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The body's 'sentinel' prevents the spread of tumours

Researchers at Karolinska Institutet have discovered a new method of treating advanced colorectal cancer without the need for chemotherapy. By removing special lymphocytes (white blood cells), cultivating them and returning them to the patient's body, scientists can strengthen the patient's immune defence and stop the spread of the tumour.
Kjell Dahl is a specialist physician at Stockholm South General Hospital. In his thesis, he presents immunotherapy as an alternative to chemotherapy (cytotoxins and cytostatics) for the treatment of advanced colorectal cancer. The method has no adverse effects and may save and prolong the lives of seriously ill patients.
Cancer tumours in the large bowel spread into the body through the lymphatic system, passing into the lymph nodes via the lymphatic vessels. The first lymph node passed is commonly called the sentinel node, from where the lymph spreads in different directions around the body. The sentinel node is therefore a good indicator of whether or not the cancer has spread. The lymph nodes contain lymphocytes, which form part of the body's immune defence. Different lymphocytes react with and kill different intruders that invade the body.
The scientists have managed to identify the sentinel nodes during surgery and have found the lymphocytes that attack cancer tumours in the large bowel. They have also succeeded in isolating the lymphocytes and cultivating them in vitro, and then returning them to patients via blood transfusions. This procedure, which strengthens their immune defence, is called immunotherapy and has no adverse effects since it uses the body's own material.
"Patients treated with this method fared better than those treated in the conventional way," says Dr Dahl. "In some patients, the tumour was completely eradicated. The average lifespan of patients with serious forms of advanced colorectal cancer was prolonged from less than a year to, on average, just over two and a half years."
The scientists have also discovered that it is possible to identify the first draining lymph node of the daughter tumours of a tumour (metastases), and that these nodes also contain tumour-reactive lymphocytes. These nodes are called metinel nodes and they too can be isolated and cultivated in vitro before being returned into the patient's body.
Dr Dahl stresses that the study has its limitations, but also that the indications are good. A more broad-based trial is now being planned in a multi-centre study to be run by SentoClone, a company specialising in immunotherapy.
"Human colorectal cancer: Experimental staging and therapeutics", Kjell Dahl, Institutionen för klinisk forskning och utbildning, Södersjukhuset, Karolinska Institutet.
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Study Suggests Vitamin D Improves Survival From Colorectal Cancer

A study led by Kimmie Ng, M.D., M.P.H., of the Dana-Farber Cancer Institute has found that colorectal cancer sufferers with high levels of vitamin D had better survival rates during a follow-up period when compared to those with low levels of the vitamin. The study also involved the Harvard School of Public Health, Brigham and Women’s Hospital and the Medical University of South Carolina.These findings are significant because, while previous research have shown a link between vitamin D levels and colorectal cancer occurrence, this study actually establishes correlation between levels of vitamin D in the blood with survival among persons who have already developed colorectal cancer.Methodology and DetailsThe study, reported in a June issue of the Journal of Clinical Oncology, looked at data pertaining to 304 persons who had participated in the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS) -- these studies monitored the health of participants for many years.The 304 persons had been diagnosed with colorectal cancer from 1991 to 2002 and also had their blood vitamin D levels measured at least two years before their cancer diagnoses.The patients were categorized into four quartiles according to the measured levels of 25-hydroxy vitamin D3 (25(OH)D) levels in their blood -- top 25%, next 25%, and so on. 25(OH)D levels in the blood reflect the body’s store of all sources of vitamin D, including that from diet, supplements, as well as that synthesized by the body after exposure to sunlight. The patients were then observed till January 2005 (for the HPFS) or June 2005 (for the NHS), or until they passed away, whichever took place first.During the follow-up period, 123 persons passed on, with the cause of death being colon cancer or rectal cancer for 96 of them.The study found that persons in the top quartile -- in other words those with the highest measured levels of vitamin D in their blood -- were 48% less likely to die in the follow-up period than those in the bottom quartile. This figure relates to death from any cause. With specific regard to colorectal cancer, the reduction in risk was found to be 39%. This is a significant relationship.The results remained largely unchanged even after the exclusion of patients who were diagnosed within 5 years of having their blood samples collected.The study, partly supported by grants from the National Cancer Institute, concluded that "among patients with colorectal cancer, higher pre-diagnosis plasma 25(OH)D levels were associated with a significant improvement in overall survival".And the protective effects of vitamin D are not restricted to colorectal cancer. For example, a study on non-small-cell lung cancer (NSCLC) reported in the Journal of Clinical Oncology in Feb 2007 concluded that "vitamin D may be associated with improved survival of patients with early-stage NSCLC, particularly among stage IB-IIB patients".Possible LimitationsThe nature of the study could make its findings limited in some ways. For example, the sample size of the study, especially those who did die from colorectal cancer, was relatively small.There were also variations in the time period between the point of vitamin D measurement and cancer diagnosis. In addition, information on the treatment taken by the cancer patients was not taken into account.Then, there may be related factors which could contribute to the difference in survival rates. For example, those with higher vitamin D levels in their blood also tended to be physically more active.However, even after physical activity, body-mass index (BMI) and other factors which influence cancer survival were controlled, the association between higher levels of vitamin D and better survival rates was still independently significant.Thus, all in all, despite these limitations, the findings of the study are still important.Previous Studies on Vitamin D and Prevention of Colorectal CancerThe role of vitamin D in battling colorectal cancer becomes more pronounced when we consider its protective effects against the disease. As mentioned earlier, numerous other studies have already shown vitamin D to have a preventative effect on colorectal cancer.For example, a pooled analysis of the results of five previous serum studies carried out by the University of California, San Diego in 2006 concluded that 'the evidence to date suggests that daily intake of 1000-2000 IU of vitamin D(3) could reduce the incidence of colorectal cancer with minimal risk'.In Jan 2007, the American Journal of Epidemiology reported the findings of a multi-ethnic study which "support the hypothesis of protective roles for calcium, vitamin D, and dairy products in the risk of colorectal cancer".Another study conducted by the National Cancer Center in Tokyo, Japan and published in July 2007 suggested that "a low level of plasma 25(OH)D may increase the risk of rectal cancer".Should Cancer Patients load up on Vitamin D?Investigators involved in the NHS / HPFS study feel that it is premature to recommend vitamin D supplements as part of cancer treatment. Dr. Ng has advised that current sufferers of the disease should consult their doctors regarding vitamin supplementation, and she suggested that future studies should look at the use of vitamin D supplements by colorectal cancer patients.Sources of Vitamin DThe truth is, there are some studies which suggest that dietary vitamin D does not significantly lower the risk of colorectal cancer. However, according to "A Critical Review of Studies on Vitamin D in Relation to Colorectal Cancer", authored by William B. Grant and Cedric F. Garland, the likely reason for this is that "dietary sources provide only a portion of total vitamin D, with supplements and synthesis of vitamin D in the skin in association with solar UV-B radiation providing the balance".Further, in "Do sunlight and vitamin D reduce the likelihood of colon cancer?", Cedric F Garland and Frank C Garland state that "the strong inverse association of sunlight and colon cancer raises the possibility that vitamin D, which prevents rickets, may also act in the prevention of colon cancer".What Next?How do all these add up?Colorectal cancer is today one of the major causes of death in the United States and many first world countries. Somewhat surprisingly, though, relatively little research has thus far looked into the impact of lifestyle factors on the survival prognosis of colorectal cancer patients. This includes lifestyle habits both during active cancer treatment as well as after.With the health benefits and immune-boosting effects of sunshine and vitamin D well-documented, there is really no need to wait for bigger and better designed studies to empirically prove that vitamin D forms a useful part of the arsenal against colorectal cancer. Instead, as part of an overall healthy lifestyle, it is an extremely good idea to spend some time out in the open, without sunscreen, to enjoy moderate sun exposure.Throw in some exercise -- according to the Textbook of Cancer Epidemiology, physical activity is also linked to better survival rates from several types of cancer, including colorectal cancer -- and we have got a much more potent mix in the battle against colon and rectal cancers.Main sources:Circulating 25-Hydroxy vitamin D Levels and Survival in Patients With Colorectal Cancer ( 25-Hydroxy vitamin D Levels Predict Survival in Early-Stage Non–Small-Cell Lung Cancer Patients ( vitamin D status for colorectal cancer prevention: a quantitative meta analysis ( and Vitamin D Intake and Risk of Colorectal Cancer: The Multiethnic Cohort Study ( vitamin D and risk of colorectal cancer: the Japan Public Health Center-Based Prospective Study ( A Critical Review of Studies on Vitamin D in Relation to Colorectal Cancer ( sunlight and vitamin D reduce the likelihood of colon cancer? (
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'Snus' is linked to a doubled risk of cancer

People who use Swedish moist snuff (snus) run twice the risk of developing cancer of the pancreas. This is the main result of a follow-up study conducted by Karolinska Institutet researchers amongst almost 300,000 male construction workers. The study is published in the medical journal The Lancet.
Tobacco smoking is a known risk factor for pancreatic cancer, which is an unusually malignant form of the disease. Since it is common for people who take snus - a tobacco product designed for insertion between the gum and upper lip - to also smoke cigarettes, the challenge facing epidemiological research into snus and cancer has been to isolate the effects of the different kinds of tobacco. What makes this study unique is that it has been possible to study the correlation between snus and cancer risk in a large enough group of men who have never smoked.
The subjects attended health check ups between 1978 and 1992, during which they were asked to report on their smoking and 'snusing' habits. The researchers have also studied rates of oral and lung cancer amongst the men, but found no correlation to snus.

