Monday 26 March 2012

Anaesthesia and colonoscopy

In UK NHS, colonoscopy is usually carried out under conscious sedation using a combination of a benzodiazepine sedative and an opiate painkiller. The endoscopist administers this combination of drugs. Whilst colonoscopy using these drugs is well tolerated by most patients, some still find their experience of colonoscopy to be very unpleasant.

In the private sector, both here in the UK and in the USA, propofol sedation has become increasingly popular with patients and endoscopists. Patients wake from the sedation with no recollection of the procedure.

Propofol sedation is only occasionally used in the NHS. Its use is usually confined to patients where previous attempts to carry out colonoscopy under benzodiazepine sedation have failed or certain patients requiring complex endoscopic procedures.

Unfortunately, only a trained anaesthetist can give propofol. This clearly has cost implications and as a result claims for anaesthetic services in the USA have continued to increase steadily over recent years. A report in the Journal of the American Medical Association estimates that anaesthetic services for low risk endoscopies now costs the US health economy $1.1 billion every year.

The development of computerised propofol delivery systems is therefore very attractive and already well underway. If the safety and efficacy of such systems is established, their use could become widespread. This would remove the necessity for a trained anaesthetist to be present, reduce the cost of propofol sedation for colonoscopy and improve the patient experience of what can be for some, an uncomfortable procedure.

JAMA 2012; 307: 1178-84.

Simon Radley March 2012

Sunday 25 March 2012

Is cancer screening always worthwhile?

Whilst catching up with what’s new in other specialities I found an interesting article on prostate cancer screening in the New England Journal of Medicine. The article reports on the outcome of a European study looking at prostate specific antigen (PSA) testing to detect prostate cancer. After 12 years follow up, men screened by 4yearly PSA tests were 21% less likely to die of prostate cancer than unscreened men. Whilst fewer patients died of prostate cancer in the PSA screened group, there was no difference in all cause mortality rates between the screened and unscreened groups.

The study highlights the importance of looking at all the results from a clinical trial and not just the principal outcome measure.

Crudely this means that screening might stop you dying of prostate cancer but will not stop you dying of something else instead.

Despite the high profile celebrity advocates of PSA screening, particularly from the USA, the answer to the question “does PSA screening save lives?” remains uncertain.

New England J Medicine 2012; 366: 981-90.

Simon Radley March 2012

Monday 19 March 2012

CT scans aid colon cancer treatment

CT colonography (CTC) has been shown to be comparable to standard colonoscopy in accurately detectingcancer in older patients.

According to a research paper published online in Radiology, CTC can be just as effective as standard methods when used to check for cancer and precancerous polyps in people aged 65 and over.

The results are consistent with findings from the ACRIN National CT colonography trial, published in 2008 by the New England Journal of Medicine, which showed that CTC can be used for adults aged 50 and above as a primary option for colorectal cancer screening.
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Patients may dread having a colonoscopy, but study finds they halve risk of colon cancer death

  • Treated patients had 53% lower risk of dying from colon cancer than would be expected in a similar group in the general population
  • Procedure involves inserting a tiny camera on a tube through the anus into the large intestine
  • It is a procedure that is both uncomfortable and embarrassing, but a new study has found patients don't endure colonoscopies in vain.

    Removing precancerous growths spotted during the test can cut the risk of dying from colon cancer in half, say researchers from the Memorial Sloan-Kettering Cancer Center in New York.
    Doctors have long assumed a benefit, but research hasn't shown before that removing polyps would improve survival - the key measure of any cancer screening's worth.

    Read more:

    Tuesday 13 March 2012

    'We shared hospital beds on our wedding night': Bride kept tragic secret that husband-to-be had three months to live so she could marry him

    When Carrie Coggins proposed to her husband Ric, she was hiding a terrible secret.

    Ric had been diagnosed with bowel cancer and tragically Carrie had just been told that he only had three months at the most to live.

    So she did the bravest thing any bride-to-be could do. She didn’t tell Ric how much time he had left, and instead went through her wedding vows knowing she would have only a short time left to spend with her husband.

    Mrs Coggins, 30, said: ‘When the doctor told me Ric only had three months to live, I was devastated.

    ‘But I asked him to marry me, and on our wedding day I knew how little time he had left, but he didn’t.

    ‘I didn’t want to tell him, as I wanted him to keep on fighting right until the end.’

    Read more:

    Cancer drug should be available to all

    A CANCER survivor who owes her life to a miracle drug has condemned the decision by health bosses not to provide it on the NHS.
    The National Institute for Health and Clinical Excellence (Nice) issued its final guidance yesterday which does not recommend the drug Avastin (also called bevacizumab) for treating bowel cancer.
    Barbara Moss, aged 57, of Aconbury Close, Worcester, says the only reason she is still alive is because she had the drug, which shrank the tumour in her bowel until it became operable.
    She was given months to live more than five years ago and the family had to pay £21,000 for Avastin.

