Screening for Lynch syndrome and its impact on lowering risk for colon cancer
March 29, 2017
By Anwaar Saeed, MD, and Anup Kasi, MD, MPH
While colorectal cancer is the third most common cancer in both men and women, incidence rates have decreased over the past two decades. Consequently, mortality rates from colorectal cancer have also declined in men and women, reflecting this and improvements in early detection and treatment. Early detection is made possible through screening and colonoscopy.
Our data show that if people aged 50 and older were screened regularly, we could prevent 6 of 10 deaths from colorectal cancer. Multiple efforts are underway, both nationally and locally, to expand colorectal screening to younger people who may be at higher risk. This includes those with a known history of colon cancer and those with known hereditary familial syndromes, like Lynch syndrome.
Lynch syndrome is a genetically inherited disorder that increases the risk of colorectal and endometrial cancers and several other malignancies. In the U.S., an estimated 1 million people live with Lynch syndrome. Lynch syndrome was described in the medical literature in the 1950s, and much of the genetic etiology was uncovered in the early 1990s. Still, many patients remain undiagnosed or have a significant delay in diagnosis. This can critically impact affected patients and their family members.
One way to identify people with Lynch syndrome is to obtain a family history for cancer and then apply risk-prediction models, like Bethesda and Amsterdam II criteria. If the patient meets the clinical criteria, then we can test for DNA abnormalities related to colorectal and endometrial cancers. If abnormalities exist, we can perform definitive germline genetic testing and offer counseling to determine whether an individual has Lynch syndrome.
If the patient is diagnosed with Lynch syndrome, he/she is at risk for developing other Lynch-related cancers. Family members must undergo genetic counseling and germline testing for the disease as well. Lynch syndrome is associated with an autosomal dominant pattern of inheritance and is likely to clinically manifest in those with the abnormal gene. Family members diagnosed with Lynch syndrome are at risk of developing Lynch-related cancers in the future.
Timely identification of Lynch syndrome is critical. Not only does it allow for cancer screening at an earlier age, it also has the potential to improve patient outcomes. In addition to subspecialized gastrointestinal oncology clinics, we also have a high-risk gastrointestinal clinic for patients with a family history of colon cancer or Lynch syndrome. This clinic focuses on primary prevention methods like screening colonoscopy, formulating surveillance plans and referrals for surgical intervention, if needed.
Caring for colon cancer patients and their families provides us with tremendous insight and perspective. Their daily battles are heart-wrenching and motivate clinical researchers like us to continue our efforts fighting this life-threatening and potentially preventable malignancy. It is an honor and a privilege to care for our patients and make a difference in their lives using standard-of-care treatments, investigational therapeutics or chemoprevention approaches.
Colorectal cancer screening: the choice is yours
March 6, 2017
Have you been postponing your colonoscopy? Good news! You have a variety of options outside of this traditional screening method. If you’re like me, having options can make it easier to make the right healthcare decisions. And getting screened is the right healthcare decision – colorectal cancer is the second leading cause of death from cancer in the U.S.
- • Everyone between the ages of 50-75 years of age should be routinely screened for colorectal cancer.
- • For colorectal cancer screening, people can choose to do simple tests at home once per year or clinical procedures once every 5 or 10 years in a clinical setting.
Tests performed at home
Fecal immunochemical test (FIT) also referred to as fecal occult blood test (FOBT) are done at home once each year. After passing stool, a sample is put onto a card, which is mailed to a lab for analysis. If the test detects blood hidden in the stool, the patient will need a follow-up colonoscopy.
FIT-DNA stool tests are tests that can be performed at home every 1 to 3 years. Patients collect stool samples at home and mail them to clinical labs to be analyzed. If the test indicates a need for follow-up, the patient will require a colonoscopy.
Tests performed in a clinical setting
A colonoscopy is a procedure performed by a physician in a clinical setting once every 10 years. A doctor puts a lighted camera in a tube inside a patient’s colon in order to see the inside of the colon. Suspicious growths are removed and checked by another doctor. Sometimes, removal of the growths can prevent cancer from developing. If a cancerous growth is detected by the procedure the patient is referred for treatment.
