Colorectal Cancers on Rise
In the last issue, we discussed Colorectal Cancer and its rising incidence, especially in Kashmir. We went through the risk factors which included being overweight or obese, have a sedentary life style, consume a diet scarce in fresh fruits and vegetables and rich in processed foods and red meats.
Having anemonas (polyps), Vitamin D deficiency, working night shifts for a long time, Inflammatory Bowel Disease (IBD) and family history of cancers are also additional conditions that increase the risk of getting this type of cancer.
Early diagnosis of cancers, including Colorectal Cancers can help in better management and treatments. It is therefore important to recognise the symptoms.
SYMPTOMS OF COLORECTAL CANCER:
Colorectal cancer might not cause symptoms right away, but if it does, it may cause one or more of these symptoms:A change in bowel habits, such as diarrhoea (Loose stools), constipation, or narrowing of the stool, that lasts for longer periods of time.
A feeling that you need to have a bowel movement that’s not relieved by having one. Rectal bleeding with bright red blood. Blood in the stool, which might make the stool look dark brown or black. Cramping or abdominal (belly) pain. Weakness and fatigue.
Unintended weight loss.Colorectal cancers can often bleed into the digestive tract. Sometimes the blood can be seen in the stool or make it look darker, but often the stool looks normal. But over time, the blood loss can build up and can lead to low red blood cell counts (anemia). Sometimes the first sign of colorectal cancer is a blood test showing a low red blood cell count. And unfortunately, some people may have signs that the cancer has already spread to other parts of the body.
A study from SKIMS in 2019 showed that about 96% patients were non-vegetarian and most patients (75%) presented with change in bowel habits A worrying trend the study showed was that about 50% of the patients had stage III disease at presentation.
Reasons of diagnosis at a later stageThe most important reason in the Kashmiri population is the lack of awareness among the people regarding the disease and that the symptoms especially bleeding per rectum, unexplained weight loss, unexplained anaemia can be due to Colon cancer.
People especially females are very reluctant and very shy about disclosing the symptoms, seeking medical attention and getting colonoscopies done. Most patients attribute their gastrointestinal symptoms to Intestinal infection( sic) and usually take a lot of medications, antibiotics , probiotics, antisecretory medications(loperamide) from local chemists before seeking opinion from primary care physicians or a gastroenterologist.
Diagnosis
The best diagnostic tests are visual examination of the colon using a colonoscope where in the tumor if present can be visualised, biopsied and even removed and this is the reason that screening tests for colorectal cancer are very cost effective. Polyps which can develop into malignancies over years or polyps which may contain malignant cells can be removed in toto thus protecting the person from the disastrous effects of malignancy.
Colonoscopy
For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, a flexible tube with a light and small video camera on the end. It’s put in through the anus and into the rectum and colon. Special instruments can be passed through the colonoscope to biopsy (take a sample) or remove any suspicious-looking areas such as polyps, if needed.
Flexible sigmoidoscopy
A flexible sigmoidoscopy is similar to a colonoscopy except it doesn’t examine the entire colon. A sigmoidoscope (a flexible, lighted tube about the thickness of a finger with a small video camera on the end) is put in through the anus, into the rectum and then moved into the lower part of the colon.
But the sigmoidoscope is only about 2 feet (60cm) long, so the doctor can only see less than half of the colon and the entire rectum. Images from the scope are seen on a video screen so the doctor can find and possibly remove any abnormal areas.
CT colonography (virtual colonoscopy)
This test is an advanced type of computed tomography (CT) scan of the colon and rectum that can show abnormal areas, like polyps or cancer. Special computer programs use both x-rays and a CT scan to make 3-dimensional pictures of the inside of the colon and rectum.
It does not require sedation (medicine to sleep) or any type of instrument or scope being put into the rectum or colon.This test may be useful for some people who can’t have or don’t want to have a more invasive test such as a colonoscopy.
It can be done fairly quickly however If polyps or other suspicious areas are seen on this test, a colonoscopy will still be needed to remove them or to explore the area fully.
Screening
The ACS recommends that people at average risk* of colorectal cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below.People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.
For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history.People over 85 should no longer get colorectal cancer screening.*For screening, people are considered to be at average risk if they do not have:
A personal history of colorectal cancer or certain types of polypsA family history of colorectal cancerA personal history of 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
Screening tests:
These tests can be divided into 2 main groups:
Stool-based tests: These tests check the stool for signs of cancer. These tests are less invasive and easier to have done, but they need to be done more often.
Visual (structural) exams: These tests (colonoscopy and sigmoidoscopy) look at the structure of the colon and rectum for any abnormal areas.
Stool Based Tests Fecal immunochemical test (FIT): The advantage is that there is no bowel preparation needed nor there is any direct risk to the colon, It is fairly inexpensive and can be done at home and does not require any pre-test dietary or medication change.
However, it may miss some cancers, needs to be done yearly and colonoscopy will be needed if abnormal.Guaiac-based fecal occult blood test (gFOBT):The advantage is that there is no bowel preparation needed nor there is any direct risk to the colon, It is fairly inexpensive and can be done at home.
However, it requires dietary and medication changes, it may miss some cancers, can have false positive report, needs to be done yearly and colonoscopy will be needed if abnormal.Stool-DNA tests.