**14. Recommendations for prophylaxis of CRC according to our data**

You must follow these rules to be protected from colorectal cancer:


198 Cancer Prevention – From Mechanisms to Translational Benefits

The *first* group includes all patients who have no family history for cancer and no personal

The *second* group includes patients with family history for CRC or related neoplasia (stomach, mammary gland, endometrium, ovary, adrenal glands), patients with polypectomy of polyps with low-grade dysplasia, patients with large bowel resection due to

The *third* group includes patients: with familial adenomatous polyposis (FAP), with polypectomy of polyps with high-grade dysplasia, patients with large bowel resection due to CRC (up to 5 years post-surgery), with Peutz-Jeghers syndrome, juvenile polyposis, Cowden`s disease, HNPCC, IBD patients, with acromegaly and ureterosigmoidostomy.

The most appropriate follow-up method of patients, who have undergone polypectomy, is colonoscopy. The intervals according to the patients` risk and starting age are summarized

Follow-up, chemoprevention and polypectomy are cornerstones of tertiary CRC prvention. Tertiary prevention is performed after surgical treatment for CRC and its aim is elongation of the survival and improvement of the quality of life of patients who have been treated with resection for curable CRC. This purpose can be achieved by treatment of the patient's complaints, which are connected with the primary disease or with the systemic chemotherapy, as well and by disclosure of relapses in early and curable stage. We have not to forget, that occupational and psychosocial rehabilitation are very important in these patients. Large studies, which offer standard approach to these patients, are missing. Nevertheless, the following factors must be considered: tumor stage, general condition of the patient and life expectancy, and the patient's gain from treatment with a new, potentially curable surgeon intervention in case with proven relapse of CRC. 8,4 % of our patients develop metachronous CRC with mean age 69±11 years. The mean difference between diagnosis (CRC) of first and second localization is 6 years (2-15). This is the time for

Follow-up of patients with CRC is achieved by: personal history, physical examination, carcinoembryonic antigen (CEA) test, lab tests, fecal occult blood test, chest X-ray,

In conclusion, primary prophylaxis of the disease is the ultimate aim of every clinical physician. Can we apply the primary prophylaxis in colorectal adenomas and CRC?

abdominal ultrasound, echo-endoscopy, CТ, MRI, colonoscopy and PET-CT.

development of CRP and CRC 50 years 10 years 2 With moderately elevated risk for CRC 40 years 5 years 3 With extremely high risk for CRC 10-30 years 1-3 years

screening colonoscopy

Interval for control colonoscopy

history for polypectomy or cancer in the past.

CRC (5 years post-surgery), male gender.

<sup>1</sup>With average statistical risk for

**13. Tertiary prophylaxis of CRC** 

tertiary prophylaxis of CRC.

№ Patients Starting age for

Table 7. Starting age and intervals for screening colonoscopy.

in Table 7.


Risk and Protective Factors for Development of Colorectal Polyps and Cancer 201

Calle, E. E. & Thun, M. J. (2004) Obesity and cancer. *Oncogene*, Vol. 23, No. 38, pp. 6365-

Clark, L. C., Combs, G. F., Tumbull, B. W., Slate, E. H., Chalker, D. K., Chow, J., Davis, L.

Courtney, E. D., Melville, D. M. & Leicester R. J. (2004). Review article: Chemoprevention of colorectal cancer. *Aliment Pharmacol Ther,* Vol. 19, No. 1, pp. 1-24. Crandall, C. J. (1999). Estrogen replacement therapy and colon cancer: a clinical review*. J* 

Cummings, J. H. & Bingham, S. A. (1998). Diet and the prevention of cancer. *BMJ,* Vol.

