"What's next?" is one of the most common questions asked by anyone who is diagnosed with cancer. In the immediate days and weeks following a cancer diagnosis, "what's next?" will focus on treatment options, such as surgery, chemotherapy, and radiation therapy. You'll figure out what to ask your doctor and how to plan your next steps.

For people who are a little further into their cancer care plan, "what's next" may mean "for the rest of my life." It's not uncommon to feel a sense of letdown after treatment ends. Without the structure of regularly scheduled treatment appointments and reporting to clinic for blood tests, many people feel lost.

Questions, Questions

Compounding these stresses are questions about your medical future. How often do you need to see your oncologist? How will you be monitored to make sure cancer is caught early if it comes back? How will you be monitored for any long-term side effects from your cancer or it's treatment? Will your primary care doctor understand what you've been through? The questions are endless.

A Guide for Finding Answers

A noted group of cancer experts, some of the best in the world, have come together to publish a comprehensive cancer survivorship report to help answer these, and many other, questions. The entire report is available online and outlines the key components of a good long-term care plan for cancer survivors, such as:

• Addressing employment concerns of cancer survivors
• Improving access to adequate and affordable health care
• Prevention of recurrent and new cancers and other late effects of cancer care
• Good coordination between specialists and primary helath care providers to make sure all of the cancer survivor's health needs are met
• Identifying psychosocial and mental health needs and care plans for survivors
• Connecting survivors with supportive services, if needed

If you are a cancer survivor, and remember that "cancer survivor" includes anyone diagnosed with cancer, from the moment of diagnosis onward, this report can be a terrific guide. It can help you figure out what you need, physically, mentally, and emotionally, and how to get it from your cancer care and primary health care teams.

Chemotherapy is a life-saving medical option for many people diagnosed with cancer. Even so, it can cause very serious, even life-threatening side effects. For this reason, it's important that clear standards be followed for how chemotherapy is given and how the health of people receiving it is monitored before, during, and after chemotherapy.

The American Society of Clinical Oncology and the Oncology Nursing Society have come together to produce the Chemotherapy Administration Safety Standards. This is a very important step forward in creating the safest possible treatments for cancer.

The final list includes 31 safety standards and covers important aspects of giving chemotherapy including:

• Careful review of each patient's clinical (medical) information
• Selection of the treatment option
• Treatment planning
• Informed consent from the patient; informed consent is the formal way of making sure that each patient understands and accepts the risks and benefits of the treatment options and agrees with the treatment plan
• How the treatment is ordered, for example, whether this is done electronically or with a written prescription
• How the chemotherapy medication is prepared; usually, this refers to how it is prepared in the pharmacy
• Assessment, or keeping track of, how well the treatment plan is being followed (compliance); this means making sure medications are given as planned, and on the part of the patient, that medications are taken as prescribed
• Administration and monitoring; this refers to what actually happens in the clinic each time chemotherapy is given
• Assessment of response, which means tracking how well the patient is doing after chemotherapy is given and making sure the cancer itself is responding as expected
• Toxicity monitoring, which means tracking all of the negative side effects of treatment, such as low blood counts, nausea, or fatigue.

This may not seem like such a big deal or maybe feels like a "mere formality". However, these guidelines are much more important than many people realize. Most of the cancer care in the United States, roughly 80%, is given in small community oncology clinics. Because of this, there can be a lot of variation in the safety standards around how chemotherapy is given.

By creating a standardized set of safety guidelines that are available to every oncologist in the country, The American Society of Clinical Oncology and the Oncology Nursing Society have taken a positive step toward making sure every single person treated for cancer is treated as safely as possible.

If you're interested, you can see a full set of the guidelines, for yourself. You can even print them out and take them to your next appointment. If you have questions about the guidelines and what they mean for you, your doctor can get you the information you need to make informed choices about your cancer care.

Colonscopy is the gold standard for detecting colon cancer. There is no doubt that colonoscopy saves lives. Even so, researchers are always looking for ways to make this test even better. This is because the more effectively colonoscopy screening can detect the smallest tumors or pre-cancerous colon growths, the more likely it is that these growths will be caught and removed early, before they have spread.

