Fight Colorectal Cancer

Radiation therapy given before surgery to remove rectal cancer can reduce the risk that the cancer will return at the site of the original tumor. In some cases it can shrink tumors significantly allowing for surgery that spares the sphincter muscle closing the anus and avoiding a permanent colostomy.

However, research in the [October 2005 *Annals of Surgery*](http://www.annalsofsurgery.com/pt/re/annos/toc.00000658-200510000-00000.htm;jsessionid=DLXGyCyb1Tc8BDtrfGDR254EBG0zJn5b48F6zJPWzjOts8wwT9il!586698740!-949856144!9001!-1) found that radiotherapy results in more sexual problems in men than surgery alone.

Surgeons studied the difference between surgery alone and surgery with pre-operative radiotherapy in 201 men being treated for rectal cancer. They assessed the ability to achieve and maintain an erection, have an orgasm, and be sexually active at 7 time points, beginning before surgery and ending 4 years later.

The most severe dysfunction was found 8 months after surgery when there was a 7.4% difference in achieving an erection, 12.6% difference in maintaining one, and a 16.2% difference in having orgasm between the radiotherapy and surgery only groups. In addition, men who had radiotherapy were 13.7% less likely to be sexually active. Recovery of sexual functioning after the 8 month point was slow, but never returned completely.

The effect increased with age.

The researchers were able to build and validate a model to help patients and doctors predict how much radiotherapy might effect the sexuality of an individual man.

The research and the predictive model were reported in the *Annals of Surgery* (240-4:502-511, October 2005). The lead author was Alexander G. Heriot. The team concluded:

Conclusions: Radiotherapy has an adverse effect on sexual function, the effect being maximal at 8 months after surgery. The risk of sexual dysfunction can be quantified preoperatively using the proposed index and can assist patients in making better informed choices on the type of treatment they receive.

In [a Dutch study in the March 20, 2005 edition of the *Journal of Clinical Oncology*](http://www.jco.org/cgi/content/abstract/23/25/6199), 900 men and women, who were part of a randomized trial surgery alone or surgery and radiotherapy, also showed poorer sexual functioning in males. Females also had sexual problems after pre-surgical radiotherapy.

In addition, radiation-treated patients recovered normal bowel movements more slowly and were less active 3 months after surgery than those who had surgery alone.

However, the patients reported no significant differences in health-related quality of life on questionnaires answered before treatment and at 3, 6, 12, 18, and 23 months after treatment.

Since there is a way of predicting the risk of sexual problems after radiation treatment for rectal cancer developed by Dr. Heriot’s team, patients should be encouraged to discuss risks and benefits of radiation prior to surgery.

[Read the abstract of the Heriot study in the *Annals of Surgery*.](http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200510000-00005.htm;jsessionid=DLXGyCyb1Tc8BDtrfGDR254EBG0zJn5b48F6zJPWzjOts8wwT9il!586698740!-949856144!9001!-1)

[Read the Marijnen study abstract in the *Journal of Clinical Oncology.*](http://www.jco.org/cgi/content/abstract/23/9/1847)

Since visiting Congress March 15, 2005 during the One Voice Against Cancer (OVAC) Lobby Day, Colorectal Cancer Coalition (C3) advocates worked hard to get their Senators and Representatives to sign a letter from Congress to the President in support of the Administration’s goal of eliminating cancer death and suffering by the year 2015. The closing and sending of the letter brings the time to thank those who did sign and the time to ask why to those who did not sign.

Below are suggested letters you can send to your Senators and Representative. Feel free to make it your own by making changes as you see fit. Be sure to add the name and address of you Senator or Representative at the beginning, to add your name and contact informaition at the end and to make the appropriate change in the third paragraph.

Go here to find out if your Senators and Representative signed the 2015 goal letter.

Example letter to Senators who signed:

>Thank you for joining 92 of your Senate colleagues in signing a letter to the President in support of the Administration’s goal of eliminating suffering and death due to cancer by the year 2015. A similar letter was also sent to the President from 275 Members of the House of Representatives.

>Thanks to prior investments in cancer research and programs, we can now actually envision a time when the outcomes of cancer — suffering and death — can be eliminated. While the 2015 goal is clearly ambitious, we will make real progress towards it if we make cancer a higher national priority and make the right policy choices.

>As a (cancer survivor)(caregiver for someone with cancer) I thank you again for your support. I look forward to working with you to make the 2015 goal a reality.

