American Cancer Society's Complete Guide to Colorectal
Cancer, 1st Edition
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al.
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Home, Revised Edition, Houts and Bucher
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Couples Confronting Cancer: Keeping Your Relationship Strong, Fincannon
and Bruss
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Continental Divide, Bischke
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Good for You! Reducing Your Risk of Developing Cancer
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by Blyth)
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Recovery, Second Edition, Eyre, Lange, and Morris
Kicking Butts: Quit Smoking and Take Charge of Your Health
Lymphedema: Understanding and Managing Lymphedema After Cancer
Treatment
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Also by the American Cancer Society
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Published by
American Cancer Society
Health Promotions
1599 Clifton Road NE
Atlanta, Georgia 30329, USA
Copyright © 2006 American Cancer Society
Illustrations on pages 161, 163, 164, 165, 176, 178, 179, and 273 by Eric Grafman.
© 2006 American Cancer Society
All rights reserved. Without limiting the rights under copyright reserved above, no part of this
publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any
form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the
prior written permission of the publisher.
Printed in the United States of America
Designed by Shock Design Inc, Atlanta, GA and Jill Dible Design, Atlanta, GA
Cover designed by Shock Design, Inc. Atlanta, Georgia
5 4 3 2 1 05 06 07 08 09
Library of Congress Cataloging-in-Publication Data
Levin, Bernard, 1924-
[Complete guide to colorectal cancer]
American Cancer Society’s complete guide to colorectal cancer / by Bernard Levin, Terri B. Ades,
Durado Brooks. — Rev. ed.
p. cm.
Includes bibliographical references and index.
ISBN 0-944235-55-7
1. Colon (Anatomy)--Cancer. 2. Rectum--Cancer. I. Ades, Terri B. II. Brooks, Durado. III.
American Cancer Society. IV. Title.
RC280.C6L46 2006
616.99′4347--dc22
2005024711
A Note to the Reader
The information contained in this book is not intended as medical advice
and should not be relied upon as a substitute for talking with your doctor.
This information may not address all possible actions, treatments,
medications, precautions, side effects, or interactions. All matters regarding
your health require the supervision of a medical doctor or appropriate
health care professional who is familiar with your medical needs. For more
information, contact your
Advisory Panel and Medical Review
Terri Ades, MS, APRN, AOCN
Director of Cancer Information, American Cancer Society, Atlanta, GA
Durado Brooks, MD, MPH
Director, Prostate and Colorectal Cancer, American Cancer Society, Atlanta,
GA
John M. Dorso
Volunteer, American Cancer Society, Member, United Ostomy Association,
and Colorectal Cancer Survivor, Marietta, GA
Ted Gansler, MD
Director of Medical Strategy, American Cancer Society, Atlanta, GA
Amy E. Kelly
Co-founder and Director, Colon Cancer Alliance, New York, NY
John S. Macdonald, MD
Professor of Medicine, Medical Director, and Chief, Gastrointestinal Oncology
Service, St. Vincent’s Comprehensive Cancer Center, New York, NY
Bruce D. Minsky, MD
Professor and Vice Chairman, Department of Radiation Oncology,
Memorial Sloan-Kettering Cancer Center, New York, NY
Joel E. Tepper, MD
Professor and Chair, Clinical Research, Radiation Oncology, University of
North Carolina Chapel Hill School of Medicine and Lineberger
Comprehensive Cancer Center, Chapel Hill, NC
Copyeditor
Rodney Atkins
Editor
Amy Brittain
Managing Editor
Gianna Marsella, MA
Book Publishing Manager
Candace Magee
Book Publishing Director
Len Boswell
Strategic Director, Content
Chuck Westbrook
We would like to thank the many people who generously shared their personal
experiences with colorectal cancer with us.
BRIEF CONTENTS
Foreword by Katie Couric
Preface by Bernard Levin, MD
Introduction
Section I: What Is Colorectal Cancer?
