Colorectal Cancer Association of Canada - CCAC
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Colleen Doyle, MS, RD, Lawrence H. Kushi, ScD, Tim Byers, MD, MPH, Kerry S. Courneya, PhD, Wendy Demark-Wahnefried, PhD, RD, LDN, Barbara Grant, MS, RD, Anne McTiernan, MD, PhD, Cheryl L. Rock, PhD, RD, Cyndi Thompson, PhD, Ted Gansler, MD, MBA, Kimberly S. Andrews on behalf of for the 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee

ABSTRACT

Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplement use to improve their treatment outcomes, quality of life, and survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information from which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity issues during the phases of cancer treatment and recovery, living after recovery from treatment, and living with advanced cancer; select nutrition and physical activity issues such as body weight, food choices, and food safety; issues related to select cancer sites; and common questions about diet, physical activity, and cancer survivorship.

INTRODUCTION

Over 10 million persons in the United States are cancer survivors.1 Anyone who has been diagnosed with cancer, from the time of diagnosis through the rest of life, is considered a cancer survivor. Many cancer survivors are highly motivated to seek information about food choices, physical activity, dietary supplement use, and complementary nutritional therapies to improve their response to treatment, speed recovery, reduce risk of recurrence, and improve their quality of life.2

Nutritional needs change for most persons during the phases of cancer survivorship. Although many cancer survivors live with active or advanced disease, a large and growing number live extended, cancer-free lives. Sixty-five percent of Americans diagnosed with cancer now live more than 5 years.1 The need for informed lifestyle choices for cancer survivors becomes particularly important as they look forward to successful completion of therapy and search for the best strategies to recover from treatment and improve their long-term outcomes. For long-term cancer survivors, an appropriate weight, a healthful diet, and a physically active lifestyle aimed at preventing recurrence, second primary cancers, and other chronic diseases should be a priority. For some, managing nutritional needs while living with advanced cancer becomes a particular challenge.

After receiving a diagnosis of cancer, survivors soon find there are few clear answers to even the simplest questions, such as Should I change what I eat? Should I exercise more? Should I lose weight? Should I take dietary supplements? Cancer survivors receive a wide range of advice from many sources about foods they should eat, foods they should avoid, how they should exercise, and what types of supplements or herbal remedies they should take. Unfortunately, this advice is often conflicting.

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SARASOTA, Fla., Oct. 20 /PRNewswire/ — Riley Powell taught high school English, and spent her summers training horses at a nearby dude ranch. When she noticed blood in her stool, she thought it was hemorrhoids, from spending so many hours on horseback. But when it persisted, she saw her doctor. At age 34, she was diagnosed with colon/rectal cancer, and was advised to have surgery and a colostomy. Powell opted to travel out of the country for non-invasive treatment that would eliminate the need for a colostomy bag. According to TMD Limited, a medical tourism company, Powell was one of nearly a million Americans seeking alternative treatment outside the US last year.

Over a hundred thousand Americans will be diagnosed with colon/rectal cancer this year, and half of them will die of the disease. This is the fourth most common cancer in the US, and usually strikes older Americans. There is no known cause, and early colorectal cancer often has no symptoms.

When symptoms do develop, they include blood in the stool, diarrhea or constipation, narrow stools, gas and cramping, fatigue, weight loss and nausea or vomiting.

Powell had a fecal occult and a carcinoembroyonic antigen (CEA) blood test, a colonoscopy, digital rectal exam and an endorectal ultrasound. A chest X-ray was done to look for spread to the lungs.

When cancer is confined to the colon, surgery followed by radiation and chemotherapy is the standard treatment in the USA. Powell’s cancer was in both the colon and the rectum. When the cancer is in the rectum, a colostomy is also recommended.

The surgeon creates a stoma, or new opening in the abdomen called a colostomy. A bag is fitted over the stoma to collect waste. Complications include being unable to control bowel movements or urine, vomiting, bloody stools and tender skin.

"My grandfather had a colostomy when I was barely a teenager. I remember that my grandmother had to help him with it, and he was humiliated. I remembered how he looked going through chemotherapy – he was miserable, looked like a skeleton and lost all his hair. I didn’t want to go through that," Powell said.

