Colon Cancer Diagnosis

Colonoscopies lead to many more infections than previously thought

Colon Cancer Diagnosis | Johns Hopkins Medicine

Colonoscopies and upper-GI endoscopies performed at outpatient specialty centers in the United States result in far more infections than previously believed, according to a new study.

An analysis of data from 2014 shows that patients who had one of the common procedures at facilities known as ambulatory surgery centers, or ASCs, were at greater-than-expected risk of bacterial infections, including E. coli and Klebsiella. Results of the study were published online this month in the journal Gut.

“Though patients are routinely told that common endoscopic procedures are safe, we found that post-endoscopic infections are more common than we thought, and that they vary widely from one ASC facility to another,” says lead researcher Susan Hutfless of Johns Hopkins University.

Colonoscopy is one of six options suggested by the American Cancer Society for colon cancer screening. The traditional recommendation is that patients be regularly screened starting at 50, but the ACS recently reduced its recommended age to 45.

Upper-GI endoscopies, known as EGDs, can be used to diagnose a number of problems in the upper digestive tract, including heartburn, swallowing issues, and abdominal pain.

Each year in the United States, there are more than 15 million colonoscopies and 7 million EGDs. Both procedures are performed with an endoscope, a reusable optical instrument that gives doctors a view of a patient's gastrointestinal tract. Besides screening and diagnosis, they can be used for procedures such as removing polyps without invasive surgery.

Researchers examined data from six states—California, Florida, Georgia, Nebraska, New York, and Vermont—to track infection-related emergency room visits and unplanned inpatient admissions within seven and 30 days after a colonoscopy or EGD.

Post-endoscopic infection rates were previously believed to be in the neighborhood of one in a million, Hutfless says. The new study found a rate of infection seven or fewer days after a procedure was slightly higher than one in 1,000 for screening colonoscopies and about 1.6 per 1,000 for non-screening colonoscopies. Rates for EGDs within that time were more than three per 1,000.

Patients who had been hospitalized before undergoing one of the procedures were at even greater risk of infection. Since many ASCs lack an electronic medical record system connected to hospital emergency departments, those ASCs are unly to learn of their patients' infections, Hutfless says.

“If they don't know their patients are developing these serious infections, they're not motivated to improve their infection control.”

Though the nation's first ASC was established more than 40 years ago, the facilities gained popularity over the past 20 years as more convenient, less expensive alternatives for outpatient surgeries and other procedures.

The team found evidence that, among the ASC post-procedure infections, the rates were slightly higher for diagnostic procedures than for screening procedures.

ASCs with the highest volume of procedures had the lowest rates of post-endoscopic infection.

According to the Ambulatory Surgery Center Association, in 2017, 64 percent of ASCs were owned by physicians and 28 percent were affiliated with hospitals or health systems.

While the overwhelming majority of ASCs follow strict infection-control guidelines, says Hutfless, she and her team found infection rates at some ASCs more than 100 times higher than expected.

The study's other authors are Peiqi Wang, Saowanee Ngamruengphong, Martin A. Makary, and Anthony Kalloo of the Johns Hopkins University School of Medicine; and Tim Xu of McKinsey & Company in Washington, D.C.

The study was funded by the U.S. Department of Health and Human Services Agency for Healthcare Research & Quality.

Posted in Health

colon cancer, gastroenterology

Source: https://hub.jhu.edu/2018/06/01/colonoscopy-gi-endoscopy-infection-rate-study/

Colorectal Cancer Experts | Johns Hopkins Kimmel Cancer Center

Colon Cancer Diagnosis | Johns Hopkins Medicine

The Johns Hopkins Colon Cancer Center has specialists from multiple disciplines who provide comprehensive approaches to the treatment of colon cancer. The team specializes in creative, multi-modal treatments for complicated, advanced colon and rectal cancers.

Experts by Specialty

Our team provides treatment locations in Baltimore, Washington, D.C., and the surrounding metropolitan areas.

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Murphy, Adrian Gerard, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

Primary Location: Johns Hopkins Medicine – Green Spring Station

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

 

Primary Location: Johns Hopkins Medicine – Green Spring Station

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: Johns Hopkins Bayview Medical Center

Primary Location: Sibley Memorial Hospital

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: Johns Hopkins Bayview Medical Center

Primary Location: Johns Hopkins Bayview Medical Center

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: The Johns Hopkins Hospital

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: The Johns Hopkins Hospital

Primary Location: The Johns Hopkins Hospital

Primary Location: Johns Hopkins Bayview Medical Center

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Primary Location: The Johns Hopkins Hospital (Main Entrance)

Mary-Eve Brown, R.D., L.D.N.

