Keeping your bowel safe from cancer

Cancers of the gut and colon can be cured completely if detected and treated early

Spells of good health and illness are a part of life. But, of late, noncommunicable diseases are taking a heavy toll on the health and economy of the world as they are penetrating deeper into societies, afflicting many more people. Cancers, for instance, are rising in number and prevalence.

Among all forms of cancer, colonic (gut) and rectal or anal cancers are on the rise significantly. Colorectal cancer (CRC) is third-most-common cancer worldwide, with approximately 1.80 million new cases in 2018. This cancer arises from the lining of the colon and rectum. Polyps — benign cellular lumps (abnormal growth of cells) — are found on the lining of the rectum and colon. Some of these polyps, over time, may change in character to become cancerous.

The symptoms of CRC include the change in bowel habit, rectal bleeding, rectal mass, sudden loss of weight and anaemia. Some people may experience pain and abdominal distention.

Colonoscopy is the most effective method of screening to detect colon cancer. Histopathology of a sample of the growth will say if it is cancerous.

Reduce your risk for CRC

If diagnosed and treated early, colorectal cancers are curable. Once diagnosed, treatment depends on the stage, location and overall health of the patient. Treatment options include surgery, chemotherapy, radiation, and targeted therapy. This is why people should never ignore symptoms and go for screening soon.

Prevention is always better than cure. While CRC is not entirely preventable, you can bring down your risk with a healthy lifestyle, regular exercise, a balanced diet with fruit, vegetables, whole grains and foods containing fibre, awareness of the symptoms, and seeking help when concerned. A routine check after the age of 40 years can be useful in certain high-risk groups or when symptomatic. A colonoscopy done at that point can remove pre-cancerous polyps or identify cancers at a very early stage.

High-risk groups comprising people with inflammatory bowel diseases, family history of cancers, familial syndrome families and those prone to polyps need early and regular screening. Symptomatic patients need colonoscopy as a gold standard. Generally, everyone over the age of 40 years is at risk. However, whether regular annual screening is justified in the absence of high incidence and prevalence as in the West is questionable.

Risk factors

Longer life spans as seen today, better diagnostic facilities, more effective and efficient treatments, affordability, awareness and increasing risk factors are some of the causes of increasing incidence and prevalence of CRC.

The common risk factors for gut and butt cancers include advanced age; a sedentary lifestyle; excessive alcohol and tobacco consumption; obesity; regular consumption of red meat, processed meat, high-fat diet; and inadequate consumption of dietary fibre and fruits.

There are other risk factors too. Inflammatory bowel disease such as Crohn’s Disease and ulcerative colitis, family history of cancer or polyps, familial adenomatous polyposis (FAP), a genetic syndrome, and Lynch syndrome - an inherited condition, increase the risk of colon cancer.

Intestines are called gut. The large intestine is about two metres long. Within the large intestine is a micro-biological environment. Organisms live in it in symbiosis. Disruption of the balance here is known to cause gut problems and also cancers. The risk factors that damage the lining of the gut play a role in causing cancer. The risk factors include processed foods, a high-fat diet, excessive red meat and lack of fibre in the diet.

Maintaining a healthy eating habit with a balanced diet is vital for good gut health. As important as eating healthy is the evacuation of the waste. An unhealthy toilet habit and toileting positions can lead to stools rich in toxic metabolites such as ammonia. This causes damage to the lining of the colon and rectum. The damage triggers a change in the cells which are precursors for cancers.

Preventing cancer is to a large extent in your hands. Stick to the traditional home-cooked food rich in balanced nutrients and greens. Get a daily dose of exercise and keep your weight in check. Finally, go for proper toileting postures that give maximum exercise to the bowel muscles.

(The author is a colorectal surgeon)