OncoLink eNews: On the Forefront of Colorectal Cancer, Summer 2001

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The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 21 de noviembre del 2001

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OncoLink would like to recognize the contribution of the National Colorectal Cancer Research Alliance (NCCRA) whose initiative with Pharmacia Oncology and Pfizer has made this publication possible.

OncoLink and NCCRA join forces to fight colorectal cancer on-line!

OncoLink has joined forces with the National Colorectal Cancer Research Alliance (NCCRA) to form the NCCRA Clinical Trials Resource Center at the University of Pennsylvania Cancer Center. Together, we will strive to raise public awareness about colorectal cancer. The NCCRA is studying the risk factors associated with colorectal cancer and identify potential preventive and treatment therapies. The NCCRA combines basic, clinical, and epidemiological research, conducted by the nation's leading scientists, to search for better, non-invasive tests to help detect colorectal cancer in its early, easy-to-treat stages.

We can make progress by encouraging participation in clinical trials that will help us find ways to prevent and treat this potentially devastating disease. It is only through research that we can make progress in preventing and treating colorectal cancer. This can best be achieved by allowing our leading scientists to study families with a history of colon cancer and through developing new drugs to prevent and treat this cancer. Through a collaboration with the OncoLink, the NCCRA has created this clinical research center that will enable the nation's leading scientists to conduct pivotal research on preventing and treating colorectal cancer.

Visit the OncoLink Colorectal Cancer Section or the NCCRA website.

Join the NCCRA/OncoLink Registry

We encourage you to learn more and become active in conquering colorectal cancer. You can help by taking a confidential survey, which was developed by cancer experts as an interactive way to help our leading scientists study families with a history of colorectal cancer. Although the survey contains several questions about you and your family, it should only take about 10 minutes of your time. Your answers may help the NCCRA study the risk factors associated with colorectal cancer and identify potential preventive and treatment therapies. We assure you that your answers will remain on a secure server. Only the principal investigators and participating researchers in the clinical trials approved by the NCCRA scientific advisory board will have access to your information in order to determine your initial eligibility for their particular trial.

After you complete the survey, your name will be entered into a national registry. NCCRA Scientists will use the information you volunteer to determine your eligibility for research studies called clinical trials that will help us find ways to prevent and treat this potentially devastating disease. If you are eligible for a trial you will be contacted by one of the NCCRA research scientists.

Remember that your eligibility for these trials is based upon the answers you provide today. If your health history changes, please visit again and repeat the survey to update our registry. You can help us make progress toward conquering colorectal cancer. To take the survey on OncoLink or call the toll free hotline at 866-724-4100.

Learn about Clinical Trials endorsed by the NCCRA for the Prevention and Treatment of Colorectal Cancer on the Web or call toll free 1-866-724-4100.

About Colorectal Cancer

Colorectal Cancer is the nation's second leading cancer killer that affects over 130,000 Americans, both men and women, every year. Unfortunately, nearly 60,000 people die from its complications annually. It does not have to be that way. According to the Centers for Disease Control, colorectal cancer is more than 90% curable if caught early. Even though the disease is highly preventable, fewer than half of all Americans over the age of 50 have ever been tested for the disease, mostly because we are afraid to talk about it. However, if found early, you can fight the disease and win.

According to the National Colorectal Cancer Research Alliance, colorectal cancer is preventable through regular testing, and through the removal of polyps (adenomas) in the colon, which often grow into cancerous tumors. You can greatly reduce your risk of getting colorectal cancer by making healthy choices and taking a few simple and easy steps -- steps that could save your life.

