What Your Doctor May Not Tell You About Colorectal Cancer: New Tests, New Treatments, New Hopeby Mark Bennett Pochapin
- What Your Doctor May Not Tell You About Colorectal Cancer was published in Warner hardcover (0-446-53188-X) in 3/04. The book features a foreword by Katie Couric.
- Dr. Pochapin made an appearance on the Today show in conjunction with the hardcover publication of this book. Previously, he had been chosen by Katie Couric to be the Medical Director of the Jay
- What Your Doctor May Not Tell You About Colorectal Cancer was published in Warner hardcover (0-446-53188-X) in 3/04. The book features a foreword by Katie Couric.
- Dr. Pochapin made an appearance on the Today show in conjunction with the hardcover publication of this book. Previously, he had been chosen by Katie Couric to be the Medical Director of the Jay Monahan Center for Gastrointestinal Health, named in honor of Ms. Couric's late husband.
- The author is an associate professor of clinical medicine at the Weill Medical College of Cornell University and Chief of Gastrointestinal Endoscopy at New York Presbyterian Hospital's Weill Cornell Medical Center.
- There are approximately 100,000 new colorectal cancer cases diagnosed annually, making it the second leading cause of cancer-related deaths in the United States. March is also Colorectal Cancer Month, so the publication of this book will benefit from heightened media awareness.
Read an Excerpt
WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT COLORECTAL CANCERNew Tests, New Treatments and New Hope
By Mark Bennett Pochapin
Warner BooksCopyright © 2004 Mark Pochapin, M.D.
All right reserved.
Chapter OneThe Truth About Colorectal Cancer
Life is going to throw you a few curveballs. One day you could suddenly find out that someone you know, someone you love, or perhaps even you, has been diagnosed with cancer of the colon or rectum, referred to together as colorectal cancer. Understandably, you're shocked and confused; if you are the one who is sick, you may simply be unable to absorb the frightening diagnosis. What does it all mean? How serious is this? Is the dire diagnosis a death sentence? How could this happen to me?
The frightening truth is that cancer can march unexpectedly into your life, affecting you directly or indirectly by striking someone you love, and colorectal cancer is no different. This year, an estimated 150,000 people in the United States will be diagnosed with colorectal cancer and more than 57,000 of them will die from it.
Colorectal cancer is the number two cause of cancer-related deaths among men and women combined. These statistics are a grim reminder of a fact that most people would rather ignore: Cancers of the colon and rectum are relatively common-and can be deadly.
But the good news-no, the great news-is that when found in its earliest stage, colorectal cancer can be cured fully more than 90 percent of the time! That said, I wish the story concluded there, but unhappily, we rarely find cancer in this early, curable stage, because not enough people are being screened for it.
A survey from the Harvard Report on Cancer Prevention shows that as many as 80 percent of Americans are not following the proper screening recommendations. Admittedly, many people shrink from the idea of colorectal cancer screening tests such as a colonoscopy because they are afraid of the preparation and procedure. More alarmingly, many health care practitioners simply are not telling their patients to get the recommended tests! Too few people understand that failing to undergo these tests means missing the chance to have potentially precancerous growths called polyps removed and facing a poor long-term outcome in the event that cancer is found in its later stages.
Colorectal cancer is in part a genetic disease, but one that is influenced greatly by your lifestyle-what you eat, whether you smoke, how active you are, how often you undergo routine screening, and, in general, how you live your life, day in and day out-all issues I will discuss in this book. As doctors, we now believe that, despite the role of genetics, almost all colorectal cancers can be prevented through lifestyle changes and regular screening. Just think: You can beat this disease with the right medical decisions and positive living.
A JOURNEY THROUGH YOUR DIGESTIVE SYSTEM
So that you can better understand the nature of colorectal cancer and how it affects your body, an important first step is to learn more about the fascinating inner workings of your digestive system. I'll run through an anatomy lesson with you, explaining key processes up front so that you can get comfortable with the terms I will be using throughout the book. For starters, let's follow a meal-say, a tuna salad sandwich-as it winds its way from your mouth down the twenty-five-foot tunnel commonly known as your digestive tract.
That sandwich you've just had for lunch begins its digestion in your mouth, where it is chewed and broken down by chemicals (enzymes) in your saliva into more absorbable forms. The carbohydrate in the bread, the protein in the tuna, and the fat in the mayonnaise each has its own set of digestive enzymes that go to work at various stages of digestion. An enzyme in your saliva, for example, begins the digestion of carbohydrates into simple sugars.
