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Do You Have Diabetes? You Might Be At Risk for Colon Cancer 

By Parker Lynch

There are several known risk factors for colorectal cancer (CRC): genetic predisposition, age, poor diet, lack of regular physical activity, high alcohol consumption, etc. Recent research is further indicating that other health conditions could also influence an individual’s risk for developing CRC. One such condition is type 2 diabetes, was previously discussed by Emma Edwards (an intern colleague at the Colon Cancer Foundation) in a previous blogpost.

Someone with type 2 diabetes typically has hyperinsulinemia, meaning that they have too much insulin in their blood. Research shows that these higher levels of insulin and sugar in one’s body creates an environment in which CRC can develop more readily. Additionally, higher levels of sugar in the bloodstream typically contributes to more inflammation, which also increases CRC risk. The two factors together mean that someone with type 2 diabetes has a 27% greater chance of developing CRC. 

Severity and Oncological Outcomes

Knowing that there is a link between diabetes and CRC, researchers wanted to specifically hone in on patients with both conditions to understand whether severe diabetes has an impact on CRC survival. 

In a Taiwanese study published in October 2023, data from the country’s Cancer Registry Database was retrospectively analyzed for the period between 2007 and 2015. The 59,202 patients included in this study had diabetes and had undergone curative radical resection for their CRC (stages Ⅰ-Ⅲ), meaning that they had surgery to completely remove their cancerous tumors. The study split the population into three groups: 

  • CRC patients with diabetic complications
  •  CRC patients without diabetic complications
  • CRC patients without diabetes

After conducting the retrospective research, it was found that those with uncomplicated diabetes had an insignificantly worse CRC survival (better survival rates), whereas those with complicated diabetes had a significantly higher risk of poor survival. Women with diabetes, in particular, suffer from more negative CRC outcomes than their male counterparts. These findings indicate that patients who don’t experience diabetic complications will have better CRC outcomes in terms of survival.

One Step At a Time

Managing diabetes alone is a lot of work. Patients must constantly manage their diet, blood glucose levels, physical activity levels, etc. Dealing with CRC on top of diabetes seems impossible. However, patients are encouraged to take their afflictions one step at a time, with the support of their healthcare team by their side, composed of both oncology specialists and endocrinologists. 

Maintaining blood sugar levels and minimizing possible diabetic complications can have a positive impact on CRC outcomes. Though colon cancer and diabetes seem like vastly different conditions, they can go hand-in-hand and should be considered together when developing a treatment plan. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Towfiqu barbhuiya on Unsplash.

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Crohn’s Disease, Ulcerative Colitis, and Colorectal Cancer: How Different Are They?

Image credit: Gordon Johnson from Pixabay

 

There have been moments where we have experienced a symptom and attributed it to a completely different disease or condition than it ended up being. There are infographics to help acknowledge the similarities and simultaneously clarify distinct differences across the common cold, flu strains, and COVID-19. Since there is much overlap and potentially confusion that can arise regarding symptoms of Crohn’s disease, ulcerative colitis, and colorectal cancer, we have created infographics to help visualize commonalities as well as distinguish their disparate characteristics. 

We hope that these graphics will provide a clearer picture of symptoms that are unique to specific conditions and diseases and where and how they manifest in our body.

 

 

Sources:

  1. Colon cancer vs. ulcerative colitis (UC) symptoms & signs. eMedicineHealth. April 2, 2020. Accessed November 8, 2023. https://www.emedicinehealth.com/colon_cancer_symptoms_vs_ulcerative_colitis/article_em.htm.
  2. Crohn’s disease and colon cancer: What you need to know. HealthMatch. October 15, 2021. https://healthmatch.io/colon-cancer/crohns-disease-and-colon-cancer#overview.
  3. Colon cancer. Mayo Clinic. July 27, 2023. https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669.
  4. Colorectal cancer – symptoms and signs. Cancer.Net. June 1, 2022. https://www.cancer.net/cancer-types/colorectal-cancer/symptoms-and-signs.
  5. Colorectal cancer signs and symptoms: Signs of colorectal cancer. Signs of Colorectal Cancer | American Cancer Society. June 29, 2020. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/signs-and-symptoms.html.
  6. Colorectal cancer: Symptoms and diagnosis. Colon Cancer Foundation. December 1, 2022. https://coloncancerfoundation.org/colorectal-cancer-symptoms-diagnosis-and-treatment/.

