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Surgical treatment provides new option for some colorectal cancer patients
October 01, 2008WINSTON-SALEM, N.C. -- Research out of Wake Forest University School of Medicine suggests that a surgical technique not traditionally used in advanced abdominal cancer may be a viable treatment option for some patients previously thought to be untreatable, offering the real possibility of extending survival for those patients.
The study, available online this month and scheduled to be published in an upcoming issue of Annals of Surgical Oncology, is the first to compare the success of techniques used to remove liver cancers to the effectiveness of those same techniques in removing cancers from the abdominal wall.
Peritoneal surface disease (PSD) appearing from the spread of colon cancer has not traditionally been considered treatable with surgery because of the difficulty of finding and removing all of the cancer, and has been treated with chemotherapy only, leaving those patients with a decreased prognosis and little hope for survival. The study prompts reconsideration of surgical treatment options in these patients and warrants further study into patient selection in this area, according to the lead researcher, Perry Shen, M.D.
The focus of the study was PSD, the development of colorectal cancer on the peritoneum, which is the lining of the abdominal wall. Researchers wanted to know if survival rates similar to those of patients who undergo liver surgery for metastatic colorectal cancer could be achieved by performing surgery to treat patients for PSD from colorectal cancer.
Shen, an associate professor of surgical oncology, and colleagues compared the outcomes of surgical removal of liver metastases from colorectal cancer, which is accepted as the treatment of choice, to the surgical removal of PSD from colorectal cancer. The PSD removal was combined with intra-abdominal heated chemotherapy. They found that patients who were able to undergo complete removal of all PSD, combined with heated chemotherapy inside the abdomen, had no significant difference in survival rates than liver metastases patients who underwent surgical removal. This showed that surgical removal is a viable possibility for some patients with PSD where it had not been considered a good option before.
"Peritoneal involvement has been considered inoperable because it is not a well-defined anatomic area and the lack of accurate imaging makes operative planning uncertain," said Shen, a fellow in the American College of Surgeons. "What we have found is though this technique is not a treatment option for everyone with PSD, it can produce long-term survival in select patients and should be considered as part of a multidisciplinary approach."
Nearly 50,000 people will die this year from colorectal cancer, according to the National Cancer Institute. An estimated 150,000 new cases will have been diagnosed in 2008.
"This type of occurrence of colorectal cancer is typically considered incurable "¦ but in some cases, we now know we can extend the survival rate," Shen said. "We are trying to change current paradigms in oncology. Physicians should refer these patients to a center that has surgeons with this experience who can deal with peritoneal involvement."
Wake Forest University Baptist Medical Center
The focus of the study was PSD, the development of colorectal cancer on the peritoneum, which is the lining of the abdominal wall. Researchers wanted to know if survival rates similar to those of patients who undergo liver surgery for metastatic colorectal cancer could be achieved by performing surgery to treat patients for PSD from colorectal cancer.
Shen, an associate professor of surgical oncology, and colleagues compared the outcomes of surgical removal of liver metastases from colorectal cancer, which is accepted as the treatment of choice, to the surgical removal of PSD from colorectal cancer. The PSD removal was combined with intra-abdominal heated chemotherapy. They found that patients who were able to undergo complete removal of all PSD, combined with heated chemotherapy inside the abdomen, had no significant difference in survival rates than liver metastases patients who underwent surgical removal. This showed that surgical removal is a viable possibility for some patients with PSD where it had not been considered a good option before.
"Peritoneal involvement has been considered inoperable because it is not a well-defined anatomic area and the lack of accurate imaging makes operative planning uncertain," said Shen, a fellow in the American College of Surgeons. "What we have found is though this technique is not a treatment option for everyone with PSD, it can produce long-term survival in select patients and should be considered as part of a multidisciplinary approach."
Nearly 50,000 people will die this year from colorectal cancer, according to the National Cancer Institute. An estimated 150,000 new cases will have been diagnosed in 2008.
"This type of occurrence of colorectal cancer is typically considered incurable "¦ but in some cases, we now know we can extend the survival rate," Shen said. "We are trying to change current paradigms in oncology. Physicians should refer these patients to a center that has surgeons with this experience who can deal with peritoneal involvement."
Wake Forest University Baptist Medical Center
Colorectal Cancer Current Events and Colorectal Cancer News RSSNew figures on cancer in Europe show a steady decline in mortality but big variations
New figures on deaths from cancer in Europe show a steady decline in mortality between the periods 1990-1994 and 2000-2004. Deaths from all cancers in the European Union (EU) between these two periods fell by nine percent in men and eight percent in women, with a large drop among the middle-aged population.
'Cross-talk' mechanism contributes to colorectal cancer
Researchers at the University of Wisconsin-Madison School of Medicine and Public Health have identified a molecular mechanism that allows two powerful signaling pathways to interact and begin a process leading to colorectal tumors.
African-Americans with colorectal cancer have poorer outcomes, lower survival rates
New research published in the November issue of the Journal of the American College of Surgeons shows that African-American patients with colorectal cancer are more likely to be diagnosed with advanced disease and are less likely to undergo surgical procedures compared with Caucasians, suggesting that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes for African-Americans.
Colon cancer screening more effective earlier in day, UCLA study finds
The effectiveness of a screening colonoscopy may depend on the time of day it is performed. According to a new UCLA study, early-morning colonoscopies yielded more polyps per patient than later screenings, and fewer polyps were found hour by hour as the day progressed.
1 disease, not 1 demographic
The Asian continent has nearly four billion people living in 47 different countries, and each of these groups has their own unique set of health issues. But when they come to the United States, they're often lumped into one large demographic: "Asian/Pacific Islander."
Study shows unsedated colonoscopy for colorectal cancer screening well accepted by patients
Researchers from Taiwan report in a new study that unsedated colonoscopy for primary colorectal cancer screening is well accepted in a majority of patients.
M. D. Anderson redefines screening guidelines for breast, cervical and colorectal cancers
Drawing on years of experience in cancer research and patient care, The University of Texas M. D. Anderson Cancer Center released today the most comprehensive, risk-based screening guidelines publicly available to date for breast, cervical and colorectal cancers.
The bowels of infection
Current research suggests that latent cytomegalovirus (CMV) infection may exacerbate inflammatory bowel disease (IBD). The related report by Onyeagocha et al, "Latent cytomegalovirus infection exacerbates experimental colitis," appears in the November 2009 issue of The American Journal of Pathology.
How to Lower Costs, Waiting Times for Colonoscopies
Colorectal cancer is a leading cause of cancer-related deaths in the United States, leading to over 50,000 fatalities every year.
Excess body weight causes over 124,000 new cancers a year in Europe
At least 124,000 new cancers in 2008 in Europe may have been caused by excess body weight, according to estimates from a new modelling study.
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