Tag Archives: Screening

Diagnostics: Screening For Colorectal Cancer

Colorectal cancer is the second-leading cause of cancer death in the U.S. Colorectal cancer cannot be totally prevented, but there are ways to lower your risk and that’s with regular screening.

The U.S. Preventive Services Task Force and the American Cancer Society encourage patients to start screening for colorectal cancer at age 45. Dr. John Kisiel, a Mayo Clinic gastroenterologist, also says patients should begin screening at 45. He recommends checking with your health care provider about your risks, and with your insurance provider about your coverage.

Procedures: Preparing For A Colonoscopy (Mayo)

A colonoscopy is an exam used to detect changes or abnormalities in the large intestine, or colon, and rectum. It’s an important exam that’s performed to check for colon cancer. But some would agree that preparing for the colonoscopy is worse than the exam itself.

In this Mayo Clinic Minute, Dr. James East, a gastroenterologist at Mayo Clinic Healthcare in London, explains what patients will need to do to prepare for this exam and how to make it a little easier.

DR. C’S JOURNAL: BENEFITS OF COLONOSCOPIES OVER 50

Colonoscopy is good preventative medicine for everybody over the age of 50. A video was posted yesterday on colon cancer metastatic to the liver. Although this is treatable, metastatic colon cancer is a miserable condition, markedly lowering quality of life. You are much better off preventing colon cancer then having to deal with it, and in this sense, colonoscopy is a very good trade off.

Colonoscopy is no fun. You have to modify your diet well in advance, and take a magnesium citrate clean out in order to get rid of fecal matter that would prevent proper visualization of your colon. You should get your first colonoscopy at age 50 or earlier depending upon your family history of polyps, colon cancer, and other bowel problems.

In my own case, I had a number of colonoscopies, and nothing serious was discovered. I still think it is a very good idea. Although I never had a colon polyp or cancer discovered, I have recently, at the age of 89, developed bladder cancer of the slowly progressive and non-invasive kind.

The thought occurred to me that getting regular cystoscopies might catch bladder cancer at an earlier stage. I was told by an authoritative Physician that this has previously been tried and not proven to be useful. I also recommend going into a dermatologist regularly to remove actinic keratoses, which have the capability of developing into cancer. I believe you cannot be too vigorous with preventative therapy.

Interestingly, good sleep, diet and exercise are recommended in the prevention of colon cancer. Please refer to the mayo clinic article on colonoscopy for more information.

–Dr. C

Mayo Clinic article

DOCTORS PODCAST: MEDICAL & TELEHEALTH NEWS (MAR 2)

A bi-weekly podcast on the latest medical, science and telehealth news.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #12: “Prostate cancer”

Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.

Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.

The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.

The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.

This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.

They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.

Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.

The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,

Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.

This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.

Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.

–DR. C

Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.

TELEMEDICINE: “FORWARD TRIAGE” FOR SCREENING PATIENTS DURING COVID-19

 Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.

Interview with Dr. Judd Hollander on how health systems can use telemedicine services during the Covid-19 pandemic.

It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach. 

Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.

Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients. Payment and regulatory structures, state licensing, credentialing across hospitals, and program implementation all take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need. In this instance, it may be a virtually perfect solution.

Read full article at NEJM