De Meester, C. & Gerber, G. B. (1995). The role of cooked food mutagens as possible

Ekbom, A., Helmick, C., Zack, M. & Adami, H. O. (1990). Ulcerative colitis and colorectal cancer: a population-based study. *N Engl J Med,* Vol. 323, No. 18, pp. 1228 -1233. Ekbom, A., Yuen, J., Adami, H. O., McLaughlin J. K., Chow, W. H., Persson, I. &

Evans, M. D., Dizdaroglu, M. & Cooke, M. S. (2004). Oxidative DNA damage and disease: induction, repair and significance. *Mutat. Res*, Vol. 567, No. 1, pp. 1-61. Fearon, E. R. & Fogelstein, B. (1990). A genetic model for colorectal tumorogenesis. *Cell*,

Fedirko, V., Bostick, R. M., Flanders, W. D., Long, Q., Sidelnikov, E., Shaukat, A., Daniel,

trial. (2009). *Cancer Epidemiol Biomarkers Prev,* Vol. 18, No. 11, 2933-2941. Ferrucci, L. M., Sinha, R., Graubard, B. I., Mayne, S. T., Ma, X., Schatzkin, A., Schoenfeld,

Fiorucci, S., Del Soldato, P. (2003). NO-aspirin: mechanism of action and gastrointestinal

Ford, E. S. (1999). Body mass index and colon cancer in a national sample of adult US men

Fuchs, C. S., Willet, W. C., Colditz, G. A., Hunter, D. J., Stampfer, M. J., Speizer, F. E. &

safety. *Dig Liver Dis,* Vol. 35 (Suppl 2), pp. 9-19.

and women. *Am J Epidemiol,* Vol. 150, No 4, pp. 390-398.

investigations. *Rev Epidemiol Sante Publique,* Vol. 43, No. 2, pp. 147-161. Eide, T. J. (1986). The age-, sex-, and site-specific occurrence of adenomas and carcinomas

etiological agents in human cancer: a critical appraisal of recent epidemiological

of the large intestine within a defined population. *Scand J Gastroenterol,* Vol. 21,

Fraumeni, J. F. Jr. (1993). Cholecystectomy and colorectal cancer. *Gastroenterol,* 

C. R., Rutherford, R. E & Woodard, J. J. Effects of Vitamin D and Calcium on proliferation and differentiation in normal colon mucosa: a randomized clinical

P. S., Cash, B. D., Flood, A., & Cross, A. J. Dietary meat intake in relation to colorectal adenoma in asymptomatic women. (2009). *Am J Gastroenterol*, Vol. 104,

Giovannucci, E. L. (2002). The influence of folate and multivitamin use on the

*Womens Health Gend Based Med.,* Vol. 8, No. 9, pp. 1155-1166.

S., Glover, R. A., Graham, G. F., Gross, E. G., Krongrad, A., Lesher, J. L. Jr., Park, H. K., Sanders, B. B. Jr., Smith, C. L. & Taylor, J. R. (1996). Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin*.* A randomized controlled trial. Nutritional Prevention of Cancer Study Group*.* 

6378.

*JAMA*, Vol. 276, No. 24, pp. 1957-1963.

317, No. 7173, pp. 1636-1640.

No. 9, pp. 1083-1088.

Vol. 105, No. 1, pp. 142-147.

Vol. 61, No. 5. pp. 759-767.

No. 5, pp. 1231–1240.


#### **15. References**


18. Make a screening colonoscopy after you reach 50 years, and if you are in risk group (familial predisposed to colorectal cancer or associated localization – stomach, endometrium, breast, ovary or if you have preceding polypectomy) – after you reach 40

Altes, A., Gimferrer, E., Capella G., Barceló M.J. & Baiget, M. (1999). Colorectal cancer and

Anti, M., Armelao, F., Marra, G., Percesepe, A., Bartoli, G. M., Palozza, P., Parrella, P.,

Aries, V., Crowther, S., Drasar, S., Hill, J. & Williams, E. (1969). Bacteria and the aetiology

Baron, A., Beach, M., Mandel, J. S., van Stolk, R. U., Haile, R. W., Sandler, R. S., Rothstein,

polyp prevention study group. *N Engl J Med,* Vol. 340, No. 2, pp. 101-107. Baron, J. A., Cole, B. F., Sandler, R. S., Haile, R. W., Ahnen, D., Bresalier, R., McKeown-

Bingham, S. A., Day, N. E., Luben, R., Ferrari, P., Slimani, N., Norat, T., Clavel-Chapelon,

Bostick, R. M., Fosdick, L., Wood., J. R., Grambsch, P., Grandits, G. A., Lillemoe, T. J.,

Bulletin of the National Centre for Health Information. (2005). (www.nchi.govenment.bg). Burnstein, J. (1993). Dietary factors related to colorectal neoplasms. *Surg Clin North Am*,

Louis, T. A. & Potter, J. D. (1995). Calcium and colorectal epithelial cell proliferation in sporadic adenoma patients: a randomized, double-blinded, placebo-controlled clinical trial. *J Natl Cancer Inst*, Vol. 87, No. 17, pp. 1307-1315.

