2. Colorectal Cancer 101

3. Overview Who is the Colon Cancer Alliance? What is Colorectal Cancer?
How Can You Help?
Colon and rectal cancer
Screening
Stages
Diagnosis
Risk factors
Treatment
Statistics
Prevention

4. Who is the Colon Cancer Alliance (CCA)?
The (CCA) is a national patient advocacy organization dedicated to ending the suffering caused by colorectal cancer.

5. Who is the CCA? The CCA has over 37,000 members.
The growth and success of the organization is due in large part to the skills and energy of our volunteers.

6. What does the CCA do?
In order to increase rates of screening and survivorship, the CCA provides:
Patient Support
Education
Research
Advocacy

7. Patient Support Services
Toll-free Helpline:
Buddy Program – Peer to Peer Support
Support through Local Chapters
MyCRCConnections.org – Online Community
Regional Seminars/Online Webinars

8. Education Services
Originally developed by CCA Voices Ambassador Anita Mitchell of the greater Seattle area.
1st national campaign introduced in st Friday in March – National Colorectal Cancer Awareness Month. Posters were distributed to the general public + the CCA volunteers + Comprehensive Cancer Centers. The CCA also distribured “Ask Me Why I’m Blue Stickers” to generate a 2 way conversation about the importance of colorectal cancer screening.

9. Education Services

10. Education Services
Regional Seminars

11. Supports Research
The CCA works to increase federal, state, and private funding for research devoted to finding more effective treatments for colorectal cancer.

12. Supports Advocacy Efforts
The CCA is dedicated to advancing and championing the cause of colon cancer.

13. What is Colorectal Cancer?

14. Colorectal Cancer Facts
The second leading cancer killer in the United States.
One person in the United States dies of colorectal cancer every 9.3 minutes.
Survival depends on early detection.
90% five-year survival rate in early detected cases.

15. What is Colorectal Cancer?
Definition of colon cancer: Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers begin in cells that make and release mucus and other fluids.
American Cancer Society ©

16. What is Colorectal Cancer?
Definition of rectal cancer: Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).
American Cancer Society ©

17. What is Colorectal Cancer?
Colorectal cancer is cancer that occurs in the colon or rectum. Sometimes it is called colon cancer, for short.

18. What is Colorectal Cancer?
The colon is the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus.

19. Colon Cancer and Polyps
Colorectal cancer comes from polyps.
One of every three adults has polyps.

20. Polyps
In most people, colorectal cancers develop slowly over a period of several years.
Before a cancer develops, a growth of tissue or tumor usually begins as a non-cancerous polyp on the inner lining of the colon or rectum.

21. Polyps
A tumor is abnormal tissue and can be benign (not cancer) or malignant (cancer).
A polyp is a benign, non-cancerous tumor. Some polyps can change into cancer but not all do.

22. Most Common Polyps: Inflammatory
Most often found in patients with ulcerative colitis or Crohn's disease.
Often called "pseudopolyps" (false polyps), they are just a reaction to chronic inflammation of the colon wall.
They are not the type that turns to cancer. They are usually biopsied to verify type.

23. Most Common Polyps:
Hyperplastic A common type of polyp which is usually very small and often found in the rectum. They are considered to be low risk for cancer.

24. Tubular adenoma or adenomatous polyp
Most Common Polyps:
Tubular adenoma or adenomatous polyp
About 70% of polyps removed are of this type.
Adenomas carry a definite cancer risk which rises as the polyp grows larger.

25. Villous adenoma or tubulovillous adenomas
Most Common Polyps:
Villous adenoma or tubulovillous adenomas
About 15% of polyps removed are of this type.
These are the most serious type of polyp with a very high cancer risk as they grow larger.

26. Most Common Tumors
More than 95% of colorectal cancers are adenocarcinomas.
These cancers start in cells that form glands that make mucus to lubricate the inside of the colon and rectum.

27. Less Common Tumors
Carcinoid tumors: These tumors develop from specialized hormone-producing cells of the intestine.

28. Less Common Tumors Gastrointestinal stromal tumors (GISTs):
These tumors develop from specialized cells in the wall of the colon.
Some are benign; others are malignant (cancerous).
Can be found anywhere in the digestive tract, they are unusual in the colon.

29. Less Common Tumors Lymphomas:
These are cancers of immune system cells that typically develop in lymph nodes.
May also start in the colon and rectum or other organs.

30. What Are The Stages of Colorectal Cancer?

31. Stages of Colon Cancer
The process used to find out if cancer has spread within the colon/rectum or to other parts of the body is called staging.
It is important to know the stage in order to plan treatment.

32. Colorectal Cancer Staging

33. Staging Overview
Stage 0: This is the earliest stage possible. Cancer hasn't moved from where it started; it's still restricted to the innermost lining of the colon.
Stage I: Cancer has begun to spread, but is still in the inner lining. 

