The carcinoembryonic antigen (CEA) test is a laboratory blood study. CEA is a substance which is normally found only during fetal development, but may reappear in adults who develop certain types of cancer.
Purpose
The CEA test is ordered for patients with known cancers. The CEA test is most commonly ordered when a patient has a cancer of the gastrointestinal system. These include cancer of the colon, rectum, stomach (gastric cancer), esophagus, liver, or pancreas. It is also used with cancers of the breast, lung, or prostate.
The CEA level in the blood is one of the factors that doctors consider when determining the prognosis, or most likely outcome of a cancer. In general, a higher CEA level predicts a more severe disease, one that is less likely to be curable. But it does not give clear-cut information. The results of a CEA test are usually considered along with other laboratory and/or imaging studies to follow the course of the disease.
Once treatment for the cancer has begun, CEA tests have a valuable role in monitoring the patient's progress. A decreasing CEA level means therapy is effective in fighting the cancer. A stable or increasing CEA level may mean the treatment is not working, and/or that the tumor is growing. It is important to understand that serial CEA measurements, which means several done over a period of time, are the most useful. A single test result is difficult to evaluate, but a number of tests, done weeks apart, shows trends in disease progression or regression.
Certain types of cancer treatments, such as hormone therapy for breast cancer, may actually cause the CEA level to go up. This elevation does not accurately reflect the state of the disease. It is sometimes referred to as a "flare response." Recognition that a rise in CEA may be temporary and due to therapy is significant. If this possibility is not taken into account, the patient may be unnecessarily discouraged. Further, treatment that is actually effective may be stopped or changed prematurely.
CEA tests are also used to help detect recurrence of a cancer after surgery and/or other treatment has been completed. A rising CEA level may be the first sign of cancer return, and may show up months before other studies or patient symptoms would raise concern. Unfortunately, this does not always mean the recurrent cancer can be cured. For example, only a small percentage of patients with colorectal cancers and rising CEA levels will benefit from another surgical exploration. Those with recurrence in the same area as the original cancer, or with a single metastatic tumor in the liver or lung, have a chance that surgery will eliminate the disease. Patients with more widespread return of the cancer are generally not treatable with surgery. The CEA test will not separate the two groups.
Patients who are most likely to benefit from non-standard treatments, such as bone marrow transplants, may be determined on the basis of CEA values, combined with other test results. CEA levels may be one of the criteria for determining whether the patient will benefit from more expensive studies, such as CT scan or MRI.
Precautions
The CEA test is not a screening test for cancer. It is not useful for detecting the presence of cancer. Many cancers do not produce an increased CEA level. Some noncancerous diseases, such as hepatitis, inflammatory bowel disease, pancreatitis, and obstructive pulmonary disease, may cause an elevated CEA level.
Description
Determination of the CEA level is a laboratory blood test. Obtaining a specimen of blood for the study takes only a few minutes. CEA testing should be covered by most insurance plans.
Preparation
No preparation is required.
Aftercare
None.
Risks
There are no complications or side effects of this test. However, the results of a CEA study should be interpreted with caution. A single test result may not yield clinically useful information. Several studies over a period of months may be needed.
Another concern is the potential for false positive as well as false negative results. A false positive result means the test shows an abnormal value when cancer is not present. A false negative means the test reveals a normal value when cancer actually is present.
Normal results
The absolute numbers which are considered normal vary from one laboratory to another. Any results reported should come with information regarding the testing facility's normal range.
Abnormal results
A single abnormal CEA value may be significant, but must be regarded cautiously. In general, very high CEA levels indicate more serious cancer, with a poorer chance for cure. But some benign diseases and certain cancer treatments may produce an elevated CEA test. Cigarette smoking will also cause the CEA level to be abnormally high.
Monday, November 10, 2008
Wednesday, November 5, 2008
steps to avoid cancer
Some do’s and don’ts for helping to avoid and fight cancer.
Your mental state
* Be positive.
* Resolve stress and past traumas.
