Johns Hopkins Health Alerts - Colon Cancer

Research Update on Colorectal Cancer

Tue, 10 Nov 2009 06:00:00 CST

Doctors who treat colorectal cancer and urological cancer have observed that patients who have had one of these cancers appear to be more likely than the average person to be diagnosed with the other.

To see if this observation reflected a true association, investigators reviewed information from more than 500,000 people with colorectal cancer or a urological cancer using data collected by the U.S. Surveillance Epidemiology and End Results (SEER) program.

They found that people with colorectal cancer had a 59% increased risk of developing cancer of the renal pelvis (a type of kidney cancer) compared with the general population and a 100% increased risk of developing cancer of the ureters (the tubes that connect the kidneys to the bladder). Similarly, people with renal pelvis or ureteral cancers were at increased risk for developing colorectal cancer.

While both of these cancers are rare, the findings from this study suggest that if you have been diagnosed with colorectal cancer, especially before age 60, you should be considered at increased risk.

If you notice symptoms of renal pelvis or ureteral cancer -- blood in your urine, pain when urinating, or frequent urination -- report it to your doctor right away. When these cancers are identified and treated early, the likelihood of cure is greater than 90%.

Reported in the Archives of Internal Medicine (Volume 168, page 1003).

Clinical Trial Terminology Explained

Tue, 20 Oct 2009 06:00:00 CDT

The National Cancer Institute estimates that between 5% and 8% of cancer patients participate in clinical trials. Why is the number so low? Part of the problem is that many patients believe that all clinical trials include a placebo (an inactive treatment with no known therapeutic value) and treat participants like "guinea pigs" -- neither of which is true. To help clear up the confusion, this Health Alert explains clinical trial terminology, including randomization, placebo, and blinding.

Clinical trials are studies conducted in humans to identify new methods of screening, preventing, diagnosing, or treating a disease or to compare innovative approaches to treatment with the standard treatments currently in use. Before researchers conduct a clinical trial, the treatment has usually gone through extensive laboratory and animal testing. Once researchers have good evidence from these preclinical studies that a treatment might work in people, they can request approval from the U.S. Food and Drug Administration to test it in humans.

When considering clinical trials, you'll be confronted with a host of terms that may be unfamiliar. For example:

Randomization. If you enter a randomized clinical trial, you will be assigned by chance to a control group or a treatment group. If you are assigned to the control group, you will receive the standard treatment or procedure -- the one you would receive if you were not participating in the study. If you are assigned to the treatment group, you will receive the experimental treatment or procedure.

Placebo group. In some phase II and III clinical trials, participants are assigned to a placebo group instead of a control group and receive an inactive pill or sham treatment that has no effect on the disease. Placebos are never used when a patient could benefit from a known effective treatment; thus, most cancer treatment trials do not have a placebo group. However, a placebo group may be used if there is no standard therapy with which to compare the experimental treatment. A placebo is also sometimes used in studies where everyone receives the standard treatment but half also receive an experimental treatment and half a placebo.

Blinding. Some randomized clinical trials are "blinded," meaning you won't know whether you are getting the treatment being studied or the standard treatment until the trial is over. In a "double-blinded" clinical trial, neither you nor the investigators will know which treatment you are getting until the trial has ended. This practice minimizes the chances that a treatment seems to work only because of the expectations or biases of those involved in the study. Blinding is often done when a placebo is included in one part of the clinical trial.

The Virtues of Virtual Colonoscopy

Tue, 18 Aug 2009 06:00:00 CDT

In a study reported in The New England Journal of Medicine (Volume 359, page 1207) virtual colonoscopy compared favorably to standard colonoscopy. Here’s what you should know.

Virtual colonoscopy, also known as computerized tomographic (CT) colonography, is comparable to standard colonoscopy, according to results from the American College of Radiology Imaging Network (ACRIN) National CT Colonography Trial. These findings provide further support for adding virtual CT to the list of recommended initial colorectal cancer screening options for people who are age 50 or over and at average risk for colon cancer.

In the ACRIN trial, which enrolled more than 2,600 patients at 15 sites across the nation, virtual CT findings were compared with those from standard colonoscopy. Study participants were at least 50 years old and had not had a colonoscopy in the five years prior to the exam.

The investigators found that CT colonography was highly accurate in detecting intermediate and large polyps: 90%of the polyps 1 cm in diameter or larger were detected. Furthermore, even polyps as small as 0.5 cm were detected by CT colonography with a high degree of accuracy. If you've been putting off getting a colonoscopy because of the invasiveness of the procedure, you now have a reliable noninvasive option.

Risks and disadvantages. There are no known risks associated with virtual colonoscopy. One disadvantage is that if a polyp is detected, you will need to have an endoscopic procedure to have it removed, which increases the overall cost. Also, virtual colonoscopy may not be able to detect flat lesions.

Preparing For Your Colonoscopy

Tue, 29 Sep 2009 06:00:00 CDT

Many people think the worst part of a colonoscopy is the preparation -- clearing your entire large intestine of fecal matter. Your doctor will give you detailed instructions about the cleansing process, which can take two days or more. Now a study reported in The Archives of Internal Medicine suggests that some bowel cleaning preparations can cause kidney damage in some adults.

If you're scheduled for a colonoscopy, be sure to check the bowel cleansing preparation you use. Oral sodium phosphate (OSP) -- a popular choice that's available over the counter -- can cause severe chronic kidney damage in older users.

Researchers compared the records of 286 older adults (age 58 to 78) who used OSP before a colonoscopy with those from 125 individuals who had not used it. The OSP group had a measurable decrease in their kidney function (as measured by creatinine level and glomerular filtration rate [GFR]) within one year of using the product.

In the OSP group, the mean creatinine level increased from 0.92 mg/dL at baseline to 1.04 mg/dL at one year (1.5 mg/dL was the laboratory's upper limit for normal). In addition, the group had an 8% reduction in their total GFR at one year.

Those who had not had a colonoscopy had a much slower decline in kidney function, which is consistent with normal aging. At baseline, their mean creatinine level was 0.92 mg/dL and it rose to 0.96 mg/dL at one year, and the total GFR decreased by only 1%.

Bottom line: If you're older or have chronic kidney disease and are scheduled for a colonoscopy or use OSP for other health reasons, speak with your doctor about alternatives, such as polyethylene glycol (PEG) solutions.

Reported in Archives of Internal Medicine (Volume 168, page 593).

When Should You Have Your First Colonoscopy?

Tue, 28 Jul 2009 06:00:00 CDT

Colonoscopy is considered the gold standard for finding and removing -- and possibly preventing -- colorectal cancer. It can detect up to 95% of colon cancers and can be used to remove precancerous polyps before they develop into cancer. So it’s important to know when you should begin colonoscopy screening: age 40 or 50?

Current guidelines recommend that colonoscopy screening begin at age 50 for individuals at average risk for getting colorectal cancer. But might we prevent more cancers and save more lives if screening were to start at age 40?

Researchers explored this question by analyzing the results of colonoscopies performed on individuals age 40 to 59 as part of an employer-provided wellness program. During the 27-month period studied, 553 people age 40 to 49 and 352 aged 50 to 59 had a screening colonoscopy. Polyps were removed from 79 people age 40 to 49 and from 56 people in the 50 to 59 age group.

No differences were seen between the two age groups in the polyps' size or location in the colon. However, the researchers did find more advanced neoplasms in the older group than in the younger group -- 3 (4%) and 11 (2%), respectively.

More studies are needed to determine whether screening at age 40 would reduce the incidence of colorectal cancer and be cost effective. For now, doctors recommend scheduling your first colonoscopy at age 50 unless you're at higher-than-average risk for colorectal cancer or you develop symptoms. Study reported in the journal Gastroenterology (Volume 134, page 1311).

Who's At Risk For Colorectal Cancer?

Tue, 07 Jul 2009 06:00:00 CDT

Are you at risk for colorectal cancer? While the exact causes of colorectal cancer are not known, studies show that the major risk factors include age, personal or family history of cancer, lifestyle practices, and diet.

It's not known exactly why colorectal cancer begins. Some people carry genes that are specific for colorectal cancer. In fact, because colorectal cancer is relatively easy to identify in the precancerous stage, the genes involved in colorectal cancer were some of the first cancer-related genes to be identified and studied.

Colorectal cancer was once considered to be a man's disease. But in terms of gender, it is actually an equal opportunity disease. Studies show that men develop these cancers only slightly more often than women, with men more at risk for colon cancer and women more at risk for rectal cancer.

While the exact causes of colorectal cancer are not known, studies show that the following risk factors increase a person's chances of developing colorectal cancer:

Age. As with many other cancers, aging also is a risk factor for colorectal; the longer you live the more exposure you have to the influences that could trigger colorectal cancer. Colorectal cancer is more common in people over the age of 50. However, colorectal cancer can occur at younger ages, even, in rare cases, in the teens.

Diet. Colorectal cancer seems to be associated with diets that are high in fat and calories and low in fiber. Researchers are exploring how these and other dietary factors play a role in the development of colorectal cancer.

Polyps. Polyps are benign growths on the inner wall of the colon and rectum. They are fairly common in people over age 50. Some types of polyps increase a person's risk of developing colorectal cancer.

Familial polyposis. A rare, inherited condition, familial polyposis causes hundreds of polyps to form in the colon and rectum. Unless this condition is treated, familial polyposis is almost certain to lead to colorectal cancer.

Personal medical history. Research shows that women with a history of cancer of the ovary, uterus, or breast have a somewhat increased chance of developing colorectal cancer. Also, a person who has already had colorectal cancer may develop this disease a second time.

Family medical history. First-degree relatives (parents, siblings, children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves, especially if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.

Ulcerative colitis. Ulcerative colitis is a condition in which the lining of the colon becomes inflamed. Having this condition increases a person's chance of developing colorectal cancer.

Having one or more of these risk factors does not guarantee that you will develop colorectal cancer. It just increases the chances. People may want to talk with a doctor about these risk factors. The doctor may be able to suggest ways to reduce the chance of developing colorectal cancer and can plan an appropriate schedule for checkups.

