IBD and the risk of Colorectal Cancer.

One of the more troubling consequences of having inflammatory bowel disease (IBD), ie Crohn's disease or ulcerative colitis, is an increased risk of developing colorectal cancer.

3.7% of patients with ulcerative colitis have colorectal cancer which is about five-fold higher than the risk for the general population. The possibility increases the longer a person lives with the disease. Until recently, it was thought that the increased cancer risk was linked to ulcerative colitis but not to Crohn's disease. However, more recent studies have shown that people with Crohn's disease that affects the colon have similar risk for developing colorectal cancer as those with ulcerative colitis. The increased risk has prompted researchers to investigate whether there may be ways to detect which patients are most likely to develop this condition.

Some risk factors are known. The three main factors are:

1. duration of the disease,
2. family history of colorectal cancer,
3. the extent of the colon that is affected by colitis.

Colorectal cancer rarely occurs until IBD has been present for at least eight years. Ulcerative colitis patients who have a first-degree relative (parent, sibling, or child) with colorectal cancer have 2.5 times greater risk of colorectal cancer; with Crohn's disease, the increased risk is 3.7 times. People in whom the entire colon is involved are at the greatest risk, those with only part of the colon having colitis are at intermediate risk, and those with inflammation only of the rectum are at lower risk. This applies to patients with both active and inactive disease.

Currently, the main method for early detection of colorectal cancer or pre-cancerous lesions in people with IBD is colonoscopy. Colonoscopy is not 100% accurate in finding cancer in people with IBD. This is partly because the signs of colorectal cancer may be different in people with IBD. In most cases, this form of cancer starts as a polyp (a small protrusion, or lump, growing from the wall of the intestine). Polyps can start out benign and become malignant, and they are usually easily detected during a colonoscopy. People with IBD, however, do not always form polyps as the pre-cancerous lesion. Instead, abnormal and potentially pre-cancerous tissue (changes in the cells, called dysplasia) may lay flat against the wall of the intestine. Also, in IBD patients, abnormal, pre-cancerous cells can be present in an area of the intestinal wall that visually appears normal. Because detection of colorectal cancer is more difficult in people with IBD, standard colonoscopy is usually accompanied by a series of biopsies. Small tissue samples from 40 to 50 areas in the wall of the colon will be taken for microscopic examination.

Chromo-endoscopy is a newer procedure that may be a more efficient method than biopsy of the colon. Specialized dyes are sprayed on the surface of the inside lining of the colon. The pattern of staining that these dyes produce allows the physician to differentiate normal from dysplastic tissue. This method appears to improve early diagnosis of pre-cancerous and cancerous tumors.

In colorectal cancer, benign pre-cancerous lesions turn malignant due to certain changes in DNA. For example, in about 85 % of all cases, changes take place that cause the loss of function of two tumor suppressor genes: APC and p53. The remaining 15 % of colorectal cancers result from the body's inability to repair its DNA. The process of DNA repair allows the body to fix damage to genes caused by environmental factors. Abnormalities in these processes can lead to cancer.

These cancer-initiating processes are similar for both IBD and non-IBD patients. However, the timing tends to be different. In ulcerative colitis patients, loss of function of the p53 gene (which causes malignancy) tends to happen earlier than loss of function of the APC gene (responsible for the formation of the tumor). It's not yet known whether this is also true in Crohn's patients who develop colorectal cancer.

In one study of 95 ulcerative colitis patients, the 37 patients with the abnormal p53 gene were more likely than those without it to develop dysplasia or cancer. Therefore, if confirmed in more studies, the p53 mutation may prove to be a useful marker of cancer risk. Other genes are also being studied as possible markers of cancer risk, including the HPP1 gene and the CDH1 promoter gene.

Another potential new approach may allow for a much simpler biopsy procedure. The genetic abnormalities associated with the development of dysplasia and cancer seem to occur within all the tissue of the lining of the colon (not just the areas in which dysplasia is found). In one study, abnormalities were present throughout the colon, but not in other areas of the gastrointestinal tract. If this finding is confirmed, it could mean that a simple biopsy can be done to determine which patients with ulcerative colitis are likely to have dysplasia..

During Digestive Disease Week, a professional gastro-enterology conference held in May, many new studies on colorectal cancer were presented. These studies focused primarily on prevention and treatment. Researchers now believe that chronic inflammation is the cause of one or more genetic mutations that may result in the development of cancer or dysplasia in people with ulcerative colitis.

