University of Pennsylvania Health System

Focus on Cancer

Friday, March 30, 2012

A Sister’s Journey: The Cancer Diagnosis

Cassandra Hogue (left) with her sister, Caroline at LIVESTRONG event.
“This was never supposed to happen to her, I remember thinking, outraged, as if she and I had been given some kind of special exemption from sickness and suffering.”

Joan Didion wrote those words in her recent memoir, Blue Nights, about her 38-year-old daughter who was seriously ill. Those, too, were my thoughts when my 58-year-old healthy sister was diagnosed with an advanced form of cancer that was particularly difficult to treat.  

“How can this be happening to her? How can this be happening to me? I cannot bear to lose my sister.” 

I am certain every family member of a cancer survivor has had similar thoughts. For me, shock and fear predominated my emotions for three months after her diagnosis.

“How could her doctors have missed this? Why didn’t they find this sooner?”

For six months she had not been feeling well and was losing weight. I was outraged, disappointed, frightened. I didn’t voice this to my sister, but she knew how I felt, and I knew how she felt. 

I tried to stay positive and stay focused on the tasks at hand. I began organizing her medical care. I made her appointments at Penn’s Abramson Cancer Center, where doctors thankfully saw her within two weeks. We waited for PET scan results to determine if the cancer had metastasized.

The next month was the seemingly endless round of medical tests, procedures, surgeries to insert a chemotherapy port and feeding tube and radiation therapy appointments. I did inordinate amounts of research to educate myself about the disease, the statistics, treatments, mortality rates, alternative therapies. I went to support groups and read up on caregiver roles, but I was still in shock, still expecting our special exemption from sickness and suffering. 

My sister told me one night when we were having a long honest talk. “Let’s make a pact that we can always cry together,” she said.

I cried a lot in those three months.

But then, I unexpectedly turned a corner. Maybe I just exhausted that leg of the grief cycle. Who knows?  I participated in the Philadelphia LIVESTRONG ™ Challenge Cycling event sponsored by the Lance Armstrong Foundation.  More than 7,000 people participated – many of them cancer survivors, family members of cancer survivors or had lost loved ones too soon.

I talked to so many people that day.  I heard many stories, so much suffering and so much strength. My sister came to every rest stop, with a great sign: “My sister is riding for me.” She had just started chemotherapy and radiation, and was wearing sun protection, but she looked great.  

I had to just get back on the bike and finish the ride….no time for crying now. 

And no special exemptions.

More next month…

Learn more about the LIVESTRONG ™ Cancer Survivorship Center at the Abramson Cancer Center.

Join the 2012 Penn Medicine/ CHOP LIVESTRONG ™ Challenge Team.

Thursday, March 29, 2012

Walkabout Program for People with Cancer and Caregivers

Collage artwork by a Walkabout program participant
Walkabout: Looking In, Looking Out is an innovative survivorship program at the Joan Karnell Cancer Center at Pennsylvania Hospital that addresses the normal psychological and physical changes that come with a cancer diagnosis and treatment. The goal of the program is to support participants with developing a strong view towards living well.

“Walkabout is a program that allows participants to move with the cancer experience towards making sense of what’s current and what’s next in life,“ says Caroline Peterson, ATR-BC, LPC, the art therapist and mindfulness meditation instructor who developed and leads the Walkabout Program. “In the eight-session Walkabout program, participants explore walking away from the medical environment into the world outside, open to discoveries using mindful attention and digital photography. Photographs, taken on the walkabout, are printed and then reconsidered and used for creative expression making collages.”

Collage art is a user-friendly creative form, and the feedback from Walkabout participants has been very positive. Each participant has used the various opportunities in Walkabout to make a deeper connection with themselves.

‘Taking the photographs reminded me of the beauty we’re surrounded by every day. The collage making gave me a surprising sense of accomplishment. It felt unexpectedly good to create something new.’ - Cancer survivor in active treatment, age 29

‘The photography allowed a filter on my perceptions . . .the resulting collages revealed more about me than I thought they would. The meditative component was also very beneficial in my daily life.’ - Caregiver, age 53

The Walkabout program is designed to be enlivening and strengthening.

“Underlying the pleasures of walking and being out in the world, the creative playfulness and relaxation is a focus on mindfulness skills training to be more attentive, aware and relaxed, less reactive to the stress of life and more at ease in daily living that can be very helpful,” says Peterson.

‘The how-to approach, meditation practice and further input with learning skills to continue on my own were very helpful. I no longer have the inner freight train going through my head. It’s okay to feel okay.’ –Cancer survivor, age 37

‘I learned through the Walkabout experience to be free of fear and to let go of anxiety, and then to be me – healthy and happy.’ - Cancer survivor, age 55

The Walkabout program welcomes those individuals with cancer in active treatment or post treatment. Caregivers are also welcome.

The walkabout is mindfully slow and not physically exerting. Participants should be able to walk slowly for up to 45 minutes.

Participants receive a mindfulness meditation practice CD for home practice following in-class instruction and teaching.

To enroll in the Walkabout program at the Joan Karnell Cancer Center, please call 215-829-8700.

Walkabout program details

Spring session dates: Wednesday evenings beginning April 4 through May 23
Summer session dates: Wednesday evenings beginning June 6 through August 1 (no meeting July 4)
Times: 4:30 to 7pm
Location: Joan Karnell Cancer Center at Pennsylvania Hospital; Farm Journal Building, 2nd Floor; 230 West Washington Square; Philadelphia PA 19106

Wednesday, March 28, 2012

Do I really need to get a colonoscopy?

Vinay Chandrasekhara, MD, is a gastroenterologist at Penn Medicine. Here, he discusses the one cancer screening you shouldn’t avoid.

Colorectal cancer (CRC) is one of the few cancers that can be prevented with screening. In the United States, it is recommended that everyone over the age of 50 be screened for CRC. If you have a family history of colon polyps, cancer at an early age or certain chronic medical conditions you may be encouraged to be screened starting at an earlier age. 