Powell spent weeks researching alternative treatments. She spoke to her acupuncturist, a nutritionist and her gynecologist. She talked with a friend who had gone to Mexico for breast cancer treatment, and finally sent her test results to Hope4Cancer Institute in Baja, who had helped her friend.

The Hope4Cancer Institute offered an intense program combining local and whole body hyperthermia, SonoPhoto Dynamic Therapy, IV therapy, detoxification, PolyMVA, enzyme therapy, cancer vaccines, nutrition and a host of other non-invasive treatments. "The doctor assured me there would be no side effects. He felt confident these treatments would shrink my tumors and heal the cancer," Powell said. "It was a two week inpatient program, with a home program that followed for several months. I figured it was worth a try."

Hyperthermia uses precise frequencies of heat waves to kill cancer cells. This therapy has been the cancer treatment of choice in Europe for over 25 years. Specific sound frequencies heat and kill cancer cells, without harming normal cells. Hyperthermia exposes tissues to high temperatures (up to 133 degrees) to damage and kill cancer cells. During local hyperthermia, heat is applied to a very small area (tumor). With a rise in temperature to 106 degrees for one hour within a tumor, the cancer cells are destroyed. Different types of energy may be used to apply heat, including microwave, radiofrequency and ultrasound, depending on the tumor location. The treatment is non-invasive and painless.

Indiba hyperthermia applies deep heat to local tissue areas. Scientists think that heat may help shrink tumors by damaging cells or depriving them of substances they need to live. The National Cancer Institute is studying local, regional and whole body hyperthermia using external and internal heating devices. It is well known that heating areas of the body that contain a cancer may help kill cancer cells without harming healthy tissue.

SonoPhoto Dynamic Therapy uses sound and light to activate a natural sensitizer, which causes free radical oxygen to ’explode’ into cancer cells to kill them. According to Dr. Antonio Jimenez, medical director of Hope4Cancer Institute, combining hyperthermia and SonoPhoto Dynamic Therapy with immune support, proper nutrition and aggressive detoxification (massage, infrared saunas, coffee enemas, IV therapy) to eliminate the dead cancer cells, patients normally regain their energy, appetite and strength and feel better right away.

"After 3 days of treatment, my bleeding stopped," Powell said. "I stayed at the clinic two weeks, and continued my home program for almost 6 months. That was 4 years ago, and my scans are still clean. I’m so glad I didn’t rush into surgery, even though some members of my family were concerned about me heading to Mexico. I took a girlfriend for moral support. We walked on the beach every day, the organic food was terrific and we both learned so much about cancer prevention. The lectures on nutrition changed our way of thinking about what we put in our bodies, and we both feel healthier now that we follow an organic diet."

According to Dr. Jimenez, Powell’s case is typical. "Our treatments work well with soft tissue cancers," he says. "We work with the body’s immune system to attack the cancer, and we address the emotional and spiritual aspects of the disease also. Riley had a great attitude, and that also helped her beat the disease. "

The National Cancer Institute (NCI) recommends colonoscopies beginning at age 50, and earlier if there are risk factors present. Pre-cancerous growths can be easily removed during a colonoscopy, and according to the NCI is the best way to prevent colorectal cancer. Yet over 40% of Americans over 50 have not been screened. New digital colonoscopy, or CTC, is done without sedation and recovery is quick, but can be uncomfortable when the bowel is briefly inflated with carbon dioxide. Both procedures require a strong liquid laxative to cleanse the bowel. There is less risk of a bowel puncture and significantly less cost with a CTC, but if polyps or lesions are discovered, a standard procedure must be done to remove them.

Surgery, chemotherapy and radiation are still the standard colorectal cancer treatments in the USA. According to the medical tourism company TMD Limited, nearly a million US citizens leave the country each year seeking less invasive, gentler treatments. Those numbers just keep increasing, as patients find alternative treatments that let them enjoy life, continue to work and improve their health. Freedom of choice, for many, is choosing a clinic outside the country.

Author Marla Manhart is a health writer and patient advocate. She can be reached at: marlamanhart@hotmail.com

By Nicole Boone | CBS NEWS Published: October 20, 2010

NEW YORK - New research finds men with prostate cancer have an increased risk of developing colon cancer.

Researchers at the University of Buffalo say prostate cancer patients have significantly more colon polyps than men without prostate problems. While most polyps are benign, studies show many colon cancers begin as polyps. Men with prostate cancer are advised to be especially diligent about having routine colonoscopies.

