Causes
Causes of colon cancer are probably environmental in the sporadic cases, (80%),
and genetic in the heredity predisposed cases (20%). Since malignant cells have
a changed genetic makeup, this means that in 80% of cases, the environment spontaneously
induces change, whereas in those born with a genetic predisposition, they are
either destined to get the cancer or it will take less environmental exposure
to induce the cancer. Exposure to agents in the environment that may induce
mutation is the process of carcinogenesis and is caused by agents known as carcinogens
(cancer-causing agents). Specific carcinogens have been difficult to identify;
however, dietary factors seem to be involved.
Colon cancer is more common in industrialized nations and diets high in fat,
red meat, total calories, and alcohol seem to predispose. Diets high in fiber
are associated with a decreased risk. The mechanism for protection by high-fiber
diets may be related to less exposure of the colon lining to carcinogens from
the environment, as the transit time through the bowel is faster with a high-fiber
diet than it is with a low fiber diet.
Age plays a definite role in the predisposition to colon cancer. Colon cancer
is uncommon before age 40. This incidence increases substantially after age
50 and doubles with each succeeding decade.
There is also a slight increase risk for colon cancer in the individual who
smokes.
Patients who suffer from inflammatory diseases of the colon known as ulcerative
colitis and Crohn's colitis are also at increased risk.
As for genetic predisposition, on chromosome 5, there is a gene called the
APC gene associated with the familial adenomatous polyposis syndrome. There
are multiple different mutations that occur at this site, yet they all cause
a defect in tumor suppression that results in early and frequent development
of colon cancer. This genetic aberration is transmitted to 50% of offspring
and each of those affected will develop colon cancer, usually at an early age.
There is another syndrome, hereditary non-polyposis colon cancer (also known
as Lynch syndrome), related to mutations in any of four genes responsible for
DNA mismatch repair. In patients with colon cancer, the p53 gene is mutated
70% of the time. When the p53 gene is mutated and ineffective, cells with damaged
DNA escape repair or destruction. This allows for the damaged cell to perpetuate
itself, and continued replication of the damaged DNA may lead to tumor development.
Though these syndromes have a very high incidence of colon cancer, family history
without the syndrome is also a substantial risk factor. When considering first-degree
relatives, history of one with colon cancer raises the baseline risk of 2% to
6%. (Most physicians think that this baseline is about 4%.) The presence of
a second raises the risk to 17%.
The development of polyps of the colon almost always precedes the development
of colon cancer by five or more years. Polyps are benign growths of the colon
lining. They can be unrelated to cancer, precancerous, or malignant. Polyps,
when identified, are removed for diagnosis. If the polyps are benign, the patient
should undergo careful surveillance for the development of more polyps or the
development of colon cancer.
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