IJET-V3I2P22

International Journal of Engineering and Techniques - Volume 3 Issue 2, March-April 2017
ISSN: 2395-1303 http://www.ijetjournal.org Page 133
A Study and Enhancement in Controlling and Patient
Management in Colorectal Cancer
Gorikapudi Maniteja
Assistant Professor, Azad College Of Engineering& Technology
INTRODUCTION:
Colorectal cancer (CRC) is a formidable health
problem worldwide. It is the third most common
cancer in men (663000 cases, 10.0% of all cancer
cases) and the second most common in women
(571000 cases, 9.4% of all cancer cases)1 . Almost
60% of cases are encountered in developed
countries. The number of CRC-related deaths is
estimated to be approximately 608000 worldwide,
accounting for 8% of all cancer deaths and making
CRC the fourth most common cause of death due to
cancer. In India, the annual incidence rates (AARs)
for colon cancer and rectal cancer in men are 4.4
and 4.1 per 100000, respectively. The AAR for
colon cancer in women is 3.9 per 100000. Colon
cancer ranks 8th and rectal cancer ranks 9th among
men. For women, rectal cancer does not figure in
the top 10 cancers, whereas colon cancer ranks 9th
.
CRC survivors are patients living with a diagnosis
of colorectal cancer after primary treatment and are
checked regularly for possible recurrent or
metastatic disease. Traditionally, in most countries
across Europe, this survivorship care of CRC is
organized in a secondary care setting and consists
of periodic CEA blood testing, imaging and
colonoscopy. Survivorship care, however, entails
more than detection of recurrent disease and should
include rehabilitation, management of physical and
psychosocial consequences of the disease and its
treatment, and management of common
comorbidities. Primary care providers are used to
deliver comprehensive generalist care, including
psychosocial support Therefore, health care
providers and policy makers argue that primary care
might be a better setting for CRC survivorship care
In the Netherlands, each patient is registered with a
general practitioner (GP) who is the caregiver of
first contact, refers patients to secondary care if
necessary, and provides continuity of care after
conclusion of treatment in secondary care.
Patients with colon cancer are often asymptomatic.
Some have symptoms of change in bowel habits,
blood in their stool, anemia, or are found to be fecal
occult blood positive. Less often, a patient may
have pain or obstructive symptoms or symptoms of
metastatic disease.A complete history, including
family history and colon cancer-specific history can
guide the surgeon to suspect hereditary cancer
syndromes, look for associated pathology or
metastatic disease, and initiate additional workup
such as mutational analysis of the tumor. Patients
RESEARCH ARTICLE OPEN ACCESS
Abstract:
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Keywords — Colorectal Cancer, Survivorship Care, Patients, Preferences, Symptoms

