– Dr. Jovita Martin Daniel, MBBS, MD, DNB, DM, MSc Medical Oncology, SRMC, Chennai
Colorectal cancer refers to cancer in the large intestine and is also known as bowel cancer, depending on where the cancer cells are present. Colorectal cancer typically affects the colon and the rectum. It stands to be the third-most common cancer, worldwide, and in India, colon cancer ranks 8th and rectal cancer ranks as 9thmost common cancer.
March is observed as Colorectal Cancer (CRC) Awareness month to make men and women aware that colorectal cancer can happen to both and often symptoms are difficult to identify in the early stages.
Symptoms to watch out for
Constipation, diarrhea, changes in stool color, blood in the stool, bleeding from the rectum, excessive gas, abdominal cramps and abdominal pain could be few of the indicators. But, most often the symptoms of this disease is difficult to identify and that is the prominent reason most cases tend to go undiagnosed and hence this calls for timely screening and diagnosis.
Impact of poor lifestyle habits
Generally, CRC is found in older adults; sixty years and above. However, in recent years there has been an increase in younger people. This is largely due to poor lifestyle (smoking, alcohol consumption), dietary habits (untimely food and spicy food intake, processed food, salty and preserved food) obesity, and lesser physical activities. Very less talked about is the incomplete defecation due to potty in the Western closet due to the pressure on the rectum by the pubo-rectalis muscle sling leading to incomplete evacuation of feces. This can be relieved by the Indian type closet or the use of a Potty stool with the Western closet.
Importance of early screening
The most effective way to reduce your risk of colorectal cancer is to get screened routinely, beginning at age 45. Colorectal cancer begins as precancerous polyps (abnormal growths) in the colon or rectum. Screening helps find the cancer tumor in its early stage and, this way, the condition can be better managed. If there is family history of cancer in 1 first degree relative or > 2 second degree relative, the screening can begin 10 years prior to the age of diagnosis of the first case of colon cancer in the family.
Types of diagnosis and treatment options to consider
In recent times, there are new diagnosis and treatment options in place. With the approach of personalized medicine moving away from holistic ones, treatment is now focused on the wellbeing of the patient and faster recovery with multimodality approaches such as surgery, radiotherapy, and chemotherapy. Fecal Occult blood Test (FOBT) and Colonoscopy are two methods of screening. When diagnosed in the early stage, the treating physician may be able to remove the tumor completely during a colonoscopy or surgical removal of the tumor is done. In advanced stage of CRC, multi modality approach is mandatory. Surgery is done either to relieve obstruction upfront via colostomy if patient came with obstructive symptoms; partial colectomy, lymph node dissection with or without metastatectomy of the resectable metastasis of liver or other organs could be done. What one must remember is that treatment largely depends on the particular situation, including the location of the cancer, its stage, and other co-morbidities. Once the surgery is done, it is followed by chemotherapy, radiation, targeted drug therapy and immunotherapy. In situations where the tumor is unresectable the Chemotherapy precedes surgery to downsize the tumor and get better surgical access and margins. In cases of rectal cancers with bleeding, chemoradiation followed by surgery.
Due to the molecular developments and the discovery of newer drugs even though there are many Stage 4 cancer the options of treatment have widened. The choice of treatment depends on the mutations present. The right-sided colon cancer most commonly presents with high microsatellite instability (MSI-H), KRAS Mutation, PDL1 +, BRAF Mutation. On the other hand left-sided colon cancer presents with KRAS wild type, Her 2 mutation.
Despite the increasing rate of occurrence of Stage 4 disease the appropriate choice and sequencing of the multimodality can convert the palliative treatment to curative. There are many situations where the stage 4 colorectal cancer patients who are treated on a palliative intent, have survived multiple lines of chemotherapy+/- targeted therapy with good quality of life and better overall survival.
As there is an increasing rate of incidence and prevalence of cancer in our society. There is a definite benefit from reconciling the ability of ‘cancer’ to instill fear and isolate people, with its positive ubiquity view of ‘overcoming cancer’. Destigmatising, desensitizing issues of cancer in the society with an increasing focus on offering therapeutic (physical, occupational, social-preventive) intervention in the community can bring forth hope and comfort. We often tend to face challenges in the public to tackle the disease on time such as; lack of time, procrastination, forgetfulness, other priorities, ambivalence, not valuing of screening tests, low perception of risk, lack of understanding, language difficulties, low socioeconomic status, living in rural locations, fear of results, marital status (single), gender (male) and cultural myths and beliefs need for financial support and manpower shortages. The General public may have cold feet or ‘fear of diagnosis’ which hinders them from coming forth to be screened. Thus screening intervention must be able to address this ‘destigmatization’ work before efforts to draw in the public can be encouraged and optimized.
Know how you can reduce the risk of Colorectal Cancer
Unhealthy lifestyle habits are linked to risk of colorectal cancer, so changing some of these lifestyle habits can lower the risk for colorectal cancer as well as other types of cancer. Maintaining a healthy weight, including vegetables, fruits, and whole grains in the diet, reduce intake of alcohol and avoid smoking are few of the best ways to reduce risk of cancer. What can go a long way to help are screening awareness, self help programs, support groups and awareness of the options of treatment.