"We're actually not that surprised," says project leader Professor Olof Nyrén of the Department of Medical Epidemiology and Biostatistics. "Pancreatic cancer has been under discussion in several earlier epidemiological studies on humans, both regarding Scandinavian snus and American smoke-free tobacco. On the other hand, previous studies of oral and lung cancer in relation to Scandinavian snus have been negative."
The main contribution of the new study is its conclusion that Swedish moist snus can be carcinogenic. However, the study also shows that the risks for users are small, and, as far as can be judged, much smaller than the risks associated with smoking.
"If 10,000 non-smoking snus users are monitored for ten years, according to our data, eight or nine of them will develop pancreatic cancer, as opposed to four amongst those who use neither product. But 9,991 wont, so the odds arent that bad," he says.
The debate on whether the net effect of snus is positive or negative has been raging for many years. Some scientists and health carers have advocated the use of snus, as it is likely to lead to that people will smoke less. However, Professor Nyrén argues that it is important to have all the facts on the table before any advice can be given about snus as a way to cut down on smoking.
"We don't only need reliable and accurate measures of the risks of both smoking and taking snus, we also need know the effects of other, alternative methods to cut smoking. We also have to be certain that an increase in snus marketing will not cause addictions in young people who otherwise wouldnt have started to smoke," he says.
Luo J, Ye W, Zendehdel K, Adami J, Adami HO, Boffetta P, Nyrén O
Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung and pancreas in male construction workers; a retrospective cohort study
Lancet, 2007 Jun 16;369(9578):2015-20
Link to the abstract in PubMed

A New Discovery Has Been Made About How Antioxidants Attack Cancer Cells

There's a new reason, and a big one, to think that we benefit from free-radical-inhibiting antioxidants. We've long thought that by reducing free radicals, antioxidants can help prevent cancer, of course. But a recent experiment at Johns Hopkins and published in the March 14 issue of Science shows how antioxidants may be doing much more: interfering with the growth of cancers that are already established, and potentially, even reversing them once established, by knocking out communications signals between cancer cells that encourage cells to grow and divide. Those communications signals turn out to be... free radicals, which the cancer cells often produce in abundance. Runaway cell division was actually slowed when cancer cells were introduced to the antioxidant N-acetyl-L-cysteine, under experimental conditions. This now demonstrates the existence of a mechanism that can allow a simple antioxidant to slow down or reverse a cancer that's already in place.Genetically altered connective tissue cells expressing the cancerous H-RasV12 gene, together with non-cancerous cells were used in the study. The cancer cells produced an abundance of superoxide, a well-known free-radical. But cells' Ras or Rac1 genes produced proteins that blocked this signal and kept the cell from turning cancerous, as did doses of other protein inhibitors. However, it was considered more significant that antioxidants could also inhibit runaway cell proliferation.At least in the case of cancers produced by the model H-RasV12 gene, other cells are influenced to become cancerous "at a distance" if free radicals or protein-inhibitors aren't present in sufficient numbers to step in and stop the process.Kaikobad Irani cautiously summarizes his research by saying that "Control of signaling pathways involving oxidants may explain why some antioxidants appear to prevent development of certain cancers." If you're equally inclined to caution, you may wish to make sure you're getting plenty of antioxidants.There are plenty of sources of antioxidants in a good diet, of course, but by far the most potent and effective antioxidant known to science is as cheap and available as a long, dark night: that is, melatonin. Turning your light switch to the off position earlier, keeping it off longer, and making sure that you are always sleeping in real darkness are excellent natural ways to boost your melatonin production. Even occasional changes in your routine, staying up for a couple of extra hours, can reduce your melatonin for weeks, just as jet lag does.
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No risk of cancer-spread via blood transfusions

Cancer patients are usually not accepted as blood donors, but it can happen that people with an undetected growth still donate. Researchers at Swedish medical university Karolinska Institutet have therefore studied whether cancer cells can be transferred via the blood and cause cancer in the recipient. Their answer is published in this week´s issue of the medical journal The Lancet: cancer can not be transmitted through blood transfusion.
"The results, which have to be considered reliable, settle one of the few remaining questions surrounding the safety of blood transfusions," says Professor Olof Nyrén of the Department of Medical Epidemiology and Biostatistics and the leader of the project.

The study was carried out in collaboration with researchers at Statens Serum Institut in Copenhagen. Digital information on 1.13 million blood donors and 1.31 million transfusion recipients in Sweden and Denmark was gathered, allowing the scientists to identify over 12,000 patients who had received blood from donors who were diagnosed with cancer within five years of the transfusion.
The recipients were followed for as long as 34 using record linkage with the Swedish and Danish cancer and cause-of-death registers and other such data. The control group consisted of 342,000 patients who could be said with certainty to have not received blood from donors with latent cancer. The cancer risk of the two groups were compared using statistical methods, taking into account sex, age, place of residence, blood group, number of transfusions and time since the first transfusion.
The team found that the patients in the two comparison groups had exactly the same cancer risk. No matter how the data was analysed, there was no evidence to suggest that patients who had received blood from donors with a yet undiagnosed tumour ran a greater risk of developing cancer themselves.
"Even though transfusion procedures are very safe, we are still constantly trying to identify any possibly overlooked risks," says Professor Nyrén. "The Swedish-Danish database that was built for this project can come in very useful here too."
Edgren G, Hjalgrim H, Reilly M, Tran TN, Rostgaard K, Shanwell A, Titlestad K, Adami J, Wikman A, Jersild C, Gridley G, Wideroff L, Nyrén O, Melbye M
Risk of cancer after blood transfusion from donors with subclinical cancer: a retrospective cohort study
The Lancet, 2007 May 19;369(9574):1724-30
Link to the abstract in PubMed

New breast cancer genes discovered

A major international study has identified five new areas in the human genome that affect the risk of developing breast cancer. Their findings reveal that the hereditary components of the disease are located at sites completely different to those where scientists have long been looking.
The large internationally collaborative study, which is presented in the journal Nature, is based on a unique study of the genomes of over 40,000 women. The scientists have now found five genetic variants that are more common in women with breast cancer than in healthy women.

"We can associate four of these variants to specific genes, and it is only one of these genes that scientists previously suspected as being associated with breast cancer," says Per Hall, one of the research scientists at Karolinska Institutet involved in the study. "This gene has nothing to do with oestrogen, which is in itself very surprising. The other genes still remain largely uncharted and are completely new for breast cancer research."
In the 1990s, it was discovered that rare hereditary mutations of a handful of genes, such as BRCA1 and BRCA2, can greatly increase the risk of breast cancer. The gene variants that how now been linked to breast cancer are, on the other hand, extremely common. Taken individually, each one has only a very small effect; in combination, however, such small changes are likely to be highly significant. The knowledge of which variants cause breast cancer can lead to the development of more effective drugs.
"Our objective is also to identify high-risk women at an early stage, so that we can give them more frequent mammographic examination and take preventative measures when they become available. This we can do by carrying out more large-scale studies of this type," says Per Hall.
Easton DF, Pooley KA, Dunning AM, Pharoah PD, Thompson D, Ballinger DG, Struewing JP, Morrison J, Field H, Luben R, Wareham N, Ahmed S, Healey CS, Bowman R, Meyer KB, Haiman CA, Kolonel LK, Henderson BE, Le Marchand L, Brennan P, Sangrajrang S, Gaborieau V, Odefrey F, Shen CY, Wu PE, Wang HC, Eccles D, Evans DG, Peto J, Fletcher O, Johnson N, Seal S, Stratton MR, Rahman N, Chenevix-Trench G, Bojesen SE, Nordestgaard BG, Axelsson CK, Garcia-Closas M, Brinton L, Chanock S, Lissowska J, Peplonska B, Nevanlinna H, Fagerholm R, Eerola H, Kang D, Yoo KY, Noh DY, Ahn SH, Hunter DJ, Hankinson SE, Cox DG, Hall P, Wedren S, Liu J, Low YL, Bogdanova N, Schürmann P, Dörk T, Tollenaar RA, Jacobi CE, Devilee P, Klijn JG, Sigurdson AJ, Doody MM, Alexander BH, Zhang J, Cox A, Brock IW, MacPherson G, Reed MW, Couch FJ, Goode EL, Olson JE, Meijers-Heijboer H, van den Ouweland A, Uitterlinden A, Rivadeneira F, Milne RL, Ribas G, Gonzalez-Neira A, Benitez J, Hopper JL, McCredie M, Southey M, Giles GG, Schroen C, Justenhoven C, Brauch H, Hamann U, Ko YD, Spurdle AB, Beesley J, Chen X; kConFab; AOCS Management Group, Mannermaa A, Kosma VM, Kataja V, Hartikainen J, Day NE, Cox DR, Ponder BA.
Genome-wide association study identifies novel breast cancer susceptibility loci
Nature, 2007 Jun 28;447(7148):1087-93
Link to the abstract in PubMed

