Fight Colorectal Cancer

When pre-cancerous polyps are found during a colonoscopy, they are removed to prevent the development of colorectal cancer,  The procedure — polypectomy — is usually accomplished during the colonoscopy itself.  However, there is a small chance of serious bleeding or hemorrhage afterwards.

A study in Japan reviewed records of 3,100 patients who had polyps taken out during colonoscopies.  More than 6,600 polyps were removed.  Hemorrhage occured in 37 patients, a little over 1%.  Hemorrhage was sometimes delayed, occuring up to two weeks after the polypectomy.

Patients with hypertension (high blood pressure) were almost six times as likely to hemorrhage. Twenty-five of the 37 patients who hemorrhaged  (68%) had high blood pressure.

Hemorrhage was more likely to be delayed in patients with hypertension, occuring at a median of 6 days compared to 2.5 days in other patients.

Other patient characteristics — smoking, alcohol use, high levels of lipids in the blood, diabetes — did not appear to increase the risk of post-polypectomy hemorrhage,

Larger polyps were also associated with bleeding.

Hirotsugu Watabe MD and his colleagues at the University of Tokyo reported their findings in the June 2006 issue of Gastrointestinal Endoscopy. They concluded:

Hypertension is a significant risk factor for delayed colorectal postpolypectomy hemorrhage. The interval between polypectomy and hemorrhage can be as long as 14 days in the presence of hypertension.

WHAT THIS MEANS FOR PATIENTS

If you have high blood pressure, you need to be particular vigilant after a colonoscopy if polyps have been removed.  Watch for bleeding and let your gastroenterologist know right away if it begins. 

Bleeding may delayed anywhere from 2 to 14 days after polypectomy, so remain alert.

Don’t avoid colonoscopy, however. It can save your life.

Early information from a large randomized clinical trial found that the combination of Xeloda and oxaliplatin (XELOX) was as effective as FOLFOX in preventing  the progression of advanced colon or rectal cancer. The FOLFOX treatment combines oxaliplatin with leucovorin and a 2–day protracted infusion of 5FU. Adding Avastin to either regimen improved progression-free survival time about 20%.

Xeloda (capecitabine) is an oral drug that is converted to 5FU (fluorouracil) in the body.

More than 2,000 patients with colon or rectal cancer that had spread from the site of the primary tumor were enrolled in the clinical trial.  They were randomly assigned to receive:

• XELOX — oxaliplatin plus oral Xeloda
• FOLFOX — oxaliplatin plus leucovorin and a 2–day protracted infusion of 5FU
• XELOX plus Avastin (bevacizumab)
• FOLFOX plus Avastin

Results showed no significant difference in progression-free survival (PFS) between XELOX and FOLFOX with Avastin adding time to PFS for both treatments.

In a news release from Hoffman-LaRoche, Inc, Ed Holdener, head of global development at Roche said,

“This is the first time that we have significant data showing that oral Xeloda in combination with oxaliplatin is as effective as Folfox, demonstrating that Xelox provides a new treatment option for colorectal cancer patients.”

WHAT THIS MEANS FOR PATIENTS

While this study provides data indicating that an oral drug can effectively replace 5FU given through an infusion pump in oxaliplatin treatments, all information from the clinical trial has not yet been analyzed or reported.

Until all results, including side effects, are fully available and reviewed at large medical meetings or for publication in a medical journal, it would be premature to replace standard FOLFOX treatment with XELOX in day-to-day medical care.

Surgery to remove colorectal cancer that has spread to the liver can be demanding on patients.  However, given its effectiveness in curing a percentage of carefully chosen patients, short-term disability and lowered health-related quality of life may be an acceptable trade-off for those patients who will benefit from surgery.

Surgical researchers in the Netherlands compared health-related quality of life before and after surgery for three groups of patients with liver metastases from colon or rectal cancer.

• Group 1 consisted on 60 patients with operable liver mets that were removed successfully.
• Group 2 included 17 patients whose mets couldn’t be removed during the surgery.
• Group 3 was a control group of 20 outpatients with inoperable mets.

Health-related quality of life was measured for all three groups at baseline before surgery, 2 weeks after surgery, and 3 months after surgery

• After surgery, health-related quality of life clearly deteriorated for the Group 1 patients, but 3 months later, quality of life had returned to the before-surgery baselines.
• For Group, quality of life deteriorated as well after their operation, but symptoms did not return to baseline at 3 months.
• Group 3 patients had hardly any loss of health-related quality of life over the three months.

The research team concluded:

The fast recovery of health-related quality of life, generally within 3 months, justifies an aggressive surgical approach to colorectal liver metastases. However, careful preoperative evaluation is crucial to avoid needless laparotomy, considering the ongoing deteriorated health-related quality of life of group 2

B.S. Langenhoff and colleagues reported their results in the British Journal of Surgery

Langenhoff et. al. British Journal of Surgery, Volume 93, Number 8, August 2006, pp. 1007-1014(8)

WHAT THIS MEANS FOR PATIENTS

 If you have liver mets that have a good possibility of being successfully removed surgically, you can look forward to recovering your quality of life within 3 months or so after your operation.

However, it is important that the extent of mets be carefully evaluated before surgery by an experienced surgeon since unsuccessful surgery reduces quality of life below that of people who do not have surgery attempted.

The American Psychosocial Oncology Society (APOS) provides help in finding local counseling services for people coping with distress from cancer. A toll-free helpline — 1-866-APOS-4-HELP – is answered live, Monday through Friday from 9 am to 5 pm.

Voice mail is available at other times with calls being returned within 24-48 hours.

Trained counselors provide referrals community resources for psychosocial counseling. If no resources are available in a caller’s community, Helpline staff will provide counseling via telephone to callers in crisis.

Anita Mitchell is alive and without any evidence of cancer, despite a diagnosis of metastatic (stage 4) colon cancer a year ago.  Her story will be featured on a live Health Talk broadcast on Monday evening, July 31st at 8:30 p.m. (Eastern).

Joining Anita are Dr. Lowell Anthony,  Director of Gastrointestinal and Neuroendocrine Oncology at Louisiana State University Health Sciences Center in New Orleans, and Dr. Thomas H. Cartwright, president of the medical staff at Ocala Regional Medical Center in Florida.  Rick Turner will host the panel.

• Colorectal Cancer: Understanding Your Options
• Monday, July 31, 2006
• 8:30 p.m. Eastern
• Via Webcast or Teleconference
• To Register

Registration is required.