Colorectal Cancer Survivorship Course
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Today, there are more than 1 million colorectal cancer survivors in the United States, 600,000-700,000 of whom have no current signs of cancer. The Colorectal Cancer Survivorship course provides the most up-to-date practice advice to assist physicians and other health care professionals in evaluating and managing colorectal cancer survivors. The course is taught by a multidisciplinary faculty team at The University of Texas MD Anderson Cancer Center that cares for colorectal cancer patients and survivors. This course is intended for physicians, nurses, physician assistants, clinical pharmacists, and other health care professionals as well as students, residents, and fellows. The course provides an overview of the etiology and epidemiology of colorectal cancer and identifies the roles of surgery, chemotherapy, and irradiation in the treatment of this disease. A core feature is helping health care professionals recognize symptoms as well as side effects and complications of treatment. It also provides advice on how to evaluate and manage the long-term and late effects of these treatment complications. Lectures on genetic testing, surveillance, and secondary primary hereditary and nonhereditary colorectal cancers and their corollaries are provided. The course includes information on recognizing when patients should be referred to specialists for follow-up specialty care.
Support for this course was provided by a generous grant from the Cancer Prevention & Research Institute of Texas (CPRIT) PP100157
The University of Texas MD Anderson Cancer Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Texas MD Anderson Cancer Center designates this enduring material for a maximum of 3.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity
- Review of Colorectal Cancer
- The Role of Surgery in the Treatment of Colorectal Cancer
- The Role of Radiation Therapy in the Treatment of Colorectal Cancer
- The Role of Chemotherapy
- Late Effects of Surgery
- Late Effects of Radiation Therapy
- Late Effects of Chemotherapy
- Second Primary Cancers
- Inherited Colorectal Cancer
Summary: Colorectal cancer is the second leading cause of cancer-related death in the United States. In her lecture, "Colorectal Cancer Survivorship: Review of Colorectal Cancer," Aki Ohinata, Physician Assistant in Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, says that the key to saving lives lies in detection and management. Ms. Ohinata specifically talks about the epidemiology and etiology of colorectal cancer and how to identify people who are at an increased risk of the disease. She describes how genetic mutations and family history play a role in colorectal cancer development. Ms. Ohinata also discusses how diet and lifestyle can be contributing factors for the disease. In addition, she defines the stages of colorectal cancer as per the guidelines of The American Joint Committee on Cancer Staging System. Ms. Ohinata also discusses how to order appropriate tests for newly diagnosed patients.
Summary: Surgery is the primary treatment for patients with localized colorectal cancer. In his lecture, "Colorectal Cancer Survivorship: The Role of Surgery in the Treatment of Colorectal Cancer," Dr. Miguel Rodriguez-Bigas, Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center, describes and illustrates the types of bowel resection used for the treatment of colorectal cancer. Dr. Rodriguez-Bigas also discusses intestinal diversions and metastasectomy for the treatment of patients with advanced disease.
Summary: Radiotherapy can play an integral role in the treatment of colorectal cancer. In his lecture, "Colorectal Cancer Survivorship: The Role of Radiation Therapy in the Treatment of Colorectal Cancer," Daniel Malatek, Physician Assistant in Radiation Oncology – GI Service at The University of Texas MD Anderson Cancer Center, describes the use of conventional radiotherapy, along with radiation seeds and proton therapy, in the treatment of colorectal cancer. Mr. Malatek shares how MD Anderson delivers the most advanced radiation therapies in treating colorectal cancer. He describes the foundational concepts in radiation therapy, possible side effects patients may face, and when it should be used in the treatment of colorectal cancer.
Summary: Combined targeted therapy with chemotherapy can improve overall survival for patients with metastatic disease. In his lecture, "Colorectal Cancer Survivorship: The Role of Chemotherapy," Dr. David Fogelman, Assistant Professor of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, discusses chemotherapy agents currently utilized in the treatment of colorectal cancer. Dr. Fogelman explains the role of chemotherapy in the neoadjuvant, adjuvant, and metastatic settings of colorectal cancer. He describes and gives examples of various administration strategies and combinations used in this setting. Dr. Fogelman also talks about the benefits of chemotherapy and explores potential factors considered prior to starting chemotherapy. He explains why it’s important that each patient’s treatment be individualized.
Summary: Pain, diminishing body image, bowel issues, and sexual dysfunction. Colleen Reeves, Advanced Practice Nurse in Surgical Oncology at The University of Texas MD Anderson Cancer Center, says these are just a few of the challenges colorectal cancer survivors may face after surgery. In her lecture for health professionals, "Colorectal Cancer Survivorship: Late Effects of Surgery," Ms. Reeves talks about how to differentiate between the acute and late effects of colorectal surgery. She discusses the complications that may arise from the late effects of surgery and offers insight into how to diagnose and manage the different types of late effects that colorectal cancer survivors may face. Ms. Reeves also discusses one late effect of surgery for colorectal cancer that the majority of colorectal cancer survivors encounter, adhesions, and the factors that contribute to their development. Ms. Reeves addresses some persistent and acute symptoms experienced by colorectal cancer survivors that may require referral to specialty care and she identifies some useful resources available to professionals and their patients.