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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NEHI Report Proposes Solutions for CRC Screening Disparities

The Network for Excellence in Health Innovation (NEHI) conducted research to shine a spotlight on disparities in colorectal cancer (CRC) screening and has proposed short-term and long-term recommendations to address these disparities. The report, Addressing Persistent Disparities in Colorectal Cancer Screening Among Racially and Ethnically Diverse Populations, proposes solutions that would help close existing gaps and legislative involvement for long-term resolutions.

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Disease-Free Survival: How Does Exercising Impact Colon Cancer?

By Parker Lynch

We all know that exercise is healthy. However, the extent to which a patient with colon cancer could improve their prognosis through exercising is something that was previously unknown, and is still being researched. Authors of one such research study published their findings after analyzing how physical activity impacted individuals with Stage III colon cancer.

Does Exercise Improve Colon Cancer Outcomes?

In collaboration with the National Cancer Institute, two groups of patients with Stage III colon cancer (one of them being a placebo or control group) were randomly assigned to various community and academic centers throughout the U.S. and Canada to be evaluated during the duration of their treatment. Patients were then instructed to report the average weekly time that they spent exercising.                                                                                                                                                                                                                                                                       

Each physical activity was assigned a specific metabolic equivalent (MET). The MET values were then multiplied by the hours that each patient reported spending each week, which were then categorized as:

  • <6 METs (light- to moderate-intensity physical activities) 
  • ≥6 METs (vigorous-intensity activities) 

Patients’ METs were evaluated throughout their chemotherapy treatments as well as six months after treatment completion. 

Here’s What They Found

During a median follow-up of 5.9 years, the study found the following relation between the status of a patient’s health and their corresponding physical activity levels: 

  • For light-intensity to moderate-intensity activities, the 3-year disease-free survival (DFS) was 65.7% with 0.0 hour/wk
  • For vigorous-intensity activity, the 3-year DFS was 76.0% with 0.0 h/wk and 86.0% with ≥ 1.0 h/wk

These results strongly indicate that more frequent, high-intensity recreational activities can improve DFS.

Implications for Patients 

Nothing is ever directly causational, and there are never guarantees that one specific lifestyle change will influence treatment outcome. However, studies like this are vital because they provide information that could change one’s quality of life while going through cancer treatment. If a patient with colorectal cancer picks up running as a new hobby because of this study and it makes them feel better in their day-to-day life, then that is a real-world influence of research studies. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Tips to Tailor Health Education on EAO-CRC for College Audiences

By Vanessa Seidner

The Colon Cancer Foundation and the 2024 Early-Age Onset Colorectal Cancer (EAO-CRC) Chair, Dr. Cathy Eng of the Young Adult Cancer Program at Vanderbilt-Ingram Cancer Center, will be hosting the 8th Annual EAO-CRC Summit in Nashville, Tennessee, which will provide the grounds for discussions about the latest technological and medical advances, how to build community, and about what actions can be taken at various levels to address the rise in EAO-CRC. 

Colorectal cancer (CRC) is the third most common cancer among men and women. This cancer occurs more often in the older population, yet there has been a rapid rise in CRC incidence among young people. Early-Age Onset (EAO) CRC refers to cases of colon or rectal cancer that occur in people under the age of 50 years. There has been an annual increase in these cases of approximately 2% since 2011.

Some of the best ways to prevent CRC or avoid unfavorable outcomes include on-time screening (starting at age 45 years – earlier if there are symptoms or family history), knowing the risk factors and family history, and consulting medical professionals when potential symptoms arise. One of the most effective ways to increase awareness of these solutions is through health education.

How Can We Encourage Health Education on EAO-CRC for College Students?

