Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
NSAIDs (non-steroidal anti-inflammatory drugs) are widely used in the treatment of
arthritis and other inflammatory conditions of the body. Some examples of NSAIDs
include aspirin, sulindac, ibuprofen, naproxen, and piroxicam. How NSAIDs prevent colon
cancer and polyps is under investigation. (NSAIDs are potent
inhibitors of prostaglandins in the body, and prostaglandins may be important in
the formation of polyps.)
In a 6-year study of approximately 700,000 men and women reported in The New England
Journal of Medicine in 1991 (volume 325, pages 1593-6), the death rates from
colo-rectal cancer were compared between groups with different levels of aspirin
consumption. It was found that adults who consumed aspirin regularly (more than
16 times per month) had a 40% lower death-rate from colo-rectal cancer
than adults who did not consume aspirin regularly.
The most impressive chemoprevention data relate to
sulindac. Ten patients with familial polyposis coli, a genetic disease that
causes individuals to form many colo-rectal cancers, were studied. These
patients had already had their colons removed to prevent colon cancer, but the
distal part of the colon, the rectum, was not removed, and there still were
pre-cancerous polyps in the rectum. Sulindac was found to cause regression (and
sometimes disappearance) of the rectal polyps after 4 months of treatment. The
study was reported in the journal, Gastroenterology, in 1991 (volume 101, pages
635-639). Unfortunately, polyps returned within a few months if sulindac was
stopped or the patient was switched to a placebo.
Why aren't
doctors recommending NSAIDs for colorectal cancer prevention? Because NSAIDs can cause stomach ulcers, intestinal
bleeding and, sometimes, adverse effects on the liver and kidneys. Even though safer NSAIDs
have been developed, doctors generally are reluctant to recommend aspirin or
other NSAIDs for preventing colo-rectal cancer until data on their effectiveness
and long-term safety are available.
When prescribing an agent for
prolonged periods of time to prevent a disease that may or may not occur, the
last thing a doctor would want is for that agent to cause
adverse site effects in a healthy person.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
A colon polyp is a benign tumor of the large intestine. Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can easily be removed during colonoscopy and are not life threatening. If benign polyps are not removed from the large intestine, they can become malignant over time.
Anal cancer, cancer located at the end of the large intestine, has symptoms that include anal or rectal bleeding, anal pain or pressure, anal discharge or itching, a change in bowel movements, and/or a lump in the anal region. Treatment for anal cancer may involve radiation, chemotherapy, or surgery and depends upon the stage of the cancer, its location, whether cancer is eradicated after the first treatment, and whether the patient has HIV.
Gardners' syndrome, or familial adenomatous polyposis (FAP), is an inherited condition in which cancer of the colon and rectum develop. Colon polyps and growths may develop as early as the teens. If these polyps are not removed, they will become cancerous. There are different inheritance patterns for familial adenomatous polyposis.
The importance of a healthy lifestyle in disease prevention is widely understood and most people know that lifestyle changes and choices can be critical to good health. Yet, few practice healthy behaviors that constitute healthy living.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
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