Bombay Hospital Journal Vol 50 No 3 2008339n the present times 80 - PDF document

Bombay Hospital Journal, Vol. 50, No. 3, 2008339n the present times 80% of the cancer arerelated to the life style and by change inlife style 80% cancer can be prevented. Thehurry, worry and curry of modern times arethe causes of many G.I. and colorectaldiseases. Colorectal cancer is the secondleading cause of cancer deaths in the UnitedStates. The number of new cases of colorectalcancer in the United States have beendecreasing slightly, and the number of deathsdue to colorectal cancer has been decreasing.The risk of colorectal cancer tends to increaseafter the age of 40.The exact cause of colorectal cancer is notknown. However, studies show that certainfactors are linked to an increased chance ofdeveloping the disease.There are a number of personal factorsinfluencing who is more likely than others todevelop colon or rectal cancer.1.Age - Colorectal cancer is more likely tooccur as people get older. The averageage for developing colorectal cancer isaround 50, but risk can begin as early as40.A history of cancer - A person who hasalready had colorectal cancer is at anincreased risk of developing it a secondtime. Women with a history of ovarian,breast, or uterine cancer have asomewhat increased chance of developingcolorectal cancer.3.A history of polyps - Polyps are relativelycommon in people over age 50. Most arebenign (noncancerous). However, somekinds of polyps are more likely to resultin the development of cancer than others.Adenomatous polyps are considered mostlikely to develop into cancer.4.A history of inflammatory bowel disease- Ulcerative colitis is a condition thatcauses inflammation and ulcers in thelining of the colon. Crohn’s colitis (alsocalled Crohn’s disease) causes chronicinflammation of the gastrointestinaltract, most often the small intestine.People who have ulcerative colitis orCrohn’s colitis may be more likely todevelop colorectal cancer than people whodo not have these conditions.5.Race - African Americans are at greaterrisk of developing colon cancer and ofdying from the disease than any otherracial or ethnic group in the UnitedStates.Risk factors linked to family1.Family history – There is an increase inrisk if a first-degree relative (father,mother, brother, sister) has a history ofeither colon cancer or polyps before age60; or two or more relatives at any age.2.Familial adenomatous polyposis (FAP) -This is a rare, inherited condition inwhich hundreds of polyps develop in thecolon and rectum. This condition canappear as early as the teen years and isvery likely to lead to colorectal cancer.*Consultant Surgeon and Associate Professor,Bombay Hospital and Medical Research Centre,Directo, Abhishek Day Care Institute a

nd MedicalResearch Centre, Mumbai. **Hon. ConsultantSurgeon; Bombay Hospital, Mumbai.Colorectal Cancer – Risk Factors and PreventionMM Begani*, Niranjan Agarwal** 340Bombay Hospital Journal, Vol. 50, No. 3, 20083.Gardner’s syndrome - Like FAP, thishereditary condition results in polyps andcolon cancer that develops at a youngage. It can also cause noncanceroustumours of the skin, soft connectivetissue, and bones.4.Hereditary nonpolyposis colorectal cancer(HNPCC) - People with this hereditarycondition tend to develop cancer at ayoung age without first having manypolyps.Ashkenazi Jews - These are Jews from,or whose ancestors are from, EasternEurope. They have an inherited changein their DNA that causes a slightlyincreased risk of developing colon cancerLifestyle risk factors1.Smoking - Recent studies show thatsmokers are 30 - 40 per cent more likelythan nonsmokers to die of colorectalcancer.Diet - Some evidence suggests that thedevelopment of colorectal cancer may beassociated with certain foodcharacteristics.  Among populations thatconsume a diet high in fat, protein,calories, alcohol, and meat (both red andwhite) and low in foods with fibre, calciumand folate (folic acid), such as wholegrains, fruits, and vegetables are athigher risk for colorectal cancer.3.Exercise - Some evidence suggests thatbeing overweight and living an inactivelifestyle may be associated with anincreased risk of colorectal cancer. Incontrast, people who exercise regularlymay be at lower risk.4.Alcohol - Heavy use of alcohol has beenlinked to colorectal cancer.Signs and symptoms of colorectalcancerUnexplained weight losslAn ongoing bloated feeling, cramping, orpain in abdomenlConstant tiredness and weaknesslA change in bowel habits that lasts formore than a few days, such as diarrhoea,constipation, or narrow stools.lA feeling that one needs to have a bowelmovement that doesn’t go away, evenafter going to the bathroom.lBlood in stool or bleeding from rectumlJaundice (yellow-green colour of the skinand the white part of the eye)lOther conditions, like infections,haemorrhoids, and inflammatory boweldisease can cause these symptoms. It isalso possible to have no signs or symptomswith colon cancer. Most people with coloncancer have normal looking stools.ScreeningThe American Cancer Society recommendscolorectal cancer screenings begin at age 50.The main tests include the faecal occult bloodtest to detect any blood in stool; a flexiblesigmoidoscopy, and a colonoscopy, and ifrequired biopsy and/or remove any polyps; ablood test called a CEA assay(carcinoembryonic antigen, a protein that issometimes present in higher levels inpatients with colorectal cancer).Screening innovations

New tests for colorectal cancer screeningare under study. For example, virtualcolonoscopy (also called computedtomographic colonography) uses special X-rayequipment to take pictures of the colon. Acomputer then assembles these pictures intodetailed images that show polyps and otherabnormalities. Virtual colonoscopy may causeless discomfort and take less time thanconventional colonoscopy; it is less invasiveand does not require sedating medication. Bombay Hospital Journal, Vol. 50, No. 3, 2008341However, it is not possible to remove polypsor do a biopsy during a virtual colonoscopy.PreventionRegular screening is recommended at age40 or earlier for people who have a high riskof colorectal cancer and beginning at age 50for everyone else.The following guidelines are for people whodo not have an increased risk for colorectalcancer.Colorectal screening guidelinesTestFaecal occult blood testEvery 1 to 2 years(FOBT)*Every 5 yearsorBarium enemaEvery 5 yearsorEvery 10 years*Some groups recommend combining a yearlyFOBT with a sigmoidoscopy every 5 years.Colorectal cancer preventionColorectal cancer can sometimes beassociated with known risk factors for thedisease. Many risk factors are modifiablethough not all can be avoided.Diet and LifestyleColorectal cancer is more likely to developthan among populations that consume a low-fat, high-fibre diet.Nonsteroidal Anti-Inflammatory DrugsSome studies have shown that the use ofnonsteroidal anti-inflammatory drugs(NSAIDs) may be associated with a reducedrisk of colorectal cancer.Polyp RemovalThe removal of polyps in the colon may beassociated with a reduced risk of colorectalcancer.Female Hormone UsePostmenopausal female hormone use isassociated with a deceased risk of coloncancer but not rectal cancer.ConclusionFew simple life style measures andappropriate health care checks for populationcan prevent morbidity and mortality fromcolorectal cancers.FENOFIBRATE AND DIABETIC RETINOPATHYKeech and colleagues state that “statins have proven unsuccessful in preventing diabetic retinopathy”,which seems premature. The two randomized trials that examined this issue found statins beneficialand attributed this to improved lipid profiles. ACCORD-EYE compares simvastatin and fenofibrate,and will help clarify the roles of lipid lowering (and fenofibrate) in retinopathy.In particular, fenofibrate did not reduce visual loss – a key clinical outcome.Second, the mechanisms by which fenofibrate modifies the risk of diabetic retinopathy are unclear.Thus, fenofibrate might act via antioxidative and anti-inflammatory mechanisms to reduce the riskof both microvascular and macrovascular complications of diabetes.The Lancet, 2008; 371 : 72