Why Colorectal Cancer Continues To Be A Common Concern Even Today

Our sedentary lifestyle is often the problem for most health conditions. One of the main causes of colorectal cancer is living an unhealthy lifestyle. So, what is colorectal cancer (CRC)? It is cancer that is caused in the colon or the rectum. The rectum is basically the track of the large intestine that connects the colon to the anus in a human body. This type of cancer is also known as Colon Cancer or Bowel Cancer.

There are many screening techniques that have been developed in order to detect and test colorectal cancer. In India, the annual incidence rates for colon cancer and rectal cancer in men are 4.4 and 4.1 per 100,000. In women, the annual rate for colon cancer is 3.9 per 100,000. With the advent of technology, it is possible to diagnose as well as treat cancer at an early stage, thus posing lesser risks to the patient.

Understanding the risk factors

There are several risk factors responsible for cancer which can be either due to lifestyle or non-modifiable risk factors. The non-modifiable factors include:

Age: With an increase in the age of an individual, the risk of catching up with this kind of problems increases as compared to younger ones

Personal History of Colorectal polyps: There is a certain type of polyp called an adenomatous polyp that can increase the risk of CRC. A colon polyp is a small clump of cells that forms on the lining of the colon

Genetics: Inherited genes may increase your colorectal cancer risk. Family history may determine when your doctor will recommend a colonoscopy to screen for colorectal cancer.

Contribution of a bad lifestyle to the disease:

Lack of physical activity leading to obesity can increase the risk of colorectal cancer

Consuming an unhealthy diet, especially low fibre diet can be risky

Alcohol consumption on a regular basis can be harmful

Smoking can be another factor

Symptoms to watch out for

The symptoms of colorectal cancer are rectal bleeding which includes bleeding during excretion, a sudden change in bowel habits, blood in faeces that make the stool look black, sudden weight loss, abdominal pain or cramps that sustain for a while and diarrhoea or constipation. Make sure that you consult the doctor in case of any symptom faced.

The importance of early screening

The most effective way to reduce your risk of colorectal cancer is to get screened routinely, beginning at age 45. Colorectal cancer begins as precancerous polyps (abnormal growths) in the colon or rectum. Screening helps find the cancer tumour in its early stage and, this way, the condition can be better managed. If there is family history of cancer in either first degree relative or second degree relative, the screening can begin 10 years prior to the age of diagnosis of the first case of colon cancer in the family.

Types of diagnosis and treatment

The treatment of the disease can be determined based on several factors like the size, location, stage etc. When diagnosed at an early stage, surgery is usually recommended to remove the cancer polyps. Apart from this, radiation and chemotherapy are also used to destroy the cancerous cells.

In recent times, there are new diagnosis and treatment options in place. With the approach of personalised medicine moving away from holistic ones, treatment is now focused on the wellbeing of the patient and faster recovery with multimodality approaches such as surgery, radiotherapy, and chemotherapy. 

Faecal Occult blood Test (FOBT) and Colonoscopy are two methods of screening. When diagnosed in the early stage, the treating physician may be able to remove the tumour completely during a colonoscopy or surgical removal of the tumour is done.

In advanced stage of CRC, multi-modality approach is mandatory. Surgery is done either to relieve obstruction upfront via colostomy if patient came with obstructive symptoms; partial colectomy, lymph node dissection with or without metastatectomy(removal of secondary cancerous growththat have spread from cancer originating in another organ in the body) of the resectable metastasis of liver or other organs could be done.

What one must remember is that treatment largely depends on the particular situation, including the location of the cancer, its stage and other co-morbidities. Once surgery is done, it is followed by chemotherapy, radiation, targeted drug therapy and immunotherapy.

In situations where the tumour is unresectable, the chemotherapy precedes surgery to downsize the tumour and get better surgical access and margins. In cases of rectal cancers with bleeding, chemoradiation followed by surgery opts.

Due to the molecular developments and the discovery of newer drugs even though there are many Stage 4 cancer the options of treatment have widened. The choice of treatment depends on the mutations present.

Despite the increasing rate of occurrence of Stage 4 disease, the appropriate choice and sequencing of the multimodality can convert the palliative treatment to curative. There are many situations where the stage 4 colorectal cancer patients who are treated on a palliative intent, have survived multiple lines of chemotherapy. Plus/minus targeted therapy with good quality of life and better overall survival.

Prevention is better than cure

Unhealthy lifestyle habits are linked to the risk of colorectal cancer, so changing some of these lifestyle habits can lower the risk for colorectal cancer as well as other types of cancer. Maintaining a healthy weight, including vegetables, fruits, and whole grains in the diet, reduce intake of alcohol and avoid smoking are few of the best ways to reduce risk of cancer. What can go a long way to help are screening awareness, self-help programmes, support groups and awareness of the options of treatment.

(The author is a senior Haemato-Oncologist, Omega Cancer Hospital, Hyderabad. Views personal)