An Integrative Approach to Colon & Rectal Cancer

-Connie Pennington, MD

 

Integrative Colon & Rectal Cancer Care involves a partenership between physican and patient to facilitate a whole-body healing plan. This plan includes state of the art western medicie, diagnostics, health optimization, surgery, and in some cases radiation and chemotherapy.  In addition to what is considered the standard of care, we promote an overall holistic health assesment and treatment plan that includes the use of food as medicine, supplement optimization, weight managment, and other healing modalities which are gaining acceptance through evidence based research. Our goal is to provide individual care plans that promote innate healing.  

 

The majority of factors that contribute to the development of colorecctal cancer are modifiable through education and life style changes. We begin with a lifestyle assessment, and then design individual treatement plans based on things that are known to prevent colon and rectal cancer as well as the developement of recurrence. 

 

Non-Modifiable Risk Factors for Colon & Rectal Cancer: 

 

  • Age greater than 50

  • Family history of colon cancer

  • Certain genetic alterations

 

 

 

Modifiable Risk Factors for Colon & Rectal Cancer:

 

  • A diet low in plants and high in red meat

  • Vitamin and mineral deficiencies 

  • Enviornmental carcinogen exposures

  • Heavy alcohol use

  • Smoking

  • Obesity

  • Diabetes

  • Metabolic Syndrome

  • Lack of Exercise

  • Excessive Stress Levels

  • Lack of quality sleep

 

 

Integrative

Colon Cancer

Pathway

 

  • Diagnosis

  • Staging

  • Overcoming Fears

  • The Spiritual Role of Healing and Wholeness

  • Developing Self-Care

  • Journaling

  • Diet Diary

  • Eating out Record

  • Water Source 

  • Cooking Methods

  • Personal Care Product Log

  • Chemical Exposures

  • Support Network

  • Gratitude Inventory

 

  • Preparing Your Body for the Best Outcome
  • Pre-operative Clearance
  • Medication Management Before Surgery
  • What to Expect on Admission
  • Personal Care Companion
  • After Surgery
  • Post-Operative Meal Plans
  • Discharge Planning
  • Meal Planning Basics

  • Recommended Cookbooks

  • Supplements

  • Mind-Body Interventions

  • Aromatherapy

  • Massage

  • Exercise

  • Living Clean & Green

 

 

 

  • Follow-Up Surveillance

  • Positive Focus

  • Healthy Nutrition for Life

  • Exercise Habits

  • Restorative Sleep

  • Peace of Mind

 

 

A Closer Look at Risk Factors for Colon & Rectal Cancer

 

Advancing Age

 

The biggest risk factor for developing colorectal cancer is advancing age.  Databases indicate that 90% of colorectal cancer occurs in person’s over 50 years of age.  The normal range for diagnosis is 65-70 years. 

 

Family History

 

The majority of colorectal cancr, or 50%-60% is sporadic. About 30% of colorectal cancers are associated with a positive family history.  Colon cancer in a first-degree relative or multiple affected family members, particularly occurring at a younger age, doubles an individual’s risk. Roughly 5% of colon cancers are due to highly penetrant familial forms of colon cancer. These include inherited gene mutations for familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch Syndrome. Lynch Syndrome cancers include colorectal cancer, uterine cancer, ovarian cancer, stomach cancer, and rarely urinary, small bowel or pancreatic cancers. 

 

Genetic Testing

 

Hereditary colorectal cancers are associated with a specific genetic abnormality. Genetic testing can be useful in these populations. Risk factors that warrent genetic testing include:

 

For Polyposis Syndrome:

 

  • Individuals with multiple colorectal adenomas (usually 10 or more cumulative adenomas)

  • Personal history of a desmoid tumor

  • Relatives of APC or MYH mutation carriers

 

 

For Lynch Syndrome:

  • Has had colorectal or endometrial cancer before age 50

  • Has had MSI-high histology before age 60:

                    Mucinous

                    Signet ring

                    Tumor infiltrating lymphocytes

                    Crohn's-like lymphocytic reaction histology

                    Medullary growth pattern

                    Has had an abnormal MSI/IHC tumor test result (Colorectal/Endometrial)

  •   Has had 2 or more Lynch syndrome cancers at any age

  •   Has had a Lynch syndrome cancer with 1 or more relatives with a Lynch syndrome cancer

  •   Has a previously identified Lynch syndrome mutation in the family

  •   Has had two or more relatives with a Lynch syndrome cancer, one before the age of 50

  •   Has had three or more relatives with a Lynch syndrome cancer at any age

  •   Has a previously identified Lynch syndrome mutation in the family

 

 

Dr. Pennington and Dr. Sheffey offer genetic testing when appropriate. The test kit requires a saliva sample and can easily be collected in the office. Results take about two weeks.

