Wednesday, December 15, 2010
Preventive Immunotherapy for Colorectal Cancer
In the Pipeline: Preventive Immunotherapy
for Colorectal Cancer
Your immune system serves as the front line in your body's defense against illness. Its job is to detect foreign intruders, like bacteria or viruses, and to then manufacture the antibodies necessary to destroy them. And it does this quite well -- except when the intruder is cancer.
The problem is that cancer cells are like double agents. They start off as normal, healthy cells, but when they become cancer cells, they act like foreign invaders. And even though they are doing things cells are not supposed to do, your immune system continues to perceive them as the normal cells they used to be.
But what if it were possible to teach your immune system that cancer cells are just like any other foreign invader that needs to be sought out and destroyed? That's the question cancer researchers have been pursuing. And they are now getting closer to finding the answer.
Preventive Immunotherapy
Most likely, you've received a number of preventive vaccines over your lifetime. And they've been incredibly effective at controlling diseases like measles and chickenpox and at virtually eradicating others such as smallpox and polio. All of these vaccines were designed to do the same thing: introduce your immune system to a virus so that it would know how to fight off the virus if it ever encountered it again.
The same strategy has been effective in fighting off some virus-related cancers: The hepatitis B vaccine, which helps prevent infection with the hepatitis B virus, reduces the risk of liver cancer, and Gardasil, the vaccine against human papillomavirus, reduces the risk of cervical cancer. But will a vaccine for colorectal cancer prevention be next in line?
That is the hope of a group of researchers at the University of Pittsburgh. They are currently conducting a phase II trial of a vaccine, called MUC1 poly-ICLC, in people at high risk for developing colorectal cancer.
MUC1 is a cell protein that is produced in large amounts by precancerous polyps and colorectal cancer tumors. The vaccine teaches the immune system that the MUC1 protein is a foreign invader and that it needs to destroy any cells that are harboring it. Poly-ICLC is a drug used to boost the body's response to vaccination.
The researchers hope that by getting the immune system to go after these cells, the vaccine will be able to prevent polyps from turning into colorectal cancers and to keep the polyps from recurring. Interest in MUC1 for colorectal cancer stems, in part, from research showing that people with pancreatic cancer or breast cancer who naturally produce antibodies against the MUC1 vaccine live longer than those who don't produce them.
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Wednesday, August 11, 2010
Personalized Colon Cancer Therapy
What if there was a test that could determine the best treatment regimens for your specific tumor? How about a test that could tell you how likely you are to have a cancer recurrence? A decade ago, doctors could only dream of such tests. But in the not-too-distant future, they will probably be the mainstay of cancer care.
These developments reflect changes in the way scientists think about cancer. Initially, researchers believed that cancer was just one disease and that all cancers could be treated in virtually the same way. Now we know that's not the case. Not only does colorectal cancer differ from, say, breast or pancreatic cancer, but the latest research demonstrates that all colorectal cancers are not the same disease biologically, either.
This, in turn, is changing the way we think about colorectal cancer care. The more we learn about the different types of tumors, the clearer it becomes that not all tumors will respond in the same way to treatment regimens. Instead, the treatment must be tailored to the tumor's specific characteristics. Your doctor might refer to this new era of cancer care as personalized medicine; others call it individualized therapy, tailored treatment, or genome-based medicine. Each term refers to the same process: using genetic information obtained from your tumor to assess which treatment plan is best for you.
Biological Markers --
To move fully into this era of personalized medicine, scientists must first identify the biological markers -- measurable characteristics, like a protein level or the presence or absence of a certain gene or gene mutation -- that can tell us about your tumor's personality. These markers fall into two broad categories: predictive and prognostic.
Predictive biomarkers provide information about which chemotherapy regimens or biological agents might be effective against your tumor and which might not be effective at all.
Prognostic biomarkers assess how likely it is that your tumor is aggressive and, in turn, how likely it is to spread or recur. If you have an aggressive tumor, you may need more or different types of treatment than if your tumor is one that can be cured successfully by surgery alone. Prognostic markers could also be used in conjunction with predictive markers to determine the type of chemotherapy you need.
KRAS: The First Predictive Biomarker -- The National Comprehensive Cancer Network's treatment guidelines now recommend that if you are diagnosed with metastatic colorectal cancer and are a candidate for anti-epidermal growth factor receptor (EGFR) therapy, your tumor tissue should be tested for a predictive biomarker called KRAS, or K-ras. KRAS is a gene that helps tumors grow by sending signals to the cell nucleus through the EGFR on the cell's surface.