Source: https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/colorectal_cancer/meet_our_experts/

Johns Hopkins Gazette | July 23, 2007

Colon Cancer Diagnosis | Johns Hopkins Medicine
Searching for less invasive screening tests for cancer,Johns Hopkins scientists have discovered proteins present in blood that accuratelyidentify colon cancer and precancerous polyps.

Initial studies of the proteins CCSA-3 and CCSA-4suggest they could be used to develop a blood test to identify at-riskindividuals.

“The reality is that many people are not gettingregular screening colonoscopies, so ideally we'd to identify those withsome molecular fingerprint for the disease and really need them,” saidcancer researcher Robert Getzenberg, a professor of urology and director ofresearch at Johns Hopkins' Brady Urological Institute.”

Current screening guidelines for healthy people callfor a baseline colonoscopy — the insertion of a flexibleoptical-scanning scope through the rectum into the colon, preceded by colonic cleansing,fasting and heavy sedation — at age 50, followed by rescreening atleast every five to 10 years. Colonoscopy is not foolproof; cancers can develop betweenscreenings.

First discovered by Getzenberg and colleagues at theUniversity of Pittsburgh through a protein scan, the two blood-dwellingproteins are thought to be remnants of cellular debris cast off from dead cancercells. Although the proteins' roles are not entirely clear, the Johns Hopkinsscientists say they are part of the scaffolding that supports structures withina cell's control center, the nucleus.

Alteration of such nuclear scaffolding is a hallmarkof cancer cells that is easily detectable under the microscope as a misshapenand discolored nucleus. That fact led Getzenberg to the notion that “there must besomething at the molecular level that would form a molecular flag for cancervia a blood test.”

To find the flag, Getzenberg's team drew blood samplesfrom 107 apparently healthy individuals the day before their scheduledcolonoscopies, and from 28 colorectal cancer patients.

Using a particular concentration of scaffold-proteinsas a marker for disease, the Johns Hopkins team — which did not knowthe colonoscopy results in advance — was 100 percent accurate in identifying the28 existing cancers.

Using the same protein markers, investigators also correctlyidentified 51 of 53 individuals (96.2 percent) with normal colons and 14 of 18people (77.

8 percent) with advanced precancerous polyps, which Getzenberg saysare the most important to detect through routine screening.

When researchers combined samples, they correctlyidentified 42 of 46 (91.3 percent) containing both cancers and advanced precancerouspolyps. Protein levels were accurate in correctly assessing additionalblood samples from 125 people with benign conditions and other cancers.

“These proteins seem very good at separating normalsamples from cancerous ones and identifying other groups with precancers at highrisk for disease as well,” Getzenberg said. Results are published in the June15 issue of Cancer Research.

The researchers are planning larger studies at severalhospitals over the next several months. It may take several years to completethe full range of testing.

Getzenberg says that storing and processing thesamples are among the major hurdles in biomarker development, a field that spansongoing research on many cancers and various body fluids.

“It is difficult to getmany facilities to adhere to precise storage and processing conditionsimportant for keeping proteins stable,” he said. “Different conditions couldcreate incorrect results.

” Researchers also differ in the type of biomarkersthey seek, with some, Getzenberg, looking for proteins, and otherssearching for DNA components.

Getzenberg and the University of Pittsburgh hold apatent for the technology described above, which is licensed to Onconome.Funding for the study described in the article was provided by Onconome and theNational Cancer Institute.

Under a licensing agreement between Onconome andthe University of Pittsburgh, Getzenberg is entitled to a share of royaltiesreceived by the university on sales of products described in this article.

Getzenberg also is a paid consultant to Onconome, which has a licensingagreement with The Johns Hopkins University covering CCSA-3 and -4 relatedtechnologies. The terms of this arrangement are being managed by Johns Hopkins inaccordance with its conflict-of-interest policies.

Additional authors are Eddy S. Leman, Grant W. Cannon,Lori J. Sokoll and Daniel W. Chan, all of Johns Hopkins; and Robert E. Schoenand Joel L. Weissfeld, of the University of Pittsburgh CancerInstitute.

Source: https://pages.jh.edu/~gazette/2007/23jul07/23colon.html

Colon Cancer: Treatments | Johns Hopkins Kimmel Cancer Center

Colon Cancer Diagnosis | Johns Hopkins Medicine

Treatment for colon and rectal cancers depend on the size and location of the tumor as well as other factors. A team of Johns Hopkins experts evaluate each patient to develop an individualized treatment plan the specific characteristics of the tumor.

These doctors may order x-rays, ultrasound, a CT scan, and blood tests to determine the extent of the disease. This evaluation is an important step in helping the medical team design the best and most effective treatment regimen.

Treatment plans may include a single therapy or combination of therapies including surgery, chemotherapy and radiation therapy.