New research has found that a type of colonoscopy testing called high-definition colonoscopy is superior to regular colonoscopy for finding colon growths that can develop into colon cancer. Results from the largest head-to-head comparison of regular vs. high-definition colonoscopy screening are clear: High-def colonoscopy should be the screening of the future.

Your Next Steps

If you're of average risk for colon cancer, health experts recommend that you begin colonoscopy screening at age 50. If you are above-average risk, for example because you have inflammatory bowel disease (IBD) or a genetic condition that increases risk, you likely need to begin colonoscopy screening much earlier and undergo it more often. Here are some steps you can take to take control of your colon health:

• Do not use these latest study results on high-def colonoscopy as an excuse to avoid getting this test altogether. Your doctor may not have access to this sort of test quite yet, but regular colonoscopy is still the single best way to detect colon cancer early, before it has spread and when it is easiest to treat and cure.
• Learn what you need to do to prepare for a colonoscopy. A little planning will help you have a sense of control over your health and your health care choices.
• Learn what happens during a colonscopy. Knowing what to expect can ease your fears significantly.
• Learn how to remove the dread and fear of colonoscopy. Nobody looks forward to getting a colonoscopy, but it likely is not as bad as you think.
• Focus on the future. Focusing on the fact that getting a colonscopy can save your life and keep you cancer-free can make it easier to pick up the phone and call your doctor to ask about this important screening.

Inflammatory bowel disease (IBD) refers to a group of conditions that cause pain and damage in the gastrointestinal tract. Crohn's disease and ulcerative colitis are the two most common inflammatory bowel diseases. Symptoms of these conditions include abdominal pain, weight loss, fever, rectal bleeding, blood in the stools, diarrhea, and skin and eye irritation.

One of the most important things to know about IBD is that having it can significantly increase your risk of developing colon cancer. It's a scary thought, and it seems completely unfair that in addition to the pain and suffering that can come with IBD itself, comes a higher risk of a potentially life-threatening cancer.

Fortunately, there something you can do to greatly increase the odds that if you do develop colon cancer, you will survive and thrive after your diagnosis. The latest research on this topic shows that regular colonoscopy screening can mean the difference between life and death for people with a history of IBD who develop colon cancer.

By The Numbers

Researchers tracked 149 people with IBD who developed colorectal cancer. They compared the survival rates after colorectal cancer diagnosis among those who had colonoscopies in the past vs. people who had not had colonoscopies.

The 5 year survival rate after colorectal cancer among the people with IBD who had undergone colonoscopy screening was 100%. Among the people with IBD who had not undergone colonoscopy as part of their medical care, the 5 years after diagnosis was 74%. Over the long-term, only one person in the colonoscopy group died specifically due to colorectal cancer. In the group of people with IBD who did not undergo colonoscopy, 29 people died due to colorectal cancer over the long-term.

The Bottom Line

If you have IBD, it is very, very important that you undergo colonoscopy testing regularly. While colonoscopy can seem unpleasant and sometimes may cause some pain for people with IBD, it is much less unpleasant than being diagnosed with, or dying of, colon cancer. Colonoscopy allows your doctor to find any colon cancer cells or small tumors very early, when they can be removed before they spread. This improves survival and makes it less likely that you'll need additional, aggressive treatment for cancer.

Facing Your Fears

If you have IBD, the following steps can help you face your fears about colonoscopy:

• Make an appointment to talk to your doctor specifically about how often you need colonoscopy screening. If your regular, primary care doctor doesn't have a specific plan for you or doesn't take your concerns seriously, ask for a referral to a gastroenterologist so you can make sure you get exactly what you need.
• Learn what you need to do to prepare for a colonoscopy. A little planning will help you have a sense of control over your health and your health care choices.
• Learn what happens during a colonscopy. Knowing what to expect can ease your fears significantly.
• Learn specific steps you can take to make colonoscopy easier on yourself. While nobody looks forward to getting a colonoscopy, it likely is not as bad as you may imagine
• Focus on the future. Focusing on the fact that getting a colonscopy can save your life and keep you healthy and cancer-free can make it easier to pick up the phone and make that important appointment with your doctor.

It is now considered the highest standard of care to test colon tumors in people with metastatic colon cancer for a biomarker called KRAS, before using certain treatments. KRAS refers to a gene that can be altered (mutated) in colon cancer cells. Studies show that if this alteration (mutation) is present, the anti-EGFR medications cetuximab (Erbitux) and panitumumab (Vectibix) are not effective and should not be used.

