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Copyright (c) 1991   Tribune Media Services, Inc.


Colorectal Cancer:  Learn the vital facts


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A real need--the need to know

     Reading this booklet may be among the most important things you ever do
because it could help save YOUR life!
     The following information is about a type of cancer that may be
avoidable, if you do certain simple things--and don't do others.  Even though
such cancers cannot always be avoided, they frequently can be treated
successfully, if found EARLY.  But if they are allowed to grow, the death rate
from them usually is high--about 60 percent within five years after the cancer
is detected.
     We now know that approximately 80 percent of cancer cases are related to
the manner in which people live.  Some examples are:  the foods we eat, the
work from which we earn our living and whether we use tobacco.  Choose
correctly and long, healthy life may be yours.  The wrong choices lead to ill
health, disease and possibly dreaded cancer.
     Knowing which things to avoid or some that might be increased can help us
all take control over our lives and decrease the known chances for developing
cancer.  Admittedly, some are very difficult to control, such as where you
work, the purity of the water you drink and the air you breathe.  Others are
easier to manage--as easy as eating the right, "good for you" foods.
     There are no guarantees, of course, but it's worth the little effort and
time it will take to read this booklet. . . you never really know, it could
make the difference between life and death

Good news

     But there is good news.  Medical science now has reliable ways to detect
cancers of the colon and rectum early and the skills to treat them immediately
and effectively, permitting you to live a full, fruitful life, but you must
learn the principle of early detection to gain these benefits for yourself and
for those you care about.  If a cancer is found before it has time to do
serious damage, grow and spread to other areas, it can be treated more easily,
with less need for radical surgery, less pain, fewer drugs along with their
side effects and less time away from work.  Naturally, early detection will
require less money to be spent while combatting the condition.
     Estimates indicate that 30,000 lives a year could be saved if people
older than 40 would have an annual bowel exam.  Others declare that the
percentage of colorectal cancer patients who survive for five years after
their cancers are diagnosed could more than double--from 40 percent to about
85 percent--if diagnosis occurred earlier.  Earlier means before the cancer
has a chance to spread into nearby lymph nodes, or to travel to other sites in
our bodies.

A "hush-hush" condition
     Many people have no problem discussing very intimate subjects, yet even
in these days, when frank conversation is the rule, some still are reluctant
to talk about their colons and rectums.  They are parts of our digestive
system that remain hidden and covered, concealed from view and thought.
Strange isn't it, because every person has them!  Also, nobody wants to talk
about cancer, as if not talking about it could lessen its occurrence or
effects.  But, like many undesirable conditions, cancer breeds well in
secrecy.
     The American Cancer Society estimates that during 1987, 145,000 new cases
of cancer of the colon and/or rectum will be found in the United States. (All
subsequent figures are for people in the United States.)  Included in this
figure are:  102,000 colon cancers and 43,000 cancers of the rectum.  Such
cancers, often referred to as "colorectal cancers," are the third most common
cancer in this country.  Only skin and lung cancers occur more frequently.
Expected deaths in 1987 from colorectal cancers will climb to an estimated
60,000 (52,000 from colon and 8,000 from rectum cancers).  Only lung cancer is
expected to cause more deaths.  These are not statistics we can pass over
lightly!
     Colorectal cancer develops over a period of time, so detection of it is
possible long before symptoms appear.  Detecting small cancers and polyps
reduces the likelihood of major surgery, yet not nearly enough people even
consider being tested for colorectal cancers.  In 1986, American men and women
older than 40 were studied by the Gallup Poll organization as to how they felt
about detection of colorectal cancer.  Results of the study showed that only
about 24 percent of people in that age group have ever asked their physicians
to examine their colon or rectum.  When they did ask for an exam, more than
half of them did so only because there apparently was something wrong with
those parts of their bodies, meaning they could have been running just a bit
late in preventing a serious situation from developing.

What is cancer?

