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News from CaSfA's Director

Blog

Colon Cancer Screening

Posted on August 15, 2018 at 11:22 AM Comments comments ()
Tonight I will be attending a wake for a woman who was taken much too soon due to Stage IV Colon Cancer.  Please heed the advice of the American Cancer Society for screening:
Research has shown that the risk of colorectal cancer has been increasing in younger adults.  This finding spurred the American Cancer Society to update their screening guidelines for colorectal cancer:
The ACS recommends that people at average risk of colorectal cancer start regular screening at age 45
For screening, people are considered to be at average risk if they do not have:
·       A personal history of colorectal cancer or certain types of polyps 
·       A family history of colorectal cancer
·       A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
·       A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
·       A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer 
People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75
For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history. 
People over 85 should no longer get colorectal cancer screening. 
 
Several test options are available for colorectal cancer screening: 
·       Stool-based tests
·       Highly sensitive fecal immunochemical test (FIT) every year
·       Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
·       Multi-targeted stool DNA test (MT-sDNA) every 3 years
·       Visual (structural) exams of the colon and rectum
·       Colonoscopy every 10 years
·       CT colonography (virtual colonoscopy) every 5 years
·       Flexible sigmoidoscopy (FSIG) every 5 years
 
There are some differences between these tests to consider (see Colorectal Cancer Screening Tests), but the most important thing is to get screened, no matter which test you choose. Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage.
If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy.
 
For people at increased or high risk
People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:
·       A strong family history of colorectal cancer or certain types of polyps 
·       A personal history of colorectal cancer or certain types of polyps
·       A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
·       A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
·       A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer
 
The American Cancer Society does not have screening guidelines specifically for people at increased or high risk of colorectal cancer. However, some other professional medical organizations, such as the US Multi-Society Task Force on Colorectal Cancer (USMSTF), do put out such guidelines. These guidelines are complex and are best looked at along with your health care provider. In general, these guidelines divide people into several groups (although the details depend on each person’s specific risk factors). 
 
1.  People with one or more family members who have had colon or rectal cancer
Screening recommendations for these people depend on who in the family had cancer and how old they were when it was diagnosed. Some people with a family history will be able to follow the recommendations for average risk adults, but others might need to get a colonoscopy (and not any other type of test) more often, and possibly starting before age 45.
2.  People who have had certain types of polyps removed during a colonoscopy
Most of these people will need to get a colonoscopy again after 3 years, but some people might need to get one earlier (or later) than 3 years, depending on the type, size, and number of polyps.
3.  People who have had colon or rectal cancer
Most of these people will need to start having colonoscopies regularly within a year of surgery to remove the cancer. Other procedures like ultrasound might also be recommended for some people with rectal cancer, depending on the type of surgery they had.
4.  People who have had radiation to the abdomen (belly) or pelvic area to treat a prior cancer
Most of these people will need to start having colonoscopies at an earlier age (depending on how old they were when they got the radiation), and might need to be screened more often than normal (such as at least every 5 years).
5.  People with inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
These people generally need to get colonoscopies (not any other type of test) every 1 to 2 years, starting at an earlier age.
6.  People known or suspected to have certain genetic syndromes
These people generally need to have colonoscopy (not any of the other tests). Screening is often recommended to begin at a young age, possibly as early as the teenage years for some syndromes – and needs to be done much more frequently. Specifics depend on which genetic syndrome you have, and other factors. 

 

Coffee and Colon Cancer

Posted on October 5, 2016 at 10:59 AM Comments comments ()
Coffee addicts rejoice!! A number of reports in recent years have suggested coffee consumption may offer some protection against various types of cancer, including postmenopausal breast cancer, melanoma, liver cancer, advanced prostate cancer and colon cancer. A recent study looking at coffee consumption in colon cancer patients provides more evidence of this effect.  From: http://jco.ascopubs.org/content/early/2015/08/11/JCO.2015.61.5062.full
Observational studies have demonstrated increased colon cancer recurrence in states of relatively high blood insulin, including sedentary lifestyle, obesity, and increased dietary glycemic load. (Glycemic index is a value assigned to foods based on how slowly or how quickly those foods cause increases in blood glucose levels.  High glycemic load foods will quickly raise blood glucose.) Greater coffee consumption has been associated with decreased risk of type 2 Diabetes and increased insulin sensitivity. The purpose of this study was to see if the effect on insulin from increased coffee intake could reduce colon cancer recurrence.
During and after 6 months of chemotherapy, 953 patients with stage III colon cancer (in the lymph nodes but not metastasized) reported dietary intake of caffeinated coffee, decaffeinated coffee, and non-herbal tea, as well as 128 other items. Researchers examined the influence of coffee, non-herbal tea, and caffeine on cancer recurrence and mortality
The greatest benefit of coffee consumption was seen in patients who drank four or more cups daily – about 460 milligrams of caffeine. These patients had a 42 percent lower rate of disease recurrence than those who didn’t drink coffee, and were 33 percent less likely to die from cancer or any other cause.  Two to three cups of coffee daily had a more modest benefit, while little protection was associated with one cup or less. Neither non-herbal tea nor decaffeinated coffee intake was associated with these outcomes.
These associations between coffee and recurrence and survival were independent of other predictors of patient outcome, diet, and lifestyle factors. Moreover, the effect of total coffee intake was largely maintained across other known or suspected predictors of cancer recurrence.
This is the first study to examine the association between coffee intake and colon cancer recurrence and survival. The researchers hypothesize that coffee might reduce colon cancer recurrence through improved insulin sensitization and decreased blood insulin levels.
 
Upshot of this…if you drink 4 cups of coffee per day, your risk of recurrence of colon cancer (and perhaps other cancers too) may be lower. (More good news for coffee drinkers:  a recent study of over 6000 women that found drinking 3 cups of coffee per day may lower one’s risk of dementia http://www.medicalnewstoday.com/articles/313182.php ).  But if you don’t drink coffee should you start? The results of these studies may not provide enough evidence to do so….

 

UMASS 2015 Colorectal Cancer Symposium

Posted on March 18, 2015 at 10:18 AM Comments comments ()
I recently attended the 2015 Colorectal Cancer Symposium at UMassMemorial Medical Center.  Take away message is colonoscopy is so important.  Everyone should have a screening colonoscopy at age 50, or earlier if you have risk factors for colorectal cancer.

Colonoscopy is one of the only cancer screening tests that also allows for treatment.  Precancerous lesions and small tumors can be removed easily with colonoscopy.

Goal is to find the cancer early!  The 5-year survival in US for colon cancer:

  • 90% for localized cancer 
  • 70% for those with regional spread 
  • 13% for those with distant spread   


Surgery is the ONLY curative treatment for colon cancer, but it must be done early before the cancer has spread!

Don’t ignore symptoms.  Colorectal cancer is often without symptoms, but may give:

  • Unexplained weight loss
  • Fatigue/weakness
  • Blood in the stool
  • Change in bowel habits


Screening is so important!  Don’t put off colonoscopy!

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