Prostate Cancer Symptoms Tips What is prostate cancer symptoms? We have tips about prostate cancer symptoms

Ursina Teitelbaum, MD, is a Penn Medicine assistant professor of medicine and medical oncologist specializing in gastrointestinal cancer, caring for older adults and symptomatic management of cancer patients.  In the second of two posts, Dr. Teitelbaum discusses Penn Medicine’s personalized approach to gastrointestinal treatment.

The era of personalized medicine is truly “here and now” in the field of colorectal cancer therapy at Penn Medicine, and it is exciting to work in a cancer center that has so much to offer in this regard.  Penn’s Abramson Cancer Center is devoted to tissue banking and studying strategies to further individualize cancer treatment. When it comes to cancer treatment, one size truly does not fit all.

Beyond traditional therapies, Penn has a very active program in experimental therapeutics or early phase clinical trials — some of which are very well suited for patients with gastrointestinal malignancies like colorectal cancer.  These early phase studies offer therapy for patients who have exhausted standard options and are fit enough to pursue innovative, experimental regimens.

Outside of clinical trials, I also work closely with specialty-trained surgical oncologists who are able to perform advanced surgeries, such as hepatic metastatectomies, thoracic resections, and HIPEC (hyperthermic Iintraperitoneal chemotherapy).  Penn also provides liver-directed therapies offered by interventional radiologists such as transarterial chemoembolization, radioembolization and radiofrequency ablation.

The Roberts Proton Therapy Center is able to deliver pinpoint radiation to tumors with decreased radiation toxicity to the surrounding tissues – this is particularly relevant for patients with liver cancer as the liver is a very sensitive organ.

All of these treatments can be combined to help patients live longer with a better quality of life, and may help patients take breaks from chemotherapy.

Caring for patients – beyond medicine

Beyond treatment, Penn’s cancer physicians strive to care for patients and their loved ones as a whole, recognizing that everyone in the family and friend network is affected by the illness.  I’m grateful that Penn offers nurse navigation, cancer counseling and supportive services, as well as excellent nutrition support.  I work closely with dedicated GI cancer nutritionists who help monitor patients through every phase of their therapy. Penn also has very well established survivorship programs to help patients during their cancer therapy and beyond.

I feel very fortunate to have many therapy options to offer patients.  Whenever I meet a new patient in my clinic, I actively review all the resources available and how best to sequence his or her care.  Every new patient is discussed in a multidisciplinary conference with the medical oncology group, radiation oncologists and surgical oncologists  — and interventional radiology and pathology is often in attendance as well as other support caregivers. 

This team approach helps open every possible avenue for every patient.

The future of colorectal cancer care

During the past 10 years, I have seen colorectal cancer become more treatable due to the discovery and approval of many new chemotherapies for colorectal cancer and biologic antibody therapies.  Even if a patient’s disease isn’t curable, I am confident that it is treatable.  Physicians used to measure life expectancy in months with metastatic disease, but now patients live years – and these are good years.

I collect magnets from all of the distant ports of call that my patients visit as a symbol of the full and active lives they are living, even when undergoing active therapy. Together we celebrate every birthday and joyful life event that these advanced therapies enable my patients to enjoy.

Learn more about the Abramson Cancer Center’s Gastrointestinal Cancers Program.

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.

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.

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.

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.

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.

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

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.

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.