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    Shoppers in awe of the Big Bowel as part of cancer awareness campaign

    SHOPPERS at a Northampton shopping centre took a tour through a giant inflatable colon as part of a drive to raise awareness of bowel cancer.

    The two-metre high colon – better known as the large intestine – attracted a lot of attention yesterday from people at the Weston Favell Shopping Centre.
    The Big Bowel is part of an NHS Northamptonshire initiative aimed at helping people to spot symptoms of bowel cancer earlier, and so increase their chances of successful treatment.
    Shopper Jayan Patel, aged 78, of Hertford Court, Meadowfield, Northampton, thought the initiative was a great idea.
    He said: “I’m really impressed.
    “All three of my children had bowel cancer and I think this is a very good way of raising awareness.”
    Dr Saqib Mirza, local GP lead for the DETECT early cancer detection project, said this was the first time the inflatable colon had been used.
    He said: “It’s all about bowel awareness and it’s certainly hard to ignore this one. What we want is for people not to ignore the possible symptoms of bowel cancer, particularly people over 50.”
    Mr Mirza said bowel cancer was one of the four major cancers, along with breast, lung and prostate.

    Read more –

    Could eating chocolate prevent bowel cancer?

    Next time you reach for that piece of chocolate, don’t beat yourself up too much as you could be doing your health a favour.

    Researchers have said eating chocolate every day could decrease the danger of developing bowel cancer.

    Dr Maria Arribas, of the Science and Technology Institute of Food and Nutrition in Spain, who headed the research, said: “Foods like cocoa, which is rich in polyphenols, seems to play an important role in protecting against disease.”

    Tests carried out on rats showed the group fed a diet which contained 12% cocoa for eight weeks grew fewer pre-cancerous lesions when they were exposed to the carcinogen azoxymethane.
    However Sarah Williams, a spokesperson from Cancer Research UK, told the Daily Mail that eating large amounts of chocolate could also be harmful to health.

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    Bowel cancer awareness factsheet to support GPs available

    A short factsheet to support GPs in the first NHS national bowel cancer symptom awareness campaign in England are available. These factsheets provide GPs with further information about the campaign and suggest how they can prepare for it.
    The aim of this national campaign is to raise public awareness of the symptoms of bowel cancer and to encourage those with persistent symptoms to present promptly. Although the great majority of people may not have bowel cancer, some may. By catching the cancer earlier it should be more treatable. This is part of the programme aimed towards improvement of cancer survival rates.

    How GPs can prepare for Be Clear on Cancer factsheet is in support of the campaign which launches on 30 January and runs until the end of March 2012.

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    Does fruit and veg chemical fight cancer?

    "A healthy fruit and vegetables diet could help guard against one of the deadliest cancers," the Daily Express has today reported. The newspaper says this is due to "a potent super-nutrient" found in these foods.

    This story is based on research into a chemical called luteolin that is found in a wide variety of plants. The substance has already been found to reduce the growth of bowel cancer cells in the laboratory, and this new study attempted to confirm how it disrupted these cancer cells. In particular, the researchers concentrated on a cellular process that blocks cells from dying naturally and causes cancers to form. After testing luteolin on bowel cancer cells the researchers found that it interfered with this process, which effectively helps to control a cell's life and death.

    The Daily Express has reported that a luteolin-rich diet prevents cancer, but this research was carried out in cells in the laboratory, and did not test the effect of the compound in humans. Also, the luteolin used in this research was in a highly concentrated pure dose, and not from dietary sources. The study demonstrates how pure luteolin reduces the growth of bowel cancer cells in the laboratory, but does not show that a diet high in luteolin-containing vegetables can prevent cancer.

    However, there is a great deal of existing research supporting a link between fruit and vegetables and benefits such as a reduced risk of bowel cancer. On this basis, there is already enough evidence to recommend including fruit and vegetables as part of a balanced diet.

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    New study suggests that two scopes might be better than one

    The NHS screening program currently offers faecal stool tests for all people aged 60 or above. One off flexible sigmoidoscopy screening is due to be introduced in the UK and offered to those reaching the age of 55.

    The UK MRC study published in the Lancet in 2010 showed that one off flexible sigmoidoscopy screening produced a significant benefit. A new study from the USA, published in the Journal of the National Cancer Institute showed that a second flexible sigmoidoscopy performed 3-5 years after the initial examination confers added benefit in terms of increased detection of cancer by 26% in women and 36% in men. Whilst this study is interesting it doesn't tell us whether an additional test will ultimately reduce the mortality from colorectal cancer and whether or not the additional screening costs and complication risks of the tests are justified.

    Uptake for the current screening program is still low in some areas and it is important that everyone take up the screening opportunity when offered.