Fermented Wheat Germ Extract Beneficial in Cancer Therapy

Wheat germ is the most nutritious part of the wheat kernel. In fact, it is one of the most nutritionally dense foods available. When subjected to yeast fermentation, wheat germ becomes a source of two biologically active substances: 2-methoxy-benzoquinone and 2,6-dimethoxy-benzoquinone. Following fermentation, the resulting product can be standardized to a benzoquinone concentration that is capable of producing the desired health effects.Investigation into the biochemical significance of fermented wheat germ began with Albert Szent-Györgyi. Szent-Györgyi was a Hungarian physiologist, credited with the isolation of vitamin C, and recipient of the 1937 Nobel Prize in Physiology or Medicine. He strongly believed in the idea of food as medicine. Szent-Györgyi noticed lower cancer rates among those who ate whole grains, compared to those eating mostly refined grains. This led him on a search to uncover the ingredient in wheat that might explain the observed cancer prevention. Later, he was able to demonstrate the potential of benzoquinone compounds in relation to cancer cell metabolism. Unfortunately, it was difficult to isolate a sufficient amount, and to achieve consistent concentrations, of the fermented product, which prevented Szent-Györgyi from taking his research to the next level.Availability and classificationSzent-Györgyi’s efforts laid the groundwork for further research and development that continues today. New and improved industrial technologies have solved the problems of production and standardization. Now, a new generation of Hungarian scientists has picked up where Szent-Györgyi left off. Dr. Máté Hidvégi developed and patented an extract of fermented wheat germ, called Avemar®.Avemar was initially released in Hungary, as a dietary supplement, in 1998. After demonstration of its anti-cancer activity, Avemar received approval for clinical studies. Based on those results, it was registered as a medical nutriment for cancer patients in 2002. Under this registration, it is recommended as a complement to cancer treatment during and after surgery, radiotherapy, chemotherapy and immunotherapy.It has since been registered for the same indications in Bulgaria and the Czech Republic, with registration pending in several other countries. In the United States, Avemar is classified as a dietary supplement, and is distributed under the name of Avé®.How does Avemar work?Mechanisms of action responsible for Avemar’s anti-cancer and immunoregulatory properties include:* Prevents cancer cell proliferation* Induces programmed cell death in cancer cells* Enhances the immune system’s ability to target cancerous cells* Increases recovery rate of immune function following immunosuppressive therapies* Decreases uptake of glucose by tumor cells* Promotes balance between cellular and humoral immunity, thus regulating the immune responseThis last point refers to one of the most interesting properties of Avemar. In cases of cancer, Avemar stimulates the immune system. In cases of autoimmunity (e.g. rheumatoid arthritis, systemic lupus erythematosus), it offers appropriate immunosuppressive effects. At first glance, this appears contradictory. However, Avemar is able to exert these seemingly opposite effects through its action on different segments of the immune system.In most cases, cancer therapy complemented with Avemar is proven to be more effective than conventional treatment alone. Avemar not only enhances these treatments, but also reduces their damaging side effects.Avemar itself has no adverse effects, and shows no toxicity toward normal cells.Evidence for the supportive role of Avemar in cancer treatmentA study examining the use of Avemar in patients with colorectal cancer, found significant improvements in those patients supplemented with Avemar. The Avemar group received traditional cancer therapy along with Avemar supplementation, whereas the control group received only traditional treatment. The results showed a significant reduction in new cancer recurrences (3% vs. 17.3%), new metastases (7.6% vs. 23.1%), and deaths (12.1% vs. 31.7%). The authors concluded that supportive use of Avemar is highly recommended in colorectal cancer treatment. This study was reported in the Orvosi Hetilap Hungarian Medical Journal.Another study, from the British Journal of Cancer, reported similar findings. Supplementation of conventional cancer therapies with Avemar was found to improve progression-free and overall survival probabilities.A research review, by the Hungarian Association of Oral and Maxillofacial Surgeons, found that the progression of malignant tumors of the oral cavity was slowed significantly with the use of Avemar. Furthermore, the five-year survival rate of patients was increased, and quality of life was improved.The International Journal of Cancer reports a study evaluating the supportive use of Avemar in high-risk melanoma patients. Again, the time to progression and the probability of progression-free survival were increased in favor of patients taking Avemar. Fewer side effects were also noted in these patients.As impressive as these results are, they represent only a fraction of the total published research on Avemar. There are currently more than 20 publications in peer-reviewed medical journals alone. Research has been funded by many government organizations including the Hungarian Scientific Research Foundation, the Ministry of Health in Spain, the Clinical Nutrition Research Unit of the University of California Los Angeles, INCO-COPERNICUS of the European Union, as well as NATO’s Scientific Program.References:Avemar®(® Product Research(® Research Publications:( Biosciences, Inc.(

Difficult to give prognosis for prostate cancer

A common prognostic method for men diagnosed with localised prostate cancer turns out to be less effective than was previously thought, according to a new study by scientists at Karolinska Institutet. The research team measured concentrations of PSA (Prostate-specific Antigen) in the blood of a group of cancer patients and then monitored the development of the disease.

The present study was conducted as part of the Scandinavian Prostate Cancer Group collaboration (project SPCG-4). The conclusion drawn by the research team is that the PSA value for the period after the diagnosis is insufficient as a method of distinguishing with any certainty the men who will develop a fatal cancer from those with a slower tumour growth. In general, men with localised prostate cancer have a good chance of surviving the disease, even without treatment. Yet many still undergo major surgery or radiotherapy, which carries the risk of impaired sexual function and urine incontinence.
"We have to find better methods of separating the patients who will develop malignant prostate cancer from those with a more benign disease," says PhD Katja Fall at Karolinska Institutet, one of the scientists behind the study. "This is important, not only to avoid unnecessary suffering, but also to make sure that hospital resources are directed towards the patients who need it most."
Previous research has shown that there is a link between how quickly the tumour will grow and the speed with which blood levels of PSA increase in the first stages of the cancer. To examine how accurately PSA development can predict the patient´s prognosis, Dr Fall and her colleagues in the Scandinavian Prostate Cancer Group monitored 267 men from Sweden, Finland and Iceland diagnosed with prostate cancer between 1989 and 1999.
The PSA values measured in the first two years after diagnosis were used to describe the appearance of the early PSA curve for each patient. On follow-up at the end of 2003, 34 patients had died of prostate cancer and 18 had developed metastases but were still alive. Despite the fact that the PSA reading and the speed with which it increased during these first two years correlated with the development of aggressive prostate cancer, neither of these values was able to screen out with any certainty which patients would have needed intensive treatment from amongst those who would have managed just as well without.
Fall K, Garmo H, Andrén O, Bill-Axelson A, Adolfsson J, Adami HO, Johansson JE, Holmberg L
Prostate-Specific Antigen Levels as a Predictor of Lethal Prostate Cancer
Journal of the National Cancer Institute, 2007 Apr 4;99(7):526-32
Link to the abstract in PubMed
More about Katja Fall's research
Department of medical epidemiology and biostatistics
Scandinavian Prostate Cancer Group

Body's own cells a new way to fight cancer

When a person develops cancer, the body's immune defence is activated to destroy the tumour cells. By removing the most effective defence cells from the body, multiplying them and then returning them to the patient, scientists can help the body to fight the cancer itself. This immunotherapy is now being tested on several different types of cancer.
Immunotherapy is about giving the body's own defences a head-start. When a tumour develops, the immune system normally starts to try to fight the cancer. But it does not always succeed, as tumour cells have various ways of getting round the body's defences. For several years scientists at Karolinska Institutet have been working on a way of helping the bodys defence cells - lymphocytes - to beat the tumour.
Tumours spread through the body when tumour cells become detached and travel through the lymph vessels to the lymph nodes. The new method is based on identifying the "sentinel node" - the first lymph node draining the tumour. Virtually all of the bodys various types of lymphocytes will be found here. These kill invaders such as viruses and bacteria, and can also destroy tumour cells. In this way they protect the rest of the body against the spread of the tumour by fighting tumour cells arriving through the lymphatic fluid. The cells on which the scientists at Karolinska Institutet have been focusing are known as CD4 cells.
"CD4 cells stay in the body and remember a tumour for the rest of our lives, even after treatment is finished and the tumour has disappeared," explains researcher and surgeon Magnus Thörn. "They act as a vaccine against that particular type of tumour."
To get hold of the cells which are active against a tumour, the sentinel node where they will be found needs to be identified. This is done by injecting a blue dye around the tumour, which then spreads through the lymph. The first lymph node is soon revealed because it turns blue. The scientists can then remove the CD4 cells from the sentinel node and identify the ones which are active against the tumour. These cells are cultured in the laboratory together with parts of the tumour and other substances from the body to stimulate them to divide and multiply. Some 400-500 million cells can be grown over the next 28 days and then returned to the patient through a blood transfusion. This method - known as the SentoClone method - has managed to increase the survival of patients with metastatic colon cancer by more than 18 months relative to the standard treatment.
"We've been able to reduce or even eliminate tumours in these patients, both solid tumours and metastases where the cancer has spread," says Thörn. "As the cells come from the patients themselves, we haven't seen any side-effects, which can be very severe with other forms of cancer treatment."
Together with Ola Winqvist, associate professor of clinical immunology at Karolinska Institutet, Thörn has also started up a company, SentoClone AB, to develop the method. The results to date come from a small unpublished study. The next step is a larger study of 80 patients with colon cancer at ten different hospitals, as well as smaller studies of malignant melanoma, bladder cancer and ovarian cancer.
If the sentinel node is free from tumour cells, this is a sign that the cancer has not yet spread. However, if it does contain cells from the tumour, this means that metastases may have taken place and that the cancer is also to be found in other parts of the body, Magnus Thörn explains. This led him to ponder the reasons why a tumour does or does not spread.
"Our hypothesis is that it's not the tumour's aggressiveness which determines whether it spreads in the body, but the properties of the lymphocytes which fight the tumour," he says. "We know that the lymphocytes in patients with metastatic cancer have reduced activity. It has also been shown that patients with lots of CD4 cells in the tumour live longer."
Recently the researchers reported that they had been able to find similar defence cells in the lymph nodes of patients with ulcerative colitis. These patients sometimes develop the early stages of cancer and run an increased risk of bowel tumours. The researchers hope that immunotherapy may also be useful in reducing the risk of future cancer in these patients.