Although the incidence of CRC and cancer-related deaths is decreasing, colon cancer screening remains underutilized. Consequently, CRC remains the third most common cancer worldwide and the second leading cause of cancer deaths. 

One of the main barriers to CRC screening is the lack of awareness of the disease. CRC tends to not be discussed as openly as other conditions such as breast or lung cancer. Furthermore, the thought of undergoing a colonoscopy is not appealing to anyone. This is compounded by the fact that there is a general misperception about the study. 

Colonoscopy can detect early tumors, and more importantly pre-cancerous growths of tissue called polyps. Polyps can be removed at the time of the procedure, thereby preventing you from ever developing cancer.

Know what to expect at a colonoscopy

Preparation for a colonoscopy involves using a prescription laxative the day before the procedure to clear the colon. Prior to the study, anesthetic medications providing “twilight” sedation are given through an IV.  You are able to follow commands under twilight sedation, but remain comfortable if not asleep during the entire exam. 

Once sedated, a long thin flexible tube with a light and a high-definition (HD) camera at the tip is inserted through the rectum and advanced to the end of your colon.  The total length of the exam is typically 20 to 30 minutes.

I tell almost all of my patients that the hardest part of the exam is the preparation the day before the procedure. Many patients wake up from the sedation unaware that the test has already been performed.  At Penn the preparation has been improved so the standard laxative solution is no longer a gallon of fluid, but is a more palatable combination of Miralax® dissolved in Gatorade®.

Alternatives to standard colonoscopy

Frequently, I am asked if there are alternatives to colonoscopy for CRC screening.  Several newer promising technologies are currently under development for CRC screening.

CT colonography or “virtual colonoscopy” is a technique whereby a series of X-rays are used to create 2- and 3-dimensional images of the colon and rectum to evaluate for large polyps and tumors.  Virtual colonoscopy has the advantage of being a less invasive test that does not require sedation.  However, this procedure does expose you to ionizing radiation. While one CT is unlikely to be harmful, recurrent exposure to ionizing radiation may pose a health risk to certain individuals. 

Unfortunately, CT colonography can only reliably detect polyps greater than 5mm in size or early cancers.  Colon polyps smaller than 5mm may be missed.  Furthermore, if a polyp or tumor is detected, a colonoscopy is required for removal of the polyp or to biopsy the area of interest for a tissue diagnosis. Finally, in order for this test to be effective, you still have to drink the colon preparation solution before the examination.

Other new technologies under development are fecal immunochemical test (FIT) and colon capsule endoscopy. 

FIT involves submitting a stool sample to analyze for the presence of occult blood. The sample can be collected in the comfort of your own home without the need for a bowel preparation; however, since this test only detects the presence of blood in the stool, it only identifies tumors or advanced polyps that are bleeding. FIT does not accurately identify early precancerous polyps. 

Colon capsule endoscopy is an intriguing new method in which you swallow a capsule containing small cameras that take pictures of your digestive tract.  Since this technology relies on cameras, you still have to do the colon preparation (the hardest part of the colonoscopy exam) and if a polyp or lesion is identified a subsequent colonoscopy is required for biopsy or removal of the polyp.  

The bottom line is that roughly 80 percent of CRCs can be prevented with adequate screening and colonoscopy screening saves lives.  I encourage everyone to begin the dialogue about CRC screening with their physicians. While no screening test is 100 percent perfect, colonoscopy remains the best method of screening for most individuals.

Are you 50 years old or older? Make an appointment at Penn Medicine for your routine colonoscopy by calling 1-800-789-PENN (7366).

March is Colorectal Cancer Awareness month – learn more.

Tuesday, March 27, 2012

A Team Approach to Treating Colon and Rectal Cancer

Cary B. Aarons, MD, is an assistant professor of surgery in colon and rectal surgery. In this blog, he discusses surgical treatment of colorectal cancer.

Colorectal cancer is the third most common type of cancer diagnosed in the United States. Fortunately, the overall prognosis for treating colorectal cancer is quite favorable if it is discovered early. In fact, up to 90 percent of patients whose colorectal cancer is diagnosed and treated in the early stages can be cured.

The management of colorectal cancer requires a team approach. From the time of diagnosis, comprehensive treatment demands a coordinated effort between the patient, family, gastroenterologist, oncologist, and surgeon. At Penn’s Abramson Cancer Center, every patient receives a multidisciplinary approach to their cancer care, meaning every member of the team involved in their care works together under one roof.

Experienced patient navigators also assist patients throughout the course of their treatment.

The treatment recommended primarily depends on the stage of the cancer, or the extent to which the cancer has spread.

Surgery offers the only potential for curing cancers localized to the colon and rectum. Invasive cancers localized to the colon typically require a partial colectomy, a procedure in which part of the colon is removed. This procedure is often done with laparoscopic surgery. The surgeon makes smaller incisions in the abdomen through, which specialized cameras and instruments can be inserted. This minimally invasive approach is often less painful and results in a quicker recovery. Laparoscopic and robotic-assisted surgery for rectal cancer are still being studied.

A physician may recommend chemotherapy and radiation be used initially to treat invasive cancers localized to the rectum to decrease the possibility of recurrence after surgery.

Advanced cases of colorectal cancer require chemotherapy and in select cases, there may be a role for surgery.

Learn more about treatment options for colorectal cancer at Penn’s Abramson Cancer Center.

Watch Focus On Gastrointestinal Cancers – an educational conference for patients with a gastrointestinal cancer.

March is colorectal cancer awareness month – learn more.

Monday, March 26, 2012

Program Connects Patients to Colorectal Screenings

Carmen E. Guerra MD, MSCE, Michael L. Kochman, MD, FACP, 
Alicia Lamanna, Medical Assistant and patient liaison for the program and Josh Ramos, 
a Penn junior who was awarded a grant to work on the navigation project.
Colorectal cancer is the second most common cause of cancer deaths in the United States. Although studies prove that screening reduces colorectal cancer morbidity and mortality and is recommended for everyone over the age of 50, only 60 percent of Americans have been screened.