    In the meantime it is everyone needs to be aware of the symptoms of bowel cancer. If you have had blood in your stools or looser stools for 3 weeks you must seek advice from your GP

    Monday 12 March 2012

    Bowel Cancer In The West Midlands

    Figures from the West Midlands Cancer Intelligence Unit indicate that 2000 men and 1500 women are diagnosed with bowel cancer in the West Midlands each year.

    Common symptoms can include:
    •Changes in bowel habit particularly diarrhoea
    •Bleeding from the bowel
    •Abdominal pain
    •Abdominals lump or masses
    •Unexplained anaemia
    •Unexplained weight loss

    If you have any of these symptoms you should consult with your GP.

    Bowel cancer treatment 'becoming more effective'

    Bowel cancer treatment and diagnostic screening methods are helping the fight against the disease.

    A new study commissioned by the Healthcare Quality Improvement Partnership found that surgery was becoming more widely used and more successful.

    Key-hole procedures were used in 30 per cent of bowel cancer cases in the 12-month period prior to July 2010 - a figure which is five percentage points higher than the annual period leading to July 2009.

    The number of patients who die within 30 days of surgery fell to 3.7 per cent.

    "Changes in surgical techniques, use of state of the art imaging techniques and the further reduction in 30-day post-operative mortality are to be welcomed," said the clinical leader of the report Paul Finan.

    He said that the statistics could be improved further if some patients were assigned a consultant as soon as they are admitted.

    According to Cancer Research UK, bowel cancer is the third most common cancer in the UK and 80 per cent of cases are diagnosed in patients over 60.

    Article source -

    Screening Finds More Left Sided Bowel Cancers

    Bowel cancer is responsible for 16,000 deaths annually in the UK alone. Bowel cancer is the second leading cause of death in the UK and Europe after lung cancer. The chances of survival are only 50% in the UK, and even remarkably lower in other similar countries.
    According to an analysis of the first one million test results of the Bowel Cancer Screening Program in England that aims to cut bowel cancer deaths by 16%, the program is on target. The findings, published in Gut, also reveal that a significantly higher proportion of identified cancers are left-sided. According to researchers, this indicates that different strategies may have to be employed to pick up the disease in both sides of the body as right-sided cancers are believed to be more aggressive.

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    Be Clear on Bowel Cancer - Impact on Colonoscopy Services

    Monday 30th January heralds the start of the DOH 9 week Be Clear on Bowel Cancer campaign.

    Results from the pilot campaigns showed a near 50% increase in GP attendances of people aged over 50 with symptoms and a 30% increase over a 6 month period in hospital referrals. This lead to a significant increase in the numbers of people waiting for a colonoscopy with that number actually doubling in some areas.

    The national campaign will inevitably have an impact on current NHS colonoscopy services at a time when colonoscopy activity in England is still low when compared with other countries. Some NHS trusts have already waiting times of greater than six weeks and the planned campaign will put further pressure on those services.

    Whilst waiting list initiatives may well be used to address the immediate issues, the pressure on colonoscopy services for trusts will not go away. Demand for colonoscopy is expected to increase year on year over the next five years at least as the age limits for bowel cancer screening are increased for people aged 70-75, more diagnostic and surveillance colonoscopies are performed and the planned flexible sigmoidoscopy screening program is rolled out.

    Hospital trusts and clinicians will need to plan for and adequately resource colonoscopy services if we are to meet the forthcoming demands.

    Bowel Cancer Screening Working Up To A Point, Results Of First Million Tests In England

    The NHS bowel cancer screening programme in England is on track to cut bowel cancer deaths by 16%, according to an analysis of the first 1.08 million faecal occult blood tests, but there are concerns that the current method is not picking up diseases as well on the right side of the body as on the left. A paper on the analysis appeared online in the journal Gut on 7 December.

    A current statement from the Bowel Cancer Screening Programme (BCSP) says that to date, around 12 million faecal occult blood (FOB) test kits have been sent out and over 11,000 cancers have been detected.

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    Sitting down all day can increase your risk of cancer

    At a recent American Institute for Cancer Research conference presenters suggested that up to 43,000 cases of colorectal cancer occurring each year in the US are linked to being sedentary. Occupational activity is associated with around 22% reduction in colorectal cancer risk with recreational activity being associated with a 23% reduction in risk.

    Dr Neville Owen Professor of Health Behaviour at the University of Queensland indicated that "sitting time is emerging as a strong candidate for being a cancer risk factor in its own right. It seems likely that the longer you sit, the higher your risk"

    The mechanisms by which physical activity decreases cancer risk might include decreases in body fat, sex hormones, prostaglandins and gastrointestinal transit time and increases in insulin sensitivity, immune and pulmonary function.

    Whilst maintaining a healthy diet, a sensible alcohol intake and not smoking are all critical for health and cancer prevention. The message is also clear that exercise is good for you and it too reduces cancer risk.

    Friday 9 March 2012

    Cancer patients ignoring alarm signs for months

    People with alarm signs of cancers frequently put off seeing the doctor for months, according to a report by the Royal College of GPs.