Coffee – Not Green Tea – Protects Against Colon Cancer

Tue, 16 Jun 2009 06:00:00 CDT

Green tea has gotten a lot of press for its healthy properties. But it turns out that coffee may be better for your colon, according to research reported in the International Journal of Cancer.

Studies show that certain behaviors are associated with colorectal cancer. For example, the risk of developing colon cancer increases if you are physically inactive, obese, drink excessive amounts of alcohol, or eat a diet high in meat, refined grains, and fats, especially those from animal sources. In addition, smokers are 30-40% more likely to die of colorectal cancer than nonsmokers.

Now researchers believe that coffee – not green tea – reduces the risk of colon cancer. When researchers reviewed data on the beverage-drinking habits of more than 96,000 Japanese men and women over a 10-year period, they found that coffee significantly lowered the risk of colon cancer in females.

Women who regularly drank three or more cups of coffee a day had a 32% lower risk of colon cancer than those who almost never consumed coffee -- even after taking into account factors that could have affected risk. Colon cancer risk was not reduced for men, and neither women nor men had a reduced risk of rectal cancer.

Researchers are not sure why coffee appears protective, since caffeine is in green tea as well. The beneficial effect, they say, may have come from another substance in coffee.

The investigators caution that their results need to be confirmed by other researchers, but these findings do provide some degree of reassurance for women who savor a morning brew and have been concerned about possible adverse effects on the colon.

Data reported in the International Journal of Cancer (Volume 121, page 1312).

Massage and Acupuncture Relieve Pain After Cancer Surgery

Tue, 14 Apr 2009 06:00:00 CDT

If you or loved one face surgery for colon cancer, you may want to consider adding massage and acupuncture to the usual care provided. Here's what a recent study recommends.

There is no "natural" cure for cancer, and so-called therapies based on that claim have injured many cancer patients -- either directly through dangerous "treatments" or indirectly because some individuals turned to unproven therapies in place of treatments validated by solid research. However, there are several nonmedical therapies that, when used along with conventional therapies, may reduce some of the adverse effects from cancer treatment or may help ease the pain and tension colorectal cancer patients may experience.

For example, studies show that practices such as meditation or guided imagery and visualization can be calming. Yoga and tai chi also may be helpful. Acupuncture has been shown to provide relief for some kinds of pain. Herbs, such as peppermint and ginger, may help ease the nausea and vomiting associated with chemotherapy.

If you have surgery for colon cancer, you may want to consider adding massage and acupuncture to the usual care provided. According to a recent study reported in the Journal of Pain and Symptom Management (Volume 33, page 258), massage and acupuncture relieved pain and depression in surgery patients more than traditional postoperative care alone.

In the study, both massage and acupuncture were given for 10-30 minutes at the bedsides of 138 people who underwent surgery for intestinal and other cancers. Swedish massage was used along with an acupressure foot massage. Acupuncture was given at points related to the patients' symptoms, which included pain and nausea.

On a scale of 1–10, pain scores in the massage/acupuncture group declined by 1.4 points compared with 0.6 points in the usual-care group. Among people who reported pain of at least level 3 on the scale, pain scores declined by nearly 2 points compared with 0.3 points for those who received usual care. Therapy with massage and acupuncture was similarly effective in alleviating depressed moods.

Bottom line: These findings require confirmation in a larger study. Nevertheless, there is a growing acceptance among healthcare providers of complementary therapies such as these to help relieve the side effects of cancer treatment. If you're scheduled for colorectal cancer surgery, find out if your hospital or cancer center offers such therapies and whether some of these treatments are covered by your insurance.

FAP Families at Risk for Colorectal Cancer

Tue, 05 May 2009 06:00:00 CDT

It is estimated that about 15% of colorectal cancers run in families. For that reason, it's important to know the health history of your immediate family and to tell your children. A family history of colorectal cancer puts you at higher risk for developing the disease, which means you should have screenings more often than the average person.

People with familial adenomatous polyposis (FAP) develop hundreds of polyps in the colon and rectum. Without treatment, FAP usually leads to colorectal cancer by age 40. Less than 1% of all colorectal cancers are due to this rare form of inherited cancer, which is caused by a change in the APC gene. A genetic variant of FAP, known as APCI1307K mutation, is found in about 6% of Ashkenazi Jews whose ancestors are from eastern Europe. About 10% of colorectal cancers in Ashkenazi Jews are associated with this mutation.

Now surprising data indicates that despite knowing they are at heightened risk for colorectal cancer, some people with or at risk for FAP fail to follow recommendations for endoscopic screening.

These are the findings from a survey of 71 people with FAP (an inherited condition that usually leads to colorectal cancer unless treated) or attenuated FAP (a related genetic condition that heightens the risk of developing colorectal cancer) and 79 close relatives. The investigators found that only 54% of those with a personal history of FAP (all of whom had intact colons and/or rectums) and 42% of the at-risk relatives had recently followed current guidelines for colorectal cancer surveillance.

The major reason respondents gave for not following up with endoscopic screening was that their healthcare provider had not recommended it. Other reasons included a lack of health insurance or reimbursement and a belief that they were not at increased risk.

The benefits of early detection in preventing death from colorectal cancer are well known, but the advice bears repeating. If you or a family member has FAP or attenuated FAP, routine screening can improve your chances of preventing the development of colorectal cancer or identifying and treating it early, which will improve your chances for survival.

This data was reported in The American Journal of Gastroenterology (Volume 102, page 153).

9 Tips To Make Your Colonoscopy Easier

Tue, 24 Mar 2009 06:00:00 CST

Colonoscopy is the “gold standard” for finding and removing precancerous polyps and colon cancers. But many people delay colonoscopy because of the uncomfortable pre-exam preparation. In this Health Alert Johns Hopkins provides practical advice to help you make the best of this necessary test.

There may be a few jokes about colonoscopy, but what you need to do to ensure the doctor a clear view of your colon is not funny: You will have to drink large amounts of an odd-tasting liquid that prompts your digestive system to clean itself out in a hurry.

Here are 9 practical tips to help you get through the colonoscopy experience more comfortably:

Colonoscopy Tip 1: Get a head start. Consider lightening up on your food intake two days before the test, avoiding hard-to-digest items such as meat, eggs, nuts, and leafy greens. Instead, eat lots of fiber in the form of vegetables and fruits, or start the liquid diet early, so there will be less to purge.

Colonoscopy Tip 2: Stock up. Get what you will need ahead of time, including clear liquids such as chicken or vegetable broth, apple juice, and bottled water with electrolytes. Buy extra-soft toilet paper, paper towels, or disposable baby wipes (be careful not to buy cleansing wipes containing scent or alcohol).

Colonoscopy Tip 3: Be gentle to yourself. Plan to take two days off work: the day before the test and the day of the test itself.

Colonoscopy Tip 4: Stay hydrated. A recent study shows that some laxative products made with sodium phosphate may contribute to dehydration and thus cause kidney damage. All laxatives cause some water loss, so drink plenty of fluids throughout the prep and after the test. Avoid both alcoholic and carbonated drinks before the procedure, as they increase dehydration.

Colonoscopy Tip 5: Reduce the opportunity for accidents. Stay home near a bathroom during the process.

Colonoscopy Tip 6: Prepare the bathroom. Line the wastebasket with a plastic bag. Instead of toilet paper, use wet washcloths or disposable wipes, such as unscented baby wipes (check that the product is flushable). Applied generously, petroleum jelly and hemorrhoid products can ease anal soreness that might develop. Soaking in a warm tub may help as well.

Colonoscopy Tip 7: Try to relax. Most people dread the actual scoping procedure, and feelings of anxiety or concern are normal. The mild sedative given for a colonoscopy relieves those problems, and you may not even remember the process. If you are feeling especially anxious, talk to your doctor beforehand about providing a mild tranquilizer or muscle relaxant for the procedure. And keep in mind that, compared with the preparation, the colonoscopy is usually over very quickly.

Colonoscopy Tip 8: Aftercare. You may feel some mild cramping or bloating and, rarely, nausea, up to a day afterward, caused by some air left in the colon. Eat lightly for a few days.

Colonoscopy Tip 9: Be relieved. When it’s over, it’s over. If the scoping shows no polyps or cancer, you are in the clear for a decade. If there are polyps, or even cancer, you will know, and you can be treated quickly.

When the Diagnosis Is Colorectal Cancer

Tue, 03 Mar 2009 06:00:00 CST

The best way to “treat” colorectal cancer is to prevent it, through regular colonoscopy screenings during which any suspicious polyps can be removed. However, if your doctor does find evidence of colorectal cancer, your treatment options include surgery, chemotherapy, and radiation. In this Health Alert, Johns Hopkins gastroenterologist Sergey V. Kantsevoy, M.D. explains what you should expect if you are diagnosed with colorectal cancer.

Cancer treatments and outcomes have greatly improved over the past few decades as a result of advances in surgery and medicine and also because of increased knowledge about how cancer progresses and responds to therapies. A diagnosis of colorectal cancer is serious, but there are options for treatment at any stage.

In most cases, a colorectal cancer diagnosis is not an emergency situation requiring immediate surgery or treatment. There is time to meet with a team of medical specialists to hear about treatment options and time to discuss and consider their recommendations. You also have time to interview doctors, to get a second opinion, and to choose a treatment center that is experienced in treating your type and stage of colorectal cancer.

Surgery for Colorectal Cancer -- Colorectal cancer surgery is typically performed using open surgery, in which one large incision is made in the abdomen to gain access to the colon or rectum. In recent years, there has been interest in performing colorectal cancer laparoscopically, which involves insertion of small surgical instruments with cameras through a few small keyhole-like incisions made in the abdomen.

With either the open or laparoscopic procedures for colorectal cancer, surgeons remove not only the part of the colon or rectum that contains the cancer but also some of the healthy tissue that surrounds it. Surgeons also remove any lymph nodes near the colorectal cancer for later study under a microscope to see if the colorectal cancer has spread to the lymphatic system. Afterward, the surgeon sews together the remaining healthy parts of the colon or rectum.

