My Colorectal Cancer Consultant
An Initiative Designed for the Metastatic Colorectal Cancer Patient.
My Colorectal Cancer Consultant
My Colorectal Cancer Consultant is an online tool designed to provide patients with metastatic colorectal cancer and their caregivers with information about potential systemic (drug) treatment options that they can discuss with their treating oncologist. In patients with stage IV (metastatic) colorectal cancer, the cancer has spread to distant organs, such as the liver or lungs.
Is This Tool for Me?
If you have or are caring for someone with stage IV (metastatic) colorectal cancer and would like to know more about potential treatment options, this tool is for you.
How Does It Work?
You will be guided through a series of questions requiring the patient’s extended pathology report. At the end, you will receive a personalized report that outlines the potential systemic treatment options that may be appropriate for the patient based on their individual diagnosis and tumour biomarkers.
The goal is to facilitate a thoughtful discussion with your treating oncologist by providing you with more information on the potential treatment options that may be available and to encourage informed and joint decision-making between the patient, caregiver and treating oncologist.
The tool and the information provided are not intended to replace the medical advice of your treating physician. Do not make any decisions about your treatment without consulting your physician. Do not start or stop any medications on your own. Always check with your physician before changing any of your medications. Always consult your physician before trying herbal or “natural” or “alternative” remedies. Regularly consult a physician in matters pertaining to your health and particularly with respect to any symptoms that may require diagnosis or medical attention.
WHAT ARE BIOMARKERS?
Biomarkers, short for biological markers or molecular markers, are molecules found in your tumour or other tissues that can reveal whether a process in your body is normal or pathogenic (causing disease).
They include DNA, proteins, and genetic mutations found in blood, tissue, or other body fluids. Biomarker testing is sometimes called tumour testing, molecular testing, and genomic testing.
Privacy Statement
All data is being collected and stored by CCRAN, a registered Canadian non-profit patient-led support and advocacy group. To ensure patient and caregiver privacy and confidentiality, individual responses will be anonymized and will not be identifiable. It is important to note that your information will be stored in a safe database without reference to patient name or any other identifying information. The data will be used to help CCRAN better understand the growing trends in the management of advanced colorectal cancer.
If you are unsure about the meaning of any word or term in this tool, visit the Glossary of Terms on the CCRAN website.
Potential Treatment Options
The goals of therapy are to maintain or to improve quality of life, to control or to delay the onset of tumour-related symptoms, and to prolong life, if possible. The aim of treatment of stage IV colorectal cancer is to reduce or eliminate cancers at the original site and those that have spread to other organs and tissues. There are three types of therapy for colorectal cancer, and most patients are offered more than one form of treatment.
SURGERY
is the most common treatment for primary colon and rectal cancer. For most patients, however, a bowel resection is required, wherein part of the intestine and nearby lymph nodes are removed in the early stages of the disease. In stage IV patients, the primary tumour may be removed if the patient is symptomatic (i.e., bowel perforation). In patients who have small-volume metastatic disease in a distant organ, surgery for the primary tumour and the metastases may occur at the same time.
RADIATION THERAPY
is also used, most notably for primary rectal tumours that need to be reduced in size before surgery and often with chemotherapy. Radiation therapy is also used in the treatment of colorectal cancer that has spread to other organs such as the liver.
More information about surgical and radiation therapies can be found on CCRAN’s website.
SYSTEMIC THERAPY
uses medicines that travel through the bloodstream, reaching and affecting cells throughout the body. Examples of systemic therapies include chemotherapy, targeted therapies and immunotherapies. Chemotherapy is usually recommended for stage IV colorectal cancer and it may be given on its own or in combination with targeted therapies. My Colorectal Cancer Consultant focuses on systemic therapies for the management of metastatic colorectal cancer.
With the introduction of precision medicine or personalized medicine, the patient’s genomic profile now guides treatment selection to optimize treatment response, which may improve patient outcomes. Tumour profiling is providing the necessary information on genetic mutations to guide selection of therapeutic options to enhance the patient journey.
