Fight Colorectal Cancer

People Living with Cancer (PLWC) now has podcasts available on the PLWC site to help with coping with cancer and treatment  Podcasts are adapted from information from PLWC website.  They can be heard over the Internet or downloaded free for listening on a computer or MP3 player.

Some current podcasts include:

• Tips on Caregiving
• Coping with the Fear of Side Effects
• Parenting and Caring for Parents with Cancer
• Strategies for a Better Night’s Sleep

Find a complete list of podcasts here. 

All  PLWC material is reviewed by medical specialists from the American Society.

Before colonoscopy it is critical to completely empty all stool from the colon.  In addition to clear liquid diet, two approaches are used most often

• PEG (polyethylene glycol), a powder that is dissolved in two to four quarts of liquid.  PEG preps include GoLytely®, Nulytely®, Halflytely®, and Miralax®.
• Sodium phosphate which is available as a liquid (Fleet Phospho-Soda®) or pills (Visicol® and OsmoPrep®).

Patient acceptance, side effects, and the ability to complete the prep vary, but most studies show little difference in how completely the colon is cleansed.

However, there has been concern when some patients experienced a rare, but dangerous kidney problem after colonoscopy preparation with sodium phosphate.  In March 2006, the FDA alerted doctors about kidney failure from acute phosphate nephropathy associated with the use of both liquid and pills containing sodium phosphate.  This has worried both doctors and patients as they chose a colonoscopy prep.

However, in a study of patients having colonoscopy in the Henry Ford Health System in Detroit, no difference in the risk of kidney problems with either PEG or sodium phosphate preps was found among patients who didn’t already have pre-existing kidney disease.

7,900 patients had a colonoscopy during the time reviewed, 6,800 of them using a sodium phosphate prep.  In the year before their colonoscopy,1,600 patients had known renal problems.  Another 4000 had no testing in the 12 months before or 6 months after their procedure.

Among the remaining 2,400 people for whom there was information about kidney functioning, 88 had a kidney problem after colonoscopy.  These patients were about equally distributed between the PEG and the sodium phosphate groups.

Risk factors for kidney problems were:

• Age over 65
• African-American race
• low baseline glomerular filtration rate (GFR) which measures potential kidney failure
• hypertension
• use of certain medications including ACE inhibitors, angiotensin-renin blockers, and thiazide diuretics

Stefan Russman MD and his team concluded,

In patients without preexisting renal disease, the risk of renal impairment after colonoscopy appears to be similar between sodium phosphate and PEG users.

However, they warned that

Sodium phosphate use in patients with preexisting renal disease is not recommended, but common in clinical practice. Sodium phosphate should not be used in patients with preexisting serious renal disease, adequate hydration should be assured in all patients, and renal function should be monitored before and after colonoscopy in those at risk of renal dysfunction.

SOURCE:  Russman et al, American Journal of Gastroenterology, Early Online Articles, October 26,2007.

WHAT THIS MEANS FOR PATIENTS

If you are scheduled for a colonoscopy, you need to discuss your medical history and the drugs you are taking with the doctor who will be performing the test.  Tests for adequate kidney function before the colonoscopy are probably important.

If you don’t have kidney or heart problems and are younger than 65, there is probably no difference in safety between large volume PEG gastric lavage colonoscopy preps and lower-volume sodium phosphate liquids or pills.  You can make a choice that meets your personal needs.

Adequate hydration — replacing liquid lost during the copious liquid bowel movements — is critical no matter what prep you use.

C3 has been told that the conference number for NIH is $899.113 million over FY 07. That would mean the funding level is $29.799 billion or 3.1% over FY 2007. With the global AIDS transfer, the NIH level is $29.999 billion.

The numbers are higher than both bills passed in the House and Senate. More details to follow.

During a clinical trial comparing bolus 5FU alone to bolus 5FU with oxaliplatin, some patients in both arms of the trial developed severe diarrhea and signs of injury to the walls of their colons.  Diarrhea and dehydration required hospitalization, and x-rays or scopes revealed damage to the bowel itself. 

The clinical trial NSABP C-07 compared weekly bolus injections of 5FU modified with leucovorin (Roswell Park regimen or FL) to the same treatment with oxaliplatin added (FLOX).  Patients were receiving chemotherapy after surgery for stage II or III colon cancer.

Bowel wall injury was characterized by:

• hospitalization for severe diarrhea and dehydration
• bowel wall thickening or ulceration shown in x-rays or endoscopy

There were 1857 patients in the trial.  Of those

• 79 (4.3 percent) developed bowel wall injury syndrome
• 38 (35.4%) in the 5FU/L only arm
• 51 (64.6%) in the FLOX arm with oxaliplatin
• 30 patients developed a serious bowel infection (enteric sepsis) with severe diarrhea and low white cell counts:  22 in the FLOX arm and 8 among those treated with FL only.

This severe gastrointestinal toxicity usually occurred in the third or fourth week during the first treatment cycle.  Patients were hospitalized and treated with fluids, medication to manage diarrhea, and antibiotics.

There were 5 deaths ((0.3%) during the trial due to bowel toxicity.  Two were related to infection (enteric sepsis) and three to both enteric sepsis and bowel wall injury.

Dr. J. Phillip Kuebler, MD and his colleagues warned,

Patients treated with adjuvant FL should be closely monitored for diarrhea and aggressively managed, especially if oxaliplatin has been added to the regimen.

Previously, overall results of the clinical trial were published in the Journal of Clinical Oncology showing a significant improvement in disease-free survival both three and four years after treatment when oxaliplatin (FLOX) was added to the bolus 5FU and leucovorin regimen (FL).  At three years, disease-free survival was 71.8 percent for FL and 76.1% for FLOX.  After four years, it was 67.0 percent for FL and 73.2 percent for FLOX. 

Bolus treatments are short injections into a vein.  5FU is also administered by continuous infusion, pumped more slowly into the vein over a two day period.  With oxaliplatin, this treatment for colorectal cancer is called FOLFOX.

SOURCE:  Kuebler et al, Cancer, Volume 110, Issue 9, November 2007.

An Italian study has found that CT-Colonography (virtual colonoscopy) can effectively be used to screen patients at higher risk for colorectal cancer.  Reported at the Eighth Annual Symposium on Virtual Colonoscopy in Boston, the IMPACT study was over 90 percent sensitive in finding adenomas larger than 1 centimeter.

Unlike previous virtual colonoscopy studies that included only patients at average risk for colorectal cancer, the IMPACT trial focused on patients with higher risk because of a previous adenoma or whose family member had an adenoma or colorectal cancer diagnosed between the ages of 40 and 65.

203 polyps and 42 colorectal cancers were found in the 934 individuals who were screened.

CT-colonography found 90.7 percent of adenomas at least 10 millimeters in size and 90.4 percent of those at least 6 millimeters.

The test accurately diagnosed polyps or no polyps in 89 percent of all patients in the trial.

Researchers led by principal investigator Dr. Daniele Regge and Dr. Andrea Laghi, who reported  results at the symposium, said that,

The results suggest CTC could be introduced as an alternative for surveillance of patients with an increased personal risk or a family history of colorectal cancer

SOURCE:  Diagnostic Imaging Online, October 15, 2007.