colon health - mediaplanetdoc.mediaplanet.com/all_projects/4646.pdf · colon health march 2010 your...
Post on 05-Jun-2018
216 Views
Preview:
TRANSCRIPT
Colon Healthmarch 2010 Your guide to preventing the nation’s 2nd most prevalent cancer
The Cancer Institute at St. Joseph Medical Center
ONE TEAM. ONE PLAN. ONE PLACE.
The Hodes Comprehensive Liver & Pancreas Center and The Colorectal Oncology CenterOur multidisciplinary team handles all aspects of colorectal cancer
including complex resections and treatment of liver metastases.
DiscoverSJ.com
COLON HEALtH
2
What makes these num-
berssodisturbing is that
itdoesn’thavetobethis
way. Colorectal cancer is one of the
mostpreventableandcurableforms
ofcancer there is.Unlikesomecan-
cers,manyimportantriskfactorsfor
colorectalcancerareeasilycontrolled,
andwithearlydetection,asmanyas
95percentofcolorectalcancerscan
becured.Despitethesefacts,colorec-
talcancerremainsthesecondleading
causeofcancerdeathsforbothmen
andwomen.
The Susan Cohan Colon Cancer
Foundation(Susie’sCause)iscommit-
tedtochangingthis.Throughdiverse
programsaimedatraisingawareness,
advancingeducationaboutcolorec-
tal cancer, encouraging prevention
and screening for early detection,
and offering knowledge, hope and
resources to those affected by this
disease,Susie’sCausehasestablish-
ing itself as the national voice of
colorectalcancer.
Thoughnooneknowsforcertain
whatcausescolorectalcancer,there
areriskfactorsthatinfluencethelike-
lihood that you will be affected by
thisdisease.Somearebeyondyour
control,butothersarenot.Research
shows that 50 percent of colorectal
cancerscouldbepreventedthrough
healthylifestylechoicessuchaseat-
inghealthfully,maintainingahealthy
bodyweight,gettingenoughphysi-
cal activity and not smoking. That
means that of the nearly 150,000
peoplewhowilllearntheyhavecolon
or rectal cancer this year, 75,000 of
them—enoughpeopletofillafoot-
ballstadium—mayhavebeenableto
prevent it.Additional livescouldbe
savedthroughearlydetection.
According to The National Can-
cer Institute, rates of screening for
colorectal cancer are consistently
lower than those for other types of
cancer.Perhapsit’sbecausethereare
somanymythsandmisconceptions
about this disease, or perhaps it’s
becausetalkingaboutitmakesmany
peopleuncomfortable.Whateverthe
reason,choosingtoignorecolorectal
cancerisadecisionthatmaybecost-
ingmanylives.
The Susan Cohan Colon Cancer
Foundation(Susie’sCause)isworking
hard to turn the tide.Over thepast
five years, Susie’s Cause has imple-
mented national, groundbreaking
educational and support programs
thathavedramaticallyimpactedthis
diseaseincluding:
The Save Our Parents Program
A unique educational model that
motivates students to talk to their
parents and family members about
the benefits of Colorectal Cancer
screening,healthydiet,andlifestyle
choices.
The Sharing, Caring, and Surviving
Colon Cancer Symposium
A multi-city symposium reaching
outtopatientsandtheirfamilies.
The Primary Care Education Series
Continuing education for primary
care physicians to better educate
them about their important role in
theearlydetectionofcoloncancer,
and the significance of remaining
involvedduringtreatment.
National Colon Cancer
Screening Month
Designates April as Susie’s Cause
Colon Cancer Screening Month to
specifically increase screening and
trackscreeningparticipation.
Susie’sCauseisproudtoprovideto
thededicatedreadersofUSAToday
the first national comprehensive
report on Colon Cancer Prevention
and Treatment. We are thankful to
our many sponsors that graciously
supportedthisextraordinaryproject.
Weappreciatetheexpertsthathave
generouslygiventheirtimeandtheir
knowledge; the familiesofprecious
lovedoneslostandpatientsliterally
fighting for their lives; and to Susie
forherdivineguidancefromabove.
Withhumilityandpride,Susie’sCause
dedicatesthisprogramtoallofyou.
CONTENTS2 TheFightAgainstColonCancer
4 WhatYouDon’tKnow
CanHurtYou!
4 SharonOsbourne
6 PanelofExperts
8 Stefanie’sStory
8 WhattoWatchFor
8 AreYouAtRiskForCRC?
9 Prevention
10 CarmenMarcValvo
10 Don’tLetFearHoldYouBack
11 GettingTheCareYouNeed
COLONHEALTH
Publisher: Jeremy Marks jeremy.marks@mediaplanet.com
Journalist: Cindy Heroux
Designer: Carrie Reagh carrie.reagh@mediaplanet.com
Photos: ©iStockphoto.com
For more information about supplements in the daily press, please contact: Kayvan Salmanpour, 1 646 922 1400 kayvan.salmanpour@mediaplanet.com
This section was written by Mediaplanet and did not involve USA Today News or Editorial Departments.
www.mediaplanet.com
a very special thanks to...
The Fight Against Colon Cancer: Knowledge is Power: Preventing Colorectal CancerBy:BOBBySMITh,ExECUTIvEvICEPRESIDENTANDDAvIDRODMANCOhAN,PRESIDENT,ThESUSANCOhANCOlONCANCERFOUNDATION(SUSIE’SCAUSE)
Onein20Americansare likelytodevelopcolorectalcancer intheir lifetimeandalmost50,000peoplewilldiefromcolorectalcancerthisyearalone.
QuidelCorporationenhancesthehealthandwellbeingofpeoplearound the globe through thedevelopment, manufacturingandmarketingofrapiddiagnos-ticsolutions.
Fiveyearsagoabeautifulyoungwomanwitheverythingtoliveforsuccumbedtoatwoyearheroicbattlewithcoloncancer.SheleftbehindalovingfamilyandtwobeautifulchildrentogrowupinaworldwithouttheirMother.hervisionwasthatnootherfamilywouldexperi-encethepainthatherfamilyendured.Susandidnotlivelongenoughtosharehervision,however,herlegacywillcarryonthroughherFoundation,The
SusanCohanColonCancerFoundation(Susie’sCause).TheFoun-dationwasestablishedbySusanandtheCohanfamilyshortlybeforehertragicdeath,andisapublic501(c)(3)charity.
