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AT RISK FOR COLORECTAL CANCER

Q: My father recently died from colorectal cancer. He was such a strong and kind man, and his death was so hard on everyone.

While I was his main caregiver, I learned that my risk of getting the same disease was a lot higher than that of most people. Please tell me more about my risk and if there is anything I can do about it.

-- N.C., Fairfield, Conn.
A: Even with some significant advancement in cancer treatment and some major improvements in outcomes, cancer remains one of the most frightening medical diagnoses. It's easy to understand your anxiety.

Fortunately, there are many things you can do to decrease your chances of having the same thing happen to you. These fall into two categories. The first is to decrease the chance of colorectal cancer developing. The second is detecting it earlier if it does.

Colorectal cancer (cancer of the colon and rectum) is the second most common form of cancer and the second leading cause of cancer death in North America. About one in 10 of those who die from cancer die from colorectal cancer.

There is a one in 20 chance that a person will get colorectal cancer sometime in his or her lifetime. But the risk almost doubles for someone who has a close relative who has or had the disease. The risk for someone with certain bowel diseases also increases. People with ulcerative colitis and Crohn's disease have a much higher risk of developing colon cancer.

Lifestyle and diet can play important roles in increasing and decreasing the risk of colorectal cancer. Smoking is the worst thing you can do in this regard. It increases the risk more than having a relative with the disease.

A dietary component that has consistently been shown to increase the risk is red meat. Although alcohol intake has been implicated in the past, a good, recent study did not find this to be so.

Increased amounts of vitamin D, calcium, fiber and isothiocynates all reduce the risk of colorectal cancer. Isothiocynates are found in many vegetables, but there is a higher concentration in cruciferous vegetable, which include cauliflower and Brussels sprouts.

Nonsteroidal anti-inflammatory drugs such as aspirin and the COX-2 inhibitory drugs have been shown to decrease the development of colorectal cancer. Many experts recommend them as part of treating this disease.

If colorectal cancer can't be prevented, the next best thing is to detect it early. A very useful screening test is the test for blood in the stools. That's because colorectal cancer bleeds rather early in its development. Recent research has shown that a test for cancer DNA in the stools is even more effective, but the cost is very high and it is not available in many places.

The best way to diagnose colorectal cancer is through a colonoscope. This is a long flexible tube that is inserted through the anus. It is long enough to reach near the upper end of the colon.

Treatment is based on how much the cancer has spread. The main treatment for colorectal cancer is surgical removal of the affected section of the bowel. If the cancer has spread beyond the wall of the colon, chemotherapy is usually added to the treatment.

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