* Accept yourself and your emotions, including the negative ones.
* Practice meditation, yoga, tai chi or some other form of relaxation.
Your diet
* These vegetables have great cancer-fighting characteristics: beets, Brussels sprouts, cabbage, garlic, kale, leeks and scallions.
* Also good are onions, blueberries, raspberries, cherries, red wine, soy.
* Increase your intake of omega-3s, typically found in fish (herring, trout, sardines, mackerel, halibut) and flax seeds and oils.
* Avoid sugar, white flour, vegetable oils, white rice and non-organic animal fat (meat, eggs, milk, cheese).
* Filter your tap water.
Your activity
* Spend 20 to 30 minutes a day on a physical activity like tennis, swimming or walking.
* Be out in the sun for 20 minutes every day.
And...
* Avoid being surrounded by people who smoke.
* Use cosmetic products that don’t contain parabens or phthalates.
* Use skin-care products without estrogens or placental by-products.
* Use cleaning products without synthetic chemicals.
* Don’t prepare food in a scratched Teflon pan.
* Reduce the influence of cell phones by using a headset consistently.
Source: David Servan-Schreiber, Anticancer 11-05-08
David Servan-Schreiber | November 2008 issue of ODE Magazine
Your mental state
* Be positive.
* Resolve stress and past traumas.
* Accept yourself and your emotions, including the negative ones.
* Practice meditation, yoga, tai chi or some other form of relaxation.
Your diet
* These vegetables have great cancer-fighting characteristics: beets, Brussels sprouts, cabbage, garlic, kale, leeks and scallions.
* Also good are onions, blueberries, raspberries, cherries, red wine, soy.
* Increase your intake of omega-3s, typically found in fish (herring, trout, sardines, mackerel, halibut) and flax seeds and oils.
* Avoid sugar, white flour, vegetable oils, white rice and non-organic animal fat (meat, eggs, milk, cheese).
* Filter your tap water.
Your activity
* Spend 20 to 30 minutes a day on a physical activity like tennis, swimming or walking.
* Be out in the sun for 20 minutes every day.
And...
* Avoid being surrounded by people who smoke.
* Use cosmetic products that don’t contain parabens or phthalates.
* Use skin-care products without estrogens or placental by-products.
* Use cleaning products without synthetic chemicals.
* Don’t prepare food in a scratched Teflon pan.
* Reduce the influence of cell phones by using a headset consistently.
Source: David Servan-Schreiber, Anticancer 11-05-08
David Servan-Schreiber | November 2008 issue of ODE Magazine
Tuesday, October 7, 2008
How Often Should You Get a Colonoscopy?
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.
Posted in Colon Cancer on October 7, 2008
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.
Posted in Colon Cancer on October 7, 2008
Wednesday, September 17, 2008
PET Scans for Recurrent Colorectal Cancer
September 10, 2008 — The use of positron emission tomography (PET) scans led to changes in disease management for more than half of all patients with suspected or proven recurrent colorectal cancer, according to the results of a study published in the September issue of the Journal of Nuclear Medicine.
In this large multicenter trial, PET scanning detected additional disease sites in 48.4% of patients in 1 study group (group A) and in 43.9% of patients in the second study group (group B). The use of PET scanning also changed the planned disease management in 65.6% of patients in group A and 49.0% of those in group B.
"The data from our study, as well as from other studies, clearly demonstrates that PET can alter management decisions, and in many meaningful ways," lead study author Andrew M. Scott, MD, director of the Centre for PET and the Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Australia, told Medscape Oncology in an interview. "It can help confirm the presence of disease, identify additional sites of disease, and assist in making the most appropriate treatment decisions."
"It should be emphasized that some patients have isolated disease that can be resected, which will allow them to have long progression free survival periods or even a potential cure," Dr. Scott added. "PET scanning can more appropriately identify patients that will benefit from these treatments."
