You’ve Been Diagnosed With Colon Cancer—What’s Next?

Advice for first steps and long-term thinking

Whether it comes through a routine colonoscopy or because of worrisome symptoms, facing a diagnosis of colon cancer is never easy. You probably have questions about your short-term options and long-term outlook.

Patients who have no symptoms but receive a diagnosis through a screening often feel blindsided, says oncologist Alok Khorana, M.D., Cleveland Clinic’s Director of GI Malignancies. And those whose diagnosis is triggered by symptoms such as gastrointestinal bleeding have their own set of anxieties.

Below, experts offer reassurances about the prognosis of this disease — and advice about how you should approach your treatment and long-term care management.

Know that colon cancer develops over years

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Most patients will think: “I have cancer. Can I get this taken care of tomorrow?”

The reality is that colon cancer develops over years, not days. In fact, a polyp can take as long as 10 years to develop into cancer, Dr. Khorana says.

Patients also have a good chance of surviving this disease. Five-year survival rates range from 70 percent to 97 percent when diagnosis comes in early stages, which is why screening is so important, Dr. Khorana says. The 10-year survival rate is about 10 percent for stage IV colon cancer, but even these patients have a better outlook today thanks to new treatments and targeted therapies.

“The majority of colon cancer patients will be cured from the cancer,” Dr. Khorana says, “and it’s important that we reassure patients about it, because that’s the biggest worry.”

David Dietz, M.D., Vice Chair of Colorectal Surgery, stresses that these positive outcomes depend on an early diagnosis. “If your primary care physician doesn’t recommend [a colonoscopy] when you turn 50, ask for one. And make sure you stay up-to-date on your colonoscopies.”

Don’t rush in choosing a team — or treatment

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Because most colon cancer isn’t immediately life-threatening, it’s important to develop a precise diagnosis and care plan, Dr. Khorana says.

Ask for a second opinion. And if your hospital offers support and navigation services that go beyond medical treatment, take advantage of them.

You may also need additional imaging and other tests to refine a diagnosis. And if your cancer has hereditary red flags, your doctor may refer you for genetic counseling. In addition, search for institutions that perform high volumes of treatment for colon or rectal cancer; they generally have better outcomes and fewer complications, Dr. Khorana notes.

“Much of what we do with colon cancer is a team approach: a colorectal surgeon, a medical oncologist and radiation oncologist,” he says. “It’s important to meet with all three disciplines so they can make a recommendation on whether you need just an operation, or additional chemotherapy and radiation before or after the operation.”

Dr. Dietz points to another major patient fear: whether they’ll need a permanent colostomy or stoma. This procedure creates an alternative opening in the large intestine for waste to pass through following colon or rectal cancer surgery.

Most patients with colon cancer should able to avoid a permanent stoma, he says. “Stomas are a bigger question in patients with rectal cancer, and the need for one is largely determined by the location of the tumor in the rectum.” Patients who had tumors located close to the anal opening are more likely to need a colostomy — but even in those cases they may be avoidable, he adds.

Stick with healthy habits

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If you ate well and exercised often before a diagnosis, you may be skeptical about how much those healthy habits matter. But be patient and stick with them, Dr. Khorana urges. If your habits were questionable beforehand, ask for help making changes.

Why? Because data suggest lifestyle changes after surgery — such as getting regular exercise — can drive down the risk of cancer coming back, Dr. Khorana says.

“Our recommendation is to do regular cardiovascular exercise, 20 to 30 minutes most days of the week,” he says. “Eat plenty of fresh fruits and vegetables, not too much red meat.”

Your treatment schedule may temporarily change those healthy habits. But even then, you can get help, such as advice on maintaining your weight during chemotherapy. It’s just one of many examples of how to strategize for the best long-term outcomes, starting with your diagnosis and continuing long after your treatment.

Source: Cleveland Clinic

 

6 Scary Myths About Cancer

Myth 1: Cancer is always fatal.

Most forms of cancer, depending on when they’re caught, are treatable and curable. Some forms of cancer are even curable at advanced stages. In addition to curing advanced testicular cancer and lymphomas (Hodgkin’s disease and non-Hodgkin lymphomas), we usually expect to cure most early forms of breast, colon, prostate and skin cancer, including melanoma.

Myth 2: Cancer will make your hair fall out.

Cancer itself won’t make your hair fall out. Of course some forms of cancer treatment — chemotherapy and radiation — can. So there’s an element of truth here.

But you should know that there are lots of treatments that cause limited or no hair loss. I’d estimate around half of the chemotherapies we use don’t cause hair loss. Many newer, targeted drugs, too, that aren’t traditional won’t cause you to lose your hair during treatment.

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Myth 3: Cancer is contagious.

You can’t catch cancer from another person. Not through contact or secretions or anything in the air. Cancer is not contagious.