Example letter to Senators who did not sign:

>The National Cancer Institute (NCI) set a goal of eliminating cancer death and suffering by the year 2015. Thanks to prior investments in cancer research and programs, we are making remarkable progress in the fight against cancer. Achieving the 2015 goal is now within our reach if we make cancer a higher national priority and make the right policy choices.

>This September 92 of your colleagues in the Senate signed and sent a letter to the President to express their commitment to and support of the NCI’s goal. I am disappointed to know that you were one of the eight Senators who did not sign the letter.

>As a (cancer survivor)(caregiver for someone with cancer) I ask you to tell me why you did not demonstrate your commitment to and support of our country’s efforts to eradicate cancer by signing the letter to the President.

Example letter to Representatives who signed:

>Thank you for joining 275 of your colleagues in the House of Representatives in signing a letter to the President in support of the Administration’s goal of eliminating suffering and death due to cancer by the year 2015. A similar letter was also sent to the President from 92 Senators.

>Thanks to prior investments in cancer research and programs, we can now actually envision a time when the outcomes of cancer — suffering and death — can be eliminated. While the 2015 goal is clearly ambitious, we will make real progress towards it if we make cancer a higher national priority and make the right policy choices.

>As a (cancer survivor)(caregiver for someone with cancer) I thank you again for your support. I look forward to working with you to make the 2015 goal a reality.

Example letter to Representatives who did not sign:

>The National Cancer Institute (NCI) set a goal of eliminating cancer death and suffering by the year 2015. Thanks to prior investments in cancer research and programs, we are making remarkable progress in the fight against cancer. Achieving the 2015 goal is now within our reach if we make cancer a higher national priority and make the right policy choices.

>This September 280 of your colleagues in the House of Representatives signed and sent a letter to the President to express their commitment to and support of the NCI’s goal. I am disappointed to know that you were one of the 160 Members who did not sign the letter.

>As a (cancer survivor)(caregiver for someone with cancer) I ask you to tell me why you did not demonstrate your commitment to and support of our country’s efforts to eradicate cancer by signing the letter to the President.

More than $500,000 has been donated to the [ASCO Foundation](http://asco.org/ac/1,1003,_12-002144-00_18-0042423,00.asp) to help pay for cancer-related expenses for people affected by Hurricanes Katrina and Rita.

Patients and their families can get assistance by calling **800 813 HOPE.**

Those funds will be managed by [CancerCare](http://www.cancercare.org/), an organization with the staff and resources to get help into the hands of those cancer patients who need it. In addition, the [Lance Armstrong Foundation](http://www.livestrong.org/site/c.jvKZLbMRIsG/b.594849/k.CC7C/Home.htm) and the [Susan G. Komen Foundation](http://www.komen.org/intradoc-cgi/idc_cgi_isapi.dll?IdcService=SS_GET_PAGE&ssDocName=katrina) have contributed additional money to CancerCare for the effort.

Diane Blum of CancerCare writes:

The ASCO Foundation has asked CancerCare to be the primary organization to disburse more than $500,000 that has been raised to help cancer patients who have been displaced by Hurricanes Katrina and Rita. We have also received funds from the Lance Armstrong Foundation and the Komen Foundation for this purpose. These organizations recognize CancerCare’s long experience in providing financial assistance along with psychosocial support

We will be able to distribute up to $2500 per family for cancer treatment and supportive care, durable medical equipment, homecare, childcare, transportation and lodging. We will also provide support services in the form of counseling, support groups, and education.

Professionals and advocates with questions about the program can call Jane Levy, CancerCare’s Director of Patient Assistance at 212 712-8356.

Again, patients affected by Katrina or Rita should call 800 813 HOPE for financial assistance with cancer-related expenses.

Although some surgeons believe that removing small, early rectal tumors through the anus rather than a larger opening in the abdomen is safer surgery for patients and reduces the need for colostomy, two studies show this treatment carries a higher risk of local recurrence.

A study published in the October, 2005 edition of [*Annals of Surgery*](http://www.mdlinx.com/HemeOncLinx/thearts.cfm?artid=1337876&specid=17&ok=yes) reviewed outcomes for 319 consecutive patients treated for T1 rectal cancers over a 17 year period. 151 were treated with ransanal excision (LE). A second group of 160 had surgery that opened the abdomen and removed the tumor and part of the rectum (RAD). This group actually had more poor progrostic factors than the local excision group including larger tumors and an 18% rate of lymph node spread.