Chemotherapy for Colorectal Cancer -- Chemotherapy uses medications to attack cancerous cells throughout the body. It sometimes follows surgery to increase the chance that all cancer cells have been eliminated. When used in this way, patients generally begin chemotherapy about one month after surgery and continue for about six months. Chemotherapy may also be administered before surgery to help shrink a tumor.

When colorectal cancer has spread to the lymph nodes or beyond the colon or rectum, physicians may use chemotherapy to slow progression of the cancer and to relieve the symptoms of colorectal cancer without expecting to achieve a cure.

Radiation Therapy for Colorectal Cancer -- Radiation therapy involves the use of x-rays to target cancer cells. This approach is used for rectal -- but not colon -- cancer. As with chemotherapy, physicians may use radiation to destroy any cancer cells that remain after surgery, to decrease the size of a cancer before surgery, or for symptom relief. Unlike chemotherapy, which affects the entire body, radiation therapy is designed to target cancer cells while minimizing damage to healthy tissues.

Eating To Lower Your Cancer Risk

Tue, 20 Jan 2009 06:00:00 CST

Can diet prevent colorectal cancer from coming back? A number of researchers are zeroing in on certain foods and nutrients that may play an important role in preventing the recurrence of adenomas (polyps that have a high likelihood of becoming cancerous). Here's the latest thinking from Johns Hopkins cancer experts.

Unfortunately, there is no special diet that can prevent the recurrence of polyps or colorectal cancer. But based on the evidence available to date, cancer experts suggest this recipe for healthier eating:

Get most of your foods from plant sources (fresh vegetables and fruits, whole grains, dry beans, and nuts)

Avoid processed foods, including processed meats and refined grains

Choose chicken, fish, or beans as your protein foods instead of red meat

Avoid junk food, including sodas and sugar-laden snacks

Limit alcoholic drinks to one or fewer a day

To reduce your risk of colorectal cancer, try to get most of your nutrients from foods rather than supplements. For example:

Dry beans may protect against cancer. Findings from the Polyp Prevention Trial, which looked at dietary factors that impacted adenoma recurrence in more than 2,000 men and women, suggest an improved outlook for people with a history of polyps who eat plenty of cooked dry beans.

According to the researchers, dry beans have a wide range of nutrients that may be protective against cancer. They also have a low glycemic index, meaning that dry beans cause a slower rise in blood sugar compared with white bread. Low-glycemic foods have been associated with a reduced risk of colorectal cancer in a number of primary prevention studies.

Calcium. According to a recent study in the Journal of the National Cancer Institute, use of a calcium supplement for at least four years may protect against recurrent colorectal adenomas for up to five years after you stop using them. These results are from the 11-year Calcium Polyp Prevention Study, which followed more than 800 people who previously had a colorectal adenoma.

Folic acid. A recent study in the Journal of the American Medical Association suggests that not only do folic acid supplements not decrease the risk of colorectal tumors, they might actually increase the risk of recurrence in people with a history of colorectal adenomas.

For now, the best advice is to get your folic acid from foods that naturally contain high amounts -- citrus fruits and dark green leafy vegetables, especially spinach -- and to avoid folic acid supplements unless directed to take them by your doctor.

Questioning Colonoscopy for the Very Elderly

Tue, 09 Dec 2008 06:00:00 CST

Is there an age beyond which it doesn't make sense to have a colonoscopy anymore? Research suggests the risk of colonoscopy may outweigh the benefits in octogenarians. Johns Hopkins explores the research.

So far, there is no recommended cut-off age for a colonoscopy or for Medicare reimbursement. But as the number of Medicare recipients grows, along with the number of elderly people having regular colonoscopies, researchers are taking a look at the costs as well as the risks and benefits of colonoscopy in older people.

Two recent studies reviewed the results of more than 3,000 colonoscopy tests to address the question of when people might stop having these procedures. While the risks of developing colon cancer increase with age, the researchers observed, life expectancy decreases after age 80. Because colon cancers are slow to develop, and cancer rarely develops within 10 years of a negative colonoscopy, people over age 80 are likely to die of other causes even if colon cancer begins to develop.

In fact, the same German study that investigated the risks of a 20-year interval between colonoscopy tests also found that people who had a negative colonoscopy after age 55 probably have a very low risk for the rest of their lives. And in one study that reviewed colon exams in people age 50 and up, screening people who were at least the age of 80 only resulted in a 15% gain in life expectancy when compared with the benefit seen in the younger participants who were screened.

While a colonoscopy is safe for the elderly, it is never pleasant -- even for the young -- and research indicates that elderly people are less likely to cleanse their bowels adequately and are more likely to experience incomplete exams and complications. Putting all of these findings together, researchers suggest that doctors carefully consider the indications for colonoscopy in people who are over age 80. The colonoscopy may not be needed or appropriate for everyone.

Talking With Your Doctor About Your Colon Cancer Diagnosis

Tue, 30 Dec 2008 06:00:00 CST

The stress of a colon cancer diagnosis can feel overwhelming, so it's very important to have a support system to help you with questions and decisions. In this Health Alert, Johns Hopkins provides practical advice to help you cope.

Q. My doctor just told me that I have colon cancer and will need to undergo colon cancer surgery. How can I get a second opinion?

A. It is common for people to request a second opinion, especially before surgery or other involved treatment. Indeed, many insurance companies require a second opinion, and this is a good place to start.

Ask your insurance company what your policy covers and if it requires you to see a doctor within that plan. Also tell your doctor you would like to have a second opinion. Most doctors are accustomed to this and will be supportive.

Ask for a referral and for copies of your medical records, including all test results, x-rays, and other imaging tests to take with you to the next doctor. You may have to sign a release and pay a copying fee, but there should be no problem in getting your records. If a second opinion (or the doctor you wish to consult) is not covered by insurance, it may be worthwhile to pay for this examination out of pocket.

When you meet with your doctor, here are some questions you may want to ask:

Where is the colon cancer located?

Is the cancer in more than one place?

Are the lymph glands involved?

Has the cancer spread outside the colon? Are other organs involved?

What stage is the cancer, and exactly what does that mean?

Is this type of cancer life threatening?

Are there other tests I should have?

How soon do I need to begin cancer treatment?

What are the side effects of cancer treatment?

Could this affect my relatives?

For Colonoscopy, Location Matters

Tue, 18 Nov 2008 06:00:00 CST

Not all colonoscopies are equal, a new study finds. Colorectal cancer is more likely to be missed if the colonoscopy is performed in a doctor's office rather than in a hospital or clinic.

Canadian investigators analyzed data from more than 12,000 people with colorectal cancer who had reportedly normal colonoscopies no more than three years before their diagnosis. The investigators found that 3% of the people had a new or missed cancer, some within six months of their last colonoscopy. And those who had a missed cancer were more likely to have had the procedure performed by an internist or family physician in an office setting.

When looking specifically at colonoscopies performed by a family physician or internist in a doctor's office, they found that men were three times more likely and women were nearly twice as likely to have a new or missed cancer compared with those who underwent the procedure in a hospital.

The researchers also found that older men and women, people with diverticular disease, and women who had previously had abdominal surgery were at increased risk for a missed colorectal cancer.

Bottom line: For peace of mind, particularly if you're in one of the groups at increased risk for a missed cancer, have your next colonoscopy performed at a hospital or clinic by a doctor with experience performing the procedure.

How Often Should You Have a Colonoscopy?

Tue, 07 Oct 2008 06:00:00 CDT

If you are at low risk for colorectal cancer, how long should you wait between colonoscopy screenings? Johns Hopkins looked into this question and provides advice.

Most of us grudgingly accept the need for regular colonoscopy screenings but may wonder: Is it really safe to wait a decade before your next colonoscopy? Some researchers have wondered as well.

The 10-year interval, the gold-standard period between screening colonoscopies for people at low risk, is based in part on the amount of time it usually takes a benign polyp to become cancerous. Until recently, there was little evidence to support this practice in people whose previous colonoscopies showed no evidence of cancer or polyps.

But new research suggests that the 10-year standard is more than adequate. In fact, it may be safe -- although not recommended -- to wait up to 20 years between colonoscopy screenings. For example, a Canadian study that reviewed colonoscopy records of 35,975 people confirms that those with a negative (cancer-free) test result had a 72% lower risk of developing cancer over 10 years than the general population.

A German study that spanned more than a decade confirmed this finding and went even further: For people with a prior negative colonoscopy, the low-risk period can extend to 20 years. We're not suggesting that you allow 20 years to pass between your colonoscopy screenings. But if you have a normal colonoscopy result, you can most likely wait at least a decade before undergoing the procedure again.

Important: If a screening colonoscopy catches even one polyp, your risk of colon cancer goes up and so does the recommended frequency of screenings. The same is true if you have a family history of colorectal cancer or other risk factors for colorectal cancer.

The Size of a Pea and a Lot More Dangerous

Tue, 16 Sep 2008 06:00:00 CDT

Colorectal polyps are small, noncancerous (benign) clumps of cells that grow in the rectum and colon. Over the course of 10–15 years, some of these polyps -- usually the ones that are larger than a pea -- can become cancerous. Fortunately, regular screening for colorectal cancer helps to identify and remove polyps, often before they progress to cancer.

It is not known why polyps develop, but some people are more prone than others. For instance, the older you get -- especially after age 50 -- the more likely you are to have polyps. You're also more likely to develop polyps if you've had them before (polyps tend to recur) or if someone in your family has had polyps or cancer of the colon.

Your behavior also influences your risk: Eating a lot of fatty foods, smoking cigarettes, drinking alcohol, not exercising, and being over weight can all contribute to the formation of polyps.

Q. I've had a colon polyp removed. What can I do to prevent colorectal cancer?

A. One crucial step is to have a follow-up colonoscopy every three to five years, depending on the number and size of your polyps.

You also need to get moving. The American Cancer Society stresses the importance of exercise for those trying to prevent polyp recurrence. Excess body weight and inactivity are linked with shorter survival times; one study found that people who exercised regularly were about half as likely to die of colorectal cancer within four years as those who did not exercise.

No diet is guaranteed to prevent colorectal cancer recurrence, but experts suggest this recipe to help lower your risk:

Get most of your foods from plant sources (fresh vegetables, fruits, and nuts).

