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Hanover Medical Specialists, P.A. is a multi-specialty practice in Wilmington, NC consisting of gastroenterology, cardiology, endocrinology and hematology / oncology.

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Colon Cancer - What You Need To Know!
Birgit A. Arb, M.D.

As you may know, March is "Colon Cancer Awareness" month and April has been designated as "Cancer Prevention" month. In combining these concepts, one must remember that the cause of most cancers remains unknown and this is also the case with colon cancer. We know that risk factors for colon cancer include advanced age, a family history of colon cancer and inflammatory bowel disease but further insight remains limited. Screening is strongly recommended since this remains a curable disease. For the general population, screening should include a colonoscopy every 5-10 years starting at the age of 50 years along with regular check ups. In patients with a strong family history of colon cancer, certain genetic syndromes and inflammatory bowel disease, earlier screening with colonoscopy is advised. The goal of all screening is to detect colon cancer in its earliest stages and allow curative treatment to take place.

Although the cause of colon cancer continues to elude us, there have been recent advances in this disease. Several genes have been discovered which are part of familial syndromes which predispose patients to develop colon cancer at an early age. Although these familial syndromes are rare, it is important to test for these genes since special preventive treatment is available to these patients.

The first gene is called the "APC gene". This gene is found to be abnormal in patients with a syndrome called familial adenomatous polyposis. Familial adenomatous polyposis is a rare syndrome with a very high risk of colon cancer by the age of 40. The discovery of the "APC gene" allows us to test families to look for this disorder and thereby initiate earlier screening and preventive treatment.

The second genetic abnormality is referred to as "MSH1" and "MSH2"; these genes are abnormal in patients with a genetic syndrome called HNPCC. Patients with this abnormality are high risk for developing colon cancer and earlier screening is advised; again the goal being prevention of colon cancer.

Treatment advances have also been made in this disease. Surgical advances, the development of adjuvant chemotherapy and improved surveillance have led to improved disease free and overall survival in colon cancer. A great area of research is focused on identifying those patients who are at increased risk for recurrence or relapse after surgery. Focus remains on biomarkers and molecular abnormalities within the cancer cells with the hope that we can identify those patients with tumors that are likely cured vs. those that are at high risk for relapse after surgery. The goal of identifying these good risk vs. poor risk cancers is to streamline anti-cancer therapy to allow all patients to have a better chance for cure.

Although there are still many questions to be answered about the cause, prevention and treatment of colon cancer through ongoing research, advances are being made daily. For your health, remember that appropriate screening remains one of the most important steps in the prevention of this disease.

Birgit A. Arb, M.D.