    It found an eighth of cancer patients are waiting two months or more before seeing a family doctor.

    Sadly, the audit discovered almost half of cancers have already spread beyond the original tumour by the time they are diagnosed, reducing the likelihood of long-term survival.

    The report, led by Greg Rubin, professor of general practice and primary care at Durham University, found almost three-quarters of cancer patients (73.2 per cent) were referred to a specialist after one or two consultations.

    But it found patients were sometimes waiting a "surprising" length of time before seeing their GP in the first place.

    The report found: "Overall, 12 per cent of patients were recorded as having symptoms for two months or more prior to first presentation.

    "There were some surprising patient delays relating to alarm symptoms - 12 per cent of those with breast lump, 26 per cent of those with change in bowel habit and 20 per cent of those with rectal bleeding delayed for more than two months before consulting."

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    Paul Burstow MP writes: The hidden potential of early diagnosis

    To be told that you or a loved one has cancer is likely to be one of the most gut-wrenching moments of anyone's life. To be further informed that the chances of survival are low is devastating. But if more people knew they could live a fuller life for longer, we could ease the impact of that devastating time.

    Last week I commissioned health officials to conduct a scoping exercise into early diagnosis across the health service. The plan is that research will help us to understand what, if any, evidence exists as to the extent of delayed diagnosis and its impact on patients. I expect to receive the results of this work in March next year and hope it will help to paint a better picture in terms of how a more 'preventative' NHS might work.

    In Coalition we are already working to improve patients' lives by reducing delayed diagnosis. This month I launched a national dementia awareness campaign to encourage people to spot the early signs of the disease in the run-up to Christmas. In September the Coalition announced £10 million for dementia memory services to improve early diagnosis and treatment of the condition. And in February this year I announced the first-ever Government campaign to raise awareness of the early signs of bowel cancer, after successful pilots in two areas saw a 48% increase in the over 50s going to their GP with symptoms.

    To put it starkly, if people are diagnosed in the early stages of bowel cancer the chances of them surviving for at least five years is over 90%, compared to just 6.6% at a later stage. A delay in diagnosis can also lead to increased mortality from diseases such as cancer and can raise the risk of accidents, falls and fractures - or the need for more complex and intensive treatment further down the line.

    So, by investigating the possibilities of early diagnosis we can demonstrate how innovative solutions have the potential to improve the quality of care given to patients and ensure they live longer, healthier lives.

    Article source -

    Be clear on cancer- a new initiative to increase bowel cancer awareness

    The government has recently announced its plans to role out its first ever campaign to increase awareness of bowel cancer.

    'Be clear on cancer' bowel cancer awareness will launch nationally in January. The advertising campaign will feature real doctors talking to patients, encouraging them to talk about changes in their bowels and bleeding.

    Regional pilot studies have shown that there was a near 50% increase in the numbers of patients seeking advice from GPs and a one third increase in the numbers of urgent hospital referrals.

    Health Minster Paul Burstow said "Early diagnosis makes a huge difference to your chance of survival. Results from our regional bowel cancer campaign shows campaigns really work to raise awareness and get patients to their GPs"

    Bowel cancer symptoms do vary but important symptoms include:
    •A persistent change in your bowels, going to the toilet more frequently and diarrhoea
    •Bleeding from the back passage
    •A lump in your abdomen
    •Unexplained anaemia (low blood count)
    •Unexplained tiredness.

    Anyone with concerns should contact their GP as soon as possible.

    Simon Radley December 2011

    Cancer is biggest cause of premature death in UK, but survival rate increasing

    New figures released from Cancer Research UK show that cancer is the biggest cause of premature deaths in the United Kingdom. But thanks to the development of better treatments, more people are surviving the disease than ever before.

    Based on 2009 figures, the latest year for which UK mortality data is available, cancer is responsible for killing 40% of people in the UK who die prematurely between the ages of 25 and 73.

    More people die from cancer than from deadly diseases like heart disease and AIDs, as well as other causes like road accidents, suicides and murder.

    Overall in 2009 there were 156,090 deaths from cancer in the UK. This is 73,000 more deaths than those caused by coronary heart disease, and 35,000 more than those caused by respiratory diseases.

    Of all the cancers, lung cancer is the deadliest, killing 35,000 people in the UK in 2009. This is followed by bowel cancer with 16,000 deaths, breast cancer with 11,700 deaths, and prostate cancer with 10,300 deaths. Together, these four forms of the disease count for almost half of the deaths caused by cancer.

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    Can the UK narrow the gap with Europe on cancer survival?

    Studies have shown an improvement in 5 year survival for colorectal and breast cancer but despite this the gap between England and most of the rest of Europe remains.

    If the UK were to match the best in Europe for cancer survival then 10,000 lives a year might be saved including 1700 with colorectal cancer.

