Colon Rectal Cancer & Sleep Aids Link to Alzheimer’s
The American Cancer Society recommends that people at average risk of colon-rectal cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test) or with an exam that looks at the colon and rectum (a visual exam).
Colorectal screening age 45 instead of 50
According to the National Cancer Institute, colorectal cancers diagnosed before age 50 have increased by 51% since 1994. Research by the American Cancer Society shows that these younger people are more likely to receive a late-stage diagnosis, which is more challenging to treat.
*For screening, people are considered to be at average risk if they do not have:
- Personal history of colorectal cancer or certain types of polyps
- A family history of colorectal cancer
- A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
- Confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
- A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
Risk for Colon Cancer
- A personal history of colorectal cancer or certain types of polyps
- A family history of colorectal cancer
- A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
- A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
- A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
A small proportion of colorectal cancers—around 5 percent—are hereditary, including conditions such as Lynch syndrome, which is caused by mutations in genes responsible for repairing errors in DNA replication.
Another 20 percent or so have a family history of colorectal cancer, although it’s not clear whether it’s predominantly genetic or environmental factors that cause the disease
This year, the American Cancer Society estimates that 12% of all new colon-rectal cancer cases – approximately 18,000 people – will be diagnosed in patients younger than 50 [1].
Compared with non-Hispanic whites, Black patients are 20% more likely to develop colon cancer and nearly 40% more likely to die from it.
By 2030, 10% of colon cancers and 22% of rectal cancers diagnosed in the U.S. are expected to be in patients younger than 50. This is an alarming forecast when compared with the rates of 4% and 9% for colon-rectal cancer, respectively, from just 10 years ago.
About 75% of colon cancer occurs in the descending-sigmoid location. Patients may experience dark red blood mixed with stool or sometimes clots.
Other signs may be increased bowel frequency or abdominal pain. Right-sided cancer in the sigmoid accounts for 20% of colon cancers and appears asymptomatic until they have weight loss or anemia occurs.
Investigations
- Abdominal examination
- Colonoscopy – A camera is inserted through the rectum and extends throughout the entire colon. The doctor is looking for any abnormalities such as polyps, or abnormal growths on the inside of the colon. If polyps are found, the doctor will remove them during the procedure. These would be sent to a pathologist for further testing to check for malignancy.
Tests
Stool-based
- Highly sensitive fecal immunochemical test (FIT) every year
- Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
- Multi-targeted stool DNA test (mt-sDNA) every 3 years
Blood-based
- LFT
- FBC
- Tumor marker CEA
Staging
- Biopsies
- Pet scans
- CT scans
Visual (structural) exams of the colon and rectum
- Colonoscopy every 10 years
- CT colonography (virtual colonoscopy) every 5 years
- Flexible sigmoidoscopy (FSIG) every 5 years
Lifestyle Choices to Reduce Your Risk of Colon-rectal Cancer
- Stop smoking
- Limit alcohol intake
- Eat a healthy diet
- Regular exercise
- Maintain healthy weight
Dukes staging (5-year survival)
- Stage 0 – Benign
- Stage 1 – 90% 5-year survival
- Stage 2 – 70% 5-year survival
- Stage 3 – 30% 5-year survival
- Stage 4 – (Metastasis) <10% 5 year survival
Management
- Surgical procedures
- Surgical resection – colectomy
- The surgical reaction of lymphatic nodes – lymphadenectomy
- Chemotherapy
- Involves 5-fluorouracil
- Metastatic organ removal
- Palliative care
Sleep Aid Medication Linked to Increased Risk of Alzheimer’s
Alzheimer’s is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. This disease accounts for 60-80% of dementia cases.
The healthcare cost of dementia is estimated at $290 billion in the United States in 2019 alone. The prevalence of dementia doubles every 5 years after the age of 65 and reaches 30% or more among those over the age of 80.
This trend is expected to continue, with the prevalence of dementia estimated to double by 2030. In addition to dementia, approximately 22% of people in the United States over the age of 70 have cognitive impairment without dementia.
Effects of Anticholinergic Drugs
Anticholinergic drugs block the action of acetylcholine. Acetylcholine transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include antihistamines, tricyclic antidepressants, medications to control an overactive bladder, and drugs to relieve the symptoms of Parkinson’s disease [2].
In the main analysis published on October 23rd, 2020, the investigators did a systematic literature review and meta-analysis assessing the impact of 3 months or longer anticholinergic use on the risk of multiple subtypes of incident dementia.
It also evaluated the association between drugs used to treat overactive bladder and dementia risk such as Oxybutynin. A total of 2122 records were identified. Out of those, 21 studies underwent qualitative synthesis.
Conclusion
Anticholinergic use for ≥3 months increased the risk of dementia on average by an estimated 46% versus nonuse. This relationship was consistent in studies assessing overactive bladder medications. Results of a recent meta-analysis, however, suggest that the link between anticholinergics and cognitive impairment/dementia has not been fully established.
Another Meta-Analysis compared the use of benzodiazepines and the development of dementia. A systematic review and meta-analysis of 12 prospective and retrospective cohort studies with over 980,000 participants suggest an association between the use of benzodiazepines and the development of dementia [3].
However, the current evidence lacks the power to infer differences between the effects of Alzheimer’s disease and vascular dementias, long-acting and short-acting benzodiazepines, and various exposure loads (duration and dose).
Do you want to know if you have colon cancer or dementia? Watch our full episode here 👇
TIME STAMPS:
00:00 – Intro
00:50 – Topic for today: Colon Rectal Cancer and Sleep Aids linking to Alzheimer’s
01:55 – Duke Staging System
03:45 – Colon cancer is hereditary
04:18 – A history of colon cancer
04:46 – Hispanics and Americans have a higher risk for colon cancer
06:00 – The Links
07:00 – A Healthy Lifestyle is a Must
09:22 – Viome and other health tests
12:10 – Colon cancer management
13:18 – Surgical management for colon cancer
14:00 – Medications
15:46 – The monetary cost of Dementia
18:18 – Polypharmacy
18:40 – Studies about Dementia
19:20 – Long-term use of Benzos
23:00 – Like Us
24:04 – The best time to change is NOW
25:10 – Take everything with a grain of salt