What Is Metastatic Colorectal Cancer (MCRC)?

Colorectal cancer is a disease that develops when abnormal cells in the colon or rectum divide without control, forming a growth or a primary tumor. As the primary tumor grows, it can spread to nearby tissue outside the colon or rectum. Eventually, cancer cells can break away and travel through the bloodstream or the lymph system to form new tumors in other parts of the body, such as the liver or lungs. This spreading process is called metastasis, and your health care team may refer to this spreading of cancer as stage IV colorectal cancer, advanced colorectal cancer, or MCRC. Even though the cancer has spread to a new part of the body, the new tumors are made up of cells from the original tumor in the colon or rectum, so it is still considered colorectal cancer.

Colon and rectal cancers are alike in many ways, which is why they are often discussed together as colorectal cancer. However, sometimes these cancers are referred to separately as colon cancer or rectal cancer.

Diagram of the digestive system

Where they grow

Colorectal cancers develop in the large intestine. The first 6 feet of the large intestine include the large bowel or colon. The final 6 inches make up the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body). The colon has 4 sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid or S-shaped colon. Cancer can develop in any of the 4 sections of the colon or rectum.

How they grow

Colorectal cancers usually begin as a small clump of benign cells (called a polyp) that start to grow in the inner wall of the colon and rectum. Over time, some polyps can become cancerous. As the cancer grows, it can spread through the wall to nearby tissue outside the colon or rectum. Eventually, cancer cells may break away and spread to other parts of the body, where they form new tumors. This spreading process is called metastasis, and the new tumors are called metastases.

Next Page: Diagnosis of Colorectal Cancer

Indication

Avastin, in combination with intravenous 5-FU–based chemotherapy, is approved by the FDA for first- or second-line treatment of people with metastatic cancer of the colon or rectum.

Serious Side Effects

Avastin can result in the development of a potentially serious, and sometimes fatal, side effect called gastrointestinal (GI) perforation. GI perforation is the development of a hole in the stomach, small intestine, or large intestine. Symptoms may include abdominal pain, nausea, vomiting, constipation, and fever. Avastin therapy should be stopped if GI perforation occurs.

Treatment with Avastin can lead to slow or incomplete wound healing (for example, when a surgical incision has trouble healing or staying closed). In some cases, this event resulted in fatality. Stop Avastin for at least 28 days before voluntary surgery. Do not start Avastin for at least 28 days after surgery and until the surgical wound is fully healed. Avastin therapy should be stopped in patients who experience slow or incomplete wound healing.

Treatment with Avastin can result in serious and sometimes fatal bleeding. This includes coughing up blood, bleeding in the stomach, vomiting blood, bleeding in the brain, nosebleeds, and vaginal bleeding. People who have recently coughed up blood or have serious bleeding should not receive Avastin.

Please click here for additional important safety information.

Indication

Avastin, in combination with intravenous 5-FU–based chemotherapy, is approved by the FDA for first- or second-line treatment of people with metastatic cancer of the colon or rectum.

Possible Serious Side Effects and Additional Important Safety Information

What is the most important safety information I should know about Avastin?

Avastin can result in the development of a potentially serious, and sometimes fatal, side effect called gastrointestinal (GI) perforation. GI perforation is the development of a hole in the stomach, small intestine, or large intestine. Symptoms may include abdominal pain, nausea, vomiting, constipation, and fever. Avastin therapy should be stopped if GI perforation occurs.

Treatment with Avastin can lead to slow or incomplete wound healing (for example, when a surgical incision has trouble healing or staying closed). In some cases, this event resulted in fatality. Stop Avastin for at least 28 days before voluntary surgery. Do not start Avastin for at least 28 days after surgery and until the surgical wound is fully healed. Avastin therapy should be stopped in patients who experience slow or incomplete wound healing.

Treatment with Avastin can result in serious and sometimes fatal bleeding. This includes coughing up blood, bleeding in the stomach, vomiting blood, bleeding in the brain, nosebleeds, and vaginal bleeding. People who have recently coughed up blood or have serious bleeding should not receive Avastin.

What are the additional possible serious side effects of Avastin?

Serious side effects with Avastin include:

The formation of an abnormal passage from parts of the body to another part, sometimes fatal. Stop Avastin therapy if this occurs
Stroke or heart problems, which can be fatal. Heart problems include blood clots, mini-stroke, heart attack, and chest pain. Stop Avastin therapy if these occur
Too much protein in the urine, which may lead to kidney problems, sometimes fatal. Your doctor will monitor your protein level and may stop Avastin therapy if your level is too high
High blood pressure. Your doctor will monitor your blood pressure and may start you on medications to control your blood pressure. Temporarily stop Avastin if not controlled with medications. Avastin should be stopped if blood pressure severely spikes or if disturbance of the brain from high blood pressure occurs
Nervous system and vision disturbances. Symptoms may include high blood pressure, headache, seizure, sluggishness, confusion, and blindness. Stop Avastin therapy if these symptoms occur
Infusion reactions. These may include high blood pressure or severe high blood pressure that may lead to stroke, difficulty breathing, decreased oxygen in red blood cells, a serious allergic reaction, chest pain, headaches, tremors, and excessive sweating. Stop Avastin therapy if severe infusion reactions occur

What are the most common side effects of Avastin?

The most common side effects of Avastin that occurred at >10% and at least twice the control rate include nosebleeds, headache, high blood pressure, inflammation of the nose, too much protein in the urine, taste change, dry skin, rectal bleeding, tear production disorder, back pain, and inflammation of the skin.

What should I do if I am pregnant or thinking of becoming pregnant?

You should not take Avastin while you are pregnant. If you stop Avastin, you should use a contraceptive for at least 6 months after your last dose before attempting to become pregnant.

What should I tell my health care provider before taking Avastin?

Avastin therapy may not be appropriate for certain people. Talk to your doctor if you:

Are pregnant or think you may be pregnant, or are planning to become pregnant. Based on animal data, Avastin may harm the fetus
Are breast-feeding. Avastin may pass into your breast milk
Are undergoing surgery. Avastin should not be given for at least 28 days after surgery and until the surgical wound is fully healed
Are under the age of 18. The safety and efficacy of Avastin in children have not been evaluated

Please see full Product Information, including Serious Side Effects, for additional important safety information.