Cancer (except prostate and testicular)

Concern about family history of cancer

Q . I recently had a pre-cancerous growth removed from my colon. The consultant indicated that within approx 6-18 months it would have become cancerous as it had been there several years.

My father (prostate cancer), his only brother (bowel cancer) my mother(brain tumour though may have been benign) and both my grandfathers (maternal-pancreatic cancer and paternal-cancer of the kidney) all died in their late fifties to early sixties. I am worried about any increased risk of cancer for myself and my two children - one boy, one girl.

Are there any screening tests I should look for? I will be checked with regard to rectal/bowel cancer every so often. Any help/advice would be most welcome. Many thanks.

First of all relax. Catching rectal cancer early, before it spreads, is almost a guarantee of complete safety. I'm sure your surgeon will have told you that you should have regular checks by sigmoidoscopy (a long flexible telescope)to ensure there are no new growths.

Risk from cancer does increase if there is any history of it in the family. It does not, however, mean that you will suffer from it and your risk remains low. There is some overlap of risk between certain cancers but generally each type carries its own level of risk. It is impracticable to check for every conceivable type of cancer and anyway there are few effective screening tests available. The big killers such as prostate cancer can be detected using a blood test (PSA) but there is still controversy over the accuracy of this test and the treatment for the cancer. Bowel cancer can be picked up with a simple test that detects blood in the stool. These will be available from pharmacists very soon. Breast cancer and cervical cancer are routinely screened for in women.

It might be worth discussing with your GP the possibility of seeing a clinical geneticist who could work out your risk and those for your children.

Could I have cancer?

Q . Off and on I experience rectal bleeding. I have seen my doctor who stuck his finger up my rectum, asking if there was any pain. I don't think so even though the act gave me pain. He said I had a small tear that opened up now and again. I don't want to disbelieve him but I've just read in my local paper of a guy who died of cancer of the colon and was diagnosed with piles by the same surgery that I attend. He had back pain and I have experienced some back pain recently, like I've pulled a muscle. Should I worry about cancer or do you think it is just a tear?

A. Yes, it is not every person's idea of a good day out to have a rectal examination. I would need to know how old you are as rectal cancer is uncommon in men under 35. If you have had this problem a long time, it is very unlikely to be rectal cancer. An anal fissure, which is what the GP is suggesting, is very common and can stay around for ages. It usually causes pain while passing a motion and then is very itchy during the day. Creams such as mild steroids can help, but dilating the rectum under an anaesthetic is the definitive way to get shot of them. If you are not happy you should most definitely ask to see a specialist.

Oesophageal cancer - how to help prevent it?

Q . Both my father and his father died at around around 60 from oesophagal cancer.

I am 50 and would like to avoid s similar fate. Any suggestions?

A. The most important risk factors in the UK for cancer of the

oesophagus are smoking, and a condition called Barratt's oesophagus which is related to reflux of stomach acid. This can be checked out by a camera at an examination called an endoscopy. You should discuss with your GP about referring you to a specialist.

Signs of throat cancer?

Q . Are there any visible signs of throat cancer? eg a few 1mm 'holes'/'indentations' on either side of the back of the throat? Caused by drinking a bit too much...?

A. This does not sound like throat cancer. Although excess alcohol can be associated with cancer of the throat or gullet, it usually atkes many years of excess consumption. Any change in voice for more than 3 weeks or any difficulty in swallowing should be followed up by your doctor.

Vitamins and cancer

Q . Should I take vitamins to reduce my cancer risk?

A. Cancer experts think diet contributes 30% to the risk of developing cancer, with genetic, environmental and aging factors the main contributors. A diet rich in fruit and vegetables is known to be protective against cancer. In the past, this has been attributed to the antioxidant vitamins — A, C and E — found naturally in these foods. Anti-oxidant nutrients 'mop up' free radicals — unstable chemicals produced as normal by-products of our body's metabolism, but which may damage healthy body cells, weakening them and making them more susceptible to cardiovascular disease and certain types of cancers.

Yet investigations so far demonstrate the positive effect of food rather than supplements in maintaining health. In fact, recent research has demonstrated that apples contain as much anti-oxidant activity as 1500mg of vitamin C, yet apples contain negligible vitamin C. The reason? Apples — like all fruit and vegetables — contain phytochemicals (plant chemicals) about which we know little, but seem to have a similar effect to vitamins.

High dose supplements of anti-oxidant vitamins (vitamin C, E and beta-carotene) have been associated with acceleration of cancer growth, and so are not recommended. The bottom line? Aim for 5 portions of fruit and vegetables a day and leave the high dose vitamins on the shelf. How do I know how much water I need?