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Biomarkers for IBD-Related Colon Cancer: CCFA Researchers Seek Better Ways to Detect Risk and Prevent Disease. Take Charge. p. 32-35. Winter 2006.

One of the complications of inflammatory bowel disease (IBD, including Crohn's disease and ulcerative colitis) is an increased risk for colon cancer, a risk that rises even more after people have had colitis or Crohn's of the colon for more than 8 to 10 years. This article discusses the biomarkers used to detect IBD-related colon cancer. Gastroenterologists urge people with IBD to have a colonoscopy every one to two years after they have had IBD for more than 8 years. The author considers the increased cancer risk (which actually applies to a minority of IBD patients, approximately 10 percent) and diagnostic or screening strategies that can distinguish between inflammatory changes in the colon and precancerous ones. The author outlines the problems with colonoscopy in this patient population and makes the case for a quick, non-invasive test for colon cancer based on a biomarker, comparable to the Prostate Specific Antigen (PSA) which is used to screen for prostate cancer. The Crohn's and Colitis Foundation of America (CCFA) is currently supporting three research projects concerning the identification and testing of genetic markers for colon cancer. The author concludes that soon some of the genetic and other tests under study will be moved from the lab to clinical use, where they will complement colonoscopy in screening people with IBD for colon cancer. The article includes quotes from and photographs from three researchers in the area of biomarkers. 3 figures.

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Cancer: New Colonoscopic Techniques. IN: Jewell, D.P., et al, eds. Challenges in Inflammatory Bowel Disease: Management of Crohn's Disease. Malden, MA: Blackwell Publishing Inc. pp. 293-302.

Patients with longstanding, extensive ulcerative colitis (UC) are at increased risk of developing colorectal cancer. Colonoscopic surveillance is recommended to reduce associated mortality. This chapter on new colonoscopic techniques is from a textbook that addresses some of the challenges in the understanding of UC and Crohn’s disease (CD), collectively known as inflammatory bowel disease (IBD). In this chapter, the authors discuss detection of premalignant lesions in UC, chromoendoscopy, the efficiency of chromoendoscopy, and future trends, including confocal laser endomicroscopy. The authors conclude that the newly developed high-resolution and magnification endoscopes offer features that allow more and new mucosal details to be seen. These techniques are commonly used in conjunction with chromoendoscopy. Endoscopic prediction of neoplastic and non-neoplastic tissue is possible by analysis of the surface architecture of the mucosa, which influences the endoscopic management. 5 figures. 1 table. 19 references.

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Colonoscopies 101: Everything You've Always Wanted to Know But Were Afraid to Ask. Digestive Health and Nutrition. 8(1): 18-20. March- April 2006.

Colorectal cancer is the third most common cancer in both men and women in the United States. A colonoscopy is used to find and remove fleshy growths in the colon (polyps) before they become cancerous. This article answers common questions about colonoscopy, including the procedure itself, why it may be used, and alternatives. The author notes that, in order for the gastroenterologist to complete the test, the patient’s colon must be entirely empty of stool. Emptying the bowel requires fasting, laxatives, and increased drinking the day before the test. A colonoscopy is typically an outpatient procedure performed under sedation. Patients must arrange transportation after the procedure. The author walks patients through each step of the procedure. A final section describes some alternative screening methods, including virtual colonoscopy, digital rectal exam (DRE), stool blood test, flexible sigmoidoscopy, and barium enema with contrast. One sidebar outlines six steps to colorectal cancer prevention; another summarizes the guidelines for colon cancer screening using colonoscopy. 3 references.

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Straight Talk on Colorectal Cancer. Digestive Health and Nutrition. 7(2): 16-18. March-April 2005.

This article discusses colorectal cancer, emphasizing the importance of early detection for best treatment results. The author cautions that because colorectal cancer does not often have symptoms in its earlier stages, screening and removal of polyps (growths on the inner wall of the large intestine) are vital. Removing a polyp eliminates the chance of it changing to a cancerous growth. The author considers some of the reasons why there are low screening rates, including people being unaware of the need for or the benefits of screening, and clinicians not recommending screening. The author also discusses the colonoscopy procedure, preparation for colonoscopy, fecal occult blood testing, recommendations for how often to have these screening tests, new testing methods that are under development (including virtual colonoscopy), risk factors for colorectal cancer, lifestyle factors that may play a role in the development of colorectal cancer, and the role of genetics in colorectal cancer. One sidebar summarizes colorectal cancer screening guidelines; another sidebar lists the different methods currently available to screen for colorectal cancer. 1 figure. 6 references.

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Colon Cancer: The Power of Prevention. Princeton, NJ: Films for the Humanities and Sciences. 2002. (videorecording).

