Hello fellow hypochondriacs! I just wanted to pop in and apologize for my long absence. I had been intending to write another information-laden post about, of all things, appendix cancer. (Yes, there is such a thing - and a friend of mine was recently diagnosed with it.) But I haven't had enough time and energy recently. (Do you think there's something wrong with me?)
I still want to write about that cancer, but was sidetracked for the entire month of February due to some family issues. Then I was on vacation for two and a half weeks, and have just gotten back into the swing of things. In addition, politics, my other obsession, has been taking up what time I have had for blogging, on my other site, Mauigirl's Meanderings.
I think to get back to my medical calling over here, I will write some shorter posts about recent medical developments before writing the long post. I hope to have something up in the next day or two!
In the meantime, no, that hacking cough you have is NOT lung cancer. It's from the dry heat in your house. Or the pollen that I hear is already blowing around out there despite the fact that every tree in my area is still starkly naked.
Of course, if the cough doesn't go away please do get it checked out...Just because you're a hypochondriac doesn't mean you don't have a fatal disease!
Saturday, March 22, 2008
Saturday, January 5, 2008
Colon Cancer
Unfortunately, many of the subjects I choose to write about in Medicana are driven by the diagnosis of someone I know with the condition in question.
In the case of colon cancer, I am sorry to report that a friend of mine was just diagnosed with it. I don't yet know all the details, but her symptoms led to an initial diagnosis of some type of ovarian tumor, based on an ultrasound and an MRI. Once surgery was performed, it was discovered the tumor was actually colon cancer that had spread to the ovaries - not a good scenario.
I do not yet know the staging of her cancer since all the tests have not come back yet, but I thought I'd do the research on colon cancer now so there would be plenty of information available once she finds out more.
I am posting this information in hopes that my research may help discover new treatments or information that may help her and her family as they work with her doctors to find the right treatment for her cancer, and help anyone else who may have been diagnosed with this disease.
Colon Cancer - What is it?
Colon cancer, more generally known as colorectal cancer, is any cancer affecting the colon or rectum. The colon is the large intestine and the rectum the last six inches of the large intestine.
Colon cancer usually begins as small, noncancerous clump of cells called adenomatous polyps. Eventually these polyps can become colon cancers.
Because polyps usually cause few symptoms, or in many cases, no symptoms at all, it is important for people to get screened for colon cancer once they reach middle age; usually 50, unless there are risk factors in the family, in which case screening should start earlier.
There are three types of polyps:
- Adenomas: These are likely to turn into cancer.
- Hyperplastic polyps: These rarely turn into cancer.
- Inflammatory polyps: These can follow a flare-up of ulcerative colitis, and can turn cancerous, which is why ulcerative colitis is a risk factor for colon cancer.
Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
What Are the Symptoms of Colon Cancer?
Often there are no symptoms that show up for colon cancer in its early stages. The symptoms to watch out for are:
- Any change in bowel habits, including diarrhea or constipation or a change in the consistency of your stool that lasts more than a week or two. Narrowing of the stool is another symptom.
- Rectal bleeding or blood in your stool
- Persistent abdominal discomfort, such as cramps, gas or pain
- Abdominal pain with a bowel movement
- A feeling that your bowel doesn't empty completely, or feeling full or bloated
- Unexplained anemia
- Weakness or fatigue
- Unexplained weight loss
According to Medicinenet.com (link below), colon cancer may be present for several years before symptoms develop. Symptoms vary according to where in the large bowel the tumor is located. The right colon has plenty of room, and cancers of the right colon can grow to large sizes before they cause any symptoms. Usually right-sided cancers cause anemia due to the slow loss of blood over a long period of time, which can lead to fatigue, weakness and shortness of breath. Because the left colon is narrower than the right colon, cancers of the left colon are more apt to cause partial or complete bowel obstruction.
What Are the Causes and Risk Factors for Colon Cancer?
There are a number of factors that put a person at higher risk for colon cancer:
Age: About 90 percent of people diagnosed with colon cancer are older than 50. Only about 10% of colon cancer cases occur in younger people.
A personal history of colorectal cancer or polyps: Naturally it makes sense that if a person has already had colon cancer they would have a risk of colon cancer again in the future. However, people who have had a history of adenomatous polyps also have a higher likelihood of getting colon cancer and will need regular screening.
Inflammatory bowel disease/conditions: Chronic conditions such as ulcerative colitis and Crohn's disease can increase the risk of colon cancer.
Genetics: Inherited syndromes passed through the family can increase the risk of colon cancer. Inherited conditions account for only about 5 percent of all colon cancers.
One such genetic condition is called familial adenomatous polyposis (FAP), which is a rare disorder that causes thousands of polyps to develop in the lining of the colon and rectum. People with untreated FAP have >90% chance of developing colon cancer by age 45.
Hereditary nonpolyposis colorectal cancer (HNPCC), which is also called Lynch syndrome, is more common than FAP. Sufferers of Lynch syndrome also tend to develop colon cancer at an early age. Both FAP and HNPCC can be detected through genetic testing.
Certain HNPCC patients are also at risk of developing uterine cancer, stomach cancer, ovarian cancer, and cancers of the ureters (the tubes that connect the kidneys to the bladder), and the biliary tract (the ducts that drain bile from the liver to the intestines).
MYH polyposis syndrome is another, recently discovered, hereditary colon cancer syndrome. Affected people tend to develop 10-100 polyps starting at around 40 years of age, and are at high risk of developing colon cancer.
According to Medicinenet.com, "Among first-degree relatives of colon cancer patients, the lifetime risk of developing colon cancer is 18% (a threefold increase over the general population in the United States).
Even though family history of colon cancer is an important risk factor, majority (80%) of colon cancers occur sporadically in patients with no family history of colon cancer. Approximately 20% of cancers are associated with a family history of colon cancer. And 5 % of colon cancers are due to hereditary colon cancer syndromes. Hereditary colon cancer syndromes are disorders where affected family members have inherited cancer-causing genetic defects from one or both of the parents."
Family history of colon cancer and colon polyps: If a person has a parent, brother or sister or a child with colon cancer, this too is a risk factor. This may be a hereditary connection or it might be due to mutual exposure to an environmental toxin, diet or lifestyle that leads to the condition.
Diet: Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. It is believed that the breakdown products of fat metabolism lead to the formation of cancer-causing chemicals. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meats. Lack of fruits and vegetables may be part of the picture, since increased consumption of these foods seems to have a protective effect against colon cancer.
Lack of exercise: If a person is inactive, they are more likely to develop colon cancer, possibly by causing waste to stay in the colon longer.
Diabetes: People with diabetes and insulin resistance may have an increased risk of colon cancer. Just one more reason to try to avoid diabetes; it seems to be implicated in so many other diseases.
Obesity: People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. Of course, obesity also may be associated with a high fat diet, sedentary lifestyle, and diabetes, so it may all be connected.
Smoking: People who smoke cigarettes may have an increased risk of getting colon cancer - and of dying of it.
Heavy Use of Alcohol: Heavy drinking may increase the risk of colon cancer.
Growth hormone disorder: Acromegaly, an uncommon disorder that causes an excess of growth hormone in the body, may increase the risk of colon polyps and colon cancer. (Sounds to me as if the use of human growth hormone by sports figures might not be a good idea).
Previous radiation therapy for cancer: Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.
How Is It Diagnosed?
There are a number of screening methodologies available to find colon cancer before it is advanced enough to cause symptoms - and at a stage where it is most curable.
Unfortunately, none of them are very appealing to people, which is why many people avoid the whole subject. This is tragic, since when caught early, colon cancer is very curable. In fact, some of the screening methods actually prevent it from developing in the first place by removing polyps before they have a chance to go bad.
The following are the screening techniques currently used to detect colon cancer:
- Fecal occult blood test: This is a fancy way of saying it's a test to detect hidden (occult) blood in the stool. It can be done in the doctor's office, or by using a kit at home. If blood is detected, the doctor would then order more tests to find out the cause. Blood in the stool does not always mean cancer; it can be caused by a polyp that has not yet become cancerous, certain foods or medications (such as aspirin), or hemmorrhoids. A negative test for occult blood is not a guarantee of no cancer, either: Not all cancers bleed, and some only bleed occasionally, so they can be missed. This test, however, is least invasive and more apt to be performed willingly by the patient. A digital rectal exam may also be performed to check for growths or blood in the lower part of the rectum.