You Can Help Reduce Your Risk of Colorectal Cancer

  • Exercise daily - even a small amount -- if possible
  • Don't smoke
  • Keep your weight in check
  • Limit your alcohol intake
  • Regular preventive testing, such as a Fecal Occult Blood Test, Sigmoidoscopy, Double Contrast Barium Enema, or Colonoscopy.
  • Talk to your doctor about your risk factors.
  • Talk to your family to see if anyone has had polyps or cancer in the colon, rectum, breast, or any gland.
  • Check with your physician about taking a multivitamin containing folic acid, an aspirin a day, aspirin-like drugs, and Fecal Occult Blood testing.
It usually starts as a small polyp...
Colorectal cancer usually starts as a small polyp growing on the inside of the colon or rectum. Not all polyps turn into cancer, but removing these polyps early prevents them from turning cancerous. Polyps usually take between 5 and 15 years to become cancerous, and things such as regular exercise may reduce the rate at which polyps grow.

Interview with Anil Rustgi, MD, leading colorectal cancer researcher

By Kristine Conner

Anil Rustgi, MD, the T. Grier Miller Associate Professor of Medicine and Genetics and the Chief of the Division of Gastroenterology at the University of Pennsylvania, was one of just eight medical researchers asked to serve on the medical advisory board for the National Colorectal Cancer Research Alliance (NCCRA). The NCCRA, which officially launched in March 2000 was co-founded by journalist and Today show host Katie Couric and cancer fundraising activist Lilly Tartikoff, is an organization devoted to public education about colorectal cancer and fundraising efforts that will support research into prevention, detection, and therapy.

Dr. Rustgi specializes in the molecular biology of colon cancer, chemoprevention, and molecular diagnostics - in other words, he works to understand what happens at the molecular level when someone develops colon cancer. As a member of the advisory board, he is working alongside researchers from world-class institutions.

The project's first priority has been to raise public awareness about screening, risk factors, and prevention of colon cancer. "Historically, efforts that enhance public awareness really have needed to be focused - and people who are well-known serve as catalysts," Dr. Rustgi told OncoLink. "It took years before screening for breast, cervical, and other cancers became part of the public consciousness. Such a concerted, consistent effort has not happened with colon cancer until now. This is likely to have a great impact on screening."

Much of Dr. Rustgi's research focuses on people with familial forms of colorectal cancer, which often develop before the age of 40. Familial Adenomatous Polyposis (FAP) is a rare, inherited condition that leads to the development of hundreds or thousands of adenomatous (originating in the glands) polyps in the colon and rectum, usually at a young age. Unless this condition is treated, people who have it are extremely likely to develop colorectal cancer by the time they reach age 40. Hereditary Nonpolyposis Colorectal Cancer (HNPCC) is another inherited form that tends to develop at a young age, often without the presence of polyps. Even though these syndromes account for just a small percentage of all cases of colorectal cancer - most develop sporadically, with no family history - they can provide important clues about the disease in general.

"One often gets a great deal of mechanical insight and clinical application in general from familial forms of cancer," says Dr. Rustgi, citing the example of research into the BRCA gene for breast cancer. "And it's easier to research familial forms because they are more exaggerated. Plus, many of the genetic changes that people acquire over time, and which lead to colorectal cancer, are similar to the genetic abnormalities that are present in the familial syndromes." Just as it's important for people to overcome their fear of or aversion to screening, they also shouldn't assume that a diagnosis of cancer means automatic colostomy. In most cases, the cancerous tissue can be removed and the colon resected - and it functions just as it did before. Unless the cancer has spread or the tumor is in an odd location, says Dr. Rustgi, "surgery often doesn't have to be as radical as people assume it will be."

OncoLink "Ask the Experts:"Insurance Coverage for Colonoscopy

Dear OncoLink "Ask the Experts,"
I am writing on behalf of my brother. He is 58 years old and has never had a colonoscopy. My mother had breast cancer that metastasized to her colon, requiring a colostomy. She died in 1984. My father has recently been diagnosed with colon cancer detected on a colonoscopy. He only had that one because he had two episodes of bleeding. The GI physician, after performing the colonoscopy, told my two brothers that they should both have colonoscopies immediately. My older brother got a referral from his PCP to see a GI physician, had the consultation with the GI doctor, and set a date for a colonoscopy. He was contacted earlier this week and told that the insurance company is denying payment for the colonoscopy. They said they would only pay for it if there was "active bleeding." What should he do in this situation? He obviously needs the colonoscopy with such a strong family history and being 58 years old, and his PCP agreed, or he would not have referred him in the first place. What can anyone do in a situation such as this?