    Why do such large differences exist?

    Late presentation inevitably results in poorer outcomes. Emergency presentation leads to a particularly poor survival. 27% of patients with colorectal cancer currently present as emergencies. Emergency patients have a 1year survival of only 50% compared with nearly 75% of all patients with colorectal cancer.

    How can survival rates be improved?

    At a recent National Cancer Research Institute (NCRI) meeting, Sir Mike Richards, England's clinical director for cancer outlined a campaign addressing a number of key areas:
    •Extending screening programs
    •Raising public awareness
    •Supporting GP's
    •Improving access to diagnostics
    •Improving treatment

    The governments 'Be Clear on Cancer' campaign begins at the end of January and pilot studies indicate significantly increased numbers of patients seeking advice from their GP's and numbers of patients being referred for investigation.

    Simon Radley Dec 2011

    Are bowel cancer patients dying because of a lack of surgeons?

    A recent study has again confirmed what we already know, that the chance of dying from your surgery is more than 4 times greater if you need an emergency operation for bowel cancer compared with the risks of a planned or elective operation for the disease.

    There are several possible reasons for this. Patients who present as emergencies are often sicker. Sometimes their tumours are more advanced in other cases the tumours may be blocking the bowel or in some cases have caused peritonitis. Whilst nearly all planned bowel cancer surgery is carried out by specialist colorectal surgeons, emergency surgery "out of hours" or at weekend may be carried out by non-colorectal specialists. This too may have an impact on the outcome in such cases.

    One answer would be to provide specialist on call so that all bowel cancer emergencies are operated on by a specialist colorectal surgeon yet there are simply not enough senior colorectal surgeons in UK hospitals to be able to provide that level of cover.

    Earlier identification of the disease and planned treatment may help to reduce the incidence of emergency presentation. It will be interesting to see if the the screening programme has a significant impact of on the numbers of emergency cancer presentations.

    Thursday 8 March 2012

    New bowel cancer drug could destroy tumours without side effects

    Scientists have said a new type of drug could locate and destroy cancerous tumours without damaging surrounding cells.

    The research found that the "stealth" drug took minutes to find tumours in mice and shrank them. Some of the mice who had been considered to have terminal bowel cancer tumours were completely cured.

    Current cancer treatments, such as chemotherapy and radiotherapy, focus on shrinking tumours but can have devastating side-effects for patients.

    The benefit of the new drug is that it only targets the tumour and does not affect the rest of the body.

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    Health Matters: Irritable Bowel Syndrome

    Q I have been suffering from the embarrassing symptoms of Irritable Bowel Syndrome for a few years now but recently it has become a much bigger problem. The effects have now started to interfere with day-to-day activities making it difficult to lead a normal life. I understand that there is no miracle cure but is there anything I can do to ease the symptoms?

    A Irritable Bowel Syndrome (IBS) is a common disorder of the gut and many sufferers will empathise with the embarrassing symptoms you have.

    IBS affects around one in five people at some stage in their lives and though twice as common in women than it is in men, it can affect people at any age. Many things can trigger it, including suffering from stress and anxiety as well as allergies to certain foods and drinks. Common suspects would be alcohol, fizzy drinks, chocolate, caffeine, processed snacks and fried or fatty food.

    There is no definitive cause, which is why the condition is so difficult to diagnose and treat.

    IBS is a functional disorder with a number of symptoms, some of the most common being pain and discomfort in the abdomen that can often resemble a spasm, bloating or swelling in the area, chronic diarrhoea, constipation or sometimes a combination of all of them. Symptoms such as the urgent need to go to the toilet, the feeling that you have not fully emptied your bowels and excessive wind can be both uncomfortable and embarrassing. Although IBS and the related effects are not life threatening or dangerous they can be debilitating for sufferers and can certainly interfere with simple daily activities.

    Read More

    Pill that shines a light on your tummy trouble

    A tiny capsule that uses light to detect traces of blood inside the body could help doctors diagnose a range of digestive conditions more quickly.

    The gadget, currently being trialled on 150 patients, is based on the technique used in alcohol breathalyser tests, which detects different compounds by measuring how much infrared light they absorb.

    The capsule checks for 'occult' blood — small spots of blood — as it passes through the gastro-intestinal tract.

    Patients are simply asked to swallow a tiny capsule and the light sensor transmits information as it passes through the body.

    Bleeding in the digestive tract is a symptom rather than a disease, and a number of different conditions can be responsible. These include stomach ulcers, inflammatory bowel disease or cancer.

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    Two minutes on.. Crohn's disease

    What is it?

    Crohn's disease is a rare, long-term ­inflammation of the digestive tract, ­especially the small intestine.

    Diarrhoea, pain, fever and weight loss are all common symptoms.

    Crohn's disease usually manifests ­itself in sufferers ­between the ages of ­15 and 30 and it can sometimes run in ­families, ­suggesting there may be a ­genetic component to its development. Smoking is a known risk factor.