Reviewed and Endorsed by Medical Experts
The information in this online tool is based on evidence and clinical practice guidelines. The following four highly renowned medical experts have graciously and generously agreed to represent the various disciplines in the management of the disease and have reviewed and endorsed the algorithms that form the basis of this online tool.
Dr. Christine Brezden-Masley, MD PhD FRCPC
Senior Practicing Medical Oncologist
Medical Director, Cancer Program
Director, Marvelle Koffler Breast Centre
Sinai Health System
Associate Professor, Temerty Faculty of Medicine, University of Toronto
Associate Scientist, Lunenfeld-Tanenbaum Research Institute
Christine Brezden-Masley, MD, PhD, FRCPC is a senior practicing Medical Oncologist and the Medical Director of the Cancer Program at Sinai Health System in Toronto, Canada. She is also the Director of the Marvelle Koffler Breast Centre at Sinai Health and holds the Marvelle Koffler Chair in Breast Research. She obtained her PhD in Medical Biophysics at the Princess Margaret Hospital in Toronto and her Medical Degree from the University of Toronto. She is currently an Associate Professor at the Temerty Faculty of Medicine, University of Toronto and an Associate Scientist at the Lunenfeld-Tanenbaum Research Institute, Toronto, Canada. She treats both breast and gastrointestinal (colorectal and gastric cancers) malignancies, which are her major areas of research interest. Her main area of clinical research is cardiotoxicity from cancer therapy and is the Past-President of the Canadian Cardio-Oncology Network (2017-2022). She also serves on the International Cardio-Oncology Society (ICOS) annual summit steering committees and co-chaired the 2022 Global Cardio-Oncology Summit in Toronto. She co-chairs the Junior Mentoring Program (JuMP) that fosters mentorship/sponsorship of junior medical oncology faculty across Canada and serves on the executive of WinC (Women in Cancer/All in Cancer). She is an advocate for patients and serves on CCRAN’s Medical & Scientific Advisory Board, and as a board member of ReThink Breast Cancer and MyGutFeeling.
Dr. Sharlene Gill, MD, MPH, MBA, FASCO
Professor of Medicine, UBC
Medical Oncologist, BC Cancer
Medical & Scientific Advisory Board Co-Chair,
Colorectal Cancer Resource & Action Network (CCRAN)
Dr. Sharlene Gill is a Professor of Medicine at the University of British Columbia and a medical oncologist specializing in gastrointestinal (GI) malignancies at BC Cancer – Vancouver. She received a Bachelors of Science in Pharmacy and an MD from the University of British Columbia in 1996 followed by residencies in Internal Medicine and Medical Oncology. Dr. Gill subsequently completed a fellowship in Gl Oncology at the Mayo Clinic (Rochester, MN) and a Masters of Public Health from the Harvard School of Public Health. In 2017, she completed an MBA from the Kenan-Flagler School of Business at the University of North Carolina. She is actively engaged in education and research, with over 120 peer-reviewed publications and book chapters to her credit. Dr. Gill serves as the Chair of the Canadian Clinical Trials Group (CCTG) GI Disease Site Committee and Chair of the UBC Department of Medicine Mentoring Committee. She is the Editor-in-Chief for Current Oncology and is the President of the Canadian Association of Medical Oncologists. Her TEDx talk in 2022 on ‘How to Flip the Script on Cancer’ delivered her passion for patient advocacy and empowerment.
Dr. Stephanie Snow, MD, FRCPC
Medical Oncologist, QEII Health Sciences Centre
Professor, Faculty of Medicine, Dalhousie University
Board Member, Lung Cancer Canada
Dr. Stephanie Snow is a staff Medical Oncologist at the QEII hospital in Halifax, Nova Scotia, treating thoracic and GI malignancies. After pursuing undergraduate training at McGill, she completed her training at Dalhousie, where she is now a full professor in the Faculty of Medicine. Dr. Snow has a strong interest in Medical Education and is Vice Chair of the Royal College Medical Oncology Examination Board. From a research perspective she is involved in clinical research, is Associate Editor of the peer reviewed journal Current Oncology and has been widely published in prominent journals. Finally, Dr. Snow is active in patient advocacy, serving as a current Board Member and former President of Lung Cancer Canada, and sits on the medical advisory committees of several other patient advocacy groups in colorectal and gastric cancer.
