Colorectal cancer (CRC) represents 8% of all new cancer cases and 8.4% of all cancer deaths, with a five-year survival rate of 64.9% (between 2007–2013). Pancreatic cancer represents 3.2% of all new cancer cases and 7.2% of all cancer deaths, with a five-year survival rate of just 8.2% (between 2007–2013). ONS member Christine Guarnieri, MSN, RN-BC, OCN®, of Huntington Hospital in New York, discussed both of these cancers at the Oncology Nurse Advisor Navigation Summit.

Colon cancer diagnosis relies on patient history and physical, sigmoidoscopy, colonoscopy with biopsy, and imaging for distant disease, including computed tomography (CT) of the chest, abdomen, and pelvis; magnetic resonance imaging (MRI); and positron-emission tomography with or without CT. Rectal cancer diagnosis relies on patient history and physical, rectal ultrasound, pelvic CT and MRI, and fine-needle aspiration of nodes.

Guarnieri discussed different mutation analyses for CRC. Tumors with microsatellite instability (MSI) have distinct features, such as a tendency to arise in the proximal colon, lymphocytic infiltrate, and a poorly differentiated, mucinous or signet ring appearance. They have a slightly better prognosis than CRC tumors without MSI and do not have the same response to chemotherapies.

KRAS mutations are a potent predictor or resistance to epidermal growth factor receptor-directed antibodies, such as cetuximab and panitumumab. These therapies should be used only in those with wild-type KRAS.

Mutations in one of the mismatch repair genes (MLH1, MSH2, MSH6, PMS2, EPCAM) are found in Lynch syndrome and in 15%–20% of patients of sporadic colon cancers.

Pancreatic cancer diagnosis relies on patient history and physical, jaundice, labs, CT and MRI, and endoscopic ultrasound.

Genetic mutation analysis for pancreatic cancer includes APC (familial adenomatous polyposis syndrome), BRCA1 and BRCA2, CDKN2A and P16 (supports the development of pancreatic cancer in melanoma-prone family), MLH1, MSH2, MSH6, PMS2, EPCAM (Lynch syndrome), STK11 (Peutz-Jeghers syndrome), and TP53 (Li-Fraumeni syndrome).

For these patients, Guarnieri noted the importance of referrals to support patients, such as for social work, financial assistance, support groups, nutritional assessments, community resources, clinical trials, and palliative care.

By identifying incidence, prevalence, and risk factors associated with CRC and pancreatic cancer, nurse navigators can develop screening and prevention programs to better serve these populations. In a multidisciplinary setting, a streamlined referral process is key to removing actual and potential barriers to care.

This session was supported in part by an educational grant from Celgene.

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