Jason Chertoff

COLON CANCER AND HEALTH

1. Brief introduction of everyone.

2. What is the colon?  What is colon cancer?  What are the symptoms of colon cancer?

The colon (large intestine, rectum, and anus) is the end portion of the human gastrointestinal (GI) tract which extends from the mouth to the anus. It is a muscular tube approximately 5 to 5 ½ feet in length and has an average diameter of approximately 2 ½ inches.  The main functions of the colon are absorption of water and minerals, and the formation and elimination of feces… The colon contains nearly 60 varieties of microflora or bacteria to aid digestion, promote vital nutrient production, to maintain pH (acid-base) balance, and to prevent proliferation of harmful bacteria.

There are two kinds of growths that occur in the colon: noncancerous growths, such as polyps and malignant or cancerous growths. Colon cancer usually begins with the growth of benign growths such as polyps.

Many cases of colon cancer have no symptoms. The following symptoms, however, may indicate colon cancer:

• Abdominal pain and tenderness in the lower abdomen
• Blood in the stool
• Diarrhea, constipation, or other change in bowel habits
• Intestinal obstruction
• Narrow stools
• Unexplained anemia
• Weight loss with no known reason

3. How burdensome is colon cancer?  Some statistics.

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society’s most recent estimates for the number of colorectal cancer cases in the United States are for 2010:

• 102,900 new cases of colon cancer (49,470 in men and 53,430 in women)
• 39,670 new cases of rectal cancer (22,620 in men and 17, 050 in women)

Overall, the lifetime risk in men for developing colorectal cancer is about 1 in 19 (5.2%). This risk is slightly lower in women (1 in 20). A number of other factors might also affect a person’s risk for developing colorectal cancer.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States when men and women are considered separately, and the second leading cause when both sexes are combined. It is expected to cause about 51,370 deaths (26,580 in men and 24,790 in women) during 2010.

The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping in both men and women for more than 20 years. There are a number of likely reasons for this. One is that polyps are being found by screening and removed before they can develop into cancers. Screening is also allowing more colorectal cancers to be found earlier when the disease is easier to cure. In addition, treatment for colorectal cancer has improved over the last several years. As a result, there are now more than 1 million survivors of colorectal cancer in the United States.

4. Colon cancer prevention.  What are some ways to improve the health of your colon (diet, exercise, screening, etc.)

The death rate for colon cancer has dropped in the last 15 years. This may be due to increased awareness and screening by colonoscopy.

Colon cancer can almost always be caught in its earliest and most curable stages by colonoscopy. Almost all men and women age 50 and older should have a colon cancer screening. Patients at risk may need screening earlier.  Should have either a flexible sigmoidoscopy every 5 years or a colonoscopy every 10 years.  Physician should perform a fecal occult blood test every year.

Colon cancer screening can find precancerous polyps. Removing these polyps may prevent colon cancer.

Dietary and lifestyle modifications are important. Some evidence suggests that low-fat and high-fiber diets may reduce your risk of colon cancer.

Several studies have reported that NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) may help reduce the risk of colorectal cancer. However, the U.S. Preventive Services Task Force and the American Cancer Society recommends against taking aspirin or other anti-inflammatory medicines to prevent colon cancer if you have an average risk of the disease — even if someone in your family has had the condition. Taking more than 300 mg a day of aspirin and similar drugs may cause dangerous gastrointestinal bleeding and heart problems in some people.

Although low-dose aspirin may help reduce your risk of other conditions, such as heart disease, it does not lower the rate of colon cancer.

5. What are the treatment possibilities for colon cancer?

Treatment depends partly on the stage of the cancer. In general, treatments may include:

• Chemotherapy to kill cancer cells
• Surgery (most often a colectomy) to remove cancer cells
• Radiation therapy to destroy cancerous tissue

Stage 0 colon cancer may be treated by removing the cancer cells, often during a colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous.

There is some debate as to whether patients with stage II colon cancer should receive chemotherapy after surgery. You should discuss this with your oncologist.

Almost all patients with stage III colon cancer should receive chemotherapy after surgery for approximately 6 – 8 months. The chemotherapy drug 5-fluorouracil has been shown to increase the chance of a cure in certain patients.

Chemotherapy is also used to treat patients with stage IV colon cancer to improve symptoms and prolong survival.

• Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three most commonly used drugs.
• Monoclonal antibodies, including cetuximab (Erbitux), panitumumab (Vectibix), and bevacizumab (Avastin) have been used alone or in combination with chemotherapy.

You may receive just one type, or a combination of the drugs.

For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This may include:

• Burning the cancer (ablation)
• Cutting out the cancer
• Delivering chemotherapy or radiation directly into the liver
• Freezing the cancer (cryotherapy)

Although radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for patients with stage III rectal cancer.

6. Brief introduction of your experience with colon health, screening, or cancer.

7. If you think you might have a problem with your colon and want help, you should:

A.    Contact your primary care physician to make an appointment.  Honestly disclose your symptoms and concerns (black Tar-Like stools, blood during a bowel movement, change in bowel habits).

B.   Ask your primary care physician if you should schedule a colonoscopy.

C.   If you are having any difficulties scheduling an appointment, or need further assistance, you can contact me or your case manager.

D.   Thank you!