What is Colo Rectal cancer?
The cancers which develop in Large Intestines (From Rectum to Caecum) are called Colo Rectal Cancers (CRC).Colon cancer and rectal cancer are often grouped together because they have many features like risk factors, symptoms, prevention, diagnosis and management options in common.
Anyone can suffer from colorectal cancer and often symptoms are difficult to identify in the early stages. Cases are usually detected at very advanced stages of the disease due to lack of awareness and non-specific symptoms. This makes it all the more important for individuals to learn about the risk factors, symptoms, prevention, management, and treatment options.
How common is Colo Rectal Cancer?
A study from SKIMS Soura in the year 2011 showed the crude incidence rate of colorectal cancer in both males and females at similar rates with rest of India with crude rates of 3.65/1 lakh population. Srinagar had the highest number of cases and Kupwara the lowest.
In 2019, department of Community Medicine, GMC Srinagar reported that Colo Rectal cancer was the most common malignancy in females and second most common malignancy in males.
It is expected that the incidence of colon cancers may increase in the coming years due to change in lifestyle and eating habits. There is a notion that Kashmiri population may outnumber the incidence of colorectal cancer as compared to the rest of India.
Risk Factors
Presence of a risk factor, or even many, does not mean that one will get the disease. And many people who get the disease may not have any of the known risk factors. The links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer. Some of the risk factor for CRC are summarised as
- Being overweight or obese.
- Physical inactivity.
- Consumption of a diet high in red meat (beef, lamb) and processed meats.
- History of adenomatous polyp.
- Inflammatory Bowel Disease.
- Family history of colon cancer.
- Low blood level of vitamin D.
- Cooking meat at very high temperature.
- Smoking for longer time (more pack years).
- Moderate to heavy use of alcohol.
- Diabetes Mellitus
Symptoms of Colorectal Cancer
The patients with colorectal cancer a may not have any symptoms at all. Some of the symptoms reported by patients are summarised here:
- Change in bowel habits-diarrhoea, constipation, narrowing of stools.
- A feeling of incomplete evacuation of bowels.
- Rectal bleeding- Fresh red blood.
- Blood in stools which might look dark brown or black.
- Abdominal pain which may not be located to any specific area.
- Weakness and easy fatiguability.
- Unintended weight loss
Reasons of Diagnosis at Later Stage
There is lack of awareness among the people about the symptoms of the disease. People are not well aware that the symptoms especially bleeding per rectum, unexplained weight loss, unexplained anaemia can be due to Colon cancer.
People especially females are very shy and reluctant about disclosing the symptoms to even family members. They are reluctant to seek medical attention and getting colonoscopies done. Most of patients attribute their gastrointestinal symptoms to gastric and intestinal infection and usually take lot of medications like antibiotics, probiotics, anti-secretory medications (loperamide) from local chemists before seeking opinion from primary care physicians or a gastroenterologist.
Diagnosis
Colonoscopy is the best diagnostic test for visual examination of the colon where in the tumor if present can be visualised, biopsied and even removed via polypectomy, ESD or EMR. This is the reason that screening tests for colorectal cancer are very cost effective and can be therapeutic at times. Polyps have a tendency to develop into malignancies over years and polyps which may contain malignant cells can be removed completely endoscopically thus protecting the person from the disastrous effects of malignancy.
Prevention and Screening
Modifying the risk factors mentioned above and following some useful and time tested life style modifications have been shown to reduce the incidence of colon cancer.
Maintaining a healthy weight may help lower the risk
- Being more active with regular moderate to vigorous activity lowers the risk of colorectal cancer and polyps.
- Diets that are high in vegetables, fruits, and whole grains, and low in red and processed meats, probably lower colorectal cancer risk.
- Avoiding and stopping smoking prevents colon cancers.
- Avoiding Alcohol is highly beneficial in preventing colon cancer.
- Adequate quantity of vitamins, calcium, and magnesium may help reduce the risk of CRC.
- Calcium and vitamin D might work together to reduce colorectal cancer risk.
Who Should Be Screened
There is no Indian guideline which talks about screening for colorectal cancer. The reason could be that the incidence of CRC in India is much less than western countries. Changing lifestyle and dietary habits may soon show an increase in the incidence of CRC in India.
American guidelines recommend that people with average risk of CRC should start regular screening at the age of 45 years.
People who are considered at high risk for developing CRC include:
- A personal history of colorectal cancer or certain types of polyps.
- A history of colorectal cancer in family.
- Persons who have inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
- A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
- A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
Treatment
When a person is diagnosed with a colorectal cancer, a multidisciplinary approach involving a gastroenterologist, surgeon, oncologist, pathologist and a radiologist is needed to determine the location, extent, vascular, nodal involvement and local or distant spread of the disease and to formulate an adequate treatment plan for the patient.
The management plan of each patient is different and depends on the factors mentioned and also the comorbidities, treatment resources and expertise. The most important thing in the management of colorectal cancers is the stage at which the cancer is diagnosed.
Take Home Message
The above mentioned symptoms should not be ignored. Primary care physician should be consulted in case anyone develops any of these symptoms. Awareness programs should be started by the concerned department and people should be made aware about this disease which if detected at early stage can be cured. Family members of people who suffer from colorectal cancer should be screened for possibility of the disease.
(The Author is MD/DrNB (Gastroenterology BLK-MAX New Delhi). Gastroenterologist and Hepatologist and Life Member Indian Society of Gastroenterology)
