Re: Cancer risk factors identified in bowel disease

[Guest guest]

> Has anybody information on that, how liver transplant affects the

risk of colon cancer?

Sorry, it appears to increase the risk.

Dave R.

_________________________________

Transplantation. 2005 Sep 27;80(6):759-64.

Incidence of cancers following orthotopic liver transplantation in a

single center: comparison with national cancer incidence rates for

England and Wales.

Oo YH, Gunson BK, Lancashire RJ, Cheng KK, Neuberger JM

Liver and Hepatobiliary Unit, Queen Hospital, Birmingham,

United Kingdom.

BACKGROUND: The incidence of de novo cancers is increased in liver

allograft recipients but there are few data assessing the extent of

the increased risk compared with a matched population. METHODS: A

retrospective study of 1,778 adults transplanted between January 1982

and March 2004, followed for a median of 65 months. The observed

cancer incidence was compared with age-, sex-, and calendar year-

matched expected cancer rates in England and Wales population.

RESULTS: In all, 141 (7.9%) developed a new cancer. There was an

increase in the incidence of all tumors compared with that expected

(Standardized Incidence Ratio (SIR) 207, 95% CI 174-244, P < 0.001);

the greatest increase was seen in lymphoid tumors (SIR 1026, 95% CI

608-1621, P < 0.001), skin cancers (SIR 580, 95% CI 432-763, P <

0.001), and cancer of the large bowel (SIR 496, 95% CI 290-774, P <

0.001). Large bowel cancer was more common in those patients with

ulcerative colitis than those without (SIR 2727 vs. 347) and in older

patients. Females had a greater risk of lung cancer than males (SIR

336 vs. 56). CONCLUSIONS: There is an increased incidence of tumors

following liver transplantation. Although the absolute risk of cancer

is low, we found that the increase in risk is greater in the younger

aged recipients than the older ones. Increased awareness of colon

cancer is needed especially in older patients and those with

ulcerative colitis. There should be awareness for the high lung

cancer incidence in females. Increased surveillance for breast and

cervical cancer is not necessary. PMID: 16210962.

[Guest guest]

> " We had expected to see a protective effect of (certain)

medications and colonoscopy, but did not. "

> Would they also mean udca? Most other studies seem to suggest

strongly, that udca would protect from colon cancer.

I think that this is the study in question (April 2007 Issue of Am J

Gastroenterol). It appears that the " (certain) medications " they are

referring to are sulfasalazine and mesalamine:

Am J Gastroenterol. 2007 Apr;102(4):829-36.

Risk factors for colorectal neoplasia in inflammatory bowel disease:

a nested case-control study from Copenhagen county, Denmark and

Olmsted county, Minnesota.

Jess T, Loftus EV Jr, Velayos FS, Winther KV, Tremaine WJ,

Zinsmeister AR, Harmsen W, Langholz E, Binder V, Munkholm P,

Sandborn WJ

Department of Medical Gastroenterology, Herlev Hospital, University

of Copenhagen, Copenhagen, Denmark.

OBJECTIVES: Population-based data on risk factors and protective

factors for colorectal dysplasia and cancer in patients with

inflammatory bowel disease (IBD) are sparse. We conducted a nested

case-control study of such factors in two well-described IBD cohorts

from Copenhagen County, Denmark and Olmsted County, Minnesota.

METHODS: Forty-three neoplasia cases were matched on six criteria to

1-3 controls (N = 102). Medical records were scrutinized for

demographic and clinical data. For each variable, the odds of

neoplasia were estimated using conditional logistic regression.

RESULTS: Primary sclerosing cholangitis (PSC) (odds ratio [OR] 6.9,

95% confidence interval [CI] 1.2-40), percentage of disease course

with clinically active disease (OR [per 5% increase] 1.2, 95% CI

0.996-1.4), and >or=1 yr of continuous symptoms (OR 3.2, 95% CI 1.2-

8.6) were associated with neoplasia, whereas a borderline association

with median number of small-bowel x-rays (OR 1.3, 95% CI 0.96-1.6)

was observed. We did not observe a protective effect of frequency of

physician visits (OR 1.4, 95% CI 0.96-2.0), number of colonoscopies

(OR 1.4, 95% CI 1.0-2.1), cumulative dose of sulfasalazine (OR [per

1,000 g] 1.1, 95% CI 1.0-1.3) and mesalamine (OR [per 1,000 g] 1.3,

95% CI 0.9-1.9), or partial intestinal resections (OR 1.5, 95% CI 0.3-

7.1). CONCLUSIONS: Subgroups of IBD patients-those with PSC, severe

long-standing disease, and exposure to x-ray-were at greater risk of

colorectal neoplasia. The protective effect of close follow-up,

colonoscopy, and treatment with 5-aminosalicylates was questionable.

PMID: 17222314.

Dave R.

[Guest guest]

>

> > Has anybody information on that, how liver transplant affects the

> risk of colon cancer?

>

> Sorry, it appears to increase the risk.

Thank you for the answer, also for the other question. The study you mention

there clearly

points to sulfasalazine and mesalamine as non-protective medication against

colon

dysplasia. I found some studies and articles, which support the beneficial role

of udca

against colorectal dysplasia in UC/psc.

1.

Ursodeoxycholic acid as a chemopreventive agent in patients with ulcerative

colitis and

primary sclerosing cholangitis. - Pardi DS, Loftus EV Jr, Kremers WK, Keach J,

Lindor KD.

(Gastroenerology April 2003)

CONCLUSIONS: UDCA significantly decreases the risk for developing colorectal

dysplasia or

cancer in patients with UC and PSC.

PMID: 12671884 [PubMed - indexed for MEDLINE]

2. Article on Prof. A. Stiehl (Heidelberg University) at Falk Symposium Nr. 144,

Freiburg

2004 in Deutsches Ärzteblatt, Jg. 102, Heft 6, 11. Februar 2005

The following Cleveland study did though not support the role of udca against

colon

cancer:

3. The impact of ursodeoxycholic acid on cancer, dysplasia and mortality in

ulcerative

colitis patients with primary sclerosing cholangitis. - Wolf JM, Rybicki LA,

Lashner BA.

(Aliment Pharmacol Ther. November 2005)

CONCLUSION: In ulcerative colitis patients with primary sclerosing cholangitis,

ursodeoxycholic acid did not reduce the risk of developing cancer or dysplasia.

However,

ursodeoxycholic acid may reduce mortality.

PMID: 16225486 [PubMed - indexed for MEDLINE]

Best greetings

[Guest guest]

Hi , I did not realise that PSC increased the risk of colon cancer. It has been over 18 months since has had a scope. The Doc said his last scope was so normal that it was boring.... he then suggested that a two year break between scopes was OK. Should Tim be having annual scopes? his liver function tests have actually been pretty good lately. Still abnormal, but only about 50 over what they should be. Seems to fluctuate for no good reason??? How often do most people in this group have scopes? will be having an MRCP next month, its been two years since his last one. Penny, Mum of Tim 17yrs UC 11/04, PSC 02/05 Send instant messages to your online friends http://au.messenger.yahoo.com

[Guest guest]

Current standard practice is to go back to annual 'scopes after PSC diagnosis.

My hep had a bit of an argument with my GI on that, but he prevailed - same

argument as your Dr. With the PSC wildcard, I'm not willing to take the chance,

even though I'm (currently) totally asymptomatic.

Arne

---- Penny Dunlop wrote:

=============

..... he then suggested that a two year break between scopes was OK.