meeting clinical criteria for or having a family
history of an increased susceptibility to colorectal
cancer should be referred for genetic counseling for
formal evaluation.
Patient-reported outcome measures in colorectal
cancer
Colorectal cancer-specific patient-reported outcome
measures (PROMs) should be developed foruse in
disease management and to inform outcome
measures in future clinical trials.
Why this is important
Quality of life and PROMs are now frequently
being used as secondary endpoints in clinical trials
ofcancer management. However, some
investigators continue to use non-disease-specific
genericmethodology for this purpose. The treatment
of colorectal cancer leads to very specific side
effectsrelating to bowel function and activities of
daily living. The Guideline Development
Grouptherefore believes that colorectal cancer-
specific patient-reported outcome measures should
bedeveloped to standardise the interpretation of
quality-of-life reporting as a secondary endpoint
infuture clinical trials in colorectal cancer.
Key priorities for implementation
The following recommendations have been
identified as priorities for implementation.
Diagnostic investigations
Offer colonoscopy to patients without major
comorbidity, to confirm a diagnosis of colorectal
cancer. If a lesion suspicious of cancer is detected,
perform a biopsy to obtain histological proofof
diagnosis, unless it is contraindicated (for example,
patients with a blood clotting disorder).
Staging of colorectal cancer:
Offer contrast-enhanced computed tomography (CT)
of the chest, abdomen and pelvis, to estimate the
stage of disease, to all patients diagnosed with
colorectal cancer unless it is contraindicated. No
further routine imaging is needed for patients with
colon cancer.
Offer magnetic resonance imaging (MRI) to assess
the risk of local recurrence, as determined by
anticipated resection margin, tumour and lymph
node staging, to all patients with rectal cancer
unless it is contraindicated.
Preoperative management of the primary
tumour
Do not offer short-course preoperative radiotherapy
(SCPRT) or chemoradiotherapy to patients with
low-risk operable rectal cancer (see table 1 for risk
groups), unless as part of a clinical trial.
Colonic stents in acute large bowel obstruction
If considering the use of a colonic stent in patients
presenting with acute large bowel obstruction, offer
CT of the chest, abdomen and pelvis to confirm the
diagnosis of mechanical obstruction, and to
determine whether the patient has metastatic
disease or colonic perforation.
Stage I colorectal cancer
The colorectal multidisciplinary team (MDT)
should consider further treatment for patients with
locally excised, pathologically confirmed stage I
cancer, taking into account pathological
characteristics of the lesion, imaging results and
previous treatments.
Imaging hepatic metastases
If the CT scan shows metastatic disease only in the
liver and the patient has no contraindications to
further treatment, a specialist hepatobiliary MDT
should decide if further imaging to confirm surgery
is suitable for the patient – or potentially suitable
after further treatment – is needed.
Chemotherapy for advanced and metastatic
colorectal cancer
When offering multiple chemotherapy drugs to
patients with advanced and metastatic colorectal
cancer, consider one of the following sequences of
chemotherapy unless they are contraindicated:
• FOLFOX (folinic acid plus fluorouracil plus
oxaliplatin) as first-line treatment then
single agent irinotecan as second-line
treatment or
• FOLFOX as first-line treatment then
FOLFIRI (folinic acid plus fluorouracil plus
irinotecan) as second-line treatment or
• XELOX (capecitabine plus oxaliplatin) as
first-line treatment then FOLFIRI (folinic
acid plus fluorouracil plus irinotecan) as
second-line treatment.
Follow-up after apparently curative resection
Offer patients regular surveillance witha minimum
of two CTs of the chest, abdomen, and pelvis in the
first 3 years and regular serum carcinoembryonic

antigen tests (at least every 6 months in the first 3
years).
Information about bowel function
Before starting treatment, offer all patients
information on all treatment options available to
them (including no treatment) and the potential
benefits and risks of these treatments, including the
effect on bowel function.
Patients and methods
Patients
We performed a cross-sectional study in patients
that had been treated with curative intent for
colorectal cancer (stages 1–3) at different time
points after treatment. Recruitment was done at the
outpatient clinics of the departments of surgery,
oncology and gastroenterology of six Dutch
hospitals. Patients were also eligible if they had a
(temporary) stoma or if they had received adjuvant
chemotherapy or neoadjuvantchemoradiation.
Patients were excluded in case of stage 4 disease,
hereditary colorectal cancer, cancer in a patient
with inflammatory bowel disease, (sub)total
colectomy, history of other primary cancer, or any
other condition where specialised survivorship care
was needed. The inclusion period was November
2013 until November 2014.
Methods
A cross-sectional study of CRC survivors at
different time points. For 14 different symptoms,
patients reported if they would consult a caregiver,
and who they would contact if so. Patient and
disease characteristics were retrieved from hospital
and general practice records.The symptoms that
patients were asked about were (1) abdominal pain,
(2) fatigue, (3) nausea, (4) diarrhoea, (5)
constipation, (6) fever, (7) rectal blood loss, (8)
weight loss, (9) pain, (10) reduced stamina, (11)
trouble sleeping, (12) fear that cancer had recurred,
(13) social issues, and (14) work-related issues.
SURGERY
There is no doubt that surgery remains the
definitive treatment for localised colorectal cancer
and it is important that the patient undergoes
appropriate preoperative preparation. Mechanical
bowel preparation is widely employed but evidence
from randomised trials fails to show that it has a
significant effect.However, for aesthetic reasons if
for no other, the vast majority of surgeons employ
bowel preparation certainly for left sided lesions,
though less commonly for right sided tumours.
Prophylaxis against deep vein thrombosis is
important and the most commonly used method is
low dose subcutaneous heparin. Likewise,
prophylactic antibiotics to reduce the incidence of
wound infection are well established and current
best practice is to give a single dose of intravenous
antibiotics providing both aerobic and anaerobic
cover within 30 minutes of induction of
anaesthesia.The surgery itself can be subdivided
into surgery for colonic cancer and for rectal cancer.
RESULTS:
Of 318 treated for CRC, 37 patients had a history of
first-degree relative with CRC. After excluding
patients with non-verified histopathological report
(4 patients) and Lynch syndrome (based on
Amsterdam II criteria; 2 patients), thirty-one
patients remained included in the study. None of the
patients with positive family history was diagnosed
as part of a symptomfree screening due to family
history of CRC. Patients with positive family
history had a lower T (tumour) stage (p=0.008) and
were more able to develop second primary cancer,
such as kidney, prostate, urinary bladder, skin, lung
and breast cancer (p<0.001) than patients with no
family history. In those patients with a positive
family history and colon cancer, there was
improved overall survival (p=0.012) (Figure 1), but
this was not the case for patients with rectal cancer
(p=0.416). No recurrences were observed in
patients curatively treated for colon cancer and
positive family history of CRC (p=0.035) (Figure 2).
In the multivariate analysis, there was an increased
risk for shorter overall survival among patients with
no family history for CRC.

