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For other articles and previous issues click here. March 14, 2005 Action
Required With March being Colorectal Cancer Awareness Month, now is an ideal time to make an appointment with your doctor to get tested for this manageable—if caught early—disease. The numbers aren’t pretty. According to the Colon Cancer Alliance, excluding skin cancer, colorectal cancer is the third most diagnosed cancer in the United States. Only lung and breast in women and lung and prostate in men top the devastation wrought by colon cancer. The American Cancer Society estimates that one out of 18 people in this country will develop colorectal cancer in their lifetime. Perhaps the most encouraging aspect of the disease is that regular screening can detect the cancer early, when treatment is most effective. It is hoped that with March being Colorectal Cancer Awareness Month, more people will heed advice and get tested. The fact that 90% of those diagnosed when the cancer is found at a local stage (confined to the colon or rectum) survive more than five years should be incentive enough to see a physician before it’s too late. What’s more, in many cases screening can prevent cancer altogether by finding and removing polyps before they become cancerous. Cancer Growth The colon has four sections, any of which can house cancerous cells. The walls of each of these sections, as well as the rectum, have several layers or tissues where the cancer can start as a polyp. One in four people have polyps, but most of them never become cancerous. The early stages of colon cancer carry few symptoms. The most common and obvious symptoms occur later during the course of the disease and include rectal bleeding, unexplained weight loss, a feeling that the bowel does not empty completely, constipation, and diarrhea. If the cancer becomes large enough, it can block the colon, resulting in extreme abdominal pain and the elimination of bowel movements. More specific symptoms include blood in the stool that is bright red or very dark, unusually narrow stools, and abdominal discomfort such as gas pain, fullness, cramps, and bloating. Fatigue is also common. Keep in mind that other medical conditions, both serious and harmless, have symptoms similar to those of colon cancer. Common risk factors of colon cancer include a high consumption of red meat, a low-fiber diet, obesity, and smoking. People who have been diagnosed with inflammatory bowel disease appear to be at higher risk for colon cancer. Unlike its role in breast and endometrial cancer, estrogen appears to be a protective agent when it comes to women and colon cancer. However, obesity and estrogen status interact in influencing colon cancer risk. Research suggests that women with a high body mass index (BMI) who are either premenopausal or postmenopausal and taking estrogens have an increased risk of colon cancer similar to that found for men with a high BMI. In contrast, women with a high BMI who are postmenopausal and not taking estrogens do not have an increased risk of colon cancer. Treatment “With a smaller 3-inch incision, there is less manipulation of the bowel,” Swope says. “With the more common open surgical procedure, a patient might need five to eight days in the hospital to recover. But with this laparoscopic procedure, the hospital recovery period is reduced to two to four days.” Swope says this procedure is done by specially trained surgeons, either in university or private settings. He adds that new kinds of chemotherapies are slightly improving survival rates. Dale Burleson, MD, colon and rectal surgeon for the Texas Colon and Rectal Surgeons at Medical City, says a standard colonoscopy is still the most reliable diagnostic tool available to physicians. He says the procedure has a 99% success rate in detecting cancer or polyps. A colonoscopy is a procedure in which the rectum and entire colon can be visualized and any growths removed for analysis. Burleson also says genetic testing and stool checking are ways to help determine the amount of risk associated with a particular case and adds that CAT scan colonoscopies still have a ways to go before he would advise it as a method of diagnosing a specific case. “[CAT scan] is still an invasive procedure, and some physicians who push it may do so because they stand to make more money off it,” he says. “Most importantly, I believe it is an unreliable method compared to regular colonoscopies.” Like Swope, Burleson recommends laparoscopic surgery as an alternative to open surgery and says other benefits of this procedure include a decreased risk of blood clots and smaller long-term scars in the region. “Blood clots could be a serious complication that rarely occur but are less likely with a laparoscopic procedure,” says Burleson. Swope says chemotherapy treatments should improve over the next few years both in effectiveness and the elimination of side effects. Prevention “Routine screening is the biggest key,” says Swope. “Because when that happens once you get to the recommended age [50], or earlier if you have family history, chances are it will be caught early enough for treatment to still be effective. But it’s up to each individual to get him[self] or herself tested.” Bobby Smith, executive vice president of the Susan Cohan Kasdas Colon Cancer Foundation, says 56,000 people died from colon cancer in 2004 alone, bringing the total number of lives lost to approximately 150,000 over the past three years. But it is possible to lower those figures in the future. “Healthy lifestyle