More Young Adults Getting, Dying From Colon Cancer

https://www.webmd.com/colorectal-cancer/news/20180510/more-young-adults-getting-dying-from-colon-cancer

By Jennifer Clopton

Heather Blackburn-Beel was 34 years old when the pain in her belly started. The Indiana resident was diagnosed with irritable bowel syndrome, and the mother of two and full-time nurse felt that made sense with her busy and stressful schedule.

But her mother, Kaye Blackburn, wasn’t convinced. Colon cancer runs in the family, and it had claimed the lives of many relatives, including Kaye’s older brother at age 32. She didn’t want her daughter to take any chances.

Kaye says she begged her daughter to get a colonoscopy, even offering to pay for it. But Heather didn’t feel that she had the time or that anyone needed to spend money on it. She finally relented when the pain worsened over several months, but by then, her mother’s worst fear had come true. Heather was diagnosed with stage IV colon cancer. Her colon was removed and she began chemotherapy, but the cancer had already spread to other parts of her body.

“I think her biggest concern was for her children. She wanted to live to see them. Her goal was to see them through high school,” Kaye says, pausing with heavy sadness in her voice. “But that didn’t happen.”

Heather Blackburn-Beel was diagnosed with colon cancer at age 34. She died four years later.

Heather died on May 23, 2014, after a 4 1/2-year battle against the disease. The 38-year-old is survived by a large family that includes her husband, two teenage children, mother, father, and two sisters.

“I think it’s probably the worst loss that anyone can have. I don’t think there is anything that prepares you. It’s not natural,” Kaye says. “You never get over losing a child. You just never do. You deal with it. You live with it. But you still have a lot of bad days where you miss her terribly.”

Rising Rates of Colon Cancer in Young People

Heather’s death is part of a concerning trend: More young adults are being diagnosed with colorectal cancer, and more are dying.

Because getting tested is key to prevention, the American Cancer Society released updated screening guidelines this month. The new guidelines say that adults at average risk should start getting tested at age 45 -- five years younger than the previous recommendations.

“One of the most significant and disturbing developments in CRC [colorectal cancer] is the marked increase in CRC incidence – particularly rectal cancer --among younger individuals,” the authors wrote in explaining the new recommendation.

The American College of Gastroenterology had already said that African-Americans should start routine screening at 45 because they have higher odds of getting colorectal cancer than whites. In addition, anyone with a first-degree relative diagnosed before age 60 is supposed to start getting tested either at age 40 or 10 years before the age of diagnosis of the youngest  relative who had the disease.

Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. While the death rate for young adults is small, it is on the rise. Last year, the American Cancer Society published a study finding a 1.4% annual increase in death rates for colorectal cancers for adults under 55 between 2004 and 2014. That increase only applied to white adults.

Prevent Cancer With Exercise

Adults who stay active seem to have a powerful weapon against colorectal cancer. In one study, the most active people were 24% less likely to have the disease than the least active. It didn't matter whether what they did was work or play. 

The American Cancer Society recommends getting 150 minutes per week of moderate exercise, like brisk walking, or 75 minutes per week of vigorous exercise, like jogging. Try to spread your activity throughout the week.

Reviewed by Laura Martin on 7/31/2018

An earlier study from the group showed that between 1974 and 2013, colon cancer diagnoses increased by 1% to 2% per year among people between the ages of 20 and 39, and by .5% to 1% per year for those between the ages of 40 and 54. Rectal cancer rates have been increasing even longer and faster, rising about 3% annually since the 1970s and 1980s among those between ages 20 and 39. The study did not look at race or sex.

“One of the things we’ve been trying to do with these papers is to increase awareness. There are a lot of delays in diagnosis for young people because their doctors aren’t thinking cancer when a 20-year-old says their stomachis hurting and they have rectal bleeding,” Siegel says.

A recent study found that it took 217 days after they first had symptoms for someone under the age of 50 to get treatment for rectal cancer. That compared with just 30 days for those over 50.

“We have to get rid of the old concept and old idea that young people don’t get cancer. We have to believe and understand that they can,” says Felice H. Schnoll-Sussman, MD, director of the Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medicine in New York City. It’s named after broadcaster Katie Couric’s late husband, who died of colon cancer at age 42.