San Antonio, Texas, October 18, 2010

Source: American College of Gastroenterology

Research exploring the progression of colon polyps to colorectal cancer and evaluating techniques to improve polyp detection was among the clinical science presented at the 75th Annual Scientific Meeting of the American College of Gastroenterology in San Antonio today.

The Progression to Colorectal Cancer in Flat Polyps

Precancerous growths in the colon known as sessile serrated adenomas (SSA) are found in approximately 1 percent of colonoscopy exams. A sessile serrated ademona is a premalignant flat lesion in the colon thought to lead to colorectal cancer through the serrated pathway. To understand the progression of SSAs to dysplasia, Robert M. Genta, M.D., FACG, in a study, "10,000 Sessile Serrated Polyps: Slow Progression to Low‐Grade and High‐Grade Dysplasia in a Large Nationwide Population," analyzed a large nationwide dataset of over 500,000 patient records from Caris Life Sciences, a specialized gastrointestinal pathology lab.

From among those patients who underwent colonoscopy with a biopsy of abnormal tissue, Dr. Genta and his colleagues identified approximately 41 percent who had non‐hyperplastic polyps, those which are not benign. Of this group, approximately 5 percent had sessile serrated adenomas categorized as either low or high dysplasia, reflecting the degree of cellular abnormality.

"The interval for the progression from SSA to SSA with low‐grade dysplasia can be estimated to be approximately seven years, and the further progression to high‐grade dysplasia can be estimated at an additional four years. These polyps appear to advance at a slower rate than conventional adenomas," commented Dr. Genta.

Colonoscopy Technique Increases Polyp Detection in Far Reaches of Right Colon

An endoscopic technique known as retroflexion, when used in the right side of the colon, may increase the diagnostic yield of polyps, including large adenomas (larger than 10 millimeters) and serrated lesions, particularly in men, older patients and those with polyps found on forward examination according to research conducted by Douglas K. Rex, M.D., FACG and colleagues at Indiana University Medical Center in Indianapolis, "Right Colon Retroflexion Increases Yield of Polyps in the Proximal Colon. Dr. Rex presented his findings at the 75th Annual Scientific Meeting of the American College of Gastroenterology. In retroflexion, the tip of the colonoscope is in a deflected position to better visualize the proximal side of the colon’s anatomy.

"Colonoscopy has a significant miss rate for the smallest adenomas, but retroflexion in the right side of the colon could reduce the miss rate associated with lesions on the proximal sides of the folds and flexures in the colon," explained Dr. Rex. In the study, of a total of 1000 patients who underwent colonoscopy, retroflexion in the right side of the colon was successful in 945 patients. The colonoscopists in the Indiana University study identified 500 polyps in 287 patients on forward examination of the right colon, as the colonoscope passed through, and an additional 68 polyps in 58 patients on retroflexion of the scope. Importantly, 41 percent of the patients who had polyps identified on retroflexion had negative exams on forward examination.

The researchers analyzed predictors of successful retroflexion and polyp detection using logistic regression analysis. "The risk of identifying a polyp on retroflexion was three times more likely among those who had a polyp detected on forward view compared to those patients who were negative on forward examination," according to Dr. Rex. While the presence of a polyp on forward view predicted the detection of polyps in retroflexion in this study, the analysis revealed that older age and male gender were significant predictors of finding polyps on retroflexion after a negative forward exam.

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About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 11,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost‐effective health care to gastroenterology patients. www.acg.gi.org. View releases on other research breaking at the ACG meeting at www.acg.gi.org/media/press.asp

Agence France-Presse Paris, October 21, 2010

Low doses of aspirin, taken daily and over the long term, cut cases of colorectal cancer by a quarter and the death toll from this disease by a third, according to a study published online on Friday by The Lancet. Aspirin is already recommended in low, daily doses by many doctors for patients at risk of a heart attack or a stroke.

High doses of this cheap, over-the-counter medication have similarly been found to help prevent cancer of the rectum and colon.

But, studies have also found, the benefits may well be outweighed by the risks, such as increased bleeding from high aspirin use.

Eager to verify whether low doses can also be protective, researchers followed up four trials in Britain and Sweden, conducted in the 1980s or early 1990s, on the cardiovascular impacts of aspirin.