Prompted Changes in More Than Half of Patients
PET scans have been shown to demonstrate a high degree of accuracy in the detection of recurrent and metastatic colorectal cancer, and although sensitivity is comparable with a computed tomographic (CT) scan in the detection of metastases to the liver, it is superior in the detection of extrahepatic disease. Previous reports estimate that the use of PET has changed estimates of the extent of disease in approximately one third of patients and that it can influence management decisions in patients with metastatic colorectal cancer.
However, few prospective studies evaluating the use of PET in patients with recurrent colorectal cancer have been performed, and none have been large multicenter trials. The study authors note that the effect of PET on patient outcomes, such as progression-free survival, has also not been previously reported.
The goal of the current trial was to evaluate the effect of PET on management change in patients with proven or suspected recurrent colorectal cancer and to assess the effect of management change on disease-free survival.
A total of 191 patients from 4 institutions were enrolled in the study between November 23, 2003, and August 12, 2004, and they were subsequently separated into 2 study groups. Group A consisted of 93 symptomatic patients with a residual structural lesion suggestive of a recurrent tumor, whereas group B consisted of 98 patients with potentially resectable liver or lung metastases.
Lesions Detected by PET, Management Changes
In group A, 90 (96.8%) patients underwent both PET and CT scans, whereas 3 (3.2%) patients underwent a PET scan only. In group B, 83 (84.7%) patients underwent both PET and CT scans, whereas 15 (15.3%) patients underwent a PET scan only.
Additional disease sites were identified in 45 (48.4%) patients in group A, and in the second group, additional sites were detected in 43 (43.9%) patients. Undergoing a PET scan also resulted in changes in disease management plans. On the basis of PET scan results, 61 (65.6%) patients in group A had management plans altered, and in group B, 48 (49.0%) patients had a change in management plans. In 96% of the patients participating in this study, the treatment management plan that was actually implemented was consistent with the stated post-PET management plan.
Progression-Free Survival
At 12 months, the investigators evaluated clinical outcomes by comparing the progression-free survival of patients in both groups. The researchers found that patients who had additional lesions detected on PET scan had poorer progression-free survival vs those who had conventional imaging. On follow-up, 60.5% of patients in group A had progressive disease, with additional lesions identified by PET scanning vs patients who underwent conventional imaging. In group B, progressive disease was identified in 65.9% of patients with additional lesions that were detected with PET scans.
Patients in group B who had localized disease to the liver or lungs on PET scan had a better prognosis vs those with more disseminated disease. The researchers also noted that these data clearly showed the powerful prognostic ability of PET to accurately stratify patients who are thought to have localized disease on conventional imaging. Stratification into curative and palliative groups was also improved after PET scans for patients in both groups. In addition, those in group B who planned to have surgery after undergoing a PET scan had superior progression-free survival vs patients who planned surgery before undergoing a PET scan.
"The data from our study shows that using PET scanning can impact outcomes and therapeutic decisions, and while our study did not look at cost effectiveness, there is substantial data showing that PET scanning is cost effective," said Dr. Scott.
Inappropriate treatment not only has a substantial effect on patient well-being, but also can be very costly, Dr. Scott emphasized. "PET scanning can contribute to more appropriate treatment decisions and ultimately be cost saving, but that was not specifically examined in our study."
This study was funded by the Australian Government Department of Health and Ageing.
J Nucl Med. 2008;49:1451-1457.
In this large multicenter trial, PET scanning detected additional disease sites in 48.4% of patients in 1 study group (group A) and in 43.9% of patients in the second study group (group B). The use of PET scanning also changed the planned disease management in 65.6% of patients in group A and 49.0% of those in group B.
"The data from our study, as well as from other studies, clearly demonstrates that PET can alter management decisions, and in many meaningful ways," lead study author Andrew M. Scott, MD, director of the Centre for PET and the Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Australia, told Medscape Oncology in an interview. "It can help confirm the presence of disease, identify additional sites of disease, and assist in making the most appropriate treatment decisions."
