Rectal Cancer 

  • Author: Burt Cagir, MD, FACS; Chief Editor: Jules E Harris, MD   more...
 
Updated: Mar 9, 2012
 

Background

Colon and rectal cancer incidence was negligible before 1900. The incidence of colorectal cancer has been rising dramatically following economic development and industrialization. Currently, colorectal cancer is the third leading cause of cancer deaths in both males and females in the United States.[1, 2]

Adenocarcinomas comprise the vast majority (98%) of colon and rectal cancers. Other rare rectal cancers, including carcinoid (0.4%), lymphoma (1.3%), and sarcoma (0.3%), are not discussed in this article. Squamous cell carcinomas may develop in the transition area from the rectum to the anal verge and are considered anal carcinomas. Very rare cases of squamous cell carcinoma of the rectum have been reported.[1, 3]

Approximately 20% of colon cancers develop in the cecum, another 20% in the rectum, and an additional 10% in the rectosigmoid junction. Approximately 25% of colon cancers develop in the sigmoid colon.[1]

The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer. These areas are addressed together.

An image depicting the staging and workup of rectal cancer can be seen below.

Diagnostics. Staging and workup of rectal cancer pDiagnostics. Staging and workup of rectal cancer patients.
Next

Pathophysiology

The mucosa in the large intestine regenerates approximately every 6 days. Crypt cells migrate from the base of the crypt to the surface, where they undergo differentiation and maturation, and ultimately lose the ability to replicate.

The significant portions of colorectal carcinomas are adenocarcinomas. The adenoma-carcinoma sequence is well described in the medical literature.[1, 4] Colonic adenomas precede adenocarcinomas. Approximately 10% of adenomas will eventually develop into adenocarcinomas. This process may take up to 10 years.[1]

Three pathways to colon and rectal carcinoma have been described:

  • the adenomatous polyposis coli (APC) gene adenoma-carcinoma pathway
  • the hereditary nonpolyposis colorectal cancer (HNPCC) pathway
  • ulcerative colitis dysplasia.

The APC adenoma carcinoma pathway involves several genetic mutations, starting with inactivation of the APC gene, which allows unchecked cellular replication at the crypt surface. With the increase in cell division, further mutations occur, resulting in activation of the K-ras oncogene in the early stages and p53 mutations in later stages. These cumulative losses in tumor suppressor gene function prevent apoptosis and prolong the cell's lifespan indefinitely. If the APC mutation is inherited, it will result in familial adenomatous polyposis syndrome.

Histologically, adenomas are classified in three groups: tubular, tubulovillous, and villous adenomas. K-ras mutations and microsatellite instability have been identified in hyperplastic polyps. Therefore, hyperplastic polyps may also have malignant potential in varying degrees.[5]

The other common carcinogenic pathway involves mutation in DNA mismatch repair genes. Many of these mismatched repair genes have been identified, including hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6. Mutation in mismatched repair genes negatively affects the DNA repair. This replication error is found in approximately 90% of HNPCC and 15% of sporadic colon and rectal cancers.[1, 6] A separate carcinogenic pathway is also described in inflammatory bowel disease (IBD). Chronic inflammation such as in ulcerative colitis can result in genetic alterations which then lead into dysplasia and carcinoma formation.[1]

Previous
Next

Epidemiology

Frequency

United States

Colon and rectal cancer is the third most common cancer in both females and males. The American Cancer Society estimates that 102,900 new cases of colon cancer and 39,670 new cases of rectal cancer will occur in 2010; 72,090 cases of colorectal cancers are expected in men and 70,480, in women.[2] Approximately 51,370 deaths from colorectal cancer are expected to occur in 2010.

Both colon and rectal cancer incidences, as well as mortality rates, have been decreasing for the last two decades, from 66.3 per 100,000 population in 1985 to 45.5 in 2006.[2] The rate of decrease accelerated from 1998-2006 (to 3% per year in men and 2.2% per year in women), in part because of increased screening, allowing the detection and removal of colorectal polyps before they progress to cancer. The lifetime risk of developing a colorectal malignancy is approximately 6% in the general US population. This decrease is due to a declining incidence and improvements in both early detection and treatment.