3
COLON HEALtH
1 What Are the Key Statistics for Colorectal Cancer? http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_colon_and_rectum_cancer.asp?sitearea=2 Can Colorectal Cancer be Prevented? http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_colon_and_rectum_cancer_be_prevented.asp?rnav=cri
Go to colorectal-test.com formore information. Results you can depend on.
Few things embody our generation’s coming of age like the450,000 or so people that descended onWoodstock in1969.Forty-one years later, tie-dye has become neck tie, flower power hasbecome solar power and being screened for colorectal cancer (CRC) hasbecome emblematic of where we are now. It may not be three days of peaceand music, but the numbers express the importance of CRC screening.
The QuickVue® iFOB (immunochemical Fecal Occult Blood) is an easy to use testthat detects occult blood in stool, which may be an indication of CRC. Only onesample collection is needed and there are no dietary or medicine restrictions.
March is National Colorectal Cancer Awareness Month, so make the pilgrimageto your doctor and ask to get screened. After all, the earlier cancer is detected,the more curable it is.2
©20
10Q
uid
elC
orp
ora
tio
n03
23O
N02
10D
(02/
10)
In 1969 about
450,000people attended Woodstock.
In 2010about 147,000people will be
diagnosed with
ColorectalCancer. Approximately
50,000of them willdie from it.1
QUIDEL_ColonCancer_USAToday.qxd:Layout 1 3/4/10 3:08 PM Page 1
COLON HEALtH
4
In 2008, The American College of
Gastroenterology (ACG) issued
new guidelines for colorectal
cancerscreening.Basedonthebest
evidence available, the new guide-
linesoffermorespecificrecommen-
dationsthaninthepastanddivide
screeningtestsintotwogroups:can-
cerpreventionandcancerdetection.
Asyouwouldexpect,theACGrec-
ommendsteststhatpreventcancer
overthosethatdetectit,withcolo-
noscopybeingthepreferredscreen-
ing strategy. “A colonoscopy is the
goldstandardinscreeningbecause
it is both diagnostic and therapeu-
tic,” says Dr. howard K. Berg MD,
headofcolonandrectalsurgeryat
St. Joseph’s Medical Center Cancer
Institute in Towson Maryland. That
isbecausecolonoscopyallowsyour
doctor to carefully examine inside
the rectum and the full length of
thecolon,aswellasremovepolyps
andtaketissuesamples (biopsy)of
any suspicious areas. “If a polyp is
found,95percentofthetimeitcan
beremovedduringtheprocedure,”
says Dr. Berg. “Removing a polyp
that has malignant potential can
preventapersonfromevergetting
coloncancer.”
Even if cancer is present, colo-
noscopy offers benefits. “If you are
pickingupcancerpriortotheperson
havingsymptoms,itwilllikelybeat
anearlystagewhen it ismoreeas-
ily treated and there is a dramatic
improvement in survivability,” says
Dr. Berg. “If you are average risk
and your colon is clean following
colonoscopy, the test need not be
repeatedfor10years.”
For those who cannot afford or
areunwillingtohaveacolonoscopy,
other options exist. Sigmoidoscopy
is similar to colonoscopy but only
showsthelowerportionofthecolon.
Acomputedtomography (CT)colo-
nography, or virtual colonoscopy,
everyfiveyearsisanotheralternative.
Fecal immunochemical testing
(FIT)looksforthepresenceofoccult
(hidden)bloodinstool.Unlikeolder
formsof fecaloccultbloodtesting,
FIT tests such as the Quickvue®
iFOB(immunochemicalFecalOccult
Blood) test from Quidel® Corpora-
tionuseantibodiestomeasurethe
presence of human hemoglobin
making them more sensitive and
accurate.Theyarealsonotaffected
by what or how much you eat as
older guaiac-based tests are. The
QuickvueiFOBofferstheadditional
advantageofrequiringonlyasingle
sample. FIT is a detection test and
shouldbeperformedannually.
For average risk individuals, it’s
recommendedthatscreeningbegin
atage50,butforAfricanAmericans,
even those at average risk, testing
shouldbeginat45.Ifyouhavefam-
ilyhistoryorotherincreasedriskfor
CRC,screeningshouldbeginearlier
withmore frequent follow-up.And
of course if you have symptoms,
don’twait!Talktoyourdoctorright
awayandasktobescreened.
D iagnosed in 2002, Sharon
has shared her personal
journey every step of the
way in hopes that her story would
raise awareness about the disease
andencourageotherstobeproac-
tiveaboutit’spreventionanddetec-
tion.“Nobodywantstotalkaboutit
becauseofwhereitis,”saysSharon.
“Everysinglepartofourbodiescan
get sick so why should this be so
hush hush? When you look at the
statistics thatsurround it,weneed
tobetalkingaboutit.”
Sharon is spot on. With ap-
proximately150,000newcasesand
50,000 deaths a year, colorectal
cancer isthesecondleadingcause
ofcancerdeathsforbothmenand
women behind lung cancer. But
unlikeothercancers, itdoesn’tget
the same kind of attention. “What
color ribbon is there for it?” asks
Sharon. “There isn’t one. Nobody
wants to talk about this disease.
It’snotsexy, is it?But if it’scaught
early, you don’t even need any
chemo—it’slikelyanoperationand
it’s gone.” Sharon herself was not
sofortunate.herdoctorsestimated
thatbythetimeitwasdiscovered,
hercancerhadbeenthere for four
years. Because her lymph nodes
were involved, chemotherapy was
necessary.
Appropriatetreatmentvaries for
eachpatient,butwithearlydetec-
tion colorectal cancer is one of
the most curable forms of cancer.
Unfortunately, there are often no
symptomsassociatedwithitsearly
stages. “It is one of those cancers
youjustdon’tknowyouhave,”says
Sharon. “The only reason I knew
I had it was because I was con-
stantly tired. I thought it was just
because I was so busy, but I had a
blood test and they told me I was
soanemicImustbebleedingfrom
somewhere. I didn’t believe it but
I got the colonoscopy done and it
savedmylife.”
