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1. Colorectal Cancer Facts
- The American Cancer Society estimates that
approximately 145,290 people will be diagnosed
with colorectal cancer in 2005.
- Approximately 56,290 people will die of colorectal
cancer in 2005.
- Increased incidence above age 40
- Highest incidence between ages 65 to 74
- Diet low in fiber, high in fat
- Hereditary factors
- Colon polyp leading to cancer
- Long term exposure to environmental
or occupational toxins
(A risk factor is anything that increases the likelihood of
getting a disease)
- Over age 40
- Diet low in fiber, high
in fat
- Past history of breast or
gynecologic cancer
- Family history of colorectal
cancer or adenomatous polyps
- Personal history of colorectal
cancer or adenomatous polyps
- Past history of inflammatory
disease (ulcerative colitis or
Crohn’s disease)
- Physical inactivity-people
that do not get at least a moderate amount
of exercise are at increased risk of developing
the disease.
- Adopt a low fat diet. Reduce your fat
intake to less than 30 percent
of calories.
- Increase your fiber intake to 20-35
grams per day; include a variety
of vegetables, natural fruits, whole grain products
or a fiber supplement.
- Consider taking calcium supplements
and increasing consumption of foods
with high levels of vitamins C, A, and D.
- Avoid becoming overweight
- Consume alcoholic beverages in moderation,
if at all.
- Minimize consumption of salt-cured,
pickled, and smoked foods
- Follow colorectal cancer screening guidelines.
- Rectal exam every year beginning
at age 40
- Stool blood test every year
beginning at age 40
- Colonoscopy every 10 years
beginning at 50
Earlier screening test if family members developed cancer at a young
age
2. Screening Recommendations
Understanding Colorectal Cancer Screening
What are screening tests?
Screening tests are used to check for a disease such as colon cancer
in people who do not have symptoms to suggest that disease and have
not previously had that disease. In many cases these tests can find
colorectal cancers at an early stage and greatly improve the chances
of successful treatment. Some of these cancers can also be found
early if people report any symptoms right away to their doctors.
At what age should colon cancer screening
begin?
Current recommendations indicate that colon cancer
screening should begin for both men and women at
age 50 for individuals at average
risk for the disease. Individuals in the moderate
to high-risk categories should be screened starting
at age 40. People,
of any age who think they may be
at risk or have symptoms such as rectal bleeding
are encouraged to speak with their physician about
the need for screening.
Who is at risk for
developing colon cancer?
Colorectal cancer—cancer of the large intestine
and rectum—is second only to lung cancer
in the number of cancer deaths it causes. On average,
one in 20 people will develop the disease in the
course of a lifetime. Ninety percent of
cases occur in men and women over age 50. The majority
of cases occur in people with no known medical
risk factors for colorectal cancer. But factors
known to sharply increase risk include:
• Personal
or family history of colorectal cancer.
• Personal
or family history of inflammatory bowel disease—ulcerative
colitis or Crohn’s.
• Personal
or family history of ovarian, endometrial or breast
cancer.
• People
of African American and Hispanic descent, who
are often diagnosed at a later stage of the disease.
• Men and
women over the age of 50.
• Men and
women who use tobacco.
• Screening can
prevent cancer by removing pre- cancerous
growths (polyps).
• Early detection
can diagnosis already formed cancers
before they have a chance to spread.
There are several tests used to screen for colorectal
cancer. Here is some information to help you and
your doctor pick the best test for you. Feel free
to take this booklet along with you to your next
appointment to act as a guide for your discussion
on colon cancer screening.
Your physician or other health care provider inserts
a lubricated-gloved finger into the rectum to feel
for anything not normal. This simple test can detect
many rectal cancers and can be performed during
a yearly physical or gynecological visit. A digital
rectal exam should be done beginning at age 40
or sooner if the patient exhibits any symptoms
and before each screening sigmoidoscopy, colonoscopy
or barium enema. This test alone is not sufficient
for accurate screening.
Both colon cancer and polyps can cause bleeding,
which will be passed into the stool. The most common
and most inexpensive colorectal screening device
is the fecal occult blood test. This test should
be performed beginning at age 40. This test, which
can be performed at home, involves examining a
small sample of stool to see if any hidden blood,
which you would not be able to see, is present.
False positives can be obtained with this test,
but it is inexpensive and easy to perform. This
test alone is not sufficient for accurate screening
and needs to be combined with one of the other
tests below. Medicare will pay for annual fecal
occult blood tests when ordered by the patients
attending physician.
A flexible sigmoidoscopy examines the lining of
the rectum and lower 1/3 of the colon using a short
fiberoptic tube that is inserted into the rectum.
A laxative or enema is used before the exam to
cleanse the bowel. The exam is performed in the
physician’s office. A sample of tissue can
be taken from any polyps found during this exam.
Since only one-third or less of the colon is examined,
cancers arising in the upper two thirds of the
colon may go undetected. Medicare will pay for
a flexible sigmoidoscopy once every four years
for average risk patients.
