Crohn’s & Colon Cancer: Prevention

Crohn’s patients know, or should know, that they are at higher risk for developing colon cancer than the general population – they are about 5 times more likely to get colon cancer, in fact. But they should also recognize that less than 10% of Crohn’s patients will develop colon cancer in their lifetimes.

That leads to the question, what can we as Crohn’s patients do to decrease our risk, or to prevent the development of colon cancer? Can we in fact prevent colon cancer? According to the American Cancer Society (see references at end of article) it is possible to prevent many colorectal cancers (cancers of the colon and/or rectum).

The first advice Crohn’s patients will receive from their physician regarding the prevention of colon cancer is early screening. For an otherwise healthy person, a baseline colonoscopy is suggested at age 50. For Crohn’s patients, who are regarded as being at high risk for colon cancer, a colonoscopy is advised no later than 8 years after the onset of serious colon and intestinal involvement, and then every 1 to 2 years after that. (I had my first one at age 25.) Crohn’s patients should, if possible, have their procedures done at a clinic or center with experience in Crohn’s disease and inflammatory bowel diseases (IBD), rather than at a more general clinic. Depending on where you live, this may not be possible, but it’s a goal to strive for. If cancerous or precancerous polyps are found early enough, treatment can generally eliminate the cancer; colon cancer is one of the most preventable and curable types of cancer.

Other screening tests for colon cancer that may be suggested for Crohn’s patients include fecal occult blood tests and fecal immunochemical tests, which can be done mainly at home; flexible sigmoidoscopy, barium enema, virtual colonoscopy, fecal immunochemical tests, and stool DNA tests. Testing for two genetic syndromes that are risk factors, called FAP and HNPCC, should be done if the patient has a family history of colon cancer; if they are detected, your physician will probably advise genetic counseling. These tests are all part of the early screening for colon cancer, and you can learn more about them from your doctor, or at the American Cancer Society’s website.

But to prevent the development of colon cancer, Crohn’s patients should also be proactive as soon as they are diagnosed with this risk. The most important ways for a Crohn’s patient, or indeed anyone, to prevent colon cancer is by making some lifestyle changes. Dietary changes can be extremely important in the prevention of colon cancer. Your doctor, or dietician, may advise reducing your intake of fats, especially saturated fats; reducing your consumption of meat, sugars, and refined carbohydrates; lowering your caloric intake if you are overweight (although this is not a problem for most Crohn’s patients); and increasing your fiber intake by eating more whole grains and five or more servings of fruit and vegetables each day. They will also suggest that you keep your diet varied, so that you will consume a broader range of the nutrients your body needs to help keep your immune system strong. While increasing fiber intake works well for those who don’t have an IBD, it can be difficult for Crohn’s patients. Some Crohn’s patients tolerate the fiber in whole grains, fruits and vegetables with few problems; for others, it can trigger a flare (relapse), or make an on-going flare worse. Crohn’s patients will soon find out by trial and error how much fiber they can tolerate.

Another important lifestyle change to help prevent colon cancer is to increase your activity level. A sedentary lifestyle can contribute to nearly all types of cancers, but especially colon cancer. The American Cancer Society suggests that everyone should exercise aerobically for at least 30 minutes five or more days a week; they note that 45 to 80 minutes is better. Although it will undoubtedly help to prevent colon cancer, if a Crohn’s patient is having a flare, he or she may not be able to leave the bathroom for 30 minutes, let alone exercise during that time. All Crohn’s patients should discuss personal exercise plans with their physicians, and make sure they are healthy enough to begin exercising, and stick to exercise that won’t exacerbate their condition.

Eliminating smoking and decreasing your intake of alcohol are also important factors in the prevention of colon cancer for Crohn’s patients. I’ve discussed alcohol consumption in another Crohn’s-related article on Associated Content; in that article, I noted that some studies show that the consumption of one glass of white wine, two or three times a week, may actually decrease your likelihood of getting colon cancer; beer and distilled spirits, however, should be decreased or avoided to help prevent colon cancer.

Some medications used by Crohn’s patients and others may also help to prevent colon cancer. These include aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofin (AdvilTM, for example) and naproxen (AleveTM and others). However, some of these medications can cause gastrointestinal bleeding and intestinal irritation in Crohn’s patients, so you should consult with your physician before using them. COX-2 drugs, a category to which prescription CelebrexTM belongs, may also be of some help in preventing colon cancer; however, COX-2 drugs have been linked to heart problems, so again, Crohn’s patients should consult their physicians and take their entire health profile into consideration before using these.

Daily multi-vitamin and mineral supplements are recommended to Crohn’s patients because the inflammation of the stomach and intestinal tracts reduces the ability of the body to absorb these vital nutrients from food. Conveniently, they are also recommended to help prevent colon cancer in Crohn’s patients. Specific nutrients are also being studied as cancer-preventatives; the American Cancer Society states that folic acid, or folate, may lower the risk of colon cancer, but that more study is necessary. Vitamin D, which is put into many dairy products, and which can also be obtained from sun exposure, may help to prevent colon cancer. But since sun exposure can cause or contribute to other types of cancer, and not all Crohn’s patients are able to tolerate dairy products (although some can), taking it in a multi-vitamin is the best way for Crohn’s patients to take it. Sun exposure is also a problem for Crohn’s patients taking cortico-steroids such as prednisone for inflammation.

Calcium may help prevent colon cancer too. It is important for a number of health reasons, but too much calcium has been linked to prostate cancer. Again, it’s important for Crohn’s patients to discuss the amount of calcium, if any, they should add to their diets either through foods or supplements. The American Cancer Society also mentions that there is some preliminary data that magnesium can help prevent colon cancer, especially in women; however, they say that more research is needed before this link can be considered proven.

As you can see, there are many things you can do, if you have Crohn’s, to prevent colon cancer, or at least to dramatically reduce your risk of getting it. It is a matter of both having the will to act, and having the health to act at least some of the time. Having Crohn’s disease does not mean that you will have colon cancer; it is just one of many risk factors, and you can remove or decrease other factors to give yourself a better chance at being in that 90% that won’t develop colon cancer.

(Sources include the American Cancer Society’s informational website, www.cancer.org, specifically www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_ the risk_factors_for_colon_and_rectum_cancer_asp?mav=cri ; www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_colon_and_rectum_cancer_be_prevented_asp?mav=cri ;and www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_colon_and_rectum_cancer_be_found_early.asp ; The Mayo Clinic’s website, www.mayoclinic.com , specifically www.mayoclinic.com/health/crohns-disease/DS00104 and www.mayoclinic.com/health/colon-cancer/DS00035 ; www.fda.gov/fdac/features/2000/600_colon.html , an FDA Consumer Magazine from November-December 2000; and About.com, specifically http://ibdcrohns.about.com/cs/colorectalcancer/a/crcancerrisks.htm?p=1 )

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