The study entailed looking over centralised data banks to see whether volunteers in these trials had since died or been diagnosed with colorectal cancer.

On average, the trials lasted six years, entailing volunteers who took either aspirin or a dummy lookalike pill called a placebo. The doses ranged up to 1,200 mg.

Out of 14,033 patients whose health could be traced 18 years or so since the trial, 391 had colorectal cancer, the investigators found.

Taking aspirin reduced the risk of cancer by 24 percent and the risk of dying from it by 35 percent.

The results were consistent across all four trials — and there was no increase in benefits beyond a dose of 75 mg.

Where the reduction was most remarkable was in cases of proximal colon cancer.

These occur in the upper colon and are thus liable to be missed in lower-intestine scans for polyps, the precursor of tumours.

The authors say their study had limits, as the original trials were not designed to look at aspects of colorectal cancer, nor was data available for any deaths from aspirin’s side effects.

Also, aspirin’s benefit may have been somewhat over-estimated, they said.

This was because the original trials took place before colon screening for polyps became a routine practice in those countries.

Even so, the evidence has now swung the scales in favour of low-dosage aspirin for a disease that claims 600,000 deaths worldwide each year, they said.

"Our findings suggest that long-term low-dose aspirin treatment and sigmoidoscopy screening would combine to substantially reduce cancer incidence in all parts of the colon and rectum," said the lead author, Peter Rothwell, a professor at the Department of Clinical Neurology at Oxford University.

In a commentary, doctors Robert Benamouzig and Bernard Uzzan of the Avicenne Hospital in Bobigny, on the outskirts of Paris, said the study should unleash "the next logical step," of formulating guidelines for people at risk.

Colorectal cancer is the second commonest cancer in developed countries, with a lifetime risk of five percent, according to figures cited in the city.

Aspirin is believed to have a preventive effect because it inhibits an enzyme called COX-2, which promomotes cell proliferation in colorectal tumours.

CT colonography may increase colorectal cancer (CRC) screening rates as a more convenient and less invasive alternative to colonoscopy, according to a study published Oct. 21 in the American Journal of Roentgenology.

"Although colonoscopy is the preferred test for CRC screening and prevention, the invasiveness and inconvenience of colonoscopy are often cited as reasons for noncompliance with this form of screening," Fouad J. Moawad, MD, of the department of gastroenterology at the National Naval Medical Center (NNMC) in Bethesda, Md., and co-authors wrote.

As part of a process improvement initiative at NNMC, Moawad and colleagues sought to investigate whether the reduced invasiveness of CTC compared with colonoscopy could help improve suboptimal colorectal screening, which at present is only about 50 percent nationally, survey-based studies estimate.

Two hundred and fifty consecutive asymptomatic individuals chose to undergo free colorectal cancer screening using CTC as part of NNMC’s Colon Health Initiative at NNMC. None of the self-selecting participants had ever received CTC scans, though 57 had previously undergone colonoscopy.

All patients were asked why they had chosen CTC and whether they would have undergone CRC screening if CTC had not been an option. Additionally, the 57 patients who had previously undergone colonoscopies were asked after CTC whether they preferred the CTC or colonoscopy exam.

The researchers found that the most common reason patients chose to receive CTC screening (cited by 34 percent of participants) was convenience. Because both CTC and colonoscopy required two to three week waiting periods prior to screening at NNMC, the authors interpreted this response as a result of CTC’s speed and less invasive nature. The CTC exam takes substantially less time than colonoscopy to perform and does not require sedation, therefore allowing patients to continue their daily routines with relative ease, the authors noted.

The study also found that 37 percent of subjects said they would not have undergone CRC screening if CTC were not an option. Ninety-five percent of individuals who underwent both CTC and a previous colonoscopy responded that they preferred CTC. The authors acknowledged selection bias in this question, however, since the patients had voluntarily chosen CTC as an alternative to colonoscopy.

The second most common reason for undergoing CTC, indicated by 13 percent of respondents, was because of recommendations from primary physicians. The authors attributed this finding to growing acceptance and positive perceptions of CTC among physicians as an effective modality for CRC screening. Eleven percent of respondents cited the safety of CTC as their primary rationale for choosing CTC, as the invasiveness and sedation required by colonoscopy put patients with previous health concerns at higher risks for side effects. Nine percent of the sample reported choosing CTC because they expected a normal exam, and 8 percent responded that they had fears about colonoscopy.

