Dr. Michael Santoro is a Board-certified Internist and Gastroenterologist, who is in clincal practice in Southern California. He did his medical school training at the SUNY-Health and Science Center in Brooklyn. He completed a three-year internal medicine residency at Staton Island University Hospital. This was followed by a three-year fellowship in Gastroenterology and Hepatology at Loma Linda University.
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.
Defective genes cause colon polyps and colon cancers. Individuals who have
inherited colon cancer causing gene defects are at high risk of developing colon
polyps and caners early in life. The human body is composed of trillions of
cells. Inside each cell are two sets of 23 chromosomes; one set is inherited
from each parent. Each chromosome contains long strands of DNA that are
comprised of thousands of genes strung together. The genes carry the genetic
information that is passed down from both parents. Different segments of the DNA
strands contain genes responsible for different structures and functions in the
body. For example, certain segments of DNA carry genes that determine one's eye
color, hair color, height, and other physical characteristics. Other DNA
segments of DNA carry genes that regulate the duplication and the rate of growth
of cells. Still other genes prevent cells from organs within the body from
invading neighboring organs or spreading to distant organs.
When chromosomes are damaged, genes become defective. When genes that normally
prevent cells from multiplying and growing are defective, the cells containing
the defective genes can multiply and grow without restraint. When cells grow
without restraint inside the colon, a colon polyp develops. When additional
genetic defects occur in that polyp, the polyp can turn cancerous and invade
adjacent tissue and /or spread to distant organs.
Genetic damage (damage to individual genes) can be inherited from either
parent or can be acquired after birth when normal genes in normal cells become
damaged by environmental factors such as radiation, chemicals, oxidants,
viruses, etc. Inherited genetic defects are present in every cell in the body,
whereas acquired defects are present only in the cells that are damaged and the
cells they produce, for example, in the cells of the polyp or cancer.
Generally, acquired genetic defects tend to cause only one or a few colon
polyps that can be removed by colonoscopy. (For further information, please see
the articles on colonoscopy.) Removing these polyps effectively prevents the
progression from colon polyp to colon cancer. On the other hand, inherited
genetic defects that are present in every cell have a tendency to cause numerous
(sometimes thousands) of colon polyps. These polyps may be too large or too
numerous to be removed by colonoscopy. In addition, the progression from polyp
to invasive cancer may be so rapid that even frequent colonoscopy is not
adequate to remove polyps and prevent colon cancer. Finally, some cancers may
develop directly from cells of the colon lining without the development of
polyps that can be recognized and removed. For all of these reasons, among
patients with inherited genetic defects that cause colon cancer, surgical
removal of the colon is necessary to prevent colon cancer.
Hereditary colon cancer syndromes
are caused by specific inherited mutations that are sufficient in themselves to
cause colon polyps, colon cancers, and non-colonic cancers. Hereditary colon
cancer syndrome can affect multiple members of a family. Approximately 5% of all
colon cancers in the US are due to hereditary colon cancer syndromes. Patients
who have inherited one of these syndromes have an extremely high risk for
developing colon cancer, approaching 90%-100%. Fortunately, blood tests are now available to test for these
hereditary colon cancer syndromes, once a syndrome has been suspected within a
family.
Familial adenomatous polyposis (FAP) syndrome is an example of a hereditary
colon cancer syndrome, characterized by thousands of adenomatous polyps forming
in the colon, with colorectal cancer an inevitable consequence. This usually
occurs 10 to 15 years after the onset of polyps, which most often begins at
puberty. The average age of diagnosis of familial polyposis is 25 years of age,
with cancers developing at age 20 to 30. In this syndrome, polyps also can be
present in the stomach, duodenum and the terminal ileum. The basis of this
disease seems to be a genetic abnormality on chromosome number five.
A variant of the familial adenomatous polyposis syndrome is Gardner's
syndrome. These patients also develop thousands of adenomatous colonic polyps.
What distinguishes these two syndromes from one another is that Gardner's
syndrome is associated with extra- colonic manifestations, including bony tumors
of the mandible, skull, and long bones, as well as fatty, fibrous, and mixed
tumors, which may occur anywhere in the body.
Another familial polyposis syndrome is Turcot's syndrome, a variant of familial
adenomatous polyposis in which there are fewer colon adenomas.
The Lynch syndrome also is known as hereditary non-polyposis colorectal cancer
(HNPCC). In the Lynch syndrome individuals do not form multiple colon polyps as
other individuals with the other hereditary colon polyp syndromes. Nevertheless,
they are at high risk for developing colon cancer. The syndrome is inherited,
and because it is inherited in an autosomal dominant manner, cancer is very
common within families with this syndrome. Lynch syndrome has been broken down
into Lynch syndrome I, and Lynch syndrome II, with Lynch syndrome II involving
the same risk of colon cancer as Lynch I, but in addition, cancers outside the
colon as well, particularly in the uterus, ovaries, and breast. In both Lynch
syndromes, colon cancer usually develops at a young age (40-50 years) and more
often occurs on the right side of the colon where it cannot be found by
sigmoidoscopic examination. Surveillance for all family members should include
twice-yearly fecal occult blood testing and yearly colonoscopy, beginning at an
age 10 years younger than the age at which the youngest family member has
developed cancer or at age 20 if this information is not available.
Colon Polyps - Describe Your ExperienceQuestion: Did you have any of the risk factors for colon polyps at the time of your diagnosis? If so, what were they?
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
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.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
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.
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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