Penn Medicine’s West Philadelphia GI Health Outreach and Access Program is working to improve the colorectal cancer screening rates in the West Philadelphia community. 

The program provides education about colorectal cancer screening and physical navigation through the screening process for people who live in the following zip codes:
  • 19104
  • 19131
  • 19139
  • 19143
  • 19151
Patient navigator, Alicia Lamanna, works with patients on a one-on-one basis and addresses barriers that might prevent them from getting a screening test. She also ensures patients understand the information by using language that is easy to comprehend.

Assisting patients every step of the way

The patient navigation program is committed to providing every patient the assistance and encouragement they need throughout the entire screening process.

The program provides the following:
  • Help with scheduling a colonoscopy.
  • Education about the screening including literature, instructions for the screening preparation and motivational information.
  • Encouragement and support.
  • Reminder phone calls about the screening appointment.
  • Instructions for the day of screening.
  • Transportation assistance.
  • Accompaniment to and from the screening exam. 
With financial support from the American Cancer Society and the Walmart Foundation, the program provides Miralax-Crystal Light bowel prep at no cost for patients who are unable to afford the cost of the prep, along with round-trip Septa tokens for the patient and companion to help them get to and from the procedure. 

Finally, one week after the procedure, Alicia, communicates the physician's findings and recommendations both verbally and in writing to everyone who participates in the screening.

To qualify for the program patients must:
  • Be between the ages of 50 and 75
  • Live in one of the five participating West Philadelphia zip codes
  • Have an order or prescription for a colonoscopy from your Penn primary care physician

Whether the reasons are financial, insurance or personal  — such as being embarrassed or nervous — that keep someone from getting a colorectal screening, the outreach program provides the assistance needed to obtain this life-saving screening. 

To learn more about the program, please call the patient navigation office at 215-439-8281 or email Alicia Lamanna at Alicia.lamanna@upenn.uphs.edu.

Friday, March 23, 2012

From A Sister's Point of View - Meet Cassandra

Cassandra Hogue (left) with her sister Caroline at a LIVESTRONG event
Cassandra Hogue is a new contributor to the Focus On Cancer blog.

Cassandra’s sister is a cancer survivor who was treated at Penn’s Abramson Cancer Center. Through her sister’s surgery, several rounds of chemotherapy, radiation therapy and most recently, proton therapy, Cassandra has been a solid source of support and comfort for her sister.

Cassandra recalls Caroline’s observation about their roles as patient and family member:

“Being a family member is equally as hard as being a patient, just in a different way.”

Cassandra has a special interest in quality of life issues and emotional/psychological support for both cancer survivors and their families. She knows first hand how a cancer diagnosis affects the entire family and can present difficult challenges for them.

In 2008, Cassandra joined the Penn Medicine LIVESTRONG ™ Challenge team and currently supports the LIVESTRONG ™ partnership as a grassroots leader for the southeastern Pennsylvania/ Delaware region.

As a contributor to the Focus On Cancer blog, Cassandra brings the perspective of a caregiver, cheerleader and (sometimes) travel planner for a family member with cancer.

Learn more about the LIVESTRONG ™ Cancer Survivorship Center at the Abramson Cancer Center.

Join the 2012 Penn Medicine/ CHOP LIVESTRONG ™ Challenge Team.

Thursday, March 22, 2012

Cancer-fighting Recipe: Savory Moroccan Soup

This delicious recipe is low in fat and rich in cancer-fighting ingredients like tomatoes, chickpeas, artichokes, herbs, spices and whole grains. Perhaps the best thing about this recipe is that it is quick and easy, which is perfect for someone who doesn’t have a lot of energy or time.

 

 

Savory Moroccan Soup

Cook time: 15 minutes
Prep Time: 8 minutes
Servings: 4

Ingredients

3 c low-sodium chicken or vegetable stock
1 can(14.5 oz) no-salt-added diced tomatoes with juice
1 c zucchini, sliced into half circles
1 c canned chickpeas, rinsed and drained
4 artichoke hearts, cut in half (frozen or packed in water and drained)
½ c whole wheat couscous
1/4 c fresh parsley, chopped (or 1tbsp dried parsley)
1/4 c raisins
2 scallions, thinly sliced (including green tops)
¼ tsp cinnamon
¼ tsp cayenne
½ tsp dried basil
½ tsp dried oregano

Directions

Bring stock plus 1 cup of water to a rolling boil. Reduce heat, add remaining ingredients, and simmer uncovered about 5-7 minutes. Add salt and pepper to taste and serve

Nutrition per serving: 250 cal, 2.5 grams of fat, 8 grams of fiber, 13 grams of protein

Recipe from Women’s Health Magazine (January/February 2010)

Carly Roop RD, CSO, provides nutrition education and support to patients and their families at Joan Karnell Cancer Center. She addresses nutrition-related side effects from chemotherapy and radiation as well as nutrition for survivorship, and provides educational nutrition programs, which are open to patients as well as the community.

Tuesday, March 20, 2012

Colorectal Cancer 101: Increase Your Awareness

Cary B. Aarons, MD, is an assistant professor of surgery in colon and rectal surgery. In this blog, he discusses colorectal cancer, it’s causes, screening and treatment options, including surgery.

Among adults, colorectal cancer is the third most common cancer in the United States. It is also the second most common cause of cancer-related deaths every year.

These statistics generally mean very little to the average person until they are faced with a colorectal cancer diagnosis. Then, at least initially, nothing else seems more significant.

Fortunately, the overall prognosis is quite favorable if colorectal cancer is discovered early. Up to 90 percent of patients whose colorectal cancer is diagnosed and treated in the early stages can be cured.

Most colon and rectal cancers begin as adenomas, or small polyps, that can progress over time and invade the wall of the bowel. In their later stages, colon and rectal cancer cells can spread to other parts of the body.