Avoid processed foods and limit those high in saturated fats (especially beef).

Choose chicken, fish, or beans as your main protein sources.

Avoid junk foods, including sodas and sugar-laden snacks.

Have no more than one alcoholic drink per day.

Get most of your nutrients from foods rather than supplements.

Finally, although some research has suggested that NSAIDs may prevent colorectal cancer, the U.S. Preventive Services Task Force recently concluded that the risks of long-term NSAID use -- such as gastrointestinal bleeding, kidney problems, and hemorrhagic (bleeding) stroke -- exceed the potential benefits for people at average risk for colorectal cancer.

Chinese Herbals Reduce Side Effects of Chemotherapy

Tue, 26 Aug 2008 06:00:00 CDT

Does Chinese herbal medicine help reduce the unpleasant side effects of chemotherapy? A recent study in the Annals of Oncology seeks to answer this important question.

Chemotherapy is powerful medicine. Because chemotherapy keeps cancer cells from growing, it also affects normal cells. The side effects from chemotherapy depend on the drug and on your individual physiology. The short-term effects generally include fatigue, nausea and vomiting, diarrhea, hair loss, and a low blood count that increases the risk of infection. Rashes and mouth sores also are common.

No wonder cancer patients and doctors are eager to find ways to reduce the discomfort of chemotherapy. A study reported in the Annals of Oncology (Volume 18, page 768) looked at the effect of Chinese herbal medicine (CHM) on chemotherapy patients. The results are mixed, but encouraging:

When put to the test in a double-blind placebo-controlled randomized study, CHM did not reduce the toxic blood-related effects of chemotherapy, such as low white blood cell count and severe anemia. However, it did significantly reduce chemotherapy-induced nausea.

For this study, licensed herbalists with university training and at least 15 years of experience randomly assigned 120 people in China and Hong Kong who had colon or breast cancer to receive either medicinal herbs or non-therapeutic herbs, which were taken daily during chemotherapy.

Both chemotherapy groups experienced moderate to severe reductions in white blood cells and neutrophils. In addition, four patients taking CHM and three on placebo had low neutrophil counts with fevers, requiring admission to the hospital.

But significantly fewer patients in the CHM group experienced moderate nausea from chemotherapy than did those in the placebo group -- 16% and 38%, respectively. There was no difference in the effect of CHM on other non-hematologic chemotherapy side effects.

The use of complementary and alternative medications is gaining popularity among cancer patients receiving chemotherapy. Strong clinical research studies such as this one will help clarify their role in the treatment of cancer patients and help increase acceptance among healthcare providers.

Can Diet Prevent Colon Cancer From Coming Back?

Tue, 05 Aug 2008 06:00:00 CDT

An unhealthy diet has long been associated with an increased risk of developing colon cancer, at times without much evidence other than common sense. Now a growing body of research is backing up these claims with studies showing that people who eat “good” foods may indeed be able to reduce their risk of developing colon cancer.

While most research has focused on the impact of diet on the initial development of colon cancer (what’s known as primary prevention), only a few small studies have examined the effect of diet on colon cancer recurrence. But findings from a new, larger study looking at that question suggest that eating "good" foods can reduce your risk of a recurrence of colon cancer as well and improve your odds of survival.

New research also demonstrates the value of certain nutrients in reducing the risk of colorectal polyp recurrence. But when it comes to adding some supplements to your diet to get those nutrients, there can be too much of a good thing.

What’s Your Dietary Pattern? My diet consists primarily of:

A) fruits, vegetables, whole grains, legumes, poultry, and fish

B) red meat, fried foods, full-fat dairy products, refined grains, and desserts

If you selected B, beware. Investigators who examined the relationship between the dietary patterns of more than 1,000 people who had been treated for stage III colon cancer and their risk of colon cancer recurrence found that those who followed a typical American diet (answer B) were three times more likely to experience a recurrence of colon cancer than their counterparts who followed a more prudent diet (answer A), and they also were more likely to die.

The study, which was reported in the Journal of the American Medical Association, is the first to address the effect of diet on recurrence in a population of colon cancer survivors. Since this was an observational study that relied on the participants to remember and report what they ate, the investigators caution that their results do not prove that a typical American diet causes colorectal cancers to recur. However, the results, they say, do strongly suggest that a diet consisting primarily of red and processed meats, french fries, refined grains, and sweets and desserts increases the risk of cancer recurrence and decreases survival.

When Normal Is Not Enough

Tue, 24 Jun 2008 06:00:00 CDT

Don’t assume a normal annual test for fecal occult blood (FOBT) means you can postpone your colonoscopy. According to Frank Herlong, M.D., Associate Professor of Medicine, Gastroenterology Division at Johns Hopkins and Health After 50 Board Member, FOBTs are no longer relied upon for colon cancer screening -- though some doctors may use them to test for gastrointestinal bleeding from causes other than cancer.

Before colonoscopies became widely available and covered by insurance, annual FOBTs were an affordable and easy-to-use tool for colon cancer screening. But FOBTs have always been notoriously unreliable. Most employ a chemical called guaiac that changes color if blood is present in the stool sample. Guaiac also reacts with certain fruits and vegetables and with blood from red meat, which increases the likelihood of “false positive” results. All positive results must be confirmed by colonoscopy.

Immunochemical FOBTs, or IFOBTs, test for a protein specific to human blood. They are widely available and more accurate than guaiac based tests. But no matter which FOBT you use, a negative result does not necessarily mean that you are safe. Case in point: A recent study published in The New England Journal of Medicine found that an expensive DNA-based FOBT was capable of detecting 26% more invasive cancers and potentially precancerous growths than a common guaiac-based FOBT. But even this vastly superior DNA-based test identified only 51% of all invasive cancers detected by colonoscopy.

The most important thing to keep in mind is that not all precancerous growths or colon cancers cause bleeding; by the time they do, the cancer may be advanced. In contrast to all types of FOBTs, a colonoscopy detects -- and removes -- growths whether or not they cause bleeding. Thus, colonoscopy is your best protection against colon cancer.

Introducing the Aer-O-Scope

Tue, 03 Jun 2008 06:00:00 CDT

Patients who plan to undergo colonoscopy should be on the lookout for the Aer-O-Scope, a new self-propelled colonoscope – still under development.

Colonoscopy, long the gold-standard for colorectal cancer screening, requires specialized training and sedation and can have complications, such as colon perforation. A newly developed instrument could be used with minimal training, without sedation, and perhaps with fewer complications, according to its developers.

The instrument under development is called an Aer-O-Scope. It is an endoscope that is inserted into the rectum between two balloons and is propelled through the colon by air pressure that is regulated automatically. When the instrument reaches the cecum, the process is reversed to push it back out through the colon and rectum.

In a study of 12 healthy volunteers who were not sedated, the device completed all or part of a colon examination successfully. Two volunteers asked for pain medication, and four others experienced discomfort, but there were no complications up to 30 days after the exam. (Just to be safe, there was follow-up with a regular colonoscopy.)

One disadvantage: Unlike a traditional colonoscope, with the robotic device it is not possible to remove polyps at the time of the exam, which means a possible second procedure. Also, as with a regular colonoscopy, bowel cleansing preparation is required before the procedure. [Reported in the journal Gastroenterology, Volume 130, page 672.]

Aggressive Treatment Pays Off

Tue, 13 May 2008 06:00:00 CDT

For patients with advanced, metastatic colorectal cancer that has spread to the liver, surgery offers hope, according to a study in the Annals of Surgical Oncology.

The treatments for advanced cancer are much the same as for newly diagnosed cancer. However, they are more aggressive. They include:

Surgery to remove cancer where it has returned or metastasized. This could be localized or could involve extensive surgery for metastases in the liver or other organs.

Radiation and/or chemotherapy to control and contain the cancer, especially if it is inoperable.

Other techniques could involve freezing tumors (cryosurgery), burning them away with microwaves, or other methods of treating a well-defined area where a cancer is present.

Surgery for colorectal cancer that has spread to the liver results in good long-term survival rates, even for patients who have more than one metastasized tumor, according to a Canadian study reported in the Annals of Surgical Oncology (Volume 13, page 668).

Researchers reviewed the results of liver surgeries for metastatic colorectal cancer in 423 operations over a 10-year period at one cancer center, looking at the death rate from surgery, disease-free survival, and overall survival. More than half of the operations (65%) were major, involving more than four segments of the liver.

Overall, death and illness due to the operation were fairly rare: Seven patients died (1.6%) and 74 (17%) were sicker in connection with the surgery. In contrast, the disease-free survival rate at one year was 64%; at five years, 27%; and at 10 years post surgery, 22%. The overall and long-term survival rates were even better: 93%, 47%, and 28%, respectively.

Factors that predicted less successful outcomes included older age (patients over 60); surgical margins that tested positive for malignant cells; large metastatic tumors; and many metastases. However, researchers concluded that the overall good survival rates justify taking an aggressive surgical approach, even for patients with many metastases.

Follow-Up and Recurrence

Tue, 22 Apr 2008 06:00:00 CDT

Following treatment for colon cancer, it's critically important to monitor your recovery with frequent doctor visits and to pay attention to potential symptoms of recurrence. Johns Hopkins doctor explain what to look for.

After colon cancer treatment, vigilant surveillance must continue for several years. Early detection of recurrent or metastasized cancer yields the best possibility for cure or containment. For these reasons, at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, most colon cancer patients come for follow-up every three to six months for the first three years, and then every six to twelve months for two years afterwards.

While it is not productive to worry about recurrent cancer, it is important to be able to begin treating the cancer as soon as possible. Thus it’s a double bind. Signs and symptoms of cancer recurrence or metastases can be vague, especially when you are recovering from major treatment. It may be difficult to sort out new sensations from the ones you had before surgery.

Some symptoms doctors suggest you take seriously include:

Fatigue, weight loss, loss of appetite, and anorexia. These could be connected with therapy, but can also be signs of cancer recurrence.

Abdominal pain and bowel blockage. Cancer can recur in the area of the bowel where it was treated or elsewhere in the colon. This may block normal bowel movements, so do report pain and constipation.