"It should be emphasized that some patients have isolated disease that can be resected, which will allow them to have long progression free survival periods or even a potential cure," Dr. Scott added. "PET scanning can more appropriately identify patients that will benefit from these treatments."
Prompted Changes in More Than Half of Patients
PET scans have been shown to demonstrate a high degree of accuracy in the detection of recurrent and metastatic colorectal cancer, and although sensitivity is comparable with a computed tomographic (CT) scan in the detection of metastases to the liver, it is superior in the detection of extrahepatic disease. Previous reports estimate that the use of PET has changed estimates of the extent of disease in approximately one third of patients and that it can influence management decisions in patients with metastatic colorectal cancer.
However, few prospective studies evaluating the use of PET in patients with recurrent colorectal cancer have been performed, and none have been large multicenter trials. The study authors note that the effect of PET on patient outcomes, such as progression-free survival, has also not been previously reported.
The goal of the current trial was to evaluate the effect of PET on management change in patients with proven or suspected recurrent colorectal cancer and to assess the effect of management change on disease-free survival.
A total of 191 patients from 4 institutions were enrolled in the study between November 23, 2003, and August 12, 2004, and they were subsequently separated into 2 study groups. Group A consisted of 93 symptomatic patients with a residual structural lesion suggestive of a recurrent tumor, whereas group B consisted of 98 patients with potentially resectable liver or lung metastases.
Lesions Detected by PET, Management Changes
In group A, 90 (96.8%) patients underwent both PET and CT scans, whereas 3 (3.2%) patients underwent a PET scan only. In group B, 83 (84.7%) patients underwent both PET and CT scans, whereas 15 (15.3%) patients underwent a PET scan only.
Additional disease sites were identified in 45 (48.4%) patients in group A, and in the second group, additional sites were detected in 43 (43.9%) patients. Undergoing a PET scan also resulted in changes in disease management plans. On the basis of PET scan results, 61 (65.6%) patients in group A had management plans altered, and in group B, 48 (49.0%) patients had a change in management plans. In 96% of the patients participating in this study, the treatment management plan that was actually implemented was consistent with the stated post-PET management plan.
Progression-Free Survival
At 12 months, the investigators evaluated clinical outcomes by comparing the progression-free survival of patients in both groups. The researchers found that patients who had additional lesions detected on PET scan had poorer progression-free survival vs those who had conventional imaging. On follow-up, 60.5% of patients in group A had progressive disease, with additional lesions identified by PET scanning vs patients who underwent conventional imaging. In group B, progressive disease was identified in 65.9% of patients with additional lesions that were detected with PET scans.
Patients in group B who had localized disease to the liver or lungs on PET scan had a better prognosis vs those with more disseminated disease. The researchers also noted that these data clearly showed the powerful prognostic ability of PET to accurately stratify patients who are thought to have localized disease on conventional imaging. Stratification into curative and palliative groups was also improved after PET scans for patients in both groups. In addition, those in group B who planned to have surgery after undergoing a PET scan had superior progression-free survival vs patients who planned surgery before undergoing a PET scan.
"The data from our study shows that using PET scanning can impact outcomes and therapeutic decisions, and while our study did not look at cost effectiveness, there is substantial data showing that PET scanning is cost effective," said Dr. Scott.
Inappropriate treatment not only has a substantial effect on patient well-being, but also can be very costly, Dr. Scott emphasized. "PET scanning can contribute to more appropriate treatment decisions and ultimately be cost saving, but that was not specifically examined in our study."
This study was funded by the Australian Government Department of Health and Ageing.
J Nucl Med. 2008;49:1451-1457.
Tuesday, September 16, 2008
The Size of a Pea
The Size of a Pea and a Lot More Dangerous
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.
Johns Hopkins Health Alerts 09.16.08
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.
Johns Hopkins Health Alerts 09.16.08
Tuesday, September 9, 2008
Improving Survival after Colon Rectal Cancer
African Americans are between 30 to 50 percent more likely to die from Colon Rectal Cancer than their white counterparts. Finding explanations for this disparity has been the focus of many studies.
