Multidisciplinary Care for Colorectal Cancer
Friday, January 06, 2012
Approximately 150,000 Americans are diagnosed with colorectal cancer on an annual basis, according to the American Society of Colon and Rectal Surgeons. Montefiore Einstein Center for Cancer Care takes a multidisciplinary approach to maximize outcomes for colorectal cancer patients.
Photo: Peter Shamamian, M.D.
Every Monday at Montefiore Einstein Center for Cancer Care, subspecialists in colorectal cancer — including surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, nutritionists, clinical researchers and other support staff — assemble to discuss colorectal cancer cases. The culmination of different perspectives from multiple disciplines contributes to the customized, individual patient treatment options that can lead to successful cancer care.
“Each case is presented, and a plan is formulated,” says Peter Shamamian, M.D., Chief, Division of General Surgery and Director, Pancreas and Upper Gastrointestinal Surgery, Montefiore Medical Center and Director, Colorectal Cancer Program, Montefiore Einstein Center for Cancer Care. “Liver specialists are on hand because tumors may be present on the liver as well as the colorectal region. These specialists can speak to treating these tumors in the overall view of the patient’s care — whether it’s liver resection, radiofrequency ablation, radiation therapy or infusion therapy.”
Advanced Solutions
Sphincter-sparing surgical approaches include transanal minimally invasive surgery (TAMIS), which provides surgeons an enhanced view of the rectum to remove large tumors without the pain and scarring associated with traditional approaches. Another option, transanal endoscopic microsurgery, allows surgeons to remove cancerous and benign tumors from the rectal area that cannot be removed during a colonoscopy. This procedure can be repeated as necessary as a therapeutic option. Patients with colorectal cancers that have spread to the abdominal cavity also have access to hyperthermic peritoneal perfusion. This treatment, which is being refined at the Center for Cancer Care, involves bathing the abdomen with chemotherapeutic agents to eradicate rogue cells, while sparing the patient the side effects of systemic chemotherapy.
“These leading-edge approaches ensure patients will experience the least amount of side effects while retaining continence,” says Dr. Shamamian. “Single-incision approaches are also available for benign issues with the colon.”
The Center for Cancer Care also provides the most advanced radiation oncology offerings for colorectal cancer including image-guided intensity modulated radiation techniques, targeting the tumor or tumor bed while sparing the bowel and pelvic bone marrow from radiation effects. Precise target localization is achieved by partnering with the center’s diagnostic imaging specialists, who utilize MRI techniques for rectal tumor localization and PET-CT fusion treatment planning.
The Center for Cancer Care offers colorectal cancer patients advanced medical oncology options ranging from chemotherapy to immunotherapy to other novel anticancer drugs. Partnering with the National Cancer Institute-designated Albert Einstein Cancer Center, Montefiore provides access to a variety of advanced clinical trials. These include an investigation of how to minimize the unwanted side effects of FOLFOX chemotherapy for treatment of Stage 3 colorectal cancer, a study to determine the benefit of combining FOLFOX with bevacizumab — an immunotherapy for the treatment of metastatic disease — and an exciting homegrown trial for patients with advanced colon cancer with a Kras mutation. The trial is based on the findings that Reolysin (a live virus) can kill cancer cells, especially those with a mutant Kras gene, and is focused on determining the effectiveness of combining Reolysin, a live virus and FOLFIRI chemotherapy.
Patient-Centric Care
When patients are referred to the Center for Cancer Care, the medical staff strives to make them feel at ease and informed during every step of their treatment plans. Understanding that a discussion of symptoms pertaining to colorectal health issues can be uncomfortable for patients, particularly when the physician is of the opposite gender, both male and female specialists are available to consult with a patient. Additionally, in order to facilitate the patient experience, all physicians are briefed on the progress of patients via electronic health records.
To learn more about colorectal cancer services at Montefiore Einstein Center for Cancer Care, or to refer a patient, visit www.montefiore.org/cancer/colorectal.
MD News December 2011, Lower Hudson Bronx