 |
|
|
|
|
|
|
Mayo Clinic Cancer Center has begun three clinical studies looking at the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent cancer -- colon, esophageal or lung. These studies are part of the ongoing Cancer Center chemoprevention program, using medications to prevent cancer, especially for people with increased cancer risk.
"While searching for the cure is important, even more so is finding effective ways to prevent cancer," says Paul Limburg, M.D., M.P.H., Mayo Clinic gastroenterologist and lead researcher on the colon cancer prevention study. "We have observed that some of the same biological processes that cause inflammation may also be involved in developing cancer, so the next step was to see if drugs that prevent inflammation also serve to lessen the risk of cancer."
The colon cancer study is looking at the NSAID sulindac (Clinoril), and its ability to inhibit inflammation and subsequent transformation of damaged cells into cancer cells. Sulindac's preventive effect will be measured against that of two other potential prevention agents: atorvastatin (Lipitor), a cholesterol-lowering drug with some reported cancer prevention aspects (Cancer Research, April and July 2006); and Raftilose-Synergy1, a food supplement derived from chicory, also with some supporting research conducted overseas (The British Journal of Nutrition, April 2005).
Dr. Limburg's team will treat patients at increased risk for developing colon cancer, specifically individuals age 40 or older who have advanced colorectal adenoma (precancerous tissues) or a history of colon cancer with treatment completed more than one year prior to entering the study. Tissues and blood samples will be tested pre-treatment and post-treatment to determine the preventive effects of the different medications.
Other gastroenterologists at Mayo are looking at NSAID use for patients with Barrett's esophagus. "There is evidence to support the idea that taking an NSAID will slow or reverse precancerous conditions such as Barrett's esophagus," Dr. Limburg says. "Prognosis for esophageal cancer patients is poor. We are continually looking for ways to prevent this and other cancers from ever starting, and NSAIDs provide a promising avenue for our research."
Individuals eligible for the esophageal cancer prevention study will receive esomeprazole (Nexium), an acid reflux medication, and aspirin, an NSAID. Mayo's doctors hope that using the acid reflux medication will diminish inflammation caused by acid reflux and that the aspirin will continue the healing and prevention process. Tissue in the esophagus will be tested before and after treatment to determine the benefits, if any.
The lung cancer prevention study is directed at current or former heavy smokers, age 45 or older, who are in generally good health. Those in cancer remission may be eligible to participate, if their last treatment was at least one year ago. This study is also using sulindac, which will be administered to patients with abnormal, precancerous tissues in their lungs. Pre-drug and post-drug treatment tests will determine effectiveness by reviewing the degree of abnormality of the patients' lung tissues after treatment.
"We have high hopes for all of these studies," says Dr. Limburg. "Previous work has shown that these are promising prevention avenues to pursue, and, if positive, the findings could result in substantial benefit to patients and society from a decreased cancer burden."
Mayo Clinic Cancer Center is offering the clinical studies under the auspices of membership in the Cancer Prevention Network (CPN). Dr. Limburg is the primary investigator for CPN, which is a consortium of 35 community clinics, hospitals and medical centers throughout the United States and Canada. Mayo is the lead organization and research data center for the Cancer Prevention Network, which focuses much of its research efforts on the most wide-spread and deadliest cancers.
###
More information on cancer-related clinical studies ongoing at Mayo Clinic can be found at http://clinicaltrials.mayo.edu/.
These research studies are assisted in part by Astra-Zeneca, Bayer, Boston Scientific, Fujinon, Olympus and Orafti, Inc.
Contact: Elizabeth Zimmermann
Mayo Clinic
source: http://www.ajc.com/health/content/shared-auto/healthnews/rsrc/523526.html
THURSDAY, Jan. 20 (HealthDayNews) -- Harvard researchers have found a new marker that may signal more invasive and lethal forms of colon cancer.
These findings could eventually lead to more targeted treatments and new ways to screen for more aggressive disease, report the researchers.
"If patients had elevated levels [of the marker], their prognosis was significantly worse," said study co-author Richard Bates, an instructor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.
During embryonic development and wound repair, the body normally undergoes a process called epithelial-mesenchymal transition (EMT), according to Bates. Occasionally, during EMT, epithelial cells can transform into tumor cells.