Know your risk for colorectal cancer

Roughly 75 percent of colorectal cancers occur in individuals who have an average risk of developing the disease. However, certain factors have been identified that can increase your risk, including:
  • Age: Most people diagnosed with colorectal cancer are over 50.
  • A personal history of colorectal polyps or colorectal cancer
  • Inflammatory bowel disease: Chronic inflammatory diseases of the colon, such as ulcerative colitis or Crohn’s disease, can increase the risk of colorectal cancer.
  • Family history of colorectal cancer: First-degree relatives of individuals with colorectal cancer are at increased risk of developing cancer themselves.
  • Inherited colorectal cancer syndromes: Genetic syndromes present in some families, such as, familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC), can increase the risk of colon cancer.
  • Racial/Ethnic background: African Americans have a higher incidence of colorectal cancer as compared to other groups in the United States.
  • Lifestyle factors: A diet high in fat and low in fiber as well as obesity can increase the risk for colorectal cancer.

Colorectal screening saves lives

Since the early 1980s, the mortality from colorectal cancer has decreased steadily in the United States. In large part, these declines can be attributed to increased awareness and more pervasive screening. However, recent data show that one in three adults between the ages of 50 and 75 are not up to date on recommended screening for colorectal cancer.

Common screening tests for individuals of average risk include:
Fecal occult blood test - recommended annually
Flexible sigmoidoscopy OR double contrast barium enema - recommended every five years
OR
Colonoscopy - recommended every 10 years

Screening should begin at age 50 for the average person.

Other modalities such as CT colonography (virtual colonoscopy) and stool DNA testing are also being used but have not been widely adopted.

Individuals at increased risk (see risk factors outlined above) should be screened more frequently with colonoscopy.

Watch CANPrevent Colorectal Cancer – a conference designed to help those at risk for colorectal cancer.

March is colorectal cancer awareness month – learn more.

Monday, March 19, 2012

Learn the Symptoms of Colorectal Cancer

March is colorectal cancer awareness month, and it is a good time to review the symptoms of colorectal cancer. Catching colorectal cancer at its earliest, most treatable stage offers patients better outcomes and chance for a cure.

While colon cancer is often combined with rectal cancer and referred to as “colorectal cancer,” it is important to know about the two different types, their location and their symptoms

About Colon Cancer

Colon cancer is the third most common type of cancer in both men and women, and is the second leading cause of death from cancer in the United States. Colon cancer is cancer that forms in the lining tissues of the colon. Most colon tumors begin when normal tissue forms a polyp, or pre-cancerous growth projecting from the wall of the colon. As the polyp grows, a tumor forms. Because the tumor grows slowly, early detection is possible through screening and tests.

The colon is the largest part of the large intestine, also known as the large bowel. After food is chewed and swallowed, it travels through the stomach and small intestine where it is broken down and most of the nutrients absorbed. The colon's function is to change liquid waste into solid waste and prepare it to be expelled from the body.

Symptoms of colon cancer include:
  • Bleeding from the rectum
  • Blood (bright red or very dark) in the stool or toilet after a bowel movement
  • A change, or narrowing of the stool
  • Cramping or pain in the abdomen
  • Feeling the need to have a bowel movement, but not having one
  • Excessive fatigue
  • Frequent gas, bloating or feeling of fullness
  • Weight loss for no known reason
  • Nausea and vomiting

About Rectal Cancer

Rectal cancer is cancerous tissue that grows along and invades the wall of the rectum. Rectal cancer and colon cancer are very similar and share many common features. The difference in location creates important differences in how each is treated. Rectal cancer, like colon cancer, may start as a polyp that becomes cancerous.

Symptoms of rectal cancer include:
  • Change in bowel habits including: diarrhea, constipation, feeling that the bowel has not completely emptied, stools that are narrow in shape
  • Bright red or dark blood in the stool
  • Abdominal discomfort
  • Change in appetite
  • Losing weight without dieting
  • Fatigue

It’s important to know that symptoms of colorectal cancer can look like symptoms of other conditions. Patients who experience any of these symptoms should contact their healthcare provider.

Schedule A Colonoscopy

Most colorectal cancer is found through a colonoscopy. In fact, a recent study from Memorial Sloan-Kettering stated that colonoscopies cut colon cancer death risk.

During a colonoscopy, while the patient is under sedation the physician places a thin, tube-like instrument with a light and a lens for viewing inside the rectum and colon. The scope also has a tool to remove polyps or tissue samples, which are checked for cancer in a lab.

Colonoscopies are recommended for men and women over the age of 50 as a standard preventive test. People at high risk for colon and rectal cancer or those with a family history of cancer should talk with their physicians about recommendations for screening.

View CANPrevent Colon Cancer – What You Need to Know to learn more about your risk for colon cancer.

Screening tests for colorectal cancer can detect cancer at an earlier, more treatable stage. Here, Greg Ginsberg, MD, director of endoscopic services at Penn Medicine, and physician at the Abramson Cancer Center, talks about screening for colorectal cancer.






Get screened for colorectal cancer. Schedule an appointment with a Penn physician today.

Thursday, March 15, 2012

Cancer-fighting Recipe: Multi-grain Scones

This cancer-fighting recipe for scones is healthy because it is made form whole grains, is lower in fat and is high in protein. These are a great, make ahead and freeze breakfast item, and are also great for a snack or with a cup of tea.