Canetta, C., Gentiloni, N., De Vitis, I. et al. (1994). Effects of different doses of fish oil on rectal cell proliferation in patients with sporadic colonic adenomas.

R., Summers, R. W., Snover, D. C., Beck, G. J., Bond, J. H. & Greenberg, E. R. (1999). Calcium supplements for the prevention of colorectal adenomas. Calcium

Eyssen, G., Summers, R. W, Rothstein, R., Burke, C. A., Snover, D. C., Church, T. R., Allen, J. I., Beach, M., Beck, G. J., Bond, J. H., Byers, T., Greenberg, E. R., Mandel, J. S., Marcon, N., Mott, L. A., Pearson, L., Saibil, F. & van Stolk, R. U. (2003). A randomized trial of aspirin to prevent colorectal adenomas. *N Engl J* 

F., Kesse, E., Nieters, A., Boeing, H., Tjønneland, A., Overvad, K., Martinez, C., Dorronsoro, M., Gonzalez, C. A., Key, T. J., Trichopoulou, A., Naska, A., Vineis, P., Tumino, R., Krogh, V., Bueno-de-Mesquita, H. B., Peeters, P. H., Berglund, G., Hallmans, G., Lund, E., Skeie, G., Kaaks, R. & Riboli, E; European Prospective Investigation into Cancer and Nutrition. (2003). Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observation study. *Lancet,* Vol.

HFE gene mutations. *Haematologica*, Vol. 84, No. 5, pp. 479-480.

of cancer of the large bowel. *Gut*, Vol. 10, No. 5, pp. 334-335.

15. Do endoscopic polypectomy if you have adenomatous colorectal polyps

17. Use daily acetylsalicylic acid if you do not have any contraindications

years. Consider genetic testing if you are in risk groups

*Gastroenterol*, Vol. 107, No. 6, pp. 1709-1718.

*Med*, Vol. 348, No. 10, pp. 891-899.

361, No. 9368, pp. 1496-1501.

Vol. 73, No. 1, pp. 13-29.

16. Eradicate Helicobacter pylori if you are infected

14. Fasting is good

**15. References** 


Risk and Protective Factors for Development of Colorectal Polyps and Cancer 203

Jenkins, P. J., Fairclough, P. D., Richards, T., Lowe, D. G., Monson, J., Grossman, A.,

Kim, Y. I. (2003). Role of folate in colon cancer development and progression. *J Nutr*, Vol.

Kotzev, I., Mirchev, M., Manevska, B., Ivanova, I. &, Kaneva, M. (2008). Risk and

Kritchevsky, D. (1995). Epidemiology of fibre, resistant starch and colorectal cancer. Eur J

Kryston, T. B., Georgiev, A. B., Pissis, P. & Georgakilas, A. G. (2011). *Mutat. Res*, Vol. 711,

Levin, B., Rozen, P. & Young, G. P. (2002). How should we follow up premalignant

*management*, Paul Rozen (Ed.), pp. 67-66, Martin Dunitz, London, England. Lim, K., Han, C., Xu, L., Isse, K., Demetris. A. J. & Wu T. (2008). Cyclooxygenase-2-

polyunsaturated fatty acids. *Cancer Res,* Vol. 68, No. 2, pp. 553–560. Longacre, T. A. & Fenoglio-Preiser, C. M. (1990). Mixed hyperplastic adenomatous

etiology. *Cancer Epidemiol Biomarkers Prev*, Vol. 6, No. 2, pp. 79-85.

Lubin, F., Rozen, P., Arieli, B., Farbstein, M., Knaani, Y., Bat, L. & Farbstein, H. (1997).

