Colorectal cancer

Colorectal cancer

Overview

Colorectal cancer, also called rectal cancer, bowel cancer, or colon cancer, is cancer that affects the colon as well as the rectum. Both Colon & Rectum are parts of the large intestine. Colorectal cancer has a very high prevalence and is among the second most common malignancy diagnosed, 1 in 18 people, after Breast cancer. Colorectal cancer tends to affect both men and women. However, men tend to develop it at a younger age.

Symptoms

Symptoms of colorectal cancer include:

  • Pain and bloating in the abdomen
  • Rectal bleeding
  • Mucus discharge
  • Extreme pain on defecation or when passing stools
  • Blood in faeces giving black stool appearance.
  • The sensation of a lump in the anus.
  • Change in bowel habits.
  • Fatigue or tiredness
  • Unexplained weight loss

Most of the above symptoms may also indicate other potential conditions. It is important to check with a doctor if symptoms persist for more than four weeks.

Risk factors

  • Low fibre diet
  • Diet rich in red meat & animal fat
  • High alcohol consumption
  • Smoking
  • Older age
  • Family history of colorectal cancer
  • Overweight or Obesity
  • Lack of physical activity
  • Human Papilloma virus infection
  • HIV infection
  • Familial Adenomatous Polyposis
  • Ulcerative colitis
  • Genetic diseases like Peutz-Jeghers syndrome, Gardner’s & Turcot’s syndrome etc.

Diagnosis

What Screening tools are used for diagnosing Colorectal Cancer

  • Digital rectal examination – Simple procedure that is helpful in detecting any masses and bleeding per rectum. It is recommended once a year after the age of 40 years and serves as effective mode of screening.
  • Faecal occult blood test – hidden blood in the stool is detected. Recommended once every year after the age of 40.
  • Flexible sigmoidoscopy – for visual examination of the rectum and lower portion of the colon only. Recommended once in 5 years after the age of 50 years.
  • Colonoscopy – for visual examination of the rectum and entire colon. The patient should be on a liquid diet for 1-2 days before the test. Small procedures like biopsy & polypectomy can be done while performing the procedure. The patient will be on sedation while on this procedure. Recommended once every ten years after the age of 50 years.
  • Double-contrast Barium Enema / X-ray — Useful in understanding the lining of the intestine. Recommended once in every 5-10 years above the age of 50 years.

 Other investigations helpful to confirm the diagnosis

  • Blood tests – to check for anaemia.
  • MRI &/or CT scans — to check for metastasis/spread of cancer to other parts of the body and staging of cancer. These investigations are very helpful as the final decision on the treatment mainly depends on the staging and metastasis of cancer.

Treatment

While treatment options may include chemotherapy, radiotherapy and surgery, it depends on many other factors, such as the present overall health status of the patient, the location, size and stage of cancer and whether the cancer is recurrent or not.

Surgery for Colorectal Cancer:

Surgery is the treatment of choice for all resectable colorectal tumours. Also, in Rectal cancers, Neo-adjuvant therapy may be recommended prior to surgery depending on the stage. In Colon & Rectal cancers, Adjuvant treatment in the form of Chemotherapy and Radiotherapy may be required depending on the final staging.

Chemotherapy:

Chemotherapy involves making use of medications or chemical to destroy the cancer cells. It is generally used for treating colorectal cancer before surgery, as it may help shrink the tumour.

Radiation therapy:

Radiation therapy makes use of high energy radiation beams to kill and to prevent cancer cells from multiplying. This is more commonly used for rectal cancer treatment. It is generally used before surgery in an attempt to reduce the size of the tumour.

Both chemotherapy and radiation therapy may be given after surgery to help lower the chances of recurrence.

Prevention

  • Timely screening above 45 years
  • Eat a balanced diet rich in fibre and more liquids along with more fruits, vegetables and whole grains
  • Maintain ideal weight – regular physical exercise
  • Stop smoking and take alcohol in moderation if at all needed

Conclusion

Numerous lifestyle measures, such as regular screenings, moderate, regular exercises, nutritional diet, and maintaining healthy body weight, can reduce the risk of getting colorectal cancer.