Multi-grain scones

Makes 6 to 9 scones

Ingredients
1 egg                           
½ cup oats
½ cup sugar                   
1 cup white flour
¼ cup canola oil                   
½ cup wheat flour
½ cup skim/reduced-fat milk       
¼ cup wheat germ                           
2 Tbsp. Millet or Amaranth
¼ tsp. salt
½ tsp. baking soda
2 tsp. baking powder
½ tsp. cinnamon

Directions
  1. Preheat oven to 375 degrees F.  Center rack in oven.
  2. Whisk together the egg, sugar, oil and milk in a bowl.
  3. In a separate bowl mix the dry ingredients and stir together with a spoon or fork.
  4. Slowly add the dry ingredients to the wet ingredient bowl to create dough.
  5. Light grease or spray a baking pan or cookie sheet.  Scoop the dough onto the cookie sheet a tablespoon at a time to make 6 to 9 scones.
  6. Bake for 15-20 minutes until the top is golden brown.
  7. Remove from the oven and cool on a wire rack.
Serve with marmalade or fruit spread.  If not using the same day,  individually wrap each scone in a piece of foil after they have cooled.  Place in a plastic bag in the freezer.  To heat, place the scone in a paper towel and microwave for one minute to reheat.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center. Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology. Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of integrative therapies.


She conducts cooking programs and group counseling sessions for cancer survivors.

Wednesday, March 14, 2012

Prevent Colorectal Cancer with These Nutrition Tips

Carly Roop RD, CSO, is a registered dietitian at the Joan Karnell Cancer Center (JKCC). She provides nutrition education and support to patients while addressing nutrition-related side effects from chemotherapy and radiation. Dietitians at JKCC provide educational nutrition programs that are open to patients as well as the community.

March is Colorectal Cancer Awareness month. While some risk factors for colon cancer such as genetic predisposition cannot be controlled, research has shown diet, exercise and maintaining a healthy body weight can help prevent some cancers.

The American Institute of Cancer Research (AICR) estimates that 45 percent of the colorectal cancers diagnosed each year in the United States are preventable. Based on extensive research, the AICR suggests that following these recommendations will reduce your risk of colorectal cancer.

Tips to lower your risk of colon cancer

Be as lean as possible, without being underweight. Researchers have found evidence that excess fat, especially, around the waistline, increases your risk for colon cancer as well as heart disease and diabetes.

Eat a balanced, nutritious diet. The AICR recommends filling at least 2/3 of your plate with vegetables, fruits, whole grains and beans. These foods are packed with cancer-fighting properties, water and fiber, which keep you fuller longer.

Limit your intake of red meat and avoid processed meats. A diet high in red meat (beef, lamb and pork ) or processed meats  (any meat that is preserved by salting, curing or smoking such as hot dogs, sausage or bacon) has been shown to increase the risk for developing colon cancer. Scientists suspect that the preservatives used in processed meats and the high amount of saturated fat found in red meats are the contributing factors.  The AICR recommends limiting the intake of red meat to no more than 18 ounces (cooked weight) per week.
  • Deck of cards = 3 oz of meat
  • A matchbox = 1 oz of meat
Get moving. Exercising for 30 minutes a day in any way for five days each week helps you to maintain a healthy body weight. There is also evidence that regular physical activity reduces colorectal cancer risk.

Reduce your alcohol intake. There is convincing evidence that alcohol consumption is a cause of colorectal cancer in men and a probable cause in women. The AICR recommends limiting alcoholic drinks to no more than two drinks per day for men and one drink per day for women.
One drink = 12 oz of beer, 5 oz of wine, or 1oz of liquor

Continue to follow the Focus On Cancer blog for cancer-fighting recipes. For more information about colorectal cancer prevention and recipes from AICR’s test kitchen, visit www.aicr.org

Tuesday, March 13, 2012

How Good are Do-it-yourself Genetic Tests?

Do you wonder if you have a gene mutation that put you at higher risk for certain types of cancer?

Today, direct-to-consumer genetic testing is available for anyone who is interested in knowing their risk for certain cancers like melanoma and breast cancer. In some cases, ordering an at-home test is just a few clicks away from your home computer.

While these tests may be easy to order online, deciphering the results are not as easy. Not every company requires testing be facilitated through physician or genetic counselors. Other companies do require that testing be sent through a provider. Not all providers ordering such tests may be adequately trained to interpret results and understand the current limitations and shortcomings of this testing. Such tests currently do not capture all heritable cause for disease and some providers and patients may overestimate clinical utility.

In fact, as more people have access to getting such genetic tests, researchers are trying to determine whether the general public is able to accurately interpret the test results without speaking with a qualified physician or genetic counselor.

While some researchers argue everyone should have access to their own genome information, they also acknowledge that interpreting the results can be confusing and, at times, alarming.

This article from the National Cancer Institute discusses direct-to-consumer genetic testing, the risks of genetic testing at home, and how the public is interpreting these results.

Would you want to know your risk for certain types of cancers?

Learn more about genetic testing for breast and ovarian cancers at the Abramson Cancer Center’s MacDonald Women’s Cancer Risk Evaluation Center.

Learn more about genetic testing for gastrointestinal cancers at the Abramson Cancer Center’s Gastrointestinal Cancer Risk Evaluation Program.

View the 2011 Focus On Your Risk of Breast and Ovarian Cancer – a conference designed to address the personal and medical issues facing those at risk for breast and ovarian cancers

Monday, March 12, 2012

Colorectal Cancer Awareness Month

Approximately 90 percent of colorectal cancers are thought to be preventable. With that in mind, Pennsylvania Hospital’s Joan Karnell Cancer Center is focusing on colorectal cancer awareness with an educational program 11:30 am to 1:30 pm, the week of March 19 in the Elm Garden Cafeteria at Pennsylvania Hospital. Open to hospital staff, patients and visitors, the program focuses on nutrition, genetics, prevention and screening for colorectal cancer.

Other than skin cancers, colorectal cancer is the third most common cancer diagnosis among men and women in the US.  Studies show that 1 in 20 Americans develop colorectal cancer during their lifetime. Regular screening exams such as colonoscopies can prevent colorectal cancer.  During colonoscopies, any abnormal cells that begin as polyps can be found and removed before they become cancerous. Screening can also result in early detection of colorectal cancer when it is highly curable.

