1. Y o u r C o u n t y C r u s a d e A g a in s t C a n c e r

3. COLORECTAL CANCER Let’s Get Talking...

4. ( colorectal cancer ) n It can be “embarrassing” to talk about colorectal cancer n DON’T DIE FROM EMBARRASSMENT n Colorectal Cancer CAN Be Prevented S o, L e t s G e t T a l k i n g...

5. Colorectal Cancer Overview n Where & What is the Colon? n What is Colon Cancer? n Why the Concern? n Who’s at Risk? n What Can be Done? –Prevention –Screening –Treatment n Where to Get More Information

6. Where is the Colon ?

7. What does it do? As part of the digestive system the colon: –Stores mainly non-absorbed food, fiber and water –Re-absorbs nearly all the water –Moves solid waste to the rectum where it is eliminated by defecation

8. What is cancer? n Cancer is the uncontrolled growth and spread of abnormal cells. n It includes 100’s of different diseases, usually classed by the part of the body where it is first found.

9. How does colorectal cancer develop? n Most colorectal cancers begin as polyps, or tiny abnormal growths on the inside walls of the colon or rectum. n Polyps vary in size, from tiny to a few centimeters. n Some polyps become cancerous after several years and should be removed to prevent development of colorectal cancer.

10. X-Ray of Colon and Polyps

11. Why the Concern? n 4 th leading cause of cancer-related death in world n 2 nd leading in US –Why a difference between world and US ? –Stay tuned n 2 nd leading in Missouri n 2 nd leading in YOUR County

12. Who Is At Risk of Developing Colorectal Cancer? n Men AND Women are at similar risk n Risk increases with age –  90% occurs in people aged 50 + n 85% of people with colorectal cancer had NO medical history related to colorectal cancer.

13. What are Risks for Developing Colorectal Cancer? n Poor Diet –high amount of fats –high amount of red meat –high temperature cooking of red meats –low amount of vegetables –high alcohol consumption –low water consumption

14. What are Risks for Developing Colorectal Cancer? n Physical inactivity

15. Why the Difference Between World and U.S. Rates? n Colorectal Cancer has been Called a “Cancer of Economically Developed Countries” –Diet is different –Physical activity is different

16. Ways to Reduce Your Risk n Regular moderate exercise n Healthy diet n Proper weight n Avoid smoking n Limit alcohol use n GET REGULAR SCREENING

17. Ways to Reduce Your Risk Healthy Diet “Five-A-Day” is  5 servings of fruits & vegetables / day This can reduce your risk for a number of diseases, including some types of cancer, such as colorectal cancer

18. Ways to Reduce Your Risk n Physical activity recommendations: –For 30 minutes (can be three 10 -minute segments) –At least 5 times per week –At the pace of brisk walking

19. Other possible risk reducers n Aspirin n Non-steroidal anti-inflammatories n Calcium n Vitamin D

21. Screening is KEY ! n American Cancer Society estimates for the impact of colorectal cancer in 1999: –129,400 cases diagnosed in the U.S. – 56,000 deaths in the U.S. – 1,300 deaths in Missouri n At least 1/3 of deaths could be reduced with widespread adoption of screening.

22. Don’t wait... n Colorectal cancer can develop with few or no symptoms at first. n Screening can lead to reductions in the number of deaths: –FOBT: 33% –Flexible sigmoidoscopy: 70% –Colonoscopy: 80%

23. How does screening save lives? n Prevention –By finding polyps in the colon and removing them before they become cancerous n Early detection –Finding cancer early when treatment works best

24. Who should be screened for colorectal cancer? n EVERYONE aged 50 and older: –Women and men –All races and ethnicities n May be younger than 50 for those with a family history of colorectal cancer or colorectal polyps (talk to your doctor!)