“This age of 50 that was chosen for starting colorectal screening, there is nothing magical about it. We had to decide upon an age, and the rationale is 10 years before the average age of diagnosis. But what’s the difference between a 49-year-old and a 50-year-old? Nothing,” Schnoll-Sussman says.

Lisa Johnson is well aware of that bias toward young people. She has no family history of colorectal cancer. So when the 26-years old from Rivesville, WV, first had constipation, bloating, and cramping, urgent care clinics kept telling her it was hemorrhoids.

Lisa Johnson, diagnosed with colon cancer at age 26, is now in remission.

She lived with the symptoms for several months until she got an unrelenting, stabbing pain in her right buttock. That’s when she sought out more specialized help. A surgeon found a tumor about 7 centimeters (2.75 inches) long blocking 90% of her rectum, and her colon cancer diagnosis came quickly after that.

“I have lost way too many friends in their 20s because people say screening shouldn’t start until 50 or their insurance won’t pay for it because the guideline says 50. Everyone I meet that is my age or in their 30s when diagnosed, we all have the same story.

“We had doctors who didn’t take us seriously, and we had to fight to get to a doctor who understood that something wasn’t right,” Johnson says. “If I walked into a doctor’s office in my 20s and said I found a lump on my breast, a doctor would never say, ‘Ah, you are 25, don’t worry. You’re too young for it to be cancer.’ But that’s happening all the time for patients with colon cancer.”

Cracking the Mystery

While researchers can clearly see a rise in colorectal cancer diagnoses and mortality rates in young people, they don’t know what’s driving it.

“It bothers me on a daily basis,” Siegel says.

By 2030, colorectal cancer incidence rates will be up 90% in people between ages 20 and 34, and 28% for people between ages 35 and 49.

Lack of exercisedietobesitysmoking, and alcohol can raise the odds of having colon cancer at all ages, and researchers are looking at all for potential causes. Siegel says she thinks there could also be a connection to the body's microbiome -- the bacteria that build up in our gut and are influenced by a wide variety of things in our diet and environment.

Researchers says some clues are starting to emerge, showing differences in the disease in younger people. It’s most commonly found on the left side of the colon or in the rectum. Some studies show that younger people have more aggressive cancer with worse prognoses. The disease is generally more advanced -- stage III or IV -- in younger people, perhaps a reflection of the challenge in getting diagnosed when you're younger than 50.

“Money needs to be put into this research because there are undoubtedly genes we have not found. This is only going to become more clear if we have research funds to try to figure it out. The answers are out there. We just don’t know them yet,” Schnoll-Sussman says.

The Power of Prevention

Siegel says the American Cancer Society is determined to raise awareness of colorectal cancer and improve its diagnosis. Ninety percent of people diagnosed at an early stage survive beyond 5 years, compared with an 11% survival rate after 5 years with the late-stage disease.

Colon Cancer Early Detection

Play

Current Time0:00

/

0:45

Mute

Fullscreen

Progress: 0%

Colon Cancer Early Detection

When do you need a colon cancer screening test?

ABOUT

“We need to really talk about the symptoms. No matter how old you are, if you have these symptoms and they are persisting, go to your doctor and get it checked out. It probably isn’t cancer, but it could be,” she says.

Doctors say the most common symptoms of colorectal cancer in young patients are:

Young patients may also see a difference in the shape of their stool and the frequency or difficulty with bowel movements.

Many mutations, or changes in genes, are associated with a higher chance of having colorectal cancer, and people who have those changes do often get diagnosed at an early age. But the majority of cases are sporadic, meaning there is no known cause.

Knowing your family history is important. The general population has a 2% lifetime risk of getting colorectal cancer. That goes up to over 80% for people with the inherited Lynch syndrome and 100% for familial adenomatous polyposis or FAP, both genetic mutations

Eduardo Vilar-Sanchez, MD, PhD, an assistant professor in the Department of Clinical Cancer Prevention at the University of Texas MD Anderson Cancer Center in Houston, did a study on his own hospital’s population that found one-third of colorectal cancers diagnosed before the age 35 are hereditary.

“I would interpret this for doctors or medical oncologists as saying that every time we see a patient that is young with colorectal malignancy, we must think about hereditary syndrome,” he says. “For a third of the patients, we should be referring all these people for genetic counseling. The management isn’t going to change for them, but there will be implications for family members.”