New research out of Italy, published in the medical journal PLoS ONE, suggests that in addition to testing for KRAS, cancer doctors should test for three other tumor markers, called BRAF, PIK3CA, and PTEN.

By testing patients for these three markers before treating them with anti-EGFR medications, doctors can reduce the likelihood of giving potentially toxic and very expensive therapy that isn't going to help the patient.

Why This Matters

Combining testing for KRAS, BRAF, PIK3CA, and PTEN tumor markers with other new advances in cancer care, such as better ways to determine effective treatments without trial and error and surgeries and chemotherapies to improve survival, brings us closer to the day when all cancer care is personalized, highly effective, and less toxic.

If you ask anyone who is seriously overweight about the prejudice and insensitivity they experience in their everyday lives, you will likely get an earful. From the "dirty looks" an overweight person may get from a slender seatmate on an airplane, to the not-so-subtle judgments of overweight people who order dessert in a restaurant, weight bias is everywhere in our society.

If you wonder what this has to do with colon cancer, consider that overweight and obesity cause up to a third of all colon cancer cases that occur in the United States. Pretty much, you can't talk about colon cancer prevention without talking about obesity.

So we know it's important that people receive the help and support they need to reach and maintain a healthy body weight, which in turn will reduce colon cancer risk. And it's unlikely that prejudice and bias against overweight people is going to help accomplish this. Now research suggests that this type of anti-fat bias goes beyond the general public. A new study confirms that many health care providers also have less respect for their overweight and obese patients.

This matters a lot for anyone who is ready to tackle their eating and exercise issues in order to reach a healthier body weight. When you want to lose weight and improve your health, you do not need a health care provider who is unsupportive and critical.

One of the lead researchers on the recent study about weight bias among physicians confirms that overweight patients sense this prejudice and feel it makes it harder to get good medical care. Dr. Mary Huizinga recounted that the idea for the research occurred to her because patients often told her no other physician talked to them this way before or listened to them regarding their struggles with weight issues. Many "felt they weren't receiving the type of care" that other, normal-weight patients received.

Finding the Help and Medical Care You Need

If you're significantly overweight and you want to work with your health care provider to address this issue, keep the following important points in mind:

• If you want to reduce your risk of colon cancer, getting to a healthy body weight is one of the most important things you can do to achieve this goal. Up to one-third of all colon cancers are caused by overweight and obesity.
• Weight loss is not easy. Just staying at a healthy weight as we age is difficult. If weight loss were easy, nearly 70% of the adult population of the United States would not be classified as overweight or obese.
• If you've tried to lose weight in the past and have not succeeded, keep trying! Many health experts feel that every attempt you make to adopt healthy lifestyle habits, such as losing weight or quitting smoking, is "practice" for the next time around. With every attempt, you learn more about what works and what doesn't, making it more likely that you will get it right the next time around.
• Support from a weight loss organization such as Weight Watchers or Taking Off Pounds Sensibly (TOPS) is a good place to start when trying to lose weight. Consulting with a nutrition professional such as a registered dietitian is ideal, if you can afford to do so.
• Talk to your doctor honestly about your desire to lose weight so that you can improve your health and reduce your risk of colon cancer, other cancers, heart disease, and diabetes.
• Tell your doctor that you would like help with your weight loss goals.
• If your doctor places the focus on blaming you for being overweight, consider finding a more supportive health care provider.

The Bottom Line

Being overweight markedly increases the risk of colon cancer. Being overweight also may increase the risk of colon cancer recurrence in people who have had this disease. I wouldn't be mentioning this topic of it weren't so vitally important to anyone who cares about preventing, and more effectively managing, colon cancer.

Cancer treatment has advanced tremendously in the last few decades. With more and better ways to stop the disease, doctors can give people the chance at long-term survival after diagnosis. As well, screening options for many types of cancer continue to improve. This allows for more cancers to be detected early, when they are most treatable and most likely to be cured.

Now comes news of a new method for determining the best way to treat many cancers. Researchers from the University of Virginia Health System have developed a way to rapidly sort through genetic information about each patient's tumor. The genetic and molecular characteristics of each tumor can then be used to determine a precise drug treatment that is most likely to be successful for each person.