Some risk factors for colorectal cancer include:
  • Over the age of 50
  • Personal history of colorectal polyps or colorectal cancer
  • Personal history of inflammatory bowel disease
  • Family history of colorectal cancer
  • Inherited syndromes
    • FAP – familial adenomatous polyposis
    • HNPCC – hereditary non-polyposis colon cancer also known as Lynch syndrome
    • Juvenile polyposis
    • Peutz-Jegher
    • MYH gene
  • Racial and ethnic background – African Americans and Ashkenazi Jews
  • Lifestyle factors
    • Diet high in red meats and processed meats
    • Physical inactivity
    • Obesity
    • Smoking
    • Heavy alcohol use
    • Type 2 diabetes
Screening for colorectal cancer should begin at age 50 for those with no identified risk factor other than age. People with a family history or other risk factors should talk to their doctor about starting screening when they are younger.

If you have an early onset of colon polyps, colon cancer, or multiple family members with colon polyps or colon and uterine cancer, you should consider genetic counseling and testing. Genetic counselors can be contacted at Pennsylvania Hospital by calling 215-829-6528 or at the Hospital of the University of Pennsylvania by calling 215-349-8141.

Friday, March 9, 2012

Patient Turned Advocate Promotes Awareness

John Turino was diagnosed with colon cancer in 1996. A South Jersey resident, John is married with an 18-year-old son and is chairperson of the tri-state chapter of the Colon Cancer Alliance.

My story begins on May 15, 1996. I was experiencing extreme pain on my left side. I was sent to a radiologist for a barium enema, and X-ray to look at my colon, but the liquid was unable to pass through. A tumor had blocked off the descending colon and broken the membrane. The CT scan confirmed that I had colon cancer.

I was devastated.

After trying for 10 years to have a child, my barely 3-year-old son was facing the possibility of being fatherless. For the first time in my life, at the age of 41, I was scared and alone.

You see, back in the 90s, the word "cancer" meant “death.” It was considered an elderly disease. No one ever talked about cancer. In fact, some people avoided me like the plague, thinking they could catch it from me. There was no support group I could join. There was no one to talk to about my experience, because no one knew what to expect. My wife, I'm sure, was experiencing this as well. She had no caregiver training and did not know how to deal with my cancer diagnosis.

The day of my surgery, I drove to the hospital with my wife. We grabbed each other's hands and silently cried as we looked together, ahead.

The surgery went very well. I stayed in intensive care for nine horrible days. When I got home, I had to heal for a couple of weeks before I started my weekly rounds of chemotherapy. I was relieved that I did not need radiation therapy.

I drove myself to and from the oncologist's office every Tuesday for a year. I was determined not to let my son grow up without a dad, and he came with me every trip. We'd go into the office and the first thing that hit me was this horrible odor. Every time I walked into the office for my treatment, I could never get past this odor. And every week, as they drew my blood for a white blood cell count, I was hoping mine was low, so that I did not have to have chemo that week. Each week, coming out of the office, I would get halfway to the car, vomit into the parking lot, close the door and drive off. I became very sick, but as soon as I started to recover, it was time for my next treatment.

Today, it has been almost 16 years that I have survived this disease. I still get a colonoscopy every five years to keep it in check, and the fear of cancer returning never goes away, no matter how many years go by or how strong I become.

Giving Back

About 150,000 people in the United States are diagnosed with colon cancer annually, making it one of the most common forms of cancer. Yet few people know much about it or are comfortable discussing it.

It starts as a growth, or polyp, in the colon or rectum. Some polyps can develop into cancer, but if detected in the early stages, colon cancer is 90 percent curable.

Most people are encouraged to begin screening by the age of 50. Besides colonoscopy, screening options include virtual colonoscopy, and flexible sigmoidoscopy.

Today, I have found a major way to give back and educate others about this disease.

I strive to create awareness of colon cancer through myriad programs, noting it remains the number-two cancer killer, behind lung cancer, even though colonoscopies and other screenings make it one of the most preventable types of cancer.

I am currently the chairperson of the tri-state chapter of the Colon Cancer Alliance, which encompasses New Jersey, Pennsylvania and Delaware. My goal in life is to help spread the word about colon cancer through the Colon Cancer Alliance and to reach as many people as I can.

Based in Washington, D.C., the Colon Cancer Alliance is a national patient advocacy group that strives to end the suffering caused by colorectal cancer through support, education and research.

The Colon Cancer Alliance’s signature programs include:
  • “Buddy” program: Designed to provide experienced listeners who have “been there” to support newly diagnosed patients
  • Regional seminars: Providing up-to-date information from top healthcare professionals; designed for new patients, advanced disease patients, survivors, caregivers, nurses and others
  • Connections online: Features include blogs, videos, personal pages, message boards and chat; opportunities to seek advice or provide data, updates to loved ones
  • Tributes page: Web pages can be created to memorialize or otherwise honor a friend, family member or loved one
  • Toll-free helpline: A chance to learn more about screening and treatment options and receive advice on treatment effects
  • Voices Volunteer program: An opportunity to allow advocates to use their voices to help the alliance succeed in its mission
  • “Undy” 5k run/walk: An untypical race highlighted by entrants in boxers and bloomers spreading the word about colorectal cancer.

The Philadelphia “Undy” is scheduled for Sept. 8, 2012. Registration for participants and teams is now open on the website, www.undy5000.org

This is the beginning of my journey to help those in need.

Thursday, March 8, 2012

Grab These Foods When Fatigue Sets In

Carly Roop RD, CSO, is a registered dietitian at the Joan Karnell Cancer Center (JKCC). She provides nutrition education and support to patients while addressing nutrition-related side effects from chemotherapy and radiation. Dietitians at JKCC provide educational nutrition programs that are open to patients as well as the community.

Fatigue can be an overwhelming side effect of chemotherapy and is probably one of the most common complaints I hear. Patients tell me that they are going about their normal routines and from out of nowhere, they just crash.

Eating well during cancer treatment can be a challenge, especially for those patients that suffer from fatigue. Yet, it’s important to make good food choices during treatment.