DID YOU KNOW

By 2030, colorectal cancer incidence rates will be up 90% in people between ages 20 and 34, and 28% for people between ages 35 and 49.

Heather Blackburn-Beel’s family is one of many who didn’t know Lynch syndrome ran in their family until Heather’s doctor recommended genetic testing and found she had it. Now the family understands why so many aunts, uncles, and cousins through the years have been diagnosed with, and died from, colon and stomach cancers.

Since Heather’s diagnosis, surviving family members have gotten serious about regular colonoscopies long before the recommended age of 50. Her children, for example, will start when they are 20 and get one every year. “If something happens, they’re going to know about it and be able to get ahead of it,” Kaye says.

Colonoscopies are generally the preferred screening method, and studies show they cut the odds of death by about 50%. They look at the rectum and entire colon.

Other approved methods include:

  • Sigmoidoscopies. These look at the rectum and part of the colon. If no polyps are found, these tests are generally repeated every 10 years

  • .Stool tests that detect blood in fecal matter. Studies show they can lower the number of colorectal cancer deaths by 15% to 33% in people ages 50 to 80 when done every 1 to 2 years.

  • Stool DNA test. Cologuard is currently the only FDA-approved test. This is a new test, so the benefits and harms are less well-established than for other tests.

Moving Forward

Vilar-Sanchez says managing young colorectal cancer patients requires a different approach than for patients over 50. He says his hospital started making this shift in treatment about 2 years ago.

“The expertise of a multidisciplinary team is needed, including genetic counselors, geneticists, fertility doctors, and psychological support, because being diagnosed at that age is a shock,” he says. “The best message we can get out there is young patients have their own issues, and it’s very important to recognize those.”

He also says that colorectal cancer in young people tends to be more aggressive and may need to be treated differently.

Johnson can speak to the impact a colorectal cancer diagnosis has had on her life. She was a recent college graduate, a newlywed, and worked as a dance teacher when she was diagnosed at 26. While her friends were getting married and buying houses, she had multiple surgeries, got chemotherapy and radiation, and had to give up her job.

I didn’t listen to my body for a very long time, and I want to keep others from making that same mistake.

Lisa Johnson, colon cancer patient

Now 34, she is in remission but lives with an ostomy bag. She is unable to have children because she had a complete hysterectomy and says she and her husband now focus their devotion on their nieces, nephews, and dogs. Still, she’s grateful to be alive and is working now to figure out what comes next.

“I’ve had to say goodbye to my old body. I have a new one now. This one saved my life, and I will embrace it. But the fight after the fight has been challenging. I felt like I became a really good professional cancer patient and often wonder: Now what,” Johnson says. “I think my goal now is to keep telling people my story. I didn’t listen to my body for a very long time, and I want to keep others from making that same mistake.”

Many doctors and patients also agree that doctors also need to be better educated about symptoms, no matter the age of the patient.

“I kind of blame some of the doctors who put Heather off, probably for a good 6 months to a year,” says Kaye Blackburn, now 66 years old. “It sounds cliché, but if I can help someone else avoid what we have been through, then I will do it. It was just so horrible for Heather and her kids and our whole family.

“So if you have symptoms, get them checked. If you don’t think the doctor knows what they’re talking about, find another doctor. And if you have a family history of colon cancer, you definitely need to be screened. Don’t wait until it’s too late.”

What's Your UV: IQ?

Read about how you can protect your skin from UV sun rays.
— Dr. Dale

From What's Your UV: IQ? 

The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. Yet, some of us don't consider the necessity of protecting our skin.

It's just smart to take good care of your skin

The need to protect your skin from the sun has become very clear over the years, supported by several studies linking overexposure to the sun with skin cancer. The harmful ultraviolet rays from both the sun and indoor tanning “sunlamps” can cause many other complications besides skin cancer - such as eye problems, a weakened immune system, age spots, wrinkles, and leathery skin.

How to protect your skin

There are simple, everyday steps you can take to safeguard your skin from the harmful effects of UV radiation from the sun.