According to the American Can-
cer Society, 75 percent of cases
occur in people with no risk fac-
tors. Sharon had no family history
of any type of cancer and she was
diagnosed before she was 50, the
recommendedagetobeginscreen-
ing.“Iknowsomany—agirlof19,a
ladyof26—thathavethisdisease.I
havemetpeoplethroughmyjour-
neythatareallages,allcolors,there
arenonormsforthisdisease.you’ve
gottolistentoyourbody!”
you also have to take care of it.
Sharonisconvincedthathercancer
resultedfromherpoordietandun-
healthylifestyle.“Iatesomuchcrap
and so much animal fat, especially
fromdairy—milkshakes, icecream,
butter.AndIwasaverylazyperson;
Ididn’tgetanyexercise.”Allthathas
changed.Today,Sharonishealthier
andmorevibrantthaneverandshe
intendstokeepitthatway.
“I look at it this way, every day
truly is the first day of the rest of
your life,” says Sharon. “When you
wake up tomorrow, think about
howyouhavetorespectyourbody;
you have to respect what you put
inyourbody.Sooftenwedon’t,we
abuseourbodies.Ifwetreatedour
wholebodiesthewaywetreatour
faces, that would be great!” Wise
wordstoliveby.
If discovered early, Colorectal Cancer (CRC) is curable in over 90 percent ofcases.Unfortunately,thisslowgrowingcanceroftenhasnosymptomstoalertyoutoitspresence,especiallyduringtheearlystageswhentreatmentwouldbemosteffective.That’swhyitissoimportanttobescreenedforCRC.Butwhoshouldbescreened,whenandwhattypeoftestshouldtheyhave?
Tenacious,compassionate,andcommittedtomakingadifference.ThesearejustafewofthewordsthatcometomindwhenIlistentoSharonOsbournetalkaboutherexperiencewithcolorectalcancer.
What You Don’t Know Can Hurt You!
Sharon Osbourne: Words of Wisdom from a Survivor
If you are average risk and
your colon is clean following colonoscopy, the test need
not be repeated for 10 years.
By:CINDyhEROUx
SharonOsbourne
TrimSize: 9.75” x 10.25” ONUS10UBMS01601: Publication:
Colorectal Cancer Awareness
Bristol-Myers Squibb Proudly Supports
© 2010 Bristol-Myers Squibb. All rights reserved. ONUS10UBAD02503 02/10
Bristol-Myers Squibb is a leader in the fight against cancer. We introduced our first cancer treatment over 40 years ago. Today, we continue our mission to discover, develop and deliver innovative medicines for people battling cancer and many other serious diseases. For more information, go to www.bms.com.
ONUS10UBAD02503_v1_TWCP_Kevin.indd 1 3/3/10 10:20 AM
COLON HEALtH
6
Q: Can the foods we eat increase or
decreaseourrisk forcolorectalcan-
cer?
A: “Absolutely!”saysregistereddieti-
tianCindyheroux.“Adiethighinred
and processed meats can increase
yourriskofcoloncancer,butaplant-
based diet that’s high in fruits, veg-
etablesandwholegrainscanprotect
youagainstcancer.”
Togetthemostcancerprotection,
Cindy recommends eating foods as
closetothewaynaturemadethemas
possible.“Themoreprocessedafood
isthemorelikelyitistohavelessof
whatyourbodyneeds,andmoreof
whatitdoesn’t.Also,whileindividual
nutrients are important, they rarely
workalone.Oftentimesit’sthecom-
binationofnutrientsinagivenfood
thatmakeitsopowerful.Forexample,
anappleeatenwiththepeelonhas
farmorecancerfightingabilitythan
onewiththepeelremoved.”
A whole foods, plant-based diet
helps protect you against cancer in
severalways.“Morefiberhelpskeep
everythingmoving,andtheantioxi-
dants and phytochemicals found in
brightly colored fruits and vegeta-
blesofferspecialprotectionagainst
cancer,” explains Cindy.“Fruits, veg-
etablesandwholegrainsarepacked
with nutrition, but naturally low in
calorieswhichalsomakesiteasierto
maintainahealthyweight,animpor-
tantriskfactorforcolorectalcancer.”
Q: Whyisearlydetectionofcolorectal
cancersoimportantandwhattypeof
screeningisbest?
A:“Whendetectedatanearlystage,
colorectalcanceriscurable,”saysDr.
Krasna.“Ifyouarenotscreenedprop-
erly and the cancer progresses, it’s
lesslikelytobecured.”Infact,when
detectedearly,colorectalcancermay
becurableinover90percentofcases.
Whoshouldbescreened,andwhen,
dependsonyourpersonalandfamily
history.
“There have been recent changes
intherecommendations,”explainsDr.
Krasna,“notforthoseathighrisk,but
forthegeneralpopulation.Everyone
over50whoisataverageriskshould
have a colonoscopy every 10 years.
Other options such as a flexible sig-
moidoscopyorCTcolonography(vir-
tualcolonoscopy)arerecommended
everyfiveyears.Afecaloccultblood
test (gFOBT), fecal immunochemi-
caltest (FIT)andrectalexamcanbe
doneyearly.Ifyouarepredisposedto
cancerbecauseofafamilyhistoryof
colorectalcancerorpolyps,oraper-
sonal history of Inflammatory Bowel
Disease(IBD)suchasulcerativecolitis
or Chrohn’s disease, you need to be
screenedearlier.”
Q: Why iscolonhealthso important
andwhatcanwedotohelpmaintain
ahealthycolon?
A: “Thecolonis importantfornutri-
tionalhealth,butitisalsoanimpor-
tantregionofimmunefunction,both
locallyandfortheentirebody,”says
Dr. Jampolis.“It is one of the body’s
first lines of defense against toxins
you take in through food, and hav-
ingsufficienthealthybacteriainthe
coloncanhelpboostoverallimmune
cellular function in addition to pro-
tectingyourcolon.”