Once a few bites of your sandwich have been chewed, moistened, and broken down, you swallow it-a process that involves many muscles working in sync to move the food down your esophagus (food pipe) into your stomach.
When your food arrives at the lower end of the esophagus, there is a valve, one of many "gates" that open and close, controlling entry to each digestive organ along the way. These valves are called sphincters.
They keep food and other material from passing backward into places where they shouldn't go.
Beginning in the esophagus, food moves smoothly through your entire digestive tract via a process called peristalsis, a coordinated, rhythmic wave of muscular contraction that travels in a single direction. Peristalsis works independently of gravity. You could eat while standing on your head, for instance, and food would still move from your esophagus to your stomach and through your system.
Your stomach stores the food material for hours and starts churning it into a more liquid form called chyme. Enzymes continue their work of breaking down the tuna salad sandwich. The digestion of protein occurs in your stomach, with proteins being chopped into microscopic fragments called amino acids. Protein can also be digested elsewhere in the digestive system, so even if you had your entire stomach removed, you could still digest food.
Another interesting aspect of the stomach is its production of hydrochloric acid. This acid is so corrosive that it can eat its way through metal. Fortunately, the inner lining of your stomach has a protective layer of mucus, or the acid would burn right through your stomach wall. Sometimes, acid can cause diseases such as ulcers and gastroesophageal reflux disease (GERD), but these are treatable with medications designed to block excessive acid production.
Hydrochloric acid is there for a reason: It activates some digestive enzymes in the stomach and it sterilizes the food you eat. Sterilizing food may not be such a big deal today because the food we eat is fairly clean and often cooked. It was a huge advantage ages ago, however, when early humans ingested bug-infested tree bark and rotting dead animals. Thank goodness for the invention of refrigeration and the supermarket! If you are taking medications to reduce stomach acid, don't worry. Our food supply is so clean and the digestion of nutrients is so repetitive in the gastrointestinal system that even complete acid suppression is well tolerated by the body. But back to that tuna salad sandwich: In its now partially digested form, it will usually sit in your stomach for two to four hours.
The Small Intestine
Your stomach empties the now liquefied sandwich into your small intestine via a sphincter known as the pyloric valve, which prevents the passage of partially digested food until it has been properly processed by your stomach. Made up of three segments-the duodenum, jejunum, and ileum-your small intestine is roughly twenty-one feet in length and coiled loosely in the part of your body commonly called the abdomen. When my patients tell me that they feel food and gas moving in their "stomach," what they are usually sensing is the movement of their small intestine as it digests food. In the small intestine, food is further broken down, and the jejunum and ileum are primarily responsible for absorbing the nutrients so they can be used to support the health and energy needs of your body. The lining of your small intestine is filled with closely packed, fingerlike projections called villi that greatly increase the amount of surface area available for absorbing nutrients. If all of these villi were spread out flat, their surface area would span the length of a tennis court, or about two hundred square feet. Incidentally, cancer is extremely rare in the small intestine.
Other Digestive Organs
Other digestive organs are involved in digestion. One is your pancreas, a flask-shaped organ situated just behind your stomach, toward the back. Its job is to secrete digestive enzymes into the small intestine in order to break down protein, carbohydrates, and fats. Apart from its digestive function, your pancreas also produces two hormones, insulin and glucagon, that are released into the blood and together help regulate the normal rise and fall in blood sugar. All the absorbed nutrients from digestion eventually pass through your liver, the largest solid organ in your body. The carbohydrate from the bread of the tuna sandwich, for example, arrives there as simple sugars. The liver converts these sugars to glucose, your body's primary fuel. Any glucose not used for fuel is stored in your liver or in your muscles as a larger molecule known as glycogen. The liver can also turn protein and fat into glucose if your body requires additional energy sources.
Among its many other functions, your liver also manufactures and secretes bile. Bile is a greenish liquid containing bile salts that emulsify, or break up, dietary fat so that it can be further broken down by enzymes.
Situated just under the liver is a pear-shaped organ known as the gallbladder. Its job is to receive bile from the liver and store it. During a meal, your gallbladder contracts and squirts bile into your duodenum through a tube called the common bile duct.
Once the nutrients have been absorbed by your small intestine and processed by your liver, what is left of that tuna salad sandwich moves on by peristalsis to your colon, a muscular tube between four and six feet in length. The colon connects your small intestine to the rectum, the last part of the digestive tract. By the time the sandwich reaches your colon, the remaining material consists of undigested food particles (such as fiber), water, and secretions from your small intestine.
