With early di­ag­no­sis and treat­ment of colon cancer, thou­sands of lives could be saved

Reader's Digest International - - Front Page - BY ANITA BARTHOLOMEW

TALL, LEAN STEFFI WESSA OF LANDAU, GER­MANY, had never had a se­ri­ous ill­ness, so when in late 2013, af­ter she turned 55, her physi­cian sug­gested they add a rou­tine col­orec­tal cancer screen­ing by colonoscopy to her reg­u­lar med­i­cal check-up, Steffi had no rea­son for con­cern.

Col­orec­tal cancer (CRC), of­ten called colon cancer, is a ma­lig­nancy in the large in­tes­tine, that twisty tube through which waste prod­ucts exit the anus. The last six or so inches of colon are called the rec­tum.

Dur­ing the colonoscopy—ex­am­i­na­tion of the en­tire colon with an en­do­scope—the doc­tor found two polyps, be­nign growths in the in­testi­nal wall that have the po­ten­tial to turn cancer­ous if left un­treated. Th­ese the doc­tor re­moved dur­ing the pro­ce­dure. But there was some­thing more: a five­cen­time­ter growth in the rec­tal area. It ap­peared to be a car­ci­noma.

A biopsy con­firmed the physi­cian’s sus­pi­cions: Steffi had col­orec­tal cancer. On hear­ing the news, Steffi was dis­traught. “My world col­lapsed. To me, cancer meant death.”

Steffi was just one of ap­prox­i­mately 447,000 Euro­peans to be di­ag­nosed with colon cancer that year, and the num­bers are in­creas­ing an­nu­ally. Glob­ally, CRC is the third most com­mon of all can­cers, and in con­ti­nen­tal Europe it is the sec­ond most com­mon ma­lig­nancy, af­ter breast cancer which has about 464,000 an­nual di­ag­noses. It’s also the sec­ond most deadly, killing about 215,000 Euro­peans ev­ery year.

But it needn’t be a killer. Col­orec­tal cancer, when dis­cov­ered in its early stages, is one of the most treat­able can­cers. And Steffi’s had been caught early, be­fore it could spread.

WHAT PUTS US AT RISK of get­ting colon cancer in the first place? The risk in­creases with age—those older than 50 make up the vast ma­jor­ity of cases—but it can strike much younger peo­ple as well.

“There can be ge­netic fac­tors, en­vi­ron­men­tal fac­tors, or an in­ter­play between the two,” says Dr. Jor­dan Kar­litz, MD, FACG, as­so­ciate pro­fes­sor of gas­troen­terol­ogy at Tu­lane Univer­sity School of Medicine in New Or­leans, Louisiana. He notes that ul­cer­a­tive col­i­tis and Crohn’s dis­ease can lead to the de­vel­op­ment of CRC if the ill­ness af­flicts a sig­nif­i­cant por­tion of the colon. A sedentary life­style adds to the risk.

The mod­ern diet and life­style are be­lieved to be among the most sig­nif­i­cant risk fac­tors. A diet heavy on meat, es­pe­cially pro­cessed meats,

and light on fruits, veg­eta­bles and fiber, can pre­dis­pose some­one to CRC, as can smoking to­bacco and drink­ing al­co­hol, says Dr. Luc Cole­mont, a Bel­gian gas­troen­terol­o­gist and man­ag­ing di­rec­tor of the foun­da­tion Stop Colon Cancer. Peo­ple who are obese or who have type two di­a­betes have a height­ened risk as well.

A study pub­lished in Jan­uary this year, whose lead au­thor was Dr. Shuji Ogino, pro­fes­sor of pathol­ogy at Har­vard Univer­sity, sug­gests one rea­son why diet might af­fect your CRC risk. When we eat we are feed­ing the tril­lions of mi­cro-or­gan­isms that live in


our in­testines. And if those well-fed mi­cro-or­gan­isms are of the trou­ble­some kind, they might pay you back by mak­ing you sick. CRC tu­mor tis­sue of­ten hosts a nasty germ called fu­sobac­terium nu­clea­tum. The study found that peo­ple who ate a fiber­rich, health­ful diet tended to have lower lev­els of th­ese bac­te­ria, as well as lower risk of CRC in­flu­enced by the bac­te­ria.

But known risk fac­tors still can’t ac­count for all cases of CRC. “I saw peo­ple, 56 years of age, not over­weight, never smoked, only a beer on the week­end, ev­ery day healthy food, and three times a week in fit­ness,” says Dr. Cole­mont. “But they have colon cancer.”

And doc­tors have re­cently re­ported an alarm­ing rise in the in­ci­dence of col­orec­tal cancer in peo­ple younger than 50—even among those in their 20s and 30s—which is why it’s cru­cial to see your doc­tor if you have any symp­toms, even if they seem in­signif­i­cant (see box).

