Fight Colorectal Cancer

Regular aspirin users have lower rates of colorectal cancer, but only cancers that express COX-2.  In a study reported in the New England Journal of Medicine. researchers found that 7 in 10 tumors over-expressed COX-2.  Aspirin reduced the risk of getting one of these cancers, but had no effect on the 30 percent that didn’t test positively for COX-2.

Cyclooxygenase-2 is an enzyme that stimulates inflammation and is involved in the development of colon polyps and their conversion to cancer.

The research was based on following nearly 83,000 women in the Nurse’s Health Study and over 47,000 men enrolled in the Health Professional’s Follow-up Study.  Overall, nearly two and a half million person-years were included.

Among the entire group, 636 cases of colon or rectal cancer were diagnosed, 423 or 67 percent tested moderately or strongly positive for COX-2 expression.

If an individual in the COX-2 positive was a regular aspirin user, their risk of getting colorectal cancer was 36 percent lower than someone who did not use aspirin.  But previous aspirin use made no difference for those cancer patients whose tumors tested negative or weakly positive for COX-2.

Aspirin users in the study reported that they took a full-dose 325 mg aspirin at least twice a week.   There was a strong correlation between cancer and the dose of aspirin and how long it was used.

SOURCE: Chan et. al. New England Journal of Medicine, Volume 356, Number 21, pages:2131-2142, May 24, 2007.

More information about the study is available on Medpage Today.

WHAT THIS MEANS FOR PATIENTS

While this study adds more support for the use of aspirin and COX-2 inhibition to prevent colorectal cancer, doses needed to be larger than the baby aspirin 81 mg daily used to reduce cardiovascular risk.  They also needed to be taken on a regular and long-term basis.

Other studies have shown that aspirin has a significant risk of gastrointestinal bleeding, so individuals need to discuss the regular use of of adult dose aspirin to prevent colorectal cancer with their doctors.

The study also demonstrates that there are other pathways to colorectal cancer that are not affected by blocking COX-2.  Even without considerations of its risks, aspirin should not be considered an absolute preventive for colorectal cancer.

Patients should continue regular screening for colorectal polyps and early cancers.

The Food and Drug Commission has asked that black box warnings be added to the labels of gadolinium-based contrast agents that are used to enhance the quality of magnetic resonance imaging.   Patients with severe kidney insufficiency are at risk for nephrogenic systemic fibrosis (NSF) when gadolinium is used.

 The FDA says that:

• Patients should be screened for kidney problems before receiving gadolinium-based imaging agents.
• Recommended dose should not be exceeded.
• Enough time should pass before using contrast a second time to be sure that they have been eliminated from the body.

Nephrogenic systemic fibrosis  (NSF) is a thickening of skin and connective tissue that reduces an individual’s ability to move and may cause broken bones.  There can be changes in other organs, including the diaphragm, as well.  Causes of NSF are not clear, and there is currently no effective treatment for it.  It can be life-threatening.

FDA points out that there have been no reports of NSF in people with normal kidney function or those with mild or moderate kidney insufficiency, and the risk for developing NSF among these patients is unknown.

Patients with chronic liver disease and any degree of kidney insufficiency are also at risk for NSF when the gadolinium-based contrasts are used.

Brand names of gadolinium-based contrast agents approved in the United States are Magnevist, MultiHance, Omniscan, OptiMARK and ProHance.

More answers to questions about the new warnings is available on the FDA MedWatch web site.

WHAT THIS MEANS FOR PATIENTS

Magnetic resonance imaging (MRI) is used to identify colon and rectal cancer tumors that have spread beyond the colon.  Advanced colorectal cancer and treatment can affect both liver and kidney function.

It is critical that kidney and liver function tests be done prior to MRI and gadolinium contrast be avoided if kidney function is severely impaired or if kidney function is impaired to any extent if there are also liver problems.

Patients should discuss the need for contrast during MRI with both their oncologists and radiologists.