MACC1:
A Possible Prognostic Biomarker? A German research group recently reported that it had identified a gene, called metastasis-associated in colon cancer 1 (MACC1), that promotes rapid tumor growth and encourages cancer to spread to additional organs throughout the body. Early studies suggest that if your tumor has high levels of MACC1 you are at a much greater risk for developing metastatic cancer and should consider more aggressive treatment and closer monitoring than someone whose tumor has low levels of MACC1. Larger studies will need to be done to confirm these findings. However, if the results are reproduced, we might see a day when treatment decisions are influenced by a tumor's MACC1 level.
Posted in Colon Cancer on August 11, 2010
These developments reflect changes in the way scientists think about cancer. Initially, researchers believed that cancer was just one disease and that all cancers could be treated in virtually the same way. Now we know that's not the case. Not only does colorectal cancer differ from, say, breast or pancreatic cancer, but the latest research demonstrates that all colorectal cancers are not the same disease biologically, either.
This, in turn, is changing the way we think about colorectal cancer care. The more we learn about the different types of tumors, the clearer it becomes that not all tumors will respond in the same way to treatment regimens. Instead, the treatment must be tailored to the tumor's specific characteristics. Your doctor might refer to this new era of cancer care as personalized medicine; others call it individualized therapy, tailored treatment, or genome-based medicine. Each term refers to the same process: using genetic information obtained from your tumor to assess which treatment plan is best for you.
Biological Markers --
To move fully into this era of personalized medicine, scientists must first identify the biological markers -- measurable characteristics, like a protein level or the presence or absence of a certain gene or gene mutation -- that can tell us about your tumor's personality. These markers fall into two broad categories: predictive and prognostic.
Predictive biomarkers provide information about which chemotherapy regimens or biological agents might be effective against your tumor and which might not be effective at all.
Prognostic biomarkers assess how likely it is that your tumor is aggressive and, in turn, how likely it is to spread or recur. If you have an aggressive tumor, you may need more or different types of treatment than if your tumor is one that can be cured successfully by surgery alone. Prognostic markers could also be used in conjunction with predictive markers to determine the type of chemotherapy you need.
KRAS: The First Predictive Biomarker -- The National Comprehensive Cancer Network's treatment guidelines now recommend that if you are diagnosed with metastatic colorectal cancer and are a candidate for anti-epidermal growth factor receptor (EGFR) therapy, your tumor tissue should be tested for a predictive biomarker called KRAS, or K-ras. KRAS is a gene that helps tumors grow by sending signals to the cell nucleus through the EGFR on the cell's surface.
MACC1:
A Possible Prognostic Biomarker? A German research group recently reported that it had identified a gene, called metastasis-associated in colon cancer 1 (MACC1), that promotes rapid tumor growth and encourages cancer to spread to additional organs throughout the body. Early studies suggest that if your tumor has high levels of MACC1 you are at a much greater risk for developing metastatic cancer and should consider more aggressive treatment and closer monitoring than someone whose tumor has low levels of MACC1. Larger studies will need to be done to confirm these findings. However, if the results are reproduced, we might see a day when treatment decisions are influenced by a tumor's MACC1 level.
Posted in Colon Cancer on August 11, 2010
Thursday, May 20, 2010
10 Questions to ask doctor about colon cancer
10 Questions to Ask Your Doctor
About Your Colon Cancer Diagnosis
The stress of a colon cancer diagnosis can feel overwhelming, so it's very important to have a support system of family and friends to help you with the questions and decisions you face. In this Health Alert, Johns Hopkins provides practical advice to help you cope.
Q. My doctor just told me that I have colon cancer and will need to undergo colon cancer surgery. Should I get a second opinion?
A. It is common for people to request a second opinion, especially before surgery or other involved treatment. Indeed, many insurance companies require a second opinion.
Ask your insurance company what your policy covers and if it requires you to see a doctor within that plan. Also tell your doctor you would like to have a second opinion. Most doctors are accustomed to this and will be supportive.
Ask for a referral and for copies of your medical records, including all test results, x-rays, and other imaging tests to take with you to the next doctor. You may have to sign a release and pay a copying fee, but there should be no problem in getting your records. If a second opinion (or the doctor you wish to consult) is not covered by insurance, it may be worthwhile to pay for this examination out of pocket.
When you meet with your doctor, be prepared in advance with questions you want to ask. For example:
Where is the colon cancer located?
Is the cancer in more than one place?
Are the lymph glands involved?
Has the cancer spread outside the colon? Are other organs involved?
What stage is the cancer, and exactly what does that mean?
Is this type of cancer life threatening?
Are there other tests I should have?
How soon do I need to begin cancer treatment?
What are the side effects of cancer treatment?
Is colon cancer genetic? Could my children be at risk?