  • Wear proper clothing Wearing clothing that will protect your skin from the harmful ultraviolet (UV) rays is very important. Protective clothing are long-sleeved shirts and pants are good examples. Also, remember to protect your head and eyes with a hat and UV-resistant sunglasses. You can fall victim to sun damage on a cloudy day as well as in the winter, so dress accordingly all year round.
  • Avoid the burn Sunburns significantly increase one's lifetime risk of developing skin cancer. It is especially important that children be kept from sunburns as well.
  • Go for the shade Stay out of the sun, if possible, between the peak burning hours, which, according to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), are between 10 a.m. and 4 p.m. You can head for the shade, or make your own shade with protective clothing - including a broad-brimmed hat, for example.
  • Use extra caution when near reflective surfaces, like water, snow, and sand Water, snow, sand, even the windows of a building can reflect the damaging rays of the sun. That can increase your chance of sunburn, even if you’re in what you consider a shady spot.
  • Use extra caution when at higher altitudes You can experience more UV exposure at higher altitudes, because there is less atmosphere to absorb UV radiation.
  • Apply broad-spectrum sunscreen Generously apply broad-spectrum sunscreen to cover all exposed skin. The “broad spectrum” variety protects against overexposure to ultraviolet A (UVA) and ultraviolet B (UVB) rays. The FDA recommends using sunscreens that are not only broad spectrum, but that also have a sun protection factor (SPF) value of at least 15 for protection against sun-induced skin problems. 
  • Re-apply broad-spectrum sunscreen throughout the dayEven if a sunscreen is labeled as "water-resistant," it must be reapplied throughout the day, especially after sweating or swimming. To be safe, apply sunscreen at a rate of one ounce every two hours. Depending on how much of the body needs coverage, a full-day (six-hour) outing could require one whole tube of sunscreen.

When to protect your skin

UV rays are their strongest from 10 am to 4 pm Seek shade during those times to ensure the least amount of harmful UV radiation exposure. When applying sunscreen be sure to reapply to all exposed skin at least 20 minutes before going outside. Reapply sunscreen every two hours, even on cloudy days, and after swimming or sweating.

Protecting your eyes

UV rays can also penetrate the structures of your eyes and cause cell damage. According to the CDC, some of the more common sun-related vision problems include cataracts, macular degeneration, and pterygium (non-cancerous growth of the conjunctiva that can obstruct vision). 

  • Wear a wide-brimmed hat To protect your vision, wear a wide-brimmed hat that keeps your face and eyes shaded from the sun at most angles. 
  • Wear wrap-around style sunglass with 99 or higher UV block Effective sunglasses should block glare, block 99 to 100% of UV rays, and have a wraparound shape to protect eyes from most angles.

Using the UV index

When planning your outdoor activities, you can decide how much sun protection you need by checking the Environmental Protection Agency's (EPA) UV index. This index measures the daily intensity of UV rays from the sun on a scale of 1 to 11. A low UV index requires minimal protection, whereas a high UV index requires maximum protection.

National HIV Testing Day

A day to be responsible and involved.
— Dr. Dale

From National HIV Testing Day  

June 27 is National HIV Testing Day, a day to get the facts, get tested, and get involved!

Around 1.2 million people in the United States are living with HIV, and one in eight people don't know they have it. Nearly 45,000 people find out they have HIV every year.

HIV testing is the gateway to prevention and care.

  • People who test negative have more prevention tools available today than ever before.
  • People who test positive can take HIV medicines that can keep them healthy for many years and greatly reduce their chance of passing HIV to others. Learn more about living with HIV.

More than 90% of new HIV infections in the United States could be prevented by testing and diagnosing people living with HIV and making sure they receive early, ongoing treatment.

Find more information about HIV testing, and who should be tested, on CDC's HIV Testing Basics web page.

What Can You Do?

Get the Facts. Learn about HIV, and share this lifesaving information with your family, friends, and community. Tell them about the importance of making HIV testing a part of their regular health routine.

Get Tested. Knowing your HIV status gives you powerful information to help keep you and your partner healthy.

CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. People with certain risk factors should get tested more often. Learn what those risk factors are and how often you should be tested.

To find a testing site near you:

  • visit ActAgainstAIDS,
  • text your ZIP code to KNOWIT (566948), or
  • call 1-800-CDC-INFO (232-4636).

You can also use a home testing kit available in drugstores or online.

Get Involved. CDC offers many resources to help you raise awareness about HIV testing in your community. Doing It is a new national HIV testing and prevention campaign designed to motivate all adults to get tested for HIV and know their status. Join Doing It on FacebookInstagram, and Twitter, share videos of volunteers, community leaders, and celebrities explaining why they're getting tested, and download posters and other materials.

