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On the dock

LIFE WITH COLORECTAL CANCER

There are more than 1 million survivors of colorectal cancer in the United States.
So there are many others who share your journey.

An arrow pointing downward.

Your CRC Journey

It’s estimated that nearly 1 in 20 people will develop CRC in their lifetime. In 2015, it was the third most common cancer diagnosed in both men and women in the United States. Colorectal cancer presents many unique challenges, so Lilly constantly seeks ways to help you at every turn. To show our dedication beyond just making medicine, we build partnerships so you can easily access more organizations, information, and support than when we work alone. This section contains information to help you understand what to expect in the journey ahead.

Stand Up To Cancer’s (SU2C) mission is to raise funds to accelerate the pace of groundbreaking translational research that can get new therapies to patients quickly and save lives now. SU2C brings together the best and the brightest researchers and mandates collaboration among the cancer community. By galvanizing the entertainment industry, SU2C has set out to generate awareness, educate the public on cancer prevention, and help more people diagnosed with cancer become long-term survivors. We are grateful that other organizations are joining us in this initiative. For more information, visit www.standup2cancer.org.

Lilly Oncology also gratefully partners with and supports the following organizations:

Diagnosis: What’s going on?

Colon and/or rectal cancer are often referred to as CRC. Most colorectal tumors begin as noncancerous growths of tissue on the inside lining of the colon or rectum, known as polyps. Eventually, some polyps can change into cancer—possibly growing into the wall of the colon or rectum and spreading to other areas of the body.

Comforting

About your colon and rectum

The colon and rectum are parts of the digestive system, which is also called the gastrointestinal (GI) system. The colon absorbs water and salt from the remaining food matter after it goes through the small intestine (small bowel) and helps pass waste material out of the body.

Symptoms of CRC

Growth of cancer in the colon and/or rectum may lead to symptoms such as:

  • A change in bowel habits that lasts for more than a few days
  • Diarrhea
  • Constipation
  • Narrowing of the stool
  • After passing stool, still feeling the need to go
  • Rectal bleeding
  • Stool that is bloody or dark
  • Persistent abdominal discomfort, bloating, vomiting
  • Feeling tired or weak
  • Unexplained weight loss

How CRC is diagnosed

Tests used to screen for CRC include:

Physical exam and medical history

A general examination is performed to check for signs of disease and to record overall health.

Laboratory tests

Blood work and other tests may be ordered by the doctor.

Biologic therapy—Testing

Before beginning biologic therapy, your doctor may perform a genetic test to look for specific molecules found in tissue, blood, or other bodily fluids. These substances are known as biomarkers. When your doctor and you understand the specific biomarkers associated with CRC, it may help guide decisions on treatment options and overall treatment planning.

Biopsy

This involves the removal of a tissue sample from the colon or rectum. This tissue is then examined under a microscope in a lab.

FIT and gFOBT tests

Samples of stool (feces) are checked for blood, which might be a sign of a polyp or cancer.

Stool DNA test

A sample of stool is checked for certain abnormal sections of DNA (genetic material) from cancer or polyp cells.

Sigmoidoscopy

A flexible, lighted tube is put into the rectum and lower colon to check for polyps and cancer.

Colonoscopy

A long, flexible tube is used to look at the entire colon and rectum.

Double contrast barium enema

This is an x-ray test of the colon and rectum.

CT colonography (virtual colonoscopy)

This is a type of CT scan of the colon and rectum.

How CRC is staged

Staging is a way to classify the size of a tumor and whether the cancer has spread to nearby tissues or other distant parts of the body. The most common staging system is TNM:

  • T describes how deeply the main (primary) tumor (T) has grown into the wall of the bowel and whether it has grown into nearby areas. A T0 cancer is in its earliest stage while T4 cancer has grown through all layers of the wall or grown into nearby areas
  • N tells whether the cancer has spread to the lymph nodes. N0 means there is no cancer in the lymph nodes. N1 and N2 mean it has spread to the lymph nodes. The higher the number, the degree of lymphatic involvement is higher.
  • M tells whether the cancer has spread (metastasized) to other parts of the body. M0 means it hasn’t spread far from its original site, while M1 means the cancer has spread to more distant locations

The TNM system is then used to stage the tumor in a range from 0 to IV (4). The higher the number, the greater the size and spread of the tumor. Your doctor will use the stage number to help determine how your colorectal cancer should be treated.

Distress: This can’t be happening.

As you may have discovered, a diagnosis of cancer may result in many questions, worries, and fears.

All feelings are normal

Learning you have cancer may be a shock, and how you react to this news is very personal. There is no right or wrong way to feel. However, there are many common emotions and reactions that people feel and have when they learn they have cancer.

