Surgery to remove colon or rectal cancer that has spread to the liver can sometimes cure the cancer.  However, the cancer can return again to the liver.  If it does, a second surgical liver resection can be effective in producing 5-year survivals.

Reviewing 111 second hepatectomies done in a Tokyo cancer center from 1985 through 2004, researchers found that overall 41% of patients lived at least five years after surgery.  They identified the following risk factors that led to poorer survival. 

• Presence of liver mets at the time that the primary tumor in colon or rectum was surgically removed. (synchronous liver and primary cancers)
• More than three liver mets at the time of the second liver resection.
• Cancer involved with the hepatic vein and/or the portal vein at the time of first resection.

Five-year survival after the second liver resection depended on the number of those risk factors present.

• No risk factors — 62%
• One risk factor — 38%
• Two risk factors — 19%
• Three factors — 0%

Seiji Ishiguro and colleagues at the National Cancer Center Hospital in Tokyo, Japan concluded:

Second hepatectomy is beneficial for patients without any risk factors. Before second hepatectomy, chemotherapy should be considered for patients with any of these risk factors, especially with two or three factors, in the adjuvant or neoadjuvant setting to prolong survival. These results need to be confirmed and validated in another data set or future prospective trial according to the scoring scheme we outline.

WHAT THIS MEANS FOR PATIENTS

This is a study done in a single hospital over a fairly long period of time.  Information about chemotherapy before or after liver resection is not included. 

If your liver mets have returned, you should consider whether the pain and risk of surgery is worthwhile in light of the risk factors outlined above, but you should also work with a multidisciplinary team of surgeons, oncologists, and radiologists to decide the best treatment.

In some situations second liver resections are not only possible but they lead to excellent outcomes.

No risk factors or one factor might mean that surgery would give you a good chance of 5-year survival.

Low-income Wyoming residents would be eligible for reimbursement under a bill working its way through the state legislature, The Wyoming Cancer Control Act (S 131) would authorize the state to provide a colonoscopy reimbursement to people over the age of 50 who are at or under 250 percent of the poverty level and who haven’t had a colonoscopy within the past ten years.

The Associated Press reported the bill’s sponsor Sen. Charles Scott, R-Casper, as saying:

“A colonoscopy is a well-proven technique for preventing colorectal cancer. If they find a polyp (during the screening process) they take it out to prevent cancer from developing and the prevention rate is well over 90 percent… It is often poorly covered by insurance. And unfortunately the risk of getting a high bill is becoming an obstacle to people getting a colonoscopy.”

As approved by the Senate the act would cost Wyoming approximately $4.3 million of which about $3.9 million was slated for the colonoscopy voucher program. The House Labor Committee, chaired by Rep. Jack Landon Jr., R-Sheridan, amended the bill to limit the contribution for the procedure to $1,500. Then the House Appropriations Committee, chaired by Rep. Frank Philp, R-Shoshoni, reduced the proposal’s colonoscopy funding to only $1.2 million.

Sen. Scott estimated that colonoscopies cost between $1,000 and $4,500, in situations where polyps need to be removed. Rep. Landon said the $1,500 voucher would cover most routine colonoscopies. According to the AP report the funding cut “was based on information the state Health Department obtained from a similar program in Colorado.” It quoted Rep. Philp as saying “It wasn’t like we were just giving it a haircut for the heck of it. We had the numbers from the Health Department to go along with our decision.” Sen. Scott responded by saying the House Appropriations Committee took too much.

Tuesday the Senate defeated the bill as amended by the House which was to be expected given the overwhelming support the Senate gave its original bill. Latter that day the bill was amended on the floor of the House to say that the state would provide reimbursement “at the rate paid under the Wyoming Medical Assistance and Services Act for colonoscopies including polyp removal.” The bill now goes to a conference committee which will try to work out differences between the two versions of the bill.

According to a Casper Star Tribune article, Wyoming Comprehensive Cancer Control program manager Kim Rogers said:

“The average cost of treatment for an early detection of colorectal cancer is $30,000. But at the late stage it runs about $120,000, so we’re looking at a big cost savings for the state if we’re able to detect things earlier.”

It is important to remember that colon and rectal cancer can not only be detected in early, more treatable stages but that it can be prevented with the removal of polyps before they become cancerous thus resulting in even greater cost savings.

An interesting section of S 131 would require the Health Department to obtain colonoscopy provided by a sealed, competitive bid process. Voucher users would be required to go to these providers for colonoscopies.

Also covered is what happens if a cancer is found during a colonoscopy performed under the act. If the person is not covered by Medicaid and is without health insurance the Health Department is “authorized to pay for the treatment needed for that individual.” The patient pays the first $10,000 unless this is waved by the department with the maximum paid by the department of $50,000 for any one case.

Please note: The Super Colon is a project of the Prevent Cancer Foundation and is not affiliated with C3: Colorectal Cancer Coalition. If you would like to learn more about The Super Colon or to get information about scheduling the exhibit, please visit the Super Colon page on the Prevent Cancer website.

Crawl through it.  Walk through it.  Explore it.  See what’s inside!

The Super Colon is a 20 foot long, 8 foot high inflatable model of the human colon.  Visitors can view healthy colon tissue, non-cancerous colon disease including Crohn’s disease and colitis, polyps, and colon and rectal cancer.

The 2007 Super Colon Tour is scheduled for more than 30 cities during the year.