34. Staging Overview
Stage II: Cancer has spread to other organs near the colon or rectum. It has not reached lymph nodes.
Stage III: Cancer has spread to lymph nodes, but has not been carried to distant parts of the body.

35. Staging Overview
Stage IV: Cancer has been carried through the lymph system to distant parts of the body. This is known as metastasis. The most likely organs to experience metastasis from colorectal cancer are the lungs and liver.

36. Five-Year Survival Rates by Stage at Diagnosis

37. Stages
Localized: Cancer that is confined to the place where it started.
Regional: Cancer that has grown beyond the organ of origin to regional lymph nodes and/or organs and tissues next to the original site.
Distant: Cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes.

38. What Are The Risk and Protective Factors?

39. At Risk Men and women age 50 and older
Tobacco users, are obese, and/or are inactive
Personal or Family history of colorectal cancer or even non-cancerous colorectal polyps
Personal or family history of Irritable Bowel Syndrome

40. Risk Factors Strong Moderate Modest Advanced age High red meat diet
High fat diet
Country of birth
Previous adenoma or cancer
Smoking and alcohol consumption
FAP/HNPCC
Familial adenomatous polyposis /Hereditary non-polyposis colorectal cancer
Pelvic irradiation
Obesity
Long-standing ulcerative colitis
Cholecystectomy
Familial adenomatous polyposis is a rare disease that runs in families. Hereditary non-polyposis colorectal cancer is a rare gene fault that runs in families

41. Protective Factors Moderate Modest High physical activity
High vegetable/fruit diet
Aspirin/NSAIDS (Non-steroidal anti-inflammatory drugs).
High fiber diet
High folate/methionine intake
High calcium intake
Postmenopausal hormone therapy

42. Most at Risk
Alaska Natives and American Indians, African-Americans, and Hispanics are more likely to be diagnosed with colorectal cancer in advanced stages.
As a result, the percentage of minorities who die of colorectal cancer is higher than for Caucasians.

43. High Risk-Populations: African Americans
Third most common cancer among African-Americans.
Less likely to have polyps detected in their earliest, most treatable stages.
Less likely to live five or more years after being diagnosed with colorectal cancer.
Death and incidence rates remain higher for African-Americans than those for other ethnic groups. . From 1995 to 2000, the five-year colorectal cancer survival rate was 55 percent for African-Americans-compared with 64 percent for Caucasians. Recent research indicates that African Americans are often diagnosed at an earlier age; experts suggest that they begin screening at 45.

44. High Risk-Populations: African Americans
Younger mean age at diagnosis (60-66 years)
The American College of Gastroenterology (ACG) recommends that screening begin at age 45 in African Americans.
African American men have a 46% higher mortality rate than European Americans.

45. High Risk Populations: American Indians and Alaskan Natives
2nd leading cause of death among American Indians and Alaska Natives over the age of 45.
Higher death rates than Caucasians
and African Americans.
The types of cancers experienced within Native communities varies significantly by geographic region.

46. High Risk Populations: Hispanics
3rd most commonly diagnosed cancer.
Hispanics have the lowest rates for colorectal cancer screening, along with American Indian/Alaska Natives.
Among Hispanics aged 50 and older surveyed by the Centers for Disease Control and Prevention, fewer than 12 percent reported having a fecal occult blood test in the preceding year. Only 25 percent of those surveyed underwent a sigmoidoscopy or proctoscopy in the last five years. Hispanic Americans are less likely to follow screening recommendations for the disease.

47. How Common is Colorectal Cancer?

48. Colon Cancer Rates

49. Colorectal Cancer Rates by Race
Source: National Cancer Institute ©
Incidence =‘s New Cancer Diagnosis
This chart shows that for all races new cases of colorectal cancer is going down.

50. Colon Cancer Rates
Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the United States.
About 72% of cases arise in the colon and about 28% in the rectum.

51. Deaths from Colon Cancer
If Alaska Natives death rates were ran alone – they would have the highest rates of CRC, over any other population.

52. Colorectal Cancer Deaths by Race
Source: National Cancer Institute ©

53. Colorectal Cancer Death Rates by State, Race & Sex 2001-2005
Source: American Cancer Society ©

54. Colorectal Cancer Death Rates by State, Race & Sex 2001-2005
Source: American Cancer Society ©

55. Colorectal Cancer Death Rates by State, Race & Sex 2001-2005
Source: American Cancer Society ©

56. Colorectal Cancer Death Rates by State, Race & Sex 2001-2005
Source: American Cancer Society ©

57. Colorectal Cancer Deaths
Colorectal cancer is the #2 cancer killer in the United States.
African Americans are particularly at risk of dying of colorectal cancer.
More men than women die of colorectal cancer because they are typically diagnosed at a later stage.

