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«Contact: Mathilde Fenoulhet, Fundraising Project Coordinator EORTC Headquarters mathilde.fenoulhet +32 2 774 15 17 SPECTAcolor: ...»

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Colorectal Cancer Facts and Figures

In support of the SPECTAcolor Biobank Project

THE NETHERLANDS

Contact:

Mathilde Fenoulhet, Fundraising Project Coordinator EORTC Headquarters

mathilde.fenoulhet@eortc.be +32 2 774 15 17

SPECTAcolor: http://spectacolor.eortc.org

Table of Contents

1. Colorectal Cancer Statistics

2. What is colon cancer? What is rectal cancer?

3. Main types of colorectal cancers

4. The Colon and Rectum

5. Understanding Cancer

6. Risk Factors and Prevention

7. Screening as part of Prevention

8. Symptoms

9. Diagnosis

10. Staging of colorectal cancer

11. Treatment

Getting a Second Opinion

Treatment Methods

Surgery

Chemotherapy

Biological Therapy

Radiation Therapy

Treatment for Colon Cancer

Treatment for Rectal Cancer

12. Nutrition and Physical Activity

13. Useful links and contacts

–  –  –

THE NETHERLANDS

Colorectal cancer (CRC) – Cancer of the colon and rectum is the 2nd most frequently encountered cancer in Europe. Colorectal cancer remains also the 2nd leading cause of European cancer-related deaths. When in advanced stages the average life expectancy beyond diagnosis for fatal cases is estimated to 2 to 3 years. Many of these lives could be saved with early detection and treatment.

1. Colorectal Cancer Statistics2

In The Netherlands3 specifically:

- Colorectal cancer is the 2nd cause of death per cancer for men (after lung cancer) and the 3rd cause of death per cancer for women ( after lung and breast cancer)

- In 2012, the estimated number of new cancer cases is 7600 for men and 6320 for women

- In 2012, the estimated number of death from colorectal cancer is 2760 for men and 2480 for women Global Colorectal Cancer Statistics New cases of colorectal cancer are predicted to be 9.7% of the total global cancer cases by 2020. The increase is driven by population growth and ageing in the next decade.

 In Europe colorectal cancer (cancer of the colon and rectum) is the second most common malignant tumor  More than 450,000 citizens in Europe are newly diagnosed every year with the disease  Colorectal cancer kills 230,000 Europeans every year  Colorectal cancer is the third most common cancer worldwide 1 Source: National Cancer Institute 2 Source: Europacolon 3 Source: European Journal of cancer (2013)

–  –  –

Colon Cancer Survival Rates Since the mid-1980s, colon cancer death rate has been dropping due in part to increased awareness and screening. By finding more polyps and cancer in the earlier (local and regional) stages, it is easiest to treat. Improved treatment options have also contributed to a rise in survival rates.

 The five-year survival rate for colon cancer found at the local stage is 90%  The five-year survival rate for colon cancer found at the regional stage is 70%  The five-year survival rate for colon cancer found at the distant stage is today up to 20%

2. What is colon cancer? What is rectal cancer?

Colon cancer: Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

Rectal cancer: Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).

3. Main types of colorectal cancers Colorectal cancers originate from carcinoma and adenocarcinoma as well as adenocarcinoma in situ.

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells are found in tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices, or other fluids. Most cancers of the breast, pancreas, lung, prostate, and colon are adenocarcinomas Adenocarcinoma in situ: A condition in which abnormal cells are found in the glandular tissue that lines certain internal organs, such as the uterus, cervix, lung, pancreas, and colon. Adenocarcinoma in situ, which occurs most often in the cervix, may become cancer and spread to nearby normal tissue. This type of cancer is also called (AIS).

Marker specific types of cancer: Specific types of colorectal cancers are identified with biomarkers that enable to assess the type and stage of the disease. There are 5 main colorectal cancer biomarkers (KRAS, BRAF, MSI, PI3K, NRAS) that characterize features of the cancer.

–  –  –

Biomarker: A parameter that can be used for diagnosis or to measure the prognostic of a disease or the effects of the treatments.

4. The Colon and Rectum The colon and rectum are parts of the digestive system. They form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first 4 to 5 feet of the large intestine, and the rectum is the last several inches.





Partly digested food enters the colon from the small intestine. The colon removes water and nutrients from the food and turns the rest into waste (stool). The waste passes from the colon into the rectum and then out of the body through the anus.

The below picture shows the colon and the rectum;

–  –  –

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

 Benign tumors are not cancer:

–  –  –

When colorectal cancer spreads outside the colon or rectum, cancer cells are often found in nearby lymph nodes. If cancer cells have reached these nodes, they may also have spread to other lymph nodes or other organs. Colorectal cancer cells most often spread to the liver.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if colorectal cancer spreads to the liver, the cancer cells in the liver are actually colorectal cancer cells. The disease is metastatic colorectal cancer, not liver cancer. For that reason, it is treated as colorectal cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.

