Texas Health Presbyterian Hospital Dallas
Vol. 1, No. 3 - February 2011
In this Issue
The Importance of Screening for Colorectal Cancer
By Rajeev Jain, MD
Colorectal cancer is the second-leading cause of cancer-related death in the United States. The majority of colorectal cancers start as precancerous polyps which progress to cancer over seven to ten years. The goal of colorectal cancer screening is prevention or early detection of cancer.
|Rajeev Jain, MD
Screening for colorectal cancer begins at age 50 in both men and women who are considered at average risk for colon cancer. Some patients are considered at higher risk for colorectal cancer and screening commences at younger ages, depending on factors such as family history of colorectal cancer, genetic polyp syndromes (familial adenomatous polyposis or Lynch syndrome) or personal history of inflammatory bowel disease (Crohn's colitis or ulcerative colitis). Other factors that may increase the risk of colorectal cancer are smoking, obesity and African-American ethnicity.
Colorectal cancer screening tests have been categorized by the American College of Gastroenterology into two groups: 1) cancer prevention tests and 2) cancer detection tests. Tests that prevent cancer are colonoscopy, flexible sigmoidoscopy and CT colonography (i.e., virtual colonoscopy). Tests that detect cancer are stool occult blood testing and fecal DNA testing. In the U.S., colonoscopy has been become the dominant screening strategy because it allows detection and removal of precancerous polyps, thereby reducing the subsequent risk of colorectal cancer by more than 50 percent.
Colonoscopy is an invasive test that requires a bowel preparation and sedation for the procedure. If a screening colonoscopy is normal in an average-risk person, the next screening colonoscopy is recommended in 10 years. Flexible sigmoidoscopy is a less-invasive procedure that examines only the last one-third of the colon and the rectum. If this part of the colon is normal, a repeat examination is recommended after five to 10 years. CT colonography is a specialized CT scan of the colon. As with colonoscopy, a bowel preparation is required. However, if polyps are detected, the patient will need to undergo a conventional colonoscopy.
Colorectal cancer detection tests such as stool occult blood testing with guaiac attempt to detect colorectal cancer by finding blood in the stool which is not visible to the eye. Occult blood testing is non-invasive and inexpensive but requires dietary and medication modification before being performed. Also, for it to be effective in detecting colorectal cancer, stool occult testing needs to be performed yearly. A new more-sensitive version of stool occult blood testing is the fecal immunochemical test (FIT), which does not require any dietary modification. At this time, fecal DNA testing is in evolution and is not universally recommended for colorectal screening by any major U.S. medical societies. If any of the colorectal cancer-detection tests are positive, then a colonoscopy is indicated.
In summary, colorectal cancer is preventable, and all average-risk patients should discuss their screening options with their primary care providers being at age 50. Persons at higher risk for colon cancer may need to undergo a colonoscopy at younger ages. The most important aspect of colorectal cancer prevention and screening is undergoing one of the previously mentioned tests, as only 60 percent of adults in the U.S. have undergone some type of colorectal cancer screening.
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Eat Right to Decrease Your Odds of Becoming Another Colon Cancer Statistic
By Carla Hysell, RD, LD
It is estimated that 142,570 new colon and rectal cancers were diagnosed in 2010. Some people believe there is nothing they can do to prevent cancer, but when it comes to colon cancer, that is definitely not the case. The No. 1 action is to get regular colon cancer screenings after the age of 50. In addition to screening, maintaining a healthy body weight, getting regular exercise and eating a mostly plant-based diet have been shown to decrease the odds of getting many kinds of cancer, including colon cancer.
There is a great deal of evidence that people with a healthy weight are diagnosed less often with colon and rectal cancer. Body mass index (BMI) is a way of looking at body weight in relation to height. Your BMI should be less than 25 to be considered healthy. This is easy to determine by going to nhlbisupport.com/bmi. You can fill in your height and weight, and the website will do the work for you.
One of the ways to attain a healthy body weight is to exercise regularly. Thirty to 60 minutes of moderate exercise five to seven days a week are recommended to decrease cancer risk. If you're exercising moderately, you should break a sweat, be able to carry on some conversation, but not be able to sing during the exercise. Examples of moderate exercise are brisk walking, dancing, biking, mowing or playing volleyball. Being physically active helps you feel better and is a major contributor to weight control.
Finally, eating a primarily plant-based diet can decrease your odds of being diagnosed with colon cancer. This doesn't mean you have to be a vegetarian. iI simply means that a majority of your calories should come from minimally processed plant foods. The American Institute for Cancer Research recommends that we fill two-thirds to three-fourths of our plates with vegetables, fruits and whole grains. The remaining one-fourth to one-third should be filled with lean protein such as chicken, turkey or fish. Regular consumption of red and processed meats has been linked to colon cancer. Save lean red meat (beef, pork and lamb) for special occasions.
Sources: National Cancer Institute, National Heart Lung and Blood Institute. The American Institute for Cancer Research
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Susan G. Komen Grant Allows Texas Health Dallas to Provide Free Mammograms
By Julia Taylor
The Peggy A. Bell Women's Diagnostic and Breast Center was awarded a grant from the Susan G. Komen Dallas affiliate to provide screening mammograms for the uninsured or underinsured women of Dallas County. The Breast Center has provided breast health education, one-on-one consultation with a registered nurse and screening mammograms for 213 women who would otherwise not have had this valuable early- detection service.
Texas Health Presbyterian Hospital Dallas still has screening mammogram slots available to women who qualify. Here are some of the qualification guidelines:
- Women age 35 and older
- Must live in Dallas County
- Does not have medical insurance
- Does not have cancer
- Does not currently have breast problems
If you or someone you know would like to learn more about our free mammogram service, please call the SEARCH Program at 214-345-4072.