Sigmoidoscopy is a procedure performed in a clinical setting once every 10 years with annual FIT/FOBT or every 5 years without FIT/FOBT. Sigmoidoscopy allows a physician to look at a select part of the colon where cancer is most likely to develop, rather than the entire colon. Based on sigmoidoscopy findings, patients may need to have a colonoscopy, surgery, or other treatments determined by their physician.
Some people may be more likely to develop colorectal cancer, so you should talk to your doctor about the best test for you. However, everyone, even those with lower risk for colorectal cancer, should be screened regularly. After looking at the tests above, find the one you think will work for you. Let your doctor know which test you prefer and choose to be screened. Remember, when it comes to colorectal cancer screening, you have a choice.
Screening: A national health priority
Increasing colorectal screening rates in the U.S. is a national priority and part of the 10 recommendations by the Blue Ribbon Panel for the Cancer Moonshot announced in October 2016. It is endorsed by the National Cancer Advisory Board.
In response to this, The Center to Reduce Cancer Health Disparities at the National Cancer Institute developed the Screen to Save program which promotes efforts to encourage screening to save lives and increase outreach, awareness, and care provision in racially/ethnically diverse communities and rural areas
The University of Kansas Cancer Center is proud to be a part of this initiative with screening and education events to take place throughout Kansas and Missouri over the next several months.
The connection between nutrition and cancer
March 3, 2017
About 1 out of 3 of the most common cancers are related to poor diet and a lack of physical activity. To prevent cancer, the American Institute for Cancer Research recommends changing three important dietary patterns:
- Increase the consumption of plant-based foods
- Limit the intake of red meat and alcoholic drinks
- Avoid processed meat, sugary drinks and salty processed food
Adopting a healthy lifestyle by following a good diet and being physically active is highly important during cancer treatments to support the body with nutrients and avoid weight change.
At The University of Kansas Cancer Center, our Nutrition Shared Resource group, which is comprised of nutrition experts, supports the investigation of novel nutrition strategies for cancer prevention and treatment.
In this multi-part series, I’ve broken nutrition-focused blog and vlog posts into small, bite-sized pieces. I’ll highlight a few of the important discoveries made by researchers at KU Cancer Center, as well as nutrition tips for cancer patients.
Good Nutrition Improves Cancer Therapy Outcomes: Supports Immune System
A New Hope for Bladder Cancer Patients
Bladder cancer is the fifth most common cancer in the U.S. leading to approximately 16,000 deaths each year.
Now, a bladder cancer drug discovered and developed at The University of Kansas Cancer Center is set to become its first cancer drug to go from bench to bedside
Learn more about our research
Bladder cancer survivors who have undergone a radical cystectomy (a surgical procedure that removes all or part of the bladder) are at significant risk of infection, rapid muscle wasting, and complications due to impaired immune function and post-surgical stress. Researchers at the University of Kansas Medical Center tested a nutrition drink high in arginine, omega-3 fatty acids, and vitamin A compared to a control drink, an identical nutrition supplement lacking the immuno-modulators. In this randomized pilot trial, we found that giving the nutrition drink before and after surgery reduced complications by 33 percent and most notably, reduced infections by 39 percent compared to the control drink.
The nutrients had immediate effects on immune and inflammatory responses, muscle sparing, and wound healing after cystectomy. While the results are encouraging, the team will next lead a national clinical trial to confirm whether this intervention can significantly reduce complications.
- What you can do now: In the meantime, cancer patients should choose a diet ample in fish, fruits, and vegetables to support the immune system.
Weight Loss Reduces Cancer Risk
Excess body weight contributes to as many as 1 in 5 cancer-related deaths and is associated with increased risk of at least eight types of cancer. It is important to avoid being overweight or obese, and staying as lean as possible. Weight loss actually reduces cancer markers in the blood and breast tissue of overweight women.
Women at high-risk of developing breast cancer may reduce risk by avoiding obesity or losing weight if overweight or obese. Researchers at The University of Kansas Cancer Center found favorable effects on blood and tissue markers of breast cancer risk with a 10 percent weight loss in overweight and obese women. This team is leading several studies to test weight loss in combination with omega-3 fatty acids to prevent breast cancer.
