New Year’s Day is a time of introspection for me —. a day that is usually quiet and often, in this cloudy upstate New York landscape, snowy and a bit bleak.  I keep my Christmas decorations up in January to provide light and some glitter against the cold and give me time to daydream. 

It’s been twelve years since I spent New Year’s Day waiting for surgery to remove a mass on my ovary.  It had been about 18 months since my second colon cancer had been discovered, and this new mass was (1) no cancer at all (very unlikely)  (2) a brand-new ovarian primary cancer (not good news, but better than the alternative) which was (3) a metastasis of the colon cancer.  Dumb luck, many prayers, a tickled DNA?  Who knows, but in January 2006 I have been cancer-free for 12 years after surgery and chemotherapy that essentially cured ovarian cancer.

Of course, the second-shoe of hereditary non-polyposis colon cancer (HNPCC or Lynch Syndrome) hangs over my head, waiting to bring fresh excitement into an already too-full-of-excitement life.  I’ll have an annual colonoscopy in a couple of weeks to keep an eye on any polyps that might be waiting in the wings, but obsessing about dangling shoes or unlucky swords of Damocles isn’t much my style anymore. I plan to keep on keeping on in 2006, staying as healthy and busy as I possibly can.

Here’s my 2006 New Year’s Wish List:

• A simple, non-invasive screening test for colorectal cancer that is as sensitive as colonoscopy in finding polyps before they become cancer
• While we are waiting for that test, a way of preparing for colonoscopy that is safe, tasty, and doesn’t provoke nausea, vomiting, or cramps.
• A reliable way to predict which patients will benefit from chemotherapy and which ones really don’t need the risks and hassles.
• Methods to reduce oxaliplatin neuropathy and the skin rash from Erbitux and panitumumab.
• No more diarrhea!
• Treatment for metastatic colorectal cancer that CURES . . .  or at least keeps the cancer in check without suffering until people with the disease can die of a quiet and peaceful old age.
• One hundred percent public awareness that colorectal cancer can be prevented through timely and effective screening.
• A health care system that pays for quality screening and state-of-the-art treatment for everyone — rich or poor.
• Solid clinical trials that fill up fast, zip to conclusions, and are the offered to every newly diagnosed patient as a first treatment choice.

Cock-eyed optimist that I am, I fully believe that these are reasonable, do-able wishes.  They will take dedication, but there is lots of that available from researchers, advocates, and planners.  They will take money, of course, but lack of funding should never get in the way of dreams.

So, let’s dream that 2006 brings us giant steps toward ending death and suffering from colorectal cancer — and that patients, caregivers, and survivors find health, strength, and peace in their struggles.

Colorectal cancer patients who had little physical activity and excess abdominal fat  prior to their diagnosis were more likely to die of the disease.  A study of patients in Australia found that body fat, waist circumference, and exercise patterns were all related to risk of death from colorectal cancer.

Researchers reviewed information from nearly 42,000 people enrolled in the Melbourne Collaborative Cohort Study from 1990 through 1994.  When individuals entered the study, their body measurements and exercise activity were recorded.

Between 1994 and 2002, there were 526 cases of colorectal cancer in the cohort, including 181 deaths from the disease.  Analyzing the deaths 5 1/2 years after diagnosis and the information about body fat and exercise obtained at the beginning of the study, the research team found:

• Non-exercisers were 27% more likely to die of colorectal cancer.
• The greatest exercise impact was for stage II and III cancers, where exercise reduced the risk of death in half.
• Obesity increased the risk of death by 1/3, particularly when fat was located around the waist.

Dr. A.M.M. Hayden and colleagues at the Monash Medical School in Melbourne, Australia reported the results of their study in the January, 2006 issue of GUT. They concluded:

Increased central adiposity and a lack of regular physical activity prior to the diagnosis of colorectal cancer is associated with poorer overall and disease specific survival.

German researchers compared dark lumen magnetic resonance imaging to conventional optical colonoscopy in 92 patients referred for a non-screening colonoscopy.  After standard pre-colonoscopy colon cleansing, patients received MR imaging followed immediately by colonoscopy.