–  –  –

Research has shown that people with certain risk factors are more likely than others to develop colorectal cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for colorectal cancer:

 Age over 50: Colorectal cancer is more likely to occur as people get older. More than 90 percent of people with this disease are diagnosed after age 50. The average age at diagnosis is 72  Colorectal polyps: Polyps are growths on the inner wall of the colon or rectum. They are common in people over age 50. Most polyps are benign (not cancer), but some polyps (adenomas) can become cancer. Finding and removing polyps may reduce the risk of colorectal cancer  Family history of colorectal cancer: Close relatives (parents, brothers, sisters, or children) of a person with a history of colorectal cancer are somewhat more likely to develop this disease themselves, especially if the relative had the cancer at a young age. If many close relatives have a history of colorectal cancer, the risk is even greater  Genetic alterations: Changes in certain genes increase the risk of colorectal cancer  Hereditary nonpolyposis colon cancer (HNPCC) is the most common type of inherited (genetic) colorectal cancer. It accounts for about 2 percent of all colorectal cancer cases. It is caused by changes in an HNPCC gene. Most people with an altered HNPCC gene develop colon cancer, and the average age at diagnosis of colon cancer is 44  Familial adenomatous polyposis (FAP) is a rare, inherited condition in which hundreds of polyps form in the colon and rectum. It is caused by a change in a specific gene called APC.

Unless FAP is treated, it usually leads to colorectal cancer by age 40. FAP accounts for less than 1 percent of all colorectal cancer cases Family members of people who have HNPCC or FAP can have genetic testing to check for specific genetic changes. For those who have changes in their genes, healthcare providers may suggest ways to try to reduce the risk of colorectal cancer, or to improve the detection of this disease. For adults with FAP, the doctor may recommend an operation to remove all or part of the colon and rectum.

 Personal history of cancer: A person who has already had colorectal cancer may develop colorectal cancer a second time. Also, women with a history of cancer of the ovary, uterus (endometrium), or breast are at a somewhat higher risk of developing colorectal cancer  Ulcerative colitis or Crohn disease: A person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn's disease) for many years is at increased risk of developing colorectal cancer  Diet: Studies suggest that diets high in fat (especially animal fat) and low in calcium, folate, and fiber may increase the risk of colorectal cancer. Also, some studies suggest that people who eat a diet very low in fruits and vegetables may have a higher risk of colorectal cancer. However,

–  –  –

Because people who have colorectal cancer may develop colorectal cancer a second time, it is important to have checkups. If a patient has colorectal cancer, there also may be concerns that the family members may develop the disease. People who think they may be at risk should talk to their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups. See the "Screening" section to learn more about tests that can find polyps or colorectal cancer.

7. Screening as part of Prevention Screening tests help find polyps or cancer before you have symptoms. Finding and removing polyps may prevent colorectal cancer. Also, treatment for colorectal cancer is more likely to be effective when the disease is found early.

To find polyps or early colorectal cancer:

 People in their 50s and older should be screened  People who are at higher-than-average risk of colorectal cancer should talk with their doctor about whether to have screening tests before the age of 50, what tests to have, the benefits and risks of each test, and how often to schedule appointments

The following screening tests can be used to detect polyps, cancer, or other abnormal areas:

 Fecal occult blood test (FOBT): Sometimes cancers or polyps bleed, and the FOBT can detect tiny amounts of blood in the stool. If this test detects blood, other tests are needed to find the source of the blood. Benign conditions (such as hemorrhoids) also can cause blood in the stool.

 Sigmoidoscopy: The doctor checks inside the rectum and the lower part of the colon with a lighted tube called a sigmoidoscope. If polyps are found, the doctor removes them. The procedure to remove polyps is called a polypectomy  Colonoscopy: The doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. The doctor removes polyps that may be found  Double-contrast barium enema: Patients are given an enema with a barium solution, and air is pumped into the rectum. Several x-ray pictures are taken of the colon and rectum. The barium and air help the colon and rectum show up on the pictures. Polyps or tumors may show up.

 Digital rectal exam: A rectal exam is often part of a routine physical examination. The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas 8|P a g e MF-06Feb2014

8. Symptoms

A common symptom of colorectal cancer is a change in bowel habits. Symptoms include:

 Having diarrhea or constipation  Feeling that the bowel does not empty completely  Finding blood (either bright red or very dark) in the stool  Finding the stools are narrower than usual  Frequently having gas pains or cramps, or feeling full or bloated  Losing weight with no known reason  Feeling very tired all the time  Having nausea or vomiting Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. Anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.

Usually, early cancer does not cause pain. It is important not to wait to feel pain before seeing a doctor.

9. Diagnosis If the screening test results suggest cancer or associated symptoms, the doctor must find out whether they are due to cancer or some other cause. The doctor asks about the personal and family medical history and gives patients a physical exam. If the physical exam and test results do not suggest cancer, the doctor may decide that no further tests are needed and no treatment is necessary. However, the doctor may recommend a schedule for checkups.

If tests show an abnormal area (such as a polyp) a biopsy to check for cancer cells may be necessary.

Often, the abnormal tissue can be removed during colonoscopy or sigmoidoscopy. A pathologist checks the tissue for cancer cells using a microscope.

10. Staging of colorectal cancer If the biopsy shows that cancer is present, the doctor needs to know the extent (stage) of the disease to plan the best treatment. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

The following tests are carried out:



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