Tominimizeexposuretotoxins,im-
proveregularity,andkeepthecolon
healthy, Dr. Jampolis recommends
consuming a diet high in naturally
occurringfibersuchaswholegrains,
fruitsandvegetables,aswellasfoods
containing probiotics (healthy bac-
teria) such as yogurt.“Naturally oc-
curring fiber is important,” explains
Dr. Jampolis. “Research has shown
thataddingwholegrainstoyourdiet
hasaprotectiveaffectagainstcolon
cancer.That’snotnecessarilythecase
with simply adding fiber to other
foods,especiallylesshealthyones.”
Dr. Jampolis adds,“Fiber not only
speeds transit time and increases
stool bulk which can help control
constipation,butitalsoprovidesfood
to support the growth of healthy
bacteriawhichcanalterthephofthe
colon, providing added protection
andimprovingmineralabsorption.”
Q: Prevention or early detection of
colorectal cancer is ideal, but are
there options for people who have
advanceddiseasethathasspreadto
otherpartsofthebody?
A: “There are numerous options for
thesepatientssuchaschemotherapy
combinationsthathavebeenshown
tobeeffective,aswellassurgicaland
chemotherapycombinations,”saysDr.
Bartlett.“AtUPMCCancerCenters,we
havedevelopedaColonCancerSpe-
cialtyCareCenterwherethemedical
oncologist,thesurgeonandtheradia-
tiononcologistworktogethertocome
up with individualized treatment
plansforeachpatient.”
Thosetreatmentplansofteninvolve
novelapproachessuchasdelivering
chemotherapy during surgery. Dr.
Bartlett explains,“We can surgically
isolate a region of the body such as
theabdominalcavity,oranorgansuch
astheliver.Bydeliveringthechemo-
therapydrugsdirectlytothatregion
ororgan,wecanminimizesideeffects
totherestofthebodyanddelivera
muchhigherconcentrationofchemo-
therapydrugstothetumor.”
Participationinclinicaltrialsmaybe
anoption.“Inadditiontothemedical
specialists,wehaveourteamofclinical
researchexperts,”saysDr.Bartlett.“This
offerspatientsinvolvementinclinical
trials,someofwhichareuniquetothe
ColonCancerSpecialtyCareCenterat
UPMC Cancer Centers.” For patients
with metastatic colon cancer, these
innovativetherapiesoffermorethan
justoptions,theyofferhope.
Panel Of Experts
CINDyhEROUx,RDSpeaker,AuthorofThe Manual That Should Have Come With Your BodyPresident,SpeakingofWellnesslC
MARKKRASNA,MDMedicalDirectoroftheCancerInstituteSt.JosephMedicalCenterinTowson,Maryland
BRANDONhAyES-lATTIN,MDSeniorMedicalAdvisorlanceArmstrongFoundation
MElINAJAMPOlIS,MDInternistandBoardCertifiedPhysi-cianNutritionSpecialist
DAvIDl.BARlETT,MDChief, Division of Surgical Oncology
Director,SpecialtyCareCenters,
UPMCCancerCentersandUniversity
ofPittsburghCancerInstitute
Q: lance Armstrong and the
livestrongFoundationhaveprovided
knowledge, inspiration and encour-
agement to so many people. What
role does personal empowerment
playinthepreventionandtreatment
ofcolorectalcancer?
A:“ThelanceArmstrongFoundation
believes that knowledge is power,”
says Dr. hayes-lattin. “In colorectal
cancer(CRC),thisincludesknowledge
about preventing cancer, detecting
a diagnosis early, understanding a
diagnosis, finding the best therapy,
andplanningfor the future. Inorder
toapplythatknowledge,it iskeyfor
patientstohaveaccesstotheirmedi-
caldatasuchasbiologic risk factors,
pathologyandstaginginformation,or
treatmentsummaries.”
Empowerment enables patients
tobeactiveparticipantsintheirown
care—to be proactive rather than
reactive.
“Next generation electronic tools
maybetterempowerpatientstoshare
knowledge as they tell their story,”
saysDr.hayes-lattin.“Someelements
of a patient’s cancer story include
describing the psychosocial impact
andsharinghelpfulresourcesinclud-
ingdetailsaboutgeneticandbiologic
markers,treatmentresponses,andpa-
tientreportedoutcomes,allofwhich
may better inform cancer research.
The lance Armstrong Foundation is
committed to building tools which
enablepatientempowerment.”
As we move forward advancing cancer treatment,we’re leaving behind a legacy.
Doctors know that the latest cancer research doesn’t make an impact until it touches a patient.At UPMC Cancer Centers, researchers work closely with oncologists to rapidly translate lab discoveries and clinical research into effective new treatments. This means that more than 36,000new patients each year benefit from the most advanced cancer therapies. As part of one of the largest clinical care networks in the country, UPMC Cancer Centers is bringingworld-class resources and treatments directly to patients in their own communities. To learnmore about research and treatment at UPMC Cancer Centers, call 1-800-533-UPMC or visitUPMCCancerCenters.com.
Affiliated with the University of Pittsburgh School of Medicine, UPMC is ranked among the nation’s best hospitals by U.S.News & World Report. UPMC Cancer Centers works in tandem with the University of Pittsburgh Cancer Institute,
a National Cancer Institute-designated Comprehensive Cancer Center.
UPMC.com | 1-800-533-UPMC
ADV383400_CancerNationalAdUSAInsert_LGH:Layout 1 3/16/10 4:17 PM Page 1
COLON HEALtH
8
Current recommendations sug-
gest being screened for CRC
starting at age 50, but if you
experienceanyofthesymptomslisted
below, it’s important to talk to your
doctorregardlessofyourage.
Suzanne Dixon, MPh, RD, an epi-
demiologist, and the Colon Cancer
Guide for About.com, explains that
symptomsofCRCcome in twogen-
eral varieties: local symptoms and
systemicsymptoms.“localcoloncan-
cer symptoms affect your bathroom
habitsandthecolonitself,”saysDixon.
“Systemic colon cancer symptoms
are those that affect your whole
body,suchasunexplainedfatigueor
weightloss.”
localsymptomstowatchforinclude:
• Changes in the frequency of your
bowelmovements
• Changesintheconsistencyofyour
bowelmovement
Areyouexperiencingconstipation
ordiarrhea?
• Bloodinyourstool
Bloodmaybebrightred,darkcol-
ored,orblackandtarrylooking.