EARLY DE­TEC­TION is the key to beat­ing colon cancer. Ev­ery ex­pert Reader’s Digest spoke to stressed the im­por­tance of screen­ing for CRC. Screen­ing “could po­ten­tially save

more than half of the peo­ple who are dy­ing from col­orec­tal cancer,” says Dr. Kar­litz. That’s a po­ten­tial of more than 100,000 lives saved per year in Europe alone.

There are sev­eral types of screen­ing, in­clud­ing a fecal test, a CT scan, a sig­moi­doscopy and a colonoscopy.

Pos­si­bly the most com­mon/read­ily ac­ces­si­ble in Europe is the fecal


test. It’s both sim­ple and in­ex­pen­sive. You get a kit from the doc­tor, fol­low the at-home di­rec­tions for col­lect­ing a stool sam­ple, and ship ev­ery­thing back. Th­ese tests look for blood in the sam­ple that isn’t ap­par­ent to the naked eye. A pos­i­tive re­sult may be ev­i­dence of ei­ther pre-cancer­ous polyps or of cancer.

A pos­i­tive re­sult is usu­ally fol­lowed by a colonoscopy, a test typ­i­cally re­peated ev­ery ten years. The in­di­vid­ual fecal test can be less ac­cu­rate than a colonoscopy, but be­cause fecal tests are done more of­ten, the like­li­hood of de­tec­tion in­creases with each suc­ces­sive test.

A sig­moi­doscopy, al­though sim­i­lar to a colonoscopy, is not as ex­ten­sive. In this pro­ce­dure, the last 40 or so cen­time­ters of the colon, plus the rec­tum, are ex­am­ined by en­do­scope. Typ­i­cally it is re­peated ev­ery five years. An­other, less com­mon screen­ing method is CT colonog­ra­phy—es­sen­tially a CAT scan of the colon. And a test us­ing a pill-sized cam­era that is swal­lowed and videos the lin­ing of the colon is avail­able in a num­ber of coun­tries for those who can’t un­dergo colonoscopy.

But colonoscopy is con­sid­ered the gold stan­dard of screen­ing. It can dis­cover more ab­nor­mal­i­ties than any other screen­ing test. It can de­tect more pre-cancer­ous polyps, and at an ear­lier stage, than fecal tests. That’s im­por­tant be­cause find­ing and re­mov­ing polyps dur­ing colonoscopy can pre­vent about 80 per cent of colon can­cers, ac­cord­ing to a 2012 study. That same re­port noted that, when peo­ple at av­er­age risk for get­ting colon cancer were screened via colonoscopy, the in­ci­dence of the dis­ease fell by 67 per cent and deaths were re­duced by 65 per cent.

But colonoscopy is an in­va­sive pro­ce­dure and it can be dif­fi­cult to per­suade peo­ple to get screened this way. When physi­cians in The Nether­lands were seek­ing to in­crease screen­ing par­tic­i­pa­tion, they sent out in­vi­ta­tions to mem­bers of the pop­u­la­tion 50 and older, of­fer­ing a va­ri­ety of screen­ing op­tions. When the in­vi­ta­tions yielded more than twice the num­ber of par-

tic­i­pants for fecal tests than colono­scopies, that’s where The Nether­lands fo­cused its ef­forts. To­day, the coun­try has the high­est rate of CRC screen­ing in Europe. In Bri­tain, too, a fecal test kit is sent ev­ery two years to ev­ery­one over 60 who is reg­is­tered with a GP. In France, fecal tests kits are sent to ev­ery­one age 50 and older.

Screen­ing rates vary dra­mat­i­cally by coun­try—or even within the same coun­try—but, on av­er­age, fewer than half of adults in Europe age 50 and older cur­rently get tested for col­orec­tal cancer.

Now 58, Steffi Wessa can at­test to the value of screen­ing. She might not be alive to­day with­out it. Af­ter her cancer was de­tected, she was treated with chemo­ther­apy and ra­di­a­tion, which shrank the tu­mor, then surgery to re­move it. Now cancer-free, she gets reg­u­lar check-ups to en­sure she stays that way.

ONCE YOU NO­TICE symp­toms of CRC, putting off screen­ing can be a bad de­ci­sion. In early 2013, Bel­gian Filip Luy­paert, 44, was fo­cused on his ca­reer as a high-pow­ered ex­ec­u­tive for an in­ter­na­tional med­i­cal de­vice com­pany. In great phys­i­cal con­di­tion, he had no known risks for cancer. But he’d re­cently no­ticed blood in his stool. When he men­tioned this to his GP, the doc­tor rec­om­mended a sig­moi­doscopy, just as a pre­cau­tion.

“I was run­ning twice a week, ten kilo­me­ters, trav­el­ing around the globe for work,” Filip re­calls. At his age and con­di­tion, nei­ther he nor his doc­tor se­ri­ously be­lieved he could have col­orec­tal cancer.