     Cancer is not one disease.  There are more than 100 different kinds of
"cancer."  Yet, they all have this in common:  an abnormal growth of cells
that use up our bodies' reserves rather than building or repairing vital
tissues.
     Healthy cells, that usually make up all the body's tissues, normally
grow, divide and replace themselves in an orderly, self-controlled manner.
Sometimes those normal cells lose their ability to limit and direct their
growth. . . then they may grow wildly and form tumors.
     Tumors can be of two types:  benign or malignant.  Benign tumors do not
often spread and seldom are a threat to life.  Frequently, these can be
removed by surgery, and usually do not return.
     Malignant tumors are cancerous.  They can invade and destroy other nearby
tissues and organs.  Cancers also can metastasize, or spread, to other,
sometimes distant, parts of the body and continue to grow.  Many scientists
currently believe most cancers are caused in two steps by two kinds of agents.
Those are "initiators" and "promoters."
     "Initiators" start the damage to a cell that can lead to cancer. . . that
could be cigarette smoke, X-rays and some chemicals.  "Promoters" often do not
cause cancer alone.  They change cells already damaged by an initiator from
normal to cancerous.  Some studies have shown that alcohol promotes the
development of cancers in the mouth, throat and probably in the liver,
especially when combined with an initiator such as tobacco.
     Cancer afflicts humans and probably all other animals.  It can arise in
any organ or tissue in the body.  It is second only to diseases of the heart
and blood vessels as the major killer of Americans.
     Another of cancer's characteristics is its appearance when viewed through
a microscope.  Its individual cells vary in size and shape, and the orderly
pattern displayed by normal tissue is replaced by disorganization that may be
so complete that no recognizable structures remain.  Such loss of normal
appearance is called "anaplasia."  Some cancers grow very slowly and destroy
neighboring tissue, others are more aggressive and spread rapidly to distant
areas of the body.  In either case they are a serious threat to life and
longevity.

What are the colon and rectum?

     Your colon and rectum are a part of your digestive tract (see diagram),
or gastrointestinal system.  The main function of the digestive tract is to
extract the essential nutrients, fluids and electrolytes from foods and
liquids that have been ingested.  Another part of the tract's function is to
dispose of wastes from the digestive process.
     The final part of the digestive tract is called the colon.  It also is
referred to as the large bowel.  It starts with the cecum, a pouch that
receives liquid material from the small intestine.  The colon extends from the
cecum to the rectum in an inverted U shape.  It is made up of four parts:  the
ascending, transverse, descending and sigmoid sections.
     The ascending colon extends from the cecum upward along the right side of
the abdomen.  At a point just under the ribs, this tubelike organ turns left
and crosses the upper portion of the abdomen.  That section is called the
transverse colon.  The descending section extends downward along the left side
of the abdomen to the pelvic region.  There it meets the S-like sigmoid
portion of the colon.  The sigmoid colon is connected to the rectum.  The
rectum is the final eight to 10 inches of the colon.  The anus is located at
the end of the rectum.

Symptoms

     Symptoms of colorectal cancers depend greatly on the location and
function of the part of the intestine where the disease develops.  The most
frequent symptom is a change in bowel habits such as being constipated or
having diarrhea.  Other symptoms include a change in the size of your stools,
discomfort or pain in your abdomen, unexpected weight loss, unexplainable and
lingering tiredness, frequent gas pains, and/or blood in your stools (it may
be black or bright red).
     Such symptoms do not necessarily mean you have cancer.  They could be
caused by other conditions such as ulcers or an inflamed colon.  It is equally
important to remember that early cancer may have no symptoms at all, and a
routine but regular examination will be the best prevention.  Whatever, the
case, however, should any of the above symptoms last for up to two weeks, see
your doctor as soon as possible.  That's when the principle of "early
diagnosis:  can be made to work in your favor.

Who's most likely to develop it?

     In Western industrialized countries, colorectal cancers attack both men
and women, blacks and whites.  Colorectal cancer is particularly common in the
United States and Canada, the United Kingdom, Australia, New Zealand and other
highly industrialized nations.
     Contrastingly, it occurs infrequently in India, Colombia, Senegal and
other areas that are economically poorly developed.  So it appears that the
environment and eating habits have a great deal to do with who is most likely
to develop such cancers.
     The conditions occurs most often in people older than 40.  The risk
becomes even greater at 50 and doubles with each decade, reaching a peak at
age 75.  Also, it is particularly frequent in people who have a personal or
family history of colorectal cancer, cancer in other parts of the body, in
people with a history of polyps in the colon or rectum and those with
inflammatory bowel diseases (such as ulcerative colitis).
     Nearly all colorectal cancers develop from polyps, especially adenomas.
Most polyps in the colon do not become cancerous, but their presence--or a
history of polyps--points to increased risk.  The greater the number and size
of polyps in the colon, the greater the risk.  Approximately 5 percent of
patients who have a single diagnosed colon cancer develop another somewhere
else in the colon.  More black male and female Americans develop, and die
from, cancer--including colorectal cancer--than do their white counterparts,
according to statistics covering a 30-year time span.