National Men's Health Month

It’s time make your health a priority.
— Dr. Dale

From National Men's Health

Take action to be healthy and safe and encourage men and boys in your life to make their health a priority. Learn about steps men can take each day to improve health.

Celebrate National Men’s Month

Get Good Sleep

Adults need between 7-9 hours of sleep. Insufficient sleep is associated with a number of chronic diseases and conditions, such as diabetes, cardiovascular disease, obesity, and depression. Also, poor sleep is responsible for motor vehicle and machinery-related accidents.

Toss out the Tobacco

It’s never too late to quit. Quitting smoking has immediate and long-term benefits. It improves your health and lowers your risk of heart disease, cancer, lung disease, and other smoking-related illnesses.
Also avoid secondhand smoke. Inhaling other people's smoke causes health problems similar to those that smokers have. Babies and kids are still growing, so the poisons in secondhand smoke hurt them more than adults.

Move More

Adults need at least 2½ hours of moderate-intensity aerobic activity every week, and muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) on two or more days a week. You don't have to do it all at once. Spread your activity out during the week, and break it into smaller amounts of time during the day.

Eat Healthy

Eat a variety of fruits and vegetables every day. Fruits and vegetables have many vitamins and minerals that may help protect you from chronic diseases. Limit foods and drinks high in calories, sugar, salt, fat, and alcohol.

Tame Stress

Sometimes stress can be good. However, it can be harmful when it is severe enough to make you feel overwhelmed and out of control. Take care of yourself. Avoid drugs and alcohol. Find support. Connect socially. Stay active.

Stay on Top of Your Game

See your doctor or nurse for checkups. Certain diseases and conditions may not have symptoms, so checkups help identify issues early or before they can become a problem.

Pay attention to signs and symptoms such as chest pain, shortness of breath, excessive thirst, and problems with urination. If you have these or symptoms of any kind, be sure to see your doctor or nurse. Don’t wait!

Keep track of your numbers for blood pressure, blood glucose, cholesterol, body mass index (BMI), or any others you may have. If your numbers are high or low, your doctor or nurse can explain what they mean and suggest how you can get them to a healthier range. Be sure to ask him or her what tests you need and how often you need them.

Get vaccinated. Everyone needs immunizations to stay healthy, no matter how old you are. Even if you had vaccines as a child, immunity can fade with time. Vaccine recommendations are based on a variety of factors, including age, overall health, and your medical history.

Rectal Cancer

https://emedicine.medscape.com/article/281237-overview

Rectal cancer is a disease in which cancer cells form in the tissues of the rectum; colorectal cancer occurs in the colon or rectum. Adenocarcinomas comprise the vast majority (98%) of colon and rectal cancers; more rare rectal cancers include lymphoma (1.3%), carcinoid (0.4%), and sarcoma (0.3%).

The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer. The image below depicts the staging and workup of rectal cancer.

Diagnostics. Staging and workup of rectal cancer patients.

 

Signs and symptoms

Bleeding is the most common symptom of rectal cancer, occurring in 60% of patients. However, many rectal cancers produce no symptoms and are discovered during digital or proctoscopic screening examinations.

Other signs and symptoms of rectal cancer may include the following:

  • Change in bowel habits (43%): Often in the form of diarrhea; the caliber of the stool may change; there may be a feeling of incomplete evacuation and tenesmus

  • Occult bleeding (26%): Detected via a fecal occult blood test (FOBT)

  • Abdominal pain (20%): May be colicky and accompanied by bloating

  • Back pain: Usually a late sign caused by a tumor invading or compressing nerve trunks

  • Urinary symptoms: May occur if a tumor invades or compresses the bladder or prostate

  • Malaise (9%)

  • Pelvic pain (5%): Late symptom, usually indicating nerve trunk involvement

  • Emergencies such as peritonitis from perforation (3%) or jaundice, which may occur with liver metastases (< 1%)

See Clinical Presentation for more detail.

Diagnosis

Perform physical examination with specific attention to the size and location of the rectal tumor in addition to possible metastatic lesions, including enlarged lymph nodes or hepatomegaly. In addition, evaluate the remainder of the colon.