Nausea, vomiting, or yellow discoloration of eyes and skin may be signs of metastases to the liver.

Shortness of breath might indicate lung tumors.

Infrequent urination accompanied by hip or back pain can indicate that the cancer has spread to the urinary system skeleton.

Preventing Colon Cancer With Exercise

Tue, 11 Mar 2008 06:00:00 CST

Men who took part in a regular exercise program had fewer precancerous changes to the colon lining than non-exercisers, a study shows -- and the more vigorous the exercise, the better the results.

While there is no surefire way to prevent colon cancer or a recurrence, lifestyle choices may lower your risk of colon cancer. Much of the new information echoes time-honored common sense: Eat a healthy diet high in fruits and vegetables, maintain an appropriate weight, and exercise regularly.

Studies reported in the journal Cancer Epidemiology, Biomarkers and Prevention (Volume 15, page 1588 ) associate exercise with a lowered risk of colorectal cancer. Researchers in this study thought exercise might help prevent cellular changes associated with development of polyps in the colon lining. They recruited 102 men and 100 women ages 40–75 and randomly assigned them to a control group or to a group that did 60 minutes per day of moderate to vigorous exercise six days a week for a year. All had a colonoscopy within three years of the study and after the study.

All men who exercised 250 minutes a week had a reduction in potentially cancerous cell growth, and men who exercised longer (300 minutes a week) had twice the reduction in cell proliferation of the control group. Those who increased cardiovascular fitness by at least 5% had more than double the reduction of those who exercised but did not have the same cardiovascular improvements.

However, women in the same study who also exercised or increased cardiovascular fitness did not have notable changes in the markers of cell proliferation.

Advice to Speed Recovery From Colon Cancer Surgery

Tue, 19 Feb 2008 06:00:00 CST

Research suggests that chewing sugarless gum after colon cancer surgery can speed recovery and shorten hospital stays by as much as a third.

The first line of treatment for colon cancer is to remove the primary tumor or tumors. If your colon cancer is confined to polyps or a small area, surgery is probably the only treatment that you need. After major surgery, you will have some pain for two or three days, which is relieved with morphine or other pain medication. You will not be able to eat and will be given intravenous fluids. After a few days, you should be able to eat, and bowel function will resume, although it may take a few days to return to normal function. A typical hospital stay for colorectal surgery is between four and eight days, and full recovery takes about two months.

Now a report in the Archives of Surgery (Volume 141, page 174 ) suggests that chewing sugarless gum after colorectal surgery may help patients to get up and go, shortening hospital stays by a third.

After colon cancer surgery, most patients don’t want food or water, and it takes a few days for bowel function to resume. If the intestinal shutdown lasts much longer, it can lead to longer hospital stays that may expose patients to infection and other complications. Chewing gum triggers the same reflex as eating, stimulating gastrointestinal hormones connected with bowel activity.

The study looked at 34 people who had part of their sigmoid colon removed because of colon cancer or diverticulitis. Half chewed one stick of sugarless gum for about an hour three times a day, starting the morning after colon cancer surgery. The rest were treated as usual. In the chewing-gum group, the time to producing intestinal gas was reduced by 14.8 hours, to feeling hungry by 9.3 hours, and to the first bowel movement by more than a day. The total hospital stay for the gum group was 59.8 hours shorter than the control group, with discharge in 4.3 days instead of 6.8. Researchers noted that hospitals cost an average of $1,500 a day. Sugarless gum costs 4 cents per stick.

When It Comes to Colonoscopy, How Old Is Too Old?

Tue, 29 Jan 2008 06:00:00 CST

Two research studies report on the benefits and risks of colonoscopy in adults over age 80.

Colonoscopy is considered the gold standard for finding and removing -- and possibly preventing -- colorectal cancer. It can detect up to 95% of colon cancers and can be used to remove precancerous polyps before they develop into cancer.

Now new research shows that after age 80, colonoscopies are of limited value. According to two studies reported in the Journal of the American Medical Association (JAMA ) (Volume 295, page 2357 ) and the Journal of Diseases of the Colon and Rectum (Volume 49, page 646 ) colonoscopy after the age of 80 may not be worth the risk of complications.

These studies are the first to address the issue of when people might stop colonoscopy screenings, which are recommended every 10 years. Altogether, they reviewed results from more than 2,000 patients.

Though the risks of developing colon cancer increase with age, life expectancy decreases after age 80. Since cancer-prone polyps (adenomas) grow slowly, older people are more likely than younger ones to die of other causes before a polyp turns cancerous, researchers noted.

In one study that reviewed colonoscopy in people ages 50 to over 80, screening in the very elderly resulted in only 15% of the expected gain in life expectancy of younger persons. Researchers also noted an increase in incomplete exams, inadequate bowel preparation, and complications in elderly patients. The colonoscopy is safe for the elderly, its limited value suggests that risks and patient preferences should be considered, wrote the researchers in JAMA. Those writing in the Journal of Diseases of the Colon and Rectum recommend limiting colonoscopy in the elderly to patients with symptoms or specific clinical indications.

Questionnaires Help Predict Inherited Colon Cancer Risk

Tue, 08 Jan 2008 06:00:00 CST

After age 80, heredity is a major risk factor for colorectal cancer. Now scientists have a new tool to help them identify people at risk for genetically linked colon or endometrial cancer.

It’s not known exactly why colorectal cancer begins. Some people carry genes that make them unusually susceptible to certain cancers, and some people have genes that are specific for colorectal cancer. In fact, because colon cancer is relatively easy to identify in the precancerous stage, the genes involved in colon cancer were some of the first cancer-related genes to be identified and studied.

Now an article in the Journal of the American Medical Association (Volume 296, pages 1469 and 1479) reports that two independent research teams have developed questionnaires that may help identify the risk of a genetically linked hereditary colon or endometrial cancer.

Lynch syndrome, which represents 2–7% of all colorectal cancers, is due to a mutation on the genes MLH1, MSH2, or MSH6, which usually protect against cancer. It is also known as hereditary nonpolyposis colon cancer (HNPCC) and is connected with endometrial cancer. Genetic testing can confirm the syndrome, but it is expensive and may not be necessary. The written tests can screen for the possibility of Lynch syndrome based on patients’ answers to questions about family and personal health histories, say researchers at Johns Hopkins University, who developed one of the questionnaires. They validated the program, called MMRpro, by testing it on 279 patients’ family histories and then testing their genes.

A similar test based on histories of 1,914 patients was developed at the Brigham and Women’s Hospital in Boston. That program, called PREMM1,2, is a risk assessment for mutations on genes MLH1 and MSH2. The questionnaires are available free on the Internet, but researchers caution that they should be used with the advice of a physician or a genetic or cancer counselor.

Further references:
The original Johns Hopkins Press Release for MMRPod is here:
http://www.jhsph.edu/publichealthnews/press_releases/2006/chen_mmrpro.html

The model software is available to download at
http://astor.som.jhmi.edu/BayesMendel/mmrpro.html
The study authors warn that MMRpro results should be interpreted by physicians and cancer counselors.

The PREMM1,2 program is at the Dana-Farber Cancer Institute Website.
http://www.dfci.org/pat/cancer/gastrointestinal/crc-calculator/default.asp

There is an online 'quiz' but it is really intended for health professionals. There are special tables and so on at the bottom that should consulted as well before any 'results' can be determined.
So all means take the quiz, but discuss your results and concerns with your doctor.

Research from the Forefront of Colorectal Cancer

Tue, 27 Nov 2007 06:00:00 CST

Colorectal Cancer Finding #1: Survey Reveals Lack of Knowledge About Colon Cancer Screening

According to a recent consumer survey, Americans have a poor grasp on when and why to get tested for colon cancer.

The most startling result was that 38% of people over age 50 were able to name a judge on the hit television show “American Idol,” yet only 34% knew they were at risk for colon cancer. Women were less likely than men to believe they were at risk, although the risk of colon cancer is equal in men and women. Seventy percent of those over age 50 believed that getting tested for colon cancer could reduce their risk of colon cancer, but less than half (44%) knew when they should start testing (the answer is age 50).

Colon cancer is the third leading cause of cancer in the United States: Estimates suggest that 146,000 people were diagnosed with colon cancer in 2005 and 56,000 died from it. Screening tests are very effective in detecting colon cancer, and the chance of surviving colon cancer is greatest when the disease is caught early. The American Cancer Society encourages all Americans age 50 and over to talk to their doctor about colon cancer screening tests. Reported by the American Cancer Society and published online at www.cancer.org.

Colorectal Cancer Finding #2: Sigmoidoscopy Misses Two Thirds of Colorectal Cancers in Women

Research suggests that flexible sigmoidoscopy, a screening test for colorectal cancer, is not as accurate in women as in men. In the study of 1,463 women (age 50–79) who underwent colonoscopy for routine colorectal cancer screening, 5% were found to have advanced colorectal cancer. The researchers estimated that if a sigmoidoscopy -- which examines only the rectum and lower portion of the colon -- had been performed, two thirds of these cancers would have been missed because they occurred too far up in the colon to be detected by sigmoidoscopy.

A colonoscopy examines the entire colon and rectum. When the results were compared to those of a similar study in men, sigmoidoscopy was half as accurate in women: While 66% of men would have had advanced colon cancers detected via sigmoidoscopy, only 35% of advanced colon cancers in women would have been found.

Based on these data, a colonoscopy is the preferred method of screening for colon cancer in both men and women. Even though a sigmoidoscopy is easier and less costly to perform and can be done without sedation, a colonoscopy is the gold standard screening test for colon cancer and is the one you should opt for, especially if you are a woman. Reported in The New England Journal of Medicine (Volume 352, page 2061).

Advice to Beat the Odds of Colorectal Cancer

Tue, 06 Nov 2007 06:00:00 CST

Johns Hopkins Health Alerts |

Colon Cancer | Advice to Beat the Odds of Colorectal Cancer

The evidence that links various foods with the risk of colon cancer is increasing. Fortunately, most of the foods that are good for you are good to eat as well.

