“Knowing what your risk is allows us to help you start to reduce that risk,” said Dana Farengo Clark, M.S., a board-certified genetic counselor at the Cooper Cancer Institute. Clark works closely with medical oncologists Generosa Grana, M.D., and Robert A. Somer, M.D., to direct Cooper’s Cancer Genetics Program.

Cancer Risk Assessment & Genetic Testing

The Cancer Genetics Program at the Cooper Cancer Institute provides risk assessment and counseling, as well as recommendations for screening, risk reduction measures, and prevention options to people at high risk for – or who have been diagnosed with – breast, colorectal, endometrial and ovarian cancers.

“Our program specializes in making cancer genetics understandable for patients so that they can make informed decisions about testing and the medical management of their risks,” Clark said. “Our team works with each patient individually to develop a personalized plan of care, which includes screening and prevention, and then works with each patient’s primary care physician or oncologist to implement the plan. Our patients typically are happy to be given a chance to be proactive about their health,” Clark said.

Generosa Grana, M.D., FACP, and Dana Farengo Clark, M.S., of the Cancer Genetics Program discuss genetic testing and counseling.

The program provides information about how inherited and environmental factors might increase the risk for cancer in individuals and their families, as well as the process of genetic testing (blood tests), its risks, benefits, limitations and costs.

“Genetic testing is a personal choice and is not for everyone. Cancer risk assessment is the first step, and can be accomplished without genetic testing. These assessments can help people decide if testing might be helpful to them and/or to their family members,” Clark said.

Before their appointment, patients are asked to gather medical information about themselves and their family members. From this, a family tree is developed. Medical records also may be requested to clarify information.

Patients then meet with a board-certified genetic counselor (for an hour to an hour and a half) to review their personal medical history and their families’ history of cancer. Based on this information, a determination is made as to the likelihood of a hereditary risk for cancer, and how the risk can impact the patient and other family members. Patients also meet with an oncologist, who helps in developing a medical management plan based on the patient’s personal and/or family history of cancer.

Who can benefit from cancer genetic evaluation?

People who are concerned about their family or personal history of cancer may benefit from cancer risk assessment. Risk assessment can be especially helpful for:

• People who have been diagnosed with any cancer at an early age (younger than 50).
• People with two or more close relatives (siblings, parents, children, grandparents, aunts, uncles), on the same side of the family, with the same or related types of cancer (for instance, breast and ovarian, colon and uterine).
• People who have had more than one type of cancer.
• People with a rare cancer (for instance, male breast cancer, sarcoma, medullary thyroid cancer, or pheochromocytoma).
• Families that have a known cancer predisposition gene.

To learn more about the Cooper Cancer Institute’s Cancer Genetics Program, call Vicki Kay, at 856.968.7322.

Related Links

• Cancer Genetics Program
• Cooper Cancer Institute

Research now shows that like tobacco and alcohol use, many cancer-risk factors are within our control, namely, our weight, the foods we eat, and our level of physical activity.

Experts say that, by keeping off the extra pounds, eating the right foods and exercising daily, we can cut our chances of developing several types of cancer.

According to reports from the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR), carrying excess body fat causes more than 100,000 cancer cases annually in the United States. In its commissioned review of the scientific literature, the WCRF/AICR found convincing evidence that excess body fat is a cause of six different cancers: colorectal, post-menopausal breast, endometrial, pancreatic, kidney and esophageal.

“The way to achieve a healthy body weight is to balance energy intake (food and drink) with energy used (physical activity),” said registered dietitian Linda A. Goldsmith, M.A., R.D., an out-patient oncology dietitian at the Cooper Cancer Institute. “Research shows that exercise not only plays a role in weight control, it also fights cancer independent of weight,” Goldsmith said.

Holding Down the Pounds

The healthiest way to keep your weight down is to limit your intake of added sugars, saturated fats and trans fats, all of which provide a lot of calories and little to no essential nutrients. Fried foods, cookies, cakes, candy, ice cream and sweetened soft drinks are a few examples.

Also, you can healthfully reduce your calorie intake by decreasing the size of your food portions. Pay attention to standard serving sizes and read food labels to become more aware of the number of actual servings you eat. For instance, the recommended serving for ready-to-eat cereal is one ounce.

Eating the Right Foods

Your diet should emphasize foods from plant sources (vegetables, fruits, whole grains and beans) and limit processed meats (bacon, ham, sausage, cold cuts, hot dogs), and red meats (beef, pork, lamb). The WCRF/AICR report found that eating more than 18 ounces of red meat per week increases the risk of colorectal cancer.* The compounds in plant-based foods may help stop possible carcinogens from becoming cancerous, but there is no clear research linking these foods to stopping the possible cancer-effects from red meat.

The AICR recommends that the food on your plate be composed of more than two-thirds plant foods and less than one-third animal foods; this will help ensure your meat intake is low and allow you to enjoy satisfying and potentially protective meals.

*One MacDonald’s Big Mac contains 7.5 ounces of red meat. If you eat three Big Macs a week, you’re consuming 4.5 ounces more than the recommended weekly limit.

