Colon Cancer Follow-up and Recurrence

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.

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Helplessly Handicapped

Helplessly Handicapped
4/12/08 5:02 AM

I cheated again
Used handicapped parking
But I’m not handicapped.
Told myself I earned my handicap status
Cause I am a cancer survivor
Every year DMV’s computer
Keeps renewing my blue handicapped pass
So I can cheat when I want
I can park for free, its OK I am special
I am helplessly handicapped
Push my car into a blue zone
Able-bodied people push money into meters
It is so tempting my parking pass
It sits in my glove compartment
Hiding like Halloween candy
Its OK, you earned it.
Being handicapped is a 12-step process
Hi, I’m Doug I’m slightly handicapped
I can park for free in Oakland all day
Cause I got a blue card hanging on my mirror
So easy, just hang the blue handicapped plaque
On the rear view mirror,
lock the car and walk away
I’m entitled to use my pass
Because?
Because I got cancer 5 years ago
Doesn’t that blue card expire?
Nope, I have become hopelessly handicapped
DMV will make sure it’s forever
My handicap status is permanent
But you are cured of cancer!
I am
So why are you helplessly handicapped?
Because I can still justify this behavior.
Really, and you can sleep at night?
Yeah. sometimes

Colon Cancer Special Report from Johns Hopkins April 1, 2008

Alternative and Complementary Therapies for Colon Cancer

Johns Hopkins specialists discuss eight complementary therapies to ease symptoms of colon cancer.

The truth: There is no "natural cancer cure,” and so-called therapies based on that claim have injured many cancer patients -- either directly, because of dangerous "treatments,” or indirectly, by keeping them from using methods validated by solid research.

Now the good news: Many complementary therapies, used along with conventional medicine, can support cancer treatments, reduce some of the adverse effects of cancer treatment, ease tension and pain, and contribute to overall health. This is known as integrative medicine.

Integrative medicine can be particularly important for palliative care: interventions that contribute to comfort and well-being but not necessarily to a cure. Yoga, acupuncture, meditation, aromatherapy, relaxation techniques, and spiritual healing are used often in this way.

If you decide to try something your doctor has not prescribed, be sure to tell your medical team. Your cancer treatments have been carefully tailored for your situation, and adding anything else could have serious effects or interact with your cancer treatments. Look for an integrative practitioner who is also a licensed physician or who works with a medical doctor. Any integrative therapist should be willing to give reports to and consult with your doctor.

• Complementary Cancer Therapy 1: Acupuncture -- The ancient treatment has been shown to ease many conditions associated with cancer, especially those connected with chemotherapy. Studies have show that acupuncture may relieve postoperative nausea and vomiting and chemotherapy-induced acute vomiting, especially when used along with conventional medications. It can also relieve peripheral neuropathy, an often-painful form of nerve damage sometimes caused by chemotherapy.
• Complementary Cancer Therapy 2: Mind–Body Therapies -- A solid body of evidence shows that meditation and relaxation can ease pain, relieve stress, and improve depression. In fact, your cancer center or local clinic probably has a stress-reduction program that insurance will cover, at least in part. Programs may involve guided imagery or visualization, relaxation, and breathing techniques to enhance treatment and control pain. Meditation has been shown to contribute to relaxation and pain relief and to enhance some treatments.
• Complementary Cancer Therapy 3: Yoga and Tai Chi -- These ancient Eastern movement practices were developed to balance mind and body and have been shown to improve mood and ease pain. They also contribute to muscle strength, energy level, and balance. However, they involve physical exercise, and some classes can be quite strenuous. Ask at your cancer center about tai chi or yoga classes. Some are covered by insurance or offered at a minimal cost. Look for classes developed especially for people with chronic illness or who are recovering from cancer. There are also videos and DVDs especially for cancer patients that you can use at home.
• Complementary Cancer Therapy 4: Aromatherapy -- An entire philosophy and even some research support the idea that certain odors can be calming or stimulating. Most aromatherapy involves essential oils from plants or herbs. You may find aromatherapy pleasant, and it is unlikely to cause harm.
• Complementary Cancer Therapy 5: Spiritual Healing -- Religion and spiritual practices bring solace and comfort to many and can be an important part of your mental well-being. Studies show they may relieve stress and anxiety and contribute to relaxation, and others who share your spiritual beliefs can be supportive. However, do not expect a cure from spiritual or religious practices, and avoid anyone who says that your thoughts or a lack of faith caused your cancer. Such negative influences will not help you to get well or feel better.
• Complementary Cancer Therapy 6: Healing Retreats -- Cancer retreats can help patients and their families and caregivers. These are special residential centers, often in a beautiful setting, that offer programs to help understand and cope with the stress and complex emotional aspects of a cancer diagnosis. Programs often include mind–body exercises, such as meditation and yoga; nutritional advice; help with the effects of both the cancer and its treatments; and an opportunity to be in a private setting with others who are going through a similar experience.
• Complementary Cancer Therapy 7: Herbs and Supplements -- It’s true that many conventional medicines were developed from botanicals and herbal therapies. However, when used in their unprocessed state, as supplements, “special natural formulas,” and herbal remedies, most have not been shown effective in treating or preventing cancer. In fact, many of the so-called natural cancer cures may cause harm. They can damage other organs and even lead to death. Also, anything you ingest could interact with conventional cancer treatments.