Screening for colorectal cancer
     Examining people with no symptoms to detect cancer is known as screening.
Several techniques have been studied to develop effective screening methods
for colorectal cancer.  One of the simplest, safest and cheapest is to test
for occult (hidden) blood in the stool.  The most reliable of these tests
usually require a laboratory, but home tests have a real role in the detection
of cancer.  While not as reliable as those performed in clinical laboratories,
any test for blood that aids in early diagnosis must be considered valuable.
     Large-scale public screening programs have been suggested by some
researchers.  They state that such tests could uncover asymptomatic (showing
no symptoms) bowel cancer and point out that examinations for occult blood in
a test group doubled the detection of colorectal cancer.  Others argue that
because compliance by the public would be low, and test results are not always
correct, wide-scale screening would not be worth the money and effort
required.

Asymptomatic patients
     A doctor may suspect that a patient could have colorectal cancer even
though he/she is asymptomatic.  Asymptomatic patients could be those without
rectal bleeding, etc., but who have anemia or in whom unsuspected findings
were discovered during examination.  Patients with past histories of adenoma,
colorectal cancer, ulcerative colitis or family histories of cancer
particularly will need frequent check-ups.  It may surprise you to learn that
65 percent of cancers of the colon or rectum are within reach of an examining
finger or can be detected by a simple sigmoidoscopic examination.

Diagnosis
     A physical examination from your doctor is the only way to be positive
that you do not have colorectal cancer.  To check the rectal area, your
physician will insert a gloved, lubricated finger into it and gently feel for
anything abnormal
     The doctor may decide to do a "procto" (an exam which allows him/her to
actually look into the rectum).  To do that a proctoscope (small, short,
rigid, hollow, lighted instrument) is inserted into the rectum.  To examine
the sigmoid portion of your colon, a sigmoidoscope (a small, hollow, lighted
instrument) may be inserted into the anus.  There may be need for further
tests.
     Perhaps your doctor will want you to have a series of "lower GI"
X-rays--taken after a thick solution of barium flows into the bowel through an
enema tube.  The barium allows an outline of the large intestine to show on
the X-ray pictures.  On occasion, air is pumped into the colon during a
barium-enema to provide better photographs of any small tumors that may be
present.  That is called an air-contrast barium enema.  Results from such
X-ray photographs may reveal tumors that were not found during other tests.
     Nowadays, however, you are more likely to undergo an exam using a
colonoscope.  Colonoscopes allow a physician to visually examine the entire
colon through a long, small, flexible, hollow, lighted fiber-optic instrument.
Colonoscopes permit identification of colorectal cancers at an earlier stage
than is possible with X-rays or other external examination techniques.  The
instrument also allows the doctor to remove precancerous polyps or other
suspicious growths in the colon during the examination.  Such growths must go
through a laboratory process called biopsy for definite determination of
whether they are malignant or benign.
     It was this procedure, on a routine examination, that led to the
discovery of President Reagan's cancer and its successful removal.
Additionally, the use of the colonoscopy often can replace what formerly was
known as "exploratory surgery" (surgically opening the body to find what is
causing a problem), thereby saving pain, anxiety, inconvenience, time and
money.

Treatment

     If a malignant tumor is found, your doctor will want to start a treatment
plan for you.  The plan will be designed to fit the type and extent of both
your cancer and your individual needs.

Staging

     The first step in treatment often is to find out the "stage" of the
cancer.  Colorectal cancer is classified, or staged, by direct observation of
the tumor, either during microscopic examination of tumor cells (pathologic
staging) or during surgery.  Staging tests show whether the disease has spread
from its starting point to other parts of the body and will help your doctor
plan the best treatment.
     Physicians often order X-rays or other visual exams (scans) of the chest,
liver, kidneys and bladder.  Blood tests are used to measure certain
substances that may increase in the liver or the blood of those having such
cancers.  The same types of blood tests sometimes are used later to determine
how well a patient is responding to treatment.
     Duke's pathologic staging system, developed years ago, separates
colorectal cancers into three groups--Stage A:  tumors that are found only in
the wall of the bowel and do not extend into surrounding muscle; Stage B:
those that have penetrated into the muscle; and Stage C:  cancer that has
spread into lymph nodes.  The system has been modified to include more
distinct phases that can occur in stages B and C.  Some physicians have added
a stage D.  And as our knowledge has increased, other systems of staging the
extent of the cancer have been developed and are used by some physicians.