So far, there is no surefire way to prevent colon cancer or a recurrence. But increasing knowledge about contributing factors has revealed that lifestyle choices may lower your risk. Some of the information is surprising and may challenge your assumptions. However, much of the new information echoes time-honored common sense: Eat a healthy diet high in fruits and vegetables, maintain an appropriate weight, and exercise regularly. (It also helps a lot if your ancestors didn’t have colorectal cancer.)

Foods to avoid are red meat, charred meat, processed meat, and saturated fat. All are connected with higher cancer risks, though the reason remains unclear. Charred and processed meats have high levels of cancer-promoting chemicals, and saturated fat in red meat may upset the balance of bile acids used for digestion. These foods also contribute to heart disease and other ills.

There is an abundance of good foods. The Mediterranean Diet, which is based on whole grains, fruits, vegetables, fish, and a small amount of meat, is a healthy basis for nutrition.

Fiber is high on the “good” list. It helps to move food through the digestive system and may increase some chemicals known to protect the colon. Studies have generally linked high levels of dietary fiber with low rates of colon cancer and adenomatous polyps, although one recent mega-study did not confirm this. The jury remains out, but for many reasons it’s still good to add fiber (beans, whole grains, fruits, and vegetables) to your diet.

Folic acid -- also known as folate -- is related to a 20–50% lower risk of colon cancer and polyps. It can also offset some effects of alcohol, which inhibits folate production in the body. There is evidence that taking folic acid in a daily multivitamin for five years lowers the risk of colon cancer by almost 50% among women with a family history of colon cancer. All of the sources of dietary fiber listed above contain some folic acid, and you can take it in supplements as well.

Vitamin D and calcium may reduce risks. Higher levels of vitamin D are connected with lower colorectal cancer rates, and calcium in food may lower risks. However, when taken as a supplement, calcium does not appear to have the same effect. Up the odds of lowering your risks by eating calcium-rich dark green vegetables and getting vitamin D in fish, yogurt, milk, and a small amount of daily sunshine.

Other good foods linked with lower colon cancer risks include olive oil, garlic, turmeric, and colorful fruits and vegetables, which are high in antioxidants. The evidence is mixed for coffee, but a moderate amount may reduce risks of both liver and colon cancer.

Johns Hopkins Health Alerts |

Colon Cancer | Advice to Beat the Odds of Colorectal Cancer

More Reasons to Exercise

Tue, 16 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Colon Cancer | More Reasons to Exercise

It's never too late to begin to exercise. In one study, those with advanced colon cancer who exercised regularly more than doubled their disease-free survival time.

If you have been diagnosed with polyps -- cancerous or benign -- you now have an incentive to make some different lifestyle choices.

Stop smoking and limit your use of alcohol. Exposing yourself to these known toxins can cause cell damage that promotes cancer. A recent study shows that alcohol and tobacco users developed colorectal cancer an average of 7.8 years earlier (age 63.2 years in women and 62.1 years in men) than those who never drank alcohol or smoked.

Eat a balanced, low-fat diet with fruits and vegetables. Studies show that a Mediterranean diet low in red meat and saturated fat and high in fiber, fruits, and vegetables is associated with overall health, including colon health. This also reduces inflammation, which is now associated with many diseases including cancer.

Keep an appropriate weight for your age and body type. Studies show that those who are overweight are at higher risk for colorectal cancer, and being very obese increases that risk by 50% for men and by 80% for women.

Make daily exercise a habit. People who exercise are at lower risk for colorectal cancer and appear to have a reduced risk of polyps.

Speaking of exercise: Data from two recent studies show that after cancer diagnosis, vigorous exercise significantly increases disease-free survival and lowers recurrence risks.

In the first study, 832 patients with advanced (stage III) colon cancer who underwent surgery and chemotherapy were asked to report on their recreational physical activities six months after completing treatment. Researchers found those who reported the most activity had twice the disease- free survival rate and half the recurrence rate of the least active patients. The benefit applied regardless of gender, age, weight, number of involved lymph nodes, and chemotherapy received.

The second study reviewed the physical activity of 573 women with stage I–III nonmetastatic colon cancer, before and after diagnosis, and their change in activity after diagnosis. They found that those who increased their exercise levels or began exercising after their diagnosis had a significantly lower death rate from cancer or other causes than those who exercised less. They also found that the level of activity before diagnosis wasn’t relevant. The two separate studies from the Dana Farber Cancer Institute – and reported in the Journal of Clinical Oncology (Volume 24, pages 3527 and 3535) -- were based on observation and not on controlled clinical trials. However, they concur with studies that associate exercise with lower risks of developing colon cancer.

Johns Hopkins Health Alerts |

Colon Cancer | More Reasons to Exercise

Colon Cancer Proteins Show Promise For Blood Test

Tue, 03 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Colon Cancer | Colon Cancer Proteins Show Promise For Blood Test

This article on new colon cancer biomarkers comes from a Johns Hopkins Medicine Press Release.

Searching for less invasive screening tests for cancer, Johns Hopkins scientists have discovered proteins present in blood that accurately identify colon cancer and precancerous polyps.

Initial studies of the proteins, CCSA-3 and CCSA-4, suggest they could be used to develop a blood test to identify individuals at-risk for colon cancer.

"The reality is that many people are not getting regular screening colonoscopies," says cancer researcher Robert Getzenberg, Ph.D. "So, ideally we'd like to identify those with some molecular fingerprint for colon cancer and really need them."

Current colon cancer screening guidelines for healthy people call for a baseline colonoscopy at age 50, followed by re-screening at least every five to 10 years. Colonoscopy is not foolproof; colon cancer can develop between screenings.

First discovered by Getzenberg and colleagues at the University of Pittsburgh through a protein scan, the two blood-dwelling proteins are thought to be remnants of cellular debris castoff from dead cancer cells. Although the proteins' roles are not entirely clear, the Johns Hopkins scientists say they are part of the scaffolding that supports structures within a cell's control center, the nucleus.

Alteration of such nuclear scaffolding is a hallmark of cancer cells that is easily detectable under the microscope as a misshapen and discolored nucleus. That led Getzenberg to the notion that "there must be something at the molecular level that would form a molecular flag for cancer via a blood test."

To find the flag, Getzenberg's team drew blood samples from 107 apparently healthy individuals the day before their scheduled colonoscopies, and from 28 colorectal cancer patients.

Using a particular concentration of scaffold-proteins as a marker for colon cancer, the Johns Hopkins team -- which did not know the colonoscopy results in advance -- were 100 percent accurate in identifying the 28 existing colon cancers. Using the same protein markers, investigators also correctly identified 51 of 53 individuals (96.2 percent) with normal colons and 14 of 18 (77.8 percent) people with advanced precancerous polyps, which Getzenberg says are the most important to detect through routine screening.

When researchers combined samples, they correctly identified 42 of 46 (91.3 percent) containing both colon cancers and advanced precancerous polyps. Protein levels were accurate in correctly assessing additional blood samples from 125 people with benign conditions and other cancers.

"These proteins seem very good at separating normal samples from cancerous ones and identifying other groups with pre-cancers at high risk for disease as well," says Getzenberg, who is a professor of urology and director of research at Johns Hopkins' Brady Urological Institute. Results are published in the June 15 issue of Cancer Research.

The researchers are planning larger studies at several hospitals over the next several months. It may take several years to complete the full range of testing.

Getzenberg and the University of Pittsburgh hold a patent for the technology described above, which is licensed to Onconome Inc. Funding for the study described in this article was provided by Onconome Inc. and the National Cancer Institute. Under a licensing agreement between Onconome Inc. and University of Pittsburgh, Getzenberg is entitled to a share of royalty received by the University on sales of products described in this article. Getzenberg also is a paid consultant to Onconome Inc. which has a licensing agreement with The Johns Hopkins University covering CCSA-3 and -4 related technologies. The terms of this arrangement are being managed by The Johns Hopkins University in accordance with its conflict of interest policies.

Additional authors are Eddy S. Leman, Grant W. Cannon, Lori J. Sokoll, and Daniel W. Chan at Johns Hopkins; and Robert E. Schoen and Joel L. Weissfeld at the University of Pittsburgh Cancer Institute.

Johns Hopkins Health Alerts |

Colon Cancer | Colon Cancer Proteins Show Promise For Blood Test

Two Promising Therapies for Colorectal Cancer

Tue, 14 Aug 2007 06:00:00 CDT

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Two Promising Therapies for Colorectal Cancer is no longer current, and has therefore been removed.

If you would like to read related articles about colon cancer, please go to the Colon Cancer Topic page. Thank you.

Four Genes That Cause Colorectal Cancer

Tue, 25 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Colon Cancer | Four Genes That Cause Colorectal Cancer

Johns Hopkins professor Ross C. Donehower, M.D., F.A.C.P. discusses four newly-identified genes for colorectal cancer.

Scientists are identifying specific genes that confer a high risk of developing some cancers, including colorectal cancer. If you happen to carry one of these specific genes, your risk of colorectal cancer is increased considerably. Your doctor may recommend genetic testing if cancer seems to run in your family or if a close relative has been found to carry one of these genes.

Colorectal Cancer Gene 1: Hereditary Nonpolyposis Colorectal Cancer (HNPCC) -- Also called Lynch syndrome, this inherited tendency to develop colorectal cancer represents between 2% and 7% of all colorectal cancers. Not all people who inherit this genetic disorder will develop colorectal cancer, but they do inherit a significantly increased risk as well as a risk of developing other related cancers. Cancer tends to show up during puberty or the early twenties.

Colorectal Cancer Gene 2: Familial Adenomatous Polyposis (FAP) -- This rare form of inherited cancer causes a massive overgrowth of polyps in the colon and rectum, often among people who are in their teens. Less than 1% of all colorectal cancers are due to FAP, which is also known as Gardner’s syndrome, familial polyposis, or hereditary polyposis of the colorectum.

Colorectal Cancer Gene 3: APC I1307K Mutation -- This is a genetic variant of FAP found in about 6% of Ashkenazi Jews whose ancestors came from eastern Europe. The mutation increases the risk of developing colorectal cancer by as much as 30%. (The risk among the general population is about 5–6%.) Compared with FAP, the number of polyps in the colon is much lower, as is the risk of cancer.

