The month of March marks the awareness for Colorectal Cancer. This month, have a read on colorectal cancer and how to keep our large intestines in the pink of health.
The colon and the rectum are names given for the large intestine of the digestive system. They help in the absorption of water and the removal of solid waste from the digestive tract.
Colorectal cancer is an abnormal growth of cells and tissue (tumour) in the colon or rectum, which are parts of the large intestine. The cancer can spread (metastasize) to other parts of the body. It is the third most common cancer among men and the second most common cancer among women. In 2018, over 1.8 million new cases of colorectal cancer was recorded.
What are the causes of colorectal cancer?
Most cases of colorectal cancer start as abnormal growths called polyps on the inner wall of the colon or rectum. Other times, abnormal changes to genes (genetic mutations) can cause cells to form cancer.
What increases the risk for colorectal cancer?
Colorectal cancer is more likely to occur if you are older than 50, or have multiple polyps in the colon or rectum. A person with diabetes will also have increased risk of developing colorectal cancer. Diet plays an important part as well. A diet that is high in fat (especially animal fat) and low in fibre, fruits, and vegetables coupled with an inactive (sedentary) lifestyle will increase the risk of developing colorectal cancer. Smoking and excessive alcohol consumption are known risk factors as well.
What are the signs or symptoms of colorectal cancer?
Early colorectal cancer often does not cause symptoms. As the cancer grows, symptoms may include changes in bowel habits and feeling like the bowel does not empty completely after a bowel movement. Blood may be found in the stool, which may cause anaemia in the long run. Discomfort, pain, bloating, fullness, or cramps in the abdomen are also common symptoms and there will be unexplained weight loss with constant fatigue.
How is colorectal cancer diagnosed?
The doctor will make a query on your medical history and a physical examination will be performed. An initial digital rectal exam will normally be done in the clinic, followed by blood test and a stool test called faecal for occult blood. X-rays, CT scans and MRI scans will also be performed. The confirmation of diagnosis would require a colonoscopy. This test is done to view the inside of the colon. During this test, small polyps can be removed or biopsies may be taken.
Your health care provider may order additional tests to find out whether the cancer has spread to other parts of the body (what stage it is). The stages of cancer include:
- Stage 0. The cancer is found only in the innermost lining of the colon or rectum.
- Stage I. The cancer has grown into the inner wall of the colon or rectum.
- Stage II. The cancer has grown more deeply into the wall of the colon or rectum or through the wall. It may have invaded nearby tissue.
- Stage III. The cancer has spread to nearby lymph nodes.
- Stage IV. The cancer has spread to other parts of the body, such as the liver or lungs.
How is colorectal cancer treated?
Treatment depends on the type and stage of the cancer. Treatment may include:
- In the early stages of the cancer, surgery may be performed to remove polyps or small tumours from the colon. In the later stages, surgery may be performed to remove part of the colon.
- Chemotherapy. This treatment uses medicines to kill cancer cells.
- Targeted therapy. This treatment targets specific gene mutations or proteins that the cancer expresses in order to kill tumour cells.
- Radiation therapy. This treatment uses radiation to kill cancer cells or shrink tumours.
- Radiofrequency ablation. This treatment uses radio waves to destroy the tumours that may have spread to other areas of the body, such as the liver.
Instructions to follow at home:
- Take over-the-counter and prescription medicines only as instructed by your health care provider.
- Try to eat regular, healthy meals. Some of your treatments may affect your appetite. If you are having problems eating or with your appetite, consult a food and nutrition specialist (dietitian).
- Consider joining a support group. This may help you learn about your diagnosis and cope with the stress of having colorectal cancer.
- If you are admitted to the hospital, inform your cancer care team.
- Keep all follow-up visits as told by your health care provider. This is important.
How is colorectal cancer prevented?
Colorectal cancer can be prevented with screening tests that identify polyps so that they can be removed before developing into cancer. All adults should screen for colorectal cancer starting from age 50 and continue until age 75. Your health care provider may recommend screening at age 45. People with increased risks should start screening at an earlier age.
When to Contact Your Healthcare Provider?
Early detection is vital to increasing the effectiveness of treatment. You will be the first person to notice any abnormalities, therefore it is important to know what to look out for. Visit your healthcare provider if you have diarrhoea or constipation that does not go away. Blood in the stool is also an important sign to seek help right away. Unexplained weight loss, fatigue and weakness are also indicators that professional help is needed.
- Colorectal cancer is an abnormal growth of cells and tissue (tumour) in the colon or rectum.
- Common risk factors for this condition include having a relative with colon cancer, being older in age, as well as having inflammatory bowel disease.
- This condition may be diagnosed with tests, such as a colonoscopy and biopsy.
- Treatment depends on the type and stage of the cancer. Commonly, treatment includes surgery to remove the tumour along with chemotherapy or targeted therapy.
- Keep all follow-up visits as suggested by your health care provider.
Beets-Tan RGH et al: Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 28(4):1465-75, 2018
Bray F et al: Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clinical: 2018
Carmichael JC et al: Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc. 31(9):3412-36, 2017
Majumdar SR et al: How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol. 94(10):3039-45, 1999
Vogel JD et al: The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of colon cancer. Dis Colon Rectum. 60(10):999-1017, 2017
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