Acknowledge your feelings

Try to respect the ever-changing emotions you’re feeling. Sharing your concerns is a proactive step that may help you regain a sense of control. Seek help from the people around you.

If you or someone you love is faced with a CRC diagnosis and the challenges it may bring, ask your healthcare team about local resources that may help. You and those who support you may also benefit from the help of the following organizations, which can provide focused information about CRC:

American College of Gastroenterology

http://patients.gi.org

Colon Cancer Alliance®

1-877-422-2030

www.ccalliance.org

Fight Colorectal Cancer®

1-877-4CRC-111 (1-877-427-2111)

www.fightcolorectalcancer.org

Susie’s Cause

www.coloncancerfoundation.org

All third-party names, logos, brands, and other trademarks are the property of their respective trademark owners. Those trademark owners are not affiliated with Lilly and they do not sponsor or endorse this material.

Plan: What’s next?

Information and connections

Sharing your diagnosis with family and friends may provide you with the strength and support you need. It also gives those closest to you the opportunity to do what they can to help you.

The role of caregivers

Dealing with this on your own when you have a serious illness can be overwhelming. Your caregiver can help. Talk honestly about what you’re going through, so they can better help you.

Get to know your care team

Talking things over with your healthcare team will help you be more engaged in your care. Being prepared to talk to your doctor may help put your mind at ease. Continue asking questions until you clearly understand the cancer you are facing and all the options you have to fight it.

Treat: It’s time to act.

While many people who have CRC may be more than ready to start fighting the cancer, each treatment comes with special considerations that could impact day-to-day life. Because treatment options and side effects vary, you should discuss them with your doctor, including risks and potential benefits. Keep reading to see some of the more common treatments.

A couple holding hands

How CRC is treated

There are four standard types of treatment used for CRC: surgery, radiation therapy, chemotherapy, and targeted therapy.

All of these options are described in more detail when you click on these links:

Surgery

Surgery is the most common treatment for all stages of colon cancer and rectal cancer. Whether it is colon cancer or rectal cancer, options for type of surgery will depend on the stage (extent) of the cancer, its location, and the goal of the surgery.

Surgery for this can be complex. You should speak with a surgeon who specializes in this. Your doctor can help find a colorectal surgeon, or you can obtain a list of specially trained surgeons from the American Society of Colon and Rectal Surgeons by visiting www.fascrs.org.

Radiation therapy

Radiation therapy uses high-energy x-rays to kill cancer cells or keep them from growing. The way the radiation therapy is given depends on the type and stage of the cancer:

  • Radiation therapy may be given before an operation so that large tumors can shrink to be removed more easily
  • After surgery to destroy remaining cancer cells
  • To prevent cancer from coming back
  • To treat cancer that has returned
  • In combination with chemotherapy or surgery

Chemotherapy

Chemotherapy is the use of certain medicines to fight cancer cells—though healthy cells are also affected by treatment. Chemotherapy may be given as an IV infusion (which means given intravenously, or through a vein over a period of time), or it can be taken orally.

Targeted therapy

Targeted therapy drugs interfere with specific targeted molecules needed for tumor growth.

According to the NCCN Guidelines for Patients®: Colon Cancer, all patients diagnosed with stage IV CRC should be tested for the RAS gene status. Testing will be done using a small tissue from your tumor. In this test, some material from your tumor will be genetically tested to see if your tumor has a certain kind of genetic change called a RAS mutation.

Ask your doctor about genetic tests to see if a biologic therapy may be appropriate for your type of cancer.

Other options

Palliative care

In certain instances, patients may choose to focus solely on palliative care and not to treat the cancer they are facing. If the goal is to relieve symptoms and suffering and improve quality of life, ask your healthcare team to explain the options that may be available to you.

Clinical trials

In many cancer treatment and medical centers, clinical trials are being conducted to help test new treatments or treatment combinations. Ask your doctor whether you are a good candidate for a clinical trial, and what would be involved.

New normal: Life’s different.

After treatment for CRC ends, talk with your doctor about developing a follow-up care plan.

Follow up

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years, as well as having recommended cancer screening tests. Talk with your healthcare team for information about what to expect.

Make good health choices

People recovering from CRC are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and regular physical activity. Talk with your doctor to develop a plan that is best for your needs.

Get smart

The site for the American College of Gastroenterology has a special section just for patients with information and podcasts about CRC.
http://patients.gi.org

Express your journey

Share your creative expressions with the long-standing program called Lilly Oncology on Canvas.

Keep connected

Make a free, personalized web page—to connect to family, friends, and others who want to support you in your journey—at MyLifeLine.org.

The American Cancer Society® also provides a wealth of information at www.cancer.org.