    What are the symptoms?


    Abdominal pain


    Weight loss

    General feeling of malaise

    About 10% develop other conditions linked with Crohn's, including a form of arthritis known as ankylosing ­spondylitis, kidney stones, gallstones and a rash called erythema nodosum.

    What's the treatment?

    Mild attacks of Crohn's disease may be treated with antidiarrhoeal drugs and painkillers.

    For an acute attack, your doctor may prescribe oral steroids. As soon as symptoms subside, the dosage will be reduced to avoid the risk of triggering any side effects.

    If your symptoms are very severe, you may need hospital treatment with ­intravenous corticosteroids.

    In all cases, once the dosage of ­corticosteroids has been reduced, your doctor may recommend oral ­sulphasalazine or mesalamine to ­prevent recurrences.

    An immunosuppressant drug, such as azathioprine, is sometimes considered.

    You may also require dietary ­supplements, such as vitamins, to ­counteract malabsorption.

    During severe attacks, you may need to be fed nutrients directly into a vein.

    Read more:

    Yeovil Hospital awarded £250k cancer research grant

    THE Department of Health has awarded Yeovil District Hospital a prestigious £250,000 research grant aimed at improving the quality of life for patients with rectal cancer.

    The research will be led by Consultant Colorectal Surgeon Mr Nader Francis (Research Lead) supported by a Research Fellow in Surgery and a Research Nurse.

    The study will involve 50 patients from Yeovil District Hospital and five other hospitals aiming to identify the most beneficial time for patients to have surgery following chemo-radiotherapy for rectal cancer.

    This research will be in collaboration with Imperial College, London and the Yeovil team will be working closely with Professor George Hanna to find ways of assessing surgical performance in advanced rectal surgery.

    Mr Francis said: "Surgery is the mainstay of treatment for rectal cancer but when the tumour is advanced, patients may have to undergo chemo-radiotherapy in order to reduce the tumour size prior to surgery.

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    Diet and bowel cancer

    Recent press is again highlighting the importance of diet in the development of several types of cancer.

    The role of diet in the development of bowel cancer is a complex area. There is plenty of evidence from population studies that peoples who eat large amounts of red meats (pork, beef, Lamb) have higher rates of colon cancers. The exact mechanism by which meat causes cancer is uncertain. A number of potential culprits including bile acids and heterocyclic amines have been identified.
    The role of fibre in preventing bowel cancer is less well understood. Some types of fibre seem to have a greater protective role than others. Of our other dietary constituents, a consistently high alcohol intake has been linked to an increased risk of bowel cancer.
    The government advises that people should not regularly drink more than the daily unit guidelines of 3-4 units of alcohol for men (equivalent to a pint and a half of 4% beer) and 2-3 units of alcohol for women (equivalent to a 175 ml glass of wine). Regularly drinking more than this is associated with an array of health risks.

    Simon Radley 3/11/11

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    Aspirin cuts hereditary bowel cancer risk by 60 percent

    Taking a daily aspirin has been recommended for people with a high risk of an inherited form of bowel cancer. Results published in the Lancet suggested the risk for those with Lynch syndrome could be cut by 63 percent.

    Professor Sir John Burn, of Newcastle University, who led the study, told the BBC that the evidence 'seems overwhelmingly strong'.

    A daily low dose of aspirin is prescribed to people at risk of heart attack or stroke, and some researchers had noticed that these groups showed lower rates of colorectal cancer. The Colorectal Adenoma/carcinoma Prevention Programme (CAPP2) study - the first double-blind, randomised controlled trial of aspirin focusing on the prevention of cancer - confirmed it could have a dramatic effect on the development of colorectal tumours.

    'People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition', Professor Burn recommended.

    Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is an inherited form of colorectal cancer caused by genetic mutations, which around one in 1,000 people carry. Around 90 percent of men and 70 percent of women with HNPCC will develop bowel cancer by the age of 70. They are also at risk of other cancers, such as cancer of the uterus, ovary, breast, prostate, brain, pancreas, gall bladder, ureter, stomach and kidney.

    Participants in the CAPP2 trial took 600 mg of either aspirin or placebo daily between 1999 and 2005. The 861 patients were followed for up to ten years at 43 centres across 16 countries.

    Data in 2007 showed no difference between the two groups, but an assessment in 2010 showed that while 34 people had developed new colorectal cancers in the placebo group, there were only 19 new cancers in the aspirin-treated group. Furthermore, it found that there was an overall reduction in other cancers - 23 in the placebo group, and only 10 in the aspirin group.

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    'Screen men at 50 for bowel cancer and save thousands of lives': Charity wants to bring down age of testing by ten years

    Thousands of lives could be saved if the age at which men are screened for bowel cancer is lowered by ten years, the head of a leading charity has claimed.