Summary: Lymphedema, bone fractures, sterility, fatigue, and chronic diarrhea—these are just a few of the late side effects patients (≤ 10%) may suffer following radiation therapy for colorectal cancer. In his lecture "Colorectal Cancer Survivorship: Late Effects of Radiation Therapy," Daniel Malatek, Physician Assistant in the Radiation Oncology Gastrointestinal Service at The University of Texas MD Anderson Cancer Center, differentiates acute side effects from late side effects, describes common and uncommon late side effects, and suggests how to best treat and manage late side effects. Mr. Malatek also explains why it is important to first rule out secondary cancer, as it can mimic less common side effects of radiation therapy. Finally, he discusses when it is appropriate to refer a patient to a specialist; for example, a late effect of radiation therapy such as small bowel obstructions may require hospitalization or even surgery.
Summary: Many colorectal cancer patients develop some late effects of chemotherapy following treatment. They could take weeks, months, even years to develop, but patients can experience fatigue, cognitive dysfunction known as "chemobrain," reproduction or sexuality issues, osteoporosis, and even cataracts. In her lecture, "Colorectal Cancer Survivorship: Late Effects of Chemotherapy," Dr. Alexandria Phan, Associate Professor of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, describes how to recognize general long-term or late effects of chemotherapy agents. Dr. Phan also talks about management strategies and what indications should prompt referral to a specialist.
Summary: The cancer may be gone, but the fear remains. Colorectal cancer survivors ask themselves, "Will the cancer come back or develop somewhere else?" These survivors’ health care professionals want to make sure that they are providing appropriate surveillance. Maura Polansky, Physician Assistant in the Department of Gastrointestinal Medical Oncology and Director of Physician Assistant Education at The University of Texas MD Anderson Cancer Center, takes a look at data that can help physicians plan the most effective long-term follow-up care for colorectal cancer survivors. In her lecture, "Colorectal Cancer Survivorship: Surveillance," Ms. Polansky discusses the factors that can increase a survivor’s risk of recurrent colorectal cancer within 5 years of treatment completion. She discusses the ways in which disease staging may be important in estimating recurrence risk. In addition, Ms. Polansky discusses common sites of colorectal cancer recurrence, details established practice guidelines for disease surveillance, and discusses how to order the appropriate tests for colorectal cancer surveillance based on these guidelines. She also discusses a recent study that addressed the effects of intensive and less-intensive surveillance practices in colorectal cancer survivors.
Summary: Colorectal cancer survivors, particularly women, are at an increased risk of developing a second primary cancer. In her lecture "Colorectal Cancer Survivorship: Second Primary Cancers," Dr. Therese Bevers, Professor of Clinical Cancer Prevention and Medical Director of the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, defines second primary cancers, identifies risk of second primary cancers after colorectal cancer, and discusses why second primary cancers occur more frequently in women than in men. Dr. Bevers reviews recent data and outlines mechanisms related to the development of second primary cancers in colorectal cancer survivors, including lifestyle, genetics, and the effects of treatment. She also discusses how to modify the risk of second primary cancers by offering risk-reduction strategies and suggestions for implementing appropriate screening strategies to detect second primary cancers early.
Cancer Screening for Patients with Inherited Colorectal Cancer
Summary: When managing colorectal cancer risk, it’s important to start with family history. In his lecture "Colorectal Cancer Survivorship: Cancer Screening for Patients with Inherited Colorectal Cancer," Dr. Patrick Lynch, Professor in the Department of Gastroenterology, Hepatology, and Nutrition at The University of Texas MD Anderson Cancer Center, describes how to recommend evidence-based enhanced colorectal cancer screening for patients with hereditary nonpolyposis colorectal cancer (HNPCC). Dr. Lynch also delineates the risks of extracolonic tumors, with options for and limitations of screening for such tumors.
Evaluation of Inherited Colorectal Cancer Risk
Summary: The origins of colorectal cancer are multifactorial. Some cancers progress from premalignant polyps; others may be associated with a history of inflammatory bowel disease. Other colorectal cancers are thought to be familial. The two most common inherited syndromes linked with colorectal cancer are familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). In his lecture "Colorectal Cancer Survivorship: Evaluation of Inherited Colorectal Cancer Risk," Dr. Patrick Lynch, Professor in the Department of Gastroenterology, Hepatology, and Nutrition at The University of Texas MD Anderson Cancer Center, describes how to recognize distinctions between the two syndromes (FAP and HNPCC). Dr. Lynch discusses clinical practice guidelines and how they should be applied for each of these conditions. He also talks about how to appropriately order, interpret, and effectively deliver genetic testing results.
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