There are several opportunities to host educational events. The implementation of peer educators in colleges and universities is a cost-effective approach that allows students to impart valuable knowledge to their peers about meaningful and healthy lifestyle changes. While health outlooks differ, health education can be tailored to specific audiences to increase the likelihood that someone can reach and maintain their concept of optimal health. 

Health education events can appear as presentations, panels, tabling, and expositions. 

  • Presentations
      • Longer, more information-dense messaging
        • Can incorporate interactive questions and activities and pre/post surveys that allow participants to think critically about what they have learned and about how they will apply it to their lives moving forward. Information pamphlets and giveaways can also bolster interactivity. 
      • Key takeaways: Elaborate and in-depth, allows for active participation, and allows for future action to be taken.
  • Panels
      • Question and answer sessions. These can allow for an increased sense of closeness.
        • Panelists can provide a variety of perspectives germane to their topic
        • They can share anecdotes and experiences – personal, occupational, or both 
        • Specific contact information can be provided in case an audience member wishes to reach out to a panelist.
      • Key takeaways: Allows sharing of diverse viewpoints, opportunity for an open dialogue 
  • Tabling Events 
    • Drop-by event; can give quick overviews
    • Opportunity to share information pamphlets and giveaways
    • Can host activities to engage visitors in discussion and have giveaways
    • Key takeaways: Cost- and time-effective, succinct, and engaging – tabling events are a popular health education method                                                                                                   

Colleges and universities can host one or more of these events to increase awareness on risk factors, symptoms, the need to consult a medical professional if symptoms occur, and the importance of regular screening. As for timing, it is best to do so on days where there are not as many classes, in populous areas, and during a time of day when there is a higher influx of people, such as around a mealtime or when a certain timeblock for classes commonly ends. 

March is Colorectal Cancer Awareness Month. Consider a tabling event with information about the disease and with some free merchandise. Students can also be encouraged to wear dark blue to increase awareness of CRC.

Reach out to us at info@coloncancerfoundation.org if you would like to partner on an information event in March or any other time!

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo Source: Naassom Azevedo on Unsplash

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Gut Microbes Play an Important Role in Colorectal Cancer

By Emmanuel Olaniyan

Colorectal cancer (CRC) is one of the more common types of cancer and is the third largest cause of cancer-related deaths worldwide. According to the American Cancer Society, 153,020 new cases of CRC are expected to be detected throughout the U.S. in 2023, out of which 52,550 people will die from the disease. Considering these figures, it is important to raise public awareness about CRC in order to decrease the number of CRC-related deaths and new cases.

Several studies have researched the causes of CRC, and age, diet, genetics, and the gut microbiota have all been identified as risk factors in various ways. The gut microbiome, in particular, has been shown to play an important role in a number of diseases, and research has begun to focus heavily on its role in CRC. 

What is the Gut Microbiome?

The human gut microbiota refers to the trillions of microbes, such as bacteria, viruses, fungi, and others present in the human digestive tract. The microbiome is the environment they live in. Most microbes in the body are beneficial, but they may become harmful when out of balance.

The gut microbiota is crucial for the overall functioning of a healthy digestive system because it supports the absorption of energy from digested food, guards against pathogens, controls immunological response, and fortifies biochemical barriers of the intestine. However, when harmful bacteria enter the gastrointestinal tract through eating contaminated food or drinking contaminated water and cause infection, all of these advantageous activities could be disrupted.

Jaeho Kim and Heung Kyu Lee published a study in 2022 that found a strong association between gut microbiota and CRC. They came to the conclusion that the patients with CRC experienced dysbiosis (an imbalance in bacterial composition, changes in bacterial metabolic activities, or changes in bacteria distribution within the gut) more frequently than healthy individuals. Opportunistic infections were discovered to be more prevalent, and intestinal inflammation has been shown to be reduced along with the percentage of bacteria that produce butyrate, which is an essential component of our digestive system that reduces inflammation in the digestive tract, protects the brain and prevents cancer.

How Can We Maintain a Healthy Gut Microbiome?