"Perhaps the most important finding of our initiative was that more than one third of patients queried would not have undergone CRC screening if CTC had not been available as a screening option." Given the poor screening rates in the general population for colorectal cancer, which is the second leading cause of cancer mortality in the U.S., the authors found this response encouraging. Moreover, Moawad and colleagues reported that in the three years since CTC has been offered at NNMC, CRC screening has increased by 70 percent.

The authors expressed surprise at the 4.8 percent of respondents who indicated that they had selected CTC because of its ability to detect extracolonic findings, since some physicians will not recommend CTC as a primary method for screening compared with the standard colonoscopy. Participants gave these responses after having signed the CTC consent form, which state that CTC is not as accurate as colonoscopy for identifying polyps 5 mm or smaller.

In discussing the debate over the radiation dose emitted by CTC, the authors concluded that "on the basis of low doses of radiation delivered with CTC, the advanced age of patients undergoing the examination for screening purposes, the proven performance characteristics of the examination, and the prevalence and incidence of adenomas and CRC, the risk-benefit ratio favors CTC compared with no screening.

"CTC has the potential to reduce some of the barriers associated with colonoscopy screening by providing a less invasive screening examination, with lower overall complication rates," the authors continued. "The current evaluation implies that providing CTC as an alternative screening option for CRC has the potential to entice noncompliant individuals to undergo CRC screening."

Atlanta, Georgia - Increasing colorectal cancer (CRC) screening rates to 80% by 2018 would prevent an additional 21,000 colorectal cancer deaths per year by 2030, according to a new study. The study is the first to estimate the public health benefits of increasing screening rates to “80% by 2018,” a recent initiative from the National Colorectal Cancer Roundtable (NCCR), a national coalition of public, private, and voluntary organizations, to aim for screening rates of 80% in the United States by 2018.

The study is co-authored by American Cancer Society epidemiologist Ahmedin Jemal and appears in CANCER, a peer-reviewed journal of the American Cancer Society.

Colorectal cancer (commonly called colon cancer) is the third leading cause of cancer death in both men and women in the United States, and the second leading cause for both sexes combined. An estimated 132,700 new cases and 49,700 deaths are expected in 2015 in the U.S. Data from the past decade show that both incidence and mortality from colon cancer are decreasing at rate of about 3% per year, largely due to the increased use of screening. Still, fewer than six in ten U.S. adults (58%) aged 50 to 75 years had received guideline-recommended testing in 2013.

Studies indicate lack of screening is responsible for a substantial percentage of colorectal cancer deaths. That fact led to the launch of “80% by 2018,” led by the National Colorectal Cancer Roundtable (NCCR), a national coalition of public, private, and voluntary organizations, to aim for screening rates of 80% in the United States by 2018. The current study was designed to measure the potential benefits of increasing uptake by an additional 22% in terms of the number of colorectal cancer cases and deaths

Researchers led by Reinier G. S. Meester, MS at Erasmus MC University Medical Center in Rotterdam, the Netherland used a computer model to show the effects of increasing screening rates from approximately 58% in 2013 to 80% in 2018 compared to a scenario in which the screening rate remained approximately constant.

They found increasing screening rates to 80% by 2018 would reduce projected colorectal cancer incidence rates by 17% and mortality rates by 19% during short-term follow-up (2013 through 2020) and by 22% and 33%, respectively, during extended follow-up (2013 through 2030). Those reductions would amount to a total of 277,000 averted new cancers and 203,000 averted colorectal cancer deaths from 2013 through 2030.

The authors conclude increasing the uptake of colorectal cancer screening in the United States to 80% by 2018 could have a considerable and escalating public health impact.

“The barriers to increasing colorectal cancer screening in the United States are significant and numerous,” said Richard C. Wender, M.D., chief cancer control officer and chair of the National Colorectal Cancer Roundtable. “But this study shows that investing in efforts to clear these hurdles will result in a major cancer prevention success.”

Additional authors are: Chyke A. Doubeni, MD, MPH; Ann G. Zauber, PhD; S. Luuk Goede, MPH; Theodore R. Levin, MD; Douglas A. Corley, MD, PhD; Ahmedin Jemal, DVM, PhD ; and Iris Lansdorp-Vogelaar, PhD