Few words are more feared than “I am sorry. You have cancer.” Our modern society exposes us to so much pollutants, environmental stresses, oxidative stress, that cancer has become a very common problem we all dread. Clearly the best treatment is PREVENTION rather than surgery, chemotherapy, and radiation.
So is prevention truly possible. On these pages we will share the good news, mixed with the failures of the field of medicine. We shall focus on the areas that have strong scientific proof of the benefits of prevention. Not all cancers are equal, so the emphasis is on the areas where we can truly make an impact.
Skin Cancer and Free Radical Damage
Skin cancers are the most common form of cancers and include basal cell cancer, squamous cell cancer, and melanoma. The main risk factor is damage from Ultraviolet (UV) light exposure. Sunscreen (no, not suntan lotion) limits the degree of damage the cells are bombarded with. The process of damage and repair, in a repetitive fashion is like the erosion caused by the waves on a beach. That damage and repair is called oxidative stress. It creates free radicals which damage the DNA blueprint of the cell. Antioxidants clear the free radicals, but often there are not enough antioxidants to protect the cell. The second line of defense is programmed cell death, called apoptosis. When the damaged cell dies, it allows for regeneration by new cells. Failure of the damaged cell to die leads to unregulated proliferation of the cell with its genetic damage, and the development of cancer.
Colon cancer is the third most common form of non-skin cancer, with an annual USA incidence of 140,000 people and 50,000 deaths. These numbers have fallen over the last decade due to the increasing use of colon cancer screening including colonoscopy. Research published in March 2012 demonstrated that colon cancer mortality was cut in half by a single colonoscopy after a 15 year follow-up. That was the first time that a study showed that taking out colon polyps prevented death! The length of benefit even 15 years after scope was also amazing news that we can prevent cancer. The reason we can prevent colon cancer is that there is a benign precursor tumor that can be removed by colonoscopy. These tumors or adenomas are often called polyps and can be flat, raised or have a mushroom-like stalk and are removed at the time of the colonoscopy with a wire that is like a lasso. Dietary factors that prevent colon cancer include Calcium, Vitamin D, Fiber and low saturated fat. Other factors that increase the risk of colon cancer are Ulcerative Colitis, Crohn’s disease of the colon, family history of colon cancer before the age of 60, and personal history of previous adenomas.
Over the last three decades, Cancer of the junction of the esophagus and stomach (called adenocarcinoma of the esophagus) has risen 8 fold, making it the fastest rising cancer in the country. This has corresponded to the rapid rise of esophageal reflux and the obesity epidemic. Caused by chronic damage and repair of the lining of the lower esophagus with acid and pepsin from the stomach, this cancer is directly tied to the injury caused by Gastroesophageal Reflux Disease. The precursor of Esophageal Adenocarcinoma is Barrett’s Esophagus. The repetitive injury and repair in the lower esophagus leads to such severe oxidative stress on the DNA of the cells of the esophagus, that the cells stop looking like esophagus cells or stomach cells but rather look more like intestinal cells. All the cells of the body (except sperm and egg) have the same 46 chromosomes, so that the genetic blueprint found in liver cells is identical to bone cells. So why do liver and bone cells look so differently? Context. And the context of the esophagus is normally a one way elevator going down, not a constant assault of upwardly flowing acids and digestive enzymes.
Prevention of esophageal cancer requires recognition of the damage leading to erosive esophagitis, or Barrett’s esophagus, protection of the lower esophagus with medication or surgery, and dietary control. Periodic endoscopic surveillance is required. If precancerous cells called dysplasia occur, they can be removed with a variety of endoscopic techniques such as Barrx Halo or Endoscopic Mucosal Resection before cancer occurs. This is very similar to removing a dysplastic polyp before colon cancer occurs.
The common but often unrecognized infection of the stomach called H. pylori may cause stomach cancer and lymphoma of the gastrointestinal tract. This infection does not cause fever or pain and may hide in your body from childhood to late life when it may cause disease. It is a leading cause of ulcers of the stomach and duodenum called peptic ulcers.
We congratulate Dr. Barry Marshall for his pioneering work in the discovery of the association of ulcers and Helicobacter pylori, for which he won the 2005 Nobel Prize for Medicine. Dr. Gutman has had the distinct pleasure of meeting Dr. Marshall and discussing the progress that has been made in this field.
The World Health Organization has recognized H. pylori as a class 1 carcinogen. That means that there is a direct cause of stomach cancer and lymphoma by H. pylori. We can detect the organism by biopsies or by stool or breath testing. Blood testing is unreliable.
Hepatitis C and Hepatitis B are the leading cause of cancer in the world. People with these chronic viral hepatitis are at risk of hepatocellular carcinoma and cirrhosis. Liver cancer or hepatocellular carcinoma is the leading cancer throughout the world. Many people remember that Mickey Mantle, the legendary Yankee Center Fielder, died of Liver Cancer. Did you know it was caused by Chronic Hepatitis C, an infection that affects at least 4 million people in the U.S. This often silent infection can progress to cirrhosis and Liver Cancer.
While we do not take care of Cervical Cancer at Progressive Gastroenterology, it is important to discuss this very preventable cancer. Like Liver Cancer and Stomach Cancer, we again see an infection as the central cause of this cancer that primarily affects young women, and is very preventable. The vaccination for Human Papilloma Virus is lifesaving as this common infection may cause cancer of the Cervix. Doctors perform a pap smear, which looks for dysplasia. Like Colon Cancer and Esophageal Cancer, prior to developing invasive cancer there is a stage of high grade dysplasia, where the cells are angry and disorganized in appearance but do not show signs of invasion. Even earlier there is low grade dysplasia. These stages of low-grade dysplasia and high-grade dysplasia seen in Barrett’s esophagus allow us to intervene on the benign lesions and prevent invasive cancer!
Photo By: Bala Sivakumar CC BY 2.0