Currently, many patients end up going through a sort of "trial and error" process as their doctors try one treatment after another, to figure out which one works best. This new method for quickly determining the best treatment options for each person, which is called COXEN (coexpression extrapolation), is providing hope that soon, people will be spared unnecessary treatments that aren't likely to help them anyway.

This brings us one step closer to truly personalized cancer care. Every cancer doctor wants to do whatever possible to get their patients the best treatments, with the least amount of side effects and unnecessary suffering. COXEN may offer a realistic way to begin doing this.

The publishers of a publication called Colorectal Cancer Update have created a colon cancer resource, CancerQandA.com, for patients and others affected by this disease. The aim of CancerQandA is to aid people who are "considering, undergoing, or recovering from adjuvant chemotherapy for early colorectal cancer."

With it's one-on-one interviews of cancer patients, their loved ones, and oncology health professionals, the website offers a unique and valuable perspective about the experience of being treated for colorectal cancer. The developers of CancerQandA hope that the website will encourage discussion and consideration of the various aspects of colon cancer treatment among those affected by this disease and their health care providers.

**Note: Suzanne Dixon has no financial, or any other type of relationship, with CancerQandA or Colorectal Cancer Update. Suzanne has not received any compensation for this review.

Colonoscopy remains the gold standard for colon cancer detection, but researchers are always on the look out for less-invasive ways to screen for this disease. And despite the fact that colonoscopy is not as bad as you may imagine, a simple blood test for colon cancer would be a welcome development for many.

This type of test may soon be a reality. EDP Biotech Corporation, has developed a blood test, called ColoMarker, which in preliminary studies detected a very high percentage of stages I, II, and III colon cancers in people with the disease. The ColoMarker test looks for a substance in blood called CA1-18.

Promising Early Results

In tests of 2,370 blood samples, ColoMarker showed an overall accuracy rate for detecting colon cancer of 93%. In another early trial, researchers tested for the presence of ColoMarker in 243 blood samples from patients who had symptoms of colon cancer. They compared the results of these blood tests to results from the Fecal Occult Blood Test (FOBT)

ColoMarker had a false positive rate of 11% compared with a false positive rate of 30% for FOBT. This means that ColoMarker is much less likely to identify people as having colon cancer, when they do not have the disease. In this same group of 243 patients, ColoMarker detected 100% of Stage I (early stage) colon cancers, while FOBT identified only about 40% of early stage disease.

Check Back For More Info

Clearly, the preliminary research on ColoMarker is promising. The studies suggest ColoMarker may become an important, new addition to the arsenal of tools used to detect colon cancer early, when it is most curable. The ColoMarker test requires further study before it receives FDA approval for widespread use, so check back for updates.

Next Steps

In the mean time, talk to your doctor about when you need a colonoscopy screening test. The ColoMarker may not be available for some time, and regardless of when it becomes widely available, ColoMarker is unlikely to completely displace the colonoscopy as the only, or best, colon cancer screening test.

ColoMarker is not proven to identify people with polyps, growths in the colon that if left untreated, may develop into colon cancer. Ideally, a colonoscopy will find polyps and your doctor can remove them, long before they turn into colon cancer.

Fortunately, the outlook for people with advanced or metastatic colon cancer continues to improve. And the latest research on how best to manage advanced disease points to a combination of medications that may lengthen life, and do so with fewer symptoms and side effects.

The chemotherapy medication capecitabine has improved treatment for advanced disease and researchers continue to study how to best combine it with other chemotherapy options to maximize the benefit to patients. The newest study on this topic, conducted in 94 elderly patients, 70 years of age or older, compared capecitabine combined with oxaliplatin (CAPOX) and capecitabine combined irinotecan (CAPIRI).

Researchers found that the two treatment options, CAPOX and CAPIRI, were similarly effective at treating advanced colon cancer in elderly patients, but CAPOX seemed to be better tolerated, with patients experiencing fewer and less severe side effects. The group receiving CAPOX had a median survival time of 19.3 months.

This study highlights the importance of clinical trials in identifying the best treatment options for different groups of patients. If you are interested in clinical trials, ask your medical oncologist what trials might be available and what the pros and cons of these trials are for you personally.