•Painordiscomfort
Do you have frequent gas pains,
cramps,orbloating?
• Feeling as if your bowels don’t
emptycompletely
All of these symptoms can be
caused by things other than cancer,
but don’t take unnecessary chances.
“Ifyouexperienceanyofthesesymp-
tomsfortwoormoreweeks,callyour
doctorrightawaytodiscussyourcon-
cerns,”saysDixon.
Systemicsymptomsinclude:
• Unexplainedfatigue
• Unexplainedweightloss
haveyoulostyourappetite?
• Nauseaorvomiting
• Anemia
like local symptoms, systemic
symptoms also have many possible
causes,butdon’tletthatpreventyou
fromtalkingwithyourdoctorabout
them. Early diagnosis and treatment
aretooimportanttowait.
Unlikefast-growingcancersorcancersyoucansee,colorectalcancer(CRC)oftenhasnosymptomsatall,especiallyduringtheearlystages.
Warning Signs: When to Get tested
These risk factors include:
Age
Over 90 percent of people
diagnosedwithcolorectalcancerare
overtheageof50,butcolorectalcan-
cercan—anddoes—affectpeopleof
allages.
Your Personal Health History
If you have had colorectal cancer
in the past, you are at increased risk
fordeveloping itagain inthe future.
Ifyouhaveahistoryofcolonpolyps
or InflammatoryBowelDisease(IBD)
such as ulcerative colitis or Crohn’s
disease,yourriskisalsoincreased.Ir-
ritableBowelSyndromeorIBSisnot
associatedwithanincreasedrisk.
Your Family History
If a close family member has had
colorectalcancer,especiallyifitwasat
ayoungage,orifmanyfamilymem-
bershavehadcolorectalcancer,your
riskisincreased.Itisnotclearwhether
the increased risk is due to genetics
or having similar lifestyles and envi-
ronmentalexposure.Itisimportantto
notethatonly10to20percentofCRC
casesinvolvepeoplewithafamilyhis-
tory.yourfamily’shistorymightbegin
withyou.
Inherited Genetic Alterations or
Syndromes
Inherited changes in genes can
increaseyourriskofspecificformsof
colorectalcancer.Thesealterationsac-
countforapproximatelyfivepercent
ofCRCcases.
Race and Ethnicity
AfricanAmericanshavethehighest
incidenceofcolorectalcancer in the
UnitedandStatesandJewsofEastern
European descent (Ashkenazi Jews)
havethehighestworldwiderisk.
Lifestyle
Colorectalcanceriscloselyrelated
to diets high in red meat, processed
meats,andanimalfat,andthoselow
infruits,vegetablesandfiber.lackof
exercise,smoking,andheavyalcohol
usealsoincreaseyourrisk.
Obesity
Obesityincreasesbothyourriskfor
developingCRCandyourriskofdying
fromthedisease.
Type 2 diabetes
Non-insulindependentdiabetesand
insulinresistancehavebothbeenas-
sociatedwithanincreasedriskofCRC.
Ifyouhaveanyoftheseriskfactors,
it’s important to talk with your doc-
tor.Togetheryoucanmakeinformed
decisions about colorectal cancer
screening.
Colorectalcancercanaffectanyonebutcertainriskfactorsareassociatedwithanincreasedchanceofdevelopingthisdisease.
Are You At Risk For CRC?
Astory that her mother Andrea
hopestospareotherfamilies
fromhavingtorepeat.
Stefanie’s great grandmother had
been diagnosed with colon cancer
when she was in her sixties. her
grandfatherhadbeendiagnosedwith
coloncancerforthefirsttimeinhisfif-
tiesandwentontobattlecancerfour
moretimes.herfatherwasdiagnosed
withcoloncancerwhenhewasthirty-
nineyearsoldandhada recurrence
at fifty. With each generation, the
dreadeddiagnosisarrivedyearsearlier
thanintheprecedinggeneration.yet
when Stefanie began suffering from
chronic high fevers, immunological
problemsandevenabdominalpaina
fewmonthspriortoherdiagnosis,her
parentswererepeatedlyassuredthat
hersymptomswerenotbeingcaused
by colon cancer and a colonoscopy
wasnotperformed.
For two years Stefanie worked
throughherillnessesandfollowedthe
adviceofherdoctors.Shegraduated
collegeinMayof2008,andfilledwith
excitementandanticipation,headed
toIsraelforaBirthrighttrip.Itwasdur-
ing that trip that she was overcome
withcripplingpain.
Initially, doctors again dismissed
the possibility of colon cancer, but
one insistent physician pushed for
a scan. Within hours Stefanie was
having emergency surgery and her
terrified parents heard the words
theyhad feared forso long. “Iknow
exactlywherewewere,exactlywhat
Iwaswearing,”explainedAndrea.The
doctorsimplysaid,“‘youshouldcome,
your daughter has cancer.’” As they
waitedattheairportfortheflightthat
wouldcarrythemtotheirdaughter’s
side,Stefanie’sparentsreceivedasec-
ondcalltellingthemthecancerhad
spreadtoherliver.
“Unfortunately, Stefanie’s cancer
couldnotbecontainedwithchemo
andradiation.Ineightmonthsitwas
everywhere and she died at 22. She
never complained, not even about
the terrible pain, never asked why
thishappenedtoher,shewasalways
moreconcernedabouteveryoneelse.
Shewasthebrightlightineveryone’s
life,”saysAndrea.
After Stefanie passed away, her
parentsinsistedheryoungerbrother
Evan have not only a colonoscopy,
but also an endoscopy and urine
test for bladder cancer. Even with
hisoverwhelmingfamilyhistoryand
informationabouthowfarhissister’s
cancerhadspread,thedoctorthought
theadditionaltestswereunnecessary.
“Theykept tellingmethatbasedon
statistics I should not have my son
testeduntilhewas35.WhyshouldI
wait? I don’t care what the statistic
said.Statistically,mydaughtershould
neverhavediedatherage,howcould
theytellustowait?”asksAndrea.As
was the case with Stefanie’s older
brother Josh, Evan showed no signs
of cancer, but genetic screening re-
vealedthatAndrea’ssoncarriedthe
samegeneashisfatherandsister.