Maintaining good hygiene and being mindful of the foods we eat can help keep our gut microbiota healthy. Studies have shown that eating more processed foods and a low intake of dietary fiber increase the risk of CRC. For this reason, it is recommended to consume fermented foods like cheese, soy sauce, vinegar, and yogurt as well as meals high in fiber like whole grains. It has been established that the bacteria present in these fermented foods are similar to those linked to gastrointestinal health. 

Finally, a decrease in processed food consumption and antibiotic use lowers the risk of developing CRC caused by gut microbes. 

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Image source: OpenClipart-Vectors from Pixabay

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Don’t Excessively Email Your Doctor; You Might Get Charged

By Parker Lynch

The COVID-19 pandemic has had a lot of repercussions within the healthcare realm. The inability of patients to visit their providers in-person (out of fear of COVID-19 exposure) led to the expansion and adoption of telehealth services all across the world. While we have a better handle on the pandemic in America, telehealth services are still being utilized by physicians from a vast assortment of specialties. Telehealth increased access and was beneficial to patients as well as doctors, there are some caveats.

A recent article shares how patients are now really comfortable emailing their doctor to provide health updates or ask medical questions. Patients may live several hours away from a specialist’s clinic or might be too sick, which may make it inherently difficult for them to schedule in-person appointments. Justifiably so, they might prefer to reach out to their doctors via the clinic’s or hospital’s patient portal. As a result, doctors are flooded with email messages, many of which are received after hours. Doctors feel obligated to answer all of these questions/comments, 24/7.

Patient Portal Communication Causing Physician Burnout 

Due to the burnout that physicians are experiencing from this constant and overwhelming communication, hospitals including Johns Hopkins, Houston Methodist, and the Cleveland Clinic have begun charging patients for the clinical advice that they are receiving through messages. The goal of these charges is to reimburse physicians for their time, but has discouraged patients from contacting their providers. 

Many doctors believe that open communication between them and their patients is vital to an accessible healthcare system and do not want their patients to ever refrain from reaching out. At the same time, these doctors also recognize that open communication can’t feasibly mean “open” 24/7. Moving forward, it is important to keep in mind that this issue is hardly black-or-white. Should patients continue to be charged for messaging their providers, there will be accessibility barriers for those that cannot afford these charges. On the other hand, constant communication between patients and their doctors has proven to be detrimental to the doctors themselves. Eve Rittenberg, a physician and professor at Harvard Medical School, believes that this line of communication should remain, with boundaries in place.

Implications for Cancer Patients

For patients in the cancer realm, specifically, there are some implications of this limited/“controversial” communication. Dr. Jyoti Patel, suggests several different ways in which patients can effectively use their patient portal messaging features. Most importantly, one should never send a message regarding chemo-induced fever or sudden symptom changes, rather they should immediately call the doctor’s office. Chat features with physicians should never be used to discuss complex questions that revolve around one’s diagnosis, prognosis, goals of treatment, etc. It can be very difficult for physicians to properly convey their thoughts on these matters. Instead, patients should only be asking questions that yield a straight-forward and easy response (like prescription refills, appointments, etc.). 

Boundaries can be really hard to establish between patients and their doctors. However, the fundamental goal of wishing the absolute best quality of care for a patient remains consistent. Hopefully, a happy medium can be met: allowing the patients to communicate with their providers without the providers feeling overwhelmed. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Image credit: National Institutes of Health

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Rise in CRC Among Young Adults Continues to Baffle Researchers

Cancer incidence has been growing among younger adults—not just in the U.S., but globally. According to a recent analysis, the three decades between 1990 and 2019 saw almost an 80% increase in incidence of early-onset cancer. Following breast cancer, cancers of the digestive tract (stomach and colorectal) have seen a rise among young adults—in 2019, 37% of early-onset cancers diagnosed across the world were in the colon and rectum.

These trends are also reflected in the U.S. population. Here’s a startling prediction: by the year 2040, colorectal cancer (CRC) is estimated to be the second-leading cancer in the 20-49 age group and the top cause of cancer-related death in that age group.