A study by Mak et al found that despite widespread adoption of preoperative radiation therapy for locally advanced rectal cancer, preoperative radiation therapy may be underused in certain sociodemographic groups.[7]

International

Although the incidence of colon and rectal cancer varies considerably by country, an estimated 944,717 cases were identified worldwide in 2000. High incidences of colon and rectal cancer cases are identified in the US, Canada, Japan, parts of Europe, New Zealand, Israel, and Australia. Low colorectal cancer rates are identified in Algeria and India. The majority of colorectal cancers still occur in industrialized countries. Recent rises in colorectal cancer incidence have been observed in many parts of the Japan, China (Shanghai) and in several Eastern European countries.[1]

Mortality/Morbidity

The American Cancer Society estimates that colorectal cancer will account for 9% of all cancer deaths (49,920) in 2009. In the US, mortality rates have been decreasing in both sexes for the past 2 decades. (The 1- and 5-year rate for patients with colon and rectal cancer is 83% and 64%, respectively.) When colorectal cancers are detected early and localized, the 5-year survival rate is 90%.[2]

A review of 8 trials by Rothwell et al found allocation to aspirin reduced death caused by cancer. Individual patient data were available from 7 of the 8 trials. Benefit was apparent after 5 years of follow-up. The 20-year risk of cancer death was also lower in the aspirin group for all solid cancers. A latent period of 5 years was observed before risk of death was decreased for esophageal, pancreatic, brain, and lung cancers. A more delayed latent period was observed for stomach, colorectal, and prostate cancer. Benefit was only seen for adenocarcinomas in lung and esophageal cancers. The overall effect on 20-year risk of cancer death was greatest for adenocarcinomas.[8]

A study by Banks et al showed the benefit of aspirin in preventing colon adenocarcinoma among patients with hereditary risk of colorectal cancer. In a study of 861 patients, 600 mg of aspirin daily for a mean of 25 months substantially reduced cancer incidence after 55.7 months among carriers of hereditary colorectal cancer. Further studies are needed to determine the ideal dosage and duration.[9]

Race

The incidence of colorectal cancer tends to be higher in Western nations than in Asian and African countries; however, within the United States, minor differences in incidence exist among whites, African Americans, and Asian Americans. Five-year survival rates are lower among blacks (55%) than whites (66%). Among religious denominations, colorectal cancer occurs more frequently in the Jewish population.[2]

A study by Yothers et al found that black patients with resected stage II and stage III colon cancer had worse overall and recurrence-free survival compared with white patients who underwent the same therapy.[10]

A study of racial disparities in mortality rates between black and white individuals with colorectal cancer by Robbins et al showed earlier and larger reductions in death rates for whites from 1985-2008.[11] This racial disparity could be decreased with greater education to the black population regarding colorectal cancer prevention and access to treatment, including colonoscopies and polypectomies.

Sex

The incidence of colorectal malignancy is slightly higher in males than in females. The overall age-standardized incidence of colorectal cancer was 65/100,000 for males and 47/100,000 for females between 1995 and 1999. The male-female ratio is 1.37%. Mortality rates for colorectal cancer were also higher in males (25.4 per 100,000) than in females (18 per 100,000) in 1999. Left colon carcinomas were more likely to be observed in males and right colon carcinomas were more likely to be observed in females.[2]

Age

The incidence of colorectal cancer starts to increase after age 35 and rises rapidly after age 50, peaking in the seventh decade. More than 90% of colon cancers occur after age 50. However, cases have been reported in young children and adolescents.[1]

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Burt Cagir, MD, FACS  Assistant Professor of Surgery, State University of New York Upstate Medical University; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Association of Program Directors in Surgery, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Coauthor(s)

Douglas R Trostle, MD, MBA, FACS  Chairman of Surgery, The Guthrie Clinic and Robert Packer Hospital; Clinical Professor of Surgery, The Medical College of Pennsylvania

Douglas R Trostle, MD, MBA, FACS, is a member of the following medical societies: Alpha Omega Alpha, American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Physician Executives, American College of Surgeons, American College of Surgeons Oncology Group, American Society of General Surgeons, Pennsylvania Medical Society, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Philip Schulman, MD  Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD, is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

eMedicine gratefully acknowledges the contributions of Elizabeth Cirincione, MD, to previous versions of this article.