Examination includes the use of the following:

  • Digital rectal examination (DRE): The average finger can reach approximately 8 cm above the dentate line; rectal tumors can be assessed for size, ulceration, and presence of any pararectal lymph nodes, as well as fixation to surrounding structures (eg, sphincters, prostate, vagina, coccyx and sacrum); sphincter function can be assessed

  • Rigid proctoscopy: This examination helps to identify the exact location of the tumor in relation to the sphincter mechanism

Laboratory tests

Routine laboratory studies in patients with suspected rectal cancer include the following:

  • Complete blood count

  • Serum chemistries

  • Liver and renal function tests

  • Carcinoembryonic antigen (CEA) test

  • Histologic examination of tissue specimens

Screening tests may include the following:

  • Guaiac-based FOBT

  • Stool DNA screening (SDNA)

  • Fecal immunochemical test (FIT)

  • Rigid proctoscopy

  • Flexible sigmoidoscopy (FSIG)

  • Combined glucose-based FOBT and flexible sigmoidoscopy

  • Double-contrast barium enema (DCBE)

  • Computed tomography (CT) colonography

  • Fiberoptic flexible colonoscopy (FFC)

Imaging studies

If metastatic (local or systemic) rectal cancer is suspected, the following radiologic studies may be obtained:

  • CT scanning of the chest, abdomen, and pelvis

  • Endorectal ultrasonography

  • Endorectal or pelvic magnetic resonance imaging (MRI)

  • Positron emission tomography (PET) scanning: Not routinely indicated

See Workup for more detail.

Management

A multidisciplinary approach that includes colorectal surgery/surgical oncology, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer. Surgical technique, use of radiotherapy, and method of administering chemotherapy are important factors. 

Strong considerations should be given to the intent of surgery, possible functional outcome, and preservation of anal continence and genitourinary functions. The first step involves achievement of cure, because the risk of pelvic recurrence is high in patients with rectal cancer, and locally recurrent rectal cancer has a poor prognosis.

Surgery

Radical resection of the rectum is the mainstay of therapy. The timing of surgical resection is dependent on the size, location, extent, and grade of the rectal carcinoma. Operative management of rectal cancer may include the following:

  • Transanal excision: For early-stage cancers in a select group of patients

  • Transanal endoscopic microsurgery: Form of local excision that uses a special operating proctoscope that distends the rectum with insufflated carbon dioxide and allows the passage of dissecting instruments

  • Endocavity radiotherapy: Delivered under sedation via a special proctoscope in the operating room

  • Sphincter-sparing procedures: Low anterior resection, coloanal anastomosis, abdominal perineal resection

Adjuvant medical management

Adjuvant medical therapy may include the following:

  • Adjuvant radiation therapy

  • Intraoperative radiation therapy

  • Adjuvant chemotherapy

  • Adjuvant chemoradiation therapy

  • Radioembolization

Pharmacotherapy

The National Comprehensive Cancer Network guidelines recommend the use of as many chemotherapy drugs as possible to maximize the effect of adjuvant therapies for colon and rectal cancer.

The following agents may be used in the management of rectal cancer:

  • Antineoplastic agents (eg, fluorouracil, vincristine, leucovorin, irinotecan, oxaliplatin, cetuximab, bevacizumab, panitumumab)

  • Vaccines (eg, quadrivalent human papillomavirus [HPV] vaccine)

Diet, Exercise Tied to Reduced Death Risk in Colon Cancer

https://www.medscape.com/viewarticle/895371

Good diet and exercise habits may improve survival rates for people who have colon cancer, according to results of an observational study published April 12 in JAMA Oncology.

Patients with stage III colon cancer and a lifestyle considered highly consistent with the American Cancer Society (ACS) guidelines on diet and exercise had a 42% lower relative risk for death compared with patients who did not, said Erin L. Van Blarigan, ScD, from the University of California, San Francisco, and colleagues.

In an accompanying editorial, Michael J Fisch, MD, MPH, and coauthors urged physicians to heed the lesson about the applicability of the ACS Nutrition and Physical Activity Guidelines for people already facing colon cancer.

"If you were skeptical about emphasizing nutrition and physical activity for colorectal cancer survivors based on the nature of the end points previously examined or the size of demonstrated effects, or the fact that most of the similar studies were conducted among patients with breast cancer, these data should soften those concerns," write Fisch, who works for Anthem's AIM Specialty Health, Chicago, Illinois, and coauthors.