Middleton, E. & Kandaswami, C. (1993). The impact of plant flavonoids on mammalian

Nelson, R. L. (2001). Iron and colorectal cancer risk: Human studies. *Nutr Rev*, Vol. 59, No.

Parkin, D. M., Pisani, R. & Ferlay, J. (1999). Global cancer statistics. *CA Cancer J Clin*, Vol.

Patterson, E., Kristal, R. & Newhouser, L. (2000). Vitamin supplements and cancer risk.

Peng, C. L., Lin, H. J., Wang, K, Lai, C. R. & Lee, S. D. (1995). Treatment of duodenal carcinoid by strip biopsy. *J Clin Gasteroenterol,* Vol.20, No. 2, pp. 168-171. Pfohl-Leskowitcz, A., Grosse, Y., Carrière, V., Cugnenc, P. H., Berger, A., Carnot, F.,

*Endocrinology,* Vol. 47, No. 1, pp. 17-22.

experience). Vol. 55, No. 82-83, pp. 381-387.

Cancer Prev, Vol. 4, No. 5, pp. 345–352.

*Pathol*, Vol. 14, No. 6, pp. 524- 537.

No. 1-2, pp. 193-201.

Hall, London.

5, pp. 140-148.

NJ.

5616.

49, No. 1, pp. 33-64.

133, No. 11 (Suppl 1), pp. 3731-3739.

Wass, J. A. & Besser, M. (1997). Acromegaly, colon polyps carcinoma. *Clin* 

protective factors for development of colorectal polyps and cancer (Bulgarian

conditions?, In: *Colorectal cancer in clinical practice: prevention, early detection and* 

derived prostaglandin E2 activates beta-catenin in human cholangiocarcinoma cells: evidence for inhibition of these signaling pathways by omega 3

polyps/serrated adenomas. A distinct form of colorectal neoplasia. *Am J Surg* 

Nutritional and lifestyle habits and water-fiber interaction in colorectal adenoma

biology: implications for immunity, inflammation and cancer. In: *The Flavonoids: Advances in Research since 1986,* J. B. Harborne (Ed.), pp. 619-652, Chapman &

Epidemiologic research an recommendations, In: *Primary and Secondary Preventive Nutrition,* A. Bendich & R. J. Deckelbaum (Ed.), 21-43, Humana Press.,Totowa,

Beaune P. & de Waziers, I. (1999). High levels of DNA adducts in human colon are associated with colorectal cancer. *Cancer Res,* Vol. 55, No.23, pp. 5611-

familial risk of colon cancer in women. *Cancer Epidemiol Biomark Pre,* Vol. 11, No. 3, pp. 227-234.


Geissler, M. & Graeven, U. (2005). Prävenzion. In: *Das kolorektale Karzinom,* pp. 27-42,

Gerber, M. (2003). Biofactors in the Mediterranean diet. *Clin Chem Lab Med,* Vol. 41, No. 8,

Giovannucci, E., Ascherio, A., Rimm, E. B., Colditz G. A., Stampfer, M. J. & Willett, W. C.

Giovannucci, E., Rimm, E. B., Ascherio, A, Stampfer, M. J., Colditz, G. A. & Willett, W. C.

Giovannucci, E., Stampfer, M. J., Colditz, G. A., Hunter, D. J., Fuchs, C., Rosner, B. A.,

Giovannucci, E. (2006). The epidemiology of vitamin D and colorectal cancer: recent

Gustafson-Svärd, C., Lilja, I., Hallböök, O. & Sjödahl, R. (1996). Cyclo-oxygenase-1 and

and by the bile salt deoxycholate. *Inl J Cancer,* Vol. 60, No.3, pp. 400-406. Hakama, M. (1998). Chemoprevention of cancer. *Acta Oncol,* Vol, 37, No.3 , pp. 227-230. Hamilton, S. R. (2001). Origin of colorectal cancers in hyperplastic polyps and serrated

Hardt, P. D., Mazurek, S., Toepler, M., Schlierbach, P., Bretzel, R. G., Eigenbrodt, E. &

Hawk, E. T., Umar, A. & Viner, J. L. (2004). Colorectal cancer chemoprevention-an overview of the science. *Gastroenterol,* Vol. 126, No. 5, pp. 1423-1447. Hoff, G. (1987). Colorectal polyps. Clinical implications: Screening and cancer prevention..

Institute of Medicine, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium,

Jänne, P. A. & Mayer, R. J. (2000). Chemoprevention of colorectal cancer. *N Engl J Med,* 

tool for colorectal cancer. *Br J Cancer,* Vol. 91 No. 5, pp. 980-984.

*Scand J Gastroenterol,* Vol. 22, No. 7, pp. 769-775.

National Academy Press.

Vol. 342, No. 26, pp. 1960-1968.

cyclooxygenase-2 gene expression in human colorectal adenocarcinomas and in azoxymethane induced colonic tumours in rats. *Gut*, Vol. 38, No. 1, pp. 79–84. Hague, A., Elder, D. J., Hicks, D. J. & Paraskeva, C. (1995). Apoptosis in colorectal tumour

cells: induction by the short chain fatty acids butyrate, propionate and acetate

adenomas: Another truism bites the dust. *J Natl Cancer Inst,* Vol. 93, No. 17, pp.

Kloer H. U. (2004). Faecal tumor M2 pyruvate kinase: a new, sensitive screening

Vitamin D and Fluoride. Food and Nutrition Board, Washington, DC. (1997)

Greenwald, P. (2002). Cancer chemoprevention. *BMJ,* Vol. 324, No. 7339, pp. 714-718. Guidance on Cancer Services. (2004). Improving Outcomes in Colorectal Cancers –

findings. *Curr Opin Gastroenterol,* Vol. 22, No. 1, pp. 24-29.

Manual Update. National Institute for Clinical Excellence.

3, pp. 227-234.

pp. 999-1004.

524.

1282-1283.

Georg Thieme Verlag.

*Ann Intern Med,* Vol. 122, No. 5, pp. 327-334.

*J Natl Cancer Inst,* Vol.v87, No. 4, pp. 265-273.

familial risk of colon cancer in women. *Cancer Epidemiol Biomark Pre,* Vol. 11, No.

(1995). Physical activity, obesity, and risk colon cancer and adenoma in men.

(1995). Alcohol, low methionine-low folate diets, and risk of colon cancer in men.

Speizer, F. E. & Willett, W.C. (1998). Multivitamine use, folate, and colon cancer in women in the Nurses` Health Study. *Ann Intern Med,* Vol. 129, No. 7, pp. 517-


Risk and Protective Factors for Development of Colorectal Polyps and Cancer 205

Slattery, M. L. & Potter, J. D. (2002) Physical activity and colon cancer: confounding, effect

Steinbach, G., Lynch, P. M., Philips, R. K., Wallace, M. H., Hawk, E., Gordon, G. B.,

adenomatous polyposis. *N Engl J Med*, Vol. 342, No. 26 , pp. 1946-1952. Tseng, M., Sandler, R. S., Greenberg, E. R., Mandel, J. S., Haile, R. W. & Baron, J. A.

van Gorkom, B. A., de Vries, E. G., Karrenbeld, A. & Kleibeuker, J. H. (1999). Anthranoid

Villa, E., Dugani, A., Rebecchi, A. M., Vignoli, A., Grottola, A., Buttafoco, P., Losi, L.,

determination in the stool. *Gastroenterol,* Vol. 110, No. 5, pp. 1346-1353. Weijenberg, M. P., Mullie, P. F., Brants, H. A, Heinen, M. M., Goldbohm, R. A & van den

Wenzel, U., Kuntz, S., Brendel M. D. & Daniel, H. (2000). Dietary flavone is a potent

Winawer, S. J., Fletcher, R. H., Miller, L., Godlee, F., Stolar, M. H., Mulrow, C. D., Woolf,

World Cancer Research Fund and American Institute for Cancer Research, Food,

Wu, K., Willett, W. C., Fuchs, C. S., Colditz, G. A. & Giovannucci, E. L. (2002). Calcium

Wynder, E. L., Kajitani, T., Ishikawa, S., Dodo, H. & Takano, A. (1969). Environmental

Yang, P., Cunningham, J. M., Halling, K. C., Lesnick, T. G., Burgart, L. J., Wiegert, E. M.,

rationale. *Gastroenterol*, Vol. 112, No. 2, pp. 594-642.