References

  1. Giovannucci E, Wu K. Cancers of the colon and rectum. In: Schottenfeld D, Fraumeni J, eds. Cancer. Epidemiology and Prevention. 3rd ed. Oxford University Press; 2006.

  2. American Cancer Society. Cancer Facts & Figures, 2010. American Cancer Society. Available at http://www.cancer.org/Research/CancerFactsFigures/index. Accessed April 26, 2011.

  3. Anagnostopoulos G, Sakorafas GH, Kostopoulos P, et al. Squamous cell carcinoma of the rectum: a case report and review of the literature. Eur J Cancer Care (Engl). Mar 2005;14(1):70-4. [Medline].

  4. Potter JD. Colorectal cancer: molecules and populations. J Natl Cancer Inst. Jun 2 1999;91(11):916-32. [Medline]. [Full Text].

  5. Leggett BA, Devereaux B, Biden K, Searle J, Young J, Jass J. Hyperplastic polyposis: association with colorectal cancer. Am J Surg Pathol. Feb 2001;25(2):177-84. [Medline].

  6. Wheeler JM, Bodmer WF, Mortensen NJ. DNA mismatch repair genes and colorectal cancer. Gut. Jul 2000;47(1):148-53. [Medline]. [Full Text].

  7. Mak RH, McCarthy EP, Das P, et al. Adoption of preoperative radiation therapy for rectal cancer from 2000 to 2006: a Surveillance, Epidemiology, and End Results Patterns-of-Care Study. Int J Radiat Oncol Biol Phys. Jul 15 2011;80(4):978-84. [Medline].

  8. Rothwell PM, Fowkes GR, Belch JF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomized trials. Lancet. Dec 7/2010; Early online publication;[Full Text].

  9. Burn J, Gerdes AM, Macrae F, et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet. Dec 17 2011;378(9809):2081-7. [Medline]. [Full Text].

  10. Yothers G, Sargent DJ, Wolmark N, et al. Outcomes Among Black Patients With Stage II and III Colon Cancer Receiving Chemotherapy: An Analysis of ACCENT Adjuvant Trials. J Natl Cancer Inst. Oct 19 2011;103(20):1498-1506. [Medline]. [Full Text].

  11. Robbins AS, Siegel RL, Jemal A. Racial disparities in stage-specific colorectal cancer mortality rates from 1985 to 2008. J Clin Oncol. Feb 1 2012;30(4):401-5. [Medline].

  12. Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA. Jan 12 2005;293(2):172-82. [Medline].

  13. Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, et al. Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. N Engl J Med. Jan 14 1999;340(2):101-7. [Medline].

  14. Ferrari P, Jenab M, Norat T, Moskal A, Slimani N, Olsen A, et al. Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer. Nov 1 2007;121(9):2065-72. [Medline].

  15. Kabat GC, Howson CP, Wynder EL. Beer consumption and rectal cancer. Int J Epidemiol. Dec 1986;15(4):494-501. [Medline].

  16. Tsoi KK, Pau CY, Wu WK, Chan FK, Griffiths S, Sung JJ. Cigarette smoking and the risk of colorectal cancer: a meta-analysis of prospective cohort studies. Clin Gastroenterol Hepatol. Jun 2009;7(6):682-688.e1-5. [Medline].

  17. Phipps AI, Baron J, Newcomb PA. Prediagnostic smoking history, alcohol consumption, and colorectal cancer survival: The Seattle Colon Cancer Family Registry. Cancer. Nov 1 2011;117(21):4948-57. [Medline]. [Full Text].

  18. Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol. Oct 2001;96(10):2992-3003. [Medline].

  19. Burt RW. Familial risk and colorectal cancer. Gastroenterol Clin North Am. Dec 1996;25(4):793-803. [Medline].

  20. United States Preventive Services Task Force. Screening for Colorectal Cancer. AHRQ: Agency for Healthcare Research and Quality. Available at http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm. Accessed July 15, 2009.

  21. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. Apr 18 2001;93(8):583-96. [Medline].

