March is Colorectal Cancer Awareness Month.  At Gastroenterology Care, we are working hard to prevent colon cancer by encouraging patients to get early screening tests.  The first step in the fight against colon cancer is talking to your doctor about ways to prevent it.  Below are some common myths about colon cancer.

 

Myth No. 1: I feel fine; I don’t think I will get colon cancer.

Fact: Colon cancer is a very common cancer in men and women. It tends to affect all races and all ages, although it is more frequent in older people.  There is about a 5% chance of developing colon cancer in a lifetime.  Colon cancer in early stages does not cause any problems, but by the time you develop symptoms or problems, it is often at an advanced stage. As a result, getting your screening for colon cancer is very important for prevention and early detection. 

 

Myth No. 2: None of my family members have colon cancer, so I am ok

Fact: While having a family history of colon cancer can increase your risk, you can be predisposed to developing colon cancer even without a family history.

 

Myth No. 3: I won’t get cancer because I don’t smoke or drink, and I eat healthy.

Fact: You may be right, but the interplay of certain known and unknown genetic, dietary and environmental factors can predispose you to develop cancer despite a healthy lifestyle.

 

Myth No. 4: Colon cancer cannot be prevented

Fact: Colon cancer is one of the few cancers where the natural history of progression is studied well. The cancer starts off in small growths called polyps. There are several known and unknown factors that trigger development of polyps and progression of cancer.  It is one of the cancers where identification of precursors of cancer (polyps) can be found and removed, thereby preventing development of cancer. If the polyp is found early, it can be removed – stopping colorectal cancer before it starts.

The following tests can find polyps: colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Talk to your health care provider about which test is right for you.

Other ways you can lower your chances of getting colorectal cancer:

• Maintain a healthy weight throughout your life; stay lean without being underweight.
• Be physically active; limit the time you spend sitting, lying down, watching TV, etc.
• Eat at least 2½ cups of vegetables and fruits a day.
• Choose whole grains over refined grain products.
• Limit the amount of red meat and processed meat you eat.
• If you drink alcohol, limit the amount to 1 drink per day for women, 2 per day for men.
• Do not use tobacco in any form.

 

Myth No. 5: There are no tests that can detect colon cancer early

Fact: There are several tests that can help detect polyps. Early detection and removal of polyps can prevent colon cancer. The tests can be non-invasive such as fecal or blood test, x-ray study or CT scan.   These tests have different accuracies in finding polyps or cancer.  Invasive tests (such as sigmoidoscopy or colonoscopy) not only detect polyps, but the polyps can be removed at the same time.

 

Myth No. 6: Early detection does not help me if I already have colon cancer

Fact: Early detection can lead to a better outcome from treatment and, ultimately, improve your survival rate.

 

Myth No. 7: Colonoscopy is painful

Fact: Colonoscopy is an embarrassing test and no one wants to do it. But it is a life-saving procedure that can prevent colon cancer. Just a few hours of pre-test preparation and 20-minutes (average time) of embarrassment should not prevent you from getting this important test

 

Myth No. 8: I heard the prep prior to the procedure is terrible

Fact: While this is partially true, there are improved preparations available that your doctor can suggest if you or your family member has had a bad experience in the past

 

Myth No. 9: There are no tests other than colonoscopy for early detection of colon cancer

Fact: There are several ways to detect colon polyps or cancer. They range from simple blood tests to CT scan to colonoscopy. Everyone’s needs are different. You and your doctor can decide the test that is right for you. Understanding the risk and benefit of each test, as well as its accuracy and consequences is important before undergoing any test. Colonoscopy is considered the ‘gold standard’ test for colon cancer prevention, but it has some inherent limitations and risks. The risk of anesthesia varies from person to person, depending on several factors. In general, the procedure is considered safe. The benefits far outweigh the risks, which is why doctors and medical societies endorse colonoscopy as the best test available for detecting and/or preventing colon cancer.

 

Myth No. 10: Colonoscopy is expensive and my insurance will not cover it

Fact: Colonoscopy is covered by most insurance plans when performed for age-appropriate colon cancer screening. This can mean little to no copay or coinsurance is needed.  In many cases, it literally can be a free preventive test. Check with your provider’s office for benefit details.

November is Pancreatic cancer awareness month. Pancreatic cancer is the 4^th most common cancer in the United States. The average lifetime risk of developing pancreatic cancer is about 1 in 67 (1.5%). The incidence of pancreatic cancer is expected to rise by 2020 and is projected to become the second leading cause of cancer related deaths in the United States. Pancreatic cancer is one of the most aggressive types of cancer in the body. The survival after diagnosis remains low despite advances made in the medical field. Therefore we should all be aware of it and be prepared to fight this lethal cancer. Our team at Gastroenterology Care would like to increase the public awareness of pancreatic cancer during the month of November. 