Andrea hopes that by sharing
Stefanie’sstory,somethinggoodcan
come from her daughters’ death. “If
it’sinthefamily,ifit’sgenetic—don’t
wait,gettested.Idon’twantoneother
youngpersontolosetheirlife.”
Stefanie’s Story: Cancer In Her GenesStefanieRiegerdidn’tfitthestatistics.Just22whencoloncancerclaimedher life,Stefanie’sstory tellsthetaleofanentirefamily’sstrugglewithgeneticcoloncancer.
9
COLON HEALtH
WE BELIEVE IN LIFE.
Your life. We believe in living every minute of it with every ounce of your being.
And that you must not let cancer take control of it.
We can help you face the challenges of cancer at 866.235.7205 or online at
LIVESTRONG.org/cancersupport.
Anyone, anywhere can join our fight against cancer. Join us at LIVESTRONG.org.
© 2010 LIVESTRONG, a registered trademark of the Lance Armstrong Foundation. The Lance Armstrong Foundation is a 501(c)(3) under federal tax guidelines.
The general consensus is that
atleast50percentofallcases
of colorectal cancer could be
preventedbylifestylealone,andone
recentharvardstudy foundthat the
riskcouldbereducedbyasmuchas
70to75percent!
Evidence forsome lifestyle factors
isstrongerthanforothers,buthereis
whatweknow.AccordingtoEdward
Giovannucci, MD SCD, professor of
epidemiology and nutrition at the
harvardSchoolofPublichealth,“Itis
veryclearthatmaintaininganormal
body weight would decrease some-
one’srisk forcolorectalcancer (CRC).
Alsobeingphysicallyactiveisprotec-
tive.youdon’thavetobeamarathon
runner-walking just four hours per
week decreases risk substantially.”
Smokingraisesyourriskandsodoes
excessivealcoholconsumption.
Theserecommendationsareconsis-
tentwiththosethatpromoteoverall
health and also lower your risk for
otherformsofcanceraswellasheart
disease,diabetesandstroke.
Diet—A Powerful Ally
how diet is related to colorectal
cancer(CRC)riskisthetopicofmuch
research and debate. “To the extent
thatdietimpactsobesity,it’sveryim-
portant,butbeyondthat,whatismost
consistentlyassociatedwithincreased
riskofCRCishighconsumptionofred
meat, especially processed meats,”
saysDr.Giovannucci.“It’sbeenhardto
teaseoutexactlywhythisisthecase,
butthereisevidencethatcookingcan
leadtotheproductionofcarcinogens
in well done meat, and processed
meats contain compounds that are
convertedtocarcinogens.”
Mostnutritionexpertsbelievethat
a plant-based diet offers many ben-
efits.JoelFuhrman,MD,aboardcerti-
fiedfamilyphysicianandauthorofEat
For Health and Eat To Live,explainsthat
aplant-based,“nutritarian”diet—one
that focuses on the nutritive quality
offoodandishighinfruitsandveg-
etables—not only reduces exposure
to possible carcinogens, but offers
a protective effect against cancer.
“Fruits and vegetables, cruciferous
vegetables, retard the expression of
cancergenes,”saysDr.Fuhram.“Con-
sumption is inversely related toCRC
risk.”
Both of these physicians agree
on the importance of making good
choicesasearlyaspossible.“Thereisa
longlagtime,perhapsasmuchas20
to25years,betweendietarypatterns
and development of the disease,”
explainsDr.Fuhrman.“Thosewiththe
highestconsumptionofplantfoodin
childhoodhavethelowestincidence
of CRC as adults.” Dr. Giovannucci’s
research supports this. “CRC takes
decadestoprogress,”saysDr.Giovan-
nucci.“Somenutrients,suchasfolate
(a B vitamin that is especially abun-
dantingreenleafyvegetables,beans
andpeas),whenconsumedatavery
early stage, may be preventing that
progression.”
There is significant evidence to
suggest that calcium and vitamin D
are also important. According to Dr.
Fuhrman, “Some studies show that
with adequate vitamin D levels, the
body isbetterabletotakecells that
wouldhaveprogressedtocancerand
haltthatprogressioninit’stracks.”
A simple blood test can alert you
to whether or not you are getting
enoughvitaminD.Forcalcium,800—
1000mgmaybesufficienttoprotect
againstCRC,butyoumayneedmore.
Makingchangestothewayweeat
canbechallenging,butitisaninvest-
ment inyourhealth,asDr.Fuhrman
remindsus.“Thesamedietaryrecom-
mendationsthatdecreaseriskofCRC
decrease risk of the most common
cancers simultaneously and other
conditionsaswell,includingdiabetes,
stroke,heartdiseaseandsuddencar-
diacdeathfromirregularheartbeats.”
Prevention: the Choice Is YoursColorectalCancerisacomplexdiseasethatisaffectedbymanyfactors,butonethingisabsolutelycertain—thelifestylechoicesyoumakeeachandeverydayhavethepowertoinfluencewhetheryouareeveraffectedbythisdiseaseornot.
COLON HEALtH
10
“There was something
wrongwithme, Isensed
it,” says Carmen. “So I
went to the doctor and they did all
thesetestsandtheycouldn’tfindany-
thing.Thenwedidacolonoscopy,and
theyfeltsomethingandrighttherein
themiddleoftheprocedurethedoc-
torsays,‘youhavecancerandit’sthe
sizeofalemon.’”
That’snottypicallythewayphysi-
cians share such serious news, but
whatwasequallyshockingforCarmen
wasdiscoveringthathehadafamily
historyofcoloncancerheknewnoth-
ingabout.
“Ihadthetumorremoved laparo-
scopically and they had to remove
partofmycolon,”saysCarmen.“Then
I foundoutafterwardthat Ihadtwo
family members, one on each side,
thathadcolorectalcancer(CRC).One
oftheproblemswithCRCisthatno-
bodywantstotalkaboutit.”however,
withnofamilyhistoryonrecord,Car-
men’sinsurancedidn’twanttocovera
colonoscopyuntilhewas50.“I’mfine
now,butmycancerwasstageIvwhen
it was detected,” explains Carmen.
“hadIbeenforcedtowait,myprog-
nosiscouldhavebeenmuchdifferent.
youneedtohavefulldisclosure,you
needtohavethefamilyconversation.”
