examined under a microscope to determine whether disease is present. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Corynebacterium: A genus of asporogenous bacteria that is widely distributed in nature. Its organisms appear as straight to slightly curved rods and are known to be human and animal parasites and pathogens. [NIH] Cryosurgery: Treatment performed with an instrument that freezes and destroys abnormal tissues. This procedure is a form of cryotherapy. [NIH] Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Cyclophosphamide: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water.
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Called also anhydration, deaquation and hypohydration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Deoxyguanosine: A nucleoside consisting of the base guanine and the sugar deoxyribose. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Dexamethasone: A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment. [NIH] DHEA: Dehydroepiandrosterone. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Docetaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH]
Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Edrecolomab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples
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are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopy: The use of a thin, lighted tube (called an endoscope) to examine the inside of the body. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: A thin layer of tissue that covers organs, glands, and other structures within the body. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagitis: Inflammation of the esophagus (the tube that carries food from the mouth to the stomach). [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Extracellular: Outside a cell or cells. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
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Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Flavopiridol: Belongs to the family of anticancer drugs called flavinols. [NIH] Floxuridine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorouracil: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gastric: Having to do with the stomach. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Ginseng: An herb with a root that has been used in some cultures to treat certain medical problems. It may have anticancer effects. [NIH] Glucose: Sugar. [NIH] Glutamine: An amino acid used in nutrition therapy. It is also being studied for the treatment of diarrhea caused by radiation therapy to the pelvis. [NIH]
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Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hepatitis: Inflammation of the liver. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the actions of certain cells or organs. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Ileostomy: An opening into the ileum, part of the small intestine, from the outside of the body. An ileostomy provides a new path for waste material to leave the body after part of the intestine has been removed. [NIH] Immunity: The condition of being immune; the protection against infectious
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disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunology: The study of the body's immune system. [NIH] Immunoscintigraphy: An imaging procedure in which antibodies labeled with radioactive substances are given to the person. A picture is taken of sites in the body where the antibody localizes. [NIH] Immunosuppressive: responses. [NIH]
Describes the ability to lower immune system
Immunotherapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also called biological therapy or biological response modifier (BRM) therapy. [NIH] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A drug that belongs to the family of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin reduces pain, fever, swelling and redness. It is also being used to reduce tumorinduced suppression of the immune system and to increase the effectiveness of anticancer drugs. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inflammation: A response of redness, swelling, pain, and a feeling of heat in certain areas which is meant to protect tissues affected by injury or disease. [NIH] Infusion:
A method of putting fluids, including drugs, into the
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bloodstream. Also called intravenous infusion. [NIH] Inoperable: Not suitable to be operated upon. [EU] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulin: A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and -gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intrahepatic: Within the liver. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Irrigation: Washing by a stream of water or other fluid. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable;
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fluctuating. 2. chemically unstable. [EU] Lesion: An area of abnormal tissue change. [NIH] Leucovorin: A drug used to protect normal cells from high doses of the anticancer drug methotrexate. It is also used to increase the antitumor effects of fluorouracil and tegafur-uracil, an oral treatment alternative to intravenous fluorouracil. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Levamisole: An antiparasitic drug that is also being studied in cancer therapy with fluorouracil. [NIH] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Lipid: Fat. [NIH] Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Lycopene: A red pigment found in tomatoes and some fruits. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Lymphoma: Cancer that arises in cells of the lymphatic system. [NIH] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammogram: An x-ray of the breast. [NIH] Mammography: The use of x-rays to create a picture of the breast. [NIH]
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Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Melanosis: A disorder caused by a disturbance in melanin pigmentation; melanism. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menopause: The time of life when a woman's menstrual periods stop permanently. Also called "change of life." [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastasize: To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Milligram: A measure of weight. A milligram is approximately 450,000times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom).