Is it access to health care?
Is it education?
Is it due to the type of cancer treatment?
Researchers have not solved this mystery.
09-09-08
Quoted from the Northern California Cancer Center 2007 Annual Report.
Is it access to health care?
Is it education?
Is it due to the type of cancer treatment?
Researchers have not solved this mystery.
09-09-08
Quoted from the Northern California Cancer Center 2007 Annual Report.
Can Colorectal Cancer Be Prevented?
Can Colorectal Cancer Be Prevented?
American Cancer Society
Even though we do not know the exact cause of most colorectal cancer, it is possible to prevent many colorectal cancers.
Screening:
One of the most powerful weapons in preventing colorectal cancer is regular colorectal cancer screening or testing. From the time the first abnormal cells start to grow, it usually takes about 10 to 15 years for them to develop into colorectal cancer. Regular colorectal cancer screening can, in many cases, prevent colorectal cancer altogether. (See the American Cancer Society screening guidelines in the next section "Can Colorectal Polyps and Cancer Be Found Early?"). This is because polyps, or growths, can be detected and removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable.
People who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal cancer polyps or cancer need to talk with their doctor about starting screening at a younger age and more frequent intervals.
Diet and exercise:
People can lower their risk of developing colorectal cancer by managing the risk factors that they can control, such as diet and physical activity. It is important to eat plenty of fruits, vegetables, and whole grain foods and to limit intake of high-fat foods. Physical activity is another area that people can control. The American Cancer Society recommends at least 30, preferably 45 to 60 minutes of physical activity on 5 or more days of the week. If you are overweight, you can ask your doctor about a weight loss plan that will work for you. For more information about diet and physical activity, refer to the American Cancer Society document, American Cancer Society Guidelines for Nutrition and Physical Activity for Cancer Prevention.
Vitamins, calcium, magnesium:
Some studies suggest that taking a daily multivitamin containing folic acid, or folate, can lower colorectal cancer risk. Other studies suggest that increasing calcium intake may lower risk. Some have suggested that vitamin D, which you can get from sun exposure or in a vitamin pill, can lower colorectal cancer risk. Of course, excessive sun exposure can cause skin cancer and is not recommended as a way to lower colorectal cancer risk. Calcium and vitamin D may work together to reduce colorectal cancer risk, as vitamin D aids in the body’s absorption of calcium. In addition, one recent study suggested that a diet high in magnesium may also reduce colorectal cancer risk in women.
Nonsteroidal anti-inflammatory drugs:
Many studies have found that people who regularly use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve), have a 20% to 50% lower risk of colorectal cancer and adenomatous polyps. Most of these studies, however, are based on observations of people who took these medications for reasons such as treatment of arthritis or prevention of heart attacks. Two recent studies have provided even stronger evidence regarding the ability of aspirin to prevent the growth of polyps. The advantage of these recent studies is that people were randomly selected by the researchers to receive either aspirin or an inactive placebo. One study included people who were previously treated for early stages of colorectal cancer, and the other study included people who previously had polyps removed.
But NSAIDs can cause serious or even life-threatening bleeding from stomach irritation. Currently available information suggests that the risks of serious bleeding outweigh the benefits of these medicines for the general public. For this reason, experts do not recommend NSAIDs as a cancer-prevention strategy for people at average risk of developing colorectal cancer. However, the value of these drugs for people at increased colorectal cancer risk is being actively studied. Celecoxib (Celebrex) has been approved by the US Food and Drug Administration for reducing polyp formation in people with FAP. One advantage of this drug is that it causes less bleeding in the stomach. However, celecoxib may increase the risk of heart attacks and strokes. A similar drug, rofecoxib (Vioxx), was taken off the market because people who took it had an increased number of heart attacks and strokes. Please check with your doctor before beginning to take aspirin and other NSAIDs on a regular basis.
Female hormones:
Hormone replacement therapy (HRT) in postmenopausal women may reduce their risk of developing colorectal cancer. But those women on HRT who do develop colorectal cancer may have a fast growing cancer.
