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Copyright (c) 1991-92,1993

Health Update

by Dr. Allan Bruckheim

Colorectal Cancer:  Learn the Vital Facts, part II


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Dealing with changes after cancer

     So far, we have discussed only matters dealing with your body.  But all
of us have emotions, and when we are physically ill we cannot be at our best
mentally and emotionally.  Therefore, you need to understand some of the
feelings and confusions that cancer patients, and those close to them, often
experience.
     During the course of dealing with cancer, there probably will be times
when you, and those close to you, will feel depressed and frightened.  There
also may be wide swings in feelings, from despair to hope to fear to courage.
     It is important to realize that such feelings are usually normal emotions
that most of us experience while coping with disturbing changes--particularly
those over which we have little control.  Many times talking openly with
family and trusted friends about your illness and its effects can help you
accept your condition and adjust to the emotional stresses that you are
experiencing.  Almost every patient has concerns about medical treatments,
tests, surgery, radiation, hospitals, their costs and many other parts of the
cancer-treatment world.
     Again, talking can help.  Discussions with your doctors, nurses and other
health professionals may help you deal with fear and confusion.  Do not
hesitate to discuss costs with all members of your health-care team, if you
wish.  Certainly have a full understanding of the benefits provided by your
health insurance.  Talk those matters over with your insurance agent.  If
Medicare is to be a part of your payment strategy, discuss those matters with
an official knowledgeable about Medicare.  Make sure you understand exactly
what costs are covered so that you meet no financial surprises during
treatment.
     It is wise to assume an active part in as many necessary decisions as
possible concerning your medical care.  You can do this by asking any
questions you wish about your treatment and expected course of recovery.  You
may wish to write your questions out as they occur to you and then take them
with you to the doctor's office.  Also, taking notes during your discussions
with your health-care team can be an excellent way of helping you understand
and remember what is expected of you and what you may expect.  Be sure to ask
your doctor to repeat any point about which you are not certain, or to more
fully explain any area you do not completely understand.  In the anxiety of
the moment, it is easy to misunderstand information, confuse instructions and
just be so overwhelmed by it all that nothing seems to stick in that head of
yours.  But you have a right and an obligation to know and understand.  You
just keep asking those questions until you get all the information you need.
     It is certain that those who undergo anticancer treatment are going to
have to change some of their living habits.  Unfortunately, some comfortable
ways of doing things may even have to be eliminated, or drastically reduced,
for a long period of time.  The ability to work or engage in other usual
activities will have to be dealt with.  Patients, particularly those who have
undergone surgery, often are concerned that changes in their bodies not only
may alter their appearance, but their worth to others.  Many worry that they
no longer can hold a job, take care of their families, or fulfil their sexual
roles.
     Concerns about the inability to engage in sex can be especially difficult
for patients and their sex partners.  Such concerns may alter the potentially
healing activities that a close and caring relationship can provide.  Time is
a great healer.  As a patient recovers, things begin to look brighter.
Gradually even changes such as having a colostomy can come to be accepted as a
part of one's "self." with loving support, a patient can feel reassured that
he/she has the same specialness that made him/her unique prior to cancer
treatments.
     Doctors are the people best equipped to give patients advice about
necessary, limits on specific activities.  Yet, many patients find it almost
impossible to discuss intimate feelings, fears and other extremely personal
matters with their physicians.  In that case, there are support groups that
welcome new members.  The groups are made up of cancer patients, their
relatives and other concerned people.  These groups can be located through
cancer societies in your area, from information available in your public
library, or by looking in the telephone directory.  Your public library is an
excellent source of books and articles on most aspects of cancer, including
how to adjust to its effects.  Whenever a patient's (or their relatives')
emotional problems become severe, therapy with a mental health professional
may become necessary.  Your doctor then can refer you to a reputable
specialist.