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Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Motility: The ability to move spontaneously. [EU] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH]
Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH]
Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: Refers to the death of living tissues. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH]
Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nonmetastatic: Cancer that has not spread from the primary (original) site to other sites in the body. [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] NSAIDs: Nonsteroidal anti-inflammatory drugs. A group of drugs that decrease fever, swelling, pain, and redness. [NIH]
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Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Oncology: The study of cancer. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osteoporosis: A condition that is characterized by a decrease in bone mass and density, causing bones to become fragile. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxaliplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Paclitaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Pancreatic: Having to do with the pancreas. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Pap test: The collection of cells from the cervix for examination under a microscope. It is used to detect changes that may be cancer or may lead to cancer, and can show noncancerous conditions, such as infection or inflammation. Also called a Pap smear. [NIH]
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Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Pericarditis: Inflammation of the pericardium. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: The tissue that lines the abdominal wall and covers most of the organs in the abdomen. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Phenylbutyrate: An anticancer drug that belongs to the family of drugs called differentiating agents. [NIH] Phosphorous: Having to do with or containing the element phosphorus. [NIH]
Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plantago: Three different species of Plantago or plantain, P. psyllium, P. ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH]
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Polyp: A growth that protrudes from a mucous membrane. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Postoperative: After surgery. [NIH] Potassium: A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heart beat. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proctitis: Inflammation of the rectum. [EU] Prodrugs: A compound that, on administration, must undergo chemical conversion by metabolic processes before becoming the pharmacologically active drug for which it is a prodrug. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH]
Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH]
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Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] PSA: Prostate-specific antigen. A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pulmonary: Relating to the lungs. [NIH] Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH] Radiology: The use of radiation (such as x-rays) or other imaging technologies (such as ultrasound and magnetic resonance imaging) to diagnose or treat disease. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU]
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Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Resected: Surgical removal of part of an organ. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this
Glossary 405
genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sarcoma: A cancer of the bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue. [NIH] Sargramostim: A colony-stimulating factor that stimulates the production of blood cells, especially platelets, during chemotherapy. It is a cytokine that belongs to the family of drugs called hematopoietic (blood-forming) agents. Also called GM-CSF. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An essential dietary mineral. [NIH] Semustine: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sigmoidoscope: A thin, lighted tube used to view the inside of the colon. [NIH]
Sigmoidoscopy: Inspection of the lower colon using a thin, lighted tube called a sigmoidoscope. Samples of tissue or cells may be collected for examination under a microscope. Also called proctosigmoidoscopy. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sporadic:
Neither endemic nor epidemic; occurring occasionally in a
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random or isolated manner. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stomach: An organ that is part of the digestive system. It helps in the digestion of food by mixing it with digestive juices and churning it into a thin liquid. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Sulindac: A nonsteroidal anti-inflammatory drug that is being studied as a treatment for cancer. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Systemic: Affecting the entire body. [NIH] Taboo: Any negative tradition or behavior that is generally regarded as harmful to social welfare and forbidden within a cultural or social group. [NIH]
