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Ailmemts & Remedies

Hereditary Non-polyposis Colorectal Cancer (HNPCC)

Definition:
HNPCC is an inherited genetic mutation that causes to develop colon, rectal  or bowel cancer.

In people with HNPCC, bowel cancer typically develops at a younger age than non-hereditary bowel cancer – around the ages of 40 to 50 rather than 60 to 70.

Some of the genes (basic units of heredity) that cause HNPCC are known. Nonpolyposis means that colorectal cancer can occur when only a small number of polyps is present (or polyps are not present at all). In HNPCC, colorectal cancer occurs primarily on the right side of the colon (you may see the  diagram). Sometimes other cancers can occur in families with HNPCC. They include cancer of the uterus, ovary, stomach, urinary tract, small bowel, and bile ducts. Other names for HNPCC are Lynch syndrome and cancer family syndrome.
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The gastrointestinal digestive tract is a hollow tube which begins at the mouth and ends at the anus. It has several parts including the esophagus, stomach, small intestine and colon (large intestine). Its total length is about 28 feet. The last 5-6 feet of the intestine is called the colon (large intestine, large bowel). The last 5 or 6 inches of the colon is the rectum. After food is digested, solid wastes move through the colon and rectum to the anus, where they are passed out of the body.

What are Polyps: Polyps are abnormal, mushroom-like growths. When found in the gastrointestinal tract, they occur most commonly inside the colon (large intestine, large bowel). Polyps vary in size from less than one-tenth of an inch to 1-2 inches. They may be so large as to block part of the intestine. In some people polyps may be inherited, while in others they are not inherited. Certain types of polyps can turn into colon cancer or rectal cancer.

HNPCC is also called Lynch syndrome. Henry T. Lynch (professor of medicine at Creighton University Medical Center), characterized the syndrome in 1966. In his earlier work, he described the disease entity as “cancer family syndrome.” The term “Lynch syndrome” was coined in 1984 by other authors, and Lynch himself coined the term HNPCC in 1985. Since then, the two terms have being used interchangeably, until more recent advances in the understanding of the genetics of the disease led to the term HNPCC falling out of favor.

How HNPCC is inherited: People with HNPCC have a 50% chance of passing the HNPCC gene to each of their children (see diagram p. 5). The gene can be passed on even if the parent has had surgery to remove his or her own colon. Individuals who do not inherit the gene cannot pass it to their own children. The vast majority of individuals with HNPCC develop cancer.
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Some individuals with HNPCC do not have an affected parent. These individuals, who are the first to have the condition, are referred to as having a new mutation (newly altered gene). They can, however, pass this HNPCC gene to their children.
In the United States, about 160,000 new cases of colorectal cancer are diagnosed each year. Hereditary nonpolyposis colorectal cancer is responsible for approximately 2 percent to 7 percent of all diagnosed cases of colorectal cancer. The average age of diagnosis of cancer in patients with this syndrome is 44 years old, as compared to 64 years old in people without the syndrome.

Symptoms:–
Symptoms include a change in bowel habit (needing to visit the toilet more frequently, with diarrhoea or constipation), the passage of blood with faeces, weight loss(Unusual and continuing lack of energy), change in appetite, abdominal pain and even an abdominal mass.

It should be emphasized that there is no safety in simply waiting for symptoms to develop. It is vital that persons at risk make every effort to have examinations starting by age 25 or 5 to 10 years before the age of the earliest colorectal cancer diagnosed in the family, even if they do not have symptoms.
Causes and risk factors:-
The genes affected are known as repair genes, which means they normally detect and repair damage in DNA that occurs when DNA is copied during cell division. However, when the genetic mutations are present, mistakes in DNA persist. The faulty DNA accumulates leading to uncontrolled cell growth and hence a risk of cancer.

The genes associated with HNPCC can sometimes cause other cancers, such as stomach, small intestine, liver, gall-bladder, ovary, endometrium (the lining of the womb), kidney, brain, skin and prostate gland.

Diagnosis: –
Persons at risk for HNPCC usually have a family history of two successive generations of colon cancer or at least one generation with colon cancer and one generation with polyps. Men and women at risk for HNPCC need examinations of the entire colon. Women at risk should also have yearly endometrial screening. Two tests, colonoscopy and barium enema, are available to tell whether polyps or cancer is present in the colon. For patients at risk for HNPCC, colonoscopy is the preferred method of screening.

1.Colonoscopy is an examination by means of a flexible, lighted tube, slightly larger in diameter than an enema tube, that is inserted into the colon. Tiny amounts of tissue may be removed from any part of the colon for microscopic study during this procedure. Before a person undergoes a colonoscopy a sedative is given; many persons sleep through the whole procedure and feel little or no discomfort. During this procedure it is sometimes necessary for the doctor to insert some air into the colon. Occasionally, air will cause the same kind of discomfort as a gas pain.

2.Barium enema is a test in which a white liquid called barium is inserted as an enema into the colon. This test allows the colon to be outlined when an x-ray picture is taken. If polyps are present they can be seen on the x-ray. The barium enema feels much like an ordinary enema, causing a feeling of fullness. This test should not be performed on pregnant women because of the risk of x-rays to the fetus.

For both of these tests of the colon, the patient must undergo a preparation before examination. The preparation, which includes a liquid diet and laxatives, clears stool from the colon so that all areas of the colon can be inspected. Exact instructions will be provided by the doctor before the examination.

A blood test for the HNPCC gene will tell at-risk family members if they have inherited the gene mutation identified in the family. However, gene tests do not reveal the presence of polyps or cancer.

Treatment:
If a polyp is found, removal through the colonoscope may be sufficient, although surgery may be recommended for some patients. If cancer is found at examination, the doctor will recommend colon surgery. Removing the entire colon is the only way to completely prevent the development of colon cancer or to treat existing cancer.

Several different operations are currently available for treatment of HNPCC. The three most commonly performed operations are total colectomy with: 1) ileorectal anastomosis, 2) ileoanal pull-through (pouch procedure), or 3) ileostomy. All three operations involve removal of all or most of the colon. After a complete discussion of these operations, the patient and surgeon together can decide which one is best. Women with HNPCC may also consider surgical removal of the uterus, ovaries, and Fallopian tubes.

In some cases, after colon removal, a person may have an ileostomy. An ileostomy is an opening on the abdomen through which stool leaves the body An ileostomy can be temporary or permanent. In most cases it is necessary to wear an appliance called an ileostomy bag to collect body wastes.

An ileostomy should not be considered a handicap, although it is an inconvenience. With proper care, there should be no odor or uncleanliness. Thousands of people of every age and of both sexes have had ileostomy surgery. After surgery, people can be just as busy, successful, and involved in daily routines as before surgery; in fact, they may be more active because of improved health.

However, someone with the abnormal genes can be screened for tumours.

However, someone known to have an abnormal HNPCC gene (or others in the family) can be screened for tumours with regular colonoscopy, gastroscopy and hysteroscopy, so problems may be caught much earlier when treatment is more likely to be effective.

Seven genes have been identified as causing the majority of cases of HNPCC: MSH2, MLH1, PMS1, PMS2, MSH6, TGFBR2 and MLH3. Blood tests may be used to detect them. These genes for HNPCC are inherited in an autosomal dominant pattern, which means that a person has a 50% chance of passing the abnormal gene on to each of their children. However this doesn’t mean a 50% chance of cancer in the child as not all those who inherit the genetic mutation will go on to develop cancer.

Antenatal screening is not usually offered.

Follow up  care after surgery:-
Early diagnosis of HNPCC in many patients has led to early surgery, resulting in prevention or cure of colon cancer and increased life span. However, other complications of this hereditary condition may still occur. For example, individuals with HNPCC appear to be at an increased risk for cancer of the endometrium (uterus), ovary, stomach, urinary tract, small bowel, and bile ducts. If you have had surgery for HNPCC, follow the guidelines below.

Exam guidlines for people with HNPCC aand who have had surgery:–
1.Sigmoidoscopy every year (depending on type of surgery).

2.Annual hemoccult test.

3.Annual physical exam.

4.For women: annual gynecological exam, including endometrial screening with biopsy (consider vacuum curettage or Pipel biopsy).

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resource:
http://www.bbc.co.uk/health/physical_health/conditions/hnpcc1.shtml
http://en.wikipedia.org/wiki/Hereditary_nonpolyposis_colorectal_cancer
http://www.macgn.org/cc_hnpcc1.html

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Healthy Tips

Cup of Magic

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Probiotics, prebiotics, antibiotics. The words often cause confusion because they sound similar. But, of course, they mean very different things, although all three are derived from the Greek word “bios”, meaning “life”.

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Most people would love a magic pill that would put an end to all their health problems. Preferably one that contains prebiotics (meaning “before life”) and probiotics (“helping life”), along with a few trace elements, minerals, antioxidants and vitamins.

Probiotics are defined by the World Health Organization as microorganisms, which when administered alive in adequate amounts, confer a health benefit to the host. They are advertised by the pharma industry as protective, anti-infection agents that give the body’s natural reserves a boost against disease. They are sold as capsules and powders containing organisms like Lactobacillus bulgaricus and Streptococcus thermophilus. The products are much hyped, and have fancy names and expensive packaging.

However, what advertisements do not mention is that to be effective, there should be at least 75 million live organisms in each capsule. Food and chlorine in water kill these organisms. They therefore have to be swallowed with non-chlorinated water on an empty stomach. The intestines need to be populated with these organisms. So initially, the capsules have to be swallowed four to six times a day. The minuscule numbers contained in commercially available capsules are insufficient and do not confer any real health benefit.

Probiotics are not new products; they have been around for centuries. Fermented dough and curd (yogurt) contain natural, healthy probiotics. Commercially available yogurt may not contain live lactobacillus (probiotics) unless specifically mentioned on the package.

Natural probiotics like curd have many medicinal properties that are being rediscovered now. Curd starts to act in the mouth itself. It reduces the number of plaque forming bacteria, and prevents bad breath, tooth decay and mouth ulcers.

In the stomach, curd helps neutralise gastric acidity, reducing belching, burning and dyspepsia. It prevents infections, particularly the growth and multiplication of H. pylori, which is implicated in gastric ulcers and stomach cancer.

In the intestine, probiotics live with other protective intestinal flora, reducing gas formation and diarrhoea. The immunological effects reduce the incidence and symptoms of Crohn’s disease (inflammatory condition of the intestines that may affect any part from the mouth to the anus) and ulcerative colitis. Bowel habits become regular and the incidence of colon cancer reduces in those who eat curd regularly.

The action of the probiotics on digested food results in the synthesis of B-complex vitamins. This reduces vitamin deficiencies. Children who are given curd in addition to milk have less diarrhoea than those given milk alone.

Many Indians are relatively lactose intolerant and develop bloating, abdominal pain and diarrhoea when given to drink milk. They thus tend to curtail their milk intake and in the absence of calcium supplementation become susceptible to osteoporosis. In curd, however, the milk is already partially digested, and this reduces the symptoms of intolerance. As little as one cup of curd a day is beneficial in the prevention of osteoporosis.

Studies have also shown that eating curd regularly prevents the development of candidiasis, a common vaginal fungal infection. Other studies have shown conflicting results with no real benefit. But this has not prevented pharmaceutical companies from advocating lactobacillus capsules and vaginal pessaries for candidial infection. Curd also boosts the immune system. Regular eaters swear by it, saying it reduces infections as well as the duration of illnesses.

Prebiotics, on the other hand, are soluble fibres and non-digestible food ingredients that remain in the colon. They selectively stimulate the growth and activity of beneficial microorganisms already present in the large intestine. Prebiotics are found in oats, wheat, onions and garlic. When probiotics and prebiotics are combined, they form “synbiotics”. This probably confers the best health benefits with probiotics acting in the small intestine and prebiotics in the large.

Antibiotics are used to kill harmful microorganisms in the intestine, bloodstream and the various organs. They should be used appropriately in the correct dosage and duration. Unlike probiotics and prebiotics, antibiotics are specific for a particular infection. They are not health supplements.