Night Lights Cause Breast Cancer While You Sleep

A lack of darkness at night may increase a woman's risk of developing breast cancer, according to a study conducted by researchers from the University of Haifa, Israel, and published in the journal Chronobiology International.Researchers used NASA satellite maps to determine how much light was emitted into space from various neighborhoods across Israel at night, which they believed should approximate how bright those neighborhoods are. They then overlaid this map with breast and lung cancer statistics for the same neighborhoods.As predicted, the researchers found no connection between light levels and lung cancer, but found that women living in neighborhoods with "average" lighting had breast cancer levels 37 percent higher than those living in neighborhoods with low night light levels. Women in communities with the most nighttime lighting had breast cancer rates 64 percent higher than women in communities with the least light."By no means are we saying that light at night is the only or the major risk factor for breast cancer," said lead researcher Itai Kloog, "but we found a clear and strong correlation that should be taken into consideration."Prior research has found higher cancer levels among rats kept in lighted cages at all times, and also among humans who work night shifts. This research has led the World Health Organization to classify night shift work as a "probable carcinogen."Because lung cancer is caused primarily by smoking, however, researchers believe that the effects of light on the risk of that particular cancer are minimal.Scientists believe that the carcinogenic effect of night shift work comes with the fact that light prevents the body's production of the tumor-suppressing hormone melatonin, which is normally produced at night. Light in the blue spectrum, such as that emitted by fluorescent bulbs, is particularly damaging to the body's ability to make melatonin.Supporting this hypothesis is the fact that blind women, who cannot sense light and who have higher than average melatonin levels, have lower breast cancer rates than other women.

New gene test for prostate cancer at hand

Men with susceptibility for prostate cancer will soon be identifiable through a simple DNA test. So hope scientists at the Swedish medical university Karolinska Institutet, who have shown that men carrying a combination of known risk genes run a four to five times higher risk of developing prostate cancer.
At present, men with suspected prostate cancer are identified mainly using what are known as PSA tests. However, the test has a relatively low sensitivity and better methods are needed.

"In the near future, it will be possible to combine PSA tests with simple genetic tests," says Professor Henrik Grönberg at Karolinska Institutet. "This means that fewer men will have to undergo unnecessary biopsies and that more prostate cancer diagnoses can be made."
It has long been known that prostate cancer is partly caused by inherited factors, which makes some men more likely to develop the disease than others. Five relatively common gene variants that affect this risk have so far been identified. However, each of these variants affects the risk only marginally, and knowledge of them has been of no real benefit to individual patients.
Now, however, a research group at Karolinska Institutet and their American colleagues have analysed for the first time the cumulative effect of these gene variants. The results, which are published in the prestigious scientific periodical The New England Journal of Medicine, shows that men who carry four or more risk variants run a four to five times greater risk of developing prostate cancer. This risk is increased even more if they also had close relatives with the disease.
According to the researchers, this is the first time that anyone has been able to demonstrate how a combination of genes affect the risk of developing the disease. Scientists the world over are currently searching for gene combinations behind common diseases like cancer, diabetes and asthma.
"For the first time, this type of study has made it possible to develop a clinically viable gene test," says Professor Grönberg.
The study was based on genetic analyses of approximately 4,800 Swedish men, of whom 3,000 had prostate cancer and 1,800 had no prostate cancer diagnosis.
S. Lilly Zheng, Jielin Sun, Fredrik Wiklund, Shelly Smith, Pär Stattin, Ge Li, Hans-Olov Adami, Fang-Chi Hsu, Yi Zhu, Katarina Bälter, A. Karim Kader, Aubrey R. Turner, Wennuan Liu, Eugene R.Bleecker, Deborah A. Meyers, David Duggan, John D. Carpten, Bao-Li Chang, William B. Isaacs, Jianfeng Xu, and Henrik Grönberg
Cumulative association of five genetic variants with prostate cancer
New England Journal of Medicine, online 16 januari 2008.
Link to the abstract in PubMed

Amazing New Glove Helps Women Find Breast Cancer Early

October is Breast Cancer Awareness Month. The Donna Glove is a special glove designed to detect breast lumps. It provides a safe and effective way for every woman to carry out breast self examination, especially women in high risk groups. Its special design magnifies the sense of your fingers allowing lumps the size of a grain of sugar to be detected. This is not possible with bare hand palpation.You perform a breast self exam the same way, you just use the Glove instead of your bare hands. Check from your collar bone and into your armpits and do both breasts. Since lumps can grow in a week, it is suggested to perform the procedure weekly. The Donna glove helps detect lumps, thickening and other subtle changes your bare hand may not detect. Full instructions are on the website below and are provided with the glove.The glove itself is a double layer of polyurethane with mineral oil between the layers. This allows for greatly enhanced ability to feel lumps. A clinical trial in Rome proved the efficacy of the glove.108 women were studied for nearly a year. These women all had previous lumps and were at high risk for developing breast cancer. They were split into two equal groups. Group 1 was issued a Donna Glove while group 2 continued to do self breast exams with bare hands.At the 6 month follow up, 84% (45 in each group) of these patients had recurrence of the lumps confirmed by mammography. Group 1, the group issued the Donna Glove had a 100% self-detection rate. In group 2, only 22 of 45 women had detected lumps with their bare hands.The significant difference in detection rate was present even after adjusting for combinations of age, method of detection and family history of breast cancer. Mammography upheld these percentages. The study concluded that in a population of potential breast cancer patients, breast self exam with the Donna Glove is related to a greater earlier detection and thus improves survival over bare hand self examination.More information on the glove and how to order can be found here:

Cancer widows are often emotionally isolated

Many Swedish men have no one to turn to for emotional support other than their partners, not even in particularly traumatic situations, such as when suffering from cancer. However, according to new research, the partners of cancer patients also often lack support outside the relationship.
Previous research has shown that many Swedish men over 50 with cancer confide their feelings and fears about the disease to few other people, if any. For 80 per cent of men who have prostate cancer and who live together with someone else, the partner is the only source of emotional support they have. Seventy per cent of single men with prostate cancer do not share their feelings with another person.
The same group of researchers at Karolinska Institutet has now examined the extent to which women in the same age group who have lost their husbands to cancer confide in other people. Their results show that one third of these women have nobody else with whom to share their feelings.
"We're surprised that so many women are emotionally isolated, by which we mean that they lack deep, emotional contacts," says study leader Asgeir Helgason, associate professor at Karolinska Institutet. "There's a general sense that the problem only applies to men, but this isn't the case."
"We've decided to raise this at a conference on men's health partly because of the very important role the partner plays in giving psychosocial support to men with cancer," says Dr Helgason. "Our findings suggest that the care of male cancer patients should also be directed at their partners."
Department of oncology-pathology

