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The Prevention and Treatment of Colon Cancer

Arjun Luthra
Mentor: Dr. Aakash Gajjar
UTMB Multispecialty Care Center
Teachers name: Kristi Click

Introduction

ISM Fall Semester 2015

Mentor: Dr. Aakash Gajjar, M.D.

Colorectal Surgeon

Education:

4 years of undergraduate studies

Completion of Medical School in University of Texas Health Science Center in San


Antonio

Completion of Residency at University of Oklahoma College of Medicine

Certification: The American Board of Surgery, The American Board of Colon and Rectal
Surgery (ABCRS)

Mentorship Site
UTMB Specialty Care Center

What is Independent Study Mentorship

ISM is an advanced academic course that students to observe and follow a mentor, an adult
professional, of their choice

Students will receive instruction by mentor and develop a project presentation of a specific
topic within the chosen field of study

Students are expected to complete 2 mentor and 3 activity hours per week

Students are expected to complete an activity log and submit a journal entry each week

Students develop an online portfolio that showcases their research and gathered artifacts

My Online Portfolio
http://arjunluthra.weebly.com/

Treatment and Prevention of Colon Cancer

Reason for Chosen Topic: Observation in MD Andersons Molecular Diagnostics Laboratory


(Learning about detection of cancer at a genetic level/mutation) motivated me to increase my
knowledge of cancer to how it is treated and can be prevented
Project Key Points:

What is colon cancer?

What are symptoms of colon cancer?

How is colon cancer diagnosed?

What is the treatment for colon cancer?

Lifestyle Habits to Reduce Development of Colon Cancer

Colon Cancer Statistics

According to the CDC, colorectal cancer is the second leading cause of cancer-related
deaths in the United States and the third most common cancer in men and in
women.(Center of Disease Control and Prevention)
Colon Cancer is also considered to be a preventable disease

Introduction to Colon Cancer


Stages of Colon Cancer: Stages are scaled by tumor size, whether the cancer is localized and
what layers of the colon wall has it affected
Top layer of colon is called mucosa, which is compromised by columnar epithelial cells
Submucosa: connective tissue, connects nerves, blood and lymphatics
Muscularis: Inner circular
Serosa: lymph nodes
Colon Cancer and Stem Cells: Stem cells start at crypts and differentiate into goblet cells,
colonocytes, endocrine cells, paneth cells(active in cell proliferation)

Progression of Colon Cancer

Carcinogenesis of colon cancer

Normal colon cells have normal blood cells, stem cells have DNA in chromosomes

APC gene mutation encodes proteins for cell adhesion and transcription

50 to 60 percent of activation of KRAS Oncogene- often controls loss of tumour suppressor


genes

Mutation p53 were cells become resistant to apoptosis

Adenomas become carcinomas

Tumors require the growth of blood vessels(angiogenesis) for nutrients and oxygen supply

Cancer can interfere in absorption of iron and may cause patient to become anemic

Hypermethalation occurs in promoter region and contributes to gene silencing, genomic


instability, affects DNA repair and cell-cycle control

Picture of progression of Colon Cancer

Symptoms of Colon Cancer

Can be asymptomatic(most common presentation)

Cramping and abdominal pain

Change in bowel habits that last for more than few days

Rectal Bleeding(lead to anemia)

Weakness and Fatigue

How is Colon Cancer Diagnosed

Fecal immunochemical test: Check for blood in the stool, sign of polyps
Colonoscopy: A diagnostic procedure where a thin lighted tube with a camera is inserted
through the rectum and goes to colon. This allows the physician to examine inside the colon

How is Colon Cancer Diagnosed (Continued)

Barium Enema: Doctors insert barium into rectum and takes x-ray to provide images of the
gastrointestinal tract
Positron Emission Topography: A form of radioactive sugar which is injected into the
bloodstream. Sites of cancer growth will absorb the radioactive sugar.

Who Should Go Through Colon Cancer Screening

Recommended Age of Colonoscopy is at age of 50

About 1 in 3 adults (23 million) between 50 and 75 years old is not getting tested.

According to my Survey, 36.84% of the participants above the age of 50 have not
received a colonoscopy

According to Nutrition Review, colonoscopic screening and polypectomy could


decrease colon cancer risk by as much of 80 percent

Who Should Go Through Colon Cancer Screening

Patients with Family History of Colon Cancer

Also history of Lynch syndrome

Survey Results and Brochure

Graphs of Survey Results Displayed

Treatment for Colon Cancer

Endoscopic Resection

Surgical Resection

Systemic Therapy

Chemotherapy

Biological Therapy

Endoscopic Resection

Gastroenterologist or Colorectal Surgeon can resect the tumor with colonoscopy

Tumor is removed using endoscopic tools like snare

Endoscopic mucosa resection(EMR)

Surgical Resection

Surgical Resection

Laparoscopic- use of a thin, lighted tube with a tiny camera at the end

Open-When surgery is done through a local excision(cut)