Telomerase: Essential ribonucleoprotein reverse transcriptase that adds telomeric DNA to the ends of eukaryotic chromosomes. Telomerase appears to be repressed in normal human somatic tissues but reactivated in cancer, and thus may be necessary for malignant transformation. EC 2.7.7.-. [NIH] Testicular: Pertaining to a testis. [EU] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Tetracycline: An antibiotic drug used to treat infection. [NIH] Thermoregulation: Heat regulation. [EU] Thioredoxin: A hydrogen-carrying protein that participates in a variety of
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biochemical reactions including ribonucleotide reduction. Thioredoxin is oxidized from a dithiol to a disulfide during ribonucleotide reduction. The disulfide form is then reduced by NADPH in a reaction catalyzed by thioredoxin reductase. [NIH] Thoracic: Having to do with the chest. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Tomography: A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an x-ray machine. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Trastuzumab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. Trastuzumab blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. [NIH]
Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [NIH] Tumour: 1. swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. a new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unresectable: Unable to be surgically removed. [NIH] Uricosuric: 1. pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. an agent that promotes uricosuria. [EU] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urology:
A surgical specialty concerned with the study, diagnosis, and
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treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] ZD1839: A substance that is being studied as an anticancer drug. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
The Cancer Dictionary by Roberta Altman, Michael J., Md Sarg; Paperback - 368 pages, 2nd Revised edition (November 1999), Checkmark Books; ISBN: 0816039542; http://www.amazon.com/exec/obidos/ASIN/0816039542/icongroupinterna
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Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational
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Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna ·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Stedman’s Oncology Words by Beverly J. Wolpert (Editor), Stedmans; Paperback - 502 pages, 3rd edition (June 15, 2000), Lippincott, Williams & Wilkins; ISBN: 0781726549; http://www.amazon.com/exec/obidos/ASIN/0781726549/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co., ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
410 Colon Cancer
INDEX A Abdomen ..30, 31, 32, 120, 159, 160, 200, 268, 279, 385, 386, 387, 389, 396, 397, 399, 401 Abdominal....... 12, 15, 17, 160, 175, 188, 201, 216, 279, 317, 400, 401 Aberrant...............................134, 145, 311 Abscess .................................37, 278, 391 Algorithms............................................196 Alkaline ..................................31, 133, 386 Allogeneic ....................................168, 230 Anal .................................................11, 37 Anastomosis ......15, 17, 18, 240, 243, 252 Anatomical...........................................128 Anemia ................................................123 Anorectal ...............................................37 Antibiotic .....161, 336, 337, 388, 401, 405, 406 Antibody .......74, 88, 89, 90, 96, 112, 113, 114, 169, 174, 177, 242, 253, 278, 386, 387, 391, 395, 407 Antigens...............112, 137, 144, 168, 386 Anus ...11, 13, 31, 32, 33, 37, 62, 63, 182, 385, 389, 392, 394, 404 Apoptosis ....131, 141, 146, 149, 151, 207, 313, 314, 316, 318 Appendicitis .........................181, 278, 391 Arterial ...........83, 244, 245, 245, 253, 253 Arteries ................................112, 199, 386 Ascites .................................................196 Aspirin..........................................188, 199 Assay...................134, 135, 174, 177, 395 Asymptomatic .....126, 175, 190, 198, 200, 226, 238, 400 Autologous...........................168, 230, 242 Azoxymethane.....................311, 316, 319 B Bacteria ......112, 115, 161, 193, 200, 340, 354, 385, 386, 389, 390, 394, 404, 405, 406, 408 Barium ....13, 23, 24, 25, 26, 77, 120, 128, 174, 186, 188, 189, 198, 269, 270 Benign ...............26, 41, 63, 194, 399, 403 Berberine .............................................319 Bereavement .........................................52 Bilateral................................................199 Biochemical ....... 131, 162, 165, 176, 247, 255, 262, 407 Biometry ..............................................132 Biopsy............................................31, 387 Bladder ..................63, 114, 181, 395, 407