Duringhistreatmentandrecovery,
Carmen struggled with the kind of
“crazyemotionalrollercoaster”many
cancerpatientsdo.“Ilovegardening,”
says Carmen, “so I started weeding
anditwaslikeIwasweedingthecan-
ceroutofmybody.ThenIdecidedto
plantacancergardenandIplantedall
kindsofflowersandthatwasmyway
ofdealingwiththeemotionaltrauma.”
ItalsohelpedCarmenreflectonwhat
hewasdoingwithhislife.“Whenyou
are dealing with cancer you really
reevaluateyourlifeinastrangeway.”
Carmendecidedtobreakhissilence
andusehisplaceinthefashionworld
as a vehicle for raising awareness.
“Sometimes fashion can seem so
frivolous,” says Carmen. “But I love
whatIdo.Ilovedressingwomenup,
I lovehelpingthemfeelempowered
ontheirspecialoccasions.Fashionis
mypassion,butusingfashiontoraise
awarenessofCRCgivessomuchmore
meaningtowhatIdo;throughfashion
Icanreachsomanywomenwithan
evenmoreempoweringmessage.”
Carmen is now an ambassador
for the National Colorectal Cancer
Research Alliance (NCCRA). he has
also participated in a host of cancer
awareness events, partnering with
celebrities like Katie Couric and
vanessaWilliams,andtheEntertain-
ment Industry Foundation (EIF). In
recognition of his work, he received
the first ever Advocate Award from
KatieCouricin2006.Recently,hehas
beentakinghisfashionshowonthe
road to attract attention and raise
moneyforthisimportantcausewith
retailpartnersandtheAARP.“We’ve
made breast cancer fashionable,
we’ve made ovarian cancer fashion-
able,IwanttomakeCRCfashionable,”
saysCarmen.
It seems we are OK with routine
screenings associated with our
breastsandourprostates,butthe
mere thought of having our colons
andrectumsexaminedsendspeople
running for cover. For some, it’s a
sourceofembarrassment;othersare
concerned about the discomfort or
inconvenienceofscreeningtests.But
formostpeople,thegreatestfearof
alliswhatthetestsmightreveal.
“People often associate being
screened for CRC with the assump-
tion that something is wrong,” says
lynda Mandell, MD, PhD, a dually
boarded radiation oncologist and
psychiatristwithaprivatepsychiatry
practiceinNewyorkCityspecializing
is psycho-oncololgy. “This assump-
tion, which provokes fear even in
individuals not at high risk for the
disease,oftenresultsinavoidanceof
screeningtests.”
A board member of the Ameri-
can Psychosocial Oncology Society
andTheSusanCohanKasdasColon
Cancer Foundation, Dr. Mandell’s
uniquebackgroundgivesheradeep
appreciation for what patients go
through.Sheexplains,“forthosewith
nofamilyhistoryofcancer,muchof
the anxiety associated with being
screened stems from anticipatory
worry—‘What will happen if I have
cancer?’ For people who have wit-
nessed a loved one experience the
disease,thatanxietyisintensifiedby
thethoughtthatwhathappenedin
thepastwillhappentothem.”InCog-
nitiveBehaviorTherapy,thisisknown
asacognitiveerror.
Dr.Mandellhelpspatients recon-
struct these thoughts to more ac-
curately reflect the realities of their
personal situation. “It’s important
toacknowledgethose thingsabout
the present situation that may be
the same as what happened in the
past,butthentolookatwhatisdif-
ferent.Ifafamilymemberwasolder
ordiagnosedwithanadvancedstage
ofcancerbutyoucatchcancerearly,
yourexperiencecouldbecompletely
different.”
Catastrophizing is another form
ofcognitiveerrorthatholdspeople
back.“Apersonstartsbleedingalittle
bit and their first thought is ‘I have
cancer,’“saysDr.Mandell.“Thenthey
startthinkingaboutalloftheterrible
thingsthatcouldhappen—I’mgoing
die,bedisfigured,myspouseisgoing
to leaveme,andsoon.Theseesca-
latingthoughts trigger fear,anxiety
andguiltsointenseit’simmobilizing,
even though the bleeding may not
becanceratall.”
Dr.Mandell recommends looking
at each of these fears and examin-
ing the likelihood of them happen-
ing. “For example, if you are afraid
of dying, focus on how curable this
canceris,especiallyifdetectedearly.
Ifyouareworriedaboutsideeffects,
recognizing how advanced current
treatment options are compared to
thoseofthepastcanhelpreducethe
intensityofyouranxiety.”
It’salsohelpfultothinkaboutoth-
ers.“Ifyoucan’tdothisforyourself,
thendo it for thepeopleyou love,”
saysDr.Mandell.“Ifyoudohavecan-
cer, early intervention could spare
your loved ones’ unnecessary emo-
tionaldistressandheartache.Ifyour
cancerisgenetic,havingthatknowl-
edgeandsharingitwithyourfamily
allows them to make the best deci-
sions possible for their own health
andcouldevensavetheirlives.”
For a long time Carmen Marc valvo, one of New york’s hottest fashiondesigners,kepthiscoloncancerprivate,evenfromhisclosestfriends—untilhe discovered that the silence and the stigma that so often surround thisdiseasealmostcosthimhislife.
Accordingto theNationalCancer Institute, ratesof screening forcolorectalcancer(CRC)areconsistentlylowerthanthoseforothertypesofcancer.
Opening Up About CRC
Don’t Let Fear Hold You Back
this assumption, which provokes fear even in individuals not at high risk for the disease, often results in
avoidance of screening tests.Ph
oto
cre
dit
by
Mel
anie
Du
nea
CarmenMarcvalvo
11
COLON HEALtH
“When a patient hears
a diagnosis of
colorectal cancer,
everypatientseesitasadeathsen-
tence,”saysMarkKrasna,MD,medical
directoroftheCancerInstituteatSt.
Joseph Medical Center in Towson,
Maryland.“But it’s important to ask
‘What stage of cancer do I have?’
Stagepredictssurvival;itshouldalso
determinetreatment.”
Colorectalcancer(CRC)iscurable,
especiallyifitiscaughtearly.Newap-
proachestotreatmentandadvanced
surgical options such as minimally
invasive laparoscopic surgery have
improvedsurvivability,andinmany
casesmadetreatmentlesstraumatic.
“IfyouarefoundtohavestageI,the
correct treatment is a colonectomy
withclearmarginsand lymphnode
sampling,” says Dr. Krasna. “If the
tumorisinthewall,andyoucanre-
move10”–12”,andthelymphnodes
arenegative,that’sfantasticbecause
you don’t really need other treat-
ment.”
If your cancer is more advanced,
additionaltreatmentmaybeneces-
sary.Dr.Krasnaexplains,“InstageII
or IIIwherethecancerbeginstoin-
vadeotherstructuresortheremight
be local lymph node involvement,
treatmentnotonlyinvolvessurgery,
butalsochemotherapy.”Twoofthe
biggest advances in CRC treatment
areadjuvant(inadditionto)therapy
followingsurgery,andneo-adjuvant
therapy—usingradiationand/orche-
motherapybeforesurgery,especially
in cases of locally advanced rectal
cancer.“Offeringchemotherapyand
radiationbeforesurgeryreducesthe
bulk of the disease making surgery
lessdebilitating,”saysDr.Krasna.
Inthemoreadvancedstages,mul-
tidisciplinarycareandindividualized
treatment is especially important.
“When you have stage II, III or Iv
cancer,youneedtohaveateamof
experts, not just one. you need a
surgeon, a medical oncologist and
perhapsaradiationoncologist,”says
Dr. Krasna. “Every patient with CRC
should be able to have their case
discussedprospectively(beforetreat-
ment)andhaveaconsensusreached
beforeanytherapyisstarted.”
Findingthatqualityofcareisget-
ting easier thanks to The National
CommunityCancerCenterProgram
(NCCCP), a government sponsored
initiativeofleadingcommunitycan-
cercenterscommittedtodelivering
the highest standards of care. “85
percent of cancer patients receive
careclosetohomeintheirowncom-
munity,” says Dr. Krasna. “The goal
of the NCCCP program is to ensure
these patients have access to the
samequalityofcareasthosewhoare
treated at large research hospitals;
care that includes multidisciplinary
care,screeningpatientsfromdispa-
ratepopulationsincludingtheunder-
served,andconductingclinicaltrials.”
“Thebestcareapatientcanreceive
according to NCI guidelines is in a
clinicaltrial,”saysDr.Krasna.“Inpart
becausetheyarebeingfollowedso
muchmorecloselybyawholeteam.”
St.Joseph’sisoneofonly16cancer
centersacrossthecountrythatispart
oftheNCCCPprogram.“Thereisno
reasonwhyapersoninacommunity
care setting can’t get the best care
possible.St.Joseph’sisacommunity
hospital, but we are sharing best
practices with a large network and
changingthefaceofCRCacrossthe
country.”
Improved standards of care and
medical advances offer great hope
forpeoplediagnosedwithCRC.Says
Dr.Krasna,“Today,evenpatientswith
metastatic dis-
ease can actu-
ally be offered
a chance at
cure.”
Nooneeverwantstohearthewords“youhavecolorectalcancer.”Butifyouorsomeoneyoulovedoes,it’simportanttoknowhowtofindthebestcarepossible.yourlifecoulddependonit.
Getting The Care You Need
“It’s a very exciting time in on-
cology,” says Rodrigo Brito
Erlich M.D., Director of he-
matologyandOncologyatGeisinger
healthSystemshenryCancerCenter
inWilkesBarre,PA.“Therehavebeen
majorchangesinourunderstanding
of solid tumors.We understood the
biologyofhowapolypprogressedto
cancer, but now we understand the
biologyofthecanceritself.”
Cancer results from mutations to
DNAthat result inabnormalcelldi-
vision.Byidentifyingthegenesthat
arealteredinaspecificcancer,drugs
canbecreatedto“target”molecules
neededfortumorgrowth.Targeted
therapiesaremoreeffectivethanex-
istingtreatmentsandarelessharmful
tonormal,non-cancerouscells.
Being able to screen patients for
thesegeneticalterationsalsoenables
doctors topredictwhetherornota
particularcancerwill respondto,or
beresistanttocertaindrugs.Dr.Erlich
explains, “If the colon cancer has a
mutationofagenecalledKRAS,that
cancer will be completely resistant
to treatment with the monoclonal
antibodies cetuximab (Erbitux) and
panitumumab(vectibix),drugscom-
monly used in the the treatment of
advancedCRC.Forpatientswiththis
mutation, these drugs won’t work
and alternative treatment options
mustbeconsideredinstead.”
Colorectalcancermostcommonly
metastasizes(spreads)totheliveror
thelungs.Inthenottoodistantpast,
ifcancerreachedtheliver,chancesof
survivalwereminimal,butthatisno
longer thecase. “Even if cancerhas
spread to the liver, it’s not a death
sentence,” says Mark Fraiman, MD,
SurgicalDirectoroftheComprehen-
siveliverandPancreasCenteratSt.
Joseph’s Medical Center in Towson,
Maryland.“Theliveristheonlyorgan
inthebodythatregenerates.Wecan
remove up to 70-75 percent of the
liverandin6weeksit’sgrownbackto
itsnormalsize.Wearebettertrained
andmoreaggressiveintreatingthis
diseasethanweusedtobe.”
Surgicalremovalorresectioningof
colorectal liver metastasis has been
demonstrated to be not only safe,
buteffective,especiallywhen there
isnoevidenceofcanceroutsidethe
liverandthesurgeryisperformedby
an experienced liver surgeon. “The
surgeryissafer,thechemoisbetter
andwearecuringalotmorepeople
than we used to,” says Dr. Fraiman.
“One third to one half of patients
withmetastatic,stageIvdiseasecan
becured.”
Medicine On The Cutting EdgeTremendousprogresshasbeenmade in thetreatmentofcolorectalcancer(CRC) in recent years. The emergence of “targeted” therapies that enhancetheeffectivenessoftraditionalchemotherapy,andsaferyetmoreaggressivesurgicalproceduresofferhopeeventopatientswithadvancedstagesofCRC.
top related