When a family member has cancer

     When anyone in your family is stricken with cancer, you and everyone else
in your family group will feel that awful blow.  It can be confusing and
frightening, make you feel alone and defenseless, provoke emotions of both
anger and guilt, and much more.  You know that any illness changes family life
for a while, but cancer is different.
     The patient needs special medical treatment and may be required to visit
the hospital or clinic very often for a long while.  Everyone in the family
probably will worry, both for the patient and for themselves.  Most likely
everyone in your family will react differently; they may be nervous about the
future, tired and very concerned.  Some may go on just as though little had
happened; some may cry a great deal and be so upset that they have trouble
operating in a normal manner.
     There are times when family members experience anger at the patient and/
or others in the family for the way they are acting, for the limits and
interruptions the illness places on the lives of all family members.  The best
way to deal with these various and sometimes confusing emotions is to talk
with each other and try to gain a better understanding about what each person
is feeling.  If the emotions become so complex that talking at home does
little good, discuss the situation with your family physician.  He/she may be
able to suggest a group, social or governmental agency, or another specialist
who can help you.
     Sometimes it helps to know how others have felt in similar situations; it
may make your own feelings and fears a bit more easily dealt with.  The
following list contains information that other families have found helpful to
know:

  -- More people are living with cancer now than ever before and new ways
     to treat it are being discovered with greater frequency.
  -- Nothing that a family member did, did not do, or said caused the loved
     one to have cancer.
  -- Having cancer does not necessarily mean the patient will die.
  -- Cancer is not contagious.
  -- Not you, nor anyone else, could have protected your loved one from
     cancer.
  -- If one of your parents has cancer, you, or your siblings, will not
     necessarily develop the disease.
  -- If you become ill, it does not mean that you have cancer also.
  -- There are no answers to questions concerning why anyone has to have
     cancer, or any other disease. . . or why you are healthy and someone
     else is critically ill.

     Above all, do not be ashamed or afraid of the way you feel.  Others in
your situation have felt the same way.  It may not be very easy to live in
your family right now but it's the only alternative you have.  And then we all
have a faith that tells us that somehow, things will get better. . . soon.

Chances for survival

     More than 5 million Americans who have had some form of cancer are alive
today!  Some of them were colorectal cancer patients who now are living
meaningful, rewarding lives.  Colorectal cancer survival statistics have
improved a bit over the past 20 years.  Improvements appear to be related to
advances in surgical techniques, along with those in anesthesia and
refinements in postoperative care.  Additionally, cancer research scientists
are making frequent advances in their continuing efforts to discover more
effective ways to detect cancer, treat those who suffer from it and help
patients regain their health.
     It bears repeating that the survival outlook for each patient depends on
the type of the cancer he/she is stricken by, the stage of the disease, as
well as the individual patient's age, general health, medical history and
response to treatment.  Physicians often use the term "surviving" cancer.  At
other times they may say "remission" or "disease-free interval" rather than
the word "cure."
     That is done because a cancer that was not detected early may spread by
the time the diagnosis was made.  It may reappear in another part of the
patient's body long after the original cancer has been destroyed and the
patient is feeling well.  As mentioned earlier, such an unwelcome reappearance
is called a "recurrence."  That's why physicians check and recheck on a
regular schedule over long periods of time after your original treatment to
make sure the cancer was completely destroyed and is not silently attacking a
different part of your body.  And that's why patients who have been treated
for colorectal cancer must have scoping exams and stool tests checked for
blood as often as twice every year.

You are not a statistic

     There are many "chances for survival" statistics appearing in the media
almost every week.  They are even mentioned in this booklet.  However, it is
important for you to keep in mind that all cancer survival statistics are
based on the results of many, many cases of cancer.  Yet, no two cancer
patients are alike.  So trying to figure out your own chances based on
statistics that you have read, or that a friend thinks he/she has heard about,
really is a waste of your time.  Only your doctor and those who take care of
patients with conditions and histories much like yours know enough about the
situation to predict your course of recovery. . . and even that will only be a
highly educated guess!  Remember you are different from anyone else, and that
uniqueness has a lot to do with your prognosis.

Are clinical trials for you?

