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May 15, 2012 > Are You at Risk for Colorectal Cancer?

Are You at Risk for Colorectal Cancer?

Washington Hospital Seminar Focuses on Inflammatory Bowel Disease

If you experience abdominal pain, cramps, and diarrhea, you could have inflammatory bowel disease. Crohn's disease and ulcerative colitis are the two most common types of inflammatory bowel disease.

"Both Crohn's and ulcerative colitis can raise your risk for colorectal cancer," said Dr. Annamalai Veerappan, a gastroenterologist and member of the Washington Hospital medical staff. "Crohn's raises your risk if it occurs in the colon. If you have had either disease for seven to 10 years, you may need to start getting a colonoscopy every year."

Veerappan will present "Crohn's, Colitis, and Colorectal Cancer Risk" on Tuesday, May 22, from 1 to 3 p.m. The free seminar will be held at the Conrad E. Anderson, M.D. Auditorium, located at 2500 Mowry Avenue (Washington West) in Fremont. You can register online at or call (800) 963-7070 for more information.

While Crohn's disease is an inflammatory bowel disease, it can affect the digestive tract anywhere from the mouth to the anus. It is an autoimmune disease, which occurs when the body mistakenly attacks and destroys healthy tissue.

"Our immune system helps to fight infection and attacks cells that could turn into cancer," Veerappan explained. "But with autoimmune diseases, our body sees normal cells as bad cells. With Crohn's disease, it sees the bowel as a foreign invader and attacks it, causing inflammation and irritation."

No Cure

Crohn's can occur at any age, but is usually first diagnosed in people between the ages of 15 and 35, according to the National Institutes of Health. There is no known cause and no cure.

"There are various theories about what causes it, but none have been proven," Veerappan said. "About 10 to 20 percent of the people who get Crohn's have a family history."

Researchers believe genes play a role in the disease. In addition to having a family history, those who are Jewish are at higher risk for the disease. People of color have a lower risk, he added. Symptoms include abdominal pain, cramps, fever, fatigue, loss of appetite, rectal bleeding, and diarrhea. It can also cause inflammation in the eyes, joint pain, and liver disease.

"About 10 percent of people who have Crohn's get one outbreak and then never have another occurrence," he said. "Those are the lucky ones. About 5 percent have continual flare ups. They get it and it never goes away. But for most people, it's a cycle of exacerbation and remission."

Veerappan will talk about some of the medications that are available to keep Crohn's under control. If medications don't work, surgery may be required.

He said the standard protocol is to start with the weakest medications that have the least side-effects and then "step up" to more potent drugs as needed. But more recently, gastroenterologists have started to change their thinking.

"The direction we are heading now is to start with the strongest medication right out of the gate for those patients who are younger and have a very aggressive form of the disease," Veerappan explained. "We are seeing success with this approach and believe outcomes will be much better for these patients in the long-term."

Ulcerative Colitis

Ulcerative colitis is also an autoimmune disease, but unlike Crohn's it only affects the inner lining of the colon. It tends to run in families and can cause eye inflammation, joint pain, and liver disease. Symptoms include abdominal pain, cramps, diarrhea, and rectal bleeding.

For most people, the symptoms are intermittent. Some people go for months or even years without any symptoms, while a small percentage experience symptoms all the time, according to Veerappan.

"Ulcerative colitis can be cured by removing the colon," he added. "We prefer to control the symptoms with medication."

Cancer Risk

People who have had Crohn's disease in the colon or ulcerative colitis for seven to 10 years are at increased risk for colorectal cancer and should get regular screenings no matter how old they are, according to Veerappan. Adults without any history of these diseases should start getting a colonoscopy at age 50.

Colorectal cancer begins as a microscopic polyp on the wall of the colon or in the rectum. A colonoscopy is a screening method that allows physicians to see the inside the rectum and colon using a small tube with a camera on the tip. If polyps are present, they are usually removed during the colonoscopy, preventing them from becoming cancerous. If no polyps are present and you aren't at increased risk for colorectal cancer, the next screening is not needed for another 10 years,
Veerappan explained.

"Screening is the best way to prevent colorectal cancer," he said. "With regular screenings, we can actually prevent colorectal cancer from developing."

For more information about other classes and seminars offered at Washington Hospital, visit

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