Originally published 12:00 a.m., January 11, 2011 Updated 10:23 a.m., January 11, 2011

At one point in her 20s, Kimberly Tucker-Bowman thought she’d never enjoy a normal life, such as having a full-time job, getting married or traveling.

The James Island resident, 34, has ulcerative colitis, a chronic, autoimmune disease that affects the colon or large intestine. the disease, which along with Crohn’s is under the umbrella of irritable bowel disease, can cause an array of symptoms, including bloody diarrhea, abdominal cramping, rectal pain, the constant urge to use the bathroom and/or inability to do so, pain, fatigue, dehydration and significant weight loss.

If left untreated, the colon may be damaged, be prone to cancer and/or need to be removed.

Tucker-Bowman’s symptoms began in the spring of 2003. For eight months, she was using the bathroom 25 or more times a day and was withering away. Months of scary medical scenarios passed before she even heard about ulcerative colitis.

“I was a healthy, productive 27-year-old living her life,” recalls Tucker-Bowman, adding that the symptoms became so severe that she couldn’t work. “It took a three-week hospitalization at Duke for me to be diagnosed.”

Relief, however, didn’t come until the summer of 2004 when she began treatment at the Medical University of South Carolina with a intravenous drug called Infliximab, known by its trade name Remicade, that is used to treat several autoimmune diseases including rheumatoid arthritis. like others, Tucker-Bowman must get ongoing treatments every six to eight weeks, but she doesn’t mind.

“It (the treatment) has given me my life back. until then, I wasn’t living. I was wasting away,” she says.

In February, Tucker, who works for an event rental company, did what she once thought would never be possible. she got married and honeymooned in England.

She gives large credit to Merriman Dowdle, a physician’s assistant at MUSC’s department of gastroenterology & hepatology, for working with her on fine-tuning her treatments.

On a daily basis, Dowdle sees the toll the disease takes on patients as well as their loved ones.

“This disease affects everyone in their (the patient’s) life,” says Dowdle. “There have been divorces over it because some spouses just can’t cope with it.”

The difficulty often involves the need to use the bathroom up to 30 times a day as well as painful cramping and fatigue.

Dowdle says because it’s an “intimate disease,” often involving diarrhea, many don’t want to talk about it, and that can hinder diagnosis. But she added the problem doesn’t just lie with patients, but doctors who may not have it on their radar screen and, therefore, not order tests for it.

“The earlier the diagnosis, the better because once scarring takes place (in the intestines), the intestines don’t work as well,” says Dowdle.

While the lack of communication may be one factor in delaying diagnosis, another factor is that the disease affects everyone differently, and some may have a flare-up once and not experience problems again for months or even years, says Dowdle.

Because of the nature of the treatment, Dowdle and patients become close. she often gets invited to their weddings and baptisms.

Both she and Tucker-Bowman also are committed advocates for treating the disease.

This past year, Tucker-Bowman joined forces with the Voices of Ulcerative Colitis, a group of 1,000 patients — including former “Dawson’s Creek” star James Van Der Beek, whose mother has it — who share their experiences in their various communities in an effort to help others.

“What I try to emphasize is that there are resources out and that you can get treated,” says Tucker-Bowman.

For more info: voicesofuc.com

Reach David Quick at 937-5516.

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Posted on: Monday, 20 December 2010, 08:14 CST

(Ivanhoe Newswire) — Epstein-Barr virus (EBV) infects 90% of people at some point in their lives – and most will never know it.  However, HIV patients, receivers of organ transplants, and others with immune system problems may not be so lucky. EBV puts such people at a greater risk of cancer, and scientists are just discovering why.

Duke Cancer Institute researchers recently found a pathway used by infected cells to fight EBV infection, and may be able to use this discovery to better understand how the immune system responds to cancerous viruses.

"Using cell culture studies, we have uncovered a major pathway that the infected host cell activates to prevent an oncogenic virus from causing cancer," lead author of the study Michah Luftig, Ph.D, and Assistant Professor of Molecular Genetics and Microbiology was quoted as saying.  "We proposed that the cell was sensing that the virus is trying to take over.  When this oncogenic stress response is activated, it keeps the virus in check, and now we know why."

The research team studied the ways in which EBV can overtake cellular response, and hope that their findings will lead to the development of EBV-fighting therapies for those with weakened immune systems.  one key discovery is that two enzymes, called kinesis, stimulate the oncogenic stress response which typically fights EBV infection in strong immune systems (usually early in life).

In their study, the researchers blocked these kinesis, called ATM and Chk2, and observed an uncontrolled growth of infected cells.  they accumulated at ten times the typical amount, a large growth typically associated with many types of cancers, such as post-transplant lymphproliferative disorder.

"the findings can be extended to the general case of any oncogene being activated that might start the process of tumor formation," Luftig was quoted as saying.  "About 20 percent of all human cancers are caused by infectious agents, where about 80 percent of these infections are viral."

The human papilloma virus, for example, is a viral infection which is known to lead to cervical cancer.

EBV is a unique virus, affecting people in different ways.  Children aged four to five may first suffer mild illness symptoms.  Teenagers may develop mononucleosis and suffer much more acute symptoms such as chronic fatigue.  for those with immune problems, different types of lymphoma can form.

SOURCE: Duke University Medical Center, December 2010

Source: Ivanhoe Newswire

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Posted on: Monday, 13 December 2010, 14:07 CST

Cancer prevention experts have long been frustrated by the lack of a meaningful way to screen women for ovarian cancer. It is a relatively rare disease that often progresses with few symptoms until it is too late for potentially curative treatments, and elevated values of the most commonly used biomarker used in screening, CA125, are also related to other disorders.

Now, scientists at the Duke Cancer Institute say that incorporating the latest information about the biological diversity of ovarian cancer appears to lessen the potential value of screening even further.

"I feel that what this and other studies are telling us is that we will have to do a whole lot more than screening to protect women from this terrible disease," said Laura Havrilesky, MD, an associate professor of gynecologic oncology at Duke and the lead author of the study appearing in the journal CANCER. "we need to work harder to find better approaches to screening and also consider the potential value of preventive strategies."

Until recently, ovarian cancer has been regarded as a single disease. but studies at Duke and elsewhere have shown that it has at least two distinct subtypes, a slow-growing, indolent form, which takes months to years to move into an advanced stage, and a more aggressive variety driven by key gene mutations that gallops through stages I and II in about half that time.

Havrilesky led a research team that used information in the SEER database to create a decision model for screening for ovarian cancer. The SEER database, maintained by the National Institutes of Health, includes information on cancer incidence, prevalence and survival in over a quarter of the U.S. population and breaks out ovarian cancer by type.

They then validated the model using early data from a real-life study, the U.K. Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), a large, randomized trial that is using CA125 values and ultrasound to screen a general population of post-menopausal women for ovarian cancer.

In conceptualizing ovarian cancer as a single disease, the model predicted that screening women over the age of 50 in the United States could potentially lower cancer deaths by about 15 percent. but incorporating the two subtype concept, the model predicted deaths would fall by only 11 percent.

Havrilesky says it just makes sense: Screening is more likely to pick up a greater number of slow-growing, as opposed to fast-growing tumors, because indolent cancers remain in a more treatable early stage almost twice as long as their more virulent counterparts. "but catching and successfully treating the slower-growing cancers isn’t going to do as much to reduce deaths from ovarian cancer as much as catching the more lethal tumors would do."

In an accompanying editorial, Patricia Hartge, MA, ScD, a senior investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, notes the modest benefit of screening for a general population, but says that screening for women at higher risk of ovarian cancer – those who carry mutations known to be related to the disease or who have a family history of it – presents a more hopeful picture.

But Havrilesky is not so sure. She says screening in even the highest risk population has not yet been proven successful and says other options are under study that may hold merit.

‘We know that women who take oral contraceptives have a reduced risk of ovarian cancer, and the Duke Evidence-Based Practice Center is currently doing a systematic review and model to determine if this might be a reasonable approach for some women."

• Duke University Medical Center

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