Exercising Regularly

When it comes to increasing your level of physical activity, the recommendation is to engage in regular, intentional exercise of moderate to vigorous intensity at least 30 minutes a day, five or more days per week. (Forty-five to 60 minutes per day is preferred. Be sure to check with your doctor before starting any exercise program.)

Moderate intensity activities are those that require effort equal to a brisk walk. In addition to walking, other examples of moderate exercise include dancing, leisurely bicycling, yoga and doubles tennis.

Vigorous intensity activities generally are those that use large muscle groups and cause a faster heart rate, deeper and faster breathing, and sweating. Jogging, running, aerobic dancing, circuit weight training and fast bicycling are some examples of vigorous exercise.

Getting Started

To begin eating mindfully and living actively to help prevent cancer, Goldsmith offers these helpful hints:

• Commit to adding 30 minutes of intentional physical activity to your day. You can break up the amount of time you engage in the activity, such as 15 minutes of brisk walking in the morning and 15 minutes in the evening. Remember, your goal is to be more active than you are right now.
• Take a good look at what and how much you are routinely eating. Assess how lifestyle, social or emotional factors might be contributing to over-eating or poor nutritional choices. Let this awareness guide you to better food choices and portion control.
• Remember, putting more plant-based foods on your plate takes the worry out of watching your weight. Because plant-based foods contain lots of water, fiber and very little fat, you’ll feel satisfied on fewer calories.

Join Us for a Free Seminar: Nutrition, Physical Activity and Cancer – The Power of Prevention

For more detailed information on this topic, register for “Nutrition, Physical Activity and Cancer – The Power of Prevention,” a free seminar presented by the Cooper Cancer Institute’s Linda A. Goldsmith, M.A., R.D.

This seminar will be offered at 1 p.m. on three Thursdays in June:

• June 3, 2010, at the Cooper Health Education Center in Voorhees
• June 10, 2010, at the Willingboro Public Library
• June 24, 2010, at Three Cooper Plaza in Camden

Call 1.800.826.6737 for more information and to register.

While the cause of many types of gastrointestinal cancers is unknown, some types of cancers have “lifestyle” risk factors. These risk factors include excessive alcohol consumption, smoking, and diets high in animal fat and/or salted, cured or processed meats, such as bacon, ham and salami.

Genetics and family history notwithstanding, other risk factors for gastrointestinal cancers include obesity, chronic pancreatitis and increasing age.

In general, cancer begins when an error (mutation) occurs in a cell’s DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when normal cells would die. The accumulating cancerous cells form a tumor that can invade nearby structures. The cancer cells can break off from the tumor and spread throughout the body (metastisis).

How gastrointestinal cancer is diagnosed depends on what type of cancer is suspected. Lab tests, imaging tests, biopsies, colonoscopy and endoscopy all are methods of diagnosing gastrointestinal cancers.
Once cancer is confirmed, the stage (how far the cancer has advanced) is then determined and a treatment plan is designed.

Treatment for gastrointestinal cancer depends on the type of cancer, the stage, and other general health factors. The most commonly used treatment method is surgery, chemotherapy and/or radiation therapy.

While symptoms of gastrointestinal cancer also vary with the type of cancer, common symptoms to watch for include:

• Abdominal pain, tenderness, or discomfort.
• Change in bowel habits, such as frequency or consistency or shape.
• Rectal bleeding or blood in stool.
• Bloating.
• Loss of appetite.
• Nausea/vomiting.
• Unintentional weight loss.
• Fatigue.

Cooper University Hospital surgical oncologist Francis R. Spitz, M.D., Deputy Director of the Cooper Cancer Institute, notes that lifestyle modifications could help reduce your risk of getting gastrointestinal cancer. He offers this advice:

Drink alcohol in moderation.

A high alcohol intake is associated with an increased risk of cancers of the esophagus, pancreas, liver and bowel.

Avoid smoking.

Smoking doubles the risk for cancer of the pancreas and is associated with increased risk for cancer of the esophagus when combined with high alcohol intake.

Eat plenty of green vegetables and fruits.

A high intake of green vegetables is associated with a reduced risk for bowel cancer, and a high vitamin C intake (found in fruits and green vegetables) is associated with reduced risk for stomach cancer.

Avoid preserved or burnt meats, and limit red meats.

Salted and smoked meats are associated with a high risk of stomach cancer, probably due to their high content of nitrates, which, in the stomach, form highly carcinogenic nitroso-amines. Burnt meats have been found to be linked with bowel cancer because of their high content of carcinogenic cyclic amines. A high intake of red meats is particularly associated with increased risk of bowel cancer.

Maintain a normal weight.

Obesity carries an increased risk of bowel cancer. It also increases the risk of diabetes, which is associated with a modestly increased risk of pancreatic cancer.

Exercise regularly.

Regular physical activity is linked with a reduced risk for bowel cancer, regardless of body weight.

Take preventative steps.

Screening tests, such as endoscopy and colonoscopy, can detect gastrointestinal cancers early, even before symptoms occur. They also can detect some precancerous conditions, which can be easily treated at the time of the screening.