Using 6_MP for recurring Crohn's after having had Colon Cancer

In Nov 2010, I had an (70 cm) ileocecal resection for Crohn's. During the operation, they found adenocarcinoma in the ascending colon. I was staged at IIIC because of a PTD (all 17 lymph nodes sampled were negative). I underwent FOLFOX chemo for two months but had to stop because of severe weight loss from diarrhea.

Fortunately, CT-scans and colonoscopies since have been negative for any local recurrences or metastases.

But my Crohn's has returned just proximal to the anastomosis as determined by a recent ileocolonoscopy.

My understanding is that treating a Crohn's recurrence with biologicals, such as Remicade, after having Colon Cancer is not recommended because they suppress TNF which helps prevent the angiogenesis needed for metastasis, for instance, to the liver.

My GI is considering using 6-MP instead. But I'm deeply concerned about the use of any treatment that suppresses the immune system since I question how well we really understand the role of the immune system vis a vis Cancer and, in particular, what might promote angiogenesis. My oncologist can't or won't give me a definitive answer on the suitability of 6-MP for my case.

I would greatly appreciate any guidance anyone can give me on this matter.

Hi frank and :welcome:

I am so sorry to hear that you have had issues with cancer as well as IBD.

I am not sure what to advise in these circumstances but I will tag a couple of people that have also had to deal with treating IBD with a previous cancer diagnosis: Mountaingem and Livilou. I will also tag Aussie and see if he has any thoughts on the matter.

Good luck, I hope the doctors are able to provide you with some clear and concise answers.

Dusty. xxx

Hi Frank and Dusty.

Colorectal cancer (CRC) is more common in an area of chronic active inflammation, so treating that inflammation will likely decrease the risk of malignancy.

In regards to 6MP, there wouldn't be an increased risk of CRC, it is probably risk neutral to a slight decrease in the risk of CRC.

There is however an increased risk of other malignancies, like non-melanoma skin cancer and lymphoma.

I would suggest using the 6MP which will hopefully decrease the inflammation, which should theoretically decrease your risk of CRC.

Best wishes.

Hi! My daughter (at age 16) was diagnosed with a stage 1 thyroid cancer after being treated with 6mp for many years. She was also on Humira at the time of her diagnosis. We went to consult with several top notch GI specialists in the NYC area...most agreed that my daughter not be placed on any TNF blockers for at least 5 years after cancer diagnosis.She is currently on Stelara (as recommended by an MD from Mt. Sinai) and doing well...we just went for labs last week, and this is the first time in a year that all her values are normal!!! Doctors are not really sure if 6mp or Humira were responsible for the cancer...I am terrified of what untreated CD could do my daughter..even more terrifying than the cancer and risks with these immunosuppresant drugs! You should ask your doctor about Stelara; it is still not approved for CD, but can be prescribed off label by your doctor. Good Luck! KIm

Hi Frank,

I think all oncologists are hesitant to speak of the safety of biologicals after cancer. I, too, had adenocarcinoma but mine was in the anus. It was Stage 1 and because it was outside the colon and also in the early stage, my doctor was comfortable keeping me on Remicade. I do take a higher dose of Methotrexate just to shut down anything that may begin, and I also get blood tests every six weeks that include colon cancer screening. I have had one recurrence but it also was caught very early.

The problem with any cancer is that inflammation feeds it, so having unchecked inflammation is just as dangerous as taking biologicals. I hope your doctor has answers for you, because it is a very difficult thing to proceed with a treatment when you are uncertain of the potential consequences. Please feel free to PM me if you ever just want to talk. Best wishes to you!

I very much appreciate all the responses to my question. I've been on travel and haven't checked back on this forum until now.

But I have been actively seeking an answer to my question offline, including consultation with medical oncologists with expertise in solid malignancies such as colon cancer. Apparently the evidence-based consensus to date is vague. In fact, it neither supports or refutes the suspicion that biologicals should be avoided after having a solid cancer, notwithstanding the widespread policy of recommending against their use in such cases.

There doesn't seem to be any widely held opinion about using immunomodulators when there is a history of a solid cancer such as colon.

I appreciate that chronic inflammation contributes to the chances of getting a new primary cancer (presumably because the repeated replacement of chronically inflamed cells increases the chances of corruption producing a cancerous cell,). It's not clear to me however that this chronic inflammation increases the chance of metastases of a past cancer.

Dusty thank you for tagging Aussie. Aussie, I interpret your answer as applying to new cancers as opposed to metastases of cancer cells lurking in other organs as a consequence of past cancers ("micro-metatases"). If I misinterpreted, please advise.

Kim, I can only begin to imagine the grief when something like that befalls one of our children. Reading your story was literally painful.

Jeannette, given your extensive meds list, it was exceptionally generous of you to reply to my question. Anything definitive I learn from my upcoming consultations that might possibly be of value to you I will be happy to share with you.

Saw a terrific Oncologist today who has expertise with solid cancers such as colon cancer. I found him in the book listing Top Doctors in America for various medical fields. His reviews from patients were also glowingly complimentary. Why is it that the most competent MD's are usually the nicest as well?

He indicated, as Aussie did, that 6-MP would likely reduce the chances of new solid cancers. But also he felt that the 6-MP dose for Crohn's might act like a "chronic" low dose chemo (since 6-MP at higher doses is used for certain blood cancers) which could reduce the chances of metastasies of my past Colon cancer. This latter issue is, as I mentioned before, my focus.

At the same time, the Oncologist indicated that it might still be better to delay the use of 6-MP until I'm past the 5 year point since my Colon cancer surgery. My Crohn's symptoms are very mild except for anemia which is being treated with iron infusions and procrit injections.

Finally, he indicated that this 6-MP after Colon Cancer issue is a rare one in his experience with very little if any evidence based.

Jeannette, your statement "I hope your doctor has answers for you, because it is a very difficult thing to proceed with a treatment when you are uncertain of the potential consequences" rings all too true with me.

BTW, rereading my last reply I was a bit embarrassed by how stilted and almost contrived it seemed to me. I attribute that in part to my rush to respond to the replies from others after a long delay. But also it reflects how awkward my writing can be when I'm writing personal stuff instead of engineering stuff. (Yes, I'm an engineer!! gasp!