Colon Cancer Update with The Cleveland Clinic (cont.)

MEMBER QUESTION:
Is there a correlation between having gastritis and colon cancer? What about Crohn's or IBS or IBD? Are any of these linked to colon cancer?

CHURCH:
There is no association between gastritis and irritable bowel syndrome and colon cancer. Patients with longstanding ulcerative colitis and Crohn's colitis, are at increased risk of developing colon or rectal cancer. Once the colitis has been present for 7 to 8 years, we recommend regular colonoscopies with biopsies to detect precancerous changes in the lining of the colon.

MEMBER QUESTION:
Is it very rare to have colon cancer under the age of 30?

CHURCH:
Yes. Less than 2% of colon cancers arise under the age of 40. When a patient has colon or rectal cancer under the age of 50, there is a strong suspicion that the patient may have some sort of inherited predisposition, such as familial adenomatous polyposis or HNPCC (hereditary nonpolyposis colorectal cancer).

MODERATOR:
Does age play any role in colon cancer risk?

CHURCH:
Yes. I quoted a 6% lifetime risk for the average American. This is the average of an ever-increasing risk from very close to zero at birth to the highest point in the 80s and 90s. The longer you live the higher the risk of colon and rectal cancer. The risk is very low until age 40 and then increases gradually until age 50 and then becomes much higher with each decade.

MEMBER QUESTION:
If you are diagnosed young is there any increase of risk of it returning later in life?

CHURCH:
Yes, for two reasons.

  • If there is an inherited form of colorectal cancer, there is a much higher chance of developing another cancer later in life. The surgery designed for these syndromes usually involve removal of the entire colon, just for this reason.
  • Outside of hereditary syndromes, a young person with a colon or rectal cancer obviously has something about them that has made the cancer arise early. In other words, they're prone to get them. If their colon is able to produce one cancer, it is probable that it will produce another.
"Only about 4% of all colorectal cancers occur because of an inherited genetic mutation."

MEMBER QUESTION:
Are all polyps removed in colonoscopy submitted to lab analysis for cancer detection?

BURKE:
We recommend that all polyps on colonoscopy be removed and sent to the lab for analysis because you cannot tell by looking what type of polyp it is.

Some colon polyps do not increase someone's risk of colorectal cancer and do not warrant special follow-up. However, all precancerous colon polyps do increase the risk of getting new precancerous polyps or cancer and require special follow-up.

MEMBER QUESTION:
Are there reliable genetic tests available to determine colon cancer risk?

BURKE:
Only about 4% of all colorectal cancers occur because of an inherited genetic mutation. For patients in families with these inherited genetic mutations, blood tests are very helpful in showing which members of the family are at risk and which are not. For 96% of all colon and rectal cancers genetic blood testing to determine risk is of no help. Sometimes we can look at the genetic makeup of the tumor itself, but this is still largely a research area.

MEMBER QUESTION:
What kind of special follow-up do precancerous colon polyps require?

BURKE:
The number and size of precancerous polyps found on a colonoscopy, in association with the family history of colorectal polyps and cancer, as well as the patient's previous history of colorectal polyps and cancer, dictate the interval for the next colonoscopy.

Generally, if one to two small (less than one centimeter) adenomas are removed, and the individual has no other risk factors, the next colonoscopy should be in five years. If more than two or larger (greater and equal to 10 millimeters) polyps are removed, the follow-up is generally in three years. However, your doctor may recommend a longer or shorter interval based on the quality of the colonic preparation and other risk factors.

MEMBER QUESTION:
If one or more years generally separate colonoscopies, is it safe to assume that polyps grow very slowly?

BURKE:
It's presumed the development of polyps takes about five years and roughly another five years for them to turn into cancer.

MEMBER QUESTION:
Are you able to determine how long a cancerous tumor has been present? Do colon cancer tumors grow at a fixed rate?

CHURCH:
Colon cancer tumor growth rate is very variable. You cannot tell how long a tumor has been present by its size or degree of invasion. The reason is that the growth and spread of a colon cancer depends partly on the aggressiveness of the cancer itself and partly on the ability of the patient's body defenses to contain them. The stage at which a colon cancer presents is, therefore, the result of these two factors. Each patient is different.

MEMBER QUESTION:
Does drinking alcohol increase your risk of getting colon cancer?

BURKE:
There is data suggesting excessive alcohol may lead to colon polyps and cancer. However, recent data shows that drinking alcohol in modest amounts may prevent colon polyps and cancer.

The best approach to colon cancer prevention is a healthy and moderate diet, including fruits and vegetables, low fats and red meats, modest alcohol intake, a reasonable body weight and enhanced activity level.

MEMBER QUESTION:
With gastric bypass surgery becoming more common these days, are you seeing an increase in colon issues as a result?


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