Adjuvant Treatment of Colorectal Cancer

Brian M. Wolpin, MD, Jeffrey A. Meyerhardt, MD, MPH, Harvey J. Mamon, MD, PhD and Robert J. Mayer, MD

Dr. Wolpin is Instructor in Medicine, Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA.
Dr. Meyerhardt is Assistant Professor of Medicine, Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA.
Dr. Mamon is Assistant Professor of Radiation Oncology and Clinical Director, Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Dr. Mayer is Professor of Medicine and Director, Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA.

This article is available online at http://CAonline.AmCancerSoc.org
To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org

ABSTRACT

Colorectal cancer is the fourth most common noncutaneous malignancy in the United States and the second most frequent cause of cancer-related death. Approximately three quarters of patients are diagnosed with disease limited to the bowel wall or surrounding lymph nodes. Over the past decade, significant progress has been made in the treatment of localized colorectal cancer due to advances in surgery, radiotherapy, and chemotherapy. For patients with Stage III colon cancer, an overall survival benefit for fluorouracil-based chemotherapy has been firmly established, and recent data have shown further efficacy through the inclusion of oxaliplatin into adjuvant treatment programs. For patients with Stage II colon cancer, the use of adjuvant chemotherapy remains controversial, but may be appropriate in a subset of individuals at high risk for disease recurrence. In the treatment of patients with rectal cancer, improved outcomes have been noted with the use of total mesorectal excision and preoperative concurrent chemoradiotherapy. Current randomized clinical trials in the adjuvant therapy of colorectal cancer are examining the value of adding agents known to be active in metastatic disease, including those that modify specific molecular targets.

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Cancer Risk Elicitation and Communication

Lessons from the Psychology of Risk Perception

William M. P. Klein, PhD and Michael E. Stefanek, PhD

Dr. Klein is Associate Professor, Department of Psychology, University of Pittsburgh, Pittsburgh, PA.
Dr. Stefanek is Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA.

This article is available online at http://CAonline.AmCancerSoc.org


ABSTRACT

Cancer risk perceptions are a key predictor of risk-reduction practices, health behaviors, and processing of cancer information. Nevertheless, patients and the general public (as well as health care providers) exhibit a number of errors and biases in the way they think about risk, such that their risk perceptions and decisions deviate greatly from those prescribed by normative decision models and by experts in risk assessment. For example, people are more likely to engage in screening behaviors such as mammography when faced with loss-based messages than gain-framed messages, and they often ignore the base rate of a given disease when assessing their own risk of obtaining this disease. In this article, we review many of the psychological processes that underlie risk perception and discuss how these processes lead to such deviations. Among these processes are difficulties with use of numerical information (innumeracy), cognitive processes (eg, use of time-saving heuristics), motivational factors (eg, loss and regret aversion), and emotion. We conclude with suggestions for future research in the area, as well as implications for improving the elicitation and communication of personal cancer risk.

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Minimal Access Cancer Management

Frederick L. Greene, MD, Kent W. Kercher, MD, Heidi Nelson, MD, Chris M. Teigland, MD and Anne-Marie Boller, MD

Dr. Greene is Chairman, Department of General Surgery, Carolinas Medical Center, Charlotte, NC.
Dr. Kercher is Chief of Minimal Access Surgery; and Co-director of the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, NC.
Dr. Nelson is Professor of Surgery; and Division Chief, Department of Surgery and Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN.
Dr. Teigland is Chairman, McKay Department of Urology, Carolinas Medical Center, Charlotte, NC.
Dr. Boller is Fellow, Department of Surgery and Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN.

This article is available online at http://CAonline.AmCancerSoc.org
To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org.
Disclosures: The authors have no financial support or financial interest in products or manufacturers of products mentioned in the manuscript

ABSTRACT

Minimal access approaches in the treatment of a variety of solid tumors of the stomach, large bowel, and genitourinary system are now being advocated in several surgical specialty areas. The laparoscope has evolved from a diagnostic tool to a modality that allows for removal of tumors using small incisions and the application of pneumoperitoneum with carbon dioxide. Through studies using animal models and patient investigation, the immunologic benefits of laparoscopic cancer procedures appear to be beneficial when compared with conventional laparotomy. Overall benefits of analgesic reduction, more rapid postoperative recovery, and patient satisfaction are the byproducts of minimal access approaches. Patients with cancers of the stomach, colon, and kidney show similar long-term outcomes when compared with conventional open techniques. Caution, however, should be exercised in recommending laparoscopic approaches for routine management of primary tumors of the rectum and adrenal gland.