One of the most deadly forms of cancer is also one of the most preventable. In this program, doctors from the University of Pennsylvania School of Medicine, Vanderbilt-Ingram Cancer Center, Memorial Sloan-Kettering Cancer Center, and elsewhere focus on three case studies of senior citizens with colon cancer to explore the etiology and pathology of colon cancer, risk factors, and screening options. Prevention through colonoscopic examinations is emphasized, and treatments such as surgery with adjuvant therapy and combination chemotherapy involving 5-FU, Camptosar, and oxaliplatin are described.

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Facing Reality: The Facts About 'Virtual' Colonoscopy. Arlington, VA: American College of Gastroenterology. 2003. 2 p.

This brochure describes virtual colonoscopy, also called CT colonography, an x-ray test that looks for cancer and precancerous growths (polyps) in the colon (large bowel). Virtual colonoscopy is based on a CT scan of the abdomen and pelvis. During the examination, a tube is placed in the rectum and the colon is filled with air, followed by an abdominal-pelvic CT scan, which is then repeated with the patient lying in a different position. Because air is pumped into the colon, cramping may result. By contrast, in a conventional colonoscopy most patients receive sedative drugs that alleviate discomfort. Written in question and answer format, the brochure discusses how the test is performed, what the patient may experience, the expected results of the test, the role of conventional colonoscopy, and the guidelines of professional organizations regarding virtual colonoscopy. The brochure stresses that there has been no definitive demonstration to support either the overall effectiveness or cost-effectiveness of virtual colonoscopy. The brochure includes the contact information for the American College of Gastroenterology (www.acg.gi.org).

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Virtual Colonoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2003. 2 p.

Virtual colonoscopy (VC) uses x rays and computers to produce two- and three-dimensional images of the colon (large intestine). The procedure is used to diagnose colon and bowel disease, including polyps, diverticulosis, and cancer. VC can be performed with computed tomography (CT) or with magnetic resonance imaging (MRI) scans. This fact sheet describes virtual colonoscopy, including the preprocedure activities, and the advantages and disadvantages of VC. One sidebar briefly describes conventional colonoscopy. A final section describes the goals and work of the National Digestive Diseases Information Clearinghouse.

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Colonoscopy. Ostomy Quarterly. 40(3): 58-60. Spring 2002.

This newsletter article describes colonoscopy, a common and relatively routine procedure that allows the physician to visualize the colon and rectal lining by looking through a long flexible scope or using a video monitor attached to the scope. The author covers history, indications, patient preparation, sedation, the procedure itself, and possible complications. Colonoscopy is used to diagnose and monitor many colorectal diseases and to screen for colorectal cancer (particularly in patients over age 50). Major complications can include bleeding or perforation; minor complications include the effects of bowel preparation, low blood pressure, low oxygenation, bacteria in the bloodstream, bloating, and abdominal cramping. The article concludes with a list of five web sites for additional information. 8 figures. 10 references.

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Complications of Gastrointestinal Endoscopy. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 539-548.

Complications of gastrointestinal (GI) endoscopy are remarkably uncommon, in spite of the striking increase in the number and diversity of procedures performed since the 1970s. This chapter on complications of GI endoscopy is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include general complications, such as adverse effects of medications, cardiopulmonary problems, infectious complications, electrosurgical hazards, and abdominal distension; complications of upper endoscopy, including perforation, bleeding, and miscellaneous complications; and complications of sigmoidoscopy and colonoscopy, including perforation, bleeding, and miscellaneous complications. The authors stress that adherence to all safety issues, particularly sedation and monitoring, and the standardization of endoscopic training and practice may lower the complication rate of endoscopy and improve the already good safety record. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 1 figure. 6 tables. 124 references.

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Low-Salt Bowel Cleansing Preparation (LoSo Prep) as Preparation for Colonoscopy: A Pilot Study. Alimentary Pharmacology and Therapeutics. 16(7):1327-1331. July 2002.

Currently available colon cleansing preparations are often poorly tolerated. This article reports on a study undertaken to evaluate the efficacy of a low-volume, low-salt preparation for colonoscopy. This was a pilot study in patients scheduled for colonoscopy. The preparation consisted of 34 grams of magnesium citrate and four bisacodyl tablets the day before the procedure, and one bisacodyl suppository on the morning of the procedure. The study included 20 patients (age range 49 to 81 years, all male). There were no significant side effects associated with the preparation. All rated the taste as 'tolerable or better.' The examination was considered to be adequate, with no limitations, in 17 patients (85 percent) and was scored as good to excellent (no solid stool) in 11 patients (55 percent), acceptable (small amounts of solid stool) in six patients (30 percent) and poor in three patients (15 percent). Importantly, two of the failures then received a standard polyethylene glycol preparation and again failed to show adequate colon preparation. The authors conclude that the low-salt colon cleansing preparation was an effective alternative preparation for colonoscopy. 2 tables. 34 references.

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