Fig 1. Overall survival in patients treated for
colon cancer with positive and negative family
history for colorectal cancer in first-degree
relatives.
Fig 2. Time to recurrence in curatively treated
patients with colon cancer and positive or
negative family history of colorectal cancer in
first-degree relatives
DISCUSSION:
In this study, the relationship between CRC patients
with a family history of CRC in first-degree
relatives and survival was analysed. We
demonstrated that patients with colon cancer and
positive family history had better overalland cancer
specific survival and prolonged time to recurrence
compared to patients with negative family history.
The basis of survival benefits associated with
familial CRC is though unclear. However in recent
years increased attention has gained towards
tumour biology. MSI tumours are associated with
hereditary CRC, rightsided colon cancer and
improved survival, and one explaining factor in the
discrepancy of why colon cancer patients have
improved survival might be due to MSI. As CRC is
a common disease in the general population, the
proportion of patients with positive family history
of CRC has been reported between 16- 19%. In the
present cohort, only 10% of patients with first-
degree relative with CRC were identified. The
proportion of patients with positive family history
was low which is due to only including patients
with verified histopathological reports of their
relatives with CRC. In contrast to previous studies,
the median age of patients with positive family
history in this cohort was 75 years; and therefore, it
was considered population based.
CONCLUSION
Significant advances in the treatment of colorectal
cancer have been made in recent years and in terms
of improved survival the most important areas
appear to be early detection and high quality
surgery, particularly in the pelvis. The role of
adjuvant therapy has been partially clarified but the
treatment of advanced disease remains inadequate;
as our understanding of the genetic and biochemical
basis of cancer improves it is hoped that new
biological modifiers and gene therapy may have a
part to play in the future.Family history of CRC in
first-degree relative in patients with CRC was an
individual prognostic factor in patients with colon
cancer. This improvement in survival could not be
explained by known clinico-pathological
factors.For many symptoms that may occur,
however, patients would contact their GP. Men,
older patients and patients with chronic comorbid
conditions more likely prefer to consult their GP,
while women patients with stage 3 disease, and
patients that have been treated with adjuvant
chemotherapy more likely prefer to consult a

secondary care provider. Symptoms that alarm
patients to possible recurrent disease, such as rectal
blood loss, weight loss or the fear that cancer has
recurred would prompt patients to consult either
both primary and secondary care providers
simultaneously or a secondary care provider
directly.
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