- Flexible Sigmoidoscopy: For this test, the lower colon must be cleaned out ahead of time, usually through an enema; the sigmoidoscopy is usually done in the doctor's office, where the doctor examines the last two feet (1/3) of the colon for polyps or other anomalies, using a slender, flexible lighted tube. The colon is inflated with air to enable the doctor to examine the colon. The drawback to this test is that since it only examines part of the colon, polyps or growths farther up will not be detected. I had one of these once after I'd noticed blood in my stool (it turned out to be hemmorrhoids).
- Barium Enema: In this test, barium is inserted into the cleaned colon, with or without air added. Barium is a contrast dye that enables the doctor to see irregularities along the colon walls through X-ray examination. Sometimes a flexible sigmoidoscopy is done as well. The barium enema is not able to identify small cancers and small polyps. A colonoscopy is usually recommended if suspicious lesions are sighted in the barium enema test, since no sampling is possible during this test.
- Colonoscopy: The gold standard of colon cancer screening, the colonoscopy enables the physician to examine the full length of the colon with a flexible lighted tube, similar to the one used in sigmoidoscopy, with a video camera and monitor attached. The colon must be thoroughly cleaned out ahead of time; the patient must consume a laxative solution the night before. The beauty of the colonoscopy is that the doctor is able to remove polyps or other suspicious growths with the colonoscope, and find out whether they are cancerous. As mentioned previously, removal of the polyps can actually prevent cancer since they will no longer have the opportunity to develop into cancer once they are removed. Patients are under sedation during this procedure so there is no discomfort; most people do not remember the experience due to new medications that are used. If nothing suspicious is found during the colonoscopy, patients are advised to have another one in 7-10 years.
I had a colonoscopy at age 47, since both of my parents have had polyps. I didn't feel a thing and felt fine afterwards. I am due for another this year and you can be sure I'm going to get it.
- Virtual Colonoscopy: Although many insurance companies do not yet cover this method, it is becoming more popular since it is not invasive. The patient cleans the colon ahead of time, similar to preparation for the standard colonoscopy, but instead the procedure is a simple computerized tomography (CT) scan. There is no sedation, no recovery needed; and no risk of perforating the colon. However, the colon does need to be filled with air, which is uncomfortable. Virtual colonoscopy is not as good as the real thing in finding very small polyps or flat lesions on the wall of the colon. In addition,if anything is seen on the scan, the patient would still need a standard colonoscopy to follow up, since there is no way to sample anything suspicious that is seen.
All of the invasive methods carry some risk of perforating the colon; however, the benefits of screening far outweigh the risks.
If a person presents to the doctor with actual symptoms, rather than just needing a routine screening, usually a colonoscopy would be ordered so as to enable the physician to take biopsies of anything that is found. When it is less clear that the symptoms are colon-related, MRIs, CT scans or ultrasounds may be ordered first.
If cancer is diagnosed, the next step is staging. The first step may be to have a CT scan of the abdomen and a chest X-ray to make sure nothing has spread yet.
How Is Colon Cancer Treated?
Surgery is the first line of treatment for colon cancer. It is important to remove as much of the cancer as possible, and also to remove lymph nodes in the abdomen to help stage the cancer and prevent it from spreading.
Depending on how much of the colon is affected, the patient may need to have more or less of it removed. In some cases the entire colon has to be removed; in others, just a section - and in some cases, only the cancerous polyp needs to be taken out.
During surgery, the tumor, a small piece of the surrounding healthy colon, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. Recent studies have indicated that the more lymph nodes removed at the time of surgery, the better the prognosis.
If the cancer is in the right or left side of the colon but above the rectum, usually a resection of the colon will work. If the rectum or anal sphincter is involved, it may be necessary for the patient to have a colostomy bag; he or she can no longer defecate and stool goes into the bag instead.
According to EMedicineHealth.com, in the case of early cancers, sometimes there is no further treatment, just follow-up:
"Once your cancerous colon has been removed and you receive any other treatment recommended by your cancer care team, you will see your gastroenterologist or cancer specialist (oncologist) regularly for follow-up visits. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.
These follow-up visits should include, at minimum, the following:
Colonoscopy within 3 months after your surgery.
Colonoscopy 1 year after surgery and every 3 years after that.
Test for occult (hidden) blood in your stool every year, followed by colonoscopy if the test result is positive.
A screening tool—measurement of carcinoembryonic antigen (CEA) level—is available to test for cancer recurrence following cancer surgery.
CEA is a protein normally found in trace amounts in your bloodstream but is present in increased amounts in people with colon cancer. It is referred to as a tumor marker.
Blood CEA levels should be measured before colon cancer surgery and then at intervals of 2-3 months.
Increasing levels of serum CEA may indicate that colon cancer has come back and that you should seek further evaluation.
Once you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, no one is sure how long you should continue to have the tests."
Colon cancer, as mentioned before, is staged based on how much it has spread. If it is not caught early, further treatment is needed.
What Are the Stages of Colon Cancer?
There are a number of ways to stage colon cancer; there is a simple Stage I-IV method, but the more complex way to stage cancer is to divide up the various aspects of it into the tumor itself, the lymph node involvement, and whether or not it has spread (metastasized). From the Oncology Channel (link below), here is the breakout of these details:
"TNM Staging System (Tumor, Node, Metastasis)
Tumor
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into the pericolic or perirectal tissues.
(NOTE: these are all fancy words for the various layers of the intestinal wall).
T4: Tumor directly invades other organs or structures, and/or perforates.
Node
N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.
Metastasis
M0: No distant metastasis.
M1 Distant metastasis present.
Stage Groupings
Stage I: T1 N0 M0; T2 N0 M0
Cancer has begun to spread, but is still in the inner lining.
Stage II: T3 N0 M0; T4 N0 M0
Cancer has spread to other organs near the colon or rectum. It has not reached lymph nodes.
Stage III: any T, N1-2, M0
Cancer has spread to lymph nodes, but has not been carried to distant parts of the body.
Stage IV: any T, any N, M1
Cancer has been carried through the lymph system to distant parts of the body. This is known as metastasis. The most likely organs to experience metastasis from colorectal cancer are the lungs and liver."
Treatment may include chemotherapy, radiation, or both. According to Oncology Channel, the following regimens are frequently used:
"Chemotherapy is often used as a first-line treatment for metastatic colorectal cancer to destroy cancer cells that have metastasized (spread). It also may be used prior to surgery (called neoadjuvant therapy) to shrink the tumor, may be administered following surgery (called adjuvant therapy), and may be combined with biological therapy (also called immunotherapy) and radiation therapy.
Newer combinations of chemotherapy drugs, such as FOLFOX (5-fluorouracil [5-FU], leucovorin, and oxaliplatin [Eloxatin®]) and FOFIRI (5-fluorouracil [5-FU], leucovorin, and irinotecan [Camptosar®]) may be used to prevent recurrence following surgery or to shrink the tumor prior to surgery.
A combination of chemotherapy drugs (5-fluorouracil [5-FU], leucovorin, and irinotecan [CPT11]), administered intravenously, is standard treatment for metastatic colorectal cancer. Side effects include diarrhea, mouth irritation (mucositis), low white blood cell count (e.g., neutropenia), and hair loss (alopecia).
Colorectal cancer with liver metastasis also may be treated using floxuridine (FUDR®) administered intra-arterially (i.e., through an artery). Side effects include nausea, vomiting, diarrhea, and inflammation of the intestine (enteritis).
In addition to chemotherapy drugs, blocking agents (e.g., cetuximab [Erbitux®]) may also be used to treat metastatic colorectal cancer. These drugs prevent cancer cell receptors from receiving factors (e.g., epidermal growth factor) that cause cell growth, cell division, and additional metastasis. Blocking agents target specific cells so they usually do not cause systemic side effects. Side effects of these drugs include allergic reactions (e.g., difficulty breathing, hives, low blood pressure, rash).
Bevacizumab (Avastin®) may also be used to treat advanced colorectal cancer. This medication prevents new blood vessels, which are necessary for tumor growth, from forming. It does not affect normal tissues that already have an established blood supply. Side effects include blood clots and high blood pressure, which can be controlled with medication.
(NOTE: Avastin is one of a new class of drugs called angiogenesis inhibitors and they have shown to be quite effective against colon cancer.)
Panitumumab (Vectibix™) is the first entirely human monoclonal antibody approved by the Food and Drug Administration (FDA) to treat patients with metastatic colorectal cancer following chemotherapy. This medication is administered intravenously once every 2 weeks.
Immunotherapy
Immunotherapy, or biological therapy, attempts to stimulate the immune system to fight disease and protect the body from side effects of chemotherapy. Immunotherapy agents that may be used to treat colorectal cancer include bacilli Calmette-Guerin (BCG) and levamisole (Ergamisol®).
Immunotherapy may cause flu-like side effects such as the following:
Chills
Diarrhea
Fever
Loss of appetite
Muscle aches and weakness
Nausea and vomiting
Radiation Therapy
Radiation therapy uses high energy x-rays to destroy cancer cells and shrink tumors. External beam radiation (i.e., radiation from a machine outside the body) may be used in addition to surgery to treat colorectal cancer (called adjuvant therapy). It also may be used to relieve symptoms (called palliative treatment) in patients with metastatic colorectal cancer.
Side effects include fatigue, hair loss, reddened skin, and swelling (edema). Medicines and other treatments can reduce the intensity of the side effects. As with other cancer treatments, the incidence of side effects varies with patient health and the exact nature of the treatment.
Follow-up Treatment
Follow-up care is recommended for colorectal cancer patients to ensure that recurrent or metastatic disease is detected as soon as possible. Patients should undergo regular physical examinations, fecal occult blood tests, colonoscopies, CT scans, and chest x-rays.
Prognosis
Prognosis depends on the stage of the disease and the overall health of the patient. Overall, colorectal cancer patients have a 5-year survival rate of about 61%. The 5-year survival rate is about 92% when the disease is treated before it has spread (metastasized); 64% when the cancer has spread to nearby organs or lymph nodes; and 7% when it has spread to other parts of the body (e.g., liver, lungs)."
Depending on the severity of the disease, some patients may want to try to get into clinical trials. If you have been diagnosed with advanced colon cancer and you are located near a major cancer center, it is possible trials are being held of treatments that are not yet generally available to patients that may be more effective than current methods.
Clinical trials can be found on-line in a number of places. Please see below for some links.
http://bethesdatrials.cancer.gov/colorectal/index.aspx
http://www.mdanderson.org/patients_public/clinical_trials/?Referrer=Google&KW=Cancer_Research&gclid=CObv_IKH4ZACFShsGgodSzLZYA
http://www.fightcolorectalcancer.org/patients/clinicaltrials/index.htm
http://www.mskcc.org/mskcc/html/14075.cfm
http://www.ccalliance.org/patient/clinical/clinical.html
http://clinicaltrials.gov/ct/search?term=colon+cancer
http://www.mayoclinic.org/colon-cancer/clintrials.html
http://www.nlm.nih.gov/medlineplus/colorectalcancer.html#cat27
Be sure to check out the trials available before starting any treatment; always get a second opinion on your treatment before committing to something. For one thing, clinical trials don't always accept patients who have already had other treatments first.
Please note, although these trials are usually "double blind" trials (that is, patients and physicians don't know which patients are getting the experimental treatment), those who do not get the new treatment are given the current accepted treatment for the cancer, so no one gets a placebo.
Will You Get It?
You could, especially if you have any of the risk factors above. Colorectal cancer is the fourth most common cancer in the United States and the second leading cause of cancer death. A person at age 50 has about a 5 percent lifetime risk of being diagnosed with colorectal cancer and a 2.5 percent chance of dying from it.
Most people will not get it if they get screened at the recommended times. Unfortunately, people younger than 50 who have no other risk factors can get it too, and they are younger than the recommended age to start screening.
So any time you notice anything unusual about the way your body feels or how you feel overall, be sure to go to the doctor and get checked out.
And if you do find out you have cancer, always go to experts for your treatment. Get more than one opinion. Go to a major cancer center. I may sound like a broken record, but I'd rather be repetitive than not get the message across. Your life may depend upon it.
Sources:
http://www.medicinenet.com/colon_cancer/article.htm: Medicinenet.com
http://www.mayoclinic.com/health/colon-cancer/DS00035: The Mayo Clinic
http://www.cancer.gov/cancertopics/types/colon-and-rectal: Cancer.gov
http://www.emedicinehealth.com/colon_cancer/article_em.htm: EMedicineHealth.com
http://www.oncologychannel.com/coloncancer/staging.shtml: Oncology Channel
http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm
For more information/treatments:
http://www.mdanderson.org/diseases/Colorectal/?gclid=CPKkh6fp4JACFRuhFQodBTLrXA: M.D. Anderson
http://www.mskcc.org/mskcc/html/5789.cfm: Memorial Sloan Kettering
http://www.nlm.nih.gov/medlineplus/ency/article/000262.htm: National Institutes of Health
In the case of colon cancer, I am sorry to report that a friend of mine was just diagnosed with it. I don't yet know all the details, but her symptoms led to an initial diagnosis of some type of ovarian tumor, based on an ultrasound and an MRI. Once surgery was performed, it was discovered the tumor was actually colon cancer that had spread to the ovaries - not a good scenario.
I do not yet know the staging of her cancer since all the tests have not come back yet, but I thought I'd do the research on colon cancer now so there would be plenty of information available once she finds out more.
I am posting this information in hopes that my research may help discover new treatments or information that may help her and her family as they work with her doctors to find the right treatment for her cancer, and help anyone else who may have been diagnosed with this disease.
Colon Cancer - What is it?
Colon cancer, more generally known as colorectal cancer, is any cancer affecting the colon or rectum. The colon is the large intestine and the rectum the last six inches of the large intestine.
Colon cancer usually begins as small, noncancerous clump of cells called adenomatous polyps. Eventually these polyps can become colon cancers.
Because polyps usually cause few symptoms, or in many cases, no symptoms at all, it is important for people to get screened for colon cancer once they reach middle age; usually 50, unless there are risk factors in the family, in which case screening should start earlier.
There are three types of polyps:
- Adenomas: These are likely to turn into cancer.
- Hyperplastic polyps: These rarely turn into cancer.
- Inflammatory polyps: These can follow a flare-up of ulcerative colitis, and can turn cancerous, which is why ulcerative colitis is a risk factor for colon cancer.
Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
What Are the Symptoms of Colon Cancer?
Often there are no symptoms that show up for colon cancer in its early stages. The symptoms to watch out for are:
- Any change in bowel habits, including diarrhea or constipation or a change in the consistency of your stool that lasts more than a week or two. Narrowing of the stool is another symptom.
- Rectal bleeding or blood in your stool
- Persistent abdominal discomfort, such as cramps, gas or pain
- Abdominal pain with a bowel movement
- A feeling that your bowel doesn't empty completely, or feeling full or bloated
- Unexplained anemia
- Weakness or fatigue
- Unexplained weight loss
According to Medicinenet.com (link below), colon cancer may be present for several years before symptoms develop. Symptoms vary according to where in the large bowel the tumor is located. The right colon has plenty of room, and cancers of the right colon can grow to large sizes before they cause any symptoms. Usually right-sided cancers cause anemia due to the slow loss of blood over a long period of time, which can lead to fatigue, weakness and shortness of breath. Because the left colon is narrower than the right colon, cancers of the left colon are more apt to cause partial or complete bowel obstruction.
What Are the Causes and Risk Factors for Colon Cancer?
There are a number of factors that put a person at higher risk for colon cancer:
Age: About 90 percent of people diagnosed with colon cancer are older than 50. Only about 10% of colon cancer cases occur in younger people.
A personal history of colorectal cancer or polyps: Naturally it makes sense that if a person has already had colon cancer they would have a risk of colon cancer again in the future. However, people who have had a history of adenomatous polyps also have a higher likelihood of getting colon cancer and will need regular screening.
Inflammatory bowel disease/conditions: Chronic conditions such as ulcerative colitis and Crohn's disease can increase the risk of colon cancer.
Genetics: Inherited syndromes passed through the family can increase the risk of colon cancer. Inherited conditions account for only about 5 percent of all colon cancers.
One such genetic condition is called familial adenomatous polyposis (FAP), which is a rare disorder that causes thousands of polyps to develop in the lining of the colon and rectum. People with untreated FAP have >90% chance of developing colon cancer by age 45.
Hereditary nonpolyposis colorectal cancer (HNPCC), which is also called Lynch syndrome, is more common than FAP. Sufferers of Lynch syndrome also tend to develop colon cancer at an early age. Both FAP and HNPCC can be detected through genetic testing.
Certain HNPCC patients are also at risk of developing uterine cancer, stomach cancer, ovarian cancer, and cancers of the ureters (the tubes that connect the kidneys to the bladder), and the biliary tract (the ducts that drain bile from the liver to the intestines).
MYH polyposis syndrome is another, recently discovered, hereditary colon cancer syndrome. Affected people tend to develop 10-100 polyps starting at around 40 years of age, and are at high risk of developing colon cancer.
According to Medicinenet.com, "Among first-degree relatives of colon cancer patients, the lifetime risk of developing colon cancer is 18% (a threefold increase over the general population in the United States).
Even though family history of colon cancer is an important risk factor, majority (80%) of colon cancers occur sporadically in patients with no family history of colon cancer. Approximately 20% of cancers are associated with a family history of colon cancer. And 5 % of colon cancers are due to hereditary colon cancer syndromes. Hereditary colon cancer syndromes are disorders where affected family members have inherited cancer-causing genetic defects from one or both of the parents."
Family history of colon cancer and colon polyps: If a person has a parent, brother or sister or a child with colon cancer, this too is a risk factor. This may be a hereditary connection or it might be due to mutual exposure to an environmental toxin, diet or lifestyle that leads to the condition.
Diet: Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. It is believed that the breakdown products of fat metabolism lead to the formation of cancer-causing chemicals. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meats. Lack of fruits and vegetables may be part of the picture, since increased consumption of these foods seems to have a protective effect against colon cancer.
Lack of exercise: If a person is inactive, they are more likely to develop colon cancer, possibly by causing waste to stay in the colon longer.
Diabetes: People with diabetes and insulin resistance may have an increased risk of colon cancer. Just one more reason to try to avoid diabetes; it seems to be implicated in so many other diseases.
Obesity: People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. Of course, obesity also may be associated with a high fat diet, sedentary lifestyle, and diabetes, so it may all be connected.
Smoking: People who smoke cigarettes may have an increased risk of getting colon cancer - and of dying of it.
Heavy Use of Alcohol: Heavy drinking may increase the risk of colon cancer.
Growth hormone disorder: Acromegaly, an uncommon disorder that causes an excess of growth hormone in the body, may increase the risk of colon polyps and colon cancer. (Sounds to me as if the use of human growth hormone by sports figures might not be a good idea).
Previous radiation therapy for cancer: Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.
How Is It Diagnosed?
There are a number of screening methodologies available to find colon cancer before it is advanced enough to cause symptoms - and at a stage where it is most curable.
Unfortunately, none of them are very appealing to people, which is why many people avoid the whole subject. This is tragic, since when caught early, colon cancer is very curable. In fact, some of the screening methods actually prevent it from developing in the first place by removing polyps before they have a chance to go bad.
The following are the screening techniques currently used to detect colon cancer:
- Fecal occult blood test: This is a fancy way of saying it's a test to detect hidden (occult) blood in the stool. It can be done in the doctor's office, or by using a kit at home. If blood is detected, the doctor would then order more tests to find out the cause. Blood in the stool does not always mean cancer; it can be caused by a polyp that has not yet become cancerous, certain foods or medications (such as aspirin), or hemmorrhoids. A negative test for occult blood is not a guarantee of no cancer, either: Not all cancers bleed, and some only bleed occasionally, so they can be missed. This test, however, is least invasive and more apt to be performed willingly by the patient. A digital rectal exam may also be performed to check for growths or blood in the lower part of the rectum.
- Flexible Sigmoidoscopy: For this test, the lower colon must be cleaned out ahead of time, usually through an enema; the sigmoidoscopy is usually done in the doctor's office, where the doctor examines the last two feet (1/3) of the colon for polyps or other anomalies, using a slender, flexible lighted tube. The colon is inflated with air to enable the doctor to examine the colon. The drawback to this test is that since it only examines part of the colon, polyps or growths farther up will not be detected. I had one of these once after I'd noticed blood in my stool (it turned out to be hemmorrhoids).
- Barium Enema: In this test, barium is inserted into the cleaned colon, with or without air added. Barium is a contrast dye that enables the doctor to see irregularities along the colon walls through X-ray examination. Sometimes a flexible sigmoidoscopy is done as well. The barium enema is not able to identify small cancers and small polyps. A colonoscopy is usually recommended if suspicious lesions are sighted in the barium enema test, since no sampling is possible during this test.
- Colonoscopy: The gold standard of colon cancer screening, the colonoscopy enables the physician to examine the full length of the colon with a flexible lighted tube, similar to the one used in sigmoidoscopy, with a video camera and monitor attached. The colon must be thoroughly cleaned out ahead of time; the patient must consume a laxative solution the night before. The beauty of the colonoscopy is that the doctor is able to remove polyps or other suspicious growths with the colonoscope, and find out whether they are cancerous. As mentioned previously, removal of the polyps can actually prevent cancer since they will no longer have the opportunity to develop into cancer once they are removed. Patients are under sedation during this procedure so there is no discomfort; most people do not remember the experience due to new medications that are used. If nothing suspicious is found during the colonoscopy, patients are advised to have another one in 7-10 years.
I had a colonoscopy at age 47, since both of my parents have had polyps. I didn't feel a thing and felt fine afterwards. I am due for another this year and you can be sure I'm going to get it.
- Virtual Colonoscopy: Although many insurance companies do not yet cover this method, it is becoming more popular since it is not invasive. The patient cleans the colon ahead of time, similar to preparation for the standard colonoscopy, but instead the procedure is a simple computerized tomography (CT) scan. There is no sedation, no recovery needed; and no risk of perforating the colon. However, the colon does need to be filled with air, which is uncomfortable. Virtual colonoscopy is not as good as the real thing in finding very small polyps or flat lesions on the wall of the colon. In addition,if anything is seen on the scan, the patient would still need a standard colonoscopy to follow up, since there is no way to sample anything suspicious that is seen.
All of the invasive methods carry some risk of perforating the colon; however, the benefits of screening far outweigh the risks.
If a person presents to the doctor with actual symptoms, rather than just needing a routine screening, usually a colonoscopy would be ordered so as to enable the physician to take biopsies of anything that is found. When it is less clear that the symptoms are colon-related, MRIs, CT scans or ultrasounds may be ordered first.
If cancer is diagnosed, the next step is staging. The first step may be to have a CT scan of the abdomen and a chest X-ray to make sure nothing has spread yet.
How Is Colon Cancer Treated?
Surgery is the first line of treatment for colon cancer. It is important to remove as much of the cancer as possible, and also to remove lymph nodes in the abdomen to help stage the cancer and prevent it from spreading.
Depending on how much of the colon is affected, the patient may need to have more or less of it removed. In some cases the entire colon has to be removed; in others, just a section - and in some cases, only the cancerous polyp needs to be taken out.
During surgery, the tumor, a small piece of the surrounding healthy colon, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. Recent studies have indicated that the more lymph nodes removed at the time of surgery, the better the prognosis.
If the cancer is in the right or left side of the colon but above the rectum, usually a resection of the colon will work. If the rectum or anal sphincter is involved, it may be necessary for the patient to have a colostomy bag; he or she can no longer defecate and stool goes into the bag instead.
According to EMedicineHealth.com, in the case of early cancers, sometimes there is no further treatment, just follow-up:
"Once your cancerous colon has been removed and you receive any other treatment recommended by your cancer care team, you will see your gastroenterologist or cancer specialist (oncologist) regularly for follow-up visits. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.
These follow-up visits should include, at minimum, the following:
Colonoscopy within 3 months after your surgery.
Colonoscopy 1 year after surgery and every 3 years after that.
Test for occult (hidden) blood in your stool every year, followed by colonoscopy if the test result is positive.
A screening tool—measurement of carcinoembryonic antigen (CEA) level—is available to test for cancer recurrence following cancer surgery.
CEA is a protein normally found in trace amounts in your bloodstream but is present in increased amounts in people with colon cancer. It is referred to as a tumor marker.
Blood CEA levels should be measured before colon cancer surgery and then at intervals of 2-3 months.
Increasing levels of serum CEA may indicate that colon cancer has come back and that you should seek further evaluation.
Once you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, no one is sure how long you should continue to have the tests."
Colon cancer, as mentioned before, is staged based on how much it has spread. If it is not caught early, further treatment is needed.
What Are the Stages of Colon Cancer?
There are a number of ways to stage colon cancer; there is a simple Stage I-IV method, but the more complex way to stage cancer is to divide up the various aspects of it into the tumor itself, the lymph node involvement, and whether or not it has spread (metastasized). From the Oncology Channel (link below), here is the breakout of these details:
"TNM Staging System (Tumor, Node, Metastasis)
Tumor
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into the pericolic or perirectal tissues.
(NOTE: these are all fancy words for the various layers of the intestinal wall).
T4: Tumor directly invades other organs or structures, and/or perforates.
Node
N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.
Metastasis
M0: No distant metastasis.
M1 Distant metastasis present.
Stage Groupings
Stage I: T1 N0 M0; T2 N0 M0
Cancer has begun to spread, but is still in the inner lining.
Stage II: T3 N0 M0; T4 N0 M0
Cancer has spread to other organs near the colon or rectum. It has not reached lymph nodes.
Stage III: any T, N1-2, M0
Cancer has spread to lymph nodes, but has not been carried to distant parts of the body.
Stage IV: any T, any N, M1
Cancer has been carried through the lymph system to distant parts of the body. This is known as metastasis. The most likely organs to experience metastasis from colorectal cancer are the lungs and liver."
Treatment may include chemotherapy, radiation, or both. According to Oncology Channel, the following regimens are frequently used:
"Chemotherapy is often used as a first-line treatment for metastatic colorectal cancer to destroy cancer cells that have metastasized (spread). It also may be used prior to surgery (called neoadjuvant therapy) to shrink the tumor, may be administered following surgery (called adjuvant therapy), and may be combined with biological therapy (also called immunotherapy) and radiation therapy.
Newer combinations of chemotherapy drugs, such as FOLFOX (5-fluorouracil [5-FU], leucovorin, and oxaliplatin [Eloxatin®]) and FOFIRI (5-fluorouracil [5-FU], leucovorin, and irinotecan [Camptosar®]) may be used to prevent recurrence following surgery or to shrink the tumor prior to surgery.
A combination of chemotherapy drugs (5-fluorouracil [5-FU], leucovorin, and irinotecan [CPT11]), administered intravenously, is standard treatment for metastatic colorectal cancer. Side effects include diarrhea, mouth irritation (mucositis), low white blood cell count (e.g., neutropenia), and hair loss (alopecia).
Colorectal cancer with liver metastasis also may be treated using floxuridine (FUDR®) administered intra-arterially (i.e., through an artery). Side effects include nausea, vomiting, diarrhea, and inflammation of the intestine (enteritis).
In addition to chemotherapy drugs, blocking agents (e.g., cetuximab [Erbitux®]) may also be used to treat metastatic colorectal cancer. These drugs prevent cancer cell receptors from receiving factors (e.g., epidermal growth factor) that cause cell growth, cell division, and additional metastasis. Blocking agents target specific cells so they usually do not cause systemic side effects. Side effects of these drugs include allergic reactions (e.g., difficulty breathing, hives, low blood pressure, rash).
Bevacizumab (Avastin®) may also be used to treat advanced colorectal cancer. This medication prevents new blood vessels, which are necessary for tumor growth, from forming. It does not affect normal tissues that already have an established blood supply. Side effects include blood clots and high blood pressure, which can be controlled with medication.
(NOTE: Avastin is one of a new class of drugs called angiogenesis inhibitors and they have shown to be quite effective against colon cancer.)
Panitumumab (Vectibix™) is the first entirely human monoclonal antibody approved by the Food and Drug Administration (FDA) to treat patients with metastatic colorectal cancer following chemotherapy. This medication is administered intravenously once every 2 weeks.
Immunotherapy
Immunotherapy, or biological therapy, attempts to stimulate the immune system to fight disease and protect the body from side effects of chemotherapy. Immunotherapy agents that may be used to treat colorectal cancer include bacilli Calmette-Guerin (BCG) and levamisole (Ergamisol®).
Immunotherapy may cause flu-like side effects such as the following:
Chills
Diarrhea
Fever
Loss of appetite
Muscle aches and weakness
Nausea and vomiting
Radiation Therapy
Radiation therapy uses high energy x-rays to destroy cancer cells and shrink tumors. External beam radiation (i.e., radiation from a machine outside the body) may be used in addition to surgery to treat colorectal cancer (called adjuvant therapy). It also may be used to relieve symptoms (called palliative treatment) in patients with metastatic colorectal cancer.
Side effects include fatigue, hair loss, reddened skin, and swelling (edema). Medicines and other treatments can reduce the intensity of the side effects. As with other cancer treatments, the incidence of side effects varies with patient health and the exact nature of the treatment.
Follow-up Treatment
Follow-up care is recommended for colorectal cancer patients to ensure that recurrent or metastatic disease is detected as soon as possible. Patients should undergo regular physical examinations, fecal occult blood tests, colonoscopies, CT scans, and chest x-rays.
Prognosis
Prognosis depends on the stage of the disease and the overall health of the patient. Overall, colorectal cancer patients have a 5-year survival rate of about 61%. The 5-year survival rate is about 92% when the disease is treated before it has spread (metastasized); 64% when the cancer has spread to nearby organs or lymph nodes; and 7% when it has spread to other parts of the body (e.g., liver, lungs)."
Depending on the severity of the disease, some patients may want to try to get into clinical trials. If you have been diagnosed with advanced colon cancer and you are located near a major cancer center, it is possible trials are being held of treatments that are not yet generally available to patients that may be more effective than current methods.
Clinical trials can be found on-line in a number of places. Please see below for some links.
http://bethesdatrials.cancer.gov/colorectal/index.aspx
http://www.mdanderson.org/patients_public/clinical_trials/?Referrer=Google&KW=Cancer_Research&gclid=CObv_IKH4ZACFShsGgodSzLZYA
http://www.fightcolorectalcancer.org/patients/clinicaltrials/index.htm
http://www.mskcc.org/mskcc/html/14075.cfm
http://www.ccalliance.org/patient/clinical/clinical.html
http://clinicaltrials.gov/ct/search?term=colon+cancer
http://www.mayoclinic.org/colon-cancer/clintrials.html
http://www.nlm.nih.gov/medlineplus/colorectalcancer.html#cat27
Be sure to check out the trials available before starting any treatment; always get a second opinion on your treatment before committing to something. For one thing, clinical trials don't always accept patients who have already had other treatments first.
Please note, although these trials are usually "double blind" trials (that is, patients and physicians don't know which patients are getting the experimental treatment), those who do not get the new treatment are given the current accepted treatment for the cancer, so no one gets a placebo.
Will You Get It?
You could, especially if you have any of the risk factors above. Colorectal cancer is the fourth most common cancer in the United States and the second leading cause of cancer death. A person at age 50 has about a 5 percent lifetime risk of being diagnosed with colorectal cancer and a 2.5 percent chance of dying from it.
Most people will not get it if they get screened at the recommended times. Unfortunately, people younger than 50 who have no other risk factors can get it too, and they are younger than the recommended age to start screening.
So any time you notice anything unusual about the way your body feels or how you feel overall, be sure to go to the doctor and get checked out.
And if you do find out you have cancer, always go to experts for your treatment. Get more than one opinion. Go to a major cancer center. I may sound like a broken record, but I'd rather be repetitive than not get the message across. Your life may depend upon it.
Sources:
http://www.medicinenet.com/colon_cancer/article.htm: Medicinenet.com
http://www.mayoclinic.com/health/colon-cancer/DS00035: The Mayo Clinic
http://www.cancer.gov/cancertopics/types/colon-and-rectal: Cancer.gov
http://www.emedicinehealth.com/colon_cancer/article_em.htm: EMedicineHealth.com
http://www.oncologychannel.com/coloncancer/staging.shtml: Oncology Channel
http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm
For more information/treatments:
http://www.mdanderson.org/diseases/Colorectal/?gclid=CPKkh6fp4JACFRuhFQodBTLrXA: M.D. Anderson
http://www.mskcc.org/mskcc/html/5789.cfm: Memorial Sloan Kettering
http://www.nlm.nih.gov/medlineplus/ency/article/000262.htm: National Institutes of Health
Thursday, December 13, 2007
Prostate Cancer
I've known several people who have been diagnosed with prostate cancer, which is not surprising given that this is a common cancer among men, and I am now at that age that my male friends are in the likely age range to develop it.
Luckily, prostate cancer, when found early, is highly curable and in most cases not that aggressive. It is said more men die with prostate cancer than of it.
What is Prostate Cancer?
As it is described in nearly every website on the subject, the prostate is a "walnut-sized gland" located under the bladder and in front of the rectum.
Helpfully, the American Cancer Society also explains that only men have one, which, if you didn't already know this, is good information to have if you're a woman - this means if you are a female hypochondriac it's one cancer you don't have to worry about. (Don't worry, you have several other female-only cancers to choose from that men don't have to worry about, so don't get too smug).
According to the American Cancer Society, over 99% of prostate cancers develop from the "gland cells," which make the fluid that is added to the semen. The cancer arising from this type of cell is called "adenocarcinoma."
Other types of cancer that can start in the prostate gland include sarcomas, small cell carcinomas, and transitional cell carcinomas. Because these other types of prostate cancer are so rare, this post will just focus on adenocarcinoma.
Overall, prostate cancer tends to be slow-growing, and autopsy studies show that many older men who died of other diseases also had prostate cancer. The studies indicate that 70% to 90% of the men had cancer in their prostate by age 80, but in many cases neither they nor their doctors even knew they had it.
How Is It Diagnosed?
In the past, men frequently didn't receive a diagnosis until symptoms showed up, by which time it often was too late. Now there are methods available that can diagnose prostate cancer at a much earlier stage. From the Mayo Clinic website: the following screening tests are used today:
Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.
Memorial Sloan Kettering recommends the following criteria in interpreting PSA tests:
"To balance the influence of age on PSA levels, the following age-specific PSA level cut-offs should be considered:
Greater than or equal to 2.5 ng/mL for men up to age 49
Greater than or equal to 3.5 ng/mL for men aged 50 to 59
Greater than or equal to 4.0 ng/mL for men aged 60 and older.
Men with values outside their age-allowed targets should be considered as candidates for prostate biopsy.
For those men being screened for PSA velocity, a PSA velocity of greater than or equal to 0.75 ng/mL per year should necessitate a prostate biopsy -- even if the PSA level is in the normal range."
There are differences of opinion among experts about PSA testing. The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. However, men at high risk, which includes African American men and men with a strong family history of close relatives diagnosed at an early age, should begin testing at age 45.
Experts in favor of regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening feel that because most prostate cancers grow so slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems. Although the jury is out on this one, given that two of my friends discovered their cancers solely through an abnormal PSA test, I tend to believe in testing.
The following tests are used to diagnose prostate cancer if the initial DRE and PSA tests raise a red flag. (From the Mayo Clinic site):
"Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.
Prostate biopsy. If initial test results suggest prostate cancer, your doctor may recommend a prostate biopsy. During a biopsy, small tissue samples are taken and analyzed to determine if cancer cells are present.
To do a biopsy, your doctor inserts an ultrasound probe into your rectum. Guided by images from the probe, your doctor identifies any suspicious areas. Then a fine, hollow needle is aimed at these areas of your prostate. A spring propels the needle into your prostate gland and retrieves a very thin section of tissue."
The biopsy could show either no cancer, precancerous or cancerous cells.
It is believed that prostate cancer begins with a pre-cancerous condition called "prostatic intraepithelial neoplasia" or PIN. Almost half of all men have this condition by the time they reach 50. Under a microscope, the gland cells with PIN appear changed, but not invasive. They can be low-grade (almost normal) or high-grade (more abnormal).
Doctors recommend that men with high-grade PIN be watched carefully and a repeat biopsy may be necessary.
Another type of precancerous condition that may be found is "atypical small acinar proliferation," or ASAP, sometimes known as "atypia." It just means there are some possibly cancerous cells showing up in the biopsy, but not enough to be sure. If ASAP is found, there's about a 40% to 50% chance that cancer is also present in the prostate, which means it's best to get a repeat biopsy within a few months. You might think of "ASAP" as meaning "get another biopsy ASAP!"
If the cells that are evaluated turn out to be cancer, then there may be more tests ordered to understand how advanced the cancer is, if there is a possibility cancer may have spread (from the Mayo Clinic website):
"Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.
Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.
Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but they can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.
Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.
Lymph node biopsy. If enlarged lymph nodes are found by a CT scan or an MRI, a lymph node biopsy can determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present."
Once a cancer is identified and necessary tests are done, Grading and Staging can be performed. These evaluations help you and the doctor decide on your treatment.
Grading
Grading is the process by which cancer cells are evaluated in terms of how aggressive they may be. The most common cancer grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer.
The pathologist then assigns scores to the cancer, called Gleason scores. The Gleason score adds the grades of the two most aggressive types of cancer cells found in the tissue, so scoring may range from 2 (non-aggressive cancer) to 10 (very aggressive cancer).
Staging
The next step is called staging, which determines if or how far the cancer has spread:
Stage I. Signifies very early cancer that's confined to a microscopic area; it cannot be felt by the doctor.
Stage II. The cancer can be felt, but it remains confined to your prostate gland.
Stage III. Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
Stage IV. The cancer has spread to lymph nodes, bones, lungs or other organs.
What Symptoms Can Prostate Cancer Cause?
Although early prostate cancer doesn't cause any noticeable symptoms, eventually it can cause the following:
-Dull pain in your lower pelvic area
-Urgency of urination
-Difficulty starting urination
-Painful urination
-Weak or intermittent urine flow;dribbling
-A feeling that your bladder doesn't empty
-Frequent urination, especially at night
-Blood in the urine
-Painful ejaculation
-General pain in the lower back, hips or upper thighs
-Loss of appetite and weight
-Bone pain
Please don't panic if you do have some of these symptoms, as there are other conditions that can cause them. One of the most common is BPH, or benign prostatic hyperplasia. This is a harmless enlargement of the prostate caused by changes in the body's hormone levels. In older men, the inner part of the prostate around the urethra may continue to grow, and eventually cause problems leading to symptoms such as frequent urination, difficulty urinating, urination during the night, etc. Although this is a benign condition, it is important to get symptoms checked out and make sure that they aren't caused by cancer. BPH can be treated with medications, or if it is more severe, a surgical procedure called a TURP can solve the problem.
What are the Risk Factors for Prostate Cancer?
Age
Age is the strongest risk factor for prostate cancer; the chance of getting it rises quickly over the age of 50. Two-thirds of prostate cancers are found in men over 65.
Race/Ethnicity
Prostate cancer occurs more often in African-American men than in men of other races. African-American men are also more likely to be diagnosed at an advanced stage, and are more than twice as likely to die of prostate cancer as white men.