When colon cancer is detected in an early stage, it is most commonly treated with a surgical procedure called a colectomy. The surgeon removes the part of the colon that contains the cancer as well as a small portion of surrounding normal tissue.

In all but the rarest cases, the surgeon is able to reconnect the healthy sections of the colon and rectum, and bowel function soon returns to normal. If the cancer is completely removed during surgery, and pathologists determine that it was an early stage cancer, no further treatment is needed.

If surrounding tissue is found to contain any cancer cells, the doctors will ly recommend adjuvant chemotherapy. treatment with anticancer drugs. The drugs are given intravenously and/or orally and travel through the bloodstream to destroy tumor cells that may have broken away from original tumor and could begin to grow again elsewhere in the body.

Sometimes chemotherapy is given prior to surgery to shrink a tumor and reduce the extent of surgery. This is called neo-adjuvant therapy. Chemotherapy is also given when the cancer has spread beyond the scope of surgery.

Medical Oncology

Oral or intravenous chemotherapy may be part of the treatment for stage 3 colon cancer after surgery. Patients receive the drugs over a continuous number of days or several times a week, usually for six months after surgery. Chemotherapy may be recommended for stage 4 cancers even if a patient has not undergone surgery.

Some of the most common intravenous chemotherapy used to treat stage 4 colon cancer are combinations of drugs called FOLFOX and FOLFIRI.

Other medicines for patients with advanced colon cancers include drugs that target tumor blood vessel growth, such as bevacizumab, and antibody drugs, such as cetuximab and panitumumab, that block the action of a protein called eGFR that helps cancer cells grow.

Immunotherapy refers to medical treatments that harness or strengthen the body’s own immune defense system against cancer cells. Johns Hopkins researchers led the first clinical trials of one type of immunotherapy, known as immune checkpoint inhibitors, and are continuing their work through the Bloomberg~Kimmel Institute for Cancer Immunotherapy.

For stage 4 metastases to the liver, Johns Hopkins medical oncologists may work with radiation oncologists to perform a procedure called chemoembolism, which delivers chemotherapy directly through the artery that supplies blood to the liver tumor.

Radiation Oncology

Un rectal cancer, radiation therapy is not used as a primary treatment for colon cancer. The colon is not a fixed structure inside the body — the bowel naturally moves around — making it more difficult to target accurately with radiation. Radiation therapy is not recommended for stage 1 and 2 colon cancers.

For stage 3 and stage 4 colon cancers, radiation therapy may be used in combination with surgery and medical therapies to target tumors in fixed places close to the colon, such as the abdominal wall, or in distant organs such as the lungs or liver.

If there are only a few limited areas of metastases in stage 4 colon cancer, the Johns Hopkins team will consider an aggressive approach to radiation oncology to increase a patient’s long-term survival. For liver metastases, for instance, radiation oncologists may use stereotactic body radiation therapy (SBRT), a computer-guided, short-term, high-dose radiation treatment.

Liver metastases may also be treated with a type of radiation therapy called radioembolism, in which radioactive beads are injected into the artery that supplies blood flow to the tumor in the liver. This high-dose radiation therapy specifically targets tumor tissue without damaging surrounding healthy liver tissue.

Surgery

Surgery to remove tumors is the most common treatment for colon cancer, especially early stage cancer that is contained in the colon. About 95 percent of stage 1 and 65 to 80 percent of stage 2 colon cancers are curable by surgery. The main goals of colon cancer surgery are to remove the cancer completely and to reconstruct the bowel if necessary.

This type of surgery is called a colectomy. The bowel is divided into sections the different arteries that supply blood to each part of the bowel. Surgery removes the part of the colon with the cancer and then rejoins the remaining colon and its blood supply. Depending on the location of the tumor, more than one part of the colon may be removed.

The Johns Hopkins colon cancer team has specific expertise in minimally invasive colon surgeries, such as laparoendoscopic surgery. This type of surgery requires small incisions in the abdomen through which surgical instruments are inserted and used with the guidance of a small camera.

Endoscopy is also used at Johns Hopkins to remove flat colon polyps (clumps of cells inside the colon that could develop into colon cancer) that are difficult to remove with other methods.

Some of our surgeons also use robotically guided surgical techniques to precisely identify and remove colon cancers.

Certain types of stage 4 colon cancer may spread into the peritoneal cavity, the space between a membrane layered on the abdominal wall and a membrane around the abdominal organs.

To treat this, surgeons at Johns Hopkins may use an aggressive approach that involves cytoreductive surgery to remove as many of the cancerous cells as possible from this space.

Cytoreductive surgery may be followed by a highly concentrated, heated type of chemotherapy called hyperthermic intraperitoneal chemotherapy (HIPEC), which is delivered directly to the abdomen.

Source: https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/colorectal_cancer/about_colon_cancer/treatments.html