In this test a contrast medium (barium) is infused
into the rectum. As barium fills the colon, x-ray
pictures are taken that allows the radiologist
to see large polyps or cancers (greater than 10
millimeters) in the entire large intestine. Before
the exam you will be asked to cleanse your bowel
using special oral laxatives or by taking an enema.
While this test examines the entire colon it
may miss small cancers or polyps and
cannot be used to biopsy or remove polyps or tumors.
When the barium enema identifies a polyp, or tumor,
a second test, colonoscopy, usually must be done
to confirm the results, and to remove or obtain
a sample of the growth. Medicare always requires
pre-certification for a barium enema if it is to
be used for colon cancer screening.
This exam is currently considered the “gold
standard” for detecting
polyps and cancers. Additionally it allows
for removal of small polyps and the biopsy
of larger growths. After bowel preparation
with special laxatives ordered by your physician,
the patient is sedated. A long flexible scope
with a video chip is inserted into the entire
length of the colon. The image is projected
onto a video screen, allowing the physician
to view the lining of the colon (large intestine).
Medicare will pay for screening colonoscopy
once every two years for beneficiaries over
50 who meet the definition of a high-risk patient.
Medicare will also pay if patients have positive
results on one of the other colorectal screening
tests.
“Capsule” endoscopy is an exciting
new technique using a disposable video capsule
swallowed by the patient that allows visualization
of much of the small bowel not within reach of
standard upper and lower endoscopy. It allows more
access to the small bowel for patients with an
unknown source of gastrointestinal bleeding. Other
potential uses for the capsule are under investigation.
This technology may be particularly helpful in
discovering the cause of bowel bleeding when standard
upper endoscopy and colonoscopy are negative.
Virtual colonoscopy is a new technique that uses
data collected from CT or MRI imaging scans to
create two and three dimensional x-ray pictures
of the large intestine. Before performing virtual
colonoscopy, the bowel is first cleansed with oral
laxatives. A small tube is inserted into the rectum
and the colon is inflated with air. Sedation is
not generally used for this procedure.
The technology is able to identify polyp’s
10 centimeters in diameter—about the size
of a blueberry but may miss smaller polyps. If
an abnormality is found, the patient then undergoes
a conventional colonoscopy so the polyp can be
removed. There is a learning curve involved with
reading the results of these exams and there are
currently no national standards in technique and
in the training of the individuals who interpret
virtual colonoscopy images.
Although the FDA has cleared this technology for
use, there is not yet a Medicare coverage policy
for virtual colonoscopy. In addition, many insurance
companies do not pay for the procedure.
To summarize, one of the limiting aspects of virtual
colonoscopy has been the software processing time,
with several hours required to reconfigure these
images in order for interpretation, but this will
be overcome with time. Other issues center on cost.
In order for a screening test to proliferate, it
must be cost effective.
DNA STOOL TEST: This test currently
in clinical trials is expected to be available
soon. DNA found in stool is examined to detect
the presence of colorectal cancer or pre-cancerous
polyps. This test can be performed in the home
and requires no preparation.
Making Prevention a Way of Life
Prevention Tips
There are several ways to reduce the risk of developing
colon cancer. One way is to have benign polyps
removed via colonoscopy. Though not definitely
proven, there is some evidence to suggest that
diet may play a large role in preventing colorectal
cancer. As far as we know, a high fiber, low fat
diet might help prevent colorectal cancer. Other
steps to reduce your risks include:
• Follow
colorectal cancer screening guidelines beginning
at age 50 or sooner depending on your family
history or symptoms. While colorectal cancer
screening is increasing, most Americans are still
not screened for colon cancer on a regular basis.
• Talk to
your family members to find out if there is any
history of colon cancer or polyps.
• Eat a diet that is low in
total fat, and high in fruits, vegetables and
fiber. Follow the recommendations of The Food
Guide Pyramid. The Food Guide Pyramid is an outline
of what to eat each day based on USDA guidelines.
It’s not a rigid prescription but a general
guide that lets you choose a healthful diet that’s
right for you. The Pyramid calls for eating a
combination of foods from the five food groups.
Be sure to eat at least the lowest number of
servings from these five groups:
1) Milk, Yogurt, & Cheese
Group: 2-3 Servings
2) The Vegetable
Group: 3-5 Servings
3) Meat, Poultry,
Fish, Dry Beans, Eggs, & Nuts Group: 2-3
Servings
4) Fruit Group:
2-4 Servings
5) Bread,
Cereal, Rice and Pasta Group: 6-11 Servings
6) Fats, Oils
and Sweets—Use Sparingly
• Drink plenty
of fluids
• Achieve
and maintain a healthy weight
• Quit smoking
• Don’t
be a “couch potato”; get at least
30 minutes of physical activity on most days.
Choose activities that you enjoy and that you
can do regularly. Some people prefer activities
that fit into their daily routine, like gardening
or taking extra trips up and down stairs. Others
prefer a regular exercise program, such as a
physical activity program at their worksite.
The important thing is to try to be physical
active each day.
• Decrease
alcohol consumption
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