Washington, DC: Banta Books.

Vol. 23, No. 5, pp. 1210-1220.

*Biomarkers Prev,* Vol. 6, No. 12, pp. 1029–1032.

pp. 913-919.

No. 4, pp. 443-452.

620–629.

3823-3831.

6, pp. 437-446.

pp.639-645.

modification and biological mechanism. *Med Sci Sports Exercise,* Vol. 34, No. 6,

Wakabayashi, N., Saunders, B., Shen, Y., Fujimura, T., Su, L. K. & Levin, B. (2000). The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial

(1997). Dietary iron and recurrence of colorectal adenomas. *Cancer Epidemiol* 

laxatives and their potential carcinogenic effects. *Aliment Pharmacol Ther,* Vol. 13,

Perini, M., Trande, P., Merighi, A., Lerose, R. & Manenti, F. (1996). Identification of subjects at risk for colorectal carcinoma through a test based on K-ras

Brandt, P. A. (2008). Dietary glycemic load, glycemic index and colorectal cancer risk: results from the Netherlands Cohort Study. *Int J Cancer,* Vol. 122, No. 3, pp.

apoptosis inducer in human colon carcinoma cells. *Cancer Res,* Vol. 60, No. 14, pp.

S. H., Glick, S. N., Ganiats, T. G., Bond, J. H., Rosen, L., Zapka, J. G., Olsen, S. J., Giardiello, F. M., Sisk, J. E., Van Antwerp, R., Brown-Davis, C., Marciniak, D. A. & Mayer, R. J. (1997). Colorectal cancer screening: clinical guidelines and

Nutrition and the Prevention of Cancer: A Global Perspective. (1997)

intake and risk of colon cancer in women and men*. J Natl Cancer Inst*, Vol. 94, No.

factors of cancer of colon and rectum. II. Japanese epidemiological data. *Cancer*,

Christensen, E. R., Lindor, N. M., Katzmann, J. A. & Thibodeau, S. N. (2000). Higher risk of mismatch repair-deficient colorectal cancer in α1-antitripsin deficiency carriers and cigarette smokers. *Mol Genet Metab,* Vol. 71, No. 4 ,


Rayman, M. P. (2000). The importance of selenium to human health. *Lancet, Vol.* 356, No.

Rex, D. K. (2000). Colonoscopy. *Gastrointest Endosc Clin N Am,* Vol. 10, No. 1, pp. 135-

Ribarova, F., Ilieva, Sv. & Nachev, Ch. (2004). The richness of the Balkan diet. Proceedings

Rustgi, A. K. (2003). Aspirin and colorectal adenoma prevention. *Gastroenterol,* Vol, 124,

Sandler, R. S., Halabi, S., Baron, J. A, Budinger, S., Paskett, E., Keresztes, R., Petrelli, N.,

previous colorectal cancer. *N Engl J Med,* Vol. 348, No. 10, pp. 883-890. Sandler, R. S. (2004). Aspirin prevention of colorectal cancer: more or less? *Ann Intern* 

Schatzkin, A., Lanza, E., Freedman, L. S., Tangrea, J., Cooper, M. R., Marshall, J. R.,

Scieszka, M., Danch, A., Machalski, M. & Drózdz, M. (1997). Plasma selenium

Scottish Intercollegiate Guidelines Network. Management of Colorectal cancer. A national

Sedelnikova, O. A., Redon, C. E., Dickey, J. S., Nakamura, A. J., Georgakilas, A. G. &

Seitz, K. & Osswald, B. R. (1992). Effect of ethanol on procarcinogen activation. In: *Alcohol and cancer,* Watson R. R (Ed.)*,* pp. 55-72, CRC Press, Boca Raton, FL. Seitz, K., Pöchl, G. & Simanowski, U. A. (1998). Alcohol and cancer. *Recent Dev Alcohol,* 

Seo, Y. R., Kelley, M. R. & Smith, M. L. (2002). Selenomethionine regulation of p53 by a

Serfaty, L., De Leusse, A., Rosmorduc, O., Desaint, B., Flejou, J. F., Chazouilleres, O.,

Sigimura, T., Wakabayashi, K, Nakagama, H. & Nagao, M. (2004). Heterocyclic amines:

pathogenesis. *Mutat. Res,* Vol. 704, No. 1-3, pp. 152-159.

study. *Hepatology,* 2003, Vol. 38, No. 1, pp. 203-209.