Chapter 1: Overview of Colorectal Cancer
Chapter 2: Risk Factors and Prevention
Section II: The Diagnosis
Chapter 3: Early Detection
Chapter 4: Initial Evaluation
Chapter 5: Diagnosis and Staging
Chapter 6: Understanding Your Prognosis
Section III: After the Diagnosis
Chapter 7: Coping With Your Diagnosis
Chapter 8: Making the Medical System Work for You
Section IV: Treatment Options
Chapter 9: Making Informed Decisions About Treatment Options
Chapter 10: Surgery
Chapter 11: Radiation Therapy
Chapter 12: Chemotherapy
Chapter 13: Clinical Trials and Emerging Therapies
Chapter 14: Complementary and Alternative Medicine
Section V: During Treatment
Chapter 15: Strategies for Coping With Symptoms and Side Effects
Chapter 16: Living With a Colostomy
Chapter 17: Taking Care of Practical Matters: Work, Insurance, and Money
Section VI: After Treatment
Chapter 18: Follow Up
Chapter 19: Living Well After Cancer
Section VII: For Loved Ones and Caregivers
Chapter 20: When Your Loved One Has Colorectal Cancer
Resources
References
Glossary
About the Editors
List of Contributors
Index
CONTENTS
FOREWORD by Katie Couric
How Colorectal Cancer Changed My Life
Raising Awareness to Increase Screening and Early Detection
How This Book Can Help
PREFACE by Bernard Levin, MD
Advancements in Colorectal Cancer
Why We Wrote This Book
Acknowledgements
INTRODUCTION
Who This Book Is For
What This Book Is About
How This Book Is Organized
About the American Cancer Society
SECTION I: WHAT IS COLORECTAL CANCER?
CHAPTER 1
Overview of Colorectal Cancer
The Profile of Colorectal Cancer in the United States
About the Digestive System
What Is Cancer?
What Is Colorectal Cancer and How Does It Develop?
CHAPTER 2
Risk Factors and Prevention
Age
Race and Ethnicity
Your Health History
Lifestyle Factors for Risk and Prevention
Dietary Factors for Risk and Prevention
Tumor-Blocking Medications
What Can You Do?
SECTION II: THE DIAGNOSIS
CHAPTER 3
Early Detection
Early Detection Makes a Difference
Types of Screening Tests
Recommendations for Screening
Why Are These Tests So Important?
Which Test is Best?
CHAPTER 4
Initial Evaluation
What Is a Medical History?
Personal Health History and Current Health Status
Family Health History
Physical Examination
Diagnostic Tests
Imaging Tests
Why Is All This Information Gathering Necessary?
CHAPTER 5
Diagnosis and Staging
The Role of the Pathologist
Grading: How Aggressive Is the Cancer?
Staging: How Widespread Is the Cancer?
The Pathology Report
Getting a Second Pathologist’s Opinion
CHAPTER 6
Understanding Your Prognosis
Prognosis
Understanding Five-Year Survival Rates
What Combination of Factors Predict Outcome?
SECTION III: AFTER THE DIAGNOSIS
CHAPTER 7
Coping With Your Diagnosis
Consider Your Whole Self
Coping With Emotions
Taking Action
Talking About Your Cancer
Building Your Support Network
Looking Ahead
CHAPTER 8
Making the Medical System Work for You
Building Your Health Care Team
Choosing a Doctor
Choosing a Treatment Facility
Establishing Your Role on Your Health Care Team
Communicating With Your Health Care Team
Getting a Second Opinion
Maintaining Your Medical Information
Getting the Best Care Possible
SECTION IV: TREATMENT OPTIONS
CHAPTER 9
Making Informed Decisions About Treatment Options
Treating Your Colorectal Cancer: You Have Choices
The Standard of Care
Your Role in Decision Making
Gathering Additional Information
Getting the Most from Your Doctor’s Appointments
Comparing Your Options
Your Personal Treatment Plan
Making the Best Decision…for You
CHAPTER 10
Surgery
The Process of Elective Radical Colon Surgery
Overview of Colon Surgery
The Process of Elective Radical Proctectomy
Overview of Rectal Surgery
Adjuvant and Neoadjuvant Therapy
Surgery for Metastatic Colorectal Cancer
CHAPTER 11
Radiation Therapy
How Is External Beam Radiation Delivered?
Who Delivers Radiation Therapy?
How Does Radiation Therapy Work?
When Is Radiation Therapy Used?
Radiation and Surgery
Radiation and Chemotherapy
Side Effects of Radiation Therapy
CHAPTER 12
Chemotherapy
What Is The Purpose of Chemotherapy?
Misconceptions About Chemotherapy
When Is Chemotherapy Used?
How Is Chemotherapy Administered?
Duration and Frequency of Treatment
Chemotherapy Options
What Are the Potential Side Effects?
Which Chemotherapy Treatment Is the Best?
Making Your Treatment Decisions
CHAPTER 13
Clinical Trials and Emerging Therapies
What Is a Clinical Trial?
New Approaches to an Old Problem
Emerging Therapies in Colorectal Cancer
Lots of Progress, Still No Magic Bullet
CHAPTER 14
Complementary and Alternative Medicine
What Is the Difference Between Complementary and Alternative
Treatments?
What are Complementary Treatments?
Complementary Treatments for Symptoms and Side Effects
Herbs and Supplements for the Treatment of Cancer
What Are Alternative Treatments?
Do What’s Best for Your Body
SECTION V: DURING TREATMENT
CHAPTER 15
Strategies for Coping With Symptoms and Side Effects
Common Effects of Cancer or Cancer Therapies