Dr. Crescence Allen Reveals Why She Chose Alternative Breast Cancer Treatments

NaturalNews) At the close of the White Rose Symposium on contemporary health issues, leading psychologist, health advocate and life coach Crescence Allen agreed to be interviewed about her bout with breast cancer and her decision to forgo the “standard of care” in favor of pursuing alternative treatments. Crescence’s expertise includes child development, learning theory, and stress management. She is the author of Adaptive Coping Strategies of High Mastery Caregivers. She is also an herbalist and hypno-therapist.Crescence was simultaneously diagnosed with two different forms of breast cancer for which she underwent surgery. Before she was even approaching full recovery from that ordeal, she was bombarded with a list of statistics by an oncologist and a radiologist who were eager to recruit her into their treatments. She reports leaving their office in a state of fright, horror and intimidation. For a short period of time she was in a state of shock that left her unable to think clearly and advocate for herself. But due to her background and knowledge base, she was able to rally and regain her ability to think clearly. It was at this point that she made the decision to reject the traditional medical model and embrace an alternative treatment modality.Barbara: Author Danielle Steele compares a diagnosis of breast cancer to being struck by lightening. What did this diagnosis mean to you?Crescence: Not that. It wasn’t a surprise. I think some part of me knew that I had it. I had a dream that must have pertained to what was coming in my future. What really bowled me over was the trip to the doctor. Historically I have a hospital, doctor anxiety issue.People are either shocked or say they always knew, and I think that the way a person responds depends on which end of this continuum she is on. I can only speak for myself. I viewed having breast cancer as a wake up call to look at my own life, lifestyle and personal psychology rather than it being a terrifying assault. I viewed it as a growth opportunity. Of course I had to force myself to view it that way, but I would rather take that position than view myself as at the mercy of randomness.Barbara: What were your impressions of the cancer industry?I believe in being empowered, and I think that leads into the question of what I think about the typical approach of the medical establishment toward women with breast cancer. The medical establishment has a hard time dealing with an empowered patient. I do believe that there is a cancer industry, and it is unfortunate. I agree that cancer is big business. The medical establishment and doctors in general are indoctrinated toward a certain point of view. They have their established protocols that are supposedly based on science and research. But as a person who utilizes research, I felt that they used it inappropriately. Because I understand the use of statistics, I realize that the model you create cannot be a one size fits all model. But the doctors seem to think using a one size fits all set of statistics for everyone is acceptable. There is just not enough individualization in the way the medical establishment deals with people.As a consumer of physical or medical model services you have to be knowledgeable, assertive and empowered. You have to make your physician deal with you as an individual, as a whole person, not a statistic. The individual person has to be willing to say -- I am more than this cancer. I am a mind, a psychology, a social being with responsibilities to my family, to my work. All of those things have to be considered. But the only thing physicians want to look at are statistics about some tumor.Barbara: Do you want to describe what kind of breast cancer you had?Crescence: I don’t really care what kind of breast cancer I had. It is all generic in my mind. The stages and grades that the medical establishment gives it are artificial and have no real meaning. Articles I have read about holistic healers say that doctors who take an alternative approach really don’t care about the pathology reports. This is because that tumor is no longer in your body. I went to a surgeon but I didn’t do the chemotherapy or radiation, or the life long follow up of drugs. I chose the alternative approach to the after-surgery treatments based on the information I got as an empowered person.What the oncologists gave me that made me turn away from their treatments was a discussion of statistics that had nothing to do with me as a person. It was just statistics put forth as part of the standard of care protocol. I couldn’t understand why they didn’t want to give me tests to determine how I was after the first intervention. But they weren’t interested in the Me that was there. They were only interested in the pieces of me they had removed. The pieces were what was important--the actual human being that was there in front of them was not important. This didn’t make any sense to me. I asked the oncologist, “Aren’t you going to do any blood tests to see the levels of my hormones or the levels of cancer antibodies in my blood to see how I am reacting right now, four weeks after the surgery?” She said, “No, because we have data, all these statistics that determine what we are going to do to you.”This really bugged me. I have a negative bias toward chemotherapy to begin with, so she would have had to prove to me that it was absolutely necessary, and then I may have still said “no”. Based on my previous education in chemistry and my knowledge of how the human body works and how drugs are created and tested--that the dosages of drugs are set right below the level that is lethal-- we have to be really careful about what we agree to take.When they create a drug to fight cancer, they are creating a drug to kill off tumors that are actually made out of the same material that your whole body is made of, as opposed to antibiotics that are created to only kill off a foreign thing in the body. Chemotherapy attacks every cell in the body and works to kill every cell in the body. It destroys the immune system or damages it permanently. A physician probably wouldn’t agree with me, but I don’t think you ever get your immune system back. Anything that is so poisonous as to make the hair fall out of your head is deadly. Chemotherapy also destroys your organs.Barbara: How did you come to the alternative treatments you decided on?Crescence: After I sought out an alternative approach, I was lucky enough to find a medical doctor who is also a naturopath and believed in supporting the immune system through alternative approaches, trusting the body to health itself. If your physician gives you the idea that chemotherapy will cure you, you are being misled. Chemotherapy will kill off parts of your body, as well as manifested tumors. The alternative approach is based on trusting the body to heal itself. Only the body can heal itself. That’s why damaging the immune system is actually criminal in my mind.If you find a good physician who believes in an alternative protocol, that physician’s protocol will include doing actual scientific tests to see if the areas of the body are functioning appropriately and at the rates they should be to foster good health. They will see what the levels of your estrogens are and your progesterone and so forth. My physician looked at new knowledge bases that are known in the EU. She worked from that format, looking at research being done on healthier, effective means for supporting the body and the immune system for good health. I can tell you what we have done in general.We have supported the natural enzymes that are depleted from our food sources. These enzymes are essential to our good health. There is a whole biochemistry involved with good health that has to do with eating fresh fruits and vegetables and getting natural enzymes from them--because that is really the only place to get these potent enzymes. You can really see that an alternative physician cares about how the environment impacts health, and to me that is important – to look at the whole person living her life. In other words, the alternative physician wants to eliminate from your lifestyle the things that created the cancer. They are interested in preventing cancer, not in just killing cancer cells. My physician is interested in helping my body heal from cancer, not in continuing to punish my body because it developed cancer. It is very different from the oncologists’ approach.The protocol is designed on my doctor’s theories and various models of what causes cancer. She deductively goes back into my life history and makes lifestyle suggestions, food suggestions and supplement suggestions that will promote and maintain my health. Among the things suggested are not just healthy enzymes but also the Budwig diet, with its emphasis on flax oil, vitamin D, iodine, and the healthy things you find in broccoli, beans and legumes, also glyconutrients. Her supplement choices were based on the ongoing series of tests I have done – blood tests and urine tests. A protocol can’t be generic. It has to be tailor made for the person. I can’t say that if you do thus, and so you won’t get breast cancer.Barbara: What would you tell someone who is newly diagnosed and unsure of what to do?Crescence: My advice to someone newly diagnosed and unsure of what to do is to calm down, ground yourself, discuss things with your inner self, trust your inner self, your personal guidance. Because I don’t think you need to rush into anything too quickly. This cancer has been growing in your body for a long time, for several years. Once it is discovered, it is not going to kill you tomorrow, or the next day, or the next month. You can take some time to think. What made me lose my focus and be at my wits end was when I was in the oncologists’ office and they have you rushing here, and there, and they bombard you with their techno-jargon.I think physicians lose their perspective because they have been trained to approach everything as an immediate crisis, and they view themselves as dragging people back from the edge of death. It is a fear mongering situation. They want you to be afraid, because then you will be a compliant patient and do what they want you to do when they want you to do it. Their whole occupation is conscious or unconscious manipulation of people by their fears and making them feel guilty if they don’t do what they’re told. It’s that old physician as god syndrome. So my advice is, don’t let yourself be manipulated. Chemotherapy and radiation don’t have to be done immediately after surgery. You should allow yourself time to heal from surgery and gain perspective before you make a decision about chemotherapy and radiation. Be an empowered person.Barbara: This is going to be a wonderful interview. I think you are putting out information that will benefit many people. Thanks so much.

Screening program reduces the risk of cervical cancers

Women who do not undergo regular screening tests are more likely to be diagnosed with cervical cancer than those who do participate in screening, according to an audit of the Swedish national cervical cancer screening program. The audit was conducted based on data from a national cervical cancer registry at Karolinska Institutet, and shows that participation in screening reduces the risk for all types of cervical cancers in all ages.
"However, better assessment of the women who are screened could further reduce cervical cancer rates", says Bengt Andrae, Senior Consultant at Gävle Hospital, who lead the study together with Associate Professor Sven Törnberg and Professor Pär Sparén, Karolinska Institutet.
Cervical cancer screening programs reduce the incidence of disease, but the effectiveness of such programs varies among populations. Regular audits of such programs are valuable because they provide insight into how a program works and how it might be improved. In 2002 the Swedish National Board of Health and Welfare funded a National Cervical Cancer Screening Registry, which is coordinated by the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.
In a nationwide casecontrol study, published in the Journal of the National Cancer Institute, Bengt Andrae and colleagues compared the rates of cervical cancer diagnosis in women who had been screened and those who had not. Using data from the Swedish Cancer Registry and from the National Cervical Cancer Screening Registry, the researchers identified 1,230 cervical cancer cases who were diagnosed between 1999 and 2001, and 6,124 age-matched control subjects from the population register, who had not been diagnosed with cervical cancer.
Women who did not undergo a Pap smear test within the recommended 3- or 5-year interval were 2.52 times as likely to be diagnosed with cervical cancer as were women who had Pap tests regularly. These women had also a 4.82 times higher risk to be diagnosed with advanced disease than those who were screened. Novel findings were that participation in screening reduces the risk for all types of cervical cancers and also in the age group between 23 and 30. It was also possible to demonstrate a beneficial effect of screening against adenocarcinomas of the cervix.
Screening did not completely protect women from cervical cancer diagnoses, however. Abnormal smears, particularly if not assessed by a biopsy, were an important risk factor also within the Screening program. Women with abnormal Pap tests accounted for 11.5% of all of the cervical cancer cases. This increased risk was however not seen for advanced cancers.
Affiliations and funding
Bengt Andrae is Senior Consultant at the Department of Obstetrics and Gynecology, Gävle Hospital and Chairman of the Cervical Cancer Prevention Group at the the Swedish Society of Obstetrics and Gynecology. Sven Törnberg is Associate Professor at Karolinska Institutet and Senior Consultant at the Cancer Screening Unit, Oncologic Center, Karolinska University Hospital. Pär Sparén is Professor at the Department of Medical Epidemiology and Biostatistics and coordinator for the National Cervical Cancer Screening Registry Karolinska Institutet. Professor Joakim Dillén, unit for Medical Microbiology at Lund University and other scientists at the Umeå University Hospital, Sahlgrenska University Hospital, and University Hospital MAS also took part in the work with the audit. Among the funders were The Swedish Cancer Society and the Research and Development Center of Gävleborg County.
Andrae B, Kemetli L, Sparén P, Silfverdal L, Strander B, Ryd W, Dillner J, Törnberg S.
Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden.
J Natl Cancer Inst, 2008 May 7;100(9):622-9. Epub 2008 Apr 29.

Link to the abstract in PubMed

Higher-risk people are shunning colon cancer screens

[2008-05-23] It is difficult to make colon cancer screening effective, according to a follow-up study conducted by Karolinska Institutet of a screening programme from 1999. Many of the people who would probably have benefited most from the survey opted not to take part.

