Richard G. Petty, MD

Colon Cancer: Improving the Chances of Cure

I was very pleased to see how many people have read and downloaded the advice about reducing your risk of colon cancer. I was also very happy with the announcement this morning that Tony Snow’s cancer has not spread to his liver.

People who develop cancer of the colon can often be cured of their original tumors, but some grow back and then they can be more difficult to eradicate. Most relapses occur within 2.5 to 3.0 years. If a tumor has not returned within five years, many doctors consider that the patient has been cured.

The risk of getting a tumor and of it recurring is greater if there is some “predisposing factor,” including a positive family history for colon cancer, familial polyps of the colon or inflammatory bowel disease. The risk of recurrence is also higher in people who get the illness before the age of fifty. We are beginning to see the emergence of genetic tests that can help predict people at high risk of developing colon cancer. People with any of these factors should get particularly careful screening.

Over the last ten years several new drugs for the treatment of colon cancer have been approved by the Food and Drug Administration:
Avastin (Bevacizumab)
Camptosar (Irinotecan)
Eloxatin (Oxaliplatin)
Erbitux (Cetuximab)
Vectibix (Panitumumab)

None is a cure, but they may help in people whose disease has spread to other organs. Most are used in combination with older and often more toxic chemotherapies.

Colorectal cancer is the number two cause of cancer-related death in the United States. It is estimated that there will be 153,000 new cases this year that will ultimately result in 52,000 deaths. The earlier that the disease is caught, the better the chance of a cure. The American Cancer Society has published these five-year survival figures:
Stage 1 – Limited to the colon 93%
Stage 2 – Spread through the wall of the colon 72-85%
Stage 3 – Spread to local lymph nodes 44-83%
Stage 4 – Spread to other organs 8%

Bear in mind that even the most gloomy figures are only based on current treatments: we do not know what the future holds.

The data are also for people who have only had conventional treatments. Integrated Medicine suggests using conventional treatment as well as addressing the psychological, social, subtle and spiritual aspects of the illness. We have little empirical data that such a comprehensive approach works better than conventional medicine alone, but clinicians around the world have accumulated a great deal of experience to indicate that this kind of comprehensive approach helps not only with survival, but also in quality of life and in comprehending the meaning and purpose of the illness.

Anti-inflammatories and Colon Cancer

I just had a very good question after I published my list of Twelve Tips to Reduce Your Risk of Colorectal Cancer.

Dear Dr. Petty,

“That’s a great list, but I am wondering why you haven’t included aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)? I thought that they had been shown to reduce the risk of colon cancer.”

This is an excellent question, and I deliberately omitted mention of anti-inflammatories because the research suggests that they may cause more harm than good.

There is a report in today’s edition of the Annals of Internal Medicine from the United States Preventive Services Task Force, a highly regarded and independent panel of experts in primary care and prevention, that confirms that screening for colorectal cancer is still important and everyone over 50 should have it. But they urge caution on taking preventive drugs, saying that on balance the health risks of aspirin outweigh the benefits when it comes to preventing colon cancer. This advice holds even for those people with a family history of the disease, as long as they have only an average risk of colon cancer. (20 per cent of people who get colorectal cancer also have a close relative with the disease, with proportionally more cases among African Americans than other races.)

They found good evidence that high doses of aspirin (i.e. 300 mg a day or more) and possibly ibuprofen protect against colorectal cancer but this comes with increased risk of intestinal bleeding, stroke and kidney failure.

In low doses – under 100 mg a day – the Task Force says that good evidence supports the notion that aspirin protects against heart disease. However, at this dosage it will have no preventive effect on colorectal cancer.

The US Preventive Services Task Force regularly reviews the available research evidence and issues advice based on what they regard the strength of the evidence to be. They use a grades to help guide practice. For example a grade A recommendation is equal to "strongly recommends", while a B is just "recommends", and C is "no recommendation for or against".

In this case the Task Force has issued a grade D "recommends against" to the routine use of aspirin and NSAIDs to prevent colorectal cancer.

So for now I recommend following the Twelve Tips that I published yesterday.

Twelve Tips to Reduce Your Risk of Colorectal Cancer

Colon cancer, or, more accurately colorectal cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of death among cancers in the Western world. Colorectal cancer surpasses breast and prostate cancers as a leading cause of cancer deaths in both men and women.