Antioxidants are found in coloured fruits and vegetables. Oxidation is essential for cell metabolism. During this process a few cells die releasing harmful free radicals. This is prevented by antioxidants.

All said and done, health does not come packaged as an expensive magic capsule containing probiotics and antioxidants to be drunk with a glass of artificial fibre. For good health,

Eat four to five helpings of fresh fruits and vegetables daily. The green, yellow, orange and red ones contain antioxidants

Curd reduces infections as well as the duration of illnesses

Eat one tablespoon of homemade curd first thing in the morning on an empty stomach

Eat chappatis four or five times a week

Give these health ingredients an extra boost by exercising one hour everyday.


Source: The Telegraph (Kolkata)

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Appendix is Also a Valuable Organ

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Your appendix is a slimy sac that hangs between your small and large intestines. It has long been thought of as a worthless evolutionary artifact, good for nothing except a potentially lethal case of inflammation. But now researchers suggest that your appendix is a lot more than a useless remnant.
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Not only was it recently proposed to actually possess a critical function, but scientists now find it appears in nature a lot more often than they had thought. And it’s possible some of this organ’s ancient uses could be recruited by physicians to help the human body fight disease more effectively.

Your appendix may serve as a vital safehouse where good bacteria can lie in wait until they are needed to repopulate the gut after a case of diarrhea. Past studies have also found the appendix can help make, direct and train white blood cells.

The appendix appears in nature much more often than previously acknowledged. It appears in Australian marsupials such as the wombat and in rats, lemmings, meadow voles, and other rodents, as well as humans and certain primates.

Resources:
Live Science August 24, 2009
Journal of Evolutionary Biology August 12, 2009 [Epub Ahead of Print]

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Diagnonistic Test

Barium Enema

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Alternative Names : Lower gastrointestinal series
Definition:
Barium enema is a special x-ray of the large intestine, which includes the colon and rectum. Before x-rays are taken, a liquid called barium sulfate is placed in the rectum. The liquid is a type of contrast. Contrast highlights specific areas in the body, creating a clearer image. The barium eventually passes out of the body with the stools.

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Because the colon and rectum are normally not visible on x-rays, you need to temporarily coat their inner surfaces with barium, a liquid that does show up on x-rays. This makes the outline of these organs visible on the x-ray pictures. This test is useful for diagnosing cancers and diverticuli (small pouches that may form in the intestinal wall).

How do you prepare for the test?
Tell your doctor if there is any chance you might be pregnant. If you have diabetes and take insulin, discuss this with your doctor before the test.

You will be given very specific instructions to ensure that your colon is completely empty before the test. You may be told to eat only a light breakfast and a liquid lunch and dinner (such as broth, fruit juice, or plain gelatin) on the day before the test. You may also be instructed to drink a large amount of clear liquid between meals and to avoid dairy products. You will need to take a laxative, a medicine that stimulates your intestine to move things through more quickly, so that you have a bowel movement to empty the colon. It is a good idea to stay at home or at least near a bathroom for a few hours after taking the laxative. On the day of the test, do not eat any breakfast.

How the Test is Performed
This test may be done in an office or a hospital radiology department. You lie on the x-ray table and a preliminary x-ray is taken. You will then be told to lie on your side. The health care provider will gently insert a well-lubricated tube (enema) into your rectum. The tube is connected to a bag that contains the barium. The barium flows into your colon.

A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. The health care provider monitors the flow of the barium on an x-ray fluoroscope screen, which is like a TV monitor.

You must completely empty your bowels before the exam. This may be done using an enema or laxatives combined with a clear liquid diet. Your health care provider will give you specific instructions. Thorough cleaning of the large intestine is necessary for accurate pictures.

There are two types of barium enemas:
1.Single contrast barium enema uses barium to highlight your large intestine.
2.Double contrast barium enema uses barium, but also delivers air into the colon to expand it. This allows for even better images.

You are asked to move into different positions and the table is slightly tipped to get different views. At certain times when the x-ray pictures are taken, you hold your breath and are still for a few seconds so the images won’t be blurry.

The enema tube is removed after the pictures are taken. You will be given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. One or two x-rays may be taken after you use the bathroom.

What happens when the test is performed?
You wear a hospital gown and lie on a table in the radiology department. To administer the enema, a nurse pushes a small tube an inch or two into your rectum, and then uses this tube to fill your colon and rectum with barium liquid. You may find the sensation of the filling of your colon somewhat strange (you might feel like you need to have a bowel movement), but it is not painful.

The x-ray for this test is taken as a video that begins immediately after your enema is started. The x-ray video is taken by a large camera positioned over your abdomen. Usually the room is darkened while the video is taken so that the doctor can watch the pictures on a TV screen. If the doctor wants to save a view in “freeze frame” (developed later for a closer look), you may be asked to hold your breath for a few seconds so that your breathing movement does not blur the image. A few more pictures may be taken after the lights are turned back on. After this, you are asked to empty your bowel in a nearby bathroom.

Usually one picture is taken of your abdomen after you have had your bowel movement, to make sure that the bowel has emptied well.

How the Test Will Feel
When barium enters your colon, you may feel like you need to have a bowel movement. You may also have a feeling of fullness, moderate to severe cramping, and general discomfort. Try to take long, deep breaths during the procedure. This may help you relax.

Risks Factors:
There are no significant risks. You will be exposed to a small amount of radiation during the test. The amount of radiation from a barium enema is larger than from a simple chest x-ray, but still very small — too small to be likely to cause any harm.

Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of the x-ray.

A more serious risk is a perforated colon, which is very rare.

Must you do anything special after the test is over?
In some cases, if some stool was still present in your colon despite your preparation the day before, the test must be repeated.

How long is it before the result of the test is known?
It takes the x-ray department 30 minutes to an hour to develop the pictures from your barium enema, and it will take additional time for a doctor to examine the x-rays and to decide how they look. Typically you can get the results within a day or two.

RESULTS:-

Normal Results: Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.

What Abnormal Results Mean

Abnormal test results may be a sign of:
*Acute appendicitis
*Cancer
*Colorectal polyps
*Diverticulitis
*Irritable colon
*Twisted loop of the bowel
*Ulcerative colitis

Additional conditions under which the test may be performed:
*Crohn’s disease
*Hirschsprung’s disease
*Intestinal obstruction
*Intussusception
*Ulcerative colitis

Resources:
https://www.health.harvard.edu/fhg/diagnostics/barium-enema.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm

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Bacteria Defends Gut Against Cancer

Diagram of the Human Intestine.
Image via Wikipedia

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The presence of bacteria in the human gut could produce substances that protect against colon cancer and provide therapy for inflammatory  bowel disease.

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Researchers from the University of Aberdeen Rowett Institute of Nutrition and Health and from the MTT Agrifood Research Institute in Finland report that bacteria in the gut convert linoleic acid, a naturally-occurring fat in the diet, into a form called conjugated linoleic acid (CLA) which is absorbed by the gut wall.

There are different types of CLA and not all of them have beneficial effects. “The ‘good’ form of CLA is present in dairy foods such as milk and cheese,” said John Wallace of the Rowett Research Institute, “but eating lots of dairy foods won’t necessarily help our gut health as most of the fats are digested in the small intestine before they get to the large intestine, where most of our gut bacteria are found.”

The results of these latest studies showed that several different forms of CLA are produced by gut bacteria. Fortunately, most was of the “good” kind, but Wallace stressed that more extensive studies are needed. One subject produced small amounts of a CLA whose beneficial or otherwise effects are much less clear.

The implications are that, if small quantities of dietary linoleic acid can be delivered to the large intestine, the effects on gut health will be generally beneficial in most people, said an Abereen release.

“The results are of special interest for individuals using anti-obesity treatments that prevent the small intestine from absorbing fats. This means that those fats – including linoleic acid – will pass into the large intestine and the gut bacteria will produce CLA. It has to be the correct CLA, so it is important to understand how individuals produce different CLA. This must depend on which types of bacteria are present,” Wallace said.


Sources: The Times Of India

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