The editorialists also say that the new study will allow physicians who previously gave vague advice about diet and exercise to be more precise, and recommend five to six servings of fruits and vegetables per day and 150 minutes of exercise per week.

The editorialists describe the findings as a "cancer control gem that came out of the ashes of" an earlier failed trial.

That trial was the Cancer and Leukemia Group B (CALGB) 89803 study, a chemotherapy trial among patients with colon cancer involving irinotecan and started about 20 years ago. However, a lifestyle survey was administered in the clinic during and after chemotherapy as part of this study. After exclusions, there were 992 patients eligible for analysis by Van Blarigan and colleagues for an observational study.

Over a 7-year median follow-up, there were 335 recurrences and 299 deaths, including 43 deaths without recurrence. Compared with patients with a poor ACS guidelines score (0 to 1; n = 262; 26%), patients with an excellent score (5 to 6; n = 91; 9%) had a 42% lower relative risk for death during the study period (hazard ratio [HR], 0.58; P = .01 for trend) and improved disease-free survival (HR, 0.69; P = .03 for trend).

High adherence to the ACS guidelines (score of 5 to 6) was also associated with a 9.0% absolute reduction in the risk for death at 5 years compared with a score of 0 to 4, reported the study authors.

The editorialists described that mortality difference as "striking."

There may be no harm in recommending that patients who have stage III colon cancer adopt the ACS lifestyle recommendations, while acknowledging that this may be difficult for them, Van Blarigan said in an JAMA podcast interview.

"There's no reason to put it off, but they may not feel up to it if they are currently undergoing treatment," she said.

There's a demand for this kind of detailed information about lifestyle recommendations for people who have been treated for colon cancer, said senior study author, Jeffrey A. Meyerhardt, MD, MPH, from the Dana-Farber Cancer Institute in Boston, Massachusetts, in the same podcast.

"That's a question that patients ask a lot about…'What should I eat? Should I exercise?'" he said.

More Study Details

To compare outcomes based on lifestyle choices, the study authors assigned an ACS guidelines score for each included patient based on a combination of factors: body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red and processed meats. As noted above, scores ranged from 0 to 6, with higher numbers indicating healthier behaviors.

The researchers also examined the connections between these factors and death after colon cancer on their own.

They reported that patients with a body mass index (BMI) of 25.0 to 29.9 had lower risk for death than patients with a BMI of 30 or higher. Compared with patients who abstain from alcohol, heavy drinkers had a non–statistically significant increased risk for death, while patients consuming low to moderate amounts of alcohol had a non–statistically significant decreased risk for death, the authors said.

Consuming five or more servings of vegetables and fruits per day appeared to be helpful, but the findings on red and processed meat ran contrary to what might be expected, the authors said. Low intake of red and processed meat after colon cancer was associated with an increased risk for death.

"Higher protein intake may be beneficial for cancer survivors," Van Blarigan and study colleagues write. "Thus, it is possible that red meat is inversely associated with colon cancer mortality, despite being positively associated with colon cancer incidence."

The authors noted the limitations of their study. They couldn't conclude, for example, that the associations are independent of a patient's prediagnosis lifestyle or that changing behaviors after cancer diagnosis can achieve these results. They also pointed out that the study population was predominantly white and may not be representative of all patients with colon cancer.

The National Cancer Institute funded this study. The study authors and editorialists have disclosed no relevant financial relationships.

JAMA Oncol. Published online April 12, 2018. Abstract

 

5 Everyday Habits That Are Giving You Hemorrhoids

Come see me if you think you have hemorrhoids!
— Dr. Dale

https://www.menshealth.com/health/a19546742/causes-of-hemorrhoids/

BY ELIZABETH MILLARD

Just like everyone else on the planet, you have hemorrhoids.

Yep: You were born with them, and you’ll croak with them, but hopefully they won’t cause you too much trouble along the way.

That’s because hemorrhoids are actually a normal part of your anatomy.

“Hemorrhoids are nothing more than veins that are inside and outside your anal canal,” says Mitchell Bernstein, M.D., Director in the Division of Colon & Rectal Surgery at NYU Langone Health. “It’s when they become symptomatic that you have a problem.”

There are two types of hemorrhoids: internal and external hemorrhoids. With internal hemorrhoids, the most common issues are irritation that causes bleeding, and prolapse, which means they “drop” out of the rectum. For the latter, many patients simply tuck them back in manually and it’s fine, says Dr. Bernstein.

