Colorectal Cancer

Background

EarlyStages keyColorectal cancer refers to cancers of the large intestine and rectum. They usually begin as benign polyps that become cancerous over time. The exact cause of colorectal cancer is not known, but risk factors include age, family history, obesity, lack of exercise, diets high in red and processed meats, and heavy alcohol use. Individuals with a history of ulcerative colitis or Crohn’s disease are also at higher risk for colorectal cancer.

According to the National Cancer Institute, colorectal cancer accounted for more than 142,000 new cases and 50,000 deaths in 2013. About 90% of all colorectal cancers occur in individuals older than 50 years.

Current Treatment

Early stage cancers that are confined to the polyp can often be treated with colonoscopy or endoscopic mucosal resection. If the cancer has spread along or into the colonic wall, laparoscopic surgery can be performed to remove the polyps and explore the adjacent lymph nodes. A partial colectomy (removal of cancerous portion of the colon) can be performed in cases where the cancer has invaded the colonic wall. In advanced cases, surgery may be performed to remove blockages of the colon and mediate symptoms associated with the cancer. This surgery is not meant to cure the cancer but rather to make the patient more comfortable.

Chemotherapy can shrink tumors before surgery or to mitigate the symptoms and spread of the cancer after surgery. It is often used in combination with radiation therapy. Targeted drug therapy is often used in late stage colorectal cancer.

Focused Ultrasound

Focused ultrasound could treat colorectal cancer by heating and destroying the tumor. In 2004, researchers in China published a study suggesting that focused ultrasound combined with radiation could be safe and effective in patients with rectal carcinoma. In 2008, researchers at the University of Lyon described an endoscopic transducer for focused ultrasound treatment of tumors in the esophagus, colon, and rectum. To date, this has been used for treatment of small renal tumors.

It should be noted, however, that research on the use of focused ultrasound alone remains limited for colorectal cancer. Part of the reason for this is that the colon wall is very thin, and ultrasonic energy could result in a perforation of the colon, with the likelihood of serious infections and other issues as a result. In addition, focused ultrasound transmission is best accomplished when the ultrasonic pathway does not encounter air, which is commonly found in the colon. Steps to control or evacuate the colonic air adds another challenge to delivery of this type of care. Finally, the colon has a series of periodic contractions and relaxations known as peristalsis. Peristalsis helps propel the contents inside the intestine, but these movements create another variable in terms of having a stable treatment target during the application of focused ultrasound.

Research continues, however focused ultrasound as a definitive treatment option for colorectal cancer remains at a very early stage. Most effort is looking at using focused ultrasound to target metastatic colonrectal cancer that has gone to the liver or other locations.

Notable Papers

Chu W, Staruch RM, Pichardo S, Tillander M, Köhler MO, Huang Y, Ylihautala M, McGuffin M, Czarnota G, Hynynen K. Magnetic Resonance-Guided High-Intensity Focused Ultrasound Hyperthermia for Recurrent Rectal Cancer: MR Thermometry Evaluation and Preclinical Validation. Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1259-67. doi: 10.1016/j.ijrobp.2016.03.019. Epub 2016 Mar 24.

PLOS ONE Staff. Correction: First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. PLoS One. 2015 Mar 30;10(3):e0123751. doi: 10.1371/journal.pone.0123751. eCollection 2015.

Dupré A, Melodelima D, Pérol D, Chen Y, Vincenot J, Chapelon JY, Rivoire M. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. PLoS One. 2015 Feb 26;10(2):e0118212. doi: 10.1371/journal.pone.0118212. eCollection 2015. Erratum in: PLoS One. 2015;10(3):e0123751.

Mouratidis PX, Rivens I, Ter Haar G. A study of thermal dose-induced autophagy, apoptosis and necroptosis in colon cancer cells. Int J Hyperthermia. 2015;31(5):476-88. doi: 10.3109/02656736.2015.1029995.

Zhang X, Yang G, Zhang Y, Huang P, Qiu J, Sun Y, Shen Z, Liao X, Xia H, Shao S, Wang D. An experimental research into endostatin microbubble combined with focused ultrasound for anti-tumor angiogenesis in colon cancer. Gastroenterol Rep (Oxf). 2014 Feb;2(1):44-53

Sazgarnia A, Shanei A, Taheri AR, Meibodi NT, Eshghi H, Attaran N, Shanei MM. Therapeutic effects of acoustic cavitation in the presence of gold nanoparticles on a colon tumor model. J Ultrasound Med. 2013 Mar;32(3):475-83.

Park MJ, Kim YS, Yang J, Sun WC, Park H, Chae SY, Namgung MS, Choi KS. Pulsed high-intensity focused ultrasound therapy enhances targeted delivery of cetuximab to colon cancer xenograft model in mice. Ultrasound Med Biol. 2013 Feb;39(2):292-9.

Cheung TT, Poon RT, Yau T, Tsang DS, Lo CM, Fan ST. High-intensity focused ultrasound as a treatment for colorectal liver metastasis in difficult position. Int J Colorectal Dis. 2012 Jul;27(7):987-8.

T Leslie, R Ritchie, R Illing, G Ter Haar, R Phillips, M Middleton, F Wu, D Cranston. High-intensity focused ultrasound treatment of liver tumours: post-treatment MRI correlates well with intra-operative estimates of treatment volume. Br J Radiol. 2012 Oct; 85(1018): 1363–1370. doi: 10.1259/bjr/56737365

Ritchie, Robert W, Tom A Leslie, Gareth D H Turner, Ian S D Roberts, Leonardo D'Urso, Devis Collura, Andrea Demarchi, Giovanni Muto, and Mark E Sullivan. Laparoscopic High-intensity Focused Ultrasound for Renal Tumours: a Proof of Concept Study. BJU International 107, no. 8 (April 2011): 1290-1296. doi:10.1111/j.1464-410X.2010.09620.x.

Monzon L, Wasan H, Leen E, Ahmed H, Dawson PM, Harvey C, Muhamed A, Hand J, Price P, Abel PD. Transrectal high-intensity focused ultrasonography is feasible as a new therapeutic option for advanced recurrent rectal cancer: report on the first case worldwide. Ann R Coll Surg Engl. 2011;93(6):e119-21.

 


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