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Are malignant degenerations in the gastrointestinal tract more frequent in patients with CF?

Dear expert team, I have the following question which might seem ridiculous to you but which has been on my mind a lot. Recently I have been reading in scientific literature about cystic fibrosis (a medical book), that in adult patients with CF who are above 40 years of age malignant degeneration of cells in the gastrointestinal tract (cancer of the large and small bowel) may be 6,5 times more frequent compared to healthy adults of the same age.

In fact I did not detect any alarming sings (no abdominal pain, no blood in the stool) that could point to that (I am suffering from CF and I am older than 40 years). Nevertheless I am asking myself if it is true what is written there and if yes, if it would be advisable to do a rectoscopy, sigmoidoscopy or even a high colonoscopy once a year to CF patients older than 40 years, of course on a voluntary basis.

I could provide you with the reference where I got this information from if needed. I am aware of the fact that me as a CF patient over 40 years of age, I have to reckon on other special problems (e.g. diabetes mellitus, pneumothorax, or bleeding of the lung-until now none of these problems occurred, however), but the statement concerning the possible higher risk of cancer in CF (what has not been proved, however) shocked me quite a bit. Did you ever hear anything about this? As already mentioned, even if there is no reason from the medical point of view that I should worry about this, this question has bee on my mind a lot.

Yours sincerely,

CF patient, 41 years old

for a long time there have already been indications that with increasing life-expectancy in CF there is an increasing frequency of cancer. That concerns especially tumours in the abdominal cavity (large and small bowel, as well as pancreas). In spite of the fact that the risk of getting a tumour is higher compared to the normal population, those tumours do not have a significant effect on the over-all life-expectancy in CF. Here the illness of the lung is so predominant that statistically the cancer does not play any role.

That means not, of course, that one should not look for a tumour, as in the individual situation it is important to detect a tumour as soon as possible. The way of searching for a tumour and what can be done has to take into account that the investigations and probably the resulting therapy can be tolerated by the patient. Therefore it is nearly not possible to say that a prophylactic colonoscopy (or other things) over the age of 40 makes sense (tolerable and effective) in any case, as that depends very much on the condition of the patient. In case the patient is in a very good condition, it makes rather sense, than in case you have to fear that such an investigation will not be tolerated by the patient. Up to now there are no existing recommendations at what age a prophylactic colonoscopy should be done to CF patients. Therefore your CF care team has to discuss with you what makes sense in your individual case.

Yours sincerely,

Prof. Dr. TOF Wagner