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Advances in Colorectal Cancer

New drugs show promise, but more research needs to be done.

Focusing on Inflammation

Increasingly, researchers believe that inflammation -- the villain that contributes to heart disease, stroke, and diabetes -- may play a role in colorectal cancer.

In one recent study published in TheJournal of the American Medical Association, researchers found that higher levels of a marker for inflammation -- C-reactive protein, or CRP -- in the blood were associated with an increased risk of colon cancer. After studying the records of 22,000 people, researchers found that people with high levels of CRP were 2.5 times more likely to eventually develop colon cancer than those with low levels.

"We've seen that inflammation is an underlying component of a lot of diseases, including cancer," says Mooney. "The next step is to see whether we can manipulate that mechanism and alter the course of the disease."

Many researchers have looked at using drugs that reduce inflammation, in the hopes that they might cut the risk of colorectal cancer. And there is evidence that using a class of such drugs, nonsteroidal anti-inflammatory drugs, or NSAIDs, does just that. This class of drugs includes that humble and trusted resident of everyone's medicine tablet, aspirin.

"We know that people who use NSAIDs reduce their risk of developing colon cancer," says Polly Newcomb, PhD, Head of the Cancer Prevention Program at the Fred Hutchinson Cancer Research Center. "It's very exciting."

However, she points out that researchers don't yet know what dosage should be used. Also, some doctors are concerned that the risks of using NSAIDs, such as increased danger of bleeding and ulcers, may outweigh the benefits.

Newcomb and Mooney say that the next step is to try using NSAIDs in people who already have colorectal cancer to see if they help lengthen life or shrink tumors. Several studies are being conducted now.

Screening and Prevention

The connection between colorectal cancer and inflammation has potential implications in how the disease can be prevented as well. If further studies establish the relationship between high levels of CRP and colorectal cancer, it's possible that researchers could develop a blood test that would identify people at high risk of the disease. Other new screening tests are also in development.

While researchers are devising new ways of identifying people at risk of colorectal cancer, Newcomb points out that the screening tests we have now work pretty well.

"About 60%-80% of all cases of colorectal cancer can be prevented by endoscopies," she tells WebMD.

The endoscopy -- a procedure in which a doctor examines the colon with a device inserted into the rectum -- does not have a good reputation, Newcomb admits. "People worry it's unpleasant, and it's not as easy as a blood test," she says, "but it works pretty well."

The reason endoscopies -- either sigmoidoscopy or colonoscopy -- are so successful at preventing colorectal cancer is that they can detect abnormalities, such as polyps, that may be precursors to developing cancer. While other cancer screening tests, such as a mammography for breast cancer, only find cancer that's already in the body, endoscopies can catch abnormalities before they turn cancerous.

While people may avoid getting an endoscopy, Newcomb points out that the benefits are long lasting - five to 10 years or more -- because the test is so accurate.

Newcomb also says that researchers continue to look at the effects of diet and exercise on colorectal cancer risk. A number of studies have found that regular exercise does cut the risk; other studies have suggested that a diet low in meats and high in vegetables may do the same.

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