Here again, though, an element of truth: Some viruses and infections can increase your cancer risk. The best-known example of this is human pappilomavirus (HPV), which can lead to an increased risk of cervical and oropharyngeal cancer, a type of head and neck cancer. Epstein-Barr virus is linked to nose and throat cancer and certain lymphomas. Cancers from viruses can take decades after exposure to take place.

Myth 4: Cancer is always painful.

Some cancers never cause pain. For those that do, one of our main focuses in treating cancer is paying attention to pain. Palliative care — pain management— is a huge aspect of treatment. It’s very important to talk to your doctor about your pain.

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Myth 5: “My mom had cancer — that means I’ll get it too.”

Having a family member with cancer may modestly increase your risk of developing certain cancers, like breast or colon cancer. Still, developing cancer in these cases isn’t inevitable.

Some people have a very strong family history of cancer, or a family member diagnosed at an unusually young age. Both suggest the presence of a heritable cancer gene, like the breast cancer gene BRCA1. We have testing for many of these mutations and work closely with genetic counselors.

But here’s the bottom line: Most people with cancer have no family history of the disease. And most people with a family history of cancer never develop the disease.

Myth 6: Cancer always has to be treated immediately.  

Surprisingly, no. Because you get a cancer diagnosis doesn’t mean it has to be treated right away. We can wait. That’s hard to tell some people and hard for them to understand.

For some slow-growing cancers, rather than go charging in with invasive treatments, we often use “watchful waiting,” where we observe to see if the cancer spreads. These cancers include slow-growing lymphomas and leukemias, as well as some forms of prostate cancer. Or sometimes the best option is to use therapies that manage rather than cure the disease, where people can live for years with the cancer.

In some circumstances it may be appropriate to do nothing at all. If you have other significant diseases cancer may not be the biggest threat, or if you’re in late stages of a cancer you may choose not have treatment for the cancer but receive palliative care to keep you comfortable.

It all depends on what you need.

Source: Cleveland Clinic

Could Sitting Too Much Boost Your Cancer Risk?

A recent study found that people who spend a lot of time sitting have an increased risk of developing certain types of cancer. We know that lack of activity can lead to obesity and that obesity is a risk factor for certain types of cancer. That is why we always tell our patients how important it is to stay active.

The study analyzed data from 43 previous studies. Together, they included nearly 70,000 cancer patients. According to the findings, people who spent a lot of time sitting had a much greater risk of developing endometrial cancer, colon cancer or lung cancer.

Tips for increasing activity to reduce your risk

Some people think it’s OK to sit all day if they are going to work out for an hour-and-a-half when they get home. But working out does not negate the fact that they just sat for nine hours.

Periods of inactivity will still put you at risk. What you do throughout your entire day will impact your health.

It’s time to re-think how we orient our work day so we can get in at least five minutes of activity every hour without decreasing productivity.

For example, if your secretary sits about 100 feet from you, instead of sending an e-mail or picking up the phone when you need something, you should walk out to her desk and talk to her.

There are lots of other little things you can do pretty easily that won’t impose on your work day. Here are a few more examples:

• Take a break every hour and walk down the hall for a glass of water
• Stand while talking on the phone
• Instead of taking 30 minutes to run errands to a bunch of different people at work, run one errand each hour
  

Surprises in the study findings

One of the interesting findings was that they found no correlation between sitting and breast cancer which, along with colon and endometrial cancer, is also associated with obesity.

They did find a correlation between too much sitting and lung cancer. It is typically associated with smoking, rather than obesity. The reason for this may be that people who smoke don’t have good lung function, so they’re also less likely to be up and active. 

While the findings in this study are significant, keep in mind that these types of studies aren’t perfect. They rely on people to recall and report how often they are active, so there are some biases in terms of what people remember and what they will admit to.

The bottom line is that sitting is a correlate of obesity. The more you sit, the more likely you are to be overweight. The real takeaway in all of this is to stop being inactive.

Source: Cleveland Clinic

Itchy Bottom? Don’t Blame Hemorrhoids

A lot of patients come to my office and announce that they have hemorrhoids.

“What are your symptoms?” I ask.

They tell me their bottoms itch and they feel extra skin down there as they wipe. Must be hemorrhoids, right?

So they treat themselves with medicated wipes or cream. And yet the “hemorrhoids” don’t go away — they itch even more.

For most, I have a simple answer: You don’t have hemorrhoids, and what you’re doing to treat this non-issue is likely making the problem worse.

The trouble with self-diagnosing hemorrhoids

People self-diagnosing hemorrhoids is something I see almost daily in my practice. Hemorrhoids are the favorite scapegoat for many of my patients.

Certainly bring up any concerns you have with your doctor. And if you notice rectal bleeding along with the other symptoms I mentioned above, be sure to talk to your doctor about further treatment.