During March, Colorectal Cancer Awareness Month, the Super Colon will be at the following sites:

• March 1-4       Grand Rapids, MI – St. Mary’s Healthcare Health Fair at Hospital and Mall
• March 2-3       Niles, OH – Humility of Mary Health Partners Health Fair at Mall
• March 8-9       Houston, TX – VA Hospital
• March 9-11     Huntington, WV – Edwards Cancer Center Health Fair
• March 17         Atlanta, GA — Tanner Health System Health Fair at Mall
• March 20-21   Orlando, FL  — M. D. Anderson Cancer Center Orlando
• March 24-25   St. Cloud, MN – Coborn Cancer Center Health Fair at Mall
• March 24         Washington, DC – Scope It Out 5K
• March 26-27    Minneapolis, MN – Get Your Rear In Gear 5K *
• March 31 – April 1     Topeka, KS — Endoscopy and Surgery Center of Topeka and Kansas Medical Center

Complete 2007 schedule of  Cities and dates for the Super Colon.

Experts at the University of Michigan Comprehensive Cancer Center provide accurate information for twelve common fears misconceptions about colon and rectal cancer.

MYTH 1:  Colon cancer is a white man’s disease.

In fact, colon cancer affects men and women equally and it is diagnosed in people of all races.

MYTH 2:  I don’t have any symptoms, so I must not have colon cancer.

The most common symptom is no symptom at all.  More than half of people diagnosed with colon cancer will not have symptoms of the disease.  After symptoms appear, advanced disease is more likely.

MYTH 3:  Colonoscopy is difficult to prepare for.

Ask your doctor or pharmacist about your options

“People shouldn’t be afraid of it because they don’t want to drink the laxative. There are many more options so you can find something that is tolerable,” Kim Turgeon ,MD says. 

MYTH 4:  Colonoscopy is unpleasant and uncomfortable.

During the procedure itself patients are sedated to reduce discomfort.  The colonoscopy takes 20 to 30 minutes, and people can resume normal activities the next day.

MYTH 5: I saw Katie Couric get a colonoscopy on the Today Show, so I should get one too

The UM experts say,

Colonoscopy screening is recommended for men and women beginning at age 50, unless other risk factors exist. If you’re 50 or older, talk to your doctor about screening. If you are younger than 50 but have other risk factors – such as family history, obesity, smoking, ulcerative colitis or Crohn’s disease – talk to your doctor about your screening needs. But remember, age is the most significant risk factor for colon cancer

Myth 6: Colonoscopy is the only way to screen for colon cancer.

There are several approved methods for screening for colorectal cancer including fecal occult blood test, flexible sigmoidoscopy, and double contrast barium enema.  But colonoscopy can view the entire colon and can remove polyps and diagnosis cancer.

Myth 7: A polyp means I have cancer.

Most polyps are benign, but some — adenomatous polyps — have the potential to become cancer.  Removing them prevents colorectal cancer.

Myth 8: Colonoscopy is just a screening technique.

Colonoscopy screens for colorectal cancer, finds and removes precancerous polyps, and diagnoses colon cancer.

Myth 9: If I have colon cancer, it means I am dying.

Colon cancer found at the earliest stage is 95% curable.  Even when it has spread beyond the colon to liver or lungs, improvements in chemotherapy and surgery are extending and saving lives.

Myth 10: Surgery will be disfiguring and recovery painful.

The experts say,

New surgical advances allow for minimally invasive procedures that leave only a small scar. Patients undergoing laparoscopic surgery may have an easier recovery than patients who have open surgery. Some evidence suggests cancer control is better with a minimally invasive approach.

Myth 11: If I have colon surgery, I’ll need a colostomy bag.

Permanent colostomies are rare today with improved surgical techniques and radiation treatment for rectal cancer.

Myth 12: Few research advances focus on colon cancer.

The truth, according to the University of Michigan experts is,

Much exciting research is occurring in colon cancer. At U-M, research has focused on improving radiation techniques, including using radiation to shrink tumors that have spread to the liver. Researchers are also working with colon cancer stem cells, the small number of cells within a tumor that fuel its growth. It’s believed that identifying the cancer stem cells will allow more effective drugs to be developed. Other research is looking at multiple genes involved in colon cancer and at improving screening techniques so more cancers can be detected early. This includes searching for markers in blood, stool or urine that might provide an easier screening tool to early signs of colon cancer. In the area of prevention, researchers are looking at the effects of curcumin (found in curry), resveratrol (found in red wine), ginger and the Mediterranean diet on the growth and development of colon cancer.

Twelve Myths About Colon Cancer was written by Nicole Fawcett at the University of Michigan.  Answers to the myths have been adapted for this post by C3.

During a phase I study of Iressa® (gefitinib) researchers found that Iressa® did not add substantial benefit to Camptosar® (irinotecan) for patients with advanced colorectal cancer.

Patients in the trial had colorectal cancer that had already progressed on chemotherapy, but they had not been treated with irinotecan.  At the maximum tolerated dose, about one patient in ten had their tumors shrink on the combination treatment.  Median survival time was a little over nine months.

Severe side effects included diarrhea in one-third of patients, lethargy in 15%, low white cells counts in 15%, lowered white cells and fever in 10%, and rash in 8%.

Led by Ian Chau and David Cunningham at the Royal Marsden Hospital in London, the team concluded:

Irinotecan and gefitinib at this dose schedule was tolerable, but gefitinib did not appear to add substantial efficacy to irinotecan.

Their study was published online in the Annals of Oncology on February 23, 2007.