     I have been asked often if there's some new, experimental drug that could
be obtained to help a patient.  While some cancer patients express desires to
take part in clinical trials in efforts to have access to new and still
unproven chemicals used in research, others are not sure what a clinical trial
is.  Therefore, this section will serve as a brief introduction to the subject
and explain how further, more complete information may be obtained.
     In research for new weapons against cancer, clinical trials are studies
conducted with cancer patients most often aimed at evaluating specific new
treatments and answering scientific questions concerning safety and
effectiveness of the new, proposed medication.
     Before a new treatment is tried on human patients, there has been much
basic research in laboratory and animal studies.  Those substances that yield
the most promise are researched further to try to find how they can best be
used.  However, such research cannot accurately predict exactly how a new
treatment will work in real clinical situations.  Nor can it predict exactly
what risks there will be.
     Nevertheless, additional information is gained during trials about a new
treatment:  how safe it is; what some of its side effects may be; how well it
actually works when given to humans.  There is always the possibility that the
results of these new treatments will be disappointing and that the drug will
be ineffective.
     Only patients who wish to do so and who understand exactly what is
required may participate in clinical trials.  They do so most often in hope of
receiving benefits for themselves such as being cured or perhaps living longer
and feeling better during that time.  Also, many wish to make some
contribution to research efforts that possibly could help others.
     Of course, those patients participating in a clinical trial are among the
first to receive the new research treatment before it is made widely
available.  Patients are carefully monitored during the study and must
participate in follow-up studies that may last for years.
     Understand that new treatments--like all treatments, new or old--can
cause side effects and risks depending on the type of treatment and the
patient's condition.  Clinical trials may research new areas of knowledge
where it is not always possible to correctly evaluate the possible risks,
though a tremendous amount of time, money and effort have been invested to
find out as much as possible about those risks.
     Clinical trials come in many forms.  They range anywhere from studies of
ways to prevent, detect, diagnose, control and treat cancer, to those of the
psychological impact of the disease and methods of improving a patient's
quality of life.  Most such trials concerning cancer deal with new treatments,
often involving surgery, radiation therapy and/or chemotherapy.
     Anyone considering joining a clinical trial needs to know what is
involved in it, what the expected side effects are and as much as possible
about the uncertainties they might be facing.
     Informed consent is required in trials that are federally regulated or
funded, as well as by many state laws.  It means a patient has been given
information so that he/she can understand what is involved in the trial,
including potential benefits and risks, and then has decided freely to take
part.
     Not every cancer patient can or should participate in trials of this
sort.  The trials are designed to answer sets of specific research questions.
Only when a patient fits the particular guidelines for a trial will he/she be
eligible to enroll, and only special types of individuals who can deal with
the uncertainties of untried therapy should even consider the possibilities of
participating.  While there is always the hope of a desired cure, there is
always the possibility of failure.

How might it be prevented?

     This whole booklet might never have been written, if it were possible to
completely and totally prevent colorectal cancer.  Obviously we haven't made
it to that point yet.  But there are some good tips to help you lessen the
risk of falling victim to this killer.  Here they are.  Read them carefully
and try to make as many of them as possible a part of your health program.
     Patients who have no symptoms but who are older than 40 should have an
annual physical examination which includes an occult blood test of the feces.
Sigmoidoscopy should be done every three to five years to make certain that
your colon is still free from polyps.

  -- Patients who have had prior adenoma polyps removed should be kept under
     surveillance and have a colonoscopy on the average of every three years.
  -- Those suffering from ulcerative colitis for seven years or more should
     have a colonoscopy once each year.

     Medical scientists are making increasing progress in identifying things
in our environment that are associated with the development of colorectal
cancer, as well as people who probably are at high risk for such cancers.
Different researchers are taking differing approaches to how colorectal cancer
might be prevented.  At this time, many of those approaches include a prudent
diet and efforts to develop medications to help prevent cancer.  While no
concrete dietary advice can be given that will guarantee prevention of any
specific human cancer, the following nutritional guidelines recommended by the
American Cancer Society may help reduce your chances of developing colorectal
(and other) cancer:

  -- Avoid obesity.  Approximately a million American men and women were
     studied for more than 10 years with results that showed higher cancer
     risks among those who are overweight.  The obese, especially those 40
     percent over their ideal weights, have a 1 1/2 times greater risk of
     colon/rectal cancer.
  -- Eat a diet high in fiber.  While still controversial, the possibility of
     real advantages of this type of diet makes this advice reasonable.
     Should it someday be proven that fiber is not a protective against cancer
     as some evidence would make it appear, high-fiber fruits, vegetables and
     cereals are wholesome substitutes for the dangerous fatty foods.
  -- Drastically reduce your intake of fat and sugar. Cutting back on fatty,
     sugar-filled foods helps reduce your chances of developing cancers of
     many types.  Additionally, reducing fats and sugars will help you
     maintain your best weight, or perhaps help you in a weight-reduction
     program.
  -- Eat some foods rich in vitamins A and C every day.  Note that this says
     foods.  Avoid excessive supplementary consumption of capsules or tablets
     of vitamin A, which can be quite harmful. (A few high-vitamin A foods
     are: apricots, dried beans, asparagus; some of those with high vitamin C
     content are:  citrus fruits, red and green peppers and brussels sprouts.)
  -- Eat some cruciferous vegetables--cabbage, broccoli, brussels sprouts,
     kohlrabi and/or cauliflower--daily.
  -- Be moderate in drinking alcohol.  Heavy drinkers, particularly if they
     smoke also, place themselves in an unusually high risk group who often
     develop cancers of the mouth and throat.  Alcohol abuse also can result
     in cirrhosis, which in turn can lead to cancer of the liver.

     Just because you change your eating habits does not mean you have to give
up all the foods you like in your efforts to protect yourself and your loved
ones against cancer risks.  The idea is to choose more often the foods that
may help reduce your risks of cancer and choose less often the foods that
might well increase your risks of developing cancer.
     Changing the manner in which you prepare foods also can be a great help.
Whatever you do, at the start make the changes that are the easiest for you.
You do not have to make them all at one time.  Simply eat more fruits and
vegetables. . . a little more each day.  Buy more low-fat milks, cheeses and
yogurts.  Also, choose 100 percent whole wheat or whole grain baked goods. You
will find it is not at all hard to eat more healthfully and it can be real fun
to figure out what is best for you and what tastes best to you.
     Because there has been so much publicity regarding the advisability of
increasing our intake of fiber, a word or two of additional explanation may be
helpful.  Fiber, particularly that found in natural cereals, absorbs water in
the stomach, which helps to increase fecal weight and speeds bowel movements.
Rapid elimination of feces reduces certain acids in the bowel and decreases
the time body waste is in contact with the wall of the bowel.  That lowers the
possibility of the bowel's walls being injured by harmful elements present in
the stool.  Additionally, the increased bulk created by fiber helps dilute the
effects of potential cancer-causing substances.
     To add 15 gm of fiber to your diet, consume one additional serving of a
cereal, legume, vegetable and fruit every day.  Remember that is in addition
to the amount you are already eating.  It is wise to make small increases in
fiber intake over a period of days because an abrupt change in the amount
eaten could lead to diarrhea and increased gas.  A few high-fiber foods are:
bran, corn, apples, raisins, bananas, peas, potatoes, baked beans, dried peas,
macaroni and whole wheat spaghetti.

How to get help

     "Seek and you shall find!"  That's our principles here and will continue
to be our motto whenever we need information about ourselves and our health.
We have to find a place to start and follow up all the leads that we can
develop until we arrive at the place where we can get the answers we need and
have the right to know.
     You can start with the telephone book that you have at hand right now.
Turn to the pages marked "community service numbers."  (In some areas it may
be labeled "human services.") Look under "health services."  I'll bet you
never knew some of these services existed.  They represent starting points as
we begin our "treasure hunt" to seek help.  If the number we choose does not
have ass the answers ask for a recommendation of another agency or another
number to call.  Perhaps there is an address where you can send a letter or
request.  DON'T GIVE UP!  Keep your calls and letters going until you find
what you are seeking.
     Another good place to start is your public library.  It is loaded with
books filled with information and addresses where you might find the answers
to your special questions.  To get you started and on your way, here are a few
special names and numbers from my personal collection of resources:


     CANCER INFORMATION SERVICE:  (800) 4-CANCER, (800) 638-6070 in Alaska
only, (202) 636-5700 in the District of Columbia only, (808) 524-1234 in Oahu,
Hawaii (neighbor islands can call collect) or write:  Office of Cancer
Communications, The National Cancer Institute, Bethesda, Md., 20892.  CIS will
answer cancer-related questions from the public, cancer patients and families
and health professionals.  The CIS staff members do not diagnose cancer or
recommend treatment for individual cases.