The external hemorrhoids—which develop under the skin around the anus—are the ones that grab all the attention, because when something goes awry there, they tend to become swollen and very painful. That’s when simply sitting down can start to hurt like hell.

If anything’s irritating your hemorrhoids or causing them to flare up, it can certainly be unpleasant. So that’s why playing the preventive game for hemorrhoids is extra-important. Here, 5 things that might be causing your hemorrhoids to become symptomatic.

Why you get hemorrhoids: You’re sitting on the toilet too long

Look, we get it. Maybe toilet time is the only chance you get to scroll through social media or watch old Jackass clips on YouTube. You might think being on the toilet is the same as simply sitting in a chair. But that’s absolutely not true, says Dr. Bernstein.

“Hemorrhoids tend to become symptomatic whenever you have increased, downward pressure,” he says, noting that being on the toilet not only separates your butt cheeks, but the shape of the bowl and the way you sit causes a very slight suction effect. Basically, gravity is not your friend here.

“The longer you sit, the more your blood pools down in those veins, and the gravity creates more pressure,” says Dr. Bernstein. That creates inflammation that makes hemorrhoids flare. “Go in, do your business, and get out.”

In fact, you should never sit on the toilet longer than 15 minutes, as we reported.

Why you get hemorrhoids: You wait too long to poop

Part of the major function of the colon is to remove water from fecal matter, according to Heather Bartlett, M.D. a family practice physician in Columbus, Ohio. If you abide by your body’s signals to evacuate, your water-to-poop ratio is usually fine, unless you’re dehydrated to some degree.

But if you tough it out, the colon will continue its water removal mechanism, making the stool firmer.

“With less water content, it’s like trying to get a brick to go through a Play-Doh maker,” she says. “That causes tears and fissures, and makes the veins more easily exposed. When you add straining in there, then you’ll become symptomatic.”

Why you get hemorrhoids: You’re pushing too hard

Speaking of straining, it’s another top contributor to hemorrhoids becoming a problem. That’s because it’s a source of downward pressure, says Dr. Bernstein.

Trying to push the poop out can overtax the veins enough that it could damage a vein’s surface and cause it to bleed, or may be enough to push an internal hemorrhoid out.

Related:3 Things You Don't Want to Find In Your Poop

Why you get hemorrhoids: You don't get enough fiber and water

Anything that limits your time in the bathroom and makes your stools more pliable is a good thing, says Dr. Bernstein. Fiber has been touted endlessly as a make-you-go tool, and for good reason: Fiber adds bulk to your digestive system, shortening the time it takes for waste to travel through the colon.

Water, too, speeds the process by keeping your intestines smooth and flexible.

Ideally, your poop should be soft and easy to pass, Dr. Bernstein says. Check out the Bristol Stool Chart for some insight on how you rate.

Anything that involves having to push is usually an indication that you’re not as hydrated as you could be, adds Dr. Bartlett.

Related: The Right Amount Of Water to Drink While You Exercise

Why you get hemorrhoids: You squat too heavily, too quickly

This can be particularly true for those who don’t work their way up gradually, and aim to do all the squats, all in one day. Dr. Bernstein says leg presses can have the same effect, or even helping a friend move.

“It’s all about the sudden pressure as you’re pushing,” he says. “We often see people who’ve done a heavy workout come in with hemorrhoid issues.”

He advises warming up by doing lighter weight sets first, so you push less when you get to those heavier weights.

Related: The Best Warmup to Do Before You Squat

When to see a doctor for hemorrhoids

Symptomatic hemorrhoids are very common, but that doesn’t mean you shouldn’t keep an eye out for some signs that you might need to get checked out.

Dr. Bernstein says that any time you have rectal bleeding, make an appointment. It’s most likely that it’s hemorrhoids, but since that’s also a warning sign for colon or rectal cancer, it’s better to be safe (Here are 7 signs of colon cancer young guys should never ignore).

Also, if the pain becomes too intense or continues for more than a couple weeks, see your doctor for some relief. He or she can do therapies designed to cut off blood flow from the hemorrhoid, which cause it to shrink. In more advanced cases, you may need surgery to remove a hemorrhoid completely, or staple one that’s prolapsed back into place.