Bolus .. 247, 249, 250, 256, 257, 258, 260, 278, 387 Bypass .......................................... 18, 252 C Calcium ...... 181, 212, 228, 246, 255, 261, 337, 341, 342, 345, 392 Capecitabine ................. 70, 250, 251, 259 Capsules ............................................. 343 Carbohydrate .............................. 173, 342 Carboplatin............................................ 72 Carcinogenesis ................... 131, 191, 314 Cardiac................................................ 196 Cardiovascular .................................... 266 Carmustine.................................. 245, 253 Cellulose ............................................. 311 Ceramide ............................................ 151 Cerebellar ........................................... 248 Cervical ... 50, 62, 180, 181, 265, 376, 388 Chemoembolization .............................. 75 Chemoprevention .... 37, 42, 45, 131, 154, 314 Cholangitis .......................................... 123 Cholesterol.................. 181, 267, 340, 342 Chronic....... 123, 193, 194, 196, 200, 216, 219, 274, 366, 389, 398, 400 Chronotherapy ............................ 112, 389 Cirrhosis...................................... 185, 196 Cisplatin .............. 152, 247, 256, 315, 320 Colectomy.. 15, 23, 31, 87, 123, 141, 233, 269, 389 Colitis ...... 12, 25, 26, 38, 123, 184, 186, 188, 191, 196, 216, 217, 225, 265, 268 Colonoscope ................... 13, 32, 267, 390 Colonoscopy .. 23, 24, 25, 26, 37, 77, 120, 121, 122, 123, 124, 126, 127, 129, 130, 174, 175, 186, 188, 189, 267, 268, 270 Colostomy............... 15, 32, 196, 269, 390 Concomitant........................................ 269 Constipation .............. 12, 26, 37, 196, 266 Corticosteroids ............................ 336, 390 Cryosurgery .......................... 76, 253, 254 Cryotherapy ........ 112, 245, 253, 254, 390 Curative ....... 52, 174, 226, 230, 233, 236, 243, 245, 354, 399 Curcumin............................................... 78 D Degenerative ...................................... 341 Dehydration................................. 252, 260 Dehydroepiandrosterone .................... 144 Deoxyguanosine ................................. 316 Dexamethasone.................................... 73
Index 411
Diarrhea....... 26, 196, 216, 248, 251, 252, 259, 260, 266, 337, 340, 393 Distal....................126, 128, 160, 187, 403 Distention.............................................121 Diverticulitis .........................269, 278, 391 Dysplasia .....................................123, 126 E Edrecolomab .........................................89 Elective ................................................122 Electrophoresis....................................143 Encapsulated.......................................282 Endometrial .........................................225 Endometrium .........................12, 278, 392 Endoscope.............................32, 268, 392 Endoscopy...........................121, 268, 269 Enema ....... 13, 23, 24, 26, 77, 120, 128, 186, 188, 189, 198, 269, 270 Enzyme........................178, 248, 309, 403 Epidemiological ...........................217, 218 Epidermal ............................................132 Epithelial ................93, 134, 135, 242, 317 Esophageal......................................87, 91 Esophagitis ..........................................196 Esophagus....11, 113, 184, 194, 196, 197, 200, 265, 392, 404 Extracellular.........................................152 F Fatigue.........................155, 181, 216, 386 Ferritin .................................................152 Fetus......................................34, 341, 408 Fissure...................................................37 Fistula ....................................................37 Flavopiridol ..........................................313 Floxuridine .............73, 245, 245, 253, 253 Fluorescence .......................143, 157, 393 Folate...................................208, 315, 316 G Gallbladder ....30, 155, 181, 193, 385, 393 Gastritis ...............................................265 Gastrointestinal.....13, 41, 44, 45, 92, 120, 127, 175, 181, 185, 212, 219, 265, 268 Genotype .....................................160, 401 Ginseng ...............................................314 Glucose .......................................156, 388 Glycoprotein ...... 158, 174, 205, 226, 242, 397 Grade.....96, 113, 123, 126, 157, 236, 394 Grading ........................................157, 394 H Hepatitis...............................................196 Histamine.............................112, 146, 389 Histology..............................................130 Hormonal .............................................188 Hormones .....33, 113, 158, 279, 391, 397, 399, 400 Hybridization........................................135