  22. Brounts LR, Lehmann RK, Lesperance KE, Brown TA, Steele SR. Improved rates of colorectal cancer screening in an equal access population. Am J Surg. May 2009;197(5):609-12; discussion 612-3. [Medline].

  23. Meredith KL, Hoffe SE, Shibata D. The multidisciplinary management of rectal cancer. Surg Clin North Am. Feb 2009;89(1):177-215, ix-x. [Medline].

  24. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. Aug 30 2001;345(9):638-46. [Medline].

  25. Baxter NN, Garcia-Aguilar J. Organ preservation for rectal cancer. J Clin Oncol. Mar 10 2007;25(8):1014-20. [Medline].

  26. Rothenberger D, Garcia-Aquilar J. Rectal cancer, local treatment. In: Current Therapy in Colon and Rectal Surgery. 2nd ed. Philadelphia, Pa: Mosby; 2005.

  27. Peng J, Chen W, Venook AP, et al. Long-term outcome of early-stage rectal cancer undergoing standard resection and local excision. Clin Colorectal Cancer. Mar 1 2011;10(1):37-41. [Medline].

  28. Weiser MR, Landmann RG, Wong WD, Shia J, Guillem JG, Temple LK, et al. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum. Jun 2005;48(6):1169-75. [Medline].

  29. Bullard KM, Rothenberger DA. Colon, rectum, and anus. In: Schwartz SE, ed. Principles of Surgery. 8th ed. New York, NY: McGraw Hill; 2005.

  30. Li S, Chi P, Lin H, Lu X, Huang Y. Long-term outcomes of laparoscopic surgery versus open resection for middle and lower rectal cancer: an NTCLES study. Surg Endosc. Oct 2011;25(10):3175-82. [Medline].

  31. van Helmond J, Beart RW. Cancer of the rectum: Operative management and adjuvant therapy. In: Current Therapy in Colon and Rectal Surgery. 2nd ed. Philadelphia, Pa: Mosby; 2005.

  32. Maurer CA, Renzulli P, Kull C, et al. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol. Jul 2011;18(7):1899-906. [Medline].

  33. Dhir M, Lyden ER, Wang A, et al. Influence of margins on overall survival after hepatic resection for colorectal metastasis: a meta-analysis. Ann Surg. Aug 2011;254(2):234-42. [Medline].

  34. Margalit DN, Mamon HJ, Ancukiewicz M, et al. Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Int J Radiat Oncol Biol Phys. Dec 1 2011;81(5):e735-41. [Medline].

  35. Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. Jan 21 2009;CD006041. [Medline].

  36. Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. Apr 18 2007;CD002102. [Medline].

  37. Ng K, Ogino S, Meyerhardt JA, et al. Relationship Between Statin Use and Colon Cancer Recurrence and Survival: Results From CALGB 89803. J Natl Cancer Inst. Oct 19 2011;103(20):1540-51. [Medline]. [Full Text].

  38. NCCN. Clinical Practice Guidelines in Oncology Symposium: Colon, Rectal and Anal Cancers. Available at http://cme.medscape.com/viewprogram/8374.

  39. NCCN. Clinical Practice Guidelines in Oncology. Rectal Cancer V.2.2009. Available at http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf. Accessed May 2009.

  40. Cao S, Bhattacharya A, Durrani FA, Fakih M. Irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer. Expert Opinion on Pharmacotherapy. 2006;7(6):687-703.

  41. Maughan TS, Adams RA, Smith CG, et al. Addition of cetuximab to oxaliplatin-based first-line combination chemotherapy for treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial. Lancet. Jun 18 2011;377(9783):2103-14. [Medline].

  42. Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. Nov 1 2010;28(31):4697-705. [Medline].

  43. Peeters M, Price TJ, Cervantes A, Sobrero AF, Ducreux M, Hotko Y. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol. Nov 1 2010;28(31):4706-13. [Medline].

  44. Simkens LH, Koopman M, Mol L, et al. Influence of body mass index on outcome in advanced colorectal cancer patients receiving chemotherapy with or without targeted therapy. Eur J Cancer. Nov 2011;47(17):2560-7. [Medline].

  45. Cheng X, Chen VW, Steele B, Ruiz B, Fulton J, Liu L, et al. Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997. Cancer. Nov 15 2001;92(10):2547-54. [Medline].

