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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify the risk factors for colorectal cancer.

  2. Recognize the signs and symptoms of colorectal cancer.

  3. Describe the treatment options for colorectal cancer based on patient-specific factors, such as stage of disease, age of patient, genetic mutations, and previous treatment received.

  4. Outline the pharmacologic principles for agents used to treat colorectal cancer.

  5. Develop a monitoring plan to assess the efficacy and toxicity of agents used in colorectal cancer.

  6. Educate patients about the adverse effects of chemotherapy that require specific patient counseling.

  7. Outline preventive and screening strategies for individuals at average and high risk for colorectal cancer.

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KEY CONCEPTS

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  • Image not available. Although there are numerous risk factors for developing colorectal cancer, age is the biggest risk factor for sporadic colorectal cancer.

  • Image not available. Diets high in fat and low in fiber are associated with increased colorectal cancer risk, whereas the regular use of aspirin (and nonsteroidal anti-inflammatory drugs [NSAIDs]) and calcium supplementation may decrease the risk of colorectal cancer.

  • Image not available. Effective colorectal cancer screening programs incorporate annual fecal occult blood testing in combination with regular examination of the entire colon starting at age 50 years for average-risk individuals and should be recommended by all health care providers.

  • Image not available. Most patients with colorectal cancer are asymptomatic early but may develop changes in bowel or eating habits, fatigue, abdominal pain, and blood in stool.

  • Image not available. The stage of colorectal cancer is determined by the tumor-node-metastasis (TNM) staging system and is the most important prognostic factor for patient survival. Disease stages I to III are curable, but patients with stage IV disease are treated with the goal of palliation.

  • Image not available. Adjuvant chemotherapy is not needed in patients with stage I colon cancer, may be beneficial in selective high-risk patients with stage II colon cancer, and is standard of care in patients with stage III colon cancer. 5-Fluorouracil (5-FU), leucovorin and oxaliplatin chemotherapy (FOLFOX) is the standard regimen used in adjuvant colon cancer. It is usually given for 6 months.

  • Image not available. Triple-drug therapy consisting of 5-FU and leucovorin with oxaliplatin or irinotecan improves survival compared with 5-FU plus leucovorin alone and is considered standard first-line therapy for metastatic disease. The addition of bevacizumab is recommended to be added to 5-FU–based regimens based on improvements in overall survival.

  • Image not available. Pharmacogenetic testing for KRAS mutation status should occur in all patients before starting an epidermal growth factor receptor (EGFR) targeted agent. EGFR inhibitors should be considered for addition to standard chemotherapy regimens only in patients with metastatic disease and a wild-type KRAS mutation status.

  • Image not available. Treatment of relapsed or refractory metastatic disease uses agents not given in the first-line setting; patients who receive all effective chemotherapy options have improved outcomes compared with those who do not.

  • Image not available. Adjuvant therapy consisting of 5-FU–based chemotherapy in combination with radiation therapy should be offered to patients with stage II or III cancer of the rectum. Metastatic rectal cancer is treated similar to metastatic colon ...

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