Colorectal or bowel cancer

Introduction

Colorectal or bowel cancer is cancer of the colon or rectum. Worldwide, an estimated 1.23 million new cases of colorectal cancer were diagnosed in 2008. Colorectal cancer is the third most common cancer in men (663 000 cases, 10.0% of the total) and the second in women (570 000 cases, 9.4% of the total) worldwide. In India, Colorectal cancer ranks as the fifth most common cancer, with 64,332 cases of colorectal cancer diagnosed in 2012. Although this accounts for only 6.3% of the cancers, the mortality or death rate in India is amongst the highest worldwide due to late presentation and diagnosis.

Risk Factors

• Family history of colorectal cancer
• Inflammatory bowel disease
• Obesity
• Physical inactivity
• Smoking
• Heavy alcohol consumption
• A diet rich in red or processed meat & inadequate consumption of fruits and vegetables

Symptoms

Early stages of colorectal cancer may not cause symptoms. However, the following may be an indication of the disease

• Anaemia
• Rectal bleeding or blood in or on the stool
• Change in bowel habits (constipation or diarrhoea)
• Stomach discomfort (bloating, fullness or cramps)
• Feeling of the bowel not emptying completely
• Anal pain or discomfort
• Weight loss for no apparent reason.

Tests & Diagnosis

The gold standard test for examining the colon and rectum is colonoscopy. Colonoscopy is a special test in which a flexible telescope is passed into the bowel to look for problems. Other tests will include blood tests, CT scans and sometimes MRI scans.

Screening for a disease means testing for a condition in people who do not have symptoms. The good news, as far as colorectal cancer is concerned is that there is a pre-cancerous stage. It is established that if we can pick up and remove these precancerous lumps or polyps by colonoscopy screening then we will reduce the incidence of colorectal cancer. Also picking up developed cancers at an early stage improves the outcomes and makes surgery a lot easier.

Although men and women above age of 50 are screened in western countries, the true incidence of colorectal cancer in India is not very clear due to lack of robust data and audit mechanisms. People who will definitely need screening in India are those with

• A family history of colorectal cancer or polyps
• Longstanding history of Ulcerative Colitis or Crohns disease
• Previously treated for colorectal cancer or polyps
• Developing new bowel symptoms for more than 6 weeks

Treatment

The treatment of colorectal cancer follows a multidisciplinary approach where a team of colorectal surgeons, medical oncologists, radiologists, pathologists and specialist nurses provided integrated care. The mainstay of treatment for colorectal cancer is surgery. Minimally invasive techniques such as laparoscopic or robotic colorectal surgery are the latest treatments being offered at Apollo Hospitals Chennai for colorectal cancer. The major advantages of these new techniques are less pain, faster recovery, lesser complications and excellent cancer cure rates. More importantly with these advanced techniques we are able preserve normal route of defecation avoiding permanent colostomy or bags. Sometimes it may be necessary to add chemotherapy or radiotherapy to standard treatment to improve outcomes.

Prevention

Prevention is always better than cure. Following a healthy lifestyle could help avoid the condition

• Increasing physical activity and exercising regularly helps maintain weight in the ideal range.
• Ensure a high fiber diet rich in fruits, vegetables, nuts, beans and whole grains.
• Consume calcium rich foods like low fat or skim milk,
• Limit red meat consumption and avoiding processed meats and foods
• Stop smoking and reduce alcohol intake

Creating awareness about colon and rectal cancer will help patients to seek help earlier. A major problem we face as clinicians is that patients presume all rectal bleeding and related problems are due to piles or haemorrhoids. Very often we do see patients treated for piles for months landing up in out patients with advanced colorectal cancer. So remember the golden rule: if anyone has colorectal symptoms mentioned above for more than 6 weeks, they should have themselves checked by a doctor!

Dr Venkatesh Munikrishnan

MRCS(Ed), FRCS(UK), CCT(UK),
Consultant Colorectal Surgeon