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Oncology Research at Texas Health Dallas
By Lalan Wilfong, MD
Offering new therapies to our patients through clinical research is an important focus of care at Texas Health Presbyterian Hospital Dallas and Texas Oncology Presbyterian Dallas Cancer Center. Through our association with the U.S. Oncology research network, the American College of Surgical Oncologists Group, and the Texas Health Resources research department, we are able to offer national and local research trials to our patients. In 2005, the American Society of Clinical Oncology awarded Texas Health Dallas the Clinical Trial Participation Award, which is given to only a select handful of practices in the United States. Our physicians are among the leaders in the field of clinical research, with many presentations and publications among them.
|Lalan Wilfong, MD
We currently offer many studies for patients with breast, prostate, colon, pancreatic, ovarian and lung cancers, among others. We were one of the first sites to offer an exciting new drug to patients with metastatic triple negative breast cancer, a PARP inhibitor. We are also involved in a multinational clinical trial to evaluate better chemotherapy regimens for breast cancer patients after surgery. For a difficult type of colon cancer, kras mutant disease, we are offering a trial with exciting new agents that inhibit different pathways in this disease. Pancreatic cancer patients are also a focus, with trials looking at better ways to treat this deadly disease.
We also offer a study investigating a new imaging method for detecting breast cancer in women that are at moderate risk of developing breast cancer. This method, digital tomosynthesis, creates a three-dimensional picture of the breast using x-rays.Studies have shown that images obtained by this method improve visibility of an abnormal area and therefore have the potential to increase cancer detection. Since the standard breast cancer screening is a two-dimensional mammogram, cancer can be hidden by tissue overlap.
If you are interested in any of our current research programs, please contact Kay Smith, RN, who is the director of Texas Oncology research at Texas Health Dallas, at 214-739-4175. The Texas Health Resources research team can be reached at 214-345-8339.
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Hope After Colon Cancer
"If you have symptoms, don't hesitate to get checked," said Greg Johnson, who reminds many that the month of March is National Colon Cancer Awareness month.
Five years ago, Johnson was commuting an hour, working 60 hours a week, and as a business owner, had no time to get sick. He ignored his lower gastrointestinal pain as symptoms got worse. When he attended to his health, a colonoscopy confirmed stage IV colon cancer and CT scans identified metastasis to his liver.
"There is really no right way to say to someone that you have cancer," said Johnson, adding, "But Dr. Howard Weiner, my GI specialist, explained everything to me and led my expedition." As Johnson shared, his physicians were "awesome." They included Dr. Lalan Wilfong, his oncologist, Dr. Thomas Shires, a liver specialist, and Dr. Jefferson Hurley, his colon surgeon — all on the medical staff of Texas Health Presbyterian Hospital Dallas where he chose to receive care "because the doctors all communicate with one another and with me."
Johnson has turned his denial into acceptance and endurance training. He has participated in 12 triathlons since his cancer diagnosis, and is currently training for an eventual Ironman competition.
Life change was gradual for Johnson. He was in denial about his cancer even after his first surgery for partial colon resection and radiofrequency ablation on his liver, an advanced, less invasive surgical technique. He was too active too soon, leading to infection and the need to reopen the surgical area for wound cleaning.
When healed, Johnson spent six months on heavy chemotherapy treatment followed by another six months of 'lighter,' targeted chemotherapy. It was during these frequent therapy sessions at Texas Oncology when Johnson took on positive thinking as well as humor. "You have to laugh to get through the dark moments," he said. "I researched and took notes about every regimen and type of 'chemo-cocktail' that I was on and used writing as therapy. I decided to do my part and take better care of myself."
That's when Johnson began paying attention to better nutrition and training for triathlons. He completed his first triathlon in 2007 while still undergoing treatment. "Cancer is almost like an endurance sport, a test of your will," he said.
Today, at age 53, Johnson says he is in the best shape of his life mentally and physically. After enduring return of a cancerous lesion on his liver and ensuing surgery in 2009, he continues to be positive, focus on healthy living and help create awareness about colon cancer.
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March 8 and April 2
Texas Health Dallas Prostate Cancer Support Group Meeting
Location: Texas Health Presbyterian Hospital Dallas, Fogelson Building, Ground level, Haggar Hall
Time: 6:30 to 8 p.m.
Speaker: Keith Kadesky, M.D., urologist, Texas Health Presbyterian Dallas
Topic: Managing Incontinence Post Treatment
The meeting is open to anyone diagnosed with prostate cancer at any time, not just newly
diagnosed. Spouses are welcome.
March 18 and April 11
Pancreatic Cancer Support Group Meeting
Location: Texas Health Presbyterian Hospital Dallas, Fogelson Building, Ground Floor, Classroom B
Time: 6 to 8 p.m.
For more information, contact Linda Vozzella at 214-345-4054.
Annual Brest Cancer Retreat
Location: Community Cancer Support on Oak Lawn
Time: 8:30 a.m. to 2:30 p.m.
The event includes a physician panel discussion featuring an oncologist, reconstructive and plastic surgeon, breast surgeon, radiologist and geneticist. We will have breakout sessions on numerous topics of importance for both newly diagnosed and long term survivors.
For more information, call 214-345-2036.
Texas Health Resources Prostate Cancer Symposium
Location: Hilton Anatole Hotel
Time: Noon to 4 p.m.
Speakers: Alan W. Partin, M.D., Chairman, Brady Urological Institute, Johns Hopkins Hospital
Pat Fulgham, M.D., urologist, Texas Health Presbyterian Dallas
Bob Hill, prostate cancer survivor and author of Dead Men Don't Have Sex
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