So, Bates and his colleagues induced EMT in colon cancer cells to see what differences they could find. They discovered a molecule -- called ?v?6 -- was expressed during EMT in the cancer cells. Because this marker is also released during wound repair, Bates explained, it was the levels of the marker that were critical, not its presence or absence.
The researchers then looked at samples from 488 human colon cancers, and found that elevated levels of the marker were associated with significantly reduced survival time. Those with high levels of the marker had an average survival rate of 4.8 years, while those with low expression of the marker survived an average of 16.5 years.
"This marker might be an attractive therapy candidate. It may be possible to design targeted therapy for invading or malignant tumors," said Bates. Also, he added, "if this marker shows up in early-stage tumors, we know those patients will be at far higher risk of developing metastatic disease and they can be treated more aggressively."
Bates added that because EMT only occurs during fetal development and wound repair, a treatment that interrupts the action of this marker would probably have few side effects.
"This is an interesting, but very preliminary, study," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation Hospital in New Orleans. "This marker may help us tell patients early on which ones are at a higher risk of more serious disease and reoccurrence. And it may help us define which patients we may need to treat earlier, and which we may not need to treat right away."
But, he added, the difference in survival rates was not dramatic, and there wasn't information on what types of treatment each patient may have received, which could also affect survival rates.
Bates said what's most important for people to remember is that "early detection is best." And, he added, "We've just come across something that may make early detection even more important."
Results of the study appear in the Feb. 1 issue of the Journal of Clinical Investigation.
Colon cancer is America's fourth leading cancer killer, according to the National Cancer Institute. Each year, almost 105,000 people are diagnosed with colon cancer and more than 56,000 people die from the disease, according to the American Cancer Society.
Risk factors include being over 50, a family history of the disease, a history of polyps in the colon, or having ulcerative colitis or Crohn's disease. Studies also suggest that a poor diet and cigarette smoking may increase your risk of developing colon cancer.
More information
To learn about preventing colon and rectal cancer, go to the National Cancer Institute.
http://www.endoatlas.com/atlas_ib.html
Left: Normal ileum.
Right: Mucosal inflammation causes redness, friability (ease of bleeding) and edema (swelling), giving rise to a granular appearance. As inflammation extends deeper into the bowel wall, edema results in a cobblestone appearance.
As inflammation progresses, ulcers appear, and may be punctate (left), linear, or more extensive (right). Repeated ulceration causes destruction of mucosa, giving the swollen surviving mucosa a raised, polypoid appearance (pseudopolyps), seen in distance on left and foreground on right.
Pseudopolyps.
In individuals with ulcerative colitis, a distinct portion of the colon is diseased. Disease starts at the rectum and moves "up" the colon to involve more of the organ. Doctors categorize ulcerative colitis by the amount of colon involved. Regardless of how little or how much of the colon is involved, symptoms can vary from mild to severe in any individual.
Types of ulcerative colitis are:
Last Reviewed: 2002 by Guy Slowik, M.D.
On this page:
|
The digestive system. |
Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea.
Crohn's disease is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the intestines. Crohn's disease can be difficult to diagnose because its symptoms are similar to other intestinal disorders such as irritable bowel syndrome and to another type of IBD called ulcerative colitis. Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine.
Crohn's disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohn's disease have a blood relative with some form of IBD, most often a brother or sister and sometimes a parent or child.
Crohn's disease may also be called ileitis or enteritis.
[ Top]
Theories about what causes Crohn's disease abound, but none has been proven. The most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine.
People with Crohn's disease tend to have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or result of the disease. Crohn's disease is not caused by emotional distress.
[ Top]
The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth.
[ Top]
A thorough physical exam and a series of tests may be required to diagnose Crohn's disease.
Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines.
The doctor may do an upper gastrointestinal (GI) series to look at the small intestine. For this test, the patient drinks barium, a chalky solution that coats the lining of the small intestine, before x rays are taken. The barium shows up white on x-ray film, revealing inflammation or other abnormalities in the intestine.
The doctor may also do a colonoscopy. For this test, the doctor inserts an endoscope--a long, flexible, lighted tube linked to a computer and TV monitor--into the anus to see the inside of the large intestine. The doctor will be able to see any inflammation or bleeding. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the intestine to view with a microscope.