I Ileostomy............................. 196, 200, 394 Immunity ............................. 177, 264, 395 Immunogenic ...................................... 173 Immunology .................................. 31, 385 Immunoscintigraphy............................ 227 Immunotherapy....................... 17, 85, 242 Immunotoxin ......................................... 87 Incision.......................... 31, 113, 389, 396 Incontinence ................... 37, 63, 196, 395 Indicative..................... 162, 166, 205, 408 Induction ..................................... 313, 316 Inoperable ........................................... 309 Insufflation................................... 120, 128 Insulin.......................... 145, 147, 150, 346 Interferon.... 236, 247, 255, 256, 262, 279, 317, 396 Intermittent .......................... 234, 247, 256 Interstitial..................... 245, 254, 280, 405 Intestine ... 11, 12, 26, 31, 32, 33, 41, 200, 265, 266, 387, 394, 396, 404 Intraepithelial ...................................... 231 Intrahepatic ............................. 73, 76, 246 Intravenous .. 76, 103, 113, 114, 237, 238, 247, 250, 251, 256, 259, 396, 397 Invasive..... 77, 78, 87, 126, 175, 180, 294 Irinotecan ... 70, 72, 76, 80, 85, 86, 95, 96, 229, 239, 249, 250, 251, 252, 257, 258, 260, 314, 315, 319 Irrigation .............................................. 197 Ischemia.............................. 149, 161, 404 L Labile .................................................. 152 Lesion ................... 31, 128, 158, 387, 397 Leukemia ............................ 113, 274, 391 Levamisole....... 227, 228, 234, 235, 236, 237, 240, 241, 242, 243, 244 Lipid .................................... 283, 314, 397 Localization ................................. 134, 141 Lupus .................................................. 181 Lymph ...... 14, 15, 62, 152, 173, 174, 194, 211, 232, 233, 241, 245, 254, 317, 388, 397 Lymphadenectomy ............................. 182 Lymphoma .................... 96, 113, 274, 391 M Malignancy............................ 40, 168, 173 Malignant ...... 4, 11, 41, 45, 63, 133, 134, 161, 242, 253, 274, 399, 406 Mediate ............................................... 131 Melanoma ..... 84, 85, 154, 180, 182, 198, 274 Melanosis............................................ 145 Membrane...... 33, 41, 159, 178, 231, 399, 400, 402 Menopause ................................. 181, 270
412 Colon Cancer
Metastasis ..114, 133, 144, 149, 150, 151, 154, 164, 171, 176, 205, 206, 211, 232, 260, 319, 398 Metastasize ....40, 63, 134, 164, 171, 176, 398 Methionine ...........................................346 Methotrexate.......114, 228, 238, 243, 246, 247, 255, 261, 397 Milligram ......................................279, 398 Millimeter .............................128, 159, 398 Modulator.............................................236 Molecular ..37, 44, 45, 132, 135, 166, 180, 183, 230, 263, 272, 273, 316, 337, 407 Molecule ..............132, 159, 160, 398, 404 Motility .........................................154, 266 Mucinous ...............................................84 Mucosa .......124, 130, 138, 159, 194, 239, 280, 397, 399, 406 Mucositis..............................................248 N Nausea ................................251, 259, 309 Necrosis...............................146, 161, 404 Neoplasia.....126, 128, 159, 225, 274, 399 Neoplasm ........4, 123, 159, 162, 399, 407 Neoplastic ....................................131, 134 Neural ..................................................341 Neuroendocrine ...................................231 Neutropenia ......248, 251, 252, 256, 259, 260 Niacin...................................................341 Nonmetastatic......................................135 O Occult .......13, 24, 25, 26, 121, 122, 126, 129, 136, 174, 175, 186, 187, 188, 189, 190, 192, 245, 253, 270 Oncogene ....................131, 159, 274, 400 Oncologist......................................63, 400 Oncology ...........................21, 38, 43, 127 Organelles ...................156, 165, 177, 390 Osteoporosis ...............................181, 215 Ovaries ......18, 19, 33, 158, 252, 397, 400 Ovary .....................................................12 Overdose .............................................341 Oxaliplatin.....72, 80, 86, 90, 94, 229, 251, 256, 259, 260, 314 P Paclitaxel .....................................313, 320 Palliative ....................18, 19, 52, 225, 269 Pancreatic...... 87, 91, 93, 200, 274, 309, 400 Pancreatitis..........................................196 Pelvis .......33, 34, 120, 337, 393, 400, 408 Peptic...........................................185, 196 Peptide ..................33, 169, 178, 402, 403 Perforation ...172, 186, 224, 240, 278, 391 Perinatal ..............................................218