58. How Do You Screen For Colorectal Cancer?

59. Screening Options Tests that Find Polyps and Cancer Recommended
Flexible sigmoidoscopy
Every 5 years
Colonoscopy
Every 10 years
Double contrast barium enema
CT colonography (virtual colonoscopy)

60. Screening Options Tests that Mainly Find Cancer Recommended
Fecal occult blood test (FOBT)
Every year
Fecal immunochemical test (FIT)
Stool DNA test (sDNA)
Uncertain

61. Screening Options Fecal occult blood test (FOBT)
This test checks for hidden blood in stools. Currently, two types of FOBT are available: guaiac FOBT and immunochemical FOBT.
Studies have shown that FOBT, when performed every one to two years in people ages 50 to 80, can help reduce the number of deaths due to colorectal cancer by 15 to 33 percent.

62. Screening Options Sigmoidoscopy:
In this test, the rectum and lower colon are examined using a lighted instrument called a sigmoidoscope. Precancerous and cancerous growths in the rectum and lower colon can be found and either removed or biopsied.
Studies suggest that regular screening with sigmoidoscopy after age 50 can help reduce the number of deaths from colorectal cancer.

63. Screening Options Colonoscopy:
The rectum and entire colon are examined using a lighted instrument called a colonoscope. Precancerous and cancerous growths throughout the colon can be found and either removed or biopsied, including growths in the upper part of the colon.

64. Screening Options
Virtual colonoscopy (computerized tomographic colonography, CTC):
Special X-ray equipment is used to produce pictures of the colon and rectum that are assembled by a computer into detailed images that can show polyps and other abnormalities.
Because it is less invasive than standard colonoscopy, it may cause less discomfort and take less time to perform. Whether virtual colonoscopy can reduce the number of deaths from colorectal cancer is not yet known.

65. Screening Options Double contrast barium enema (DCBE):
In this test, a series of X-rays of the entire colon and rectum are taken after the patient is given an enema with a barium solution and air is introduced into the colon. The barium and air help to outline the colon and rectum on the x-rays.
Research shows that DCBE may miss small polyps. It detects about 30 to 50 percent of the cancers that can be found with standard colonoscopy.

66. Screening Options Digital rectal exam (DRE):
In this test, a health care provider inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. DRE allows examination of only the lower part of the rectum. It is often performed as part of a routine physical examination.

67. Screening Options
The decision to have a certain test will take into account several factors, including the following:
the person’s age, medical history, family history, and general health
the accuracy of the test
the potential harms of the test
the preparation required for the test
whether sedation is necessary during the test
the follow-up care after the test
the convenience of the test
the cost of the test and the availability of insurance coverage

68. Most Effective Screening Method
Getting a colonoscopy can reduce the average person's risk of dying from colorectal cancer by 90%.

69. Why is colonoscopy #1? PROS CONS Most sensitive Perceived as invasive
Long lasting protection
Highest risk
Single session diagnosis and therapy
Requires bowel preparation
Comfortable
Imperfect sensitivity

70. Adherence Rates for Cancer Screening
Women are more likely to get screened for breast and cervical cancer than colorectal, even though crc affects men and women equally.
Men are more likely to get screened for colorectal cancer than women.

71. Colon Cancer Screening
Just over half of the U.S. adults aged 50+ have had a colonoscopy or sigmoidoscopy.
Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004.
Image: Virtual colonoscopy, a minimally invasive procedure, produces 3-D images and videos of the lining of the rectum and colon. The technique can detect precancerous and cancerous polyps. Image courtesy of Dr. Perry J. Pickhardt, University of Wisconsin Medical School.

72. Latest Screening Stats
The percentage of adults aged 50 years and older who reported having had a home FOBT within one year and/or lower endoscopy within 10 years before the survey increased from 54 percent in 2002, 57 percent in 2004, and to 60 percent in 2006.

73. Latest Screening Stats
The percentage of adults who reported never being screened for colorectal cancer decreased from 34 percent in 2004, 32 percent in 2004, and to 30 percent in 2006.
Good news – more and more people are getting screened.

74. Why Low Screening Rates?
lacked health insurance
those with no usual source of healthcare
those who reported no doctor's visits within the preceding year.

75. Physicians on Low Screening Rates
Believe that patients don’t want screening.
Unclear about guidelines.
Low awareness of screening benefits.
Lack of skills to perform screening.
Structural issues (lack of practice “systems”).
Low reimbursement.
Context of visit and time.

76. Patients on Low Screening Rates
Low awareness of CRC as a health threat.
Lack of knowledge of screening benefits.
Fear, embarrassment, discomfort.
Time.
Cost.
Access.
Physician didn’t recommend.