and diet are a great start, but the key is early detection via the colonoscopy—and early treatment,” says Smith. A slight variation of colon cancer is known as rectal cancer, in which malignant cells are found in the lining of the rectum. The rectum comprises the last 6 inches of the large intestine. The malignant cells may invade other surrounding tissue or spread throughout the body. Rectal cancer, which is more common in industrialized nations, carries an impressive cure rate—45% of all patients are completely cured. In recent years, rectal cancer has been appearing less in both men and women. Diets high in red meat, total calories, and alcohol consumption are common risk factors for rectal cancer. Symptoms such as red blood appearing in bowel movements, a noticeable change in bowel movements, unexplained constipation, urgent or inadequate bowel movements, and extreme buttock pain in serious cases usually appear before diagnosed. Swope says everyone aged 50 or older should be tested, regardless of family history. If someone in the family has developed colon or rectal cancer, Swope recommends being tested before the age of 50. Recurring Colon Cancer New data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial give fresh insight into the appropriate screening intervals for colorectal cancer after a negative exam. The interim report, published in the July 2, 2003, issue of The Journal of the American Medical Association, is the largest study to date of repeat sigmoidoscopy screening after an exam. The current accepted interval for sigmoidoscopy, a technique in which the rectum and lower colon are examined with a lighted instrument called a sigmoidoscope, is five years after a negative exam. This recommendation is based primarily on indirect evidence. Exactly how often to repeat sigmoidoscopy is an evolving field of research. Whether data from the new study, which measures the incidence of growths or polyps three years after an initial exam, will play a role in changing the current five-year interval is unclear. “We have very little observational data on what to expect on repeat screening after a negative exam,” says Robert E. Schoen, MD, MPH, of the University of Pittsburgh, and first author of the study. “Our data is the first representative estimate of what can be expected on repeat examination three years after a negative sigmoidoscopy in the general population.” In a study involving 9,317 participants, researchers measured the incidence of benign, precancerous, and cancerous growths in the lower 24 inches of the large intestine three years after an initial screening when no polyps or growths were found. The participants were screened using sigmoidoscopy. Those with a polyp or growth were referred to their physicians for further follow-up, usually a colonoscopy. The researchers found that 13.9% (1,292 out of 9,317) of the participants had a polyp or growth, the majority of which were benign. However, 2.3% of the participants (214 out of 9,317) had nonadvanced adenomas (precancerous lesions) and 0.8% (78 out of 9,317) had an advanced adenoma or cancer. These growths were present in the rectum or lower colon, which is the portion of the large intestine that can be visualized using sigmoidoscopy. A handful of previous smaller studies of repeat sigmoidoscopy ranging from approximately one to five years in selected populations reports an incidence rate for adenomas of approximately 5% to 6% and an advanced adenoma rate of less than 1%. For all stages of colon cancer, except stage 4, surgery to remove the tumor is the initial treatment. Stage 4, the most serious phase of the disease, is when cancer has spread outside the colon to other parts of the body, such as the liver or lungs. In a stage 4 case, the tumor can be any size and may or may not include affected lymph nodes. — Mike Scott is a freelance writer who has contributed to more than 70 magazines, newspapers, and Web sites on numerous topics—from business to healthcare to technology. Colorectal Cancer
Prevention • Diet and lifestyle: Diet appears to be associated with colorectal cancer risk. Among populations that consume a diet high in fat, protein, calories, alcohol, and meat (both red and white) and low in calcium and folate, colorectal cancer is more likely to develop than among populations that consume a low-fat, high-fiber diet. One study has found that a diet low in fat and high in fiber, fruits, and vegetables does not reduce the risk of colorectal cancer recurrence during a three- to four-year period. A diet high in saturated fat combined with a sedentary lifestyle may increase the risk of colorectal cancer. There is also evidence that smoking cigarettes may be associated with an increased risk of colorectal cancer. • Nonsteroidal anti-inflammatory drugs (NSAIDs): Some studies have shown that the use of NSAIDs may be associated with a reduced risk of colorectal cancer. • Polyp removal: The removal of polyps in the colon may be associated with a reduced risk of colorectal cancer. • Female hormone use: Postmenopausal female hormone use is associated with a reduced risk of colon cancer but not rectal cancer. — Source: National Cancer Institute
• A family history of cancer of the colon or rectum • A personal history of cancer of the colon, rectum, ovary, endometrium, or breast • A history of polyps in the colon • A history of ulcerative colitis (ulcers in the lining of the large intestine) or Crohn’s disease • Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (Lynch Syndrome) |
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