Varna international symposium for obesity and related diseases, pp. 62-65,

Pipas, J. M., Karp, D. D., Loprinzi, C. L, Steinbach, G. & Schilsky, R. (2003). A randomised trial of aspirin to prevent colorectal adenomas in patients with

Murphy, P. A., Selby, J. V., Shike, M., Schade, R. R., Burt, R. W., Kikendall, J. W. & Cahill, J. (1996). The Polyp Prevention Trial I: rationale, design, recruitment, and baseline participant characteristics. *Cancer Epidemiol Biomarkers Prev,* Vol. 5,

concentration in patients with stomach and colon cancer in the Upper Silesia.

Bonner, W. M. (2010). Role of oxidatively induced DNA lesions in human

ref1-dependent redox mechanism. *Proc Natl Acad Sci,* Vol. 99, No. 22, pp. 14548-

Poupon, R. E. & Poupon, R. (2003). Ursodesoxicholic acid therapy and the risk of colorectal adenoma in patients with primary biliary cirrhosis: an observational

mutagens/carcinogens produced during cooking of meat and fish. *Cancer Sci,*

9225, pp. 233-241.

No. 5, p. 1176.

No. 5, pp. 375– 383.

clinical guideline. 2003.

Vol. 14, pp. 67-95.

Vol. 94, No. 4, pp. 290-299.

14553.

Albena, Bulgaria, 30 May – 1 June, 2004.

*Med*, Vol. 140, No. 3, pp. 224-225.

*Neoplasma,* Vol. 44, No. 6, pp. 395-397.

160.


**8** 

Sayori Wada

*Japan* 

**of Food Components** 

*Kyoto Prefectural University* 

**Colorectal Cancer and the Preventive Effects** 

It has been reported that the cause of 30% of cancer is associated with eating habits (Anand et al., 2008). Colorectal cancer is one of the most common causes of death all over the world, and there is a strong association between this type of cancer and food intake. Despite this statement, the preventive effects of foods and nutrients on colorectal cancer have not

It has been proposed that some biologically active nutrients suppress colon carcinogenesis through the mechanisms of cytostatic properties, inhibition of cell growth, induction of

Although the positive effects of these nutrients have been shown in *in vitro* studies, it is still difficult to apply the effects of these nutrients in *in vivo* studies, due to modifications to foods during the process of absorption and delivery within the body. There might be two possible active sites, where foods and their components affect colon epithelium cells, where nutrients are distributed hematogenously after absorption, or retained in the lumen without absorption. Absorbed foods and nutrients might show the effects of anti-inflammation, antioxidant, and anti-proliferative par hematogenously in cancer epithelial cells and stromal cells, while on the other hand, the regulation of enterobacteria might be provided by the component in a poorly-absorbed form. Recent studies have focused on resistant carbohydrates functioning as prebiotics that prevent colorectal cancer (Davis & Milner,

The normal human intake of food has a great advantage for oral administration and safety, compared with the administration of medicine, because safety has been proven by long food experience. Thus, the prevention of colorectal cancer through the intake of specific foods and nutrients might have a great potential, however further studies are required, especially in regard to absorption and disposition. In this paper, we focused on foods, and their

**2. The preventive effects of food components against colorectal cancer** 

Colorectal cancer is one of the most common cancers in the world and it has been proposed that it is strongly associated with dietary habits (Anand et al., 2008; Jemal et al., 2011). Red and processed meat may convincingly increase the risk, and physical activity is only the

apoptosis, an anti-inflammation effect or modification of DNA in *in vitro* studies.

**1. Introduction** 

2009).

completely elucidated yet.

components, with cancer preventive aspects.