25. Why don’t some people get screened? n Don’t think they are at risk for colorectal cancer n Embarrassed to ask their doctor n Think it will hurt n Don’t realize that screening is covered by their insurance plans, including Medicare

26. The screening tests n Fecal Occult Blood Test (FOBT) n Flexible Sigmoidoscopy n Colonoscopy n Double Contrast Barium Enema

27. Test preparation n Preparation of the colon is important for accurate test results n If preparation is poor, tests may need to be repeated n Dietary and drug restrictions are mandatory prior to all tests n A laxative and/or enema to cleanse the bowel is required prior to some tests

28. Fecal Occult Blood Test (FOBT) n Looks for hidden (occult) blood in the stools n Stool sample is collected at home n Test preparation will likely include dietary and medicinal restrictions (check test kit instructions)

29. Example of One Type of FOBT

30. Positive test results may be due to: n Colorectal cancer or polyps. n Failure to follow pre-test dietary and medicinal restrictions. n Other bowel disorders which could cause bleeding (though not always a lower GI source): –colitis - diverticulitis - hemorrhoids, among others n Follow-up is IMPORTANT- your physician will usually recommend a full colon exam using colonoscopy or barium enema.

31. Fecal Occult Blood Test n Annual screening can lead to 33% reduction in deaths Annual FOBT test is worth the effort !!!

32. Flexible sigmoidoscopy n Uses a flexible lighted tube to examine the inside of the lower part of the colon (sigmoid). n The slender tube allows for discovery of polyps. n Polyps can be removed during sigmoidoscopy or by a follow-up colonoscopy.

33. Flexible sigmoidoscopy n Takes 10 - 20 minutes. n Cramping similar to gas pain can occur as air is blown into the colon to facilitate viewing.

34. Flexible Sigmoidoscopy Regular screening can lead to 70% reduction in deaths Regular Flexible Sigmoidoscopy is worth the effort !!!

35. Colonoscopy n Uses a flexible lighted tube to examine the inside of the entire colon n The slender tube allows for removal of polyps and tissue for biopsy

36. Colonoscopy n Takes 30 - 60 minutes. n Patient is given a sedative and anesthetic. Must remain in doctor’s office 1 - 2 hours for medication to wear off and will be drowsy. n May experience slight cramping and pressure, which diminishes when air leaves colon (gas pains).

37. Colonoscopy Regular screening can lead to 80% reduction in death Regular Colonoscopy is worth the effort !!!

38. Double Contrast Barium Enema n Radio-opaque liquid with barium put into colon n Barium coats lining of colon and rectum n Allows organs and any signs of disease to show more clearly on x-rays

39. Double Contrast Barium Enema n Last 1 - 2 hours n May need to change positions to allow different views of the colon

40. Double Contrast Barium Enema Regular screening can lead to 80% reduction in deaths Regular Barium Enema is worth the effort !!!

41. American Cancer Society recommendations for screening n For adults aged 50+ with no family history of colon cancer or polyps: –Annual FOBT PLUS –Flexible sigmoidoscopy every 5 years - - OR - - –Total colonic exam Colonoscopy every 10 years; or Double-contrast barium enema every 5-10 years

42. Treatment n More than 90% of people whose colorectal cancer is treated early survive at least 5 years after their diagnosis n Only 8% of people who are diagnosed in later stages survive past 5 years THIS IS WHY SCREENING IS SO IMPORTANT !!!

43. Remember… Lifestyle risk reducers: Healthy food choices Maintain a healthy weight Physical activityAvoid smoking Plus screening tests... FOBT and *** Colonoscopy or Sigmoidoscopy*** Double contrast barium enema Combine to save lives!

44. Where Can You Get Screening? Talk to your health care professional

45. Where Can You Get More Info? n American Cancer Society 33 East Broadway, Suite 100 Columbia MO 65203 573-443-1496 800-429-7753 ed.johnson@cancer.org www.cancer.org n Toll-free National Phone 1-800/ACS-2345

46. Where Can You Get More Info? n Missouri Department of Health & Senior Services Bureau of Cancer Control P.O. Box 570 920 Wildwood Jefferson City MO 65102 ph 573/522-2841 fax 573/522-2899 e-mail cowans@dhss.state.mo.us

47. Presented in Cooperation of Your County Community Council of the American Cancer Society Missouri Department of Health. & Senior Services Bureau of Cancer Control

48. Special thanks to the U.S. Centers for Disease Control & Prevention