Here are some easy to prepare foods to help increase nutrition input while minimizing energy output:
  • Cans or pouches of tuna, salmon and sardines are easy ways to get a healthy serving of protein and a good source of omega-3 fatty acids.
  • Canned chicken can be added to soup, tossed with rice or mixed with mayonnaise for a high protein snack or meal.
  • Edamame or soybeans are available shelled or in pods in the frozen food section. This green “super food” can be added to salads, dips, casseroles, soups and a half cup provides 12 grams of protein.
  • Canned beans are another great source of protein. Rinsing the beans under water lowers the sodium content by 20 percent. And hummus, which is made from chickpeas and tahini,is a delicious dip for crackers, pita bread, carrots or can be used in place of mayonnaise on a sandwich.
  • Nut butters like peanut, almond, soy or cashew and nuts are calorie-dense foods that contain healthy fats. Calories per 2-tablespoons of a nut butter can range from 150 to 200 calories.
  • String cheese, spreadable cheeses, low-fat cottage cheese, Greek-style yogurt, and low-fat milk are all easy ways to increase calories, protein and calcium intake.
  • Dried fruit, canned fruit in its own juice and frozen fruit with no added sugar are all easy ways to add fruit to your diet.
  • Many of us were taught that frozen vegetables are not as good as fresh vegetables, but this is not entirely true. Fresh vegetables are preferable when they are in season, but the further vegetables have to travel the more nutrition they lose. Freezing vegetables at the peak of their freshness preserves their nutrition. If you prefer fresh vegetables, choose a day when your energy is high to wash, peel and chop all of your vegetables at once. I love roasting a big batch of parsnips, broccoli, cauliflower and carrots on Sunday. Then all week long I can add it to my salads, eggs, pasta and sandwiches or even make a soup with them. 
  • Here’s a trick if you boil or steam your vegetables: keep the leftover water. Yes, the slightly green water and use it to cook rice, add it to a soup or use it for basting. It’s a great way to retain the water-soluble vitamins lost in the cooking process and it cuts down on the number of dishes.
  • Frozen soup and meals, when consumed in moderation, can help you conserve energy while providing a balanced meal. Read the labels carefully because frozen meals can be very high in sodium. There are a few brands in your grocer’s freezer aisle that are under 600 mg of sodium such as Lean Cuisine®, Healthy Choice®, Amy’s®, Kashi® and Smart Ones®.

Wednesday, March 7, 2012

Helping Patients and Families Cope With Advanced Cancer

A cancer diagnosis can be overwhelming.  For patients diagnosed with an advanced form of cancer, the issues and concerns can be particularly challenging.  To help patients and their loved ones cope with an advanced or late stage cancer diagnosis, the Joan Karnell Cancer Center has developed the Supportive Care Clinic.

“One of our goals is to help patients and their loved ones begin the conversation about the impact of a cancer diagnosis, particularly advanced-stage cancer,” said Clara Granda-Cameron, MSN, CRNP, clinic coordinator.  “Often there are important decisions, both medical and personal, that need to be made immediately. This can be very stressful.”

Patients are encouraged to contact the clinic shortly after receiving a cancer diagnosis. This allows the team to establish a relationship with the patient and their support network. The team consists of Granda-Cameron, a palliative care physician and oncology social workers.

The team works with patients and their loved ones to address issues and concerns such as:
  • Symptom management such as pain, nausea, lack of appetite, fatigue, shortness of  breath, and others
  • Emotional issues such as sadness or anxiety
  • Financial or health insurance concerns
  • Job, family issues, and goals of care
  • Coordination of care
In addition, the Supportive Care Clinic team works in collaboration with the patient’s healthcare provider, offering an extra layer of support. In this way, everyone involved in the patient’s care is working together to help alleviate stress so that patients can focus on fighting their cancer and maintaining the best quality of life.

Because issues can arise throughout cancer treatment, the one-hour sessions can be scheduled as needed.  During a typical session the team meets with the patient and family together, then allows the opportunity for one-on-one sessions at the patient’s or family’s request.

“There are some issues that, perhaps, patients and their loved ones have had difficulty discussing at home. The one-on-one session is a chance to have the support of the team to help them talk through their concerns,” said team member Dana Marcone DeDonato, MSW, LSW.

“The clinic provides a place for patients and their families to discuss what matters most to them and provides a safe environment for them to ask questions and to get honest answers,” said DeDenato.  “Patients who have come to the clinic report that they are ‘relieved’ by the support provided and the knowledge that there is a team of people available to them to help process their experience of cancer and help with decision making.”

To schedule an appointment or for more information on the Supportive Care Clinic, please contact Clara Granda-Cameron, MSN, CRNP at 215-829-8023.

Learn more about the Pain and Supportive Care Program at the Joan Karnell Cancer Center at Pennsylvania Hospital.

Tuesday, March 6, 2012

Recommended Screening Tests for Cancer

A cancer screening is a test that can detect cancer in its early stages or abnormalities that may lead to cancer before symptoms are present. When cancer is detected early, it may be easier to treat and its treatment may have better outcomes.
If you have a genetic predisposition to certain types of cancer, you may need to be screened more often or at an earlier age than the general population.

Some examples of screening recommendations are:
  • Yearly mammograms for women beginning at age 40 and continuing or as long as a woman is in good health.
  • Clinical breast exam every three years for women in their 20s and 30s and every year for women 40 and over.
  • Beginning at age 50, both men and women should follow one of these testing schedules:
    • Tests that find polyps and cancer
      • Flexible sigmoidoscopy every 5 years*, or
      • Colonoscopy every 10 years, or
      • Double-contrast barium enema every 5 years*, or
      • CT colonography (virtual colonoscopy) every 5 years*
    • Tests that primarily find cancer
      • Yearly fecal occult blood test (gFOBT)**, or
      • Yearly fecal immunochemical test (FIT) every year**, or
      • Stool DNA test (sDNA), interval uncertain*
  • All women should begin cervical cancer screening about three years after they begin having vaginal intercourse, but no later than 21 years old. Screening should be done every year with the regular Pap test or every two years using the newer liquid-based Pap test.
  • Beginning at age 30, women who have had three normal Pap test results in a row may get screened every two to three years. Women older than 30 may also get screened every three years with either the conventional or liquid-based Pap test, plus the human papilloma virus (HPV) test.
  • Women 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.
The Centers for Disease Control and Prevention recently reported that many Americans are not getting their recommended cancer screening tests. In fact, a recent report showed that screening rates were significantly lowers for certain ethnic groups, such as Asian and Hispanic. The report also found that screening tests for cervical cancer dipped nearly 3 percent since 2000.