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Young Adult Oncology

The Patients and Their Survival Challenges

Archie Bleyer, MD

Dr. Bleyer is Adolescent and Young Adult Oncologist and Medical Advisor, Cancer Treatment Center, St. Charles Medical Center, Bend, OR; Adolescent and Young Adult Oncologist, Oregon Health and Sciences University, Portland, OR; and Director, CureSearch/National Childhood Cancer Foundation, Bethesda, MD, and Arcadia, CA.

This article is available online at http://CAonline.AmCancerSoc.org
To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org
Disclosures: This review was supported by the Aflac Insurance Co. and NCI U10 Grant CA98543.

ABSTRACT

One in every 168 Americans develops invasive cancer between age 15 to 30 years. During this age interval, cancer is unique in the distribution of types that occur and rarely related to either environmental carcinogens, a recognizable inherited predisposition, or a family cancer syndrome. Patients in this age group have the lowest rate of health insurance coverage, frequent delays in diagnosis, and the lowest accrual to clinical trials. Their psychosocial needs are unique and generally less well attended to than in any other age group. Despite an intrinsically equal ability to tolerate chemotherapy, older adolescents and young adults frequently receive lower dose intensities than do younger patients, and at times less than in older patients. Whereas the 15- to 29-year age group once had a better overall survival rate than either younger or older patients, a relative lack of progress has resulted in the majority of cancers in the age group having a worse overall survival rate than in younger patients, and several of these having a worse prognosis than in older patients. Against this background, young adults with cancer have unique survival challenges—medically, psychosocially, and economically—that are now beginning to be appreciated and addressed with a national initiative.

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The Lethal Phenotype of Cancer

The Molecular Basis of Death Due to Malignancy

Robert D. Loberg, PhD, Deborah A. Bradley, MD, Scott A. Tomlins, Arul M. Chinnaiyan, MD, PhD and Kenneth J. Pienta, MD

Dr. Loberg is Research Assistant Professor, Internal Medicine and Urology, University of Michigan, Ann Arbor, MI.
Dr. Bradley is Fellow, Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI.
Mr. Tomlins is Graduate Student, Department of Pathology, University of Michigan, Ann Arbor, MI.
Dr. Chinnaiyan is S. P. Hicks Endowed Professorship; Professor of Pathology and Urology; Director of Pathology Research Informatics; and Director of Cancer Bioinformatics, University of Michigan, Ann Arbor, MI.
Dr. Pienta is Professor, Internal Medicine and Urology; and American Cancer Society Clinical Research Professor, University of Michigan, Ann Arbor, MI.

This article is available online at http://CAonline.AmCancerSoc.org
To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org
Disclosures: K.J.P. is supported by an American Cancer Society Clinical Research Professorship. A.M.C. is supported by a Burroughs Welcome Foundation Award in Clinical Translational Research. S.A.T. is supported by the Medical Scientist Training Program and a Rackham Predoctoral Award. This research was supported in part by National Institutes of Health Grant RO1 CA102872 (to K.J.P.); RO1 CA97063 (to A.M.C.); U01 CA111275 (to A.M.C.); P50 CA69568 (to K.J.P., A.M.C.); Department of Defense Grant PC051081 (to A.M.C.); Ralph Wilson Medical Research Foundation Award (K.J.P.); and a Prostate Cancer Foundation Research Award (R.D.L.)

ABSTRACT

The last decade has seen an explosion in knowledge of the molecular basis and treatment of cancer. The molecular events that define the lethal phenotype of various cancers—the genetic and cellular alterations that lead to a cancer with a poor or incurable prognosis—are being defined. While these studies describe the cellular events of the lethal phenotype of cancer in detail, how these events result in the common clinical syndromes that kill the majority of cancer patients is not well understood. It is clear that the central step that makes most cancers incurable is metastasis. Understanding the traits that a cancer acquires to successfully grow and metastasize to distant sites gives insight into how tumors produce multiple factors that result in multiple different clinical syndromes that are lethal for the patient.

