Treatment options depend on the following: The stage of the cancer

1. Treatment options depend on the following: • The stage of the cancer • Whether the cancer has recurred • The patient’s general health

2. Surgical Management • Total resection of tumor • optimal treatment

3. Pre-operative Procedure

4. Intraoperative Procedure

5. Postoperative Procedures

6. Postoperative Procedures

7. Chemotherapy • 5-FU • 15-20% of patients have partial response • Backbone of treatment • IV or oral (capecitabine) • Similar efficacy • Radiosensitizer- when given with radiotherapy • 5-FU + folinic acid (leucovirin) • Improves efficacy • Enhances binding to thymidylatesynthase • Three-fold improvement in partial response • 6 mos. after resection (stage III) • 40% decrease in recurrence rates • 30% improvement in survival

8. Chemotherapy • 5-FU + LV + Irinotecan (FOLFIRI regimen) • Topoisomerase 1 inhibitor • Improves response rates and survival of patients with metastatic disease • Diarrhea • 5-FU + LV + Oxiplatin (FOLFOX regimen) • Platinum analogue • Improves response rate • Dose-dependent neuropathy, resolves following cessation of therapy • FOLFIRI = FOLFOX

9. Chemotherapy • Monoclonal antibodies • Effective for advanced colorectal cancer • Cetuximab and Panitumumab • Directed against EGFR • Benefit previously treated patients • cetuximab – reverse cellular resistance to cytotoxic chemotherapy • Acne-like rash • Bevacizumab • Directed against VEGF • Anti-angiogenesis • HPN, proteinuria, increased likelihood of thromboembolic events

10. Treatment by Stage of Colon Cancer • Stage 0 • cancer has not grown beyond the inner lining of the colon • polypectomyor local excision through the colonoscope • Colon resection may be necessary if the tumor is too big to be removed by local excision • Stage I • cancer has grown through several layers of the colon, but has not spread outside the colon wall • Surgical resection • American cancer society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_by_Stage_of_Colon_Cancer.asp • National Cancer Institute • http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1

11. Treatment by Stage of Colon Cancer • Stage II • cancer has grown through the wall of the colon and may extend into nearby tissue • has not yet spread to the lymph nodes • Surgical resection is usually the only treatment needed • if cancer is likely to recur, radiation or chemotherapy may be recommended • Clinical trials of chemotherapy, radiation therapy, or monoclonal antibody therapy after surgery • Stage III • more advanced stage • cancer has spread to nearby lymph nodes, but has not yet spread to other parts of the body • Surgical resection is the first treatment • Adjuvant chemotherapy with 5-FU and leucovorin • Radiation therapy: if cancer was large enough to grow into adjacent tissues • American cancer society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_by_Stage_of_Colon_Cancer.asp • National Cancer Institute • http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1

12. Treatment by Stage of Colon Cancer • Stage IV and Recurrent Colon Cancer • cancer has spread to distant organs and tissues such as the liver, lung, peritoneum, or ovary • segmental resection or diverting colostomy • relieve or prevent blockage of the colon and to prevent other local complications • Surgery to remove parts of other organs, where the cancer may have recurred or spread • Radiation therapy or chemotherapy • palliative therapy to relieve symptoms and improve quality of life • Clinical trials of chemotherapy and/or monoclonal antibody therapy • locally recurrent colon cancer: local excision • Liver recurrence • Chemotherapy followed by resection • Radiofrequency ablation or cryosurgery. • Clinical trials of hepatic chemoembolization with radiation therapy • American cancer society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_by_Stage_of_Colon_Cancer.asp • National Cancer Institute • http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1