Despite poorer expected prognosis the RAD group had fewer local recurrences at the surgical site, fewer distant recurrences, and significantly better recurrence-free survival. However, overall survival and disease-specific survival were similar for both groups.

A [T1 tumor](http://www.cancer.gov/cancertopics/pdq/treatment/rectal/Patient/page2) is limited to the inner lining of the colon and does not extend into the muscular layers. These cancers have not spread to lymph nodes or distant sites. Transanal excision can avoid removing the sphincter requiring colostomy in some situations so patients and surgeons may choose the more limited operation.

David J. Bentrem, M.D. headed the study team, who concluded,

Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of T1 rectal cancers

In a different study published in the June 2005 Supplement of the [*Journal of Clinical Oncology*](http://meeting.jco.org/cgi/content/abstract/23/16_suppl/3526), researchers analyzed information in the National Cancer Database. In the database, there were 1114 patients who had T1 rectal cancers that were treated with surgery only. Slightly more than half (616 or 55.3%) were treated with local excision through the anus (LE). The other group (498 or 44.7%) had surgical resections that opened the abdomen (SR).

Local excision was more likely to be chosen by patients and surgeons if:

+ tumor was close to the anus: for tumors within 5 cm of the anal verge 58% were removed by local excision (LE) versus 42% treated with standard resection (SR)

+ tumor was small: for tumors less than 1 cm, 77% were treated by LE versus 23% by SR.

+ patients had no other serious medical problems: 58% for LE versus 42%. SR

Mortality and morbidity due to surgery were significantly worse for standard open resection than local excision: Thirty-day mortality was 2.4% for SR compared to 0.5% for LE; morbidity rates for SR was 12.7% versus 4.4% for local excision.

However, local recurrence rates significantly favored standard resection at both 5 years and 8 years. At 5 years 12.7% of patients treated with local excision had experienced local recurrence compared to 6.1% of those who had standard resections. This difference was 14.4% versus 9.5% eight years after surgery. At five years there was no difference in overall survival between the groups.

Y. N. You MD and colleagues reported their results at the 2005 ASCO meeting, and they were published in the June 1, 2005 supplement to the *Journal of Clinical Oncology.* She wrote.

Patients considering LE for T1 rectal cancer may expect lower rates of perioperative morbidity and mortality, but are likely to face greater risks of local/regional tumor recurrence. For those treated with LE, long-term and vigilant oncological follow-up is essential.

[Read the abstract of the Bentrem research in the *Annals of Surgery.*](http://www.mdlinx.com/HemeOncLinx/thearts.cfm?artid=1337876&specid=17&ok=yes)

[Read the abstract of the You study in the *Journal of Clinical Oncology.*](http://meeting.jco.org/cgi/content/abstract/23/16_suppl/3526)

[See the slides of Dr. Nancy You's presentation at the 2005 meeting of the American Society of Clinical Oncology](http://asco.org/ac/1,1003,_12-002511-00_18-0034-00_19-003345,00.asp)

While a majority of cancer patients are already fatigued before they ever begin radiation therapy, almost all will have experienced it by the end of treatment.

Researchers at the University of Rochester had 370 radiotherapy patients fill out of a symptom inventory at the beginning of their radiation treatment and each week during therapy. Before therapy began 57% were fatigued. By the end of the third week, 76% were expressing fatigue. By the end of treatment 78% said that they were fatigued. Only 13% never experienced any fatigue at any point.

Of those 160 patients who were not fatigued at the beginning of treatment, 70% developed it during radiotherapy.

Prostate cancer patients reported the least severe fatigue while the most severe was experienced by patients with lung, gastrointestinal, and head and neck cancers. Age, sex, or radiation dose was not signficantly related to how severe fatigue was.

Jane Hickock M.D. and her team, in reporting their results in the October 15, 2005 issue of *Cancer* (Volume 104, Issue 8 , Pages 1772 – 1778), concluded:

Fatigue was a common adverse effect of RT for cancer, reported by more than three-fourths of patients by the third to fifth weeks of treatment. Cancer diagnosis was the only factor found to be significantly related to variation in fatigue severity. Additional studies should be devised to identify other underlying causes of RT-related fatigue

[Read the study abstract in *Cancer*.](http://www3.interscience.wiley.com/cgi-bin/abstract/111081990/ABSTRACT)