Johannes Blom
An acknowledged problem in public health surveys is that those who take part are generally more health conscious and healthier than those who do not. If this is also true of colon cancer screening, it means, at worst, that the people at greatest risk of developing the disease are not being screened, even though they would benefit most from the procedure.
A new study from Karolinska Institutet has confirmed these fears. Nine years ago, a team of researchers invited 2,000 people between the ages of 59 and 61 to take part in a colon cancer screening programme. Thirty-nine per cent of them accepted, but 61 per cent chose not to. A follow-up of these two groups has now shown that a larger percentage of the non-participants have since developed colon cancer or died, either from colon cancer or other diseases, compared with the participants.
We do not think that the difference in incidences of cancer and death between the two groups is due to any effect the screening might have had, but believe it was down to the selection of people who took part, says Johannes Blom, one of the researchers behind the study. What we have here is the self-selection of more health conscious and healthier people , who perhaps dont benefit as much from taking part.
The team believes that those who opted out of the programme have less healthy lifestyles. This is supported by the findings that more of the non-participants have developed other forms of smoking-related cancer and that they run more than double the risk of dying from cardiovascular disease.
If higher-risk people choose not to take part, public screening programmes will become very cost inefficient, says Dr Blom. One of the greatest challenges is therefore to encourage participation, so that the less motivated are also screened.
On 1 January, the Stockholm County Council became the first health authority in Sweden to launch a screening programme for colon cancer.
Blom J, Yin L, Lidén A, Dolk A, Jeppsson B, Påhlman L, Holmberg L, Nyrén O.
A 9-Year Follow-up Study of Participants and Nonparticipants in Sigmoidoscopy Screening: Importance of Self-Selection
Cancer Epidemiology, Biomarkers & Prevention, 2008 May;17(5):1163-8.

Link to the abstract in PubMed
Institutionen för klinisk vetenskap, intervention och teknik

Exercise cuts cancer death in men

May 2008] Men who exercise often are less likely to die from cancer than those who dont exercise, according to a new study from the Swedish medical university Karolinska Institutet. In the study, the researchers looked at the effect of physical activity and cancer risk in 40,708 men aged between 45 and 79.
Over the seven year period of the study, published in the British Journal of Cancer, 3,714 men developed cancer and 1,153 died from the disease. Men who walked or cycled for at least 30 minutes a day had an increased survival from cancer with 33 per cent, than the men who exercised less or did nothing at all. The researchers also found that a more extensive programme of walking and cycling for between 60 and 90 minutes and a day, led to a l6 per cent lower incidence of cancer. But these activities only led to a five per cent reduction in cancer rates among the men who walked or cycled for 30 minutes day, a finding which could be due to chance.

Professor Alicja Wolk
The researchers surveyed men from two counties in central Sweden about their lifestyle and the amount of physical activity they did. They then scored these responses and compared the results with data officially recorded in a central cancer registry over a seven year period.
"These results show for the first time, the affect that daily exercise has in reducing cancer death risk in men aged between 45 and 79", says Professor Alicja Wolk, who led the study. "We looked at more moderate exercise such as housework, undertaken over a longer period of time and found that this also reduced mens chances of dying from the disease."
Orsini N, Mantzoros CS, Wolk A.
Association of physical activity with cancer incidence, mortality, and survival a population-based study of men
British Journal of Cancer, 2008 Jun 3;98(11):1864-9. Epub 2008 May 27.

Link to the abstract in PubMed
More about Alicja Wolk's research
Institute of Environmental Medicine

Antibiotics may prevent stomach cancer

June 2008] By identifying patients with Helicobacter pylori infection and treating them before they reach age 50, it is possible that many cases of stomach cancer could be prevented. This is the conclusion reached by gastroenterologist Tom Storskrubb in his Karolinska Institutet doctoral dissertation. The dissertation is based on the largest-ever population-based gastroscopic study, which included 1000 randomly selected healthy people in Kalix and Haparanda, Sweden.
Tom Storskrubb, of the Center for Family and Community Medicine (CeFAM) in Stockholm, studied the prevalence of the bacterium Helicobacter pylori in the stomachs of study participants. Helicobacter pylori is a main cause of peptic ulcer disease and the main risk factor for stomach cancer. Storskrubb also looked at the prevalence of scar formation and cell changes in the mucous lining of participants' stomachs. The investigation used gastroscopy, a procedure in which the physician inserts a long, flexible tube into the stomach via the mouth to examine the stomach from the inside and simultaneously collect tissue samples.
An active Helicobacter pylori infection was found in approximately a third of the 1000 people examined. A further 10 percent of participants showed signs of previous infection. Using the tissue samples, Storskrubb also looked for signs of risk factors for cancer of the stomach and found them in approximately 15 percent of those with active or past Helicobacter pylori infection.
Scar formation and cellular changes caused by Helicobacter pylori are the single most common cause of stomach cancer and may explain up to 90 percent of all cases. Storskrubb's examination of the mucous lining of participants' stomachs revealed no cellular changes in those under the age of 50 years, even if they were infected with Helicobacter pylori. It thus seems plausible that eliminating the bacteria in time in patients who seek care for dyspepsia could prevent them from developing stomach cancer later in life.
In another study, Storskrubb showed that a simple laboratory test works as well as gastroscopy to identify patients who have or had a Helicobacter pylori infection. Together, these findings challenge the prevailing strategy used in Sweden during recent years (known as scope them all) in which gastroscopy has been the most common diagnostic method used when a stomach ulcer is suspected. Storscrubb's challenge to his fellow physicians is clear:
 Be conservative with gastroscopy in young patients with dyspepsia. There is nothing to be found in the stomach of people under age 50, so we can use scope time for something else, he says.
Instead of routinely sending patients to have gastroscopies, Storskrubb wants family practitioners to learn to interpret the results of blood tests correctly and to treat patients with antibiotics if the results show it to be necessary. It is true that this would increase the comparatively low level of antibiotics used in Sweden, but the level would still be lower than in many other countries. Moreover, the blood test is the international standard, and in another study, Storscrubb showed that the advantages of treating more patients with antibiotics outweigh the disadvantages.
The laboratory tests that were used in the study consist of a panel of tests that together can show antibodies to Helicobacter pylori (indicating active or previous infection), as well as the degree, if any, of scar formation in the mucous lining of the stomach.
The bacterium Helicobacter pylori were discovered by Australians Robin Warren and Barry Marshall in 1982. The discovery revolutionized the treatment of ulcers and the understanding of the origin of stomach cancer, and Warren and Marshall were awarded the Nobel Prize in Physiology or Medicine in 2005. A large proportion of the world's population is infected by Helicobacter pylori, but only a small proportion develops ulcers. In the western world, the number of people who are infected has decreased in tandem with improvements in living conditions, while frequency of infection remains high in poorer and more highly populated parts of the world. Every year, 1000 cases of stomach cancer are diagnosed in Sweden. Of these, at least 700 are caused by a previous Helicobacter pylori infection.
Tom Storskrubb
Helicobacter pylori infection and associated stomach pathology in the adult general population
Center for Family and Community Medicine, Karolinska Institutet and Stockholm County Council.

To the dissertation
Centre for Family Medicine

Few adverse reactions to cervical cancer vaccine

WASHINGTON (Reuters) - Girls and young women given Merck and Co's Gardasil vaccine to prevent cervical cancer were not any more likely than usual to faint, have an allergic reaction, blood clot, or other adverse reaction, federal officials said on Wednesday.
The vaccine does not cause any more cases than usual of eight different adverse events, the U.S. Centers for Disease Control and Prevention found.
The report to the Advisory Committee of Immunization Practices was based on 375,000 doses of the vaccine given from August 2006 to July of 2008.
"As with all approved vaccines, CDC and FDA (U.S. Food and Drug Administration) will continue to closely monitor the safety of the HPV vaccine," the CDC said in a statement.
Gardasil protects against the four types of human wart virus, also known as human papilloma virus or HPV, that are most likely to cause cervical cancer.
Because HPV is sexually transmitted and very common, most people are infected as young adults and to protect them, the vaccine must be given before girls are sexually active. This has led to some controversy.
The CDC said it received 10,326 reports of adverse events following HPV vaccination in the United States.
"Of these reports, 94 percent were reports of events considered to be non-serious, and 6 percent were reports of events considered to be serious," the CDC said. These included 27 deaths.
Such reports do not necessarily show that a vaccine has caused a disease or event -- they simply show that someone fainted, became ill or had an allergic reaction around the time they also received the vaccine.
"Reports of non-serious adverse events after HPV vaccine have included fainting, pain and swelling at the injection site (the arm), headache, nausea and fever," the CDC said.
"Fainting is common after injections and vaccinations, especially in adolescents."
Some of the serious events included Guillain-Barre Syndrome, a rare disorder that causes muscle weakness. It can be caused by a number of infections.
"There has been no indication that the HPV vaccine increases the rate of GBS in girls and women above the rate expected in the general population, whether or not they were vaccinated," the CDC said.
Eleven of the deaths were traced to diseases such as diabetes or meningitis and unrelated to the vaccine, while the others were being investigated or did not provide enough information to assess, the CDC said.
GlaxoSmithKline has an HPV vaccine called Cervarix, which is used mostly in Europe.

Bone drug helps certain men with prostate cancer

NEW YORK (Reuters Health) - Alendronate, usually given to women for osteoporosis, is also helpful for men undergoing hormone therapy to fight prostate cancer, a study shows.
Men experience significant bone loss when they are given androgen-deprivation therapy or ADT to eliminate the testosterone that is driving their prostate cancer, the researchers explain in the Journal of Clinical Oncology.
Dr. Susan L. Greenspan from the University of Pittsburgh in Pennsylvania and colleagues examined the effect of alendronate, perhaps better known by the brand name Fosamax, on changes in bone density in 112 men on ADT for prostate cancer. The men were put on continuous weekly alendronate treatment, or intermittent treatment, or no treatment
After 2 years, continuous alendronate treatment produced the greatest increases in bone density, the team found report.
Men who had been receiving ADT for more than 36 months before beginning alendronate treatment had significantly less gain in bone density than did men who had been on ADT a shorter time.
"Improvements in bone mineral density in men with prostate cancer on androgen deprivation are greatest in men who continue to receive alendronate therapy," Greenspan's group concludes. "Furthermore, delay in treatment is detrimental to skeletal integrity."
They advise that "once-weekly oral therapy with alendronate should be considered early and continued for at least 2 years in men with prostate cancer who are receiving ADT to gain maximum benefit to the skeleton."