The cancer specialists at Penn’s Abramson Cancer Center remind everyone to get their recommended cancer screening tests. National Cancer Prevention Month serves as a reminder to you’re your screening appointments and follow this blog  for cancer prevention tips, recommendations and articles. 

Learn more about recommended screening tests for cancer.

Find out your risk for cancer with the OncoLink "What's My Risk?" tool.

Learn more about your risk for colorectal cancer at CANPrevent Colorectal Cancer on Friday, March 2, 2012 and CANPrevent Skin Cancer on Friday, May 18, 2012.

Monday, March 5, 2012

Screening for Colorectal Cancer (Video)

March is National Colorectal Cancer Awareness Month, and it is the perfect time to schedule a screening for colorectal cancer.

Screening tests for colorectal cancer can detect cancer at an earlier, more treatable stage. Here, Greg Ginsberg, MD, director of endoscopic services at Penn Medicine, and physician at the Abramson Cancer Center, talks about screening for colorectal cancer.






Get screened for colorectal cancer. Schedule an appointment with a Penn physician today.

Friday, March 2, 2012

Join the Abramson Cancer Center on Twitter

Today, Penn Medicine is live tweeting from three Focus On Cancer conferences.

 

 

 

 

 

Focus on Gastrointestical Cancer Conference

Penn’s Focus On Gastrointestinal Cancer Conference provides patient-focused information about the latest advances in gastrointestinal cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues; as well as the opportunity to network and gain support from other gastrointestinal cancer survivors.

Follow @PennMedicine for live tweeting throughout the conference with the hashtag #GICancerACC.

Chat with the Experts
Visit www.OncoLink.org/Webchat to participate in a live webchat with gastrointestinal cancer experts from the conference. The webchat takes place at 11:45 AM, ET March 2.

Focus on Pancreatic Cancer Conference

Penn’s Focus On Pancreatic Cancer Conference provides patient-focused information about the latest advances in pancreatic cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues; as well as the opportunity to network and gain support from other pancreatic cancer patients and survivors.


Follow @PennMedicine for  live tweeting throughout the conference with the hashtag #PanCancerACC.

You can also join the conference via free livestream at PennMedicine.org/Abramson/PanCaLive from 7:30 am to 3 pm EST on March 2.

Chat with the Experts
Visit www.OncoLink.org/Webchat to participate in a live webchat with pancreatic cancer experts from the conference. The web-chat will take place March 2, 1:15 pm, ET.

CANPrevent Colorectal Cancer Conference

Penn's CANPrevent Colorectal Cancer Conference provides information about colorectal cancer prevention, screening, managing high-risk, and genetic factors that contribute to colorectal cancer.

Follow @PennMedicine for live tweeting throughout the conference with the hashtag #CANPreventACC.

Thursday, March 1, 2012

Cancer-fighting Recipe: White Beans and Winter Greens Gratin

Try incorporating more meatless meals in to your everyday dinners.  This gratin is a wonderfully warming dish.  It can be quite filling and is a great one pot meal in itself.  The beans, greens and tomatoes have cancer fighting properties along with the garlic. The herb thyme in addition to it’s wonderful fragrance, has potential antibacterial properties. If you only have dried thyme available, try substituting ¼ tsp. of dried thyme or more depending on your taste preference.

White Beans and Winter Greens Gratin

Ingredients
1 cup white beans (cannelloni or great northern - use canned beans to save time)
1 bay leaf
1 sprig thyme
1 teaspoon salt
1 large bunch winter greens (mustard, chard, turnip, or a mixture)
2 tablespoons light olive oil
2 garlic cloves, finely chopped
1 cup peeled, seeded, and chopped tomatoes
1/2 teaspoon salt
1/2 cup chicken stock, homemade or canned
Topping:
1 cup of fresh bread crumbs
3 tablespoons light olive oil
1/8 teaspoon salt

Directions
If using dry beans, soak the white beans in 4 cups of cold water for 8 hours or overnight. In a medium pot, add the drained beans, 3 cups of fresh water, and the bay leaf and thyme sprig Simmer the beans for 45 minutes, and then add the salt. Continue cooking for another 15 to 20 minutes or until the beans are tender but not mushy. There should be no more than 1/2 cup of liquid left in the pot. Remove bay leaf and thyme.

Preheat the oven to 350 degrees F. Remove the stalks from the greens and wash and dry leaves. Stack them and cut crosswise into ribbons. In a large pan, sauté and the garlic in oil for approximately 7 minutes or until tender. Add the tomatoes and salt. Mix the beans and their cooking liquid, and the greens. Add some chicken stock if the mixture seems dry and spoon into a 9-inch round or a 10-inch oval oiled gratin dish.

Prepare the topping: Mix the bread crumbs with the remaining 4 tablespoons of oil and 1/4 teaspoon of salt and spread evenly on top of the bans. Bake in the oven for 40 to 50 minutes. Served with a crisp, green salad or a salad of shared fennel and pears, this is a welcome dish for a cold winter day. If you like add some sautéed pancetta or little pieces of harm to the greens and beans mixture before turning it into the grain dish.

Serves 4.

Nutrient analysis for 8 servings: 200 calories, 7g protein, 6g fiber, 1g fat, 250mg sodium.
Adapted from Greens: A Country Garden Cookbook by Sibella Kraus.
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