If these tests show Crohn's disease, more x rays of both the upper and lower digestive tract may be necessary to see how much is affected by the disease.
[ Top]
The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage. Crohn's disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases they may require surgery.
Nutritional complications are common in Crohn's disease. Deficiencies of proteins, calories, and vitamins are well documented in Crohn's disease. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption).
Other complications associated with Crohn's disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.
[ Top]
Treatment for Crohn's disease depends on the location and severity of disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. At this time, treatment can help control the disease, but there is no cure.
Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person's lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.
Someone with Crohn's disease may need medical care for a long time, with regular doctor visits to monitor the condition.
Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache.
Some patients take corticosteroids to control inflammation. These drugs are the most effective for active Crohn's disease, but they can cause serious side effects, including greater susceptibility to infection.
Drugs that suppress the immune system are also used to treat Crohn's disease. Most commonly prescribed are 6-mercaptopurine and a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person's resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteriods can eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.
The U.S. Food and Drug Administration has approved the drug infliximab (brand name, Remicade) for the treatment of moderate to severe Crohn's disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab, the first treatment approved specifically for Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a protein produced by the immune system that may cause the inflammation associated with Crohn's disease. Anti-TNF removes TNF from the bloodstream before it reaches the intestines, thereby preventing inflammation. Investigators will continue to study patients taking infliximab to determine its long-term safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.
The doctor may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.
Surgery to remove part of the intestine can help Crohn's disease but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Many Crohn's disease patients require surgery, either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the large intestine need to have their entire colon removed in an operation called colectomy. A small opening is made in the front of the abdominal wall, and the tip of the ileum is brought to the skin's surface. This opening, called a stoma, is where waste exits the body. The stoma is about the size of a quarter and is usually located in the right lower part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. The majority of colectomy patients go on to live normal, active lives.
Sometimes only the diseased section of intestine is removed and no stoma is needed. In this operation, the intestine is cut above and below the diseased area and reconnected.
Because Crohn's disease often recurs after surgery, people considering it should carefully weigh its benefits and risks compared with other treatments. Surgery may not be appropriate for everyone. People faced with this decision should get as much information as possible from doctors, nurses who work with colon surgery patients (enterostomal therapists), and other patients. Patient advocacy organizations can suggest support groups and other information resources. (See For More Information for the names of such organizations.)
People with Crohn's disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohn's disease are able to hold jobs, raise families, and function successfully at home and in society.
[ Top]
No special diet has been proven effective for preventing or treating this disease. Some people find their symptoms are made worse by milk, alcohol, hot spices, or fiber. People are encouraged to follow a nutritious diet and avoid any foods that seem to worsen symptoms. But there are no consistent rules.
People should take vitamin supplements only on their doctor's advice.
[ Top]
Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohn's disease. Even so, women with Crohn's disease should discuss the matter with their doctors before pregnancy. Most children born to women with Crohn's disease are unaffected. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases.
[ Top]
Researchers continue to look for more effective treatments. Examples of investigational treatments include
[ Top]
Crohn's & Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone: 1-800-932-2423 or (212) 685-3440
Email: info@ccfa.org
Internet: www.ccfa.org
Pediatric Crohn's & Colitis Association, Inc.
P.O. Box 188
Newton, MA 02468
Phone: (617) 489-5854
Email: questions@pcca.hypermart.net
Internet: http://pcca.hypermart.net
Reach Out for Youth with Ileitis and Colitis, Inc.
15 Chemung Place
Jericho, NY 11753
Phone: (516) 822-8010
United Ostomy Association, Inc.
19772 MacArthur Blvd.
#200
Irvine, CA 92612-2405
Phone: 1-800-826-0826 or (949) 660-8624
Fax: (949) 660-9262
Email: uoa@deltanet.com
Internet: www.uoa.org
[ Top]
The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.
2 Information Way
Bethesda, MD 20892-3570
Email: nddic@info.niddk.nih.gov
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
NIH Publication No. 03-3410
January 2003
| Home | Artemisia | Hemorrhoids | Ingredients | Applications | About Us | Testimonials |
Order |
 |
| Live help by AliveChat |
| info@herbalabs.org | ||
| © 2002-2004 Home Page ; Privacy Policy ; Disclaimer ; Parasites ; Artemisia ; Samples ; Testimonials |