At the origin of the colon is a small pouch named the cecum, which includes an opening into a tiny nonfunctional tube called the appendix. This region is located in the lower right part of the abdomen and is also the site where the small intestine joins the colon. Anatomically, the colon is made up of four sections: the ascending (right) colon; the transverse (across) colon, which hangs like a necklace down to as low as your belly button; the descending (left) colon, which moves down the left side toward your pelvic area; and the sigmoid colon (so named for its S shape, derived from the Greek letter S, sigma). Cancer can develop in any of these four sections, as well as in your rectum.
Your colon is constructed of four layers of tissue. The innermost layer, the mucosa, is smooth, thin, and has no villi. It has direct contact with the material that passes through the colon. The cells of the mucosa are in a constant state of replenishment, dying, sloughing off, and being replaced by new cells about every four to six days. Underneath the mucosa is the submucosa, a layer of tissue that provides support for the mucosa. The submucosa also harbors the white blood cells (lymphocytes, monocytes, and neutrophils) that keep bacteria from the colon out of the bloodstream. The third layer is the muscularis propria, made up of muscle cells that assist in movement.
Finally, the fourth and outermost layer is the serosa, which provides added strength to the colon and serves as a protective barrier.
Sometimes the term colon is used interchangeably with large intestine. I dislike using the term large intestine because the small intestine is actually much longer than the colon. Therefore, so as not to confuse matters, I will use the term colon rather than large intestine, although these terms do refer to the same organ. The term bowel generally refers to any part of the intestine, large or small.
The primary duties of the colon are to absorb water and electrolytes, such as sodium and potassium, from the intestinal material and to compact solid waste so that it can be eliminated from your body. Think of the colon as a large "dryer" removing the water from the wet material left by the small intestine. As water is extracted in the colon, the material becomes more solid. In this state, it is called stool or feces. Stool moves upward from the cecum into the ascending colon, across the abdomen in the transverse colon, and then down the left side of your abdomen in the descending and sigmoid colons, where it is stored until being emptied into the rectum, usually once or twice a day.
Your colon also harbors an enormous colony of bacteria. When you hear about bacteria, it often brings to mind all those TV commercials showing us how to rid ourselves and our environment of these nasty bugs. Cleanliness seems to be forever equated with being germ-free. This is not an accurate depiction, however. There are, of course, pathogenic (disease-causing) bacteria in our environment, but most of the bacteria that we encounter are friendly and actually assist in the functioning of our digestion. Scientists theorize that the energy factory within our cells (the mitochondria) were at one time bacteria that joined our cells during an evolutionary process to form a mutually beneficial relationship. The reasoning behind this theory is that mitochondria have a DNA that is more similar to bacteria than it is to human DNA. So bacteria shouldn't always be stereotyped as being the bad guys; many are our friends.
Here is another interesting fact: By numbers alone, there are more bacteria in and on each of us than there are human cells in our bodies. In some ways, we are more bacteria than human! The helpful bacteria in the body, known as the normal flora, promote health and immunity in a variety of ways. First of all, they help stimulate the immune system's production of disease-fighting white blood cells. Second, they form a protective barrier in order to keep levels of bad bacteria from attaching to the colon walls and being absorbed. Third, they produce certain types of acid that discourage harmful organisms such as yeast from proliferating. Fourth, some normal flora synthesize certain B vitamins for proper metabolism, as well as vitamin K, which is essential to normal blood clotting. Finally, these bacteria help change fecal matter into a form that can be properly eliminated.
The presence of these friendly bacteria makes your colon an important organ of immunity. There is a vast interplay between the white blood cells in the intestine and the normal flora. Without these health-promoting bacteria in your colon, your body is less capable of functioning normally and fighting off disease.
As a whole, the digestive tract is the largest immune organ inside your body. Think about it. When we eat, we ingest foreign material that is loaded with environmental bacteria. The small intestines have to keep the bacteria out of the body, while absorbing the nutrients. Moreover, the intestines must decide if the ingested bacteria is safe or disease producing. As we discuss the specifics of colorectal cancer later in this book, the concept of the digestive tract, specifically the small intestine and colon, as an immune organ becomes important.
Excerpted from WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT COLORECTAL CANCER by Mark Bennett Pochapin Copyright © 2004 by Mark Pochapin, M.D.. Excerpted by permission.
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