    Mark Flannagan, chief executive of Beating Bowel Cancer, called on the Government to lower the current screening age from 60 to 50 after a major study found the disease is far more common in men in their early 50s than previously thought.

    The recent study, the biggest of its kind, revealed that nearly one in five men between 50 and 60 had potentially cancerous tumours, compared with just one in ten in woman from the same age range.

    The findings are the most significant evidence so far to support the case for a lower screening age and are likely to put pressure on ministers to reconsider their stance.

    More than 16,000 people a year in Britain die of bowel cancer, making it the second biggest killer after lung cancer.

    Read more:

    Call for national bowel cancer screening

    Nationwide screening for bowel cancer would save more than 2,700 lives a year, scientists claimed yesterday.
    A successful two-year pilot scheme found early signs of bowel cancer in hundreds of patients. Researchers say a national screening programme such as the ones for breast cancer and cervical cancer would reduce deaths by 17 per cent.
    The results of the University of Edinburgh study will boost Government plans to roll out such a programme across the country.
    Bowel, or colorectal, cancer is the second most common cause of cancer-related death in Britain, after lung cancer. Around 34,000 people are diagnosed with the disease every year and it causes more than 16,000 deaths.
    Footballer Bobby Moore, captain of England's World Cup winning team of 1966, died of the disease in 1993 aged 51.
    The Edinburgh study tested for blood in faecal samples - an early sign of the disease - among people from Tayside, Grampian, Fife and the West Midlands. Around 300 people who were found to have positive results were offered further tests and treatment.
    An evaluation of the screening trial, funded by the Department of
    Health, was led by Professors Freda Alexander and David Weller from the university's Department of Community Health Sciences.
    Prof Weller said: 'We found that faecal occult blood testing (FOBt) screening is feasible in the UK population.
    'We are recommending to the Department of Health that FOBt screening, if introduced, should be part of a package of new national strategies targeting colorectal cancer.'
    Diets high in red meat and low in vegetables and fibre can increase the risk of suffering from bowel cancer, as does family history of the disease.
    A history of ulcerative colitis and Crohn's disease are also important factors. Ninety per cent of patients are over 50, and the cancer affects a slightly greater number men than women.

    Read more:

    Wednesday 7 March 2012

    Vitamin D3 can help reduce Crohn's disease

    Taking supplements of vitamin D3 reduces symptoms of Crohn's disease, the inflammatory bowel condition, according to a small study.

    It found, in 15 people given either a low dose (1,000 International Units) of the vitamin or a high dose (10,000IU), those given the high dose had less symptoms after six months.

    The researchers, from Weill-Cornell Medical Centre in New York, concluded: "Our interim analysis suggests that supplementation with 10,000 IU of Vitamin D3 may be an effective adjunctive therapy for ameliorating symptoms in Crohn's disease patients."

    The results were presented at the annual conference of the American College of Gastroenterology.

    Crohn's disease affects about 120,000 people in Britain. Higher incidence rates are found in countries closer the poles, leading to the theory that lack of exposure to UV light - essential for our bodies to manufacture vitamin D - is a cause.

    Article source -

    Colonoscopy simple, effective says doctor

    If you're older than 40 and have had cancer in your family, it's probably a good idea to have a colonoscopy done, said Dr. Clifford Simmang a colon and rectal surgery specialist at Baylor Medical-Grapevine.

    "The average risk for colon cancer starts at about age 50 so that's when we normally recommend getting a colonoscopy done," Simmang said. "But if you have a family history of cancer, you probably want to get one done sooner than that, probably in your 40s."

    Simmang added that, if caught early, colon and rectal cancer can be treated and cured. But, if you don't have a colonoscopy done by the time you are 50, you could be putting yourself at great risk, especially if there is a history of cancer in your family.

    "Only 6 percent of the population will get colon cancer in their lifetime," he said. "But, 20 to 30 percent of the time when we do these exams, we will find pollups that are pre-cancerous and, had we not found them early and removed them, they would have turned into cancer and caused a lot of problems for the patient."

    Simmang said that, while many people think that a colonoscopy is painful, it's not as much of an ordeal as people imagine it to be.

    "The colonoscopy itself is really no big deal," he said. "Patients are put to sleep during it so they don't really feel anything. The most difficult part is drinking that liquid that makes you go to the restroom and completely cleans your colon out. That's the part that most people find painful. But the actual colonoscopy? For most patients, it's not a problem at all. In fact, after they have it done, many of our patients will go somewhere and have a big meal because they are hungry."

    Read More -

    Cancer experts in a unique seminar

    A UNIQUE meeting took place in Basingstoke when around 60 multi-disciplinary cancer experts travelled from far and wide to attend a special colorectal clinical trials seminar which could deliver a big boost to patients.

    During the event at The Ark conference centre, the clinicians attended talks about different clinical trials and how they could benefit patients.