Robotic: Using the da Vinci Surgical System

Removal of the segment of the colon that has cancer(colectomy)

During surgery, lymph nodes are sampled to assess whether cancer has spread

Systemic Therapy
Chemotherapy: Use of anticancer drugs that enter bloodstream and kill off cancerous cells
(Useful for cancer that has been metastasized)

Often cause hair loss

Can cause nausea, vomiting, diarrhea and poor appetite

Affect blood forming cells of the bone marrow

Biological Therapy: Use of monoclonal antibodies

Advances in Treatment

Targeted Therapy

Bevacizumab stops the cancerous cells from getting blood needed for survival

Along with developing new drugs, new approaches to treat colon cancer include a new
cancer vaccine, monoclonal antibody therapy, radio-immunotherapy, imaging guided and
robot-assisted surgery and molecular-targeted therapies

Final Product: Educational Pamphlet

Purpose: To educate people about colon cancer and treatment


Include Information about the diagnosis of colon cancer, treatments like surgery and
chemotherapy for colon cancer, prognosis of colon cancer, how to reduce risk of colon
cancer

Patients Lifestyle Impact on Health

Cigarette consumption and smoking have an adverse effect on colon health

Build Healthy Practices:

People must increase their fiber intake, specifically of fruits and vegetables

According to Nutrition Review, fiber intake not only decreases the prevalence of
esophageal cancer, GERD, diverticular disease and constipation, but also leads to the
potential reduction in the risk of colorectal cancer

Studies have shown that Most people in the United States consume less than half of
the recommended levels of dietary fiber daily.

Conclusion

I liked this study because I got the chance to really go in depth about colon cancer and learn
about how all the body can affected by it. It was interesting to learn about the risks of certain
treatments and why it is important to use treatment that is least invasive to the patients
condition.
I hope you all developed an increased awareness of colon cancer and have also developed an
understanding of how it is important to seek out treatment as well as make lifestyle changes
to reduce the prevalence of colon cancer
Questions?

Thank You

I would like to thank my mentor, Dr. Gajjar, Mrs.Click and my parents Dr. Gurinder Luthra
and Mrs. Bhawna Luthra for making my independent mentorship an invaluable experience.

Works Cited
"Colon Cancer Treatment." National Cancer Institute. National Cancer Institute, n.d. Web. 22
Oct. 2015. <http://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq>.

"Colon Polyps: Symptoms, Types, Causes and Pictures." MedicineNet. N.p., n.d. Web. 11 Oct.
2015. http://www.medicinenet.com/colon_polyps/article.htm
"Colorectal Cancer." (n.d.): n. American Cancer Society. American Cancer Society. Web. 10 Oct.
2015. http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf
"Colorectal Cancer Statistics." Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention, 20 Aug. 2015. Web. 20 Nov. 2015.
<http://www.cdc.gov/cancer/colorectal/statistics/index.htm>.
Marshall, James R. "Nutrition and Colon Cancer Prevention." Current Opinion
in Clinical
Nutrition and Metabolic Care 12.5 (2009): 539-43. US National Library
of Medicine. Web. 05 Nov. 2015.
<http://www.ncbi.nlm.nih.gov/pubmed/19512917>.

Ketwaroo, Gyanprakash A., and Mandeep S. Sawhney. "Quality Measures and Quality
Improvements in Colonoscopy." Current Opinion in Gastroenterology 31.1 (2015): 5661. US National Library of Medicine. Web. 05 Nov. 2015.
<http://www.ncbi.nlm.nih.gov/pubmed/25402548>.
Perkins, Sharon. "Complications and Side Effects of Laparoscopic Colectomy Surgery." Suite.
N.p., 17 Sept. 2010. Web. 11 Oct. 2015. https://suite.io/sharon-perkins/46nm26h
Shead, Dorothy A., Laura J. Hanisch, and Lacey Marlow. "NCCN Guidelines for Patients| Colon

Cancer." National Comprehensive Cancer Network. National Comprehensive Cancer


Network Foundation, n.d. Web. 23 Oct. 2015.
<http://www.nccn.org/patients/guidelines/colon/#6>.
"Surgery for Colon Cancer." Canadian Cancer Society. Canadian Cancer Society, n.d. Web. 11
Oct. 2015. http://www.cancer.ca/en/cancer-information/cancertype/colorectal/treatment/surgery/surgery-for-colon-cancer/?region=on
"Top 10 Most Common Types of Cancer." Quantum Books. N.p., 30 Aug. 2014. Web. 11 Oct.
2015. <http://www.quantumbooks.com/health/top-10-common-types-cancer>
"UTMB Specialty Care Center at Victory Lakes." UTMB Health -. N.p., n.d. Web. 11 Oct. 2015.
http://www.utmbhealth.com/oth/Page.asp?PageID=OTH000186