Both men and women above the age of 50 years are at risk for colorectal cancer, the risk increases more so with increasing age. Colorectal cancer is a leading cancer killer. There is strong scientific evidence that screening for colorectal cancer beginning at age 50 can save lives!

WHAT IS COLORECTAL CANCER?

Cancer is a disease in which cells in the body grow out of control.

Colorectal cancer is cancer that occurs in the colon or rectum. The colon is the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus.

SCREENING SAVES LIVES

If you’re 50 or older, getting a colorectal cancer screening test could save your life.

Here’s How:

• Colorectal cancer usually starts from precancerous polyps in the colon or rectum. A polyp is a small outgrowth that shouldn’t be there.

• Over time, some polyps can turn into cancer.

• Screening tests can find precancerous polyps, so they can be removed before they turn into cancer.

• Screening tests also find colorectal cancer in early stages, when treatment works best.

AM I AT INCREASED RISK of COLORECTAL CANCER

Your risk for colorectal cancer may be higher than average if:

• You or a close relative have had colorectal polyps or colorectal cancer.
• You have inflammatory bowel disease like Crohn’s disease, or ulcerative colitis.
• You have a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer(HNPCC).

If you fall in the increased risk category, speak with your doctor about when to begin screening, which test is right for you, and how often you should be tested.

WHAT ARE THE SYMPTOMS OF COLORECTAL CANCER?

People who have polyps or colorectal cancer don’t always have symptoms initially. Someone could have polyps or colorectal cancer and not know it. If there are symptoms, they may include:

• Mucous and Blood in stool
• Altered bowel habit
• Recurrent Pains, aches, or cramps.
• Unwanted weight loss.
• Anaemia

If you have any of these symptoms, talk to your doctor. They may be caused by something other than cancer. However, the only way to know what is causing them is to see your doctor.

TYPES OF SCREENING TESTS

Fecal Occult Blood (gFOBT) /  Fecal Immunochemical (FIT) test : used to detect invisible blood in stool.

How often:  once a year.

Flexible Sigmoidoscopy (Flex Sig)

The a short, thin, flexible, lighted tube into your rectum, and checks for polyps or cancer inside the rectum and lower third of the colon.

How often: Every 5 year.

Colonoscopy

Similar to flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.

How often: Every 5-10 year.

Dr Pinak Dasgupta

consultant
Dept. of Colorectal canceer

Colorectal cancer is cancer that affects the large intestine (colon) and rectum. It is the second leading cause of death from cancer in the US. When looking at India, the western world have a higher number of new cases, but surprisingly in last decade in India alsocolorectal cancer is increasing rapidly due to poor dietary habit, lack of physical activity, obesity, increased alcohol consumption and chronic smoking.  Now in India,colorectal cancer has been ranked 5^th leading cause of cancerdeath. In last decade it had been noticed in the US that colorectal cancer death rate decreasing mainly due to increased awareness about colorectal cancer in society and increased number voluntary screening for colorectal cancer that allow early detection and removal of polyp before they progress to cancer. As compared to the western world although we are having a lower incidence of colorectal cancer, but unfortunately associated witha higher death rate as most the casesare usually diagnosed in advanced stages only.

The good news about colorectal cancer is that almost all cancer arises from polyps, which are a non-cancerous stage. This polyp exists in the colon many years before they turn to cancer.  Thus if you develop colonic polyp and they are removed timely, itdecreasesthe risk for development of cancer. Even if polyp turnsinto cancer but if diagnosed in the early stage it is definitely curable through keyhole surgery andwill lead to normal life. Unfortunately, if colon cancer progresses and invades the deeper layers, the chance of survival decreases but there is still more 50% chance of cure with multidisciplinarytreatment that includes keyhole surgery, radiationand chemotherapy. But if colorectal cancer had spread beyond, people often succumb within a few years.

SYMPTOMS

            Most of the early-stage colorectal cancer has no symptoms at all. But few patients may come with generalized weakness and low haemoglobin level. In late stagespatients present with pain in the abdomen, abdominal mass, blood in the stool, thin stool, incomplete evacuation and new onset constipation.

RISK FACTOR:

• Older age
• Familial History of colorectal cancer.
• Environmental factors such as diet and lifestyle, mainly high fat more red meat and low fibre.
• Obesity à50 to 80% more likely in obese people.
• Chronic smoking and alcohol consumption.
• Known case of ulcerative colitis and Chron’s disease

TREATMENT:

            In the present era,colorectal cancer is100% preventable, treatable and absolutely beatable.Colorectal cancer can be cured if it is removed from the body before it spreads to other organs;

• If polyp can be cured without surgery.
• If early-stage cancer can be cured with keyhole surgery.
• If an advanced stage can be treated with keyhole surgery along with chemotherapy and radiation
• Even for metastatic disease with spread to the liver can be managed very well with newer drugs followed by keyhole surgery.

Thanks to advancement in medical technology,through keyhole surgerywe can perform rectal cancer surgery without any stoma in more than 95 % cases.

SCREENING TOOL:

            We would advise a normal person without riskto docolonoscopy starting at the age of 50 and to repeat every 10 years.This will reduce up to 95% chance of getting cancer. But too high-risk person such as,familial cancer history or having IBD we recommend to do colonoscopy from the age of 40 years or ten years before they reach the age of their family member who developed cancer.

            Unfortunately, in India, less than 5% of adults are screened appropriately for colorectal cancer. It is distressing to us being colorectal surgeons to see individuals diagnosed with advanced cancer who never had been screened for colon cancer even though visiting multiple physicians and undergoing yearly health checkups.

HOW DO REDUCE RISK:

We recommend,

• To adhere to a healthy diet, low fat, high fibre, fruits and vegetables.
• Red meat should be limited to less than two servings per week.
• Regular exercise – 45 minutesof moderate activity per day.

To conclude we can say that sensible modification of diet and lifestyle will decrease 70% risk of colorectal cancer.If you are 50 years oldor morecall your doctor today to schedule a colonoscopy and unfortunately if have colorectal cancer get treated with keyhole surgery for a better chance of cure.