And the key point is that with early screening and a few simple dietary modifications, you can dramatically reduce your risk of getting it.

These are the 12 Tips to Slash Your Risk of Colorectal Cancer

  1. Receive regular colorectal cancer screenings beginning at age 50 if you are at normal risk
  2. If you are at higher risk due to a personal or family history of colorectal cancer, other cancers or inflammatory bowel disease have a discussion with your health care provider about screenings before age 50
  3. Eat between 25 and 30 grams of fiber each day from fruits, vegetables, whole grain breads and cereals, nuts, and beans
  4. Eat a low-fat diet: colorectal cancer has been associated with diets high in saturated fat, particularly fat from red meat
  5. Eat foods with folate, such as leafy green vegetables
  6. Try to drink at least 80 fluid ounces of pure water a day unless you have a medical reason for not doing so
  7. Drink alcohol in moderation: 2 units of alcohol or less each day
  8. If you smoke, here is another good reason for quitting. Alcohol and tobacco in combination are linked to colorectal cancer and other gastrointestinal cancers
  9. Exercise for at least 20 minutes three to four days a week. Moderate exercise such as walking, gardening or climbing stairs may help reduce your risk
  10. If you get any persistent symptoms such as blood in the stool, a change in bowel habits, weight loss, narrower-than-usual stools, abdominal pains or other gastrointestinal complaints, it is essential to report them to your health care provider
  11. Maintain a healthy weight. Obesity may increase the risk of colorectal cancer
  12. Maintain a good intake of calcium and vitamin D: this combination has been shown to reduce the risk of colorectal cancer

For more information, I recommend visiting the Web site of the American Cancer Society.

I keep their details in the “Resources” section on the left hand side of this blog.

Health Maintenance: Screening and Prevention

“An ounce of prevention is worth a pound of cure.”
–English Proverb

There is so much that we can do to help ourselves head off serious illnesses.

  1. Adopting the kind of health lifestyle that I’ve discussed on previous occasions . Most of us already know the key items: including what to avoid
  2. Next, be alert to signs an symptoms coming from your body: the Personal Evaluation of Wellness (PEW), is an ideal guide that took years to develop. I plan to make a computerized version soon.
  3. Be alert to messages coming from your environment. If something dreadful happens in your life, it makes no sense at all to try carrying on as if nothing happened. The universe may be sending you a message, so use your intuition.
  4. Finally, ensure that you get regular health screening. Here is a resource that will point you to the current recommendations about what you should be doing and when.

“Keep your own house and its surroundings pure and clean. This hygiene will keep you healthy and benefit your worldly life.”
–Sathya Sai Baba (Indian Spiritual Teacher, c.1926-

Add Years to Your Life and Life to Your Years: The Power of Small Changes.

I want to tell you about a mind bogglingly important study that many professionals have known about, but somehow hasn’t popped up on most people’s radar. The story  was broken by the BBC last month. It is about an exceptionally important study that has been running in Norfolk, in Eastern England, as well as other parts of Europe since 1992. The British section is directed by Professor Kay-Tee Khaw who is Professor of Clinical Gerontology at the Department of Public Health and Primary Care at the University of Cambridge. The main focus of the Clinical Gerontology Unit is the maintenance of health in aging populations, with a particular emphasis on the combined role of lifestyle, environmental and genetic factors in chronic diseases.

The UK arm of the study has been following 25,663 men and women aged between 45 and 79 years old, looking at their diet, environment, lifestyle and health. The latest results from the study have confirmed several things that we already suspected: 1. Eating five portions of fruit and vegetables a day can give you the life expectancy of someone three years younger.
2. Not smoking turns back the clock by four to five years.
3. Even increasing exercise by a moderate amount can increase your life expectancy by three years. But the amount of exercise someone would need to do to achieve that depends on their job. A sedentary office worker would need to do one hour of exercise, such as swimming or jogging every day. By contrast, a person with a moderately active job, such as a hairdresser, would need to take 30 minutes of exercise a day. Here’s some more good news: People with very active jobs, including nurses and bricklayers, do not need to do any extra exercise – as their work is strenuous enough.

I think that just about anyone can take those baby steps toward a longer and healthier life

There’s an old Yugoslavian Proverb:
“Grain by grain a loaf, stone by stone, a castle.”

That seems about right!

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