NCCN Guidelines: Colon Cancer & Rectal Cancer

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Re: NCCN Guidelines: Colon Cancer & Rectal Cancer

Postby thephotoguy » Thu Apr 04, 2024 10:20 pm

This is very helpful. Thank you for posting.

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Re: NCCN Guidelines: Colon Cancer & Rectal Cancer

Postby rp1954 » Sat Apr 20, 2024 4:13 pm

The NCCN guidelines have been substantially expanded and refined since 2010 (my wife's dx), including their split into separate Colon and Rectal Cancer versions, with a number of new targeted drugs, mostly for metastatic cancer patients. These guidelines represent the current "standard of care" choices of the American medical industrial complex that are offered to, or imposed upon, most patients in the US and some international followers. In the US, I would recommend new patients at least reading the NCCN Patients Guidelines for an hour or two. For advanced readers, those looking at advanced options in the US, or those in a serious tangle with insurance, the Physician Practice guidelines may have useful parts (it's a lot in toto, especially in the versions with Evidence blocks, and only parts will most concern a particular case).

Probably the greatest improvement for stage 2 and 3 patients without high risk factors, is the lowering of the Folfox/Capox goals from 6 months to 3-4 months in toto or without oxaliplatin sooner than the old 6 months goal. The options for stage 4 patients are substantially expanded, often with several prices paid.

The medical choices of NCCN do not necessarily represent the best or only choices, but rather the cumulative results of a formally documented path under a number of influences. Certainly other countries have made other choices. In Japan (2022), radiation is still a secondary option in colorectal cancer, their surgeons have historically claimed greater precision/results in rectal surgery. Life Extension Foundation described a CA19-9 (+CSLEX) targetable choice with cimetidine for perioperative use. The original CRC-cimetidine research with continuous chemo still appears valid - potentially providing a low key treatment path for heavily biomarked stage 2 and 3 patients that were/are fated to die in the first 5-6 years after surgery, almost like time delayed stage 4 patients. I credit the targeted cimetidine during our first year as a crucial element in helping my wife crawl back from the brink through two surgeries and her early chemo dose minimum (during 5FU-folic acid toxicity) that otherwise likely would have been inadequate to prevent continued metastasis. Capecitabine (Xeloda) remains a highly under optimized drug in these guidelines.

The Guidelines still lag in several ways. One is simple current information e.g. capecitabine is still regarded as a mildly expensive medicine (e.g. $40/pill) in the Evidence Blocks. Capecitabine is now available to varying degrees as an asian sourced generic at $1-2/pill, making possible a very inexpensive standalone chemo for stage 2 and 3 patients, never mind some advanced formulation possibilities in stage 4.

Likewise, blood testing is not cast in stone. Other countries may add other markers like CA19-9 (China, parts of Europe), CSLEX (Japan) or AFP (China), and other inexpensive panels. Less specific panels, often historically used, can still offer insights especially if undistorted by radiation or heavy chemo (at the earliest times, and later, long intervals after or between treatments, or with milder treatments). Used in personalized combinations for the patients can have several advantages with better blood data. My wife navigated stage 4 well with an average of one major scan/year (4 months - several years) with lots of blood data that were very revealing in her case. (She had the advantages of milder chemo and milder inflammation with all those supplements, IVC and eventually, celecoxib).
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

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