 

 

 

 

 

Identifying and Addressing Modifiable Risk Factors

Food is the most Important Medicinal Therapy

 

Few people reallize that the most important therapy in the treatmetn of cancer is the food that nourishes our bodies. There is strong evidence that dietary patterns can be an indicator for the development of colorectal cancer. Diets that consist of predominately or entirely fruits and vegetables are associated with an approximately 65% reduction in the risk of colorectal cancer. A dietary pattern high in red meats and processed meat consumption, along with potatoes and refined grains, is associated with an increased risk of colorectal cancer. Increased fiber intake, including whole grains, lowers the risk of developing colorectal cancer. In summary, a healthy diet for the prevention and treatment of colorectal cancer would include:

 

  • Increasing fruit and vegetable intake

  • Increasing whole grain intake

  • Utilizing healthy fats found in nuts, seeds and olive oil

  • Limiting or eliminating red meat and processed meats

  • Limiting or eliminating processed foods

 

Vitamins and Minerals

 

High calcium intakes are thought to decrease the risk for colon cancer. Unabsorbed fatty acids and particular bile acids, as a result of their irritating impact on the colonic mucosa, are thought to play a potential role in the development of colon cancer. Calcium forms a complex with both acids, theoretically reducing this detrimental effect. The recommended dose is 1000mg of calcium a day. 

 

Vitamin D deficiency has been documented in colon cancer patients. Optimizing Vitamin D levels reduces colon adenomas (pre-cancerous polyp) risks by up to 30%. Insufficient Vitamin D also impairs calcium absorption. Vitamin D levels can be easily measured, and supplements are used to replace Vitamin D to around 80 nmol/L.

 

Folate, a B Vitamin, has been investigated for its overall anti-carcinogenic effects in the prevention of colon cancer but studies are mixed. Currently it is not used to prevent colon cancer but may be of assistance is populations at risk for deficiency. Folate is naturally found in dark green leafy vegetables. At risk populations for folate deficiency may include the elderly and individuals with a high alcohol intake.

 

Environmental Carcinogen Exposure

 

One of the most common exposures is to heterocyclic amines, which occurs in charred meats in addition to nitrates in processed meats. It is best to avoid red meat all together. Processed foods also contain many additives and preservatives that are carcinogenic. Carrageenan is one such thickening agent found in many dairy and non-dairy products that is considered a carcinogen. Personal care products are another source of potential carcinogens and should be carefully examined. Dangerous household cleaning products and dry cleaning chemicals should also be avoided.

 

Alcohol

 

Alcohol consumption has been implicated as a risk factor for the development of colon cancer; however, studies have been inconsistent. What is known is that individuals who regularly consume alcohol have a greater likelihood of nutrient and mineral deficiencies, that can contribute to the development of colon cancer.

 

Smoking

 

Smoking is an independent risk factor for many types of cancer and has been associated with increased risk for pre-malignant colon polyps. Interestingly, researchers have also found that smokers do not gain the protective effects associated with consuming fruits and vegetables like non-smokers. Smoking also correlates with other poor health behaviors and smokers may be less likely to seek colon cancer screening.

 

Obesity

 

Obesity does increase the risk of developing colorectal cancer, and the risk is greater for men than women. The mechanism for this effect relates to obesity and chronic inflammation, insulin resistance, DNA damage, and immunosuppression. It is advisable that a weight loss program be promptly started when colon cancer is diagnosed. Weight loss can be safely accomplished during colorectal cancer treatment under the care of your physician. 

 

 

Metabolic Syndrome & Diabetes

 

Metabolic syndrome is a group of risk factors that include obesity, inactivity, high blood pressure, high cholesterol, and insulin resistance. Metabolic syndrome usually precedes diabetes. Metabolic syndrome and diabetes are associated with an increased incidence of heart disease, stroke, and cancer. Healthy life style changes are the first line of treatment in reversing metabolic syndrome and diabetes.

 

Stress

 

Emotional stress, in and of itself, is not likely to cause cancer but has been shown to affect outcomes and disease progression in cancer patients. Stress is mediated by epinephrine, which can be lymphocytotoxic, and cortisol, which is an immunosuppressant. Studies have shown that prolonged stress may promote tumor growth. Mindfulness based stress reduction techniques have been shown to reduce stress hormones and their effects. 

 

Exercise

 

The US Center for Disease Control and Prevention recommends 150 minutes or more of moderate intensity aerobic activity per week, along with muscle strengthening activities 2 or more days per week that work all major muscle groups. This recommendation applies to adults 18 years and older. It is a consistent finding that sedentary behavior is a risk factor for colorectal cancer.

 

Quality Sleep

 

Compromised sleep has been shown to contribute to chronic inflammation, metabolic abnormalities, heart disease, and the development of cancer. Insomnia is also a common symptom during cancer treatment. Conventional treatments including hypnotics actually suppress symptoms and disrupt sleep architecture. Guided imagery, breathing exercises, progressive muscle relaxation, and yoga are holistic modalities to consider. 

 

Spirituality

 

Many studies have analyzed spiritual well being as being a cornerstone in the coping mechanism of dealing with cancer. Those who have a strong spiritual practice report less stress and the ability to live with more meaning and hope.