Medical Conditions
Colorectal Cancer: Prevention and Early Detection
Colorectal Cancer
Approximately 160,000 new cases of colorectal cancer will be diagnosed this year, with 60,000 deaths related to this diagnosis.
Colon cancer is the third most common cancer in the United States after lung and breast cancer. The risk of developing colon cancer begins to increase slightly at age 40 and rises sharply at age 50. With each decade thereafter, the risk doubles.
Along with age, other factors that increase risk include a previous colon cancer or polyp, certain family cancers, family history of colon cancer or polyp in a close relative, such as a parent, sibling or child, and a history of inflammatory bowel disease (i.e. ulcerative colitis or Crohn’s disease) of some extended duration.
The most common symptoms include rectal bleeding, change in bowel habits (normal to diarrhea or constipation) and change in stool shape. Less common signs or symptoms include abdominal pain or unexplained weight loss.
Potential Risk Factors
An individual’s social habits and diet choices are potential risk factors, as well. A diet high in fat content, low in fiber and rich in red meats represents an established risk for colorectal cancer. In terms of prevention, a well balanced diet with a fat content intake limited to 30 percent of total calories is most important.
The diet should also include a healthy intake of fruits and vegetables (about 5 servings a day). Cereal bran fiber intake should be approximately 25 to 30 grams daily, which is the amount shown to reduce the risk of developing colon cancer. Social factors that are known to contribute to the development of colon cancer are physical inactivity and cigarette smoking. The latter is associated with increased risk of polyp growth. Regular exercise may increase colonic activity and lessen exposure to certain cancer producing agents or carcinogens.
Several agents can be classified as chemopreventive, as they may slow or prevent progression of colorectal cancer in high-risk individuals. Included in this group would be aspirin, certain arthritis medications known as non-steroidal anti-inflammatory drugs, vitamins such as folic acid, high doses of calcium and estrogen replacement therapy.
A sequence of events is felt to occur in the colon that results in transformation of normal colonic tissue into polyps and ultimately a cancer. There are genetic and environmental factors involved, but the process takes many years to occur (approximately 10 to 15) and is therefore suitable for screening large segments of the population for colorectal cancer as a means of early detection.
Treatment
Routine screening as recommended by the American Cancer Society, World Health Organization and American College of Physicians includes a digital rectal examination by your physician after age 40 and each year thereafter. Beginning by at least age 50, everyone should have a stool specimen checked annually for blood. All people age 50 and older (and earlier if at risk) should have a colonoscopy every two to ten years depending on risk factors.
Advanced Gastroenterology provides Colon Cancer Screening Services. If you feel you might benefit, do not hesitate to contact us. To date, there is statistical evidence to support screening for early detection by these methods. There has been a demonstrated reduction in death rates and ultimate health care costs related to colorectal cancer with proper preventative steps. Medicare recommends these tests in the appropriate persons.
Hepatitis C: A Silent Health Threat
Hepatitis C:
There are many viruses that can invade the body and cause serious damage. Some, such as influenza, hepatitis A and B, cold viruses, etc., produce immediate symptoms. Others, like AIDS and hepatitis C, can linger in the body for years before their harmful effects are recognized. Hepatitis C silently affects more than 3.5 million Americans. Symptoms are usually absent or minimal unless the disease is severe. Over time, 20 to 30 percent of infected patients will develop cirrhosis and disability from end stage liver disease. This can include cancer. In fact, hepatitis C is now the most common cause of primary cancer of the liver in the U.S..
Routes of Infection:
Hepatitis C is primarily transmitted through infected blood or semen and is likely responsible for more deaths than hepatitis A and B combined. Most cases are discovered by routine blood studies performed as a part of a general evaluation or during blood donation. The prevalence of hepatitis C is highest among 20 to 30 year olds and begins to decline after age 50.
Since the main route of infection is through transfusion of infected blood and blood products, newer methods of identifying infected fluids have improved the screening process. Fifty years ago, 10 to 15 percent of transfusions resulted in transmission of the disease; by 1992 the risk was down to one percent. At the present time, only about 3 percent of all cases of hepatitis C are caused by blood transfusions. Currently, intravenous drug use is the greatest risk factor, accounting for approximately 53 percent of all new cases. In addition, at least one case in 20 is transmitted by intimate contact with a virus carrier through semen, saliva or other bodily fluids. The risk of acquiring hepatitis C is highest in people with multiple sex partners. In 30 to 40 percent of cases, the source of infections is unknown. Some studies suggest that these cases might result from procedures such as tattooing or manicures. Strict methods of hygiene would obviously prevent such cases.
Close to 200,000 new cases of hepatitis C are diagnosed each year in the United States. Presently, treatment for hepatitis C may result in a cure in up to 60% of these who are able to tolerate treatment. The drugs used can have significant side effects, so not everyone can take them. This treatment appears to be less effective in patients who habitually ingest alcohol as opposed to those who do not. Recently, combining the interferons with other anti-viral agents seems to improve the response considerably.