Colorectal Cancer Gene 4: MYH Polyposis Syndrome -- This form of colon cancer is a recently discovered recessive syndrome. Those who develop the disease must have inherited a particular mutated gene from both parents. Those who inherit only one affected gene are not at special risk for cancer but may pass the gene to their offspring. Affected individuals typically develop 10–100 polyps at around 40 years of age and are at high risk for developing colon cancer.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts | Colon Cancer | Four Genes That Cause Colorectal Cancer

Research Update on Colon Cancer Screening Tests

Tue, 24 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Colon Cancer | Research Update on Colon Cancer Screening Tests

How often should you have a colooscopy for colon cancer? A large long-term study shows a 10-year interval is safe in most cases.

A Canadian study reported in the Journal of the American Medical Association confirms that a 10-year interval between colonoscopy screenings is appropriate for those who have had one negative procedure.

Ten-year intervals have long been recommended for colon cancer screening, but there has been limited evidence to show whether there are benefits to more frequent colonoscopies in this group. Researchers studying cancer risks at the University of Manitoba looked at records for nearly 36,000 patients who had negative screenings between 1989 and 2003. They compared the incidence of colorectal cancer in this group with that in the provincial population. These data are simple to obtain in Manitoba, where the government pays all health care costs and keeps all records by patient ID numbers.

Researchers found that the risk of developing colon cancer within less than 10 years of a negative colonoscopy was very low and remained lower beyond that time. In fact, one year after a negative screening, the risk of developing colon cancer was 31% lower than the risk among the general population. At 10 years, the risk of developing colon cancer was 72% lower. One anomaly: When people in the colonoscopy group developed cancer, tumors were significantly more likely than usual to develop in the right side of the colon (47% vs. 28% in the general population). Evidently early detection methods in that area need improvement.

New research shows that while more Americans are being tested for colorectal cancer, follow-up lags.

Public campaigns have raised awareness about colorectal cancer and the importance of screening. But a Veterans Administration (VA) study showed that nearly half of those who tested positive on an initial colorectal screening test didn’t get a follow-up colon cancer examination.

Researchers reviewed VA records for nearly 40,000 people who qualified for colorectal cancer screening and found that about 61% were screened with a fecal occult blood test (FOBT). They then compared test results and follow-up visits for six months after the colorectal tests. Of those whose FOBT results were positive, 59% received a follow-up colonoscopy or barium enema screening -- but 41% had no follow-up at all. Nothing about the patients themselves seemed to predict who would have follow-up tests.

It’s standard medical practice after a positive FOBT to follow up with a colonoscopy or barium enema. The VA’s screening rates are significantly higher than the national average. Its lack of follow-up shows a need for more focus on the entire screening and diagnostic process, the researchers wrote. If your FOBT is positive, ask for follow-up even if your doctor does not mention it. This research was reported in the journal Diseases of the Colon and Rectum .

Johns Hopkins Health Alerts |

Colon Cancer | Research Update on Colon Cancer Screening Tests

Choosing a Treatment for Colorectal Cancer

Tue, 12 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Colon Cancer | Choosing a Treatment for Colorectal Cancer

Johns Hopkins gastroenterologist Sergey V. Kantsevoy, M.D. explains what you should expect if you are diagnosed with colorectal cancer.The best way to “treat” colorectal cancer is to prevent it, through regular colonoscopy screenings during which any suspicious polyps can be removed. However, if your doctor does find evidence of colorectal cancer, your treatment options include surgery, chemotherapy, and radiation. When the disease is caught and treated in its early stages, the five-year survival rate is greater than 90%. Surgery for Colorectal Cancer -- Colorectal cancers are typically performed using open surgery, in which one large incision is made in the abdomen to gain access to the colon or rectum. In recent years, there has been interest in performing colorectal surgery laparoscopically, which involves insertion of small surgical instruments with cameras through a few small keyhole-like incisions made in the abdomen. With either the open or laparoscopic procedures for colorectal cancer, surgeons remove not only the part of the colon or rectum that contains the cancer but also some of the healthy tissue that surrounds it. Surgeons also remove any lymph nodes near the colorectal cancer for later study under a microscope to see if the colorectal cancer has spread to the lymphatic system. Afterward, the surgeon sews together the remaining healthy parts of the colon or rectum. However, if the colorectal cancer is located low in the rectum close to the anal sphincter, the surgeon may not be able to reconnect the healthy tissue. In such cases, a permanent colostomy will be necessary to pass stool. A colostomy connects the remaining colon or rectum to an opening in the abdomen to allow waste to pass into a colostomy bag. Chemotherapy for Colorectal Cancer -- Chemotherapy uses medications to attack cancerous cells throughout the body. It sometimes follows surgery to increase the chance that all cancer cells have been eliminated. When used in this way, patients generally begin chemotherapy about one month after surgery and continue for about six months. Chemotherapy may also be administered before surgery to help shrink a tumor. When cancer has spread to the lymph nodes or beyond the colon or rectum, physicians may use chemotherapy to slow progression of the cancer and to relieve the symptoms of colorectal cancer without expecting to achieve a cure. Because chemotherapy drugs are given intravenously and travel through the bloodstream, they can affect the entire body and produce a range of possible side effects, including nausea, vomiting, fatigue, diarrhea, mouth sores, hair loss, and bone marrow suppression. Radiation Therapy for Colorectal Cancer -- Radiation therapy involves the use of x-rays to target cancer cells. This approach is used for rectal--but not colon--cancer. As with chemotherapy, physicians may use radiation to destroy any cancer cells that remain after surgery, to decrease the size of a cancer before surgery, or for symptom relief. Unlike chemotherapy, which affects the entire body, radiation therapy is designed to target cancer cells while minimizing damage to healthy tissues.Physicians often recommend a combination of chemotherapy and radiation after surgery if the colorectal cancer has spread to areas outside the rectum. There are two types of radiation; they can be used alone or together.

Internal radiation therapy involves the placement of a radioactive implant or “seeds” in or adjacent to the cancer cells.

External radiation is delivered from an x-ray machine that directs the radiation toward the cancerous cells.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts | Colon Cancer | Choosing a Treatment for Colorectal Cancer

The Link Between Fiber and Colon Cancer

Thu, 10 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Colon Cancer | The Link Between Fiber and Colon Cancer

A fiber-rich diet has many benefits – but does it protect against colon cancer?

The idea that fiber protects against colon cancer was first proposed many years ago when researchers found that Africans who ate high fiber diets had a low incidence of colon cancer. Since then dozens of studies have supported the protective role of fiber. There are plenty of reasons fiber might lower colon cancer risk: Fiber increases fecal bulk and may dilute potential cancer-causing substances; fiber reduces the time the stool spends in the intestine, which might limit the colon’s exposure to carcinogens. Fiber may also alter the intestinal environment in other beneficial ways. Yet, several recent studies have cast doubt on the theory that fiber protects against colon cancer.

The well-known Nurses Health Study tracked more than 88,500 female nurses over a 16-year period, dividing the women into five groups based on their estimated intake of fiber. By the end of the study, 787 new cases of colon cancer occurred. Surprisingly, the women who ate the most fiber—nearly 25 grams per day—were just as likely to develop colon cancer and pre-cancerous tumors as those who ate the least (about 10 grams per day).

In a study published in 2000, researchers randomly assigned 1,429 men and women with a history of colon polyps (a pre-cancerous condition) to eat either a high-fiber or low-fiber wheat-bran supplement in addition to their ordinary diet. After three years, researchers found at least one polyp in about 50 percent of the participants in each group.

In a well-designed study published in The New England Journal of Medicine, 2,079 people with a history of polyps were randomly assigned to eat either a low-fat, high-fiber diet (consisting largely of fruits and vegetables) or a low-fiber diet. After four years, a similar number of people in each group—about 39 percent—developed at least one recurrent polyp.

Indeed, such results are confusing, but they are far from definitive. First, the amount of fiber may have been insufficient to exert an effect. Subjects in the randomized studies may not have been followed long enough to detect whether the polyps found in the high-fiber subjects have the same potential for malignancy as the polyps from the low-fiber subjects. It’s also possible that introducing dietary changes, such as increased fiber intake, later in adult life may be ineffective at reducing the risk of colon cancer.

Bottom Line: While the relationship between fiber and colon cancer is unclear, a fiber-rich diet has other definite benefits. A diet high in soluble fiber can reduce elevated cholesterol levels, and fiber-rich foods can smooth out blood sugar spikes in people with diabetes. A high-fiber diet can also aid in preventing constipation, which reduces the risk of diverticulitis. Finally, foods rich in fiber -- fruits, vegetables, legumes, and whole grains -- are important sources of vitamins, minerals, and phytochemicals.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts |

Colon Cancer | The Link Between Fiber and Colon Cancer

How Often Should You Have a Colonoscopy?

Fri, 05 Jan 2007 15:18:22 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information this article is no longer current, and has therefore been removed.

An updated version of this article is available on the Johns Hopkins Health Alerts website. To read it, please go to How Often Should You Have a Colonoscopy?. Thank you.

Is Colon Cancer in Your Genes?

Tue, 20 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts |

Colon Cancer | Is Colon Cancer in Your Genes?

Johns Hopkins Professor Frank Giardiello, M.D., Professor explains why knowing your family tree can save your life.

Following the publication of the complete sequence of the human genome in 2003, researchers announced that much of this information had been placed on a single, dime-sized glass slide called a DNA microarray or gene chip. This tool allows researchers to rapidly examine humankind’s estimated 35,000 genes so they can pinpoint those linked to disease, an achievement that promises to transform the practice of medicine in the near future.

One day gene chips may be used to generate individual genetic profiles that can quickly predict a person’s risk of many common and potentially deadly medical problems, including breast cancer, colon cancer, diabetes, heart disease, and stroke. These high-tech devices may begin to appear in your doctor’s office within the next decade or so.

In the meantime, you can harness the genetic information locked in your genes with one of the most basic and effective tools known to medicine: a detailed and accurate family history. By learning as much as you can about your own family’s health history, you can open a window on your genetic inheritance and better assess your risk of certain diseases. Armed with this information, you can step up efforts to prevent a particular disease or detect it at an early stage, when therapy is likely to be most effective.

