How do you know if you have Colorectal Cancer?

Hey Bangaloreans, how is March going for you? Are you enjoying the spring scented warm breeze? As you huff and puff through the long warm months in this city, juggling office, kid’s school, spouse’s seasonal allergies, you suddenly feel homesick. You call your parents. They inform you that your distant uncle or aunt, a vague, blurry face in your memories, has cancer. Colorectal Cancer. A niggling thought clouds your mind. What do you know about this deadly disease? Is there any way you can protect your own from Colorectal Cancer? You can always take the first step by understanding the disease.

What is Colorectal Cancer?

Picture the digestive system. Remember the area in the large intestine called colon that continues into the rectum? Pre-cancerous polyps develop from the lining of the colon or rectum, leading to a colon or rectal cancer. The name depends on the site of origin. The term colorectal cancer groups together these two characteristically similar types.

Who can get Colorectal Cancer (CRC)?

There are two types of risk factors, as described below.

Non-Modifiable risk factors

These are unchangeable modifiers.

• Mean age of CRC patients in India: 47.2 years
• Around 65% of the patients are male
• The likelihood of CRC increases with age, markedly above 50 years of age.
• Studies note an alarming increase in CRC reports from male patients still less than fifty years of age.

CRC in India

Incidence of Colorectal Cancer India differs in pattern from other countries. A prospective study carried out at the Tata Memorial Hospital, Mumbai on data collected from CRC patients between August 2013 and August 2014 revealed:

• Patients are younger.
• A higher number of Indian patients present an advanced stage of the disease.
• Signet ring carcinomas are proportionately higher.
•  Our countries socioeconomic disparity and insufficient access to healthcare could factor in these differences.

Besides age, medical history plays a role in predisposition.

1. 1. Do you have a history of adenomatous Colorectal Polyps or Colorectal Cancer? Larger size and count of polyps impose a higher risk of developing CRC.
   2. Were you diagnosed with your first colorectal polyp at a younger age?
      • If you had a CRC earlier, even after complete removal, you could develop cancers in other areas of the colon and rectum.
   3. Have you ever had any types of inflammatory bowel disease (IBD) like ulcerative colitis or Crohn’s disease?
      • If yes, you should consider going for regular screening from a younger age as you have a comparatively higher chance of CRC.
   4. Do you have a family history of Colorectal Cancer?
      • How close was the relation?
      • How young was the patient at the time of CRC development
      • How many of your close relatives had CRC?

Each of the above factors increases your risk.

1. Some genetically inherited syndromes like Familial Adenomatous Polyposis and Hereditary Nonpolyposis Colorectal Cancer (Lynch syndrome) can increase the risk of colon cancer.

Modifiable risk factors

You can modify your lifestyle to reduce the probability of developing CRC.

• Obesity
• Smoking
• Type 2 diabetes/ insulin resistance
• Heavy alcohol consumption
• Sedentary lifestyle, lack of regular activity and exercise
• Dietary habit includes red meat and processed meat
• Previous abdominal cancer treatment with radiation

Can you prevent CRC?

There is no absolute way, but you can control some aspects of your habits.

• Maintain a healthy weight
• Increase overall physical activity
• Consume limited red and processed meats
• Include more vegetables and fruits in your diet
• Avoid too much alcohol
• Quit smoking

Go for regular screening if your physician determines you are an individual at high risk. Sooner the polyps are detected, the lesser chance they become cancerous.

How do you know it’s time to see a doctor?

• When you notice a change in your bowel habits, e.g. chronic diarrhoea or constipation
• A nagging feeling that you can’t empty the bowel or an urgent need to pass the motion
• A change in stool consistency
• Dark patches of blood in/on the stool which can mean Rectal Bleeding
• Chronic abdominal cramps and bloating
• Can’t explain the recent loss of appetite or weight loss or why you have been feeling weak and fatigued
• You have pelvic pain, a warning sign as it usually appears at a later stage of CRC

Remember, many CRC patients can be asymptomatic during the early stages and remain undiagnosed until much later. Also, CRC symptoms differ in patients and depend on the size and location of the tumour in the intestine.

Is there no way you can ensure an early detection?

• You can, if you go for regular screening
• Early detection increases the possibility of curing Colorectal Cancer
• You can even avoid a CRC as some types of polyps can be removed if detected soon enough and can’t turn cancerous.

Which tests can help an early detection?

• Faecal occult blood test (FOBT) checks the presence of blood in the stool, usually from a polyp or cancer source
• Colonoscopy finds polyps or growth by inserting a long flexible tube that investigates the entire colon and rectum.
• The flexible sigmoidoscope is a flexible tube with a light source at the end. When inserted into the rectum and lower colon, it looks for polyps or cancer
• CT colonography detects small polyps by scanning the colon and rectum

No screening guideline for CRC is available in India. Gastroenterologists have to rely on recommendations from the American Gastroenterological Association and other authorities related to medicine.

Who should definitely go for a screening:

• Regular screening of high-risk individuals with a close family history of CRC or polyps
• Patients with an inherited syndrome that increase the risk of Colorectal Cancer.

Screening method and frequency:

1. FOBT: