Colon Healthmarch 2010 Your guide to preventing the nation’s 2nd most prevalent cancer

The Cancer Institute at St. Joseph Medical Center

ONE TEAM. ONE PLAN. ONE PLACE.

The Hodes Comprehensive Liver & Pancreas Center and The Colorectal Oncology CenterOur multidisciplinary team handles all aspects of colorectal cancer

including complex resections and treatment of liver metastases.

DiscoverSJ.com

COLON HEALtH

2

What makes these num-

berssodisturbing is that

itdoesn’thavetobethis

way. Colorectal cancer is one of the

mostpreventableandcurableforms

ofcancer there is.Unlikesomecan-

cers,manyimportantriskfactorsfor

colorectalcancerareeasilycontrolled,

andwithearlydetection,asmanyas

95percentofcolorectalcancerscan

becured.Despitethesefacts,colorec-

talcancerremainsthesecondleading

causeofcancerdeathsforbothmen

andwomen.

The Susan Cohan Colon Cancer

Foundation(Susie’sCause)iscommit-

tedtochangingthis.Throughdiverse

programsaimedatraisingawareness,

advancingeducationaboutcolorec-

tal cancer, encouraging prevention

and screening for early detection,

and offering knowledge, hope and

resources to those affected by this

disease,Susie’sCausehasestablish-

ing itself as the national voice of

colorectalcancer.

Thoughnooneknowsforcertain

whatcausescolorectalcancer,there

areriskfactorsthatinfluencethelike-

lihood that you will be affected by

thisdisease.Somearebeyondyour

control,butothersarenot.Research

shows that 50 percent of colorectal

cancerscouldbepreventedthrough

healthylifestylechoicessuchaseat-

inghealthfully,maintainingahealthy

bodyweight,gettingenoughphysi-

cal activity and not smoking. That

means that of the nearly 150,000

peoplewhowilllearntheyhavecolon

or rectal cancer this year, 75,000 of

them—enoughpeopletofillafoot-

ballstadium—mayhavebeenableto

prevent it.Additional livescouldbe

savedthroughearlydetection.

According to The National Can-

cer Institute, rates of screening for

colorectal cancer are consistently

lower than those for other types of

cancer.Perhapsit’sbecausethereare

somanymythsandmisconceptions

about this disease, or perhaps it’s

becausetalkingaboutitmakesmany

peopleuncomfortable.Whateverthe

reason,choosingtoignorecolorectal

cancerisadecisionthatmaybecost-

ingmanylives.

The Susan Cohan Colon Cancer

Foundation(Susie’sCause)isworking

hard to turn the tide.Over thepast

five years, Susie’s Cause has imple-

mented national, groundbreaking

educational and support programs

thathavedramaticallyimpactedthis

diseaseincluding:

The Save Our Parents Program

A unique educational model that

motivates students to talk to their

parents and family members about

the benefits of Colorectal Cancer

screening,healthydiet,andlifestyle

choices.

The Sharing, Caring, and Surviving

Colon Cancer Symposium

A multi-city symposium reaching

outtopatientsandtheirfamilies.

The Primary Care Education Series

Continuing education for primary

care physicians to better educate

them about their important role in

theearlydetectionofcoloncancer,

and the significance of remaining

involvedduringtreatment.

National Colon Cancer

Screening Month

Designates April as Susie’s Cause

Colon Cancer Screening Month to

specifically increase screening and

trackscreeningparticipation.

Susie’sCauseisproudtoprovideto

thededicatedreadersofUSAToday

the first national comprehensive

report on Colon Cancer Prevention

and Treatment. We are thankful to

our many sponsors that graciously

supportedthisextraordinaryproject.

Weappreciatetheexpertsthathave

generouslygiventheirtimeandtheir

knowledge; the familiesofprecious

lovedoneslostandpatientsliterally

fighting for their lives; and to Susie

forherdivineguidancefromabove.

Withhumilityandpride,Susie’sCause

dedicatesthisprogramtoallofyou.

CONTENTS2 TheFightAgainstColonCancer

4 WhatYouDon’tKnow

CanHurtYou!

4 SharonOsbourne

6 PanelofExperts

8 Stefanie’sStory

8 WhattoWatchFor

8 AreYouAtRiskForCRC?

9 Prevention

10 CarmenMarcValvo

10 Don’tLetFearHoldYouBack

11 GettingTheCareYouNeed

COLONHEALTH

Publisher: Jeremy Marks jeremy.marks@mediaplanet.com

Journalist: Cindy Heroux

Designer: Carrie Reagh carrie.reagh@mediaplanet.com

Photos: ©iStockphoto.com

For more information about supplements in the daily press, please contact: Kayvan Salmanpour, 1 646 922 1400 kayvan.salmanpour@mediaplanet.com

This section was written by Mediaplanet and did not involve USA Today News or Editorial Departments.

www.mediaplanet.com

a very special thanks to...

The Fight Against Colon Cancer: Knowledge is Power: Preventing Colorectal CancerBy:BOBBySMITh,ExECUTIvEvICEPRESIDENTANDDAvIDRODMANCOhAN,PRESIDENT,ThESUSANCOhANCOlONCANCERFOUNDATION(SUSIE’SCAUSE)

Onein20Americansare likelytodevelopcolorectalcancer intheir lifetimeandalmost50,000peoplewilldiefromcolorectalcancerthisyearalone.

QuidelCorporationenhancesthehealthandwellbeingofpeoplearound the globe through thedevelopment, manufacturingandmarketingofrapiddiagnos-ticsolutions.

Fiveyearsagoabeautifulyoungwomanwitheverythingtoliveforsuccumbedtoatwoyearheroicbattlewithcoloncancer.SheleftbehindalovingfamilyandtwobeautifulchildrentogrowupinaworldwithouttheirMother.hervisionwasthatnootherfamilywouldexperi-encethepainthatherfamilyendured.Susandidnotlivelongenoughtosharehervision,however,herlegacywillcarryonthroughherFoundation,The

SusanCohanColonCancerFoundation(Susie’sCause).TheFoun-dationwasestablishedbySusanandtheCohanfamilyshortlybeforehertragicdeath,andisapublic501(c)(3)charity.

3

COLON HEALtH

1 What Are the Key Statistics for Colorectal Cancer? http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_colon_and_rectum_cancer.asp?sitearea=2 Can Colorectal Cancer be Prevented? http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_colon_and_rectum_cancer_be_prevented.asp?rnav=cri

Go to colorectal-test.com formore information. Results you can depend on.

Few things embody our generation’s coming of age like the450,000 or so people that descended onWoodstock in1969.Forty-one years later, tie-dye has become neck tie, flower power hasbecome solar power and being screened for colorectal cancer (CRC) hasbecome emblematic of where we are now. It may not be three days of peaceand music, but the numbers express the importance of CRC screening.

The QuickVue® iFOB (immunochemical Fecal Occult Blood) is an easy to use testthat detects occult blood in stool, which may be an indication of CRC. Only onesample collection is needed and there are no dietary or medicine restrictions.

March is National Colorectal Cancer Awareness Month, so make the pilgrimageto your doctor and ask to get screened. After all, the earlier cancer is detected,the more curable it is.2

©20

10Q

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(02/

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In 1969 about

450,000people attended Woodstock.

In 2010about 147,000people will be

diagnosed with

ColorectalCancer. Approximately

50,000of them willdie from it.1

QUIDEL_ColonCancer_USAToday.qxd:Layout 1 3/4/10 3:08 PM Page 1

COLON HEALtH

4

In 2008, The American College of

Gastroenterology (ACG) issued

new guidelines for colorectal

cancerscreening.Basedonthebest

evidence available, the new guide-

linesoffermorespecificrecommen-

dationsthaninthepastanddivide

screeningtestsintotwogroups:can-

cerpreventionandcancerdetection.

Asyouwouldexpect,theACGrec-

ommendsteststhatpreventcancer

overthosethatdetectit,withcolo-

noscopybeingthepreferredscreen-

ing strategy. “A colonoscopy is the

goldstandardinscreeningbecause

it is both diagnostic and therapeu-

tic,” says Dr. howard K. Berg MD,

headofcolonandrectalsurgeryat

St. Joseph’s Medical Center Cancer

Institute in Towson Maryland. That

isbecausecolonoscopyallowsyour

doctor to carefully examine inside

the rectum and the full length of

thecolon,aswellasremovepolyps

andtaketissuesamples (biopsy)of

any suspicious areas. “If a polyp is

found,95percentofthetimeitcan

beremovedduringtheprocedure,”

says Dr. Berg. “Removing a polyp

that has malignant potential can

preventapersonfromevergetting

coloncancer.”

Even if cancer is present, colo-

noscopy offers benefits. “If you are

pickingupcancerpriortotheperson

havingsymptoms,itwilllikelybeat

anearlystagewhen it ismoreeas-

ily treated and there is a dramatic

improvement in survivability,” says

Dr. Berg. “If you are average risk

and your colon is clean following

colonoscopy, the test need not be

repeatedfor10years.”

For those who cannot afford or

areunwillingtohaveacolonoscopy,

other options exist. Sigmoidoscopy

is similar to colonoscopy but only

showsthelowerportionofthecolon.

Acomputedtomography (CT)colo-

nography, or virtual colonoscopy,

everyfiveyearsisanotheralternative.

Fecal immunochemical testing

(FIT)looksforthepresenceofoccult

(hidden)bloodinstool.Unlikeolder

formsof fecaloccultbloodtesting,

FIT tests such as the Quickvue®

iFOB(immunochemicalFecalOccult

Blood) test from Quidel® Corpora-

tionuseantibodiestomeasurethe

presence of human hemoglobin

making them more sensitive and

accurate.Theyarealsonotaffected

by what or how much you eat as

older guaiac-based tests are. The

QuickvueiFOBofferstheadditional

advantageofrequiringonlyasingle

sample. FIT is a detection test and

shouldbeperformedannually.

For average risk individuals, it’s

recommendedthatscreeningbegin

atage50,butforAfricanAmericans,

even those at average risk, testing

shouldbeginat45.Ifyouhavefam-

ilyhistoryorotherincreasedriskfor

CRC,screeningshouldbeginearlier

withmore frequent follow-up.And

of course if you have symptoms,

don’twait!Talktoyourdoctorright

awayandasktobescreened.

D iagnosed in 2002, Sharon

has shared her personal

journey every step of the

way in hopes that her story would

raise awareness about the disease

andencourageotherstobeproac-

tiveaboutit’spreventionanddetec-

tion.“Nobodywantstotalkaboutit

becauseofwhereitis,”saysSharon.

“Everysinglepartofourbodiescan

get sick so why should this be so

hush hush? When you look at the

statistics thatsurround it,weneed

tobetalkingaboutit.”

Sharon is spot on. With ap-

proximately150,000newcasesand

50,000 deaths a year, colorectal

cancer isthesecondleadingcause

ofcancerdeathsforbothmenand

women behind lung cancer. But

unlikeothercancers, itdoesn’tget

the same kind of attention. “What

color ribbon is there for it?” asks

Sharon. “There isn’t one. Nobody

wants to talk about this disease.

It’snotsexy, is it?But if it’scaught

early, you don’t even need any

chemo—it’slikelyanoperationand

it’s gone.” Sharon herself was not

sofortunate.herdoctorsestimated

thatbythetimeitwasdiscovered,

hercancerhadbeenthere for four

years. Because her lymph nodes

were involved, chemotherapy was

necessary.

Appropriatetreatmentvaries for

eachpatient,butwithearlydetec-

tion colorectal cancer is one of

the most curable forms of cancer.

Unfortunately, there are often no

symptomsassociatedwithitsearly

stages. “It is one of those cancers

youjustdon’tknowyouhave,”says

Sharon. “The only reason I knew

I had it was because I was con-

stantly tired. I thought it was just

because I was so busy, but I had a

blood test and they told me I was

soanemicImustbebleedingfrom

somewhere. I didn’t believe it but

I got the colonoscopy done and it

savedmylife.”

According to the American Can-

cer Society, 75 percent of cases

occur in people with no risk fac-

tors. Sharon had no family history

of any type of cancer and she was

diagnosed before she was 50, the

recommendedagetobeginscreen-

ing.“Iknowsomany—agirlof19,a

ladyof26—thathavethisdisease.I

havemetpeoplethroughmyjour-

neythatareallages,allcolors,there

arenonormsforthisdisease.you’ve

gottolistentoyourbody!”

you also have to take care of it.

Sharonisconvincedthathercancer

resultedfromherpoordietandun-

healthylifestyle.“Iatesomuchcrap

and so much animal fat, especially

fromdairy—milkshakes, icecream,

butter.AndIwasaverylazyperson;

Ididn’tgetanyexercise.”Allthathas

changed.Today,Sharonishealthier

andmorevibrantthaneverandshe

intendstokeepitthatway.

“I look at it this way, every day

truly is the first day of the rest of

your life,” says Sharon. “When you

wake up tomorrow, think about

howyouhavetorespectyourbody;

you have to respect what you put

inyourbody.Sooftenwedon’t,we

abuseourbodies.Ifwetreatedour

wholebodiesthewaywetreatour

faces, that would be great!” Wise

wordstoliveby.

If discovered early, Colorectal Cancer (CRC) is curable in over 90 percent ofcases.Unfortunately,thisslowgrowingcanceroftenhasnosymptomstoalertyoutoitspresence,especiallyduringtheearlystageswhentreatmentwouldbemosteffective.That’swhyitissoimportanttobescreenedforCRC.Butwhoshouldbescreened,whenandwhattypeoftestshouldtheyhave?

Tenacious,compassionate,andcommittedtomakingadifference.ThesearejustafewofthewordsthatcometomindwhenIlistentoSharonOsbournetalkaboutherexperiencewithcolorectalcancer.

What You Don’t Know Can Hurt You!

Sharon Osbourne: Words of Wisdom from a Survivor

If you are average risk and

your colon is clean following colonoscopy, the test need

not be repeated for 10 years.

By:CINDyhEROUx

SharonOsbourne

TrimSize: 9.75” x 10.25” ONUS10UBMS01601: Publication:

Colorectal Cancer Awareness

Bristol-Myers Squibb Proudly Supports

© 2010 Bristol-Myers Squibb. All rights reserved. ONUS10UBAD02503 02/10

Bristol-Myers Squibb is a leader in the fight against cancer. We introduced our first cancer treatment over 40 years ago. Today, we continue our mission to discover, develop and deliver innovative medicines for people battling cancer and many other serious diseases. For more information, go to www.bms.com.

ONUS10UBAD02503_v1_TWCP_Kevin.indd 1 3/3/10 10:20 AM

COLON HEALtH

6

Q: Can the foods we eat increase or

decreaseourrisk forcolorectalcan-

cer?

A: “Absolutely!”saysregistereddieti-

tianCindyheroux.“Adiethighinred

and processed meats can increase

yourriskofcoloncancer,butaplant-

based diet that’s high in fruits, veg-

etablesandwholegrainscanprotect

youagainstcancer.”

Togetthemostcancerprotection,

Cindy recommends eating foods as

closetothewaynaturemadethemas

possible.“Themoreprocessedafood

isthemorelikelyitistohavelessof

whatyourbodyneeds,andmoreof

whatitdoesn’t.Also,whileindividual

nutrients are important, they rarely

workalone.Oftentimesit’sthecom-

binationofnutrientsinagivenfood

thatmakeitsopowerful.Forexample,

anappleeatenwiththepeelonhas

farmorecancerfightingabilitythan

onewiththepeelremoved.”

A whole foods, plant-based diet

helps protect you against cancer in

severalways.“Morefiberhelpskeep

everythingmoving,andtheantioxi-

dants and phytochemicals found in

brightly colored fruits and vegeta-

blesofferspecialprotectionagainst

cancer,” explains Cindy.“Fruits, veg-

etablesandwholegrainsarepacked

with nutrition, but naturally low in

calorieswhichalsomakesiteasierto

maintainahealthyweight,animpor-

tantriskfactorforcolorectalcancer.”

Q: Whyisearlydetectionofcolorectal

cancersoimportantandwhattypeof

screeningisbest?

A:“Whendetectedatanearlystage,

colorectalcanceriscurable,”saysDr.

Krasna.“Ifyouarenotscreenedprop-

erly and the cancer progresses, it’s

lesslikelytobecured.”Infact,when

detectedearly,colorectalcancermay

becurableinover90percentofcases.

Whoshouldbescreened,andwhen,

dependsonyourpersonalandfamily

history.

“There have been recent changes

intherecommendations,”explainsDr.

Krasna,“notforthoseathighrisk,but

forthegeneralpopulation.Everyone

over50whoisataverageriskshould

have a colonoscopy every 10 years.

Other options such as a flexible sig-

moidoscopyorCTcolonography(vir-

tualcolonoscopy)arerecommended

everyfiveyears.Afecaloccultblood

test (gFOBT), fecal immunochemi-

caltest (FIT)andrectalexamcanbe

doneyearly.Ifyouarepredisposedto

cancerbecauseofafamilyhistoryof

colorectalcancerorpolyps,oraper-

sonal history of Inflammatory Bowel

Disease(IBD)suchasulcerativecolitis

or Chrohn’s disease, you need to be

screenedearlier.”

Q: Why iscolonhealthso important

andwhatcanwedotohelpmaintain

ahealthycolon?

A: “Thecolonis importantfornutri-

tionalhealth,butitisalsoanimpor-

tantregionofimmunefunction,both

locallyandfortheentirebody,”says

Dr. Jampolis.“It is one of the body’s

first lines of defense against toxins

you take in through food, and hav-

ingsufficienthealthybacteriainthe

coloncanhelpboostoverallimmune

cellular function in addition to pro-

tectingyourcolon.”

Tominimizeexposuretotoxins,im-

proveregularity,andkeepthecolon

healthy, Dr. Jampolis recommends

consuming a diet high in naturally

occurringfibersuchaswholegrains,

fruitsandvegetables,aswellasfoods

containing probiotics (healthy bac-

teria) such as yogurt.“Naturally oc-

curring fiber is important,” explains

Dr. Jampolis. “Research has shown

thataddingwholegrainstoyourdiet

hasaprotectiveaffectagainstcolon

cancer.That’snotnecessarilythecase

with simply adding fiber to other

foods,especiallylesshealthyones.”

Dr. Jampolis adds,“Fiber not only

speeds transit time and increases

stool bulk which can help control

constipation,butitalsoprovidesfood

to support the growth of healthy

bacteriawhichcanalterthephofthe

colon, providing added protection

andimprovingmineralabsorption.”

Q: Prevention or early detection of

colorectal cancer is ideal, but are

there options for people who have

advanceddiseasethathasspreadto

otherpartsofthebody?

A: “There are numerous options for

thesepatientssuchaschemotherapy

combinationsthathavebeenshown

tobeeffective,aswellassurgicaland

chemotherapycombinations,”saysDr.

Bartlett.“AtUPMCCancerCenters,we

havedevelopedaColonCancerSpe-

cialtyCareCenterwherethemedical

oncologist,thesurgeonandtheradia-

tiononcologistworktogethertocome

up with individualized treatment

plansforeachpatient.”

Thosetreatmentplansofteninvolve

novelapproachessuchasdelivering

chemotherapy during surgery. Dr.

Bartlett explains,“We can surgically

isolate a region of the body such as

theabdominalcavity,oranorgansuch

astheliver.Bydeliveringthechemo-

therapydrugsdirectlytothatregion

ororgan,wecanminimizesideeffects

totherestofthebodyanddelivera

muchhigherconcentrationofchemo-

therapydrugstothetumor.”

Participationinclinicaltrialsmaybe

anoption.“Inadditiontothemedical

specialists,wehaveourteamofclinical

researchexperts,”saysDr.Bartlett.“This

offerspatientsinvolvementinclinical

trials,someofwhichareuniquetothe

ColonCancerSpecialtyCareCenterat

UPMC Cancer Centers.” For patients

with metastatic colon cancer, these

innovativetherapiesoffermorethan

justoptions,theyofferhope.

Panel Of Experts

CINDyhEROUx,RDSpeaker,AuthorofThe Manual That Should Have Come With Your BodyPresident,SpeakingofWellnesslC

MARKKRASNA,MDMedicalDirectoroftheCancerInstituteSt.JosephMedicalCenterinTowson,Maryland

BRANDONhAyES-lATTIN,MDSeniorMedicalAdvisorlanceArmstrongFoundation

MElINAJAMPOlIS,MDInternistandBoardCertifiedPhysi-cianNutritionSpecialist

DAvIDl.BARlETT,MDChief, Division of Surgical Oncology

Director,SpecialtyCareCenters,

UPMCCancerCentersandUniversity

ofPittsburghCancerInstitute

Q: lance Armstrong and the

livestrongFoundationhaveprovided

knowledge, inspiration and encour-

agement to so many people. What

role does personal empowerment

playinthepreventionandtreatment

ofcolorectalcancer?

A:“ThelanceArmstrongFoundation

believes that knowledge is power,”

says Dr. hayes-lattin. “In colorectal

cancer(CRC),thisincludesknowledge

about preventing cancer, detecting

a diagnosis early, understanding a

diagnosis, finding the best therapy,

andplanningfor the future. Inorder

toapplythatknowledge,it iskeyfor

patientstohaveaccesstotheirmedi-

caldatasuchasbiologic risk factors,

pathologyandstaginginformation,or

treatmentsummaries.”

Empowerment enables patients

tobeactiveparticipantsintheirown

care—to be proactive rather than

reactive.

“Next generation electronic tools

maybetterempowerpatientstoshare

knowledge as they tell their story,”

saysDr.hayes-lattin.“Someelements

of a patient’s cancer story include

describing the psychosocial impact

andsharinghelpfulresourcesinclud-

ingdetailsaboutgeneticandbiologic

markers,treatmentresponses,andpa-

tientreportedoutcomes,allofwhich

may better inform cancer research.

The lance Armstrong Foundation is

committed to building tools which

enablepatientempowerment.”

As we move forward advancing cancer treatment,we’re leaving behind a legacy.

Doctors know that the latest cancer research doesn’t make an impact until it touches a patient.At UPMC Cancer Centers, researchers work closely with oncologists to rapidly translate lab discoveries and clinical research into effective new treatments. This means that more than 36,000new patients each year benefit from the most advanced cancer therapies. As part of one of the largest clinical care networks in the country, UPMC Cancer Centers is bringingworld-class resources and treatments directly to patients in their own communities. To learnmore about research and treatment at UPMC Cancer Centers, call 1-800-533-UPMC or visitUPMCCancerCenters.com.

Affiliated with the University of Pittsburgh School of Medicine, UPMC is ranked among the nation’s best hospitals by U.S.News & World Report. UPMC Cancer Centers works in tandem with the University of Pittsburgh Cancer Institute,

a National Cancer Institute-designated Comprehensive Cancer Center.

UPMC.com | 1-800-533-UPMC

ADV383400_CancerNationalAdUSAInsert_LGH:Layout 1 3/16/10 4:17 PM Page 1

COLON HEALtH

8

Current recommendations sug-

gest being screened for CRC

starting at age 50, but if you

experienceanyofthesymptomslisted

below, it’s important to talk to your

doctorregardlessofyourage.

Suzanne Dixon, MPh, RD, an epi-

demiologist, and the Colon Cancer

Guide for About.com, explains that

symptomsofCRCcome in twogen-

eral varieties: local symptoms and

systemicsymptoms.“localcoloncan-

cer symptoms affect your bathroom

habitsandthecolonitself,”saysDixon.

“Systemic colon cancer symptoms

are those that affect your whole

body,suchasunexplainedfatigueor

weightloss.”

localsymptomstowatchforinclude:

• Changes in the frequency of your

bowelmovements

• Changesintheconsistencyofyour

bowelmovement

Areyouexperiencingconstipation

ordiarrhea?

• Bloodinyourstool

Bloodmaybebrightred,darkcol-

ored,orblackandtarrylooking.

•Painordiscomfort

Do you have frequent gas pains,

cramps,orbloating?

• Feeling as if your bowels don’t

emptycompletely

All of these symptoms can be

caused by things other than cancer,

but don’t take unnecessary chances.

“Ifyouexperienceanyofthesesymp-

tomsfortwoormoreweeks,callyour

doctorrightawaytodiscussyourcon-

cerns,”saysDixon.

Systemicsymptomsinclude:

• Unexplainedfatigue

• Unexplainedweightloss

haveyoulostyourappetite?

• Nauseaorvomiting

• Anemia

like local symptoms, systemic

symptoms also have many possible

causes,butdon’tletthatpreventyou

fromtalkingwithyourdoctorabout

them. Early diagnosis and treatment

aretooimportanttowait.

Unlikefast-growingcancersorcancersyoucansee,colorectalcancer(CRC)oftenhasnosymptomsatall,especiallyduringtheearlystages.

Warning Signs: When to Get tested

These risk factors include:

Age

Over 90 percent of people

diagnosedwithcolorectalcancerare

overtheageof50,butcolorectalcan-

cercan—anddoes—affectpeopleof

allages.

Your Personal Health History

If you have had colorectal cancer

in the past, you are at increased risk

fordeveloping itagain inthe future.

Ifyouhaveahistoryofcolonpolyps

or InflammatoryBowelDisease(IBD)

such as ulcerative colitis or Crohn’s

disease,yourriskisalsoincreased.Ir-

ritableBowelSyndromeorIBSisnot

associatedwithanincreasedrisk.

Your Family History

If a close family member has had

colorectalcancer,especiallyifitwasat

ayoungage,orifmanyfamilymem-

bershavehadcolorectalcancer,your

riskisincreased.Itisnotclearwhether

the increased risk is due to genetics

or having similar lifestyles and envi-

ronmentalexposure.Itisimportantto

notethatonly10to20percentofCRC

casesinvolvepeoplewithafamilyhis-

tory.yourfamily’shistorymightbegin

withyou.

Inherited Genetic Alterations or

Syndromes

Inherited changes in genes can

increaseyourriskofspecificformsof

colorectalcancer.Thesealterationsac-

countforapproximatelyfivepercent

ofCRCcases.

Race and Ethnicity

AfricanAmericanshavethehighest

incidenceofcolorectalcancer in the

UnitedandStatesandJewsofEastern

European descent (Ashkenazi Jews)

havethehighestworldwiderisk.

Lifestyle

Colorectalcanceriscloselyrelated

to diets high in red meat, processed

meats,andanimalfat,andthoselow

infruits,vegetablesandfiber.lackof

exercise,smoking,andheavyalcohol

usealsoincreaseyourrisk.

Obesity

Obesityincreasesbothyourriskfor

developingCRCandyourriskofdying

fromthedisease.

Type 2 diabetes

Non-insulindependentdiabetesand

insulinresistancehavebothbeenas-

sociatedwithanincreasedriskofCRC.

Ifyouhaveanyoftheseriskfactors,

it’s important to talk with your doc-

tor.Togetheryoucanmakeinformed

decisions about colorectal cancer

screening.

Colorectalcancercanaffectanyonebutcertainriskfactorsareassociatedwithanincreasedchanceofdevelopingthisdisease.

Are You At Risk For CRC?

Astory that her mother Andrea

hopestospareotherfamilies

fromhavingtorepeat.

Stefanie’s great grandmother had

been diagnosed with colon cancer

when she was in her sixties. her

grandfatherhadbeendiagnosedwith

coloncancerforthefirsttimeinhisfif-

tiesandwentontobattlecancerfour

moretimes.herfatherwasdiagnosed

withcoloncancerwhenhewasthirty-

nineyearsoldandhada recurrence

at fifty. With each generation, the

dreadeddiagnosisarrivedyearsearlier

thanintheprecedinggeneration.yet

when Stefanie began suffering from

chronic high fevers, immunological

problemsandevenabdominalpaina

fewmonthspriortoherdiagnosis,her

parentswererepeatedlyassuredthat

hersymptomswerenotbeingcaused

by colon cancer and a colonoscopy

wasnotperformed.

For two years Stefanie worked

throughherillnessesandfollowedthe

adviceofherdoctors.Shegraduated

collegeinMayof2008,andfilledwith

excitementandanticipation,headed

toIsraelforaBirthrighttrip.Itwasdur-

ing that trip that she was overcome

withcripplingpain.

Initially, doctors again dismissed

the possibility of colon cancer, but

one insistent physician pushed for

a scan. Within hours Stefanie was

having emergency surgery and her

terrified parents heard the words

theyhad feared forso long. “Iknow

exactlywherewewere,exactlywhat

Iwaswearing,”explainedAndrea.The

doctorsimplysaid,“‘youshouldcome,

your daughter has cancer.’” As they

waitedattheairportfortheflightthat

wouldcarrythemtotheirdaughter’s

side,Stefanie’sparentsreceivedasec-

ondcalltellingthemthecancerhad

spreadtoherliver.

“Unfortunately, Stefanie’s cancer

couldnotbecontainedwithchemo

andradiation.Ineightmonthsitwas

everywhere and she died at 22. She

never complained, not even about

the terrible pain, never asked why

thishappenedtoher,shewasalways

moreconcernedabouteveryoneelse.

Shewasthebrightlightineveryone’s

life,”saysAndrea.

After Stefanie passed away, her

parentsinsistedheryoungerbrother

Evan have not only a colonoscopy,

but also an endoscopy and urine

test for bladder cancer. Even with

hisoverwhelmingfamilyhistoryand

informationabouthowfarhissister’s

cancerhadspread,thedoctorthought

theadditionaltestswereunnecessary.

“Theykept tellingmethatbasedon

statistics I should not have my son

testeduntilhewas35.WhyshouldI

wait? I don’t care what the statistic

said.Statistically,mydaughtershould

neverhavediedatherage,howcould

theytellustowait?”asksAndrea.As

was the case with Stefanie’s older

brother Josh, Evan showed no signs

of cancer, but genetic screening re-

vealedthatAndrea’ssoncarriedthe

samegeneashisfatherandsister.

Andrea hopes that by sharing

Stefanie’sstory,somethinggoodcan

come from her daughters’ death. “If

it’sinthefamily,ifit’sgenetic—don’t

wait,gettested.Idon’twantoneother

youngpersontolosetheirlife.”

Stefanie’s Story: Cancer In Her GenesStefanieRiegerdidn’tfitthestatistics.Just22whencoloncancerclaimedher life,Stefanie’sstory tellsthetaleofanentirefamily’sstrugglewithgeneticcoloncancer.

9

COLON HEALtH

WE BELIEVE IN LIFE.

Your life. We believe in living every minute of it with every ounce of your being.

And that you must not let cancer take control of it.

We can help you face the challenges of cancer at 866.235.7205 or online at

LIVESTRONG.org/cancersupport.

Anyone, anywhere can join our fight against cancer. Join us at LIVESTRONG.org.

© 2010 LIVESTRONG, a registered trademark of the Lance Armstrong Foundation. The Lance Armstrong Foundation is a 501(c)(3) under federal tax guidelines.

The general consensus is that

atleast50percentofallcases

of colorectal cancer could be

preventedbylifestylealone,andone

recentharvardstudy foundthat the

riskcouldbereducedbyasmuchas

70to75percent!

Evidence forsome lifestyle factors

isstrongerthanforothers,buthereis

whatweknow.AccordingtoEdward

Giovannucci, MD SCD, professor of

epidemiology and nutrition at the

harvardSchoolofPublichealth,“Itis

veryclearthatmaintaininganormal

body weight would decrease some-

one’srisk forcolorectalcancer (CRC).

Alsobeingphysicallyactiveisprotec-

tive.youdon’thavetobeamarathon

runner-walking just four hours per

week decreases risk substantially.”

Smokingraisesyourriskandsodoes

excessivealcoholconsumption.

Theserecommendationsareconsis-

tentwiththosethatpromoteoverall

health and also lower your risk for

otherformsofcanceraswellasheart

disease,diabetesandstroke.

Diet—A Powerful Ally

how diet is related to colorectal

cancer(CRC)riskisthetopicofmuch

research and debate. “To the extent

thatdietimpactsobesity,it’sveryim-

portant,butbeyondthat,whatismost

consistentlyassociatedwithincreased

riskofCRCishighconsumptionofred

meat, especially processed meats,”

saysDr.Giovannucci.“It’sbeenhardto

teaseoutexactlywhythisisthecase,

butthereisevidencethatcookingcan

leadtotheproductionofcarcinogens

in well done meat, and processed

meats contain compounds that are

convertedtocarcinogens.”

Mostnutritionexpertsbelievethat

a plant-based diet offers many ben-

efits.JoelFuhrman,MD,aboardcerti-

fiedfamilyphysicianandauthorofEat

For Health and Eat To Live,explainsthat

aplant-based,“nutritarian”diet—one

that focuses on the nutritive quality

offoodandishighinfruitsandveg-

etables—not only reduces exposure

to possible carcinogens, but offers

a protective effect against cancer.

“Fruits and vegetables, cruciferous

vegetables, retard the expression of

cancergenes,”saysDr.Fuhram.“Con-

sumption is inversely related toCRC

risk.”

Both of these physicians agree

on the importance of making good

choicesasearlyaspossible.“Thereisa

longlagtime,perhapsasmuchas20

to25years,betweendietarypatterns

and development of the disease,”

explainsDr.Fuhrman.“Thosewiththe

highestconsumptionofplantfoodin

childhoodhavethelowestincidence

of CRC as adults.” Dr. Giovannucci’s

research supports this. “CRC takes

decadestoprogress,”saysDr.Giovan-

nucci.“Somenutrients,suchasfolate

(a B vitamin that is especially abun-

dantingreenleafyvegetables,beans

andpeas),whenconsumedatavery

early stage, may be preventing that

progression.”

There is significant evidence to

suggest that calcium and vitamin D

are also important. According to Dr.

Fuhrman, “Some studies show that

with adequate vitamin D levels, the

body isbetterabletotakecells that

wouldhaveprogressedtocancerand

haltthatprogressioninit’stracks.”

A simple blood test can alert you

to whether or not you are getting

enoughvitaminD.Forcalcium,800—

1000mgmaybesufficienttoprotect

againstCRC,butyoumayneedmore.

Makingchangestothewayweeat

canbechallenging,butitisaninvest-

ment inyourhealth,asDr.Fuhrman

remindsus.“Thesamedietaryrecom-

mendationsthatdecreaseriskofCRC

decrease risk of the most common

cancers simultaneously and other

conditionsaswell,includingdiabetes,

stroke,heartdiseaseandsuddencar-

diacdeathfromirregularheartbeats.”

Prevention: the Choice Is YoursColorectalCancerisacomplexdiseasethatisaffectedbymanyfactors,butonethingisabsolutelycertain—thelifestylechoicesyoumakeeachandeverydayhavethepowertoinfluencewhetheryouareeveraffectedbythisdiseaseornot.

COLON HEALtH

10

“There was something

wrongwithme, Isensed

it,” says Carmen. “So I

went to the doctor and they did all

thesetestsandtheycouldn’tfindany-

thing.Thenwedidacolonoscopy,and

theyfeltsomethingandrighttherein

themiddleoftheprocedurethedoc-

torsays,‘youhavecancerandit’sthe

sizeofalemon.’”

That’snottypicallythewayphysi-

cians share such serious news, but

whatwasequallyshockingforCarmen

wasdiscoveringthathehadafamily

historyofcoloncancerheknewnoth-

ingabout.

“Ihadthetumorremoved laparo-

scopically and they had to remove

partofmycolon,”saysCarmen.“Then

I foundoutafterwardthat Ihadtwo

family members, one on each side,

thathadcolorectalcancer(CRC).One

oftheproblemswithCRCisthatno-

bodywantstotalkaboutit.”however,

withnofamilyhistoryonrecord,Car-

men’sinsurancedidn’twanttocovera

colonoscopyuntilhewas50.“I’mfine

now,butmycancerwasstageIvwhen

it was detected,” explains Carmen.

“hadIbeenforcedtowait,myprog-

nosiscouldhavebeenmuchdifferent.

youneedtohavefulldisclosure,you

needtohavethefamilyconversation.”

Duringhistreatmentandrecovery,

Carmen struggled with the kind of

“crazyemotionalrollercoaster”many

cancerpatientsdo.“Ilovegardening,”

says Carmen, “so I started weeding

anditwaslikeIwasweedingthecan-

ceroutofmybody.ThenIdecidedto

plantacancergardenandIplantedall

kindsofflowersandthatwasmyway

ofdealingwiththeemotionaltrauma.”

ItalsohelpedCarmenreflectonwhat

hewasdoingwithhislife.“Whenyou

are dealing with cancer you really

reevaluateyourlifeinastrangeway.”

Carmendecidedtobreakhissilence

andusehisplaceinthefashionworld

as a vehicle for raising awareness.

“Sometimes fashion can seem so

frivolous,” says Carmen. “But I love

whatIdo.Ilovedressingwomenup,

I lovehelpingthemfeelempowered

ontheirspecialoccasions.Fashionis

mypassion,butusingfashiontoraise

awarenessofCRCgivessomuchmore

meaningtowhatIdo;throughfashion

Icanreachsomanywomenwithan

evenmoreempoweringmessage.”

Carmen is now an ambassador

for the National Colorectal Cancer

Research Alliance (NCCRA). he has

also participated in a host of cancer

awareness events, partnering with

celebrities like Katie Couric and

vanessaWilliams,andtheEntertain-

ment Industry Foundation (EIF). In

recognition of his work, he received

the first ever Advocate Award from

KatieCouricin2006.Recently,hehas

beentakinghisfashionshowonthe

road to attract attention and raise

moneyforthisimportantcausewith

retailpartnersandtheAARP.“We’ve

made breast cancer fashionable,

we’ve made ovarian cancer fashion-

able,IwanttomakeCRCfashionable,”

saysCarmen.

It seems we are OK with routine

screenings associated with our

breastsandourprostates,butthe

mere thought of having our colons

andrectumsexaminedsendspeople

running for cover. For some, it’s a

sourceofembarrassment;othersare

concerned about the discomfort or

inconvenienceofscreeningtests.But

formostpeople,thegreatestfearof

alliswhatthetestsmightreveal.

“People often associate being

screened for CRC with the assump-

tion that something is wrong,” says

lynda Mandell, MD, PhD, a dually

boarded radiation oncologist and

psychiatristwithaprivatepsychiatry

practiceinNewyorkCityspecializing

is psycho-oncololgy. “This assump-

tion, which provokes fear even in

individuals not at high risk for the

disease,oftenresultsinavoidanceof

screeningtests.”

A board member of the Ameri-

can Psychosocial Oncology Society

andTheSusanCohanKasdasColon

Cancer Foundation, Dr. Mandell’s

uniquebackgroundgivesheradeep

appreciation for what patients go

through.Sheexplains,“forthosewith

nofamilyhistoryofcancer,muchof

the anxiety associated with being

screened stems from anticipatory

worry—‘What will happen if I have

cancer?’ For people who have wit-

nessed a loved one experience the

disease,thatanxietyisintensifiedby

thethoughtthatwhathappenedin

thepastwillhappentothem.”InCog-

nitiveBehaviorTherapy,thisisknown

asacognitiveerror.

Dr.Mandellhelpspatients recon-

struct these thoughts to more ac-

curately reflect the realities of their

personal situation. “It’s important

toacknowledgethose thingsabout

the present situation that may be

the same as what happened in the

past,butthentolookatwhatisdif-

ferent.Ifafamilymemberwasolder

ordiagnosedwithanadvancedstage

ofcancerbutyoucatchcancerearly,

yourexperiencecouldbecompletely

different.”

Catastrophizing is another form

ofcognitiveerrorthatholdspeople

back.“Apersonstartsbleedingalittle

bit and their first thought is ‘I have

cancer,’“saysDr.Mandell.“Thenthey

startthinkingaboutalloftheterrible

thingsthatcouldhappen—I’mgoing

die,bedisfigured,myspouseisgoing

to leaveme,andsoon.Theseesca-

latingthoughts trigger fear,anxiety

andguiltsointenseit’simmobilizing,

even though the bleeding may not

becanceratall.”

Dr.Mandell recommends looking

at each of these fears and examin-

ing the likelihood of them happen-

ing. “For example, if you are afraid

of dying, focus on how curable this

canceris,especiallyifdetectedearly.

Ifyouareworriedaboutsideeffects,

recognizing how advanced current

treatment options are compared to

thoseofthepastcanhelpreducethe

intensityofyouranxiety.”

It’salsohelpfultothinkaboutoth-

ers.“Ifyoucan’tdothisforyourself,

thendo it for thepeopleyou love,”

saysDr.Mandell.“Ifyoudohavecan-

cer, early intervention could spare

your loved ones’ unnecessary emo-

tionaldistressandheartache.Ifyour

cancerisgenetic,havingthatknowl-

edgeandsharingitwithyourfamily

allows them to make the best deci-

sions possible for their own health

andcouldevensavetheirlives.”

For a long time Carmen Marc valvo, one of New york’s hottest fashiondesigners,kepthiscoloncancerprivate,evenfromhisclosestfriends—untilhe discovered that the silence and the stigma that so often surround thisdiseasealmostcosthimhislife.

Accordingto theNationalCancer Institute, ratesof screening forcolorectalcancer(CRC)areconsistentlylowerthanthoseforothertypesofcancer.

Opening Up About CRC

Don’t Let Fear Hold You Back

this assumption, which provokes fear even in individuals not at high risk for the disease, often results in

avoidance of screening tests.Ph

oto

cre

dit

by

Mel

anie

Du

nea

CarmenMarcvalvo

11

COLON HEALtH

“When a patient hears

a diagnosis of

colorectal cancer,

everypatientseesitasadeathsen-

tence,”saysMarkKrasna,MD,medical

directoroftheCancerInstituteatSt.

Joseph Medical Center in Towson,

Maryland.“But it’s important to ask

‘What stage of cancer do I have?’

Stagepredictssurvival;itshouldalso

determinetreatment.”

Colorectalcancer(CRC)iscurable,

especiallyifitiscaughtearly.Newap-

proachestotreatmentandadvanced

surgical options such as minimally

invasive laparoscopic surgery have

improvedsurvivability,andinmany

casesmadetreatmentlesstraumatic.

“IfyouarefoundtohavestageI,the

correct treatment is a colonectomy

withclearmarginsand lymphnode

sampling,” says Dr. Krasna. “If the

tumorisinthewall,andyoucanre-

move10”–12”,andthelymphnodes

arenegative,that’sfantasticbecause

you don’t really need other treat-

ment.”

If your cancer is more advanced,

additionaltreatmentmaybeneces-

sary.Dr.Krasnaexplains,“InstageII

or IIIwherethecancerbeginstoin-

vadeotherstructuresortheremight

be local lymph node involvement,

treatmentnotonlyinvolvessurgery,

butalsochemotherapy.”Twoofthe

biggest advances in CRC treatment

areadjuvant(inadditionto)therapy

followingsurgery,andneo-adjuvant

therapy—usingradiationand/orche-

motherapybeforesurgery,especially

in cases of locally advanced rectal

cancer.“Offeringchemotherapyand

radiationbeforesurgeryreducesthe

bulk of the disease making surgery

lessdebilitating,”saysDr.Krasna.

Inthemoreadvancedstages,mul-

tidisciplinarycareandindividualized

treatment is especially important.

“When you have stage II, III or Iv

cancer,youneedtohaveateamof

experts, not just one. you need a

surgeon, a medical oncologist and

perhapsaradiationoncologist,”says

Dr. Krasna. “Every patient with CRC

should be able to have their case

discussedprospectively(beforetreat-

ment)andhaveaconsensusreached

beforeanytherapyisstarted.”

Findingthatqualityofcareisget-

ting easier thanks to The National

CommunityCancerCenterProgram

(NCCCP), a government sponsored

initiativeofleadingcommunitycan-

cercenterscommittedtodelivering

the highest standards of care. “85

percent of cancer patients receive

careclosetohomeintheirowncom-

munity,” says Dr. Krasna. “The goal

of the NCCCP program is to ensure

these patients have access to the

samequalityofcareasthosewhoare

treated at large research hospitals;

care that includes multidisciplinary

care,screeningpatientsfromdispa-

ratepopulationsincludingtheunder-

served,andconductingclinicaltrials.”

“Thebestcareapatientcanreceive

according to NCI guidelines is in a

clinicaltrial,”saysDr.Krasna.“Inpart

becausetheyarebeingfollowedso

muchmorecloselybyawholeteam.”

St.Joseph’sisoneofonly16cancer

centersacrossthecountrythatispart

oftheNCCCPprogram.“Thereisno

reasonwhyapersoninacommunity

care setting can’t get the best care

possible.St.Joseph’sisacommunity

hospital, but we are sharing best

practices with a large network and

changingthefaceofCRCacrossthe

country.”

Improved standards of care and

medical advances offer great hope

forpeoplediagnosedwithCRC.Says

Dr.Krasna,“Today,evenpatientswith

metastatic dis-

ease can actu-

ally be offered

a chance at

cure.”

Nooneeverwantstohearthewords“youhavecolorectalcancer.”Butifyouorsomeoneyoulovedoes,it’simportanttoknowhowtofindthebestcarepossible.yourlifecoulddependonit.

Getting The Care You Need

“It’s a very exciting time in on-

cology,” says Rodrigo Brito

Erlich M.D., Director of he-

matologyandOncologyatGeisinger

healthSystemshenryCancerCenter

inWilkesBarre,PA.“Therehavebeen

majorchangesinourunderstanding

of solid tumors.We understood the

biologyofhowapolypprogressedto

cancer, but now we understand the

biologyofthecanceritself.”

Cancer results from mutations to

DNAthat result inabnormalcelldi-

vision.Byidentifyingthegenesthat

arealteredinaspecificcancer,drugs

canbecreatedto“target”molecules

neededfortumorgrowth.Targeted

therapiesaremoreeffectivethanex-

istingtreatmentsandarelessharmful

tonormal,non-cancerouscells.

Being able to screen patients for

thesegeneticalterationsalsoenables

doctors topredictwhetherornota

particularcancerwill respondto,or

beresistanttocertaindrugs.Dr.Erlich

explains, “If the colon cancer has a

mutationofagenecalledKRAS,that

cancer will be completely resistant

to treatment with the monoclonal

antibodies cetuximab (Erbitux) and

panitumumab(vectibix),drugscom-

monly used in the the treatment of

advancedCRC.Forpatientswiththis

mutation, these drugs won’t work

and alternative treatment options

mustbeconsideredinstead.”

Colorectalcancermostcommonly

metastasizes(spreads)totheliveror

thelungs.Inthenottoodistantpast,

ifcancerreachedtheliver,chancesof

survivalwereminimal,butthatisno

longer thecase. “Even if cancerhas

spread to the liver, it’s not a death

sentence,” says Mark Fraiman, MD,

SurgicalDirectoroftheComprehen-

siveliverandPancreasCenteratSt.

Joseph’s Medical Center in Towson,

Maryland.“Theliveristheonlyorgan

inthebodythatregenerates.Wecan

remove up to 70-75 percent of the

liverandin6weeksit’sgrownbackto

itsnormalsize.Wearebettertrained

andmoreaggressiveintreatingthis

diseasethanweusedtobe.”

Surgicalremovalorresectioningof

colorectal liver metastasis has been

demonstrated to be not only safe,

buteffective,especiallywhen there

isnoevidenceofcanceroutsidethe

liverandthesurgeryisperformedby

an experienced liver surgeon. “The

surgeryissafer,thechemoisbetter

andwearecuringalotmorepeople

than we used to,” says Dr. Fraiman.

“One third to one half of patients

withmetastatic,stageIvdiseasecan

becured.”

Medicine On The Cutting EdgeTremendousprogresshasbeenmade in thetreatmentofcolorectalcancer(CRC) in recent years. The emergence of “targeted” therapies that enhancetheeffectivenessoftraditionalchemotherapy,andsaferyetmoreaggressivesurgicalproceduresofferhopeeventopatientswithadvancedstagesofCRC.

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