Departments of Nursing

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• Departments of Nursing/
• Health, Nutrition and Exercise Sciences

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Objectives

• Review guidelines to prevent colorectal cancer
  (CRC) with healthy living
• Review screening recommendations for CRC
• Encourage discussion of CRC screening at
  physician appointments

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Cancer DeathsNorth Dakota

• Cancer (all types) second-leading cause of death
• Colorectal cancer ranks second
• Lung Cancer 1st
• Colorectal Cancer 2nd
• Breast Cancer 3rd
• Prostate Cancer 4th
• www.cdc.gov/cancer/CancerBurden/nd.htm

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Preventable and treatable Colorectal cancer

• On average, 13 years of life lost
• 93 of cases in people over 50
• 75 of cases in people of average risk
• The disease no one has to die from.

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What is the prescription for healthy living?

• Dont smoke
• Eat a healthy diet
• Maintain a healthy weight
• Exercise regularly
• Limit alcoholic beverages
• Helps prevent cancer, heart disease and diabetes
• Eyre H et al. Cancer J Clin. 200454190-207.
  Byers T et al., CA Cancer J Clin 20025292-119.

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Smoking Increases CRC risk

• 1. Stop smoking!
• Tobacco use
• Single largest preventable cause of disease and
  premature death in the U.S.
• Smoking
• Shown to cause CRC and 13 other cancers

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The New American PlateAmerican Institute of
Cancer Research

• Meal patterns for a healthful life!

Milk 8 fl. oz.
Fruits ½ cup
Whole Grains 2 oz. equivalents
Vegetables 1½ cups
Meat, Beans, Seeds 2-3 oz. equivalents
Healthy Oils 2 tsp. equivalents
www.aicr.org
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Emphasize Plant SourcesReduces risk of CRC

• Include fruits and vegetables
• Dietary Guidelines
• 1½-2 cups fruits
• 2½-3 cups vegetables
• Include whole grains, beans, seeds and nuts

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Meat Variety and ModerationReduces risk of CRC

• Follow Dietary Guidelines
• Include a variety of lean meat/protein sources
• Use smaller portions for a total of 5-6½ oz./day
• Limit high-fat, processed meats
• Limit cooking at high temperatures
• Suggest braising, steaming, poaching, stewing,
  microwaving meats

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Calcium and Vitamin D Reduces risk of CRC
Fortified fluid milk Most reliable daily source
for both

• Vitamin D -sunshine vitamin
• Produced in the skin in sunlight
• Calcium sources
• Dairy products (milk, yogurt, cheese)
• Fortified grains and orange juice
• Calcium supplements

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Folic Acid Reduces risk of CRC

• Include food sources
• Fortified breakfast cereals
• Enriched grain products
• Orange juice and other fruits
• Green, leafy vegetables
• Beans, nuts and seeds

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SeleniumReduces risk of CRC

• Include food sources
• Protein-rich foods (meats, fish, beans, seeds,
  breads and cereals, milk)
• Content of food varies depending on the selenium
  content of soil

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Alcohol Moderation reduces risk of CRC

• Limit alcohol intake
• Women - One drink or less per day
• Men - Two drinks or less per day
• CRC risk increases substantially
• More than two drinks per day

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Maintain a Healthy Weight Reduces risk of CRC

• Overweight and Obesity
• Associated with up to 2/3 of all cancers
• Associated with a greater risk for colon cancer
• North Dakota statistics
• More than 60 of adults either overweight or
  obese

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Physical Activity (PA)Reduces risk of CRC

• Recommend
• 30 minutes or more
• 5 or more days each week
• Best reduction of risk
• 45 minutes or more of moderate to vigorous PA
• 5 or more days each week

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ScreeningReduces risk of CRC

• Early detection and removal of polyps provides a
  greater than 90 cure rate!

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CRC Screening Methods - Age 50

• Annual - Fecal Occult Blood Test -OR
• Every 5 years - Flexible Sigmoidoscopy -OR
• Combination of tests
• Annual - Fecal Occult Blood Test
• Every 5 years - Flexible Sigmoidoscopy
• -OR
• Every 10 years - Colonoscopy
• -OR
• Every 5 years - Double Contrast Barium Enema

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Fecal Occult Blood Test (FOBT)CRC screening
procedure

• FOBT detects blood in stool
• Polyps and CRC can bleed slowly
• Blood hidden in the stool
• Convenient - done at home
• Costs 3.50
• Medicare pays
• Most health insurances cover cost
• Ouyang DL et al., Am J Gastroenterol.
  20051001393-1403.

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Endoscope ProceduresVisualization of the colon

• Flexible sigmoidoscopy
• Examines lower third
• Colonoscopy
• Examines entire length

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Double Contrast Barium EnemaCRC screening
procedure

• Barium added to the enema solution
• X-rays taken of colon
• Barium outlines lining of the colon to detect
  polyps or abnormalities
• Suggested once every 5 years

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What are polyps?

• Start small and grow larger over time
• May bleed into the colon
• Use FOBT to check
• May become cancerous

David M. Martin, M.D. and Atlanta South
Gastroenterology, P.C. - www.endoatlas.com
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Removal of polypsOutpatient endoscope procedure

• Visualize
• May appear like a mushroom on a stalk
• Remove with a wire loop
• Painless
• Takes only minutes
• Analyze
• To determine if cancerous

David M. Martin, M.D. and Atlanta South
Gastroenterology, P.C. - www.endoatlas.com
Benign polyp (noncancerous)
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Early cancerous polyps Cured by wire loop
David M. Martin, M.D. and Atlanta South
Gastroenterology, P.C. - www.endoatlas.com
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Screening statisticsNorth Dakota (Age 50)

• FOBT in past two years 21
• Ever had a sigmoidoscopy or colonoscopy 54

• Screening needed for early detection!
• http//apps.nccd.cdc.gov/brfss (2004)

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People at high risk for CRCStart screening
before age 50

• Personal or family history
• Polyps or colorectal cancer
• Ulcerative colitis or Crohns disease

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Ask your doctor!Arrange to be screened for CRC

• Now that Im 50, what tests for cancer should I
  have?
• Ive read that theres more than one test for
  colon cancer. Which one do you think is right for
  me?
• www.cancer.org

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Symptoms of late CRCSee your doctor for a
diagnostic workup!!!
Symptoms persisting for more than two weeks

• A change in bowel habits
• Diarrhea or constipation
• Feeling the bowel does not completely empty
• Vomiting
• Abdominal discomfort (gas, bloating, cramps)

• Weight loss for no known reason
• Unexplained anemia
• Any blood in the stool - merits a follow-up!
• (Do not assume blood is from hemorrhoids)

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Late CRCOnly an 8 survival rate
David M. Martin, M.D. and Atlanta South
Gastroenterology, P.C. - www.endoatlas.com
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Screening saves lives!

• More than 90 of CRC deaths are preventable
• With healthy lifestyles
• With removal of benign or precancerous polyps
• With early detection of cancer and treatment

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• Thank you!
• Developed by
• Beverly Greenwald, PhD, RN
• Assisted by
• Jane U. Edwards, PhD, LRD