Perioperative............................... 229, 237 Peritoneal.................................... 142, 147 Peritoneum.......................... 159, 232, 401 Phenotype................... 134, 136, 160, 401 Phenylbutyrate ...................................... 81 Phosphorous....................................... 342 Phosphorus......................... 160, 354, 401 Polyp ......... 13, 15, 25, 121, 126, 128, 130 Polypeptide 158, 164, 165, 171, 176, 177, 394 Polyposis...... 12, 24, 25, 37, 44, 45, 125, 225 Postoperative ...... 23, 226, 227, 234, 235, 236, 237, 240, 241, 242, 243, 244, 269 Potassium ........................... 337, 342, 392 Precancerous.. 25, 33, 121, 122, 170, 402 Preclinical............................................ 294 Precursor ............................ 135, 162, 407 Predisposition ..................................... 166 Premalignant... 26, 33, 123, 170, 191, 402 Preoperative ......... 23, 197, 245, 254, 269 Prevalence .................................. 181, 217 Prodrugs ..................................... 248, 256 Progression....... 148, 166, 170, 171, 238, 249, 250, 251, 257, 258, 259 Progressive ...... 123, 162, 174, 193, 229, 239, 249, 257, 389, 407 Prolapse................................................ 38 Prostaglandins .................................... 137 Prostate....... 52, 96, 150, 155, 180, 194, 264, 274, 303, 308, 309, 313, 387, 403 Protease.............................................. 171 Proteins ....... 11, 139, 143, 158, 159, 160, 164, 171, 173, 176, 178, 204, 205, 209, 295, 312, 340, 342, 394, 399, 401, 405 Proximal .............. 125, 126, 128, 156, 391 Psychotherapy ............................ 303, 308 Pulmonary................... 150, 245, 254, 261 R Radioisotope ....................................... 169 Radiolabeled ......................................... 90 Radiotherapy ...................................... 168 Receptor .... 132, 137, 139, 142, 146, 147, 150, 317 Recurrence .. 62, 167, 205, 218, 219, 227, 228, 229, 230, 237, 240, 254, 320, 389 Reflux.......................................... 185, 196 Refractory ... 229, 239, 249, 251, 257, 259 Regimen....... 73, 77, 80, 84, 85, 121, 226, 227, 234, 235, 236, 248, 250, 251, 256, 258, 259, 260, 262 Registries ........................................ 40, 45 Relapse............................................... 135 Remission ........................... 222, 315, 404 Reperfusion......................... 149, 161, 404
Index 413
Resected ....135, 189, 226, 227, 234, 237, 241, 242, 244, 311, 318 Retinoblastoma....................................274 Riboflavin.............................................340 S Sargramostim ........................................94 Sclerosis ......................................246, 253 Secretion ....151, 157, 158, 159, 161, 394, 397, 399, 405 Selenium..............................................342 Semustine....................................227, 234 Serum ..........166, 168, 172, 205, 224, 226 Sigmoidoscope ........................13, 33, 405 Sigmoidoscopy ...23, 24, 25, 26, 121, 123, 126, 128, 129, 174, 186, 187, 188, 189, 190, 267, 268, 269, 270 Somatic................................125, 161, 406 Species .......160, 161, 177, 200, 338, 385, 389, 401, 405, 406, 408 Spectrum .....................................113, 390 Sporadic ........45, 145, 161, 191, 225, 404 Staging .....13, 27, 41, 140, 141, 172, 180, 224, 231, 233 Steroids .......................156, 336, 390, 391 Stomach .....11, 30, 32, 87, 113, 155, 168, 194, 200, 265, 278, 385, 391, 392, 393, 404 Stomatitis .....................................251, 259 Stool .......12, 13, 24, 26, 32, 63, 121, 122, 126, 175, 188, 192, 205, 210, 213, 216, 265, 267, 382, 389, 395
Sulindac .............................................. 312 Systemic ...... 16, 73, 181, 227, 237, 240, 244, 245, 245, 253, 280, 406 T Telomerase......................................... 148 Testicular ...................................... 93, 199 Tetanus ................................. 91, 114, 406 Thermoregulation................................ 340 Thioredoxin ......................................... 142 Thyroid ............ 64, 93, 354, 355, 396, 407 Thyroxine ............................................ 342 Tolerance ............ 120, 122, 162, 248, 407 Tomography...... 24, 120, 122, 124, 128, 150, 227 Transfusion ......................... 230, 229, 230 Trastuzumab ......................................... 74 Tubulin ................................................ 315 Tumour........................................ 144, 238 Tyrosine .............................................. 139 U Unresectable................... 68, 73, 244, 254 Urine ...... 62, 63, 68, 112, 204, 338, 355, 386, 387, 395, 404, 407 Urology................................................ 204 Uterus . 26, 32, 33, 62, 278, 388, 392, 400 V Vaccine ..... 31, 88, 91, 92, 93, 94, 96, 385 Vascular .............................................. 215 Veins ................................................... 199 Vincristine ................... 227, 234, 338, 407 Virus.................................................... 138
414 Colon Cancer