The Need to Raise Awareness Among Providers

What is frustrating for the early-age onset CRC (EAO-CRC) community is that young individuals are not your typical candidate for developing colon cancer, which means their symptoms are either dismissed or attributed to some other gastrointestinal issue. According to cancer epidemiologist Yin Cao, 50% of EAO-CRC cases are among those under 45 years of age. Current guidelines recommend that someone with an average risk for CRC should start screening at age 45, so anyone younger may not get screened despite their symptoms.

An average-risk person is someone who does not have a known family history of CRC or a known genetic condition that’d increase their risk for developing CRC.

As a result, diagnosis is delayed, which raises the risk of an advanced-stage disease that may be harder to treat. One such study among nearly 1,200 EAO-CRC patients found that 71% were diagnosed at an advanced stage (stage III or IV).

*Information on the various stages of CRC can be found here.

What’s Leading to the Rise in EAO-CRC?

While there are a lot of guesses, researchers and clinicians are not quite sure. There are talks about a birth cohort effect, which is a term that describes the unique experiences or exposures faced by a group of individuals based on their year of birth. For example, Americans born prior to 1945 have been found to have a lower risk of being obese.

Going back to CRC, medical oncologist Christopher Lieu told ScienceNews that those in their 40s today are at a greater risk of developing CRC than those who turned 40 a decade ago (so now in their 50s). Several different risk factors are being investigated in those who develop EAO-CRC:

  • Obesity
  • Antibiotic exposure
  • Changes in the gut microbiome (meaning the microbes that live in our gastrointestinal tract)
  • Dietary habits
  • Environmental exposures

However, there’s no definitive answer for the cause. The best preventive efforts include being physically active, managing your body weight, reducing the intake of processed food and integrating fresh fruits and vegetables in your diet.

What Do We Know?

What is definitely known are the telltale symptoms: pain in your abdomen, abnormal bowel movements (unexplained diarrhea or constipation), blood in your stools/rectal bleeding, unexplained weight loss, weakness. It is important to pay attention to these symptoms, which are often misdiagnosed as inflammatory bowel disease or hemorrhoids, especially in young adults. Any two of these signs could indicate a serious problem with your gastrointestinal tract—potentially, cancer.

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Intestinal Bacteria: Biomarkers and Targets for Colorectal Cancer

By Parker Lynch

According to a study published in Cancer Biology & Medicine, the role of intestinal bacteria in the development of colorectal cancer (CRC) has been receiving a lot of attention in recent years. Various bacteria such as Fusobacterium nucleatum, Escherichia coli, Bacteroides fragilis, Enterococcus faecalis, and Salmonella sp., have been known to cause DNA damage. Additionally, these bacteria also help tumor cells evade the body’s immune response, creating a pro-inflammatory environment. The DNA damage and other hindrances upon one’s immune system and bodily function have been associated with the development and progression of CRC.

These bacteria can be useful biomarkers for CRC. Additionally, progress is being made in developing effective antibacterial therapies, which could prove useful in the treatment of CRC.

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Pathways to Nutritional Prevention: an Infographic

Nutrition & Colorectal Cancer Prevention Series: Blog 3

In the previous installments of this blog series, we explored both the molecular pathways behind dietary prevention of colorectal cancer (CRC) as well as the barriers within the built environment that prevent individuals from properly accessing those preventative nutrients. This post will further explore strategies and resources that can aid communities in achieving a balanced diet.

With rising costs of living and barriers in the built environment such as food deserts, reducing CRC through dietary prevention can feel like a daunting task, but there are many resources available that can provide support in this process. 

So how can individuals identify resources that are available to them? This can be done through a multi-pronged approach from accessing fresh food from local organizations to engaging in nutritional education classes. 

Where can you find these resources? Findhelp.org is a database that provides direct links to resources in your zip code. Individuals can input their location and find resources from direct food access, to community gardens, to education. 

Our infographic below provides a snapshot of how integrating dietary pathways can help CRC prevention.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo credit: Nathan Dumlao on Unsplash

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