In India, the annual incidence rates for bowel, colon, or rectal cancer in men and women are 4.4 and 3.9 per 100,000 individuals, making it the fifth most common cancer in the country. Bowel cancer is slowly becoming a serious concern in Indian adults. It’s a malignancy that starts in the big intestine (colon) and rear passage, sometimes known as the rectum. Colorectal cancer is another name for the disease. While bowel cancer is more common in older adults, it can strike at any age, especially with a strong family history. As a result, your treatment is determined by where cancer begins in your bowel. Here are a few symptoms and treatment options for the disease.
Some red flags
The symptoms may differ from one patient to another, depending on the location of the tumour and stage of development. Persistent bloating after eating, changes in bowel habits, constipation, blood in the stool, abdominal pain, unexpected weight loss, abdominal or anal mass, and even iron deficiency anaemia are all red flag indicators of bowel cancer and must not be ignored. Bowel cancer will most likely spread to the liver and lungs if left untreated. If you experience any of the symptoms listed above and they last longer than 2-3 weeks, you should see your doctor right away.
Risk factors for bowel cancer
Risk factors are categorised into genetic and environmental. The environmental risk factors include smoking, processed meat, red meat, obesity, lack of fibre, sedentary lifestyle etc. Genetic and familial conditions such as familial adenomatous polyposis, HNPCC (Lynch syndrome), polyposis etc., predispose patients to cancer at an early age. If you fall into one or more of the following categories, you’re more likely to develop bowel cancer:
A strong family history of bowel cancer
Aged over 50
Non-cancerous growths (polyps) in your bowel
Longstanding inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
An unhealthy lifestyle
Early detection saves lives and there are several screening procedures available, but a colonoscopy is a gold standard for detecting colorectal cancer.
Other tests such as faecal occult blood, serum CEA, flexible sigmoidoscopy and virtual colonoscopy have all been utilised. Patients with a significant family history of cancers suggesting familial cancers need screening at an early age.
Treatment of bowel cancer
The treatment for colorectal cancers is influenced by the stage and location of cancer. Stage I and 2 cancers are predominantly treated by surgery. Stage III cancer is treated by surgery followed by chemotherapy and at times vice-versa. Stage IV cancers are treated predominantly with chemotherapy followed by surgery in the vast majority.
Radiotherapy is an option that is considered for rectal cancers only. This has been utilised for locally advanced cancers or cancers at risk of recurring once operated. In summary, surgery is the most common treatment for bowel cancers and may be supplemented with chemotherapy, radiation, or biological treatments, depending on the stage and location.
If bowel cancer is detected early, it may be possible to remove just a tiny piece of the lining of the colon/rectal wall, a procedure known as local excision; but, if the disease has spread to the muscles surrounding the colon/rectum, a colectomy/total mesorectal excision is usually required. A colectomy/rectal resection can be done in one of three ways:
An open colectomy is a procedure in which your surgeon creates a wide cut (incision) in your abdomen and removes a portion of your colon/rectum.
A laparoscopic colectomy/rectal excision is a procedure in which a surgeon makes a series of small incisions in your abdomen and removes a portion of your colon /rectum, using special instruments guided by a camera.
Robotic-assisted surgery (RAS) is a more advanced modality of minimally invasive surgery where the surgeon’s instruments guide the robot arms, which helps remove the cancerous section.
(The author is a colorectal surgeon.)
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