About Your Colon Cancer Diagnosis
The stress of a colon cancer diagnosis can feel overwhelming, so it's very important to have a support system of family and friends to help you with the questions and decisions you face. In this Health Alert, Johns Hopkins provides practical advice to help you cope.
Q. My doctor just told me that I have colon cancer and will need to undergo colon cancer surgery. Should I get a second opinion?
A. It is common for people to request a second opinion, especially before surgery or other involved treatment. Indeed, many insurance companies require a second opinion.
Ask your insurance company what your policy covers and if it requires you to see a doctor within that plan. Also tell your doctor you would like to have a second opinion. Most doctors are accustomed to this and will be supportive.
Ask for a referral and for copies of your medical records, including all test results, x-rays, and other imaging tests to take with you to the next doctor. You may have to sign a release and pay a copying fee, but there should be no problem in getting your records. If a second opinion (or the doctor you wish to consult) is not covered by insurance, it may be worthwhile to pay for this examination out of pocket.
When you meet with your doctor, be prepared in advance with questions you want to ask. For example:
Where is the colon cancer located?
Is the cancer in more than one place?
Are the lymph glands involved?
Has the cancer spread outside the colon? Are other organs involved?
What stage is the cancer, and exactly what does that mean?
Is this type of cancer life threatening?
Are there other tests I should have?
How soon do I need to begin cancer treatment?
What are the side effects of cancer treatment?
Is colon cancer genetic? Could my children be at risk?
Tuesday, April 6, 2010
How Old Is Too Old for Colorectal Cancer Surgery?
How Old Is Too Old for Colorectal Cancer Surgery?
When a reasonably healthy octogenarian gets a diagnosis of colon cancer, the issue of age is bound to come up. How old is too old for colon cancer surgery? What are the risks? What kind of recovery and quality of life can the very elderly expect afterward? Is it worth it? Johns Hopkins explores these questions and others in this Special Report.
The first line of treatment for colorectal cancer is to remove the primary tumor or tumors. If your cancer is confined to polyps or a small area, surgery is probably the only treatment that you need. For stage I or II cancers that have not spread to the lymph nodes, the expected five-year survival rate after surgery without chemotherapy is 80 to 90%.
Surgery usually involves removing the segment of the colon or rectum that has the primary cancer and a margin of healthy colon on either side of the cancer. The surgeon will also remove the tissue that holds the colon in place (mesentery) and the adjacent lymph nodes. The number of lymph nodes removed can be important in providing an accurate stage and prognosis.
It is true that the risks of colorectal cancer surgery are higher for some older people. An analysis of 28 studies found lower survival rates among the elderly who have coexisting health conditions, are diagnosed at an advanced cancer stage, and have to undergo emergency procedures. Another study found that octogenarians with early stage cancer survived 10 or more years after colorectal cancer surgery if they had no chronic illnesses.
It appears that quality of life after colorectal cancer treatment can be as good for octogenarians as it is for younger seniors -- even in the face of coexisting illness, according to a Canadian study that compared the outcomes of people over age 80 with those in their 60s. The average age of the older group was 83 years at the time of colorectal cancer surgery, while the "youngsters" ranged in age from 65-69. People in both groups underwent comparable surgical procedures and had similar coexisting health problems (such as hypertension and diabetes), although the older group had somewhat less advanced (lower-stage) cancers.
The responses to a survey on quality of life and functioning before and after colorectal cancer surgery were remarkably similar in both groups. Before surgery, both worried about pain, becoming a burden, and death. After colorectal cancer surgery, there were no major changes or differences between the groups in terms of their ability to perform daily functions or their overall health, sexual function, or quality of life.
Too Early To Draw Firm Conclusions?
The Canadian researchers emphasize that their study findings are preliminary, and some results may be biased. While the results are preliminary, the study provides further ammunition for the argument that determining which patients are candidates for colorectal cancer surgery shouldn’t be made solely on the basis of chronological age. High-functioning elderly people who undergo colorectal cancer surgery appear able to retain their ability to function and maintain a good quality of life.
Experts note that regardless of age the outcome of colorectal cancer surgery is likely to be better under these conditions:
The cancer is at an early stage. Most people in the study had stage 0, I, or II cancer; none had stage III or IV.
The person about to have treatment is functioning at a high level before surgery and in good general health, without multiple serious chronic diseases. People who have three or more chronic diseases -- such as diabetes, rheumatoid arthritis, or heart disease -- tend to have poorer outcomes.
The surgery is seen as a positive action, and the person with cancer is aware of the procedures to be performed and the potential outcomes.
Other issues that could affect outcomes at any age include a family history of longevity and a good support system of family and friends.