Thank you,

Dr. Timothy Hoops, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

Dear MB,

Coverage of colonoscopies by insurance companies has become an increasingly larger problem. Many companies are now covering "screening" colonoscopies for patients that are not above average risk for the disease. The rationale is that this procedure is more complete. It may also be safe to do this procedure once every 10 years. People who have a family history of colon cancer such as your brother have an increased risk for the development of colon cancer reaching 10 to 15% over their lifetime. Most gastroenterologists would recommend a full colonoscopy for these patients as the entire colon can be evaluated and if polyps are found, they can be removed. Alternative recommended screening methods include flexible sigmoidoscopies every 5 years and annual tests for occult blood in the stool. The opinion of many experts is that this may be a somewhat less effective method for screening these patients with an increased risk for colon cancer. Unfortunately, health care insurers use many criteria to determine how they cover certain services. Discussion of the specific issues regarding risk may cause them to change their policy for an individual. It should be stressed that any symptom such as a change in bowel habits or any rectal bleeding can then be used as a justification for the procedure. Finally, it is our hope that these policies will be changing in the near future as more public support is generated for better screening techniques.

Cutting Edge Treatments

Promising Future Treatment Options for Colorectal Cancer

According to James P. Stevenson, MD, Assistant Professor of Medicine in the Hematology/Oncology Division of the University of Pennsylvania School of Medicine, "angiogenesis inhibitors, monoclonal antibodies, and vaccines hold promise for colorectal cancer." Examples of each that are being studied in colon cancer include;

  • SU5416 (an antiangiogenesis drug),
  • C225 (a monoclonal antibody),
  • multiple vaccines directed at CEA

Dr. Stevenson states that, "At this point, no one agent seems to stand out. It is likely that any of these will be more effective when combined with chemotherapy, and some drugs actually span both classes (for example, bevacizumab or anti-VEGF, which is a monoclonal antibody designed to be antiangiogenic). Results from trials of these agents in colon cancer are expected soon."

If you are being treated for colorectal cancer and you are curious about the possibility of participating in any clinical trial, speak to your oncologist.

Colorectal Cancer Resources

OncoLink Ask The Experts
This is your chance to "Ask the Experts" everything you've always wanted to know about colorectal cancer, research, prevention, and medical management. Our experts are all University of Pennsylvania Cancer Center physicians with unparalleled expertise who volunteered to respond.

The National Colorectal Cancer Research Alliance
Co-founded by NBC TODAY show co-anchor Katie Couric and nationally-known cancer fund raiser Lilly Tartikoff to raise awareness of the seriousness of colorectal cancer, and to increase the number of people receiving preventive testing. The NCCRA also raises funds for those scientists doing the best cutting-edge research throughout the United States.

The Colon Cancer Alliance
"The Voice of the Survivors" is helping people who have colorectal cancer, and helping their families learn what to expect in dealing with the disease. The Colon Cancer Alliance began as an online community, and grew out of Internet discussion groups started in 1996. Run primarily by volunteers, the Colon Cancer Alliance is now a strong national group, dedicated to bringing the voice of survivors to battle colorectal cancer through patient support, education, research and advocacy.

OncoLink Book Review: "Don't Die of Embarrassment: Life after Colostomy and Other Adventures"
A novel by Barbara Barrie, which takes the reader through her journey of symptoms, diagnosis, surgery, radiation therapy, chemotherapy, and life with a colostomy. It is a candid view of experiences with her family, friends, and the medical profession. The ups and downs of living with a colostomy are discussed from a very personal viewpoint. See the OncoLink review of this book.


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