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Functional Imaging of Cancer with Emphasis on Molecular Techniques

Drew A. Torigian, MD, MA^*, Steve S. Huang, MD, PhD^*, Mohamed Houseni, MD and Abass Alavi, MD

Dr. Torigian is Assistant Professor of Radiology, Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
Dr. Huang is Nuclear Medicine Resident, Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
Dr. Houseni is Visiting Scholar in Nuclear Medicine, Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
Dr. Alavi is Professor of Radiology; and Director of Research Education, Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA.

This article is available online at http://CAonline.AmCancerSoc.org
To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org
Disclosures: Dr. Huang was supported by a training grant through the National Institutes of Health (NIH) (T32-CA093258–03). Dr. Houseni was supported as a visiting scholar by the Ministry of Higher Education of Egypt.
^*Please note that these authors have contributed equally to this manuscript.

ABSTRACT

A multitude of noninvasive, quantitative, functional imaging techniques are currently in use to study tumor physiology, to probe tumor molecular processes, and to study tumor molecules and metabolites in vitro and in vivo using computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and optical imaging (OI). Such techniques can be used in conjunction with structural imaging techniques to detect, diagnose, characterize, or monitor tumors before and after therapeutic intervention. These can also be used to study tumor gene expression, to track cells and therapeutic drugs, to optimize individualized treatment planning for patients with tumors, and to foster new oncologic drug development. In this article, we review the rich variety of functional imaging techniques that are available for these purposes, which are becoming increasingly important for optimal individualized patient treatment in this day and age of "personalized medicine."

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Cancer Incidence, Mortality, and Associated Risk Factors Among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese Ethnicities

Melissa McCracken, MPH, Miho Olsen, MPH, Moon S. Chen, Jr., PhD, MPH, Ahmedin Jemal, DVM, PhD, Michael Thun, MD, MS, Vilma Cokkinides, PhD, MSPH, Dennis Deapen, DrPH and Elizabeth Ward, PhD

Ms. McCracken is Epidemiologist, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Ms. Olsen is Epidemiologist, Rollins School of Public Health, Emory University; and Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Chen is Professor and Principal Investigator, Asian American Network for Cancer Awareness Research and Training; and Associate Director, Population Research and Cancer Disparities, University of California-Davis, Cancer Center, Sacramento, CA.
Dr. Jemal is Strategic Director, Cancer Occurrence, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Thun is Vice President, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Cokkinides is Strategic Director, Risk Factor Surveillance, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Deapen is Professor, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Dr. Ward is Managing Director, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.

This article is available online at http://CAonline.AmCancerSoc.org
Disclosures: The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer-reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER Program) under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries under agreement #U55/CCR921930–02 awarded to the Public Health Institute.
Funding for M.S.C.'s role is attributable to Grant Number U01 CA114640 from the National Cancer Institute and P01 CA109091–01A, funded both by the National Cancer Institute and the National Center on Minority Health and Health Disparities.
The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended, nor should it be inferred.

ABSTRACT

Many studies demonstrate that cancer incidence and mortality patterns among Asian Americans are heterogeneous, but national statistics on cancer for Asian ethnic groups are not routinely available. This article summarizes data on cancer incidence, mortality, risk factors, and screening for 5 of the largest Asian American ethnic groups in California. California has the largest Asian American population of any state and makes special efforts to collect health information for ethnic minority populations. We restricted our analysis to the 4 most common cancers (prostate, breast, lung, colon/rectum) and for the 3 sites known to be more common in Asian Americans (stomach, liver, cervix). Cancer incidence and mortality were summarized for 5 Asian American ethnic groups in California in order of population size (Chinese, Filipino, Vietnamese, Korean, and Japanese). Chinese Americans had among the lowest incidence and death rate from all cancer combined; however, Chinese women had the highest lung cancer death rate. Filipinos had the highest incidence and death rate from prostate cancer and the highest death rate from female breast cancer. Vietnamese had among the highest incidence and death rates from liver, lung, and cervical cancer. Korean men and women had by far the highest incidence and mortality rates from stomach cancer. Japanese experienced the highest incidence and death rates from colorectal cancer and among the highest death rates from breast and prostate cancer. Variations in cancer risk factors were also observed and were for the most part consistent with variations in cancer incidence and mortality. Differences in cancer burden among Asian American ethnic groups should be considered in the clinical setting and in cancer control planning.

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