Conversely, prostate cancer occurs less often in Hispanic, American Indian, and Asian/Pacific Island men than in non-Hispanic whites. It is not known why these differences occur. (See chart below from the CDC for a comparison).
Luckily, prostate cancer, when found early, is highly curable and in most cases not that aggressive. It is said more men die with prostate cancer than of it.
What is Prostate Cancer?
As it is described in nearly every website on the subject, the prostate is a "walnut-sized gland" located under the bladder and in front of the rectum.
Helpfully, the American Cancer Society also explains that only men have one, which, if you didn't already know this, is good information to have if you're a woman - this means if you are a female hypochondriac it's one cancer you don't have to worry about. (Don't worry, you have several other female-only cancers to choose from that men don't have to worry about, so don't get too smug).
According to the American Cancer Society, over 99% of prostate cancers develop from the "gland cells," which make the fluid that is added to the semen. The cancer arising from this type of cell is called "adenocarcinoma."
Other types of cancer that can start in the prostate gland include sarcomas, small cell carcinomas, and transitional cell carcinomas. Because these other types of prostate cancer are so rare, this post will just focus on adenocarcinoma.
Overall, prostate cancer tends to be slow-growing, and autopsy studies show that many older men who died of other diseases also had prostate cancer. The studies indicate that 70% to 90% of the men had cancer in their prostate by age 80, but in many cases neither they nor their doctors even knew they had it.
How Is It Diagnosed?
In the past, men frequently didn't receive a diagnosis until symptoms showed up, by which time it often was too late. Now there are methods available that can diagnose prostate cancer at a much earlier stage. From the Mayo Clinic website: the following screening tests are used today:
Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.
Memorial Sloan Kettering recommends the following criteria in interpreting PSA tests:
"To balance the influence of age on PSA levels, the following age-specific PSA level cut-offs should be considered:
Greater than or equal to 2.5 ng/mL for men up to age 49
Greater than or equal to 3.5 ng/mL for men aged 50 to 59
Greater than or equal to 4.0 ng/mL for men aged 60 and older.
Men with values outside their age-allowed targets should be considered as candidates for prostate biopsy.
For those men being screened for PSA velocity, a PSA velocity of greater than or equal to 0.75 ng/mL per year should necessitate a prostate biopsy -- even if the PSA level is in the normal range."
There are differences of opinion among experts about PSA testing. The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. However, men at high risk, which includes African American men and men with a strong family history of close relatives diagnosed at an early age, should begin testing at age 45.
Experts in favor of regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening feel that because most prostate cancers grow so slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems. Although the jury is out on this one, given that two of my friends discovered their cancers solely through an abnormal PSA test, I tend to believe in testing.
The following tests are used to diagnose prostate cancer if the initial DRE and PSA tests raise a red flag. (From the Mayo Clinic site):
"Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.
Prostate biopsy. If initial test results suggest prostate cancer, your doctor may recommend a prostate biopsy. During a biopsy, small tissue samples are taken and analyzed to determine if cancer cells are present.
To do a biopsy, your doctor inserts an ultrasound probe into your rectum. Guided by images from the probe, your doctor identifies any suspicious areas. Then a fine, hollow needle is aimed at these areas of your prostate. A spring propels the needle into your prostate gland and retrieves a very thin section of tissue."
The biopsy could show either no cancer, precancerous or cancerous cells.
It is believed that prostate cancer begins with a pre-cancerous condition called "prostatic intraepithelial neoplasia" or PIN. Almost half of all men have this condition by the time they reach 50. Under a microscope, the gland cells with PIN appear changed, but not invasive. They can be low-grade (almost normal) or high-grade (more abnormal).
Doctors recommend that men with high-grade PIN be watched carefully and a repeat biopsy may be necessary.
Another type of precancerous condition that may be found is "atypical small acinar proliferation," or ASAP, sometimes known as "atypia." It just means there are some possibly cancerous cells showing up in the biopsy, but not enough to be sure. If ASAP is found, there's about a 40% to 50% chance that cancer is also present in the prostate, which means it's best to get a repeat biopsy within a few months. You might think of "ASAP" as meaning "get another biopsy ASAP!"
If the cells that are evaluated turn out to be cancer, then there may be more tests ordered to understand how advanced the cancer is, if there is a possibility cancer may have spread (from the Mayo Clinic website):
"Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.
Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.
Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but they can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.
Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.
Lymph node biopsy. If enlarged lymph nodes are found by a CT scan or an MRI, a lymph node biopsy can determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present."
Once a cancer is identified and necessary tests are done, Grading and Staging can be performed. These evaluations help you and the doctor decide on your treatment.
Grading
Grading is the process by which cancer cells are evaluated in terms of how aggressive they may be. The most common cancer grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer.
The pathologist then assigns scores to the cancer, called Gleason scores. The Gleason score adds the grades of the two most aggressive types of cancer cells found in the tissue, so scoring may range from 2 (non-aggressive cancer) to 10 (very aggressive cancer).
Staging
The next step is called staging, which determines if or how far the cancer has spread:
Stage I. Signifies very early cancer that's confined to a microscopic area; it cannot be felt by the doctor.
Stage II. The cancer can be felt, but it remains confined to your prostate gland.
Stage III. Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
Stage IV. The cancer has spread to lymph nodes, bones, lungs or other organs.
What Symptoms Can Prostate Cancer Cause?
Although early prostate cancer doesn't cause any noticeable symptoms, eventually it can cause the following:
-Dull pain in your lower pelvic area
-Urgency of urination
-Difficulty starting urination
-Painful urination
-Weak or intermittent urine flow;dribbling
-A feeling that your bladder doesn't empty
-Frequent urination, especially at night
-Blood in the urine
-Painful ejaculation
-General pain in the lower back, hips or upper thighs
-Loss of appetite and weight
-Bone pain
Please don't panic if you do have some of these symptoms, as there are other conditions that can cause them. One of the most common is BPH, or benign prostatic hyperplasia. This is a harmless enlargement of the prostate caused by changes in the body's hormone levels. In older men, the inner part of the prostate around the urethra may continue to grow, and eventually cause problems leading to symptoms such as frequent urination, difficulty urinating, urination during the night, etc. Although this is a benign condition, it is important to get symptoms checked out and make sure that they aren't caused by cancer. BPH can be treated with medications, or if it is more severe, a surgical procedure called a TURP can solve the problem.
What are the Risk Factors for Prostate Cancer?
Age
Age is the strongest risk factor for prostate cancer; the chance of getting it rises quickly over the age of 50. Two-thirds of prostate cancers are found in men over 65.
Race/Ethnicity
Prostate cancer occurs more often in African-American men than in men of other races. African-American men are also more likely to be diagnosed at an advanced stage, and are more than twice as likely to die of prostate cancer as white men.
Conversely, prostate cancer occurs less often in Hispanic, American Indian, and Asian/Pacific Island men than in non-Hispanic whites. It is not known why these differences occur. (See chart below from the CDC for a comparison).
Prostate Cancer Death Rates by Race/Ethnicity in Men Aged 45 and Above
Nationality
Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands. It is less common in Asia, Africa, Central America, and South America. Intensive screening in the more developed countries may account for some of this difference, but other factors, such as lifestyle differences (diet, etc.) may be important as well.
Family History
Prostate cancer seems to run in some families, so there may be a genetic factor. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease. (The risk is higher for men with an affected brother than for those with an affected father.) The risk is much higher for men with several affected relatives, especially if their relatives were young at the time the cancer was found.
Scientists have found several genes that seem to raise prostate cancer risk, but they probably account for only a small number of cases overall. Genetic testing for these genes is not yet available.
(One of my friends, who was diagnosed with prostate cancer through a routine PSA test, immediately called his brothers and told them to be checked - and a good thing, too. One of his brothers was also diagnosed with prostate cancer as a result of his warning.)
Some inherited genes raise the risk for more than one type of cancer. For example, inherited mutations of the BRCA1 or BRCA2 genes, which lead to breast and ovarian cancers, may also increase prostate cancer risk in some men. So if there seems to be a pattern of women in a family with breast or ovarian cancer, the men in the family may be at a higher risk of prostate cancer and should be checked.
