Insurance makes a difference for people with rectal cancer.

Rectal cancer patients without insurance or covered by Medicaid are almost twice as likely to die within five years as those privately insured.

Not only are they diagnosed at a later stage, but fewer receive recommended treatments at every stage.

More than half of the difference between patients with private insurance and those without was due to differences in how early they were diagnosed and whether or not they got standard treatment. Read the rest of this entry »

Some colon cancer patients don’t benefit from treatment with 5-FU based chemotherapy and may even have worse outcomes than if they no chemo at all.

Of every 100 people with colon cancer, about 15 will have cancers that arise when mistakes in DNA during cell division are not caught and fixed.  Scientists call this defective mismatch repair or dMMR.

More often, colon cancer occurs when mutations in chromosomes accumulate but DNA repair pathways remain intact and mismatch repair is proficient (pMMR). This is true for about 85 percent of colon cancer.

Both prognosis and the potential benefit from FU-based chemotherapy appear to be very different for these two types of colon cancer. Knowing mismatch repair status of colon tumors can help patients and their doctors make better treatment decisions.

Patients with defective mismatch repair have better disease-free and overall survival and don’t seem to benefit from 5-FU at either stage II or stage III.  Stage II patients with dMMR have significantly poorer overall survival if they get chemo after surgery.

Caution:  These results come from studies of 5-FU plus levamisole or 5-FU plus leucovorin.  They don’t include any information from the current standard treatments of FOLFOX or FLOX which contain oxaliplatin in addition to 5-FU and leucovorin.

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By studying changes in tumor tissue from colon cancer patients whose cancers had not spread to distant organs, researchers were able to isolate a gene mutation that led to a poor outcome.

Stage I through III colon cancer patients whose tumors had a mutation in the PIK3CA gene were more likely to die of colon cancer that patients with normal or wild-type PIK3CA.  About 1 in 5 patients had that mutation in tumor tissue.

After adjusting for other variables that affect death from colon cancer, patients with a PIK3CA mutation were more than twice as likely to die from colon cancer.  This was especially true in KRAS wild-type tumors where a PIK3CA mutation increased risk of death almost four times.  However, in KRAS mutated tumors, the presence of PIK3CA made little difference in cancer-specific survival. Read the rest of this entry »