Iatrogenically caused carcinoma occurs at the site of excision after utero-sigmoidostomy and cholecystectomy (19:321).
Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease increase the risk of developing colon cancer by 7-9 fold (10:241). Based on the statistics, colonoscopy should be performed after 10 years of pancolitis, 20 years of right-sided colitis, or 30 years of left-sided colitis (10:241). It is particularly important to brush or biopsy the structures since this is the site of malignancies in over one third of cases (15:82). Frank carcinoma clearly indicates surgery. But if there is low- to high-grade dysplasia in a flat mucosa, the recommendation is to apply aggressive medical therapy and check again after six months (10:242). Persisting high grade dysplasia is an indication for surgery.
Exogenous environmental factors appear so much more innocuous than the genetic or disease factors just discussed. But their effects are no less dramatic, and these factors should be given the attention they deserve. As Weisburger points out (19:317), in the United States we have witnessed a significant decrease in coronary heart disease fatalities by educating the public to lower saturated fat and cholesterol intake, stop smoking, increase physical activity, and control high blood pressure; and the same could be done against colon cancer.
A distinction should be made between right-sided (proximal) colon cancer, for which little is known about the risk factors, and left-sided (distal) colon cancer which is prevalent in the United States and other western industrialized countries (19:317). A third type, signet-ring cancer is particularly aggressive and quickly fatal, and its causes and prevention are unknown (19:318).
High dietary fat intake promotes distal colon cancer. This applies to both saturated and unsaturated fats, but excludes those in the form of olive oil, fish oil, or medium chain trigl...
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