Diet
A number of dietary factors may raise risk of prostate cancer. Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables, so it is not clear whether it is the presence of the red meat and dairy or the absence of fruits and vegetables that is to blame. A diet high in fat also seems to be a risk factor.
Some studies have suggested that men who consume a lot of calcium may also have a slightly higher risk; this may be why dairy products are associated with a higher risk as well.
Obesity
Although being obese does not seem to be linked with a higher risk of getting prostate cancer, several studies have found that obese men may be at greater risk for having more advanced prostate cancer and of dying from prostate cancer. The reasons for this are not clear, although it may be the connection with higher fat diets and higher fat levels in the body that does it.
Infection and Inflammation of the Prostate
Some studies have suggested that prostatitis (inflammation of the prostate gland) may be linked to an increased risk of prostate cancer. Inflammation is often seen in samples of prostate tissue that also contain cancer.
Can Prostate Cancer be prevented?
Eating more fruits and vegetables, particularly tomatoes, may confer some protection. Lycopene, a substance found in tomatoes, which is also available as a supplement, may help as well. One study has shown that pomegranate juice may be protective. Several other agents, including difluoromethylornithine (DFMO), isoflavonoids, selenium, and vitamins D and E have shown potential benefits in studies. Further studies are needed to confirm this.
A drug calle finasteride is being studied as a possible preventive agent, as it lowers testosterone levels, as this hormone is another factor in developing prostate cancer.
How is Prostate Cancer Treated?
Treatments options vary depending on the grade and stage of the cancer, the patient's age and overall life expectancy. Many factors must be taken into account, including the patient's own attitude toward the cancer. Some people just want to have the cancer removed, and are not as concernd with side effects, while others are more focused on their quality of life afterward. These concerns may result in different treatment choices even within the same stage of cancer. Following are some options recommended by the American Cancer Society.
Stage I
Since these prostate cancers are small and not aggressive, for elderly patients "watchful waiting" (by following PSA numbers) may be preferred. Other choices may be radiation therapy (either external beam therapy or the implantation of radioactive seeds (called brachytherapy).
Men who are younger and healthy may consider watchful waiting, radical prostatectomy (complete surgical removal of the prostate), or radiation therapy (external beam or brachytherapy).
Stage II
Stage II cancers that are not treated with surgery or radiation are more likely to eventually spread and cause symptoms. However, for elderly men who have other health problems, watchful waiting may still be the best option if the cancer isn't causing symptoms. These men are still more likely to die of something else rather than prostate cancer. However, surgery or radiation therapy may also be options for them.
For younger men who are healthy overall, radical prostatectomy (often with removal of the pelvic lymph nodes) may be the preferred choice. This may be followed by external beam radiation if the cancer is found to have spread beyond the prostate at the time of surgery, or if the PSA level is still detectable several weeks after surgery. This may be either external beam radiation, brachytherapy, or a combination of both. Participation in a clinical trial may be considered in order to take advantage of newer treatments. For aggressive cancers (as measured by Gleason score and PSA level), hormone therapy (to block the production of testosterone) may be added.
Stage III
Stage III cancers have spread beyond the prostate gland but have not reached the bladder, rectum, lymph nodes, or distant organs.
Treatment options at this stage may include:
-external beam radiation plus hormone therapy
-hormone therapy only
-radical prostatectomy in selected cases (often with removal of the pelvic lymph nodes). This may be followed by radiation therapy.
-watchful waiting for older men whose cancer is causing no symptoms or for those who have another more serious illness
-taking part in a clinical trial of newer treatments
Stage IV
Stage IV cancers have already spread to the bladder, rectum, lymph nodes, or distant organs such as the bones. These cancers are not considered to be curable, but treatment can be palliative and prolong life.
Treatment options may include:
-hormone therapy
-external beam radiation plus hormone therapy (in selected cases)
-surgery (TURP) to relieve symptoms such as bleeding or urinary obstruction
-watchful waiting for older men whose cancer is causing no symptoms or for those who have another serious illness
-taking part in a clinical trial of newer treatments
If symptoms are not relieved by standard treatments and the cancer continues to grow and spread, chemotherapy may be considered.
Treatment of stage IV prostate cancer may also include treatments for relief of symptoms such as pain.
One of the people I knew who had prostate cancer was a friend's father, who was diagnosed when he was nearly 80. Given his age and other health problems, and the stage of his cancer (which must have been III or IV), he was treated with hormones only. He lived about 18 months after his diagnosis.
For more details on all of the types of treatments, please see the Mayo Clinic website.
What Happens Next?
After prostatectomy, PSA levels are monitored to ensure the cancer is not returning. Since surgery removes the entire prostate, PSA levels should be undetectable afterward.
After radiation therapy, PSA is also monitored, but since the prostate has not been removed, the levels are not expected to be undetectable. A PSA that is rising on consecutive tests after treatment might indicate that cancer is still present.
For recurrent prostate cancer, the same treatments are available, depending on what has already been tried. If a patient has already had radiation treatment, for instance, then radiation treatment would not be an option if the cancer recurs. Surgery may still be an option, as is hormone therapy. For those whose cancer does not respond to hormone therapy, chemotherapy can extend life and reduce pain.
All treatments have side effects, varying from discomfort to impotence. It is important to understand the risks of these side effects before starting any treatment; be sure to discuss them with your doctor and make sure the doctor understands what your priorities are.
As with all cancers, when you are diagnosed, be sure to consult with various experts, including an oncologist and a radiation oncologist, as well as a surgeon, to truly understand your options. In addition be sure to consult with a major cancer center such as M.D. Anderson, Memorial Sloan Kettering, the Mayo Clinic, Johns Hopkins, or Dana Farber.
Will You Get It?
According to the American Cancer Society, about 1 man in 6 will be diagnosed with prostate cancer during his lifetime, but the good news is, only 1 man in 35 will die of it. If you have some of the risk factors mentioned above, then just make sure to get regular checkups and even if you do get it, you will likely catch it early and be cured.
Over 90% of these cancers are now found while they are still confined to the prostate gland, making them highly curable. Five-year survival rates are now at 99% for these men; for those whose cancer has spread to distant parts of their body, only 1/3 survive 5 years.
Sources used for this article:
http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=36 (American Cancer Society)http://www.mskcc.org/mskcc/html/403.cfm (Memorial Sloan Kettering)http://www.mayoclinic.com/health/prostate-cancer/DS00043 (Mayo Clinic)
Other excellent sources of detailed information, including the latest news and other resources on Prostate Cancer:
http://www.nlm.nih.gov/medlineplus/prostatecancer.html (Medline Plus)http://www.cancer.gov/cancertopics/types/prostate (National Cancer Institute)http://www.prostatecancerfoundation.org/ (Prostate Cancer Foundation)http://www.webmd.com/prostate-cancer/default.htm (Web MD)
Saturday, December 1, 2007
Back Again
After posting every day for the month of November on my regular blog, Mauigirl's Meanderings, as part of NaBloPoMo, it is finally over, and we can return to normal programming.
In other words, I should have time to post on this blog again and give you all some new medical information. Many apologies for the long silence.
I have not yet written the next post but have two topics pending that I intend to write about very soon. One will be on prostate cancer and the other on ovarian cancer. I've known several people with the former (one of whom was just diagnosed) and I know someone else with ovarian cancer, and would like to do research to understand more about what causes these cancers, learn how they are treated, and find out whether there are any new treatments being studied today.
So, hang in there, and I'll be posting a real post shortly!
In other words, I should have time to post on this blog again and give you all some new medical information. Many apologies for the long silence.
I have not yet written the next post but have two topics pending that I intend to write about very soon. One will be on prostate cancer and the other on ovarian cancer. I've known several people with the former (one of whom was just diagnosed) and I know someone else with ovarian cancer, and would like to do research to understand more about what causes these cancers, learn how they are treated, and find out whether there are any new treatments being studied today.
So, hang in there, and I'll be posting a real post shortly!
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