Turkiye Klinikleri Journal of Medical Sciences

.: REVIEW
Kolorektal Kanser Oluşumunda Farklı Mekanizmalar ve Beslenmenin Rolü
Different Mechanisms and the Role of Nutrition in the Formation of Colorectal Cancer
Büşra ATABİLENa, Gamze AKBULUTa
aBeslenme ve Diyetetik Bölümü, Gazi Üniversitesi Sağlık Bilimleri Fakültesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2019;39(1):89-107
doi: 10.5336/medsci.2018-62192
Article Language: TR
Full Text
ÖZET
 Kolorektal kanser, dünyada ve ülkemizde en yaygın görülen üçüncü; kansere bağlı mortalite açısından ise dördüncü sırada yer alan önemli bir sağlık sorunudur. Oluşumunda genetik yatkınlığın payı olmakla birlikte; vakaların çoğunluğu sporadik olarak meydana gelmektedir. Özellikle obezite açısından düşünüldüğünde, yağ dokusunda artışla birlikte adipoz dokudan salınan adipokinlerin oranında değişim ile inflamasyon ve oksidatif stresin uyarılması kolorektal kanser gelişiminde uyarıcı olabilmektedir. Ayrıca nükleer faktör kappa-B (NF-κB) transkripsiyon faktörü ile uyarılmış inflamasyon, oksidatif stres ve lipit peroksidasyonunda artış veya inflamasyon ve oksidatif stres kaynaklı adiponektin/leptin oranında oluşan değişim kısır bir döngü halinde çeşitli mekanizmalar yoluyla kolorektal kanser gelişimini destekleyebilmektedir. Beslenme ile ilişkili risk faktörleri açısından ele alındığında ise diyet yağı, posası, antioksidan besin ögeleri, kırmızı et ve işlenmiş et ürünleri gibi birçok faktör kolorektal kanser gelişiminde rol alabilmektedir. Bu derlemede kolorektal kanser oluşumunda rol oynayan farklı mekanizmalar ve beslenme ile ilişkili risk faktörleri değerlendirilecektir.

Anahtar Kelimeler: Kolorektal kanser; adipokinler; inflamasyon; oksidatif stres; beslenme
ABSTRACT
 Colorectal cancer, the third most common cancer in the world and in our country and the fourth in terms of cancer-related mortality, is a major health problem. Although there is genetic predisposition in the formation of colorectal cancer, the majority of cases are sporadic. Particularly when considered in terms of obesity, inflammation and oxidative stress induced by the change of adipokines released from the adipocytes with an increase in fat tissue may stimulate the development of colorectal cancer. In addition, increased nuclear factor kappa-B (NF-κB) transcription factor-induced inflammation, oxidative stress and lipid peroxidation or the change in adiponectin/leptin ratio due to inflammation and oxidative stress can support the development of colorectal cancer through various mechanisms in a vicious cycle. When considered in terms of nutritional risk factors, many factors such as dietary fat, dietary fiber, antioxidant nutrients, red meat and processed meat products can play a role in the development of colorectal cancer. In this review, different mechanisms that play a role in the formation of colorectal cancer and nutritional risk factors will be evaluated.

Keywords: Colorectal cancer; adipokines; inflammation; oxidative stress; nutrition
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  110. La Vecchia C, Decarli A, Serafini M, Parpinel M, Bellocco R, Galeone C, et al. Dietary total antioxidant capacity and colorectal cancer: a large case-control study in Italy. Int J Cancer. 2013;133(6):1447-51. [Crossref] [PubMed]
  111. Papaioannou D, Cooper KL, Carroll C, Hind D, Squires H, Tappenden P, et al. Antioxidants in the chemoprevention of colorectal cancer and colorectal adenomas in the general population: a systematic review and meta‐analysis. Col orectal Dis. 2011;13(10):1085-99. [Crossref] [PubMed]
  112. Mekary RA, Wu K, Giovannucci E, Sampson L, Fuchs C, Spiegelman D, et al. Total antioxidant capacity intake and colorectal cancer risk in the Health Professionals Follow-up Study. Cancer Causes Control. 2010;21(8):1315-21. [Crossref] [PubMed] [PMC]
  113. Vece MM, Agnoli C, Grioni S, Sieri S, Pala V, Pellegrini N, et al. Dietary total antioxidant capacity and colorectal cancer in the Italian EPIC cohort. PloS One. 2015;10(11):e0142995. [Crossref] [PubMed] [PMC]
  114. Weng CJ, Yen GC. Chemopreventive effects of dietary phytochemicals against cancer invasion and metastasis: phenolic acids, monophenol, polyphenol, and their derivatives. Cancer Treat Rev. 2012;38(1):76-87. [Crossref] [PubMed]
  115. Antony ML, Singh SV. Molecular mechanisms and targets of cancer chemoprevention by garlic-derived bioactive compound diallyl trisulfide. Indian J Exp Biol. 2011;49(11):805-16. [PubMed] [PMC]
  116. World Canser Research Fund, American Institute for Cancer Research. Continuous Update Project Report Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer; 2011. p.43.
  117. Hu JY, Hu YW, Zhou JJ, Zhang MW, Li D, Zheng S. Consumption of garlic and risk of colorectal cancer: an updated meta-analysis of prospective studies. World J Gastroenterol. 2014;20(41):15413-22. [Crossref] [PubMed] [PMC]
  118. Zamora‐Ros R, Barupal DK, Rothwell JA, Jenab M, Fedirko V, Romieu I, et al. Dietary flavonoid intake and colorectal cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort. Int J Cancer. 2017;140(8):1836-44. [Crossref] [PubMed] [PMC]
  119. Demeyer D, Mertens B, De Smet S, Ulens M. Mechanisms linking colorectal cancer to the consumption of (processed) red meat: a review. Crit Rev Food Sci Nutr. 2016;56(16):2747-66. [Crossref] [PubMed]
  120. Kim E, Coelho D, Blachier F. Review of the association between meat consumption and risk of colorectal cancer. Nutr Res. 2013;33(12):983-94. [Crossref] [PubMed]
  121. Bernstein AM, Song M, Zhang X, Pan A, Wang M, Fuchs CS, et al. Processed and unprocessed red meat and risk of colorectal cancer: analysis by tumor location and modification by time. PloS One. 2015;10(8):e0135959. [Crossref] [PubMed] [PMC]
  122. Zhao Z, Feng Q, Yin Z, Shuang J, Bai B, Yu P, et al. Red and processed meat consumption and colorectal cancer risk: a systematic review and meta-analysis. Oncotarget. 2017;8(47): 83306-14. [Crossref] [PubMed] [PMC]
  123. Carr PR, Walter V, Brenner H, Hoffmeister M. Meat subtypes and their association with colorectal cancer: systematic review and meta‐ analysis. Int J Cancer. 2016;138(2):293-302. [Crossref] [PubMed]
  124. Carr PR, Jansen L, Bienert S, Roth W, Herpel E, Kloor M, et al. Associations of red and processed meat intake with major molecular pathological features of colorectal cancer. Eur J Epidemiol. 2017;32(5):409-18. [Crossref] [PubMed]
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  126. Joshi AD, Kim A, Lewinger JP, Ulrich CM, Potter JD, Cotterchio M, et al. Meat intake, cooking methods, dietary carcinogens, and colorectal cancer risk: findings from the Colorectal Cancer Family Registry. Cancer Med. 2015;4(6):936-52. [Crossref] [PubMed] [PMC]
  127. Newmark HL, Wargovich MJ, Bruce WR. Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J Natl Cancer Inst. 1984;72(6):1323-5. [PubMed]
  128. Lamprecht SA, Lipkin M. Cellular mechanisms of calcium and vitamin D in the inhibition of colorectal carcinogenesis. Ann N Y Acad Sci. 2001;952(1):73-87. [Crossref]
  129. Llor X, Jacoby RF, Teng BB, Davidson NO, Sitrin MD, Brasitus TA. K-ras mutations in 1, 2dimethylhydrazine-induced colonic tumors: effects of supplemental dietary calcium and vitamin D deficiency. Cancer Res.1991;51(16):4305-9. [PubMed]
  130. Parodi PW. Cows' milk fat components as potential anticarcinogenic agents. J Nutr. 1997;127(6):1055-60. [Crossref] [PubMed]
  131. Tsuda H, Kozu T, Iinuma G, Ohashi Y, Saito Y, Saito D, et al. Cancer prevention by bovine lactoferrin: from animal studies to human trial. Biometals. 2010;23(3):399-409. [Crossref] [PubMed]
  132. Norat T, Riboli E. Dairy products and colorectal cancer. A review of possible mechanisms and epidemiological evidence. Eur J Clin Nutr. 2003;57(1):1-17. [Crossref] [PubMed]
  133. Murphy N, Norat T, Ferrari P, Jenab M, Buenode-Mesquita B, Skeie G, et al. Consumption of dairy products and colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). PLoS One. 2013;8(9):e72715. [Crossref] [PubMed] [PMC]
  134. Aune D, Lau R, Chan DS, Vieira R, Greenwood DC, Kampman E, et al. Dairy products and col orectal cancer risk: a systematic review and meta-analysis of cohort studies. Ann Oncol. 2012;23(1):37-45. [Crossref] [PubMed]
  135. Ralston RA, Truby H, Palermo CE, Walker KZ. Colorectal cancer and nonfermented milk, solid cheese, and fermented milk consumption: a systematic review and meta-analysis of prospective studies. Crit Rev Food Sci Nutr. 2014;54(9):1167-79. [Crossref] [PubMed]
  136. Yang B, McCullough ML, Gapstur SM, Jacobs EJ, Bostick RM, Fedirko V, et al. Calcium, vitamin D, dairy products, and mortality among colorectal cancer survivors: the Cancer Prevention Study-II Nutrition Cohort. J Clin Oncol. 2014;32(22):2335-43. [Crossref] [PubMed]
  137. Keum N, Aune D, Greenwood DC, Ju W, Giovannucci EL. Calcium intake and colorectal cancer risk: dose-response meta‐ analysis of prospective observational studies. Int J Cancer. 2014;135(8):1940-8. [Crossref] [PubMed]
  138. Cho E, Smith-Warner SA, Spiegelman D, Beeson WL, van den Brandt PA, Colditz GA, et al. Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst. 2004;96(13):1015-22. [Crossref] [PubMed]
  139. Kim YI. Folate and DNA methylation: a mechanistic link between folate deficiency and colorectal cancer? Cancer Epidemiol Biomarkers Prev. 2004;13(4):511-9. [PubMed]
  140. Kennedy DA, Stern SJ, Moretti M, Matok I, Sarkar M, Nickel C, et al. Folate intake and the risk of colorectal cancer: a systematic review and meta-analysis. Cancer Epidemiol. 2011;35(1):2-10. [Crossref] [PubMed]
  141. Moazzen S, Dolatkhah R, Tabrizi JS, Shaarbafi J, Alizadeh BZ, de Bock GH, et al. Folic acid intake and folate status and colorectal cancer risk: a systematic review and meta-analysis. Clin Nutr. 2017 Oct 28. Doi: 10.1016/j.clnu.2017.10.010. [Epub ahead of print]. [Crossref]
  142. Giovannucci E. Epidemiologic studies of folate and colorectal neoplasia: a review. J Nutr. 2002;132(8 Suppl): 2350-5. [Crossref] [PubMed]
  143. Kim YI. Folic acid fortification and supplementation--good for some but not so good for others. Nutr Rev. 2007;65(11):504-11. [Crossref] [PubMed]
  144. Blount BC, Mack MM, Wehr CM, MacGregor JT, Hiatt RA, Wang G, et al. Folate deficiency causes uracil misincorporation into human DNA and chromosome breakage: implications for cancer and neuronal damage. Proc Natl Acad Sci U S A. 1997;94(7):3290-5. [Crossref] [PubMed] [PMC]
  145. Bassett JK, Severi G, Hodge AM, Baglietto L, Hopper JL, English DR, et al. Dietary intake of B vitamins and methionine and colorectal cancer risk. Nutr Cancer. 2013;65(5):659-67. [Crossref] [PubMed]
  146. Zhang XH, Ma J, Smith-Warner SA, Lee JE, Giovannucci E. Vitamin B6 and colorectal cancer: current evidence and future directions. World J Gastroenterol. 2013;19(7):1005-10. [Crossref] [PubMed] [PMC]
  147. Larsson SC, Orsini N, Wolk A. Vitamin B6 and risk of colorectal cancer: a meta-analysis of prospective studies. JAMA. 2010;303(11): 1077-83. [Crossref] [PubMed]
  148. Liu Y, Yu QY, Zhu ZL, Tang PY, Li K. Vitamin B2 intake and the risk of colorectal cancer: a meta-analysis of observational studies. Asian Pac J Cancer Prev. 2015;16(3):909-13. [Crossref] [PubMed]
  149. Feldman D, Krishnan AV, Swami S, Giovannucci E, Feldman BJ. The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer. 2014;14(5):342-57. [Crossref] [PubMed]
  150. Zhang X, Giovannucci E. Calcium, vitamin D and colorectal cancer chemoprevention. Best Pract Res Clin Gastroenterol. 2011;25(45):485-94. [Crossref] [PubMed]
  151. Grant WB. A critical review of Vitamin D and cancer: a report of the IARC Working Group on vitamin D. Dermatoendocrinol. 2009;1(1):25-33. [Crossref] [PubMed] [PMC]
  152. Wei MY, Garland CF, Gorham ED, Mohr SB, Giovannucci E. Vitamin D and prevention of colorectal adenoma: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2008;17(11): 2958-69. [Crossref] [PubMed]
  153. Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, et al. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mole Biol. 2005;97(1-2):179-94. [Crossref] [PubMed]
  154. 154. Ying HQ, Sun HL, He BS, Pan YQ, Wang F, Deng QW, et al. Circulating vitamin D binding protein, total, free and bioavailable 25-hydroxyvitamin D and risk of colorectal cancer. Sci Rep. 2015;5:7956. [Crossref] [PubMed] [PMC]
  155. Anic GM, Weinstein SJ, Mondul AM, Männistö S, Albanes D. Serum vitamin D, vitamin D binding protein, and risk of colorectal cancer. PloS One. 2014;9(7):e102966. [Crossref] [PubMed] [PMC]
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  159. Horie H, Zeisig M, Hirayama K, Midtvedt T, Möller L, Rafter J. Probiotic mixture decreases DNA adduct formation in colonic epithelium induced by the food mutagen 2-amino-9H-pyrido [2, 3-b] indole in a human-flora associated mouse model. Eur J Cancer Prev. 2003;12(2):101-7. [Crossref] [PubMed]
  160. Foo NP, Ou Yang H, Chiu HH, Chan HY, Liao CC, Yu CK, et al. Probiotics prevent the development of 1, 2-dimethylhydrazine (DMH)-induced colonic tumorigenesis through suppressed colonic mucosa cellular proliferation and increased stimulation of macrophages. J Agric Food Chem. 2011;59(24):13337-45. [Crossref] [PubMed]
  161. Chen ZF, Ai LY, Wang JL, Ren LL, Yu YN, Xu J, et al. Probiotics clostridium butyricum and Bacillus subtilis ameliorate intestinal tumorigenesis. Future Microbiol. 2015;10(9):1433-45. [Crossref] [PubMed]
  162. Bauer-Marinovic M, Florian S, Müller-Schmehl K, Glatt H, Jacobasch G. Dietary resistant starch type 3 prevents tumor induction by 1, 2dimethylhydrazine and alters proliferation, apoptosis and dedifferentiation in rat colon. Carcinogenesis. 2006;27(9):1849-59. [Crossref] [PubMed]
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  165. Worthley DL, Le Leu RK, Whitehall VL, Conlon M, Christophersen C, Belobrajdic D, et al. A human, double-blind, placebo-controlled, crossover trial of prebiotic, probiotic, and synbiotic supplementation: effects on luminal, inflammatory, epigenetic, and epithelial biomarkers of colorectal cancer. Am J Clin Nutr. 2009;90(3):578-86. [Crossref] [PubMed]

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1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com