    The talks were given in the hope that by educating clinicians about the types of trials and their various benefits, they would be able to 'match' patients with the appropriate trials.

    Every year, 38,000 people are diagnosed with bowel cancer, and the majority are eligible to be entered into such a trial.

    There is a strong belief amongst clinicians that patients who participate in clinical trials have better outcomes - yet recruitment for trials is slow, often due to uncertainty about which trial will be of most benefit to each patient.

    Mr Brendan Moran, consultant colorectal surgeon at Basingstoke hospital, said: "Patients in trials nearly always do better on average."

    At the meeting, there were specialist sessions for members of the cancer team including surgeons, nurses, radiologists, pathologists and oncologists.

    Read More -

    Contraceptive pill may protect against bowel cancer

    Taking the contraceptive pill may protect women against bowel cancer, scientists said today.

    A study indicates that the Pill may reduce the risk of suffering the disease by up to 20%.

    The research, led by Dr Carlo La Vecchia from the Institute of Pharmacological Research in Milan, pooled the results of 19 international studies looking at bowel cancer rates for women who had taken an oral contraceptive between the mid 1960s and 1980s.

    The findings were published in the British Journal of Cancer to coincide with Bowel Cancer Awareness Month.

    Death rates for bowel cancer were already known to have dropped more in women than in men over the past two decades. Scientists suspected that this was probably because of the effect of hormones in the Pill.

    Dr La Vecchia said: "For a while now we have suspected oestrogen in the Pill could protect against bowel cancer and our research has gone some way to confirm this.

    "Mortality rates for female bowel cancer have steadily dropped over the last 20 years - we believe this is partly due to the Pill.

    "In the future, it may be possible to develop new treatments that take advantage of the anti-cancer qualities of the Pill."

    Researchers believe the trend can be explained by the way the female hormone oestrogen works in the body.

    Oestrogen reduces levels of bile acids, which have been linked to colon cancer.

    Read more:

    Sacral nerve modulation is effective in the long term

    Sacral nerve modulation is a technique that I have been using for a few years
    for treating patients with faecal incontinence. Our initial results have been
    very good and it is very positive to hear that sacral nerve modulation can
    remain effective for many years with some patients in the study from St Mark's
    hospital in London, published in September's edition of Colorectal Disease,
    reporting ongoing benefit after 10 years. In their study a few patients found
    that symptoms deteriorated over time or in some that the effect was lost
    altogether. This has been our experience too and we don't fully understand why
    the procedure doesn't work or loses its effectiveness for some.

    We are about to introduce a new technique of Percutaneous
    Tibial Nerve Stimulation (PTNS) that has shown some promise. The equipment
    required is cheaper than for sacral nerve modulation and it will be interesting
    to see if the long term results match those of sacral nerve modulation.

    Simon Radley

    The Contraceptive Pill Protecting Against Bower Cancer?

    I read with interest the current press regarding the potential of the oral contraceptive pill to protect women against bowel cancer. A study from Italy, which looked at the results of 19 different studies, has been published in the British Journal of Cancer. The mortality rates for female bowel cancer has fallen steadily over several decades and it is thought that the oestrogens in the contraceptive pill might be partially responsible.

    Oestrogens in the Pill can alter bile acids profiles. Bile acids have been implicated in the development of colorectal cancer and this is an area into which I undertook scientific research for an MD thesis in 1995.

    Whatever the exact mechanism of action, the observations from this study, should lead scientists to further research to see which components of the oral contraceptive pill can be harnessed to help reduce the death rate from colorectal cancer. Up to 34,000 people were diagnosed with bowel cancer in the UK in 1996 and 17,000 people died of colorectal cancer (the second biggest cancer killer) in the UK in 1999.

    Simon Radley

    Simon Radley

    Having been a consultant since 1998, I know that most patients are
    embarrassed or frightened when seeking medical advice about bowel
    problems. Whether it is the fear of bowel cancer or problems with
    piles, making people feel at ease allows them to talk more openly and
    helps me to arrive at a speedier diagnosis. A key part of what I do
    is to give patients the time to talk about sensitive issues. Arriving
    speedily at the diagnosis is something I pride myself in. At the
    Birmingham Bowel Clinic I have rapid access to state-of-the-art
    diagnostic tests, this means that patients are not kept waiting for

    At a time when medical technology is rapidly changing I believe that
    only by staying at the forefront of technological change can I offer
    the very best to my patients. I'm constantly updating my surgical
    techniques and approaches. My emphasis has always been on introducing
    the latest minimally invasive surgical techniques including key hole
    surgery, and haemorrhoidal artery ligation-the HALO procedure.

    Working with a multidisciplinary team is key to looking after my patients. I
    meet regularly with colleagues to discuss clinical issues and ensure
    my patients benefit from the best possible advice regarding
    investigation and treatment of all bowel conditions.

    Simon Radley
    Consultant Colorectal Surgeon
    Birmingham Bowel Clinic