However, some herbs and supplements may help with your symptoms or ease some of the most unpleasant side effects of treatment. For instance, peppermint may ease nausea and vomiting, and there also is evidence that taking ginger by mouth might help reduce chemotherapy-induced nausea.

• Complementary Cancer Therapy 8: Irrigation and Enemas -- The Internet abounds with ads for “cleansing colon treatments” and enemas that are touted to prevent or cure cancer by clearing “toxins” and “unhealthy buildup” out of your colon. There is no scientific basis whatsoever for these claims. What’s more, frequent use of laxatives and enemas can cause dehydration and other health problems. Also, these treatments are not very pleasant. If you did not enjoy the colonic cleansing you underwent before colonoscopy, you probably won’t like these very much, either.

Stress

Stress and Heart Disease

Though the evidence is not definitive, a lot of research suggests a possible link between stress and heart disease. Johns Hopkins cardiologists discuss this important topic.

We've all heard the remark: "If that person doesn't slow down, he is going to have a heart attack." So it's not surprising that along with the usual advice about blood pressure, cholesterol, exercise, and diet your doctor may advise you to manage or reduce the stress in your life. Yet the presumed association between psychological or mental stress and heart disease remains just that -- a presumption.

After years of study, researchers have yet to prove that stress is a cause of heart disease or a trigger for a heart attack. But there is evidence to support a link between psychological stress and the health of your heart. For example, stress can cause you to overeat, smoke, drink too much alcohol, be physically inactive, and not take your medication -- all of which can have negative effects on your heart. It may also cause changes in your body that could make you more susceptible to heart disease and heart attacks.

Evidence: Interesting but Not Conclusive

When you are in a stressful situation, your body releases hormones to help you deal with the perceived threat. These hormones, such as epinephrine and cortisol, temporarily increase your heart rate and blood pressure. However, stress can cause other changes -- both temporary and more long lasting -- that can lead to problems for your heart.

What Should You Do? Though the evidence is not definitive, a lot of research suggests a possible link between stress and heart disease. Even if the relationship is indirect -- that is, stress causes you to engage in unhealthy behaviors or causes changes in your body that could put you at risk -- gaining control of your stress levels is important for both your physical and mental health. Here are three important steps for reining in the potential effects of stress:

1. Work with your doctor to keep track of and control any heart risk factors you may have -- from high blood pressure and high cholesterol to obesity and smoking.

2. Get regular exercise to lower your stress levels and its effects on your body. In a recent study of 134 people with coronary heart disease, those who walked or jogged for 35 minutes three times a week for four months reduced their stress levels and saw improvements in their heart rate variability and function of their blood vessels.

3. Learn some stress management techniques such as biofeedback, relaxation techniques (for example, meditation, progressive muscle relaxation, or guided imagery). These techniques can help manage your response to stress and in the process may improve some heart risk factors, too. A recent study found that meditation reduced blood pressure and blood glucose levels and improved insulin sensitivity and heart rate variability.

Duck and Cover

Duck and Cover
1961

Little ones get ready for an Atomic bomb blast
Don’t worry Duck and cover
The nun was dressed in black and white
Wooden crucifix hung around her neck
She rang the bell and commanded
Line up quietly boys and girls and face the wall
Face down I am forced to place my head in my hands
Kneel on a polished tile floor in Catholic school
Do as I say
Face down fetal position
Duck and cover
Be prepared for radiation from the Russians
It will only last five minutes

Face Down

Face Down
2003

Removed street clothes
Waited for radiation room
Waited in line with others to kill cancer
Cancer cells crawled through my caucus, hiding
Is this radiation treatment safe?
Don’t worry the doctor knows best
Face down in fetal position
Line up the lasers
Focus radiation gun to zap my back
Face down on a black table draped with a white sheet
Can’t see the man hiding behind a lead wall
Face down
No identity just a body on the slab
Bare ass exposed to the radiation gun
Hovering over my body
Face down head in my hands
Can’t look eyes closed
Fetal position
Total submission
Oh dear God kill my cancer!
Don’t move the voice said
I won’t
Don’t breathe
I won’t
Radiation gun zapped my colon
Oh God deliver me from this disease
Don’t worry
Only five minutes
You’re done now
That wasn’t so bad was it?
See you next week Mr. Beckstein

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

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.
source: John's Hopkins Health Alert Jan. 28, 2008