HRT also lowers the risk of developing osteoporosis, but it may increase the risk of heart disease, blood clots, and breast and uterine cancers. For these reasons, the decision to use HRT should be based on a careful discussion of benefits and risks with your doctor.
Other factors:
There are other risk factors that can't be controlled, such as a strong family history of colorectal cancer. But even when people have a history of colorectal cancer in their family, they may be able to prevent the disease. For example, people with a family history of colorectal cancer may benefit from starting screening tests when they are younger and having them done more often than people without this risk factor.
Genetic tests can help determine which members of certain families have inherited a high risk for developing colorectal cancer. Without genetic testing, all members of a family known to have an inherited form of colorectal cancer should be screened early and frequently. However, with genetic testing, family members who are found not to have inherited the mutated gene can be screened with the same frequency as people at average risk.
People with FAP should start colonoscopy during their teens. Most doctors recommend they have their colon removed when they are in their 20s to prevent cancer from developing.
The lifetime risk of developing colorectal cancer for people with HNPCC is about 80% compared to near 100% for those with FAP. Doctors recommend that people with HNPCC start colonoscopy screening during their 20s to remove any polyps and find any cancers at the earliest possible stage. People known to carry the genetic mutation associated with HNPCC may be offered the option of yearly screening with colonoscopy or removal of most of the colon.
Ashkenazi Jews with the I1307K APC mutation have an increased colorectal cancer risk, but do not develop these cancers when they are very young. And, as a group overall, Ashkenazi Jews (even those without the I1307K APC mutation) are more likely to develop colorectal cancer than other ethnic groups. For these reasons, most doctors recommend that they carefully follow the usual recommendations for colorectal cancer screening, but earlier or more frequent testing is usually not suggested.
Since some colorectal cancers can't be prevented, finding the disease early is the best way to improve the chance of a cure and reduce the number of deaths caused by this disease.
In addition to the screening recommendations for people at average colorectal cancer risk, the American Cancer Society has additional guidelines for people at moderate and high risk of colorectal cancer. These recommendations are described in the section "Can Colorectal Polyps and Cancer Be Found Early?" Ask your doctor how these guidelines might apply to you.
American Cancer Society
Even though we do not know the exact cause of most colorectal cancer, it is possible to prevent many colorectal cancers.
Screening:
One of the most powerful weapons in preventing colorectal cancer is regular colorectal cancer screening or testing. From the time the first abnormal cells start to grow, it usually takes about 10 to 15 years for them to develop into colorectal cancer. Regular colorectal cancer screening can, in many cases, prevent colorectal cancer altogether. (See the American Cancer Society screening guidelines in the next section "Can Colorectal Polyps and Cancer Be Found Early?"). This is because polyps, or growths, can be detected and removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable.
People who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal cancer polyps or cancer need to talk with their doctor about starting screening at a younger age and more frequent intervals.
Diet and exercise:
People can lower their risk of developing colorectal cancer by managing the risk factors that they can control, such as diet and physical activity. It is important to eat plenty of fruits, vegetables, and whole grain foods and to limit intake of high-fat foods. Physical activity is another area that people can control. The American Cancer Society recommends at least 30, preferably 45 to 60 minutes of physical activity on 5 or more days of the week. If you are overweight, you can ask your doctor about a weight loss plan that will work for you. For more information about diet and physical activity, refer to the American Cancer Society document, American Cancer Society Guidelines for Nutrition and Physical Activity for Cancer Prevention.
Vitamins, calcium, magnesium:
Some studies suggest that taking a daily multivitamin containing folic acid, or folate, can lower colorectal cancer risk. Other studies suggest that increasing calcium intake may lower risk. Some have suggested that vitamin D, which you can get from sun exposure or in a vitamin pill, can lower colorectal cancer risk. Of course, excessive sun exposure can cause skin cancer and is not recommended as a way to lower colorectal cancer risk. Calcium and vitamin D may work together to reduce colorectal cancer risk, as vitamin D aids in the body’s absorption of calcium. In addition, one recent study suggested that a diet high in magnesium may also reduce colorectal cancer risk in women.