But we all have hemorrhoids. They only become an issue when they become swollen and irritated. You can’t diagnose that yourself; your doctor needs to examine you.

So what’s causing my itchy bottom?

What my patients often suffer from is the result of, ironically, being too clean.

What happens is a circular process. Filled with good intentions, you try to keep yourself scrupulously clean by using flushable wipes. But the unexpected result is that this leads to itching and the feeling that you have hemorrhoids.

Why overcleaning can lead to feeling “dirtier”

The problem is the chemicals in the wipes dry out your bottom with the result that your skin works to produce more oil. And it still feels “dirty” down there.

Then, the more you try to clean, the more trauma to the skin, causing micro-tears and cracks. The result is pruritis. Or, itchy bottom.

And those skin flaps? They’re normal for many of us as we age. Women who’ve had children often have hemorrhoids that have stretched the skin in the perianal area and those folds are what they feel.

This is the point where you self-diagnose hemorrhoids and start using medicated wipes and creams, adding more chemicals that continue to overdry you. Even the “alcohol-free” wipes contain chemicals. And so the cycle continues.

The shockingly simple fix

I often surprise patients with my solution, which is … splash some water on it.

Rather than cleaning yourself with flushable wipes, use a bidet — a water spray which can you install on your toilet, or even a portable, spray bottle version — or a plastic sitz bath which is available at any drug store.

Whatever method you choose, rinse the area with water to clean it, then pad dry. Don’t use soap and water, unless it’s very mild like Ivory® or Dove®; the chemicals in soap dry the area too. Just plain water works fine.

My patients tell me that after they started doing this, their itching and discomfort went away.

So the moral of the story: don’t overclean yourself with chemicals. Let water do the work.

Source: Meagan Costedio, MD, Cleveland Clinic

Rectal Bleeding: What a Doctor Wants You to Know

The first thing most people worry about when they have minor rectal bleeding is that they have a cancer. Of course, colon cancer is what I worry most about, too. But it’s the cause of rectal bleeding only 1 to 2 percent of the time.

Two problems are usually responsible for blood on the paper, on the stool or in the toilet: hemorrhoids and anal fissures. The good news is that both problems are usually easy to fix.

Age and family history matter

If you’re older than 30 or have a family history of colon cancer, the first step is a colonoscopy. Colonoscopy is easy, usually painless, and rules out cancer so you don’t have to worry. If we find a polyp that is causing the bleeding, we can remove it before a cancer ever develops.

If you’re under 30, have no family history of colon cancer, and the source of pain and bleeding is obvious, then I usually won’t suggest colonoscopy right away because:

• When a hard stool causes pain and bleeding, it’s usually an anal fissure, or tear in the tissue. Chronic constipation, prolonged diarrhea, straining and anal intercourse can all cause anal fissures.

• When rectal bleeding is painless and develops after heavy lifting, a long car trip, pregnancy or constipation, it usually means internal hemorrhoids. Anything that places continual pressure on veins in the anus can engorge them. Over time, they can get bigger and bigger. Then when you get a hard stool, it scrapes them and they bleed.

A note about hemorrhoids: They’re our friends, but they get a bad rap. These are natural veins that enlarge, becoming cushions of soft tissue that line our butt muscles (the sphincters). This creates a stronger seal so gas won’t escape when we walk. Hemorrhoids also help continence up to 30 percent.

Two problems, one solution

Using stool softeners and drinking lots of water will clear up most anal fissures and hemorrhoids. Stool softener bulks up, or softens, the stool, and drinking water moves the stool through faster. Then you just sit on the toilet and go — there’s no strain. When stool comes out easily, bleeding is less likely.

If bleeding continues despite using fiber and water — or if you can’t think of any cause for the bleeding — then you need to see a doctor. An evaluation and colonoscopy exam will rule out polyps, cancer, inflammatory bowel disease (IBD) or other problems that require treatment.

Surgical options

Colorectal surgeons have different surgical options to treat hemorrhoids:

• One is to choke the veins with rubber bands, called hemorrhoid banding. We do this in the office, without anesthesia.
• We can also use staples or sutures to tie off the veins in an outpatient procedure.

These procedures are pretty painless and work well for internal hemorrhoids.

Over-the-counter remedies

If you have hemorrhoids inside, you often have them outside too. Internal hemorrhoids bleed and are painless. External hemorrhoids swell, hurt and can itch.

Over-the-counter preparations stop hemorrhoid pain and ease swelling. Some people use them for internal hemorrhoids, but they rarely stop bleeding. While these products are very safe, try not to use them long-term because they contain witch hazel and can cause itching.

A change of habits will do you good

Once you feel better, remember that it’s important to change your bowel habits. Hemorrhoids and fissures will return even if you’ve had surgery unless you fix the habits — like constipation and straining — that caused them.

Source: Cleveland Clinic