  46. Ebert MP, Tanzer M, Balluff B, et al. TFAP2E-DKK4 and chemoresistance in colorectal cancer. N Engl J Med. Jan 5 2012;366(1):44-53. [Medline].

  47. [Best Evidence] Hendlisz A, Van den Eynde M, Peeters M, Maleux G, Lambert B, Vannoote J, et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol. Aug 10 2010;28(23):3687-94. [Medline].

  48. Nielsen A, Munk C, Kjaer SK. Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia in Denmark, 1978-2008. Int J Cancer. Mar 1 2012;130(5):1168-73. [Medline].

  49. Thong MS, Mols F, Lemmens VE, et al. Impact of preoperative radiotherapy on general and disease-specific health status of rectal cancer survivors: a population-based study. Int J Radiat Oncol Biol Phys. Nov 1 2011;81(3):e49-58. [Medline].

  50. Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology. Sep 2004;232(3):773-83. [Medline].

  51. Kumar A, Scholefield JH. Endosonography of the anal canal and rectum. World J Surg. Feb 2000;24(2):208-15. [Medline].

  52. Lipton LR, Johnson V, Cummings C, et al. Refining the Amsterdam Criteria and Bethesda Guidelines: testing algorithms for the prediction of mismatch repair mutation status in the familial cancer clinic. J Clin Oncol. Dec 15 2004;22(24):4934-43. [Medline].

  53. Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med. 2003;348:919â€"932.

  54. Phang PT, Wong WD. Preoperative evaluation of the rectal cancer patient: Assessment of operative risk and strategy. In: Current Therapy in Colon and Rectal Strategy. 2nd ed. Philadelphia, Pa: Mosby; 2005.

 
Previous
Next
 
Diagnostics. Staging and workup of rectal cancer patients.
Staging and treatment. Rectal cancer treatment algorithm (Surgery followed by adjuvant chemotherapy and radiotherapy). Initial stages are Endorectal ultrasound staging (uT)
Table 1. Comparison of AJCC Definition of TNM Staging System to Dukes Classification.
Rectal Cancer StagesTNM StagingDuke Staging5-Year Survival
Stage IT1-2 N0 M0A>90%
Stage IIAT3 N0 M0B60%-85%
BT4 N0 M060%-85%
Stage IAT1-2 N1 M0C55%-60%
BT3-4 N1 M035%-42%
CT1-4 N2 M025%-27%
Stage IVT1-4 N0-2 M15%-7%
Table 2. Acceptable Minimal Distal and Proximal Resectional Margins for Rectal Cancer.[21]
Resection MarginsProximal Resection Margin(cm)Distal Resection Margin (cm)
Ideal Margins5 cm or more2 cm or more
Minimally acceptable margins5 cm or more1 cm or more
Table 3. Colorectal Chemotherapeutic Regimens
COLON AND RECTAL CANCER



COMMON CHEMOTHERAPY REGIMENS



FOLFOX (every 2 weeks)Oxaliplatin 85 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 600 mg/m2 IV Infusion day 1 and 2 (22 hours)



FOLFOX 4



(every 2 weeks)



(4 cycles)



Oxaliplatin 85 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 2400 mg/m2 IV Infusion day 1 (46 hours)



mFOLFOX 6



(Every 2 weeks)



(4 cycles)



Oxaliplatin 85 mg/m2 day 1



Leucovorin 400 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 1200 mg/m2 IV Infusion day 2 days



CapeOX



(Twice daily x 14 days)



(every 3 weeks)



Oxaliplatin 130 mg/m2 day 1



Capecitabine 850 mg/m2 PO BID for 14 days



FOLFIRI



(every 2 weeks)



Irinotecan 165 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 600 mg/m2 IV Infusion day 1 and 2 (22 hours)



FOLFOXIRI



(every 2 weeks)



Irinotecan 180 mg/m2 day 1



Oxaliplatin 85 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 3200 mg/m2 IV Infusion day (48 hours)



Bevacizumab5-10 mg/kg IV every 2 weeks with chemotherapy
Cetuximab400 mg/m2 IV day 1, then 250 mg/m2 IV weekly
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.