In this presentation, Dr. Deborah Schrag, Medical Oncologist from Dana Farber Cancer Institute covers therapy options, surgery options, and radiation options, that are specific to rectal cancer patients. She also touches on the importance of clinical trials for this population, and highlights a few trials in research that she finds most interesting.
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VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
Advancements in Rectal Cancer Treatments
1. Welcome!
Advancements in Treating
Rectal Cancer
Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series
Our webinar will begin shortly
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1. Tonight’s speaker: Dr. Deborah Schrag, MD
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7. American Cancer Society estimates 40,340
new cases of rectal cancer in 2013
Colon/Rectal cancer is the 3rd leading cause of
cancer-related death in US
8. The death rate from rectal cancer has been
dropping for 20+ years.
>1 million colorectal cancer survivors in US
Advancements:
Screening & early detection
Improvements in treatment
11. Procedure What is it? Why do it?
Biopsy & Pathology
Review
Remove tumor tissue &
examine it under a
microscope
To discover the
presence, cause or
extent disease.
Colonoscopy &
Proctoscopy
Examine colon & rectum
with a camera
To discover the
presence, cause or
extent disease.
CT of
chest/abdomen/pelvis
An x-ray scan (image)
To see if the cancer has
spread beyond the
rectum.
CEA Blood test
Carcinoembryonic antigen
(CEA) is a protein
associated with tumors.
ERUS or MRI
Medical imaging that
examines soft tissue
To discover the
presence, cause or
extent disease.
12. Stage
describes the extent of the cancer in the body
how far the main tumor has grown into nearby areas
extent of spread to nearby lymph nodes
whether the cancer has spread (metastasized) to other
organs of the body
is an important factor in determining prognosis &
treatment options
based on the results of physical exam, biopsies, &
imaging tests
14. Surgery is usually the main treatment for rectal
cancer, although radiation and chemotherapy
will often be given before and/or after surgery.
Surgeon removes tumor and surrounding
tissues (extent of resection depends on extent
of tumor)
15. Advances in techniques, equipment, and
surgical specialization
More precise excision
Availability of stapling devices
J pouch and coloplasty pouch
Attention to cancer clearance - Total mesorectal
excision has reduced local recurrence following
surgery
Microsurgery
16. High-energy rays or particles destroy cancer
cells
Radiation may
Lower the risk that the tumor will come back
Improve operability
17. External-beam radiation therapy
Similar experience to getting an x-ray
Endocavitary radiation therapy
Small device inserted to deliver radiation
Brachytherapy (internal radiation therapy)
Small pellets of radioactive material placed next to
tumor
18. May be administered before and/or after
surgery
Drugs used to treat rectal cancer
5-Fluorouracil
Capecitabing
Irinotecan
Oxaliplatin
20. Periodic screening & tests to see if the cancer
has come back.
History/Physical
CT Scan
Colonoscopy
Blood Tests
21. This research study is being done to see if
radiation can be avoided for a select group of
rectal cancer patients who have a good
response to 6 treatments with a chemotherapy
combination regimen known as FOLFOX.
The proposed study does not use new agents
or procedures, but rather sequences existing
well established treatment strategies in a
different way.
22. Stage II & III rectal cancer is treated in 3 phases:
1. Chemotherapy and radiation given together over 5.5
weeks –”chemoradiation”
Why? To prevent the tumor from coming back in the same
location in the pelvis
2. Surgery to remove the tumor
3. Chemotherapy with a drug combination called
“FOLFOX” given every 2 weeks over about 4 months
Why? To prevent the cancer from coming back in a distant
organ such as the liver
23. With modern surgical techniques, chemotherapy
advances, and MRIs it is possible that some patients
can avoid radiation to the pelvis
Because chemoradiation has side effects, it would be
valuable to avoid it for patients who can achieve good
results without it
Rectal cancer specialists hope that FOLFOX
chemotherapy before surgery will enable some rectal
cancer patients to avoid chemoradiation
24. Radiation treatment is time consuming….daily visits
Radiation often has long term effects on bowel bladder
and sexual function
Radiation in previous clinical trials does not improve
overall survival rates, but does decrease the local
recurrence rates
Radiation treatment may be unnecessary for some
patients with early stage rectal cancer
Better imaging techniques, better surgical techniques
have made it easier to carefully stage patients
We do not know the best way to treat this disease until
we carefully compare these approaches.
We need your help!
26. Chemo
for 3-4
Months*
Surgery
If tumor
responds to
chemotherapy
If tumor
does not
respond to
chemo
5.5 weeks
of radiation
with 5FU
chemo
(5FUCMT)
Surgery
Chemo
for 3-4
months
Re-
evaluation
3 mo. of
chemo
(6 FOLFOX
treatments)
4-6weeksrecovery
4-6weeksrecovery
4-6weeksrecovery4-6weeksrecovery
*If the pathologist or surgeon find evidence of more extensive disease, it is
possible that postoperative 5FUCMT could also be recommended
27. The National Cancer Institute at:
1-800-4-CANCER (1-800-422-6237)
http://cancer.gov/clinicaltrials/
http://cancer.gov/cancerinfo/
For more information about the PROSPECT trial
(N1048):
http://www.cancer.gov/clinicaltrials/search/view?cdrid=715321&
protocolsearchid=10158136&version=patient
The lead investigator for this trial, Dr. Deborah Schrag, at
deb_schrag@dfci.harvard.edu
The protocol coordinator for this trial, John Taylor, at
jtaylor1@uchicago.edu
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