Two non-gadolinium contrast agents have been approved for liver-only MRI which may prove an alternative when the liver is being imaged.

Reviewing published studies of epidermal analgesia to control pain after surgery for colon or rectal surgery, anesthesiologists found that there were benefits for patients with its use.

Studies, including randomized trials have shown that epidermal analgesia:

• Controls pain better after colorectal surgery.
• Reduces ileus or the time  until normal bowel function returns after surgery.
• May have a beneficial effect on lung function after surgery.

Evidence did not support

• Shorter hospital stays when epidermal analgesia was used.

Study information was not sufficient to decide whether or not epidermal analgesia affected rates of leaking at the surgical site, cardiovascular complications, or problems with blood clots.

While the cost of epidermal analgesia is higher initially, indirect costs and poor patient satisfaction may make a financial difference.

With epidermal analgesia, pain medication is inserted directly into the spinal area through a catheter that is left in place after surgery.

K.A. Kendall and associates writing in Colorectal Disease concluded,

Randomized controlled trials have shown a benefit for epidurals on postoperative pain relief, and ileus, and possibly respiratory complications. There is no proven benefit with regard to length of stay. There are a number of unresolved issues which further focused RCT’s may help clarify such as effects of epidural on complication rates after colorectal surgery.

SOURCE:  Kendall et. al. Colorectal Disease, Online Early.

On May 16, 2007 Janet Turcotte, C3 Advocate and stage IV colorectal cancer survivor, was formally recognized on the floor of the United States Senate by Senator Ben Cardin (D-MD) for all of her hard work in colorectal cancer advocacy.

Janet has forged a very strong relationship with the Senator and his staff. She has sat down for meetings, written letters and made phone calls all in order to educate them on colorectal cancer and the need for increased funding.

In March Janet participated in C3’s Annual Call-on Congress. During a meeting with Senator Cardin she had the opportunity to present to him one of the saddlecloths from the 2006 Preakness Stakes, an annual horserace in Maryland, which she had stitched the Colorectal Cancer Blue Star of Hope on.

“Janet Turcotte has led a courageous fight against colorectal cancer”, said Senator Cardin. “To help save lives, she is now bringing that fight to the Preakness Stakes at Pimlico Race Course. Her message is an urgent and important one. With appropriate screening, colon cancer is highly detectable and curable if found early.”

C3 applauds Janet on everything she has accomplished so far as an advocate. Janet’s recognition will be forever stored in the United States Library of Congress. To read it for yourself click here.

The FDA and NBTY, Inc. announced a national recall of 3 lots of Shark Cartilage Capsules because they are possibly contaminated with the salmonella organism.  Manufactured in 2004, the capsules were distributed to consumers through mail orders, Internet orders, and retail stores throughout the United States.

Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, or individuals with compromised immune systems including those undergoing cancer treatment.  Healthy adults with salmonella infection often experience fever diarrhea, bloody stools, nausea, vomiting, and abdominal pain.  In some instances, the infection can invade the blood vessels, heart, or joints.

Although shark cartilage is not approved by the FDA to treat any illness, including cancer, and cannot legally be advertised or promoted it as a treatment for cancer, it can be sold as a dietary supplement.

Randomized clinical trials have shown no difference between shark cartilage and placebo in improving survival or quality of life for people with advanced cancer, including colon cancer. However, it is often suggested as an alternative or complementary cancer treatment by alternative care providers or  Internet sites.  A popular book in the early 1990′s promoted the erroneous idea that sharks didn’t get cancer and that their cartilage could protect against or cure cancer.

In reporting the recall, the FDA said,

FDA posts press releases and other notices of recalls and market withdrawals from the firms involved as a service to consumers, the media, and other interested parties. FDA does not endorse either the product or the company.

Brand names and other information about the recalled products are part of the NBTY, Inc. press release.  People who purchased the supplements can return them to the place where they bought them for a full refund.  They can also contact the manufacturer at 1-800-217-7668.