Colon Cancer Update with The Cleveland Clinic (cont.)

MEMBER QUESTION:
Is Versed the sedative of choice for most colonoscopies?

BURKE:
The general approach to performing colonoscopy includes conscious sedation. Conscious sedation is sedation given through an IV and generally consists of Demerol or fentanyl with a medication like Versed or Valium.

MODERATOR:
How long does the procedure take? How soon can you get results?

BURKE:
The procedure takes approximately 15 to 30 minutes and patients are given a report of the findings on the examination immediately. Results sent to the lab often get returned to the physician within a week's time.

MODERATOR:
If colon cancer is diagnosed, what treatment options does a patient have?

CHURCH:
The only way to cure colon cancer is to remove it. This can sometimes be done through the colonoscope if there is a very small cancer that is part of a larger polyp. Usually, however, removal of the cancer requires removal of approximately 10 inches of colon around the cancer, along with the tissues containing the lymph glands, arteries and veins relating to that segment of colon. If the cancer has already spread to the lymph glands when it is removed (stage 3) then chemotherapy is usually recommended. If the cancer has spread to another organ (such as the liver) then cure is very unlikely, unless spread is very slight.

MEMBER QUESTION:
If you don't find the tumor until it is a stage 3 does that mean it is an aggressive tumor or has been there for a long time?

CHURCH:
The stage of a tumor bears little relation to the time it has been there. However, a stage 3 is an aggressive tumor and the likelihood of cure is less likely than a stage 1 or 2 cancer.

MEMBER QUESTION:
Do the latest chemotherapy drugs lessen the adverse side effects of treatment?

CHURCH:
Every chemotherapy drug has its own list of side effects, and currently there are several choices that patients and their oncologists can make. In general, the more aggressive the chemotherapy the higher the risk of side effects.

For the usual adjuvant (or preventive) chemotherapy with 5FU, Xeloda, side effects are minimal. When other drugs, such as irinotecan or oxaliplatin are used, side effects increase significantly.

MEMBER QUESTION:
What do you exactly mean by "cure"?

BURKE:
Cure generally refers to the avoidance of having recurrent colorectal cancer five years after it's been removed. In general, the survival rates are based on the colon tumor stage. For stage 1 colon cancer, the five-year survival rate or chance of cure is greater than 90%, and in some institutions, it's greater than 95%. The chance of cure or survival gets progressively worse with increasing stage so that it is 80% for stage 2, 40% to 60% for stage 3, and approximately 10% for stage 4.

MEMBER QUESTION:
How can family members assist/comfort a patient undergoing chemotherapy?

BURKE:
Receiving the diagnosis of cancer yourself or as a relative or good friend is often shocking and devastating. Making yourself available for emotional support of your loved ones can make this time easier on the individual with cancer. Many support groups are available for individuals affected with colorectal cancer and for their loved ones.

MEMBER QUESTION:
Does the gastroenterologist direct the treatment, or is he/she out of the picture once cancer has been diagnosed?

BURKE:
Once cancer has been diagnosed the treatment of the cancer, if surgery is required, is usually undertaken by the colorectal surgeon. If chemotherapy or radiation therapy is required, that care is directed by a cancer physician who is called an oncologist. However, if follow-up colonoscopies are required to check the colon for recurrent tumors, the gastroenterologist often provides those examinations.

"Make sure that you and all of your friends and family get screened for colorectal cancer so we can prevent this dreadful disease."

MEMBER QUESTION:
I'll be asking my doctor soon for a colonoscopy (my mom was recently diagnosed with Stage 4 colon cancer). Meanwhile, what over-the-counter product (type) is best to flush the colon on a regular basis to reduce the likelihood of polyp formation?

BURKE:
It's excellent that you are getting your colonoscopy performed because you are at an increased risk of colorectal cancer based on your mother's recent diagnosis of colorectal cancer. All individuals, even without symptoms, over the age of 49 should have screening colonoscopy.

There is no evidence that cleansing the colon on a regular basis will prevent polyps or cancer in the colon. The known risk factors for polyps and cancer include many things we cannot change, like our genetic makeup and age, or associated inflammatory conditions in the intestine like Crohn's disease or ulcerative colitis. The risk factors that are under our control that could minimize the risk of colon polyps and cancer include avoidance of smoking, maintaining a normal weight, having daily physical activity, and a diet that is high in fruits, vegetables, and fiber intake while avoiding fats and processed meats.

The inside of the colon is lined with mucus-secreting cells and appears pink and glistening when viewed. Many individuals are under the impression that the colon gets clogged with waste matter and requires cleansing frequently for good health. This is untrue.

MEMBER QUESTION:
My mother died at the age of 47. She had cervical cancer and colon cancer, but the colon cancer was "secondary" and an off shoot of the original cancer. So, does that put me at increased risk for colon cancer given that hers was a secondary cancer?