Nonsteroidal anti-inflammatory drugs:
Many studies have found that people who regularly use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve), have a 20% to 50% lower risk of colorectal cancer and adenomatous polyps. Most of these studies, however, are based on observations of people who took these medications for reasons such as treatment of arthritis or prevention of heart attacks. Two recent studies have provided even stronger evidence regarding the ability of aspirin to prevent the growth of polyps. The advantage of these recent studies is that people were randomly selected by the researchers to receive either aspirin or an inactive placebo. One study included people who were previously treated for early stages of colorectal cancer, and the other study included people who previously had polyps removed.
But NSAIDs can cause serious or even life-threatening bleeding from stomach irritation. Currently available information suggests that the risks of serious bleeding outweigh the benefits of these medicines for the general public. For this reason, experts do not recommend NSAIDs as a cancer-prevention strategy for people at average risk of developing colorectal cancer. However, the value of these drugs for people at increased colorectal cancer risk is being actively studied. Celecoxib (Celebrex) has been approved by the US Food and Drug Administration for reducing polyp formation in people with FAP. One advantage of this drug is that it causes less bleeding in the stomach. However, celecoxib may increase the risk of heart attacks and strokes. A similar drug, rofecoxib (Vioxx), was taken off the market because people who took it had an increased number of heart attacks and strokes. Please check with your doctor before beginning to take aspirin and other NSAIDs on a regular basis.
Female hormones:
Hormone replacement therapy (HRT) in postmenopausal women may reduce their risk of developing colorectal cancer. But those women on HRT who do develop colorectal cancer may have a fast growing cancer.
HRT also lowers the risk of developing osteoporosis, but it may increase the risk of heart disease, blood clots, and breast and uterine cancers. For these reasons, the decision to use HRT should be based on a careful discussion of benefits and risks with your doctor.
Other factors:
There are other risk factors that can't be controlled, such as a strong family history of colorectal cancer. But even when people have a history of colorectal cancer in their family, they may be able to prevent the disease. For example, people with a family history of colorectal cancer may benefit from starting screening tests when they are younger and having them done more often than people without this risk factor.
Genetic tests can help determine which members of certain families have inherited a high risk for developing colorectal cancer. Without genetic testing, all members of a family known to have an inherited form of colorectal cancer should be screened early and frequently. However, with genetic testing, family members who are found not to have inherited the mutated gene can be screened with the same frequency as people at average risk.
People with FAP should start colonoscopy during their teens. Most doctors recommend they have their colon removed when they are in their 20s to prevent cancer from developing.
The lifetime risk of developing colorectal cancer for people with HNPCC is about 80% compared to near 100% for those with FAP. Doctors recommend that people with HNPCC start colonoscopy screening during their 20s to remove any polyps and find any cancers at the earliest possible stage. People known to carry the genetic mutation associated with HNPCC may be offered the option of yearly screening with colonoscopy or removal of most of the colon.
Ashkenazi Jews with the I1307K APC mutation have an increased colorectal cancer risk, but do not develop these cancers when they are very young. And, as a group overall, Ashkenazi Jews (even those without the I1307K APC mutation) are more likely to develop colorectal cancer than other ethnic groups. For these reasons, most doctors recommend that they carefully follow the usual recommendations for colorectal cancer screening, but earlier or more frequent testing is usually not suggested.
Since some colorectal cancers can't be prevented, finding the disease early is the best way to improve the chance of a cure and reduce the number of deaths caused by this disease.
In addition to the screening recommendations for people at average colorectal cancer risk, the American Cancer Society has additional guidelines for people at moderate and high risk of colorectal cancer. These recommendations are described in the section "Can Colorectal Polyps and Cancer Be Found Early?" Ask your doctor how these guidelines might apply to you.
Subscribe to:
Posts (Atom)