- What you can do now: Eating a healthy and balanced diet plays a vital role in weight reduction. In addition, walking for at least 30 minutes or incorporating other physical activities every day helps to avoid becoming obese.
Maintaining or adopting a healthy lifestyle is highly recommended to help prevent and treat cancer, and our experts at KU Cancer Center are always striving to identify innovative cancer-fighting nutrition strategies. If you or someone you love is diagnosed with cancer, reach out to KU for help. Cancer care can be very complex, but feeding one-self or a loved one can be simplified by a nutrition professional. Providing good nutrition can help families come together to help fuel a patient before, during, and after cancer treatment.
Staying mindful and resilient during times of transition
February 7, 2017
Moira Mulhern, PhD
Co-Founder/Executive Director, Turning Point: The Center for Hope and Healing
We face many transitions throughout life. Sometimes, when we are confronted by one of these changes, we choose not to follow through and go another way. Other transitions cannot be bypassed.
Cancer is a transition that, once diagnosed, cannot be avoided. After diagnosis, you go into action, receive your treatment and begin the cure. It’s a time filled with uncertainty, fear and hope. You hope you will complete treatment and live the rest of your life as a survivor.
You may experience a roller coaster of emotions. This is where having resilience skills comes in handy. If you have the skills to meet your transitions and move through them, you will come out on the other side stronger, wiser and more resilient. If you are resilient, your life will seem easier and more peaceful.
Resilience is the ability to bounce back in the face of whatever comes your way. Resilient people may be strengthened by their experience with stress.
Key characteristics of resiliency
Resilient people share certain traits, including optimism, hope, hardiness and the ability to identify and express their emotions. Decades of research identifies 10 key characteristics of resilience:
- • The ability to self-calm
- • The ability to self-replenish
- • Hope
- • Optimism
- • Hardiness
- • Sense of coherence
- • Exercise and other self-care
- • Nonjudgment and self-supporting attitudes
- • The ability to express emotions
- • Social support
The good news is that there is considerable research showing that people can learn to be more resilient. Resiliency training benefits include greater personal balance, enhanced creativity, improved mood, increased effectiveness in the workplace and in personal relationships, and greater physical health. However, resilience training is like exercising or reducing caloric intake for weight loss. It only works if you incorporate it into your daily life.
Improving your resilience
Resilience is about maintaining inner reserves and focusing on what you need in the moment. Actions you take in response to stressful situations play a central role in determining how well you maintain and replenish reserves.
Some of the best ways to calm and replenish yourself:
- • Try exercise. A 10-15 minute brisk walk can have an effect comparable to a tranquilizer.
- • Employ mindfulness. This is the ability to focus on the moment. Research shows that people who can do this are happier. If you are driving, focus on driving. If you are cooking, focus on the activities of preparing your meal. Mindfulness meditation involves focusing on your breath, a word or phrase.
- • Apply relaxation. There are many techniques to help you relax, and deep relaxation greatly contributes to rebuilding your resources.
- • Use self-talk. Say calming and reassuring things to yourself. This can be considered a form of self-hypnosis, and is more powerful than most people think. Try it and observe the effects.
- • Visualize calming scenes. Imagine yourself in a calming situation, e.g., on a pristine beach listening to the surf, a beautiful mountain trail or next to a rippling stream. Find images that match your experience and interests.
- • Listen to a calming recording, music or voice. Select recordings that calm you and use them when needed to become more serene.
- • Connect with the energy of calming people. People range from those who are calming and comforting to those who aggravate your tension. When stressed, try to be around people who help you rebuild your resources and avoid those who make things worse.
- • Go into predictable calming routines. For example, something habitual that you love to do. One of the best ways to calm yourself and rebuild your resilience resources is to identify actions ahead of time that replenish you and be on the ready to put them to use when they are needed.
Through classes, activities and education, Turning Point: The Center for Hope and Healing, a community resource of The University of Kansas Health System, helps participants increase resilience so they may live life to the fullest, even while experiencing chronic disease. Learn more.