If your family history indicates an unusually high risk of a particular condition, your doctor may suggest considering genetic testing. “Someone who has several family members, say parents or siblings, with colon cancer— and particularly if the colon cancer developed before age 50—should think about having genetic testing,” advises Frank Giardiello, M.D., Professor and Chief of Gastroenterology at Johns Hopkins.

Scientists have identified several genes that increase the risk of developing two types of hereditary colon cancer: familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC).

People with FAP have hundreds, or even thousands, of polyps in the colon and nearly always develop colon cancer by age 40 unless their colon is surgically removed. Thus, they can benefit from aggressive monitoring and treatment.

People who carry one or more of the gene mutations responsible for HNPCC have an 80% risk of developing colon cancer during their lifetime. Furthermore, women with this mutation also have a 40% to 60% lifetime risk of endometrial cancer and a 10% lifetime risk of ovarian cancer. Genetic testing for HNPCC can produce significant benefits by identifying candidates for more intensive screening since annual colonoscopy can greatly reduce the risk of dying of colon cancer. More aggressive monitoring and, perhaps, prophylactic surgery could also reduce mortality from endometrial and ovarian cancer associated with HNPCC mutations.

Because a gene mutation for colon cancer occurs more frequently in people of Ashkenazi Jewish ancestry than in the general population, genetic testing for hereditary colon cancer might also be recommended for people with this ethnic background if they have multiple colon polyps or a family history of colon cancer.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts |

Colon Cancer | Is Colon Cancer in Your Genes?

What You Can Do To Prevent Colorectal Polyps

Tue, 10 Apr 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Colon Cancer |

Preventing Colorectal Polyps

Low-dose aspirin can help protect against colorectal cancer, but talk to your doctor first.

Colorectal polyps are small, non-cancerous (benign) clumps of cells that grow in the rectum and colon. Over the course of 10–15 years, some of these polyps—usually the ones that are larger than a pea—may become cancerous. Fortunately, regular screening for colorectal cancer helps to identify and remove polyps, often before they progress to cancer.

It’s not known why some people get polyps, but some individuals are more prone to polyps than others. For instance, the older you get—especially after age 50—the more likely you are to have polyps. You’re also more likely to develop polyps if you’ve had them before (polyps tend to recur in most people), or if someone in your family has had polyps or cancer of the colon. Your behaviors also influence your risk of getting polyps: Eating a lot of fatty foods, smoking cigarettes, drinking alcohol, not exercising, and being overweight can all contribute to the formation of polyps.

Most polyps don’t cause any symptoms. You might not know you have polyps until your doctor finds them during a physical examination or colorectal cancer screening. However, some people may notice rectal bleeding, especially after a bowel movement, constipation or diarrhea that lasts longer than a week, or blood in their stool (the stool looks black or contains red streaks). In these cases, you should see your doctor for an evaluation. Polyps can be diagnosed by a digital rectal exam, barium enema, sigmoidoscopy, or colonoscopy.

Following a healthy diet, exercising, and not smoking may help prevent polyps. Furthermore, research indicates that regular strength aspirin (325 mg a day) may thwart the growth of polyps in people who have recovered from colorectal cancer. For people who haven’t had colorectal cancer, other research suggests that aspirin use is most effective as a protectant if you have a mutated form of a gene that helps break down aspirin. Based on this data, your doctor may recommend aspirin to reduce the risk of polyps if you are at high risk. Always consult your doctor before beginning regular aspirin therapy to determine if the practice will be more beneficial than harmful given your individual medical history. In some people, regular use of aspirin can cause serious side effects, such as bleeding in the digestive tract.

More about aspirin therapy to prevent polyps and colorectal cancer

A large study in women has confirmed the benefits of long-term aspirin or nonsteroidal anti-inflammatory drug (NSAID) use in reducing the risk of colorectal cancer. But it also confirmed that bleeding in the digestive tract is a possible side effect. In the 20-year trial of 83,000 women, which was reported in the Journal of the American Medical Association, those who regularly took two or more 325-mg aspirin tablets a week had a 23% lower risk of colorectal cancer than did non-aspirin users. Those who took 15 or more aspirin tablets a week received an even greater benefit—and had half the risk of non-users. However, these reductions in risk only became apparent after 10 years of consistent aspirin use.

Similar results were found with the regular use of non-aspirin NSAIDs such as ibuprofen (Advil, Motrin). Of concern was the significantly increased risk of digestive tract bleeding in women who used large doses of aspirin or NSAIDs (15 or more tablets a week). Using aspirin to prevent colorectal cancer requires a much higher dose than that needed to prevent cardiovascular disease and regular NSAID use may increase the risk of heart attack and stroke. Thus, more studies are needed to clarify the risk to benefit ratio of high-dose aspirin in preventing colorectal cancer. Other trials have found that regular aspirin use also protects against colorectal cancer in men.

The nonaspirin NSAID celecoxib (Celebrex) was approved by the U.S. Food and Drug Administration to reduce the risk of polyp formation in people with familial adenomatous polyposis (FAP). Celebrex is associated with lower rates of digestive track bleeding than other NSAIDS. However, it may increase the risk of heart attack or stroke. If you have FAP, ask your doctor if you are a candidate for Celebrex.

From Polyp to Cancer: Click here for a colon cancer polyp diagram which shows the progression of the disease.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts | Colon Cancer |

Preventing Colorectal Polyps

What You Eat Affects Your Colorectal Cancer Risk

Tue, 27 Feb 2007 06:00:00 CST

Johns Hopkins Health Alerts | Colon Cancer |

Colorectal Cancer Diet

A number of studies have confirmed a link between diet and the risk of colorectal cancer. In one study of 150,000 adults reported in the Journal of the American Medical Association, people who ate the most red and processed meat over a 20-year period had a 50% greater risk of developing colorectal cancer than those who consumed little meat. Individuals who ate more poultry and fish than other meats had a 70% lower risk of colon cancer. Likewise, a large European study of close to half a million people found that those who ate the most red and processed meat had the highest risk of colorectal cancer, while those who ate the most fish had the lowest risk of colorectal cancer. However, eating poultry neither increased nor decreased the risk of colorectal cancer.

Finally, a third study, performed in Japan, found that women who followed a traditional Japanese diet (high in salted fish, rice, miso soup, and pickled vegetables) or a typical Western diet (high in meat and cheese) had a higher risk of colon cancer than those who consumed a healthy diet (high in vegetables, fruits, and soy). Men did not have a higher risk of colorectal cancer as a result of eating a Japanese or Western diet.

More research on diet and the risk of colorectal cancer in women

Women who consume a diet with a high glycemic load—one that includes lots of simple sugars—may be more likely to develop colorectal cancer than those who eat low-glycemic diets. Dietary factors have been strongly linked to colorectal cancer, but the long-term effects of a high-glycemic load have remained unclear.

In their study, which was reported in the Journal of the National Cancer Institute, researchers followed more than 38,000 women for an average of almost eight years. Participants were asked to record all the food they ate at the study’s onset. By the end of the study, 174 women had developed colorectal cancer. Women with the highest glycemic load were almost three times as likely to develop cancer as those who ate a low-glycemic diet. High total carbohydrate and fructose intakes were also associated with an elevated risk of colon cancer. The study authors remark that trying to establish a link between diet and disease is difficult because the factors involved are complex. For example, although a high glycemic load may be associated with an increased risk of colorectal cancer, other variables such as body weight, level of physical activity, smoking, alcohol use, and intake of other nutrients probably play a role as well.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts | Colon Cancer |

Colorectal Cancer Diet

Women and Colorectal Cancer

Tue, 16 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Colon Cancer |

Women and Colorectal Cancer

More Evidence That Calcium Reduces Colorectal Cancer Risk

A new study provides further evidence that calcium, from both dietary sources and supplements, can help reduce the risk of colorectal cancer in women—presumably by neutralizing highly irritating bile acids in the colon. The data, which were reported in the journal Cancer Epidemiology, Biomarkers and Prevention, come from more than 45,000 women enrolled in the Breast Cancer Detection Demonstration Project. During the study, the subjects were asked to complete a 62-item questionnaire about their food and supplement intake. The women were followed for an average of nine years, during which time 482 of them developed colorectal cancer.

The results showed that subjects who had higher intakes of calcium from either their diet or supplements had a 25% lower risk of colorectal cancer than those who consumed little calcium. Women who had higher intakes of calcium from both dietary sources and supplements had about a 45% reduction in risk of developing colorectal cancer. Dietary calcium reduced colorectal cancer risk starting at daily doses above 400 mg, while the cancer-reducing effects of supplemental calcium were not seen until daily doses exceeded 800 mg. It’s unclear why dietary calcium prevents colorectal cancer in lower doses than calcium supplements, but the discrepancy might be due to differences in how much calcium is absorbed from foods vs. supplements.

Vitamin B6 Protects Against Colorectal Cancer in Women

If you consume two or more alcoholic drinks a week and are a woman, you might want to consider increasing the amount of vitamin B6 in your diet. That was the conclusion of a Swedish study that looked at how vitamin B6 and alcohol intake affect the risk of colorectal cancer. The study reported in the journal Gastroenterology included 61,433 women (age 40–76) who were followed for 15 years. During this time, 805 of them developed colorectal cancer.

Women who consumed the most vitamin B6 from foods (more than 2 mg a day) had a 34% lower risk of colorectal cancer than those who consumed the least. This protective effect of high vitamin B6 was strongest in women who drank two or more alcoholic drinks per week and had the most vitamin B6 in their diet—their risk of colorectal cancer decreased by 72%. Alcohol consumption (independent of the amount of vitamin B6 the women were consuming) had no effect on colorectal cancer risk.

Vitamin B6 plays a critical role in the synthesis and repair of DNA. Alcohol impairs the absorption of vitamin B6, which may cause disruptions in DNA synthesis and repair that could lead to colorectal cancer. Good dietary sources of vitamin B6 include fruits (such as bananas), vegetables (such as potatoes), fortified cereals, legumes, fish, chicken, and red meat.

For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts | Colon Cancer |

Women and Colorectal Cancer