Plan

     Following staging, your physician will develop a treatment plan to fit
your medical history, general health, as well as the location and type or
cancer involved.  But before that treatment commences, you may want (and your
health insurance company may require) a second doctor's opinion and review of
your diagnosis and treatment plan.  If so, you may wish to take advantage of
some of the resources listed in the back of this booklet.
     No matter how many different opinions one obtains, there are only three
basic colorectal cancer treatment methods.  They are:  surgery, radiation
therapy (includes X-ray, radio, cobalt and/or irradiation therapy) and drug
therapy (chemotherapy).  Decisions regarding the use of just one of the above,
two or all of them will depend on your unique treatment needs.  You may be
referred to other physicians for specific treatment in one, or all, of those
three different specialties.

Surgery

     The above notwithstanding, the standard treatment for colorectal cancer
is surgery.  Therefore, it usually is not a question of if you need surgery,
but what type.  The size of the cancer and where it is located determines, to
a great extent, the type of surgery required.  Hopefully, your surgeon may
have to remove only a small portion of the bowel that contains the cancer.
(See diagram on Page 5.) Following that, yet during that same operation, it is
possible that the remaining healthy sections can be rejoined.  Such surgical
procedures (another term for what commonly is called an operation) are named
bowel resection.  Frequently, resections are required if a cancer is in the
right-hand side of a colon (ascending), or in the trans verse colon.  In such
cases, it often is advisable to remove nearby lymph nodes that help drain the
areas because they are among the most typical area to which colorectal cancers
spread.  The lymph system carries vital fluid throughout the body, much like
the blood system carries blood.  The lymph system also can carry cancer cells
in its fluid as it flows from one part of the body to others.  When lymph
nodes are removed there is less chance for a cancer to spread.
     When a cancer blocks the bowel an operation known as a colostomy may be
required.  Colostomies either are temporary or permanent.  Approximately 95
percent of colorectal cancer patients require only a temporary colostomy.  In
both temporary and permanent colostomies, a surgeon removes the cancerous part
of the bowel and creates an opening (called a "stoma") in the abdomen through
which wastes are routed out of the body.  A colostomy makes waste removal
possible without the necessity of it passing through the lower colon and
rectum
     Temporary colostomies are performed to allow the lower colon and rectum
to rest and heal.  Following the healing process, a second operation is
performed to close the stoma, at which time the body can resume normal
digestive and elimination functions.
     When a cancer occurs in the lower rectum, usually the entire rectum will
have to be removed.  In such cases, a permanent colostomy is needed.  After
such an operation, a bag, called an appliance, is attached to the stoma to
collect waste.  You must wear the colostomy appliance continually.  Luckily,
it does not show under everyday clothing, and a therapist can teach you how to
take care of your stoma and appliance with very little adjustment in your
everyday mode of living.
     Fortunately, advances in surgical techniques and medical care have made
extensive surgery possible for people previously considered too old or infirm
for it.  So there is new hope for all, and many more can be helped.

Radiation therapy

     Radiation therapy utilizes high-energy rays to stop cancerous cells from
growing and spreading.  It can be used prior to, or following, surgery, to
shrink a tumor, or to destroy cancer cells that might not have been removed
during an operation.  It also may relieve pain caused by some cancers.  Your
physician will define a radiation therapy schedule for you, if you need it,
based on your condition's exact requirements.
     Usually you will not have to be hospitalized while receiving radiation
therapy.  Your treatments will be administered by radiation therapists located
in private offices, clinics or hospitals.  Until recently, radiation therapy
was not used extensively in treating colorectal cancer.  However, advanced
research indicates that when radiation is used before an operation, it may be
possible to stop the growth of a large number of cancer cells.  That action
reduces the risk of recurrence and metastasis.

