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.

What is Fistula?

Anal Fistula (Fistula in Ano) is an abnormal passage or a track (communication) between the interior of the anal canal or rectum and the skin surface. Rarer forms may communicate with the vagina or other pelvic structures, including the bowel, says  Consultant Gastroenterologist, Dr S Srivatsan.

Historical connotation of Fistula:

The disease -anal fistula is as old as mankind. Thousands of years ago, Hippocrates made reference to surgical therapy for fistulose disease. English surgeon John Arderne (1307-1390) wrote “Treatises of Fistula in Ano; Haemorrhoids, and Clysters