     AMERICAN CANCER SOCIETY, 19 W.  56th St., New York, N.Y. 10019; (800)
ACS-2345, (212) 736-3030 in New York City.  Check your community telephone
directory for a local division.  The society offers counseling, educational
materials, support groups, seminars and conferences and a newsletter.

     CANCER CARE INC. and THE NATIONAL CANCER FOUNDATION INC.--1180 Avenue of
the Americas, New York, N.Y. 10036; (212) 221-3300-- offer support groups,
transportation, counseling, educational materials, seminars and conferences
and a newsletter.

     AMC CANCER INFORMATION (800) 525-3777, provides the latest information on
causes of cancer, prevention, methods of detection and diagnosis, treatment
and treatment facilities, rehabilitation and counseling services.  It's a
service of the AMC Cancer Research Center, Denver.

     HILL-BURTON HOSPITAL FREE CARE, (800) 638-0742, (800) 492-0359 in
Maryland only, provides information on hospitals participating in the
Hill-Burton Free Area Program.  A service of the Bureau of Health Care
Delivery and Assistance, U.S. Department of Health and Human Services.

     NATIONAL SECOND SURGICAL OPINION PROGRAM HOTLINE, (800) 638-6833, (800)
492-6603 in Maryland only, helps consumers locate a nearby specialist for a
second opinion in nonemergency surgery.  It's a service of the Health Care
Financing Administration, U.S. Department of Health and Human Services.

     UNITED OSTOMY ASSOCIATION, 36 Executive Park, Suite 120, Irvine, Calif.,
92714; (714) 660-8624, stresses adjustment to living with an ostomy. Trained
members visit ostomy patients to offer support and practical assistance.
Publications describe ostomy care and management, anatomy and sexual aspects
of living with an ostomy.

     DIGESTIVE DISEASES CLEARINGHOUSE, 1555 Wilson Blvd., Suite 600, Rosslyn,
Va.  22209-2461; (703) 496-9707, provides services in three major areas:
inquiry response and referral, publications development and resource
co-ordination.  A service of the National Institute of Arthritis, Diabetes and
Digestive and Kidney Diseases (NIADDK), National Institutes of Health, it
works closely with more than 20 organizations to promote a wider understanding
of digestive health and disease.

     AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY, 13 Elm St., P.O. Box
1565, Manchester, Mass., 01944; (508) 526-8330.  This professional society
furthers the knowledge of gastrointestinal disease through the use of
endoscopic technique in clinical practice and research.

     SOCIETY OF AMERICAN GASTROINTESTINAL ENDOSCOPIC SURGEONS, Thomas
Jefferson University Hospital, 111 S.  11th St., Philadelphia, Penn.  19107.
SAGES is an organization of surgeons that promotes the concepts of
gastrointestinal endoscopy as an integral part of surgery.

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     This booklet has been researched by C.R. Shelton, with Robert Demarco,
M.D., serving as contributing editor.  Though all the information contained in
the booklet is as up to date as I can make it, research in the field of the
diagnosis and treatment of all types of cancer is continuing at a most rapid
pace.  Perhaps just over the horizon, not yet visible to us, lie the secrets
of both cause and cure of these afflictions.  Your physician remains the most
vital and valid source of this knowledge and your first line of defense
against any disease.  Therefore, when you have read and understood all that
has been written here, and when you have pursued your search for more
information using the contacts found here, it is in consultation with your
family physician that you will find the answers to the special questions that
concern you, as a unique individual.

     A last word

     Really, there is no last word to this booklet or to the story of the
fight against colorectal cancer and cancer disease in general.  It's going on
even as I write this.  It is a battle in which every branch of science, and
every aspect of society, must become allies and partners.  Nothing is
impossible, and no disease may remain incurable.  French moralist Francois Duc
de La Rochefoucald, who lived in the mid 1600's, once wrote:  "Nothing is
impossible; there are ways that lead to everything, and if we had sufficient
will we should always have sufficient means.  It is often for an excuse that
we say things are impossible."  Good words to read, understand and remember.
For nothing is unattainable with work, diligence, a helping hand of good
fortune, faith and, of course, prayer.

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For additional copies of CANCERS OF THE COLON AND RECTUM, send $2.75 to
CANCER, P.O. Box 4406, Orlando, Fla.  32802-4367.  Make checks payable to
Newspaperbooks.  Multiple copy discounts are available.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.