Colon removal as cancer-prevention?

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Veteran Member

Date Joined Mar 2007
Total Posts : 2832
   Posted 1/29/2009 9:43 AM (GMT -7)   
In long-standing UC, some doctors advocate colon removal after 20-30 years on the grounds that there is no guarantee that even annual and extensive colonscopies can catch dysplasia prior to cancer developing.  So, why doesn't this same advice apply to Crohn's that includes extensive involvement of the colon?  Are Crohnie's simply supposed to put up with a higher cancer risk than UCers after so many years (assuming this medical logic is sound).  My UC is somewhat indeterminate and I assume Crohn's colitis, if it actually is that (officially it is still labelled UC) has an identical risk for cancer as UC.  Also, I notice that Crohnies rarely get jpouches - as opposed to permanent ileos- even if they have Crohn's colitis.  Not sure why this is so- seeing as there seems no guarantee the pouch will get crohn's- and if it does, the pouch can be reversed.  So I wonder why the jpouch isn't done more for crohn's colitis.
Pancolitis ~20 years, once had a full med-free 10 year remission,
but flaring/simmering on and off for years, allergic to all 5ASAs
12.5ish mg pred, 100 mg Imuran TCM (acupuncture & herbs)
Probiotics (PD, Cust.Probiot., Culturelle, VSL3, etc), DMSO, TSO, hookworm
Turmeric/circuminboswellia, fish oil, many vits/minerals
Lower-carb version of Specific Carb Diet (SCD), Remicade

Equestrian Mom
Veteran Member

Date Joined Mar 2008
Total Posts : 3115
   Posted 1/29/2009 10:55 AM (GMT -7)   
My GI recommended surgery for me a while ago...I'm 20 plus years since cancer but many other issues w/colon and rectum. Every year the risk gets greater, so I did it.

J-Pouches have a higher failure rate w/Crohn's patients... I guess it is the research behind them why most docs won't even consider them for a Crohn's diagnosis. UC's cure is removing the colon while Crohn's has no current cure...

Veteran Member

Date Joined Mar 2006
Total Posts : 1169
   Posted 1/29/2009 11:21 AM (GMT -7)   
Well I'm going to make a guess here. One factor would likely be that Crohns affecting primarily rhe colon (with overall colon involvement like in UC) is pretty rare. A second would be that since Crohns, even in the colon, has intermittent inflammation with skip areas that it is easier to biopsy those affected areas to monitor for dysplasia. And finally I am not sure that total colectomy is often suggested in UC primarily as a cancer prevention surgery; more often it is seen as curative when all meds fail to control symptoms, more a quality of life than a death prevention matter. Finally, everything I have seen through the years shows that while there is a slightly elevated colon cancer risk from longstanding Crohns with colonic involvement, that risk is statistically higher in UC.

Elite Member

Date Joined Feb 2004
Total Posts : 20577
   Posted 1/29/2009 12:22 PM (GMT -7)   
When it comes to crohn's, if you cut out the diseased portion then chances are the disease will move to healthy portions, with UC having your colon removed is actually considered a "cure" as pathetic as that is, but the disease will not move higher up into the small intestines with UC if it is true UC that the patient has.

From my understanding the J-pouch works better for UCers for the reason mentioned above.

My bum is broken....there's a big crack down the middle of it! LOL :)

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