So Filip put off screen­ing for an­other six months, ex­pect­ing the symp­toms to pass. When he fi­nally had a full colonoscopy in Oc­to­ber 2013 it re­vealed that Filip had col­orec­tal cancer. The tu­mor was too large to re­move

right away. Worse, fur­ther test­ing de­ter­mined that the cancer had spread to his liver.

Filip searched the in­ter­net for sur­vival rates in stage four CRC. The best case sce­nar­ios gave him only an 11 to 12 per­cent chance of sur­viv­ing five more years.

He’d had so many plans. His girl­friend was in the process of em­i­grat­ing


from Sin­ga­pore to be with him. How could he now ask her to leave be­hind her fam­ily, her pro­fes­sional life—ev­ery­thing—when he prob­a­bly wouldn’t be alive for much longer?

If a tu­mor is too large to re­move im­me­di­ately, surgery will be nec­es­sary to cut away the dis­eased sec­tion of the colon. “In some coun­tries, 50, 60, 70 per cent of colon cancer surgery can be done by la­paro­scopic surgery,” says Dr. Cole­mont. This less rad­i­cal type of op­er­a­tion in­volves smaller in­ci­sions than tra­di­tional “open” surgery, and of­ten trans­lates to faster heal­ing.

Over five days’ time, Filip was given the equiv­a­lent of five weeks worth of ra­di­a­tion to shrink his main tu­mor enough so it could even­tu­ally be re­moved. Then came three months of chemo­ther­apy, fol­lowed by surgery to re­move the dis­eased sec­tion of his colon. At that point, to give his wound time to heal, sur­geons redi­rected waste prod­ucts from his lower colon to a stoma, a tem­po­rary open­ing in his ab­domen. Af­ter an­other three months of chemo, it was time to op­er­ate on his liver. That was fol­lowed by more chemo.

It was al­most ex­actly a year from the time of di­ag­no­sis to Filip’s last chemo­ther­apy treat­ment. “I just had to live one day at a time, and that was, for me, very dif­fi­cult, and es­pe­cially to see the peo­ple around me suf­fer­ing from my un­cer­tainty and pain.”

Af­ter sev­eral set­backs, in­clud­ing two more surg­eries to re­move ad­di­tional metas­tases on and near his liver, Filip fi­nally got the news he’d been hop­ing for. At his last check-up, doc­tors found no trace of cancer.

And in April 2016 he ran again for the first time since his or­deal be­gan, in a 10 kilo­me­ter race in An­twerp. His girl­friend plans to join him in Bel­gium.

EVEN IF YOU’VE HAD col­orec­tal cancer, there are steps you can take to mit­i­gate the risk of your cancer re­cur­ring. Live a health­ier life­style, of course, and main­tain a healthy weight. But just as low-dose as­pirin has been shown to re­duce the risk of

heart at­tack, it may re­duce the risk of col­orec­tal cancer, in­clud­ing hered­i­tary forms. Dr. Cole­mont says that among peo­ple who take low-dose as­pirin, “It seems that they have a lower re­cur­rence rate than the peo­ple who don’t take it.”

It also may re­duce the risk of dy­ing of the dis­ease if you’ve been di­ag­nosed with CRC, ac­cord­ing to a 2015 re­search re­port. And while no Euro­pean as­so­ci­a­tions have yet rec­om­mended as­pirin for preven­tion in healthy peo­ple, the US Pre­ven­tive Ser­vices Task Force came out in favour of a daily low-dose as­pirin for cer­tain peo­ple 50 to 59 years old, but only those who are not at risk for in­creased bleed­ing, and who can com­mit to tak­ing it for ten years.

Vi­ta­min D might also play a role in preven­tion, al­though the link isn’t proven. “We have pop­u­la­tion stud­ies show­ing that of pa­tients who have lower vi­ta­min D lev­els, they have a higher rate of colon can­cers,” says Dr. Grothey.

Ac­cord­ing to the US Na­tional In­sti­tutes of Health, two ran­dom­ized con­trolled tri­als sug­gest that 1,200 to 2,000 mil­ligrams of cal­cium per day may re­duce the risk of polyps re­cur­ring. The Amer­i­can Col­lege of Gas­troen­terol­ogy rec­om­mends sup­ple­ments to col­orec­tal cancer sur­vivors.

BUT THE BEST WAY to lower your risk is to stay vig­i­lant. If you are over age 50 and have never had CRC and have no symp­toms, talk to your doc­tor about screen­ing. Those who have had CRC or are at risk for get­ting it should be screened more of­ten than the gen­eral pop­u­la­tion. And if you ex­pe­ri­ence any of the symp­toms associated with the dis­ease, even if they seem mild and in­con­se­quen­tial, tell your doc­tor. Your life could de­pend on it.

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