The following medical experts graciously represented the various disciplines included in the inaugural launch of My Colorectal Cancer Consultant, and CCRAN wishes to thank them for their time and expertise. Their contributions were essential to developing this program.
Dr. Shady Ashamalla MSc, MD, FRCSC (Surgical Oncology)
Head, Division of General Surgery
Minimally Invasive Colorectal Cancer Surgical Oncology
Young Adult Colorectal Cancer Clinic
Sunnybrook Health Sciences Centre
University of Toronto
Consultant Surgeon of the Toronto Maple Leafs
Dr. Ashamalla obtained his undergraduate Honours degree from the University of Guelph in Biomedical Sciences followed by a Master of Science degree at Queen’s University. He then returned to Toronto and completed his Medical Degree followed by a residency in General Surgery at the University of Toronto. He then went on to complete advanced training in Minimally Invasive Surgery. His clinical interest is devoted to Lower Gastrointestinal Surgical Oncology, with a clinical focus on the minimally invasive approach. He is with the surgical oncology team at Sunnybrook Health Sciences Centre in the Odette Cancer Centre with a practice completely devoted to lower gastrointestinal surgical oncology with focus on the advancement of the minimally invasive technique within the field of surgical oncology. Dr. Ashamalla also heads up the Young Adult Colorectal Cancer Clinic, a one-of-a-kind clinic at the Odette Cancer Centre at Sunnybrook Health Sciences Centre dedicated to serving the needs of the under-50 population, as they face the challenges and concerns related to a colorectal cancer diagnosis.
Dr. Christine Brezden-Masley, MD, PhD, FRCPC (Medical Oncology)
Senior Practicing Medical Oncologist
Medical Director, Cancer Program
Director, Marvelle Koffler Breast Centre
Sinai Health System
Associate Professor, Temerty Faculty of Medicine,
University of Toronto
Associate Scientist, Lunenfeld-Tanenbaum Research Institute
Christine Brezden-Masley, MD, PhD, FRCPC is a senior practicing Medical Oncologist and the Medical Director of the Cancer Program at Sinai Health System in Toronto, Canada. She is also the Director of the Marvelle Koffler Breast Centre at Sinai Health and holds the Marvelle Koffler Chair in Breast Research. She obtained her PhD in Medical Biophysics at the Princess Margaret Hospital in Toronto and her Medical Degree from the University of Toronto. She is currently an Associate Professor at the Temerty Faculty of Medicine, University of Toronto and an Associate Scientist at the Lunenfeld-Tanenbaum Research Institute, Toronto, Canada. She treats both breast and gastrointestinal (colorectal and gastric cancers) malignancies, which are her major areas of research interest. Her main area of clinical research is cardiotoxicity from cancer therapy and is the Past-President of the Canadian Cardio-Oncology Network (2017-2022). She also serves on the International Cardio-Oncology Society (ICOS) annual summit steering committees and co-chaired the 2022 Global Cardio-Oncology Summit in Toronto. She co-chairs the Junior Mentoring Program (JuMP) that fosters mentorship/sponsorship of junior medical oncology faculty across Canada and serves on the executive of WinC (Women in Cancer/All in Cancer). She is an advocate for patients and serves on CCRAN’s Medical & Scientific Advisory Board, and as a board member of ReThink Breast Cancer and MyGutFeeling.