Posted in Colon Cancer on March 6, 2010
When a reasonably healthy octogenarian gets a diagnosis of colon cancer, the issue of age is bound to come up. How old is too old for colon cancer surgery? What are the risks? What kind of recovery and quality of life can the very elderly expect afterward? Is it worth it? Johns Hopkins explores these questions and others in this Special Report.
The first line of treatment for colorectal cancer is to remove the primary tumor or tumors. If your cancer is confined to polyps or a small area, surgery is probably the only treatment that you need. For stage I or II cancers that have not spread to the lymph nodes, the expected five-year survival rate after surgery without chemotherapy is 80 to 90%.
Surgery usually involves removing the segment of the colon or rectum that has the primary cancer and a margin of healthy colon on either side of the cancer. The surgeon will also remove the tissue that holds the colon in place (mesentery) and the adjacent lymph nodes. The number of lymph nodes removed can be important in providing an accurate stage and prognosis.
It is true that the risks of colorectal cancer surgery are higher for some older people. An analysis of 28 studies found lower survival rates among the elderly who have coexisting health conditions, are diagnosed at an advanced cancer stage, and have to undergo emergency procedures. Another study found that octogenarians with early stage cancer survived 10 or more years after colorectal cancer surgery if they had no chronic illnesses.
It appears that quality of life after colorectal cancer treatment can be as good for octogenarians as it is for younger seniors -- even in the face of coexisting illness, according to a Canadian study that compared the outcomes of people over age 80 with those in their 60s. The average age of the older group was 83 years at the time of colorectal cancer surgery, while the "youngsters" ranged in age from 65-69. People in both groups underwent comparable surgical procedures and had similar coexisting health problems (such as hypertension and diabetes), although the older group had somewhat less advanced (lower-stage) cancers.
The responses to a survey on quality of life and functioning before and after colorectal cancer surgery were remarkably similar in both groups. Before surgery, both worried about pain, becoming a burden, and death. After colorectal cancer surgery, there were no major changes or differences between the groups in terms of their ability to perform daily functions or their overall health, sexual function, or quality of life.
Too Early To Draw Firm Conclusions?
The Canadian researchers emphasize that their study findings are preliminary, and some results may be biased. While the results are preliminary, the study provides further ammunition for the argument that determining which patients are candidates for colorectal cancer surgery shouldn’t be made solely on the basis of chronological age. High-functioning elderly people who undergo colorectal cancer surgery appear able to retain their ability to function and maintain a good quality of life.
Experts note that regardless of age the outcome of colorectal cancer surgery is likely to be better under these conditions:
The cancer is at an early stage. Most people in the study had stage 0, I, or II cancer; none had stage III or IV.
The person about to have treatment is functioning at a high level before surgery and in good general health, without multiple serious chronic diseases. People who have three or more chronic diseases -- such as diabetes, rheumatoid arthritis, or heart disease -- tend to have poorer outcomes.
The surgery is seen as a positive action, and the person with cancer is aware of the procedures to be performed and the potential outcomes.
Other issues that could affect outcomes at any age include a family history of longevity and a good support system of family and friends.
Posted in Colon Cancer on March 6, 2010
Wednesday, February 24, 2010
My sigmo exam
I learned two very interesting facts during my sigmo exam today...
Fact #1: The outside of my behind is way uglier than I ever imagined it to be. (All hairy and bumpy.)
Fact #2: The inside of my behind is way more beautiful than I ever imagined it to be. (All pink and smooth.)
You know, I can't tell you how happy I have been since watching that "scope". If they could run a camera through my whole body -- and if everything looked that pink and clean -- I would be happier yet!
Cancer-Free-Since-1991. email from a female breast cancer survivor.
Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. A sigmoidoscopy is an effective screening tool. Doctors use it to look for benign and malignant polyps, as well as early signs of cancer in the descending colon and rectum.
A sigmoidoscopy is similar but not the same as a colonoscopy. A Sigmoidoscopy only examines up to the sigmoid, the most distal part of the colon, while colonoscopy examines the whole large bowel.
Fact #1: The outside of my behind is way uglier than I ever imagined it to be. (All hairy and bumpy.)
Fact #2: The inside of my behind is way more beautiful than I ever imagined it to be. (All pink and smooth.)
You know, I can't tell you how happy I have been since watching that "scope". If they could run a camera through my whole body -- and if everything looked that pink and clean -- I would be happier yet!
Cancer-Free-Since-1991. email from a female breast cancer survivor.
Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. A sigmoidoscopy is an effective screening tool. Doctors use it to look for benign and malignant polyps, as well as early signs of cancer in the descending colon and rectum.
A sigmoidoscopy is similar but not the same as a colonoscopy. A Sigmoidoscopy only examines up to the sigmoid, the most distal part of the colon, while colonoscopy examines the whole large bowel.
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