77. How is Colorectal Cancer Diagnosed?

78. Diagnosis
If a patient has test results that suggest cancer and/or has symptoms, the doctor will ask about personal and family medical history and gives a physical exam. Multiple screening tests may be required.

79. Colon Cancer Rates
It is estimated that 148,810 men and women (77,250 men and 71,560 women) were diagnosed with and 49,960 men and women died of cancer of the colon and rectum in 2008.

80. What Are The Treatment Options?

81. Treatment
Depends mainly on the location of the tumor in the colon or rectum and the stage of the disease.
May involve surgery, chemotherapy, biological therapy, or radiation therapy.
It is important that the patients works with their doctors to develop a plan that meets their needs.

82. Treatment
Cancer treatment is either local therapy or systemic therapy.

83. Treatment
Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy cancer in or near the colon or rectum. When colorectal cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

84. Treatment
Systemic therapy: Chemotherapy and biological therapy are systemic therapies. The drugs enter the bloodstream and destroy or control cancer throughout the body.

85. Surgery Surgery is the most common treatment for colorectal cancer.
There are three basic types of surgery: colonoscopy, laparoscopy and open surgery.

86. Colonoscopy
A small malignant polyp may be removed from the colon or upper rectum with a colonoscope.
Some small tumors in the lower rectum can be removed through the anus without a colonoscope.

87. Laparoscopy
Early colon cancer may be removed with the aid of a thin, lighted tube (laparoscope).
The surgeon sees inside the abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed.
The surgeon checks the rest of the intestine and liver to see if the cancer has spread.

88. Open Surgery
The surgeon makes a large cut into the abdomen to remove the tumor and part of the healthy colon or rectum.
Some nearby lymph nodes are also removed. The surgeon checks the rest of the intestine and the liver to see if the cancer has spread.

89. Chemotherapy Chemotherapy uses anticancer drugs to kill cancer cells.
The drugs enter the bloodstream and can affect cancer cells all over the body; they are usually given through a vein, but some may be given by mouth.
The patient may be treated in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

90. Chemo Side Effects
The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs can harm normal cells that divide rapidly.

91. Chemo Side Effects
Blood cells: These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.

92. Chemo Side Effects
Cells in hair roots: Chemotherapy can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

93. Chemo Side Effects
Skin cells: Chemotherapy for colorectal cancer can cause the skin on the palms of the hands and bottoms of the feet to become red and painful. The skin may peel off.

94. Biological Therapy
Some people with colorectal cancer that has spread receive a monoclonal antibody, a type of biological therapy.
The monoclonal antibodies bind to colorectal cancer cells inhibiting cancer cell growth and the spread of cancer.
Patients receive monoclonal antibodies through a vein at the doctor's office, hospital, or clinic.

95. Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area.
Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types.

96. Radiation Therapy
External radiation: The radiation comes from a machine. The most common type of machine used for radiation therapy is called a linear accelerator. Most patients go to the hospital or clinic for their treatment, generally 5 days a week for several weeks.

97. Radiation Therapy
Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days.
The implants are usually removed before the patient goes home.

98. Radiation Therapy
Intraoperative radiation therapy (IORT): In some cases, radiation is given during surgery.

99. Radiation Side Effects
Side effects depend mainly on the amount of radiation given and the part of the body that is treated.
They may include: nausea, vomiting, diarrhea, bloody stools, urgent bowel movements, urinary problems and red, dry and tender skin.

100. Treatment for Colon Cancer
Most patients with colon cancer are treated with surgery. Some people have both surgery and chemotherapy. Some with advanced disease get biological therapy.
A colostomy is seldom needed for people with colon cancer.
Although radiation therapy is rarely used to treat colon cancer, sometimes it is used to relieve pain and other symptoms.

101. Treatment for Rectal Cancer
For all stages of rectal cancer, surgery is the most common treatment. Some patients receive surgery, radiation therapy, and chemotherapy. Some with advanced disease get biological therapy.
About 1 out of 8 people with rectal cancer needs a permanent colostomy.

102. How Can Colorectal Cancer Be Prevented?

103. Prevention Get screened. Know your family history.
Stay active; exercise regularly.
Eat a balanced diet with more fruits and vegetables and less meat.
Maintain a healthy weight.
Avoid smoking and excessive drinking.

104. How Can You Help?

105. Get Involved Become a member of the CCA
Join the Online Colorectal Cancer Community
Become a Voices Coordinator or Ambassador
Join the Buddy Support Program
Participate in an Undy 5000 walk/run

106. Get Involved Attend a regional seminar Create a Blue Star Tribute Page
Make a donation
Volunteer with your local community
Talk about colorectal cancer with family and friends.

107. Preventable. Treatable. Beatable!
Colorectal Cancer:
Preventable. Treatable. Beatable!
Toll-Free Helpline: