What you should know about colorectal cancer

Rapid urbanization and changing of culture has led to many diseases. Colorectal Cancer (CRC) is one such disease that can be attributed to the negative impact of changing lifestyle and food habits. Consumption of tobacco, alcohol, a diet high in processed meat and low in fiber, obesity, and low physical activity are common causes of colon cancers.

Colorectal Cancer is the third most common cancer in world, with over a million new cases added every year. In India, over 50,000 new colorectal cancer cases are detected every year, and this number is rising at an alarming rate of over 20% each year! As per the Cancer Registry data of the Mumbai region which also reflects a trend across India, it is the 10th and 8th most common cancer in men and women respectively. In India, the projected number of new cases of CRC by 2025 would about 83,000 cases. This can be attributed to rapid urbanization and the adoption of sedentary lifestyles.

What is colorectal cancer?

Colon is part of our digestive system. As the food keeps passing along the digestive tract, nutrients within it get absorbed. The Colon turns the liquid form of unused food into solid by absorbing water, which is expelled as feces. CRC is a disease in which cancer cells form in the tissues of the colon or the rectum. Our body has around 30 trillion cells which have pre-programmed rules governed by our genes about how to behave. In simple words, cancer cells defy all these rules and multiply fast invade nearby structures of our body, and can spread to a distant location within the body in late stages to form a new tumour.

Generally, this is seen in a population above 45 years of age, with complaints of changes in bowel habits like a repeated history of constipation or diarrhoea, bloating, the passage of blood or mucus in the stool, unexplained weight loss, easily fatigued, pain or swelling in the abdomen or drop in Hemoglobin levels, during routine investigations. Persons with a strong family history of CRC may have these features in their twenties even. In around 20% of the cases, patients first present with advanced disease with bowel obstruction and have to undergo emergency surgery.

Compared to other digestive cancers, CRC relatively has a far better prognosis, still, early diagnosis is of utmost importance. Lack of awareness about the significance of these symptoms, seeking late help from the doctor, ignorance about own family history of cancer, remote access to certain diagnostic modalities and health expertise in rural areas are the main reasons for its late diagnosis. Very often it could be a sign or symptom, such as a change in stool colour to red or black, which should be immediately consulted. At times, bleeding from the rectum is assumed to be due to common ailments like Piles by the patient, and even treatment from quacks is sought until late stages of cancer. It is of crucial importance to know who in our relations has had what disease at what age, and the exact relationship, as it helps in risk stratification and recommendation for screening for CRC.

Among the multiple screening methods, the most important is recommending a Colonoscopy at the age of at least 45, for the average-risk population. Patients having a family history of CRC or those showing sign/ symptoms as mentioned above should seek early colonoscopy after discussion with your doctor. The frequency of repeat colonoscopy will be decided in accordance with the patient’s age, family history and findings of the first colonoscopy.

Lifestyle modification can be an important adjunct to screening. Avoiding risk factors and adopting certain protective measures can be of great help. Avoid smoking and alcohol consumption which are carcinogenic. Studies also suggest that avoiding high-calorie foods, red and processed meat also reduce the risk of CRC, perform regular physical exercise with moderate intensity, and maintain healthy body weight to minimize the chances of CRC. One should eat a diet having vegetables, fruits and whole grains which are high in fibre. High fibre diet not only reduces the risk of CRC but also heart diseases

(The writer is Consultant Surgical Oncologist at a network of hospitals in Maharashtra)