Treatment in the Future:
Newer products are being developed at a rapid rate and numerous studies are being performed in an attempt to find other substances to improve the response rate. It is hoped that a vaccine against hepatitis C will be available in the near future. Until that time it is possible that improved forms of therapy and tightening methods to prevent infection will diminish the serious consequences of this disease.
At Advanced Gastroenterology, Laura Russell, FNP has dedicated much of her time to working with hepatitis patients. She has a special interest in the disease and works with her patients to try to cure the disease if possible. If you have hepatitis C or any of the risk factors, contact our office at (731) 884-0600 or (731) 588-0948 to see if you might benefit from a visit to us.
Hemorrhoids: No Ones Friend
Hemorrhoids are masses of swollen veins in the lower rectum (internal) or at the anus (external).
Symptoms of internal hemorrhoids include:
- Bright red rectal bleeding
- Staining of undergarments with mucus
Symptoms of external hemorrhoids include:
- Pain and itching when irritated by constipation or diarrhea
- Difficulty with hygiene
Hemorrhoids are caused by:
- Straining while defecating
- Work strain (i.e. heavy lifting, etc.)
- Chronic constipation
- Passing hard, dry, small stools
- Laxative abuse
Do not assume rectal bleeding is from hemorrhoids. If you are 40 years of age or older, you should be evaluated and consider getting a colonoscopy.
To prevent or manage hemorrhoids, increase your fiber and fluid intake. Consider adding a fiber supplement to your diet.
Avoid straining at stool or sitting on the toilet for a long time.
Clean the external area gently with soap and water following stool evacuation.
Try a topical cream or sitz baths to reduce inflammation.
Advanced Gastroenterology offers painless treatments for hemorrhoids that do not respond to these simple measures.
Colon Polyps: What Are They?
A polyp is a growth that occurs in the colon and other organs. These growths, or fleshy tumors, are shaped like a mushroom or a dome-like button, and occur on the inside lining of the colon. They may be as small as a tiny pea or larger than a plum. Colon polyps start out as benign tumors but in time can become malignant. The larger the polyp is, the more likely it is to contain cancer cells.
There are different types of polyps. Polyps known as “adenomas” have the potential to turn into colon cancer. Others known as “hyperplastic” or “inflammatory” polyps have virtually no chance developing into cancer. It is very important that you follow-up with your doctor, since the best course of action for you depends on the type, size, and location of the polyps as well as the way they were removed. Most people who have had “adenomas” removed will require repeated examinations in the future to be sure that no new polyps have developed.
Polyps are very common in men and women of all races who live in industrialized countries, which suggest
that dietary and environmental factors are important in their development. Although the exact factors are
not completely understood, some risk factors, in addition to age, appear to be:
- A high fat diet
- A diet high in red meat
- A low fiber diet
- Cigarette smoking
- Obesity
Polyps and colon cancer tend to run in families, which suggest that genetic factors are also important in their development. Studies are ongoing in the genetic development of colon polyps. First degree relatives (parent, brother, sister or child) are the most closely affected by the genetic tendency of colon polyps. It is important that you be aware of your family’s medical history and that you tell your doctor if someone in your family has had colon polyps or colon cancer.
The most important thing to do to reduce the likelihood of developing colon polyps and colon cancer is to follow your doctor’s instructions regarding screening examinations. Guidelines issued by one of the major medical societies in the United States (the American College of Gastroenterology) also suggest the following to prevent polyps:
- A diet that is low in fat and high in fruits, vegetables, and fiber
- Maintenance of normal body weight
- Avoidance of smoking and excessive alcohol use
- Dietary supplementation with 3g of calcium carbonate
Other measures that may be effective are aspirin and other nonsteriodal antiinflammatory drugs (NSAIDS), folic acid (found in most multivitamins) or selenium supplementation.
Swallowing and Heartburn
Abnormal swallowing is commonly perceived as food sticking on the way down. If this complaint persists, it is sometimes due to a serious condition and should always receive prompt medical attention.
Swallowing difficulty may be caused by a number of different problems:
Heartburn is a common problem caused by regurgitation or reflux of gastric acid into the esophagus, which connects the mouth and stomach.
Heartburn can often be eliminated by avoiding:
- Poor or incomplete chewing (possibly the result of dental problems, poorly filled dentures or eating too quickly)
- Abnormal muscle contraction
- Scar tissue from chronic inflammation
- Infection
- Cancer
- Smoking
- Fatty food in the diet
- Caffeine
- Chocolate
- Peppermint
- Overeating
- Late-night snacks
- Tight fitting clothing that restricts the abdomen
- Certain medications
- Heavy lifting/straining
It is important to consider the possibility of heart disease before attributing any kind of chest pain to gastro-esophageal reflux.
At Advanced Gastroenterology we offer several tests and treatments for heartburn and swallowing problems. These include endoscopy (running a lighted tube into the esophagus under sedation) and the Bravo capsule which measures acid in the swallowing tub over a 48 hour period.
If you feel you might benefit from our services, please contact us at (731) 884-0600
or (731) 588-0948.