One study showed that ulcerative colitis patients have extensive genomic instability-an early marker for cancer. Genomic instability is an important concept that refers to how quickly mutations occur to the genetic material in cells. The cells in our body engage in a natural process of death and renewal. It is possible for the cells to continually carry a particular mutation through several cycles, or generations, of this death and renewal, as well as develop new mutations that also carry through. The rate of these mutations is known as, genomic instability.

Marked genomic instability was detected in 33% of patients with ulcerative colitis with dysplasia, in 10% of ulcerative colitis patients without dysplasia, and in no patients in the control group, or group of people without colitis. In addition, common mutations occurred in several genes associated with sporadic colorectal cancer (cancer that is not found continuously throughout the colon, like it is in those with IBD). Researchers concluded that genomic instability is widespread in ulcerative colitis patients with dysplasia or cancer. Early discovery of the particular mutation as a possible early indicator of cancer can affect the timing and type of treatment offered.

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How to stick to an excercise program

Did you know that less than one-third of people who start an exercise program stick with it through the first year? Here are some suggestions to assist you in staying on track:

• VARY YOUR WORKOUT
  People tend to follow the same exercise routine and may overwork certain muscle groups. Try and work different muscles on different days. Example: Run on a treadmill on Mondays, exercise your chest and back muscles on Wednesdays, work legs and arms on Fridays. Apply this to your out-of-gym work-outs. Alternate bike rides with fast walks or go to the pool now and then.
• MAKE HOBBIES ATHLETIC
  Consider having at least one athletic hobby, such as golf, tennis, walking, skiing, bicycling, dancing, bowling or swimming. Even gardening counts if you do it vigorously enough. You're more likely to stick with activities that are fun, regardless of the health benefits.
• GET A WORKOUT PARTNER
  Having someone to talk to makes the time go faster and the exercise more fun. Some health clubs have programs that pair members for regular workouts. Ask around at work or in your neighborhood to find someone who enjoys the same activities that you do.
• CHOOSE A PROGRAM-PACKED CLUB
  If you plan to join a health club, select one that offers classes of interest to you. Many health clubs offer aerobics, Pilates, yoga, kickboxing, spinning and tai chi classes-and that's just the beginning.
  Classes also are a great way to try new things, meet new people and stay motivated.
• COMPETE
  You don't have to be an elite athlete to get a thrill out of competition. Sometimes, knowing that you'll be competing motivates you to work out. Most communities have a variety of athletic events for people of all ages and fitness levels-5K walks and runs, kayak races, volleyball tournaments, etc. Newspapers, health clubs and YMCAs usually have listings of upcoming events.
• GET A TRAINER
  The average health club has at least 60 aerobic and weight-lifting machines. New members often don't know how to use the machines and may stop going because they don't feel confident. Ask a trainer at the club to show you how to use the equipment. You may also want to consider hiring a personal trainer. If you would like a trainer to help you at home, ask for referrals at a local health club.

Did you know?

3 million Americans may have celiac disease & not know it. This digestive disorder is triggered by the gluten in wheat, barley, rye and certain other grains Celiac disease may be accompanied by diarrhea, constipation or vague abdominal pain. Celiac disease is treated with a gluten-free diet.

People who have had heart attacks or strokes are more likely to have untreated periodontal problems. Bacteria unique to periodontal infections have been found in the coronary arteries of heart attack victims so if you are diagnosed with heart problems, see your periodontist. The theory is that when periodontal infections are untreated, bacteria migrate and produce inflammation in heart arteries, making them prone to blockages that can trigger heart attacks or strokes.

You can help to prevent diabetes with vitamin D
In type 1 diabetes, white blood cells attack and destroy insulin-producing pancreatic cells. Vitamin D receptors, which attach to white blood cells, reduce the chance that this will happen. Also, vitamin D appears to improve the ability of cells to accept insulin for better glucose uptake, helping to prevent type 2 diabetes.
Suggestions:
Get 10 to 15 minutes of sunlight daily without sunscreen.
Get 400 to 600 international units (IU) of vitamin D daily (through diet and supplements).
Foods high in vitamin D are salmon, eggs, sardines, herring and milk.

Obesity is the second-leading cause of cancer.
It is responsible for an estimated 25% of cancers in developed countries. Leading cause of cancer: Tobacco use.

Easy way to check lung function: Hold a lit candle six inches in front of your face. Open your mouth wide, and take a deep breath. Then try to blow out the candle- without pursing your lips. If successful, your lungs are working within normal limits.

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In Good Health.
Pamela Nathan

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