47% of patients had normal conventional colonoscopies with no polyps found.  For the other 53%, there were 107 polyps discovered:  82 adenomas, 25 hyperplastic polyps, and 7 carcinomas.  MR colonography found all of the adenomas over 10 millimeters in size and 84% of those 6 to 9 millimeters.  On a per patient basis, MR colonography was 93% accurate (89% sensitive in finding polyps, 96% specific in not identifying false positive results) when polyps of all sizes were considered.

Patients were prepared for the MR test by having their colons filled with approximately 2 liters of tap water, and IV contrast was used.

Dirk Hartmann M.D. and his colleagues reported the results of their study online before print in Radiology, November 22, 2005.  They concluded,

 Dark-lumen MR colonography is a promising modality with high accuracy for detecting colorectal polyps larger than 5 mm in diameter.

Use of CT colonoscopy (so-called virtual colonoscopy) is controversial in Europe where questions of radiation concern both patients and environmental groups.  During the 2005 RSNA several papers addressed the use of dark lumen magnetic resonance colonography as a non-invasive alternative to both optical colonoscopy and CT-colonography. 

Heartburn medications that reduce stomach acidity may contribute to  Clostridium difficile infections that occur outside of hospitals. So-called community-acquired infections are much less common than those found in hospitals and appear to have a different pattern according to research in the December 21, 2005 issue of the Journal of the American Medical Association.

Researchers found that patients who were taking a proton pump inhibitor such as Nexium™, Prilosec™ or Protonix™ were three times more likely to have a C.difficile infection than study participants who were not.  H2–receptor antagonists including Tagamet™, Zantec™, and Pepcid™ doubled risk for C.difficile.  There was also a moderate increase in risk among patients taking NSAIDs — non-steroidal anti-inflammatory drugs.

Using a United Kingdom database, the research team found 1672 cases of C. difficile among patients registered in community practices.  Among them was a subset of patients with community-acquired infections.  Since C.difficile is ordinarily considered a hospital-acquired infection, it was a surprise that 70% of the patients had not been hospitalized in the year prior to their infection and 50% of them had not had antibiotic treatment within the past three months.  The patients with C.difficile were matched to controls in the practices without the disease.

The team concluded:

“The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with non-steroidal anti-inflammatory drug use should be investigated further.”

In a news release from McGill University where the research was done, Dr. Sandra Dial said,

 ”We believe drugs that reduce gastric acidity provide a more hospitable environment within which C. difficile bacteria can colonize.”

Dr. Dial and the research team at McGill compared rates of community-acquired c.difficile in  the United Kingdom General Practice Research Database (GPRD over ten years.  In discussing the increased incidence, Dr. Dial said,

 ”In 1994 there was less than one C. difficile case per 100,000 people in the database, By 2004, this number had increased exponentially to 22 cases per 100,000”

Clostridium difficile, also known as C. difficile, is a bacterial microbe that can cause an infection of the bowel. The usual symptoms are diarrhea, fever and abdominal pain.  Careful hand washing is key to preventing its spread.

Proton pump inhibitors include:

•  Prilosec™ (omeprazole)
•  Prevacid™ (lansoprazole)
•  Aciphex™ (rabeprazole)   
•  Protonix™ (pantoprazole)
• Nexium™ (esomeprazole)

H2–receptor antagonists include:

• Tagamet™ (Cimetidine)
• Zantac™  (Ranitidine) 
• Pepcid™ (Famotidine)
• Axid™ (Nizatidine)

McGill University researchers have recently sequenced the genome of the antibiotic-resistant strain of C.difficile that has caused the epidemics of hospital-based intestinal infections in the United States and Canada.

In this season of light and joy, I wish all of you health, happiness, and something nice in your stocking.  Writing these posts has been a special blessing for me over the past few months, and I am thankful that C3 – Colorectal Cancer Coalition has made this space available.  I’m looking forward to the coming year with many new posts full of  more effective treatments and even better ways to ease the difficulties of living with colorectal cancer.

So much is on the horizon.  There is real hope that we can end the death and suffering from this disease.  Prevention is becoming a stronger possibility as screening methods improve and awareness that screening prevents colorectal cancer grows..  Treatment of early stage disease is making even more cures possible.  And survival times in advanced colorectal cancer has doubled with current therapy.

Enjoy the coming days.  Eat cookies, walk in the snow (or the sunshine), buy a bone for the dog, hug the children, sing even if you can’t carry a tune.  Tonight many candles on my mantle will be lit and shining for all of you.

Love from me and Santa.

Kate