Certain drugs may develop a protective role against colonic cancer. The reasoning is based on the observation that expression of the cyclo-oxygenase isoenzyme COX-2 is increased in colon cancer tumours, and also in familial adenomatous polyposis, a premalignant condition. Evidence suggests that aspirin and other NSAIDs may exert a protective effect through inhibiting this enzyme; the protective dose of aspirin is probably higher than that used in cardiovascular disease and, clearly, any benefits must be weighed against risks from complications, notably gastrointestinal bleeding. Selective COX-2 inhibitors may possess advantage in this situation.
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