Dr. Paul J. Karanicolas, MD, PhD, FRCSC (Hepatobiliary Surgical Oncology/HAIP Chemotherapy)
Hepatobiliary, Pancreatic, and GI Surgical Oncology
Odette Cancer Centre
Sunnybrook Health Sciences Centre
Associate Professor of Surgery
University of Toronto
Dr. Karanicolasis a surgical oncologist in the Odette Cancer Centre and a scientist at the Sunnybrook Research Institute. His clinical practice is dedicated to patients with hepatobiliary, pancreatic, and gastrointestinal malignancies. Dr. Karanicolas received his Medical Degree at the University of Western Ontario, where he also completed his General Surgery residency training. He then completed a PhD in Health Research Methodology at McMaster University and a clinical fellowship in surgical oncology at Memorial Sloan-Kettering Cancer Center in New York. The main focus of his research is designing and leading randomized controlled trials in surgical oncology. Dr. Karanicolas has spearheaded the establishment of the “HepatoPancreaticoBiliary Community of Surgical ONcologists: Clinical, Evaluative, and Prospective Trials Team (HPB CONCEPT Team)”, a Canada-wide consensus-based framework for liver and pancreas cancer research. He is the principal investigator on a CIHR-funded grant to develop high-impact clinical trials on behalf of this group and including a national randomized controlled trial examining the impact of tranexamic acid on bleeding during liver resection. Dr. Karanicolas is the Medical/Scientific Director of Clinical Trials Services at Sunnybrook Health Sciences Centre. He also conducts research examining quality of life in patients undergoing surgery for cancer. Dr. Karanicolas’ team is implementing an electronic framework to integrate patient education and assessment of quality of life into routine care. He is also examining the impact of surveillance following cancer resection on patient satisfaction and quality of life. Dr. Karanicolas is the surgical lead for the hepatic arterial infusion pump chemotherapy program at the Odette Cancer Centre. This is the first program of its kind in Canada and offers an additional therapeutic option for patients with colorectal liver metastases.
Dr. Rebecca K.S. Wong, MB, ChB, MSc, FRCP
(Radiation Oncology)
Princess Margaret Cancer Center
Professor, Department of Radiation Oncology
Vice Chair of Education, Department of Radiation Oncology
University of Toronto
Director, Education, Radiation Medicine Program
Dr. Rebecca Wong is a radiation oncologist at Princess Margaret Cancer Centre, Professor and Vice Chair of Education, Department of Radiation Oncology, University of Toronto. She is a graduate of Sheffield University Medical School, completed her specialty training in radiation oncology at Queen’s University, and obtained her MSc in Clinical Epidemiology at McMaster University. Her clinical interests are in the areas of gastrointestinal malignancies, radiotherapy for patients with metastatic cancer, and theranostics. She has been active in the design and implementation of clinical trials, serving as the Chair of the Symptom Control Committee, Canadian Cancer Trials group, and has led several international trials in gastrointestinal malignancies and palliative radiotherapy. To translate evidence in practice, she has authored and served in leadership roles as part of the Cochrane Collaboration and Cancer Care Ontario Program in Evidence-Based Care. As an advocate for building capacity through education, she is actively involved in collaborative partnerships with low- and middle-income countries in training and education, especially in professional training in radiation oncology. She is the author of over 130 peer-reviewed articles.
references
Alberta Health Services. Cancer Control Alberta. Metastatic Colon Cancer. April 2020.
Feng Z, Yang X, Tian M. et al. BRCA genes as candidates for colorectal cancer genetic testing panel: systematic review and meta-analysis. BMC Cancer 23, 807 (2023). https://doi.org/10.1186/s12885-023-11328-w
National Comprehensive Cancer Network® (NCCN®). Guidelines for Patients: Colon Cancer, 2024.
Ontario Health. Cancer Care Ontario. Colon Cancer Treatment Pathway Map. Version 2020.01.
Saskatchewan Cancer Agency. Provincial Colorectal Cancer Treatment Guidelines. June 17, 2011.
Triest L, Debeuckelaere C, Vandamme T. et al. Should Anti-EGFR agents be used in right-sided ras wild-type advanced colorectal cancer? Curr Colorectal Cancer Rep 15, 130–134 (2019).