 

First, before we talk about the cancer itself, I would like to make some points about the pancreas. The pancreas is a mysterious organ located in the mid upper abdomen. It is located deep in the upper abdomen (almost above the spine). It helps digest food (by producing pancreatic enzymes) and plays a key role in metabolic functions in the body, especially with glucose regulation. Insulin, the hormone responsible for glucose metabolism, is produced by the pancreas. There are a few types of pancreatic cancer with different prognosis. The type of cancers and prognosis depends on the cell type from which they arise. The development of pancreatic cancer is due to a complex interaction between environmental and genetic factors. Patients with a history of smoking, alcohol use, family history of pancreatic cancer, history of chronic pancreatitis, history of  pancreatic cystic lesions, and patients with certain genetically inherited disorders (such as Hereditary breast and ovarian cancer syndrome, Lynch syndrome,  hereditary pancreatitis, Peutz-Jeghers syndrome, etc.)  are at increased risk of developing pancreatic cancer.

 

To treat any cancer, it is very important to diagnose it early. Screening for cancer in otherwise asymptomatic patients has been a standard of care for colon and breast cancer.  However, no tests are approved for pancreatic cancer screening, primarily due to the subtle nature of the disease and inherent limitations of currently available tests. The biggest challenge with pancreatic cancer is that there is no single best test that can be used as a screening test because pancreatic cancer tends to be occult at the early stages and often is missed on commonly performed tests such as CT scan. MRI is considered better than CT scan but it has its own limitations. A blood test (ca19-9) is available for pancreatic cancer but it lacks sensitivity and specificity, so it is not used to diagnose pancreatic cancer. Even if the blood test is abnormal, an imaging study and/or biopsy are needed for definitive diagnosis. Endoscopic Ultrasound (endoscopic procedure that combines endoscopic skill and ultrasound technology) has emerged as the most valuable test.  It can pick up small cancers that are often not seen by a scan (CT or MRI). Even though it is considered the ‘gold standard’ test, it has a few limitations (invasive test and operator dependent). Diagnosing pancreatic cancer is difficult and often requires using clinical information, laboratory, and imaging tests to help in the evaluation. Patients have survival advantage when diagnosed early-on or when the tumor is small, highlighting the need for early diagnosis.  Of the available tests, Endoscopic ultrasound is the best test to diagnose and obtain biopsy of the tumor if found during the procedure.

 

Treatment of pancreatic cancer is as difficult as diagnosis. Surgery with curative intent is possible in only 20% of patients diagnosed with pancreatic cancer, again underscoring the importance of finding better diagnostic tools so that the cancer can be diagnosed early. Surgery for pancreatic cancer (called Whipple’s surgery) is a long and complicated surgery that, for best results, should be undertaken in otherwise fit individuals in whom the cancer has not spread to other parts of the body and major abdominal blood vessels. “The best way to combat pancreatic cancer is through a multidisciplinary approach involving patients, families, primary care physicians, Gastroenterologist, Oncologist, Palliative care physician, and a Surgeon”, says Dr. Todd Howard, a nationally recognized Hepato-Pancreato-Biliary surgeon with extensive experience in pancreatic cancer surgeries. He is a part of Suburban Surgical group and works at Missouri Baptist Hospital in St. Louis. Chemotherapy and radiation therapy are often part of the treatment for pancreatic cancer. Even with combination treatment modalities, the prognosis remains dismal with pancreatic cancer. For example, 5-year survival for stage 1 pancreatic cancer is 12-14% with 1% for stage 4 cancer. Hence, in a small subset of patients with advanced disease, no therapy is recommended as the risks of treatment can outweigh benefits. In those situations, palliative care and hospice teams provide education to the caring family and keep patients comfortable.

 

If you put all this information together and think about it, you will understand that the incidence of pancreatic cancer is increasing, the disease is difficult to diagnose and once diagnosed, the treatments, at best, offer survival benefit of months to a few years. With this in mind our goal is to bring awareness to the public, patients, and physicians. My advice to patients is to be aware of pancreatic cancer, know their family history and prior pancreatic problems, to live health fully by eating a healthy diet, and not smoking or drinking alcohol. If they are 50 years old and have or had unexplained pancreatitis, weight loss, abdominal pain, jaundice, have a family history or risk factors for pancreatic cancer, they should seek help from their primary care physician or Gastroenterologist. I urge physicians to take a lead and improve awareness to the public so that together we all can put an end to this serious disease.

 

The internet is a good source if anyone wants to read or know about it. There are a few good informational websites such as cancer.org, cancer.gov, nccn.org, etc. available. But beware that the information in the internet can be overwhelming and in some cases could cause a situation where end up with more questions than answers, so do not hesitate to see your doctor if you have any symptoms or risk factors.