Resveratrol Found to Halt Growth of Pancreatic Cancer Cells

(NaturalNews) Recent research suggests that the antioxidant resveratrol, which naturally occurs in grape skins, can weaken pancreatic cancer cells and increase their vulnerability to chemotherapy."Resveratrol seems to have a therapeutic gain by making tumor cells more sensitive to radiation and making normal tissue less sensitive," said lead researcher Paul Okunieff, chief of radiation oncology at the University of Rochester Medical Center.In a study published in the journal Advances in Experimental Medicine and Biology,Okunieff and colleagues treated a group of pancreatic cancer cells with 50 mg of resveratrol, then iodized them to simulate the action of chemotherapy. Another group of cancer cells was iodized without undergoing any resveratrol treatment.Pancreatic cancer has long been known to be particularly resistant to chemotherapy. The researchers discovered that because the pancreas is continually producing digestive enzymes and pumping them into the duodenum, these enzymes actually flush away chemotherapy chemicals before they can have much impact.But in pancreatic cancer cells that had been treated with resveratrol, the cell membrane proteins responsible for this flushing had their functioning hampered. In addition to becoming more sensitive to chemotherapy, the cells also became more likely to undergo programmed death (apoptosis) due to the increased production of reactive oxygen species.While the reason for the decreased pumping action was not clear, it may have been a side effect of yet a third observed effect of resveratrol treatment: The mitochondria of the cancer cells was damaged, with its membranes depolarized. Because mitochondria are the energy source of the cell, damaged mitochondria hampers the cell's general ability to function, including its ability to flush out chemotherapy drugs.As a naturally occurring ingredient of red wine, resveratrol has drawn much attention from researchers investigating whether it might be responsible for wine's well-documented health benefits. Like all antioxidants, resveratrol is known to remove free radicals from the blood. Free radicals are known to be linked with cancer, inflammation related to cardiovascular disease, and the effects of aging.But scientists are also hard at work uncovering resveratrol's more specific effects. Numerous studies have demonstrated that the chemical can extend the lifespan of simple organisms such as worms and yeast, and even complex animals like fish. In one 2003 study, short-lived fish dosed with resveratrol lived more than 50 percent longer than fish not treated with the antioxidant. In addition, these fish had better swimming and learning ability at the end of their lives than the control fish did.Other studies have shown that resveratrol protects plants from bacterial or fungal infection and makes HIV more susceptible to certain antiviral drugs. In cells infected with the influenza virus, resveratrol treatment reduced the virus' ability to reproduce by 90 percent over a period of 24 hours.Resveratrol has also been shown to improve treadmill endurance in mice, and even to neutralize the negative effects of a high-fat diet. Mice fed a high-fat diet supplemented with 22 mg/kg of resveratrol had a 30 percent lower chance of dying when compared with mice eating only an unsupplemented high fat diet. This was approximately the same risk of death as mice eating a normal, non-high-fat diet.Finally, a number of studies have suggested that the antioxidant has anti-cancer benefits, from preventing the development of skin cancer in mice exposed to ultraviolet radiation to reducing the risk of esophageal or colorectal tumors in mice and rats exposed to carcinogens. It has also been shown to induce apoptosis in human fat cells under certain specific circumstances."Antioxidant research is very active and very seductive right now," Okunieff said. "The challenge lies in finding the right concentration and how it works inside the cell."The highest concentrations of resveratrol are found in grape skins. Peanuts contain about half as much resveratrol as grapes, while blueberries and bilberries contain only about 10 percent as much.While the resveratrol content of wine varies widely depending on the variety of grape, when and where it was grown, and how long it was fermented, the high level tends to be 30 mg per ml. This is lower than the dose used in the current study. But Okunieff said that higher doses should be safe as long as they are taken under a doctor's supervision."While additional studies are needed, this research indicated that resveratrol has a promising future as part of the treatment for cancer," he said.Approximately 33,000 new cases of pancreatic cancer are diagnosed in the United States every year. Patients have a very low rate of survival, in part due to the disease's resistance to chemotherapy.
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Cancer Drug Causes Permanent Brain Damage

NaturalNews) A widely used chemotherapy drug causes damage to the
brain that can last for years after treatment is completed, according to a study conducted by researchers from the University of Rochester and published in the Journal of Biology."It is clear that, in some patients, chemotherapy appears to trigger a degenerative condition in the central nervous system," lead researcher Mark Noble said.The findings may help explain why many chemotherapy patients complain of a condition called "chemo brain," suffering impaired concentration, memory loss, and even vision problems, dementia or seizures. According to a previous study by the same research team, more than 82 percent of breast cancer patients report at least one negative cognitive side effect from chemotherapy. A different study found that 50 percent of breast cancer survivors still felt cognitively impaired one year after the end of chemotherapy, while another estimated that the effects last for years in 15 to 20 percent of women.Many health professionals have dismissed these symptoms as side effects of cancer-related anxiety, depression or fatigue, saying there is no evidence for physical causes.In the current study, researchers gave the drug 5-fluorouracil (5-FU) to mice and observed the effects on their brains. They found that 5-FU attacked cells in the brain known as oligodendrocytes, destroying them so thoroughly that even six months after the end of treatment, the mice's brains were almost devoid of the cells.Oligodendrocytes are responsible for producing the protective myelin sheath that keeps nerve signals traveling smoothly. The degeneration of this sheath is associated with a variety of neurological conditions, including Alzheimer's disease and multiple sclerosis.5-FU is a common component of chemotherapy cocktails used to treat bladder, breast, colon, ovarian, stomach and pancreatic cancer. Another study by Noble's team found that three widely used chemotherapy drugs actually do more damage to the brain than the cancers they are being used to treat.Sources for this story include:

What You Need To Know About Cancer of the Colon and Rectum

The diagnosis of cancer of the colon or rectum, also called colorectal cancer, raises many questions and a need for clear, understandable answers. We hope this National Cancer Institute (NCI) booklet will help. It provides information on the symptoms, detection and diagnosis, and treatment, in addition to information on possible causes and prevention of cancers of the colon and rectum. Having this important information can make it easier for patients and their families to handle the challenges they face.
Together, cancers of the colon and rectum are among the most common cancers in the United States. They occur in both men and women and are most often found among people who are over the age of 50.
Cancer research has led to real progress against colorectal cancer -- a lower chance of death and an improved quality of life for people with this disease. The Cancer Information Service and the other NCI resources listed in the "National Cancer Institute Information Resources" section can provide the latest, most accurate information on colorectal cancer. Publications mentioned in this booklet and others are available from the Cancer Information Service at 1-800-4-CANCER. Many NCI publications are also available on the Internet at the Web sites listed in the "National Cancer Information Resources" section at the end of this booklet.
Understanding the Cancer Process
Cancer affects our cells, the body's basic unit of life. To understand cancer, it is helpful to know what happens when normal cells become cancerous.
The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as they are needed to keep the body healthy and functioning properly. Sometimes, however, the process goes astray -- cells keep dividing when new cells are not needed. The mass of extra cells forms a growth or tumor. Tumors can be either benign or malignant.
Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor. They may enter the bloodstream or lymphatic system (the tissues and organs that produce and store cells that fight infection and disease). This process, called metastasis, is how cancer spreads from the original (primary) tumor to form new (secondary) tumors in other parts of the body.
The Colon and Rectum
The colon and rectum are parts of the body's digestive system, which removes nutrients from food and stores waste until it passes out of the body. Together, the colon and rectum form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first 6 feet of the large intestine, and the rectum is the last 8 to 10 inches.
Understanding Colorectal Cancer
Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancers affecting either of these organs may also be called colorectal cancer.
Colorectal Cancer: Who's at Risk?
The exact causes of colorectal cancer are not known. However, studies show that the following risk factors increase a person's chances of developing colorectal cancer:
Age. Colorectal cancer is more likely to occur as people get older. This disease is more common in people over the age of 50. However, colorectal cancer can occur at younger ages, even, in rare cases, in the teens.
Diet. Colorectal cancer seems to be associated with diets that are high in fat and calories and low in fiber. Researchers are exploring how these and other dietary factors play a role in the development of colorectal cancer.
Polyps. Polyps are benign growths on the inner wall of the colon and rectum. They are fairly common in people over age 50. Some types of polyps increase a person's risk of developing colorectal cancer.
A rare, inherited condition, called familial polyposis, causes hundreds of polyps to form in the colon and rectum. Unless this condition is treated, familial polyposis is almost certain to lead to colorectal cancer.
Personal medical history. Research shows that women with a history of cancer of the ovary, uterus, or breast have a somewhat increased chance of developing colorectal cancer. Also, a person who has already had colorectal cancer may develop this disease a second time.
Family medical history. First-degree relatives (parents, siblings, children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves, especially if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.
Ulcerative colitis. Ulcerative colitis is a condition in which the lining of the colon becomes inflamed. Having this condition increases a person's chance of developing colorectal cancer.
Risk Factors Associated with Colorectal Cancer
Personal History
Family History
Ulcerative Colitis
Having one or more of these risk factors does not guarantee that a person will develop colorectal cancer. It just increases the chances. People may want to talk with a doctor about these risk factors. The doctor may be able to suggest ways to reduce the chance of developing colorectal cancer and can plan an appropriate schedule for checkups.
Colorectal Cancer: Reducing the Risk
The National Cancer Institute supports and conducts research on the causes and prevention of colorectal cancer. Research shows that colorectal cancer develops gradually from benign polyps. Early detection and removal of polyps may help to prevent colorectal cancer. Studies are looking at smoking cessation, use of dietary supplements, use of aspirin or similar medicines, decreased alcohol consumption, and increased physical activity to see if these approaches can prevent colorectal cancer. Some studies suggest that a diet low in fat and calories and high in fiber can help prevent colorectal cancer.
Researchers have discovered that changes in certain genes (basic units of heredity) raise the risk of colorectal cancer. Individuals in families with several cases of colorectal cancer may find it helpful to talk with a genetic counselor. The genetic counselor can discuss the availability of a special blood test to check for a genetic change that may increase the chance of developing colorectal cancer. Although having such a genetic change does not mean that a person is sure to develop colorectal cancer, those who have the change may want to talk with their doctor about what can be done to prevent the disease or detect it early.
Detecting Cancer Early
People who have any of the risk factors described under "Colorectal Cancer: Who's at Risk?" should ask a doctor when to begin checking for colorectal cancer, what tests to have, and how often to have them. The doctor may suggest one or more of the tests listed below. These tests are used to detect polyps, cancer, or other abnormalities, even when a person does not have symptoms. Your health care provider can explain more about each test.
A fecal occult blood test (FOBT) is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT is used to detect small amounts of bleeding.
A sigmoidoscopy is an examination of the rectum and lower colon (sigmoid colon) using a lighted instrument called a sigmoidoscope.
A colonoscopy is an examination of the rectum and entire colon using a lighted instrument called a colonoscope.
A double contrast barium enema (DCBE) is a series of x-rays of the colon and rectum. The patient is given an enema with a solution that contains barium, which outlines the colon and rectum on the x-rays.
A digital rectal exam (DRE) is an exam in which the doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.
Recognizing Symptoms Common signs and symptoms of colorectal cancer include:
A change in bowel habits
Diarrhea, constipation, or feeling that the bowel does not empty completely
Blood (either bright red or very dark) in the stool
Stools that are narrower than usual
General abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)
Weight loss with no known reason
Constant tiredness
These symptoms may be caused by colorectal cancer or by other conditions. It is important to check with a doctor.
Diagnosing Colorectal Cancer
To help find the cause of symptoms, the doctor evaluates a person's medical history. The doctor also performs a physical exam and may order one or more diagnostic tests.
X-rays of the large intestine, such as the DCBE, can reveal polyps or other changes.
A sigmoidoscopy lets the doctor see inside the rectum and the lower colon and remove polyps or other abnormal tissue for examination under a microscope.
A colonoscopy lets the doctor see inside the rectum and the entire colon and remove polyps or other abnormal tissue for examination under a microscope.
A polypectomy is the removal of a polyp during a sigmoidoscopy or colonoscopy.
A biopsy is the removal of a tissue sample for examination under a microscope by a pathologist to make a diagnosis.
Stages of Colorectal Cancer
If the diagnosis is cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the various stages of colorectal cancer.
Stage 0. The cancer is very early. It is found only in the innermost lining of the colon or rectum.
Stage I. The cancer involves more of the inner wall of the colon or rectum.
Stage II. The cancer has spread outside the colon or rectum to nearby tissue, but not to the lymph nodes. (Lymph nodes are small, bean-shaped structures that are part of the body's immune system.)
Stage III. The cancer has spread to nearby lymph nodes, but not to other parts of the body.
Stage IV. The cancer has spread to other parts of the body. Colorectal cancer tends to spread to the liver and/or lungs.
Recurrent. Recurrent cancer means the cancer has come back after treatment. The disease may recur in the colon or rectum or in another part of the body.
Treatment for Colorectal Cancer
Treatment depends mainly on the size, location, and extent of the tumor, and on the patient's general health. Patients are often treated by a team of specialists, which may include a gastroenterologist, surgeon, medical oncologist, and radiation oncologist. Several different types of treatment are used to treat colorectal cancer. Sometimes different treatments are combined.
Surgery to remove the tumor is the most common treatment for colorectal cancer. Generally, the surgeon removes the tumor along with part of the healthy colon or rectum and nearby lymph nodes. In most cases, the doctor is able to reconnect the healthy portions of the colon or rectum. When the surgeon cannot reconnect the healthy portions, a temporary or permanent colostomy is necessary. Colostomy, a surgical opening (stoma) through the wall of the abdomen into the colon, provides a new path for waste material to leave the body. After a colostomy, the patient wears a special bag to collect body waste. Some patients need a temporary colostomy to allow the lower colon or rectum to heal after surgery. About 15 percent of colorectal cancer patients require a permanent colostomy.
Chemotherapy is the use of anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumor growth, or to relieve symptoms of the disease. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel through the body. Most anticancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.
Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. Radiation therapy is a local therapy, meaning that it affects the cancer cells only in the treated area. Most often it is used in patients whose cancer is in the rectum. Doctors may use radiation therapy before surgery (to shrink a tumor so that it is easier to remove) or after surgery (to destroy any cancer cells that remain in the treated area). Radiation therapy is also used to relieve symptoms. The radiation may come from a machine (external radiation) or from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation). Some patients have both kinds of radiation therapy.
Biological therapy, also called immunotherapy, uses the body's immune system to fight cancer. The immune system finds cancer cells in the body and works to destroy them. Biological therapies are used to repair, stimulate, or enhance the immune system's natural anticancer function. Biological therapy may be given after surgery, either alone or in combination with chemotherapy or radiation treatment. Most biological treatments are given by injection into a vein (IV).
Clinical trials (research studies) to evaluate new ways to treat cancer are an appropriate option for many patients with colorectal cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the promising new treatment to one group of patients and the usual (standard) therapy to another group.
Research has led to many advances in the treatment of colorectal cancer. Through research, doctors explore new ways to treat cancer that may be more effective than the standard therapy. The NCI publication Taking Part in Clinical Trials: What Cancer Patients Need To Know provides information about how these studies work. PDQ®, NCI's cancer information database, contains detailed information about ongoing studies for colorectal cancer. NCI's Web site includes a section on clinical trials at This section provides both general information about clinical trials and detailed information about specific ongoing studies for colorectal cancer.
Side Effects
The side effects of cancer treatment depend on the type of treatment and may be different for each person. Most often the side effects are temporary. Doctors and nurses can explain the possible side effects of treatment. Patients should report severe side effects to their doctor. Doctors can suggest ways to help relieve symptoms that may occur during and after treatment.
Surgery causes short-term pain and tenderness in the area of the operation. Surgery for colorectal cancer may also cause temporary constipation or diarrhea. Patients who have a colostomy may have irritation of the skin around the stoma. The doctor, nurse, or enterostomal therapist can teach the patient how to clean the area and prevent irritation and infection.
Chemotherapy affects normal as well as cancer cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, diarrhea, and fatigue. Less often, serious side effects may occur, such as infection or bleeding.
Radiation therapy, like chemotherapy, affects normal as well as cancer cells. Side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation therapy are fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Sometimes, radiation therapy can cause bleeding through the rectum (bloody stools).
Biological therapy may cause side effects that vary with the specific type of treatment. Often, treatments cause flu-like symptoms, such as chills, fever, weakness, and nausea.
The Importance of Followup Care
Followup care after treatment for colorectal cancer is important. Regular checkups ensure that changes in health are noticed. If the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include a physical exam, a fecal occult blood test, a colonoscopy, chest x-rays, and lab tests. Between scheduled checkups, a person who has had colorectal cancer should report any health problems to the doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease, such as cancer, is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. Some people find they need help coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional burden of having cancer is often a part of a patient's treatment plan. The support of the health care team (doctors, nurses, social workers, and others), support groups, and patient-to-patient networks can help people feel less alone and upset, and improve the quality of their lives. Cancer support groups provide a setting where cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak to a member of their health care team about finding a support group. Many also find useful information in NCI fact sheets and booklets, including Taking Time and Facing Forward.
Questions for Your Doctor
This booklet is designed to help you get information you need from your doctor, so that you can make informed decisions about your health care. In addition, asking your doctor the following questions will help you understand your condition better. To help you remember what the doctor says, you may take notes or ask whether you may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.
What tests can diagnose colorectal cancer? Are they painful?
How soon after the tests will I learn the results?
Are my children or other relatives at higher risk for colorectal cancer?
What is the stage of my cancer?
What treatments are recommended for me?
Should I see a surgeon? Medical oncologist? Radiation oncologist?
What clinical trials might be appropriate?
Will I need a colostomy? Will it be permanent?
What will happen if I don't have the suggested treatment?
Will I need to be in the hospital to receive my treatment? For how long?
How might my normal activities change during my treatment?
After treatment, how often do I need to be checked? What type of followup care should I have?
Side Effects
What side effects should I expect? How long will they last?
What side effects should I report? Whom should I call?
The Health Care Team
Who will be involved with my treatment and rehabilitation? What role will each member of the health care team play in my care?
What has been your experience in caring for patients with colorectal cancer?
Are there support groups in the area with people I can talk to?
Where can I get more information about colorectal cancer?
The NCI's Web site provides information from numerous NCI sources, including PDQ®, NCI's cancer information database. PDQ contains current information on cancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoing clinical trials. also contains CANCERLIT®, a database of citations and abstracts on cancer topics from scientific literature. can be accessed at on the Internet

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