Anticancer medications

     Chemotherapy is the term used when cancer patients are treated with
anticancer drugs.  Chemotherapy usually is given when there are indications
that a cancer has spread to other parts of the body, or when that danger seems
probable.  Chemotherapy, as with all anti-cancer treatments, works best
early--before the cancer has had a chance to grow much.
     Various chemicals are used as medications in chemotherapy and there are
different ways of administering them.  Some are given orally some are more
potent when administered by injection into a vein, artery or muscle.
     Frequently, chemotherapy is given in cycles:  a period of treatment,
followed by a period with none, then another treatment period, a period with
none.  No matter how you receive chemotherapy, the medicines travel through
your bloodstream to nearly every area of your body, assisting it to halt the
growth and division of cancer cells.  Many of the medicines can be given to
you as an outpatient.  With others, you may have to be hospitalized for a few
days so that your doctors can watch what effects the drugs produce.  After
that initial stay, usually you will be able to receive your medications at the
hospital but on an outpatient basis.
     A large amount of research is being done to study the use of anticancer
drugs alone--or along with radiation--shortly after surgery in efforts to
reduce the chance of recurrence.  Many current chemotherapy research studies,
particularly those involving patients with advanced colorectal cancer, use
several drugs in combination.
     Some of the most frequently administered are:  5-flurouracil,
vincristine, methyl CCNU, methotrexate and DTIC.  Of course, other drugs are
in use in research that, hopefully, soon will increase chemotherapy's
abilities to help control cancer.
     Immunotherapy, the use of the body's own immune system to treat cancer,
also is being studied with what appears to be encouraging results.  The
National Large Bowel Cancer Project has underwritten a number of preclinical
studies to develop new medical ways to treat colorectal cancers--particularly
those in the large bowel.  These are undertaken in hope of discovering new,
innovative and, importantly, more effective methods to help cancer patients.

Treatments may have side effects

     Because any cancer can spread rapidly and with life-threatening results,
drugs used against them must be extraordinarily powerful.  Because of that, it
is almost impossible to limit the effects of chemotherapy to the point that
only cancerous cells are destroyed.  Nearby normal cells often are damaged
along with those containing cancer.
     With that in mind, you will understand why chemotherapy patients often
experience unpleasant side effects as their disease is being fought by the
medications.  Chemotherapy affects the cancer cells and other rapidly growing
ones such as hair cells and some cells that form the tissue lining the
digestive tract.  That can result in such side effects as hair loss, nausea
and vomiting.  Periods of radiation therapy may produce unusual tiredness and
skin reactions surrounding the area of treatment.  Additionally, loss of
appetite that many cancer patients experience can be a serious side effect.
     But cancer patients need to consume a balanced diet.  Research has proved
that patients who eat well are much more able to withstand various therapies
and their side effects.  Eating well also helps patients prevent serious
weight loss.  Physicians consider nutrition a necessary part of a treatment
plan.  Particularly important is having enough protein in one's diet to build
and repair organs, muscles, skin and hair.  Cancer patients often find it
easier to eat frequent, smaller meals throughout the day rather than the usual
three large meals.
     Your physician, along with dietitians and nurses, can provide expert
advice on what side effects you may experience and how best to deal with them.
They also can recommend advisable diet planning to help you keep your strength
and weight.
     When your treatments are completed, you should continue to have medical
examinations regularly so that your physician can monitor your progress.
Should physical rehabilitation be needed, your doctor may be relied upon to
offer you good counsel and direction.  Your local hospital may be quite
helpful with information, and other community organizations are prepared to
give you many kinds of help.
     The social service department at your hospital can advise about local
organizations that offer help for cancer patients and their families.  The
assistance offered may include financial aid, transportation to and from the
hospital for medical care and homemaker services. (Here again, a careful study
of some of the names and addresses of helpful organizations included in this
booklet may get you off to the living start you need.)

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, 4 W.  35th St., New York, N.Y. 100011; (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 non-emergency surgery.  It's a service of the Health Care
Financing Administration, U.S. Department of Health and Human Services.

     AMERICAN COUNCIL OF LIFE INSURANCE, HEALTH INSURANCE ASSOCIATION OF
AMERICA, (800) 423-8000, (202) 862-4054, in the District of Columbia, answers
general questions about life and health insurance; it does not handle
complaints regarding insurance claims.

     UNITED OSTOMY ASSOCIATION, 2001 W. Beverly Boulevard, Los Angeles,
Calif., 90057; (213) 413-5510, 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; (301) 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 OF COLON AND RECTAL SURGEONS, 615 Griswald, No. 1717,
Detroit, Mich.  48226; (313)  961-7880.  The society is a professional society
of physicians, specializing in diagnosis and treatment of disease of the
colon, rectum and anus.

     AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY, 13 Elm St., P.O. Box
1565, Manchester, Mass.; (617) 927-8330.  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.
ÿÿ
----------------

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.