The power of social media and your health
January 13, 2017
Research shows that patients are increasingly seeking healthcare information on the Internet, making it the third most common online activity. Combined with social networking, which accounts for nearly one-fifth of all time spent online, it’s understandable to see social media’s powerful effect on the way people approach their health.
As an NCI-designated cancer center, The University of Kansas Cancer Center embraces these facts and recognizes the value social media can bring to those seeking information about cancer. By providing cancer patients, survivors and their families with rich resources for understanding their disease, we can empower and engage them to take greater control of their own health.
The number of people living with cancer exceeds 14 million. We all know someone affected by it. The University of Kansas Cancer Center is committed to communicating this indispensable information to as many people as possible. Consequently, I am issuing you a challenge. With your help, we can provide those affected by cancer with information, tools and support via The University of Kansas Cancer Center’s social media channels.
If you don’t already, follow The University of Kansas Cancer Center Facebook page, as well as our other social media channels including Twitter, Instagram, YouTube and Pinterest. Like, share and comment to help amplify these important messages within your own communities.
By following the cancer center’s Facebook page, you will have access to the latest cancer information and be one step closer to being entered for a Lunch & Learn session. We will select one winner and a guest to have lunch with me and tour one of our cancer center labs. You’ll meet some of our researchers and learn about the latest cutting-edge cancer research. Here’s how to become eligible:
Visit The University of Kansas Cancer Center Facebook page (or search for “The University of Kansas Cancer Center” on Facebook. Be sure to look for the gray badge next to our name)
- Click “Like” under the main image at the top of the page.
- Tag at least two friends in the comments of any of our posts.
You have the opportunity to help those suffering from the devastating effects of cancer. Help us make a difference in the health and wellness of our community. Like, share and comment to help amplify important cancer information within your own communities.
Lowering your risk for cervical cancer
January 6, 2017
Thirty-year-old women with babies in diapers, toddlers in daycare and children in grade school should not be fighting cervical cancer. Sadly, I have seen two of these young mothers in the last week.
Several months after giving birth to twins, Kelly* was having irregular bleeding. She saw her gynecologist, who noted mild changes on Kelly’s pap smear. But the bleeding wouldn’t stop. Within six months, Kelly was in my office with advanced cervical cancer.
Kelly, who recently completed chemotherapy and radiation therapy, brought her three-year-old daughter to our last visit. The adorable little blonde with big rosy cheeks was worried because her mommy was spending so much time at the doctor’s and needed to have another exam. I had good news for her mom. She had responded well to treatment and was in remission.
My second patient is not as fortunate. She came to me with progressive cervical cancer, which did not respond to chemotherapy or radiation therapy. Dana* lit up as she told me about a recent visit with her boys, ages 8 and 10. She showed me pictures of their adventures at the library and their paintings of the fall leaves.
Dana no longer has the strength to care for them herself and relies on her family for assistance. At 32, Dana is facing an incurable cervical cancer. When we meet, we work together to optimize her quality of life, address her pain and symptoms, discuss her future wishes and plans for herself and the boys. I address her palliative care needs to improve the quality of her life in the time she has remaining.
Cervical cancer is predominantly caused by the human papillomavirus (HPV), and today this is a preventable illness. Pap testing has reduced cervical cancer rates significantly in industrialized countries, but it hasn’t yet brought the number of cases to zero. Both of my patients had regular screening exams and yet their HPV-related cervical cancers were not caught in time.
We can, and must, do better.
A vaccine that targets cancer-causing HPV has been available since 2006. In October, an improved, two-dose version of the HPV vaccine which targets nine different types of the virus was approved by the FDA. For 10 years, we’ve had a vaccine that can prevent cervical cancer and multiple other HPV-related cancers. And yet, millions of adolescent girls and boys are not being vaccinated. Kansas and Missouri have two of the lowest rates of HPV vaccination in the country.
My hope for the future, and my challenge to the community during Cervical Health Awareness Month this January, is to support the vaccination of girls and boys against the HPV virus. We must do this so we do not have another 30-year-old mother facing an incurable cervical cancer diagnosis. We cannot allow our women and girls to slip through the cracks when we have a safe and proven method of preventing this horrible disease.
*Names are changed to protect patient confidentiality.