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  • Image not available. Maintaining a diet with high fiber and low fat intake has not been proven to reduce colorectal cancer risk but is beneficial for reducing risk of other chronic diseases.
  • Image not available. Regular use of aspirin and other nonsteroidal antiinflammatory drugs, estrogen replacement therapy, and calcium and vitamin D supplementation may reduce risk of colorectal cancer in certain selected populations, but they are not currently recommended for routine cancer prevention.
  • Image not available. Effective colorectal cancer screening programs incorporate regular examination of the entire colon starting at age 50 years for average-risk individuals. Colorectal adenomas can progress to cancer and should be removed.
  • Image not available. The histologic stage of colorectal cancer upon diagnosis—determined by depth of bowel invasion, lymph node involvement, and presence of metastases—is the most important prognostic factor for disease recurrence and survival.
  • Image not available. The treatment goal for stages I, II, and III colon cancer is cure; surgery should be offered to all eligible patients for this purpose.
  • Image not available. Adjuvant therapy consisting of fluoropyrimidine-based chemosensitized radiation therapy should be offered to patients with stage II or III cancer of the rectum. Adjuvant fluoropyrimidine-based chemotherapy plus radiation decreases risk of local and distant disease recurrence as compared to observation alone.
  • Image not available. Six months of fluoropyrimidine and oxaliplatin-based adjuvant chemotherapy significantly reduces the risk of cancer recurrence and overall mortality as compared with fluoropyrimidine alone in patients with stage III colon cancer.
  • Image not available. Chemotherapy is palliative for metastatic disease. Fluoropyrimidine-based chemotherapy regimens, administered in a variety of schedules, provide a modest improvement in survival and can be highly beneficial in reducing patient symptoms.
  • Image not available.Bevacizumab plus chemotherapy as initial therapy for metastatic disease is considered standard of care and provides a survival benefit compared with combination chemotherapy alone. A fluoropyrimidine with oxaliplatin or irinotecan improves survival compared to fluoropyrimidine monotherapy and should be offered to patients who are candidates for aggressive treatment. The ability for patients to receive all active cytotoxic agents (e.g., fluoropyrimidine, oxaliplatin, irinotecan) during the course of their disease improves their overall survival.
  • Image not available.Capecitabine is an acceptable alternative to intravenous fluorouracil both in adjuvant therapy and in the setting of metastatic disease, as it provides similar efficacy and its oral dosing may offer greater patient convenience.
  • Image not available. Individuals whose disease progresses or is refractory to chemotherapy may benefit from cetuximab, either alone or combined with continuing irinotecan. Patients with chemotherapy-refractory disease may also benefit from single-agent panitumumab. However, patients with codon 12 or 13 KRAS gene mutations should not receive cetuximab or panitumumab as these tumor mutations predict lack of treatment response. Tumor epidermal growth factor receptor (EGFR) immunohistochemistry test results do not predict tumor response to these agents.

On completion of the chapter, the reader will be able to:

  • 1. Identify and discuss clinical risk factors associated with the development of colon cancer.
  • 2. Recommend dietary and lifestyle interventions that patients can implement to decrease the risk of colon cancer.
  • 3. Explain the role of inherited genetic mutations in the development of colon cancer.
  • 4. Describe common ...

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