What You Need To Know About Colorectal Cancer

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Mark Clark
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A COMMUNITY WELLNESS PROGRAM FOR ADULTS Winter 2006 What You Need To Know About Colorectal Cancer hicago may rank at the top of the list of great cities to live, work and raise a family.

1 A COMMUNITY WELLNESS PROGRAM FOR ADULTS Winter 2006 What You Need To Know About Colorectal Cancer hicago may rank at the top of the list of great cities to live, work and raise a family. But it s close to the bottom of the list of 100 major metropolitan areas in terms of screening rates for colorectal cancer cancer of the colon or rectum. In fact, according to the Centers for Disease Control, only 45 percent of Chicagoans at normal risk for colorectal cancer undergo screening tests as recommended by the American Cancer Society. Colorectal cancer is the second leading cause of cancer death for both men and women combined. In many cases, someone with early stages of this cancer may not have any warning signs. The good news? Colorectal cancer is preventable when individuals at risk for the disease get screened. A screening test helps doctors look for health problems in people who do not have symptoms. It can detect colorectal cancer at an early stage when treatment is most successful and it may save your life. Who Needs Screening? Early stages of colorectal cancer often may have no symptoms. That s why it is important for anyone at risk for this disease to receive regular screening tests. (continued next page) Evanston Northwestern Healthcare s (ENH) Evanston, Glenbrook and Highland Park Hospitals have once again earned the distinction of being named by Solucient, LLC, to the 100 Top Hospitals and 15 Top Major Teaching Hospitals lists. This is our 11th appearance on these lists, an accomplishment unequaled by any other U.S. hospital. That we have been named more times than any other hospital as a benchmark for our peers is testament to the dedication of our staff and physicians throughout the organization. More information about the 100 Top Hospitals list is available at

2 Colorectal Cancer Screening (continued from page 1) Who s at Risk? Men and women age 50 or over Individuals who have a personal medical history of inflammatory bowel disease, ulcerative colitis, Crohn s disease, previous colorectal cancer or polyps Individuals who have a family history of colorectal cancer or polyps, or other cancers such as breast, ovarian or uterine People who don t get regular exercise People who smoke or drink alcohol People who eat a diet low in fiber such as fruits, vegetables and grains, and high in fat and calories Ethnic Background: Individuals who are of African American, Hispanic or Ashkenazi Jewish heritage What are the Symptoms? Talk to your doctor about having a screening test even if you are younger than 50 and have risk factors for colorectal cancer or have noticed any of the following warning signs: A change in bowel habits, such as diarrhea, constipation or narrowing of the stool that lasts for more than a few days Feeling the need to have a bowel movement that you cannot relieve Rectal bleeding or blood in the stool Abdominal pain or cramping Weight loss Loss of appetite Anemia Nausea or vomiting Weakness and fatigue Screening Tests There are several different methods to screen for colorectal cancer. Talk to your doctor about the testing method that is right for you and how frequently you should be tested. Here are the screening tests that doctors usually recommend: Colonoscopy a procedure to examine a patient s rectum and large intestine with a lighted, fiber optic tube called a colonoscope. Doctors consider the colonoscopy the "gold standard" because it allows them to examine the entire length of the colon and remove precancerous polyps, or growths, during the procedure. Fecal occult blood test (FOBT) a test that checks for small amounts of hidden blood in the stool Flexible sigmoidoscopy a test with a short, thin, lighted tube that a doctor inserts into the rectum to examine the lower bowel Double contrast barium enema a series of X-rays taken after a patient is given a barium enema and air to expand the colon to check for polyps or other abnormalities Virtual colonoscopy an alternative for patients who cannot undergo traditional colonoscopy using computed tomography (CT) imaging (This is not an approved screening test by the American Cancer Society.) Take the Next Step Talk to your doctor today about the screening test that s right for you. Then call to schedule your appointment with the Evanston Northwestern Healthcare Patient Access Center: (847) Ext Evanston Northwestern Healthcare offers colorectal cancer screenings at four conveniently located GI Labs in Evanston, Glenbrook and Highland Park Hospitals and the Vernon Hills Specialty Care Center. Saturday appointments are available. Please verify coverage with your insurance company before scheduling your test. Receive 20% off your entire over-the-counter purchase at the Park Center Wellness Shoppe. The Wellness Shoppe carries a full line of over-the-counter and herbal supplements. $10 off an Abdominal Aortic Aneurysm (AAA) screening. An AAA screening scans the abdomen for signs weaknesses in the wall of the aorta, the main blood vessel that carries blood from the heart and if detected and left untreated, can be fatal. (One time use valid until June 30, The Park Center is located at 2400 Chestnut Ave, in Glenview.) Call (847) Ext to schedule this important preventive health screening at an ENH facility nearest you. (Valid until June 30, 2006.)

3 Total Health Annual Physical Preventing Infection Immunization Diptheria/Tetanus Flu Pneumonia Cardiovascular Health Frequency Every 10 years after age 50 if initial series and booster given earlier in life. Annually starting at age 50. (Earlier if patient has chronic illnesses, such as asthma or diabetes. Once, at age 65 (earlier if the patient has had a splenectomy or other high risk factors). Revaccinate at age 65 if first dose received before age 65. Risk Factors to Monitor Frequency Desirable Value Blood Pressure Every 2 years, all adults 120/70 blood pressure Obesity Body Mass Index* < 25 Physical Inactivity 20 minutes exercise daily Smoking Family History Lipids Every 5 years for men, age Total cholesterol < 200 (cholesterol/triglycerides) Every 5 years for women, age LDL < 100; HDL > 45 Diabetes Starting around age 45 for men and Blood Glucose < 126 (fasting glucose screen) women; earlier if family history Tests to further evaluate risk; requires direction of a physician Stress Test Detects possible abnormal blood flow in heart via EKG while patient exercises on treadmill (with or without echocardiogram and/or isotope). Ultrafast CT Scan CT of the coronary arteries to detect calcium; may be appropriate for men and women age 45 and older with risk factors. C-Reactive Protein Vision Care * A measure indicating how much weight is muscle/bone versus fat. Blood test for inflammation inside artery walls; high CRP level increases risk for heart attack. Screenings to further evaluate risk: does not require direction of a physician Carotid Artery Detects blockages in the main blood arteries to the brain and can help determine the risk Screening for a stroke. Fee: $45 Abdominal Aortic Scans the abdomen for signs of aneurysms or weaknesses in the wall of the aorta, Aneurysm (AAA) the main blood vessel that carries blood from the heart. Fee: $45 Screening Peripheral Vascular Disease Screening Prevention Plan For Adults Please make an appointment to review this guide with your physician. The logical place to start any program designed to assess your current health. This annual check-up should be an annual tradition for everyone. Peripheral vascular disease (PVD) occurs when the arteries in your legs or arms become narrowed or blocked, interfering with blood flow. A simple, non-invasive screening called an ankle/brachial index can detect an abnormal ratio between the blood pressure of the leg and the arm, which can let you know if you have PVD. PVD is common in people over 50 and is generally controllable with treatment. ENH provides free PVD screenings. Periodic eye exam Through age 40; yearly after age 40 and after age 45, check for glaucoma. For more information or to schedule an appointment, please call (847) Ext Visit for the latest information on services, classes and events.

4 Cancer: Early Detection and Prevention Colorectal Cancer Lung Cancer Skin Cancer Colonoscopy: Considered the gold standard test; allows physician to view colon when patient is sedated using a flexible fiber-optic tube. Recommended for all adults starting at age 50, and at regular intervals thereafter (For African Americans, Hispanics and people with family history of colorectal cancer, test may be given at an earlier age.) Virtual colonoscopy (CT colonography): A CT scan of the abdomen, less invasive than traditional colonscopy. Still considered experimental, though it may eventually be proven acceptable for detection. Low-dose CT scan of lung/spiral CT: Nationwide clinical trial is under way to determine whether this is an appropriate test to detect abnormal pulmonary nodules among current/former smokers, age 40 and older, and those exposed to asbestos. Visual Exam by physician to identify a skin lesion or change in a mole; often caused by sustained exposure to sun causing burning/peeling. FOR WOMEN Breast Cancer Cervical Cancer Screening Mammogram: American Cancer Society Guidelines recommend baseline at age 40, annually thereafter for women without a family history of breast cancer. For women with a family history, talk with your doctor about a more aggressive approach. Clinical Breast Exam: Yearly, as part of well woman exam. Pap Smear: American Cancer Society recommends that women begin screening 3 years after start of sexual activity. After 3 or more consecutive normal annual exams, the Pap test may be performed less frequently at the discretion of her physician. Pap smears are generally done at the time of a pelvic exam. FOR MEN Prostate Cancer Prostate Specific Antigen (PSA) and Digital Rectal Exam (DRE): Medical opinion varies regarding routine screening. Men age 50+ should discuss PSA testing with their physicians. PSA test is a blood test that may be helpful in identifying cancer; the DRE allows physicians to probe the prostate for lumps or growths. PSA is tested at age 40 for African-American men with a family history of prostate cancer. Other Preventative Screenings for Women Bone Density Thyroid Testing To evaluate for osteoporosis; baseline around menopause. Every 2 years thereafter if evidence of osteoporosis; otherwise as physician directs. Age 65 and every 5 years thereafter. NOTES: 4 Visit for the latest information on services, classes and events. For more information or to schedule an appointment, please call (847) Ext. 1177

Evanston Northwestern Healthcare First To Use Latest Robotic Surgical System Evanston Northwestern Healthcare proudly announces that Evanston Hospital was the first facility in Illinois to perform

The da Vinci System is a robotic-system that allows surgeons to perform complex procedures including prostate, heart and gynecological surgery using dime-sized incisions.

5 Evanston Northwestern Healthcare First To Use Latest Robotic Surgical System Evanston Northwestern Healthcare proudly announces that Evanston Hospital was the first facility in Illinois to perform surgery using Intuitive Surgical s da Vinci S Surgical System. The da Vinci System is a robotic-system that allows surgeons to perform complex procedures including prostate, heart and gynecological surgery using dime-sized incisions. For most patients, this minimally invasive approach results in significantly less pain, less blood loss, shorter recovery periods and a quicker return to normal daily activities. At Evanston Hospital, prostate cancer patients were among the first to undergo da Vinci surgery with William K. Johnston III, MD, Director of Laparoscopy and Minimally Invasive Urology and Assistant Professor at Northwestern University s Feinberg School of Medicine. While patients will experience shorter hospital stays with less postoperative pain and they typically can return to their daily routine in one week rather than six, I am equally excited about the opportunity to improve surgical outcomes with improved vision and dexterity afforded by the robotic arms and fiber optic 3-D imaging in our new S-version of the da Vinci. The four-armed system is designed to seamlessly translate the surgeon s hand movements into corresponding micro-movements of the miniaturized instruments positioned inside the patient. Two robotic arms, representing the surgeon s left and right hands, hold the instruments. The instruments which have more range of motion than the human hand are inserted into the patient through 1-2 cm incisions. A third arm holds the 3D camera, which the surgeon can easily reposition, as well as zoom and rotate to adjust his or her field of vision. The fourth arm enables the surgeon to add a third instrument to perform supporting tasks like tissue retraction, thereby eliminating the need for a patient-side assistant for selected procedures. At Evanston Northwestern Healthcare, we are all about making a difference in patients lives and restoring them to good health as quickly as possible, Dr. Johnston points out. Technology advances such as robotic surgery offer our patients state-ofthe-art medical care delivered by knowledgeable experts, who bring compassion to every patient we see. The da Vinci S system s robotic arms bring unprecedented stability and accuracy to complex procedures. William Johnston, MD, uses the system to perform minimally-invasive prostate cancer surgery.

To find an ENH physician near you: www.enh.org/findadoctor (847) 492-5700 Ext. 1181 NON-PROFIT ORG. U.S.

6 To find an ENH physician near you: (847) Ext NON-PROFIT ORG. U.S. POSTAGE PAID ELMHURST, IL PERMIT #310 Mature Health is published by Evanston Northwestern Healthcare, 2100 Pfingsten Road, Glenview, IL Nonprofit postage paid. Have you had your annual physical this year? Annual physicals are essential in the lifelong quest of maintaining good health. Please call your physician today to schedule your annual physical. If you do not have a physician, or are looking for a physician in your area and would like assistance in choosing the right one for you, please call (847) Ext Stroke is the third-leading cause of death in the United States Providing rapid diagnosis and the highest level of care has always been a hallmark of the Stroke Program at Evanston Northwestern Healthcare (ENH). Today, led by neurologist Daniel Homer, MD, ENH is making a major commitment to establishing a Primary Stroke Center at Evanston Hospital. Currently, there are only three Primary Stroke Centers in the Chicago area. Components of the ENH Primary Stroke Center include: An Acute Stroke Team for early stroke diagnosis and treatment, staffed 24 hours a day, 7 days a week A dedicated Stroke Unit; A Nurse Practitioner dedicated to the care and education of stroke patients; A Stroke Registry Nurse; and A Nurse Educator for the community. Dr. Homer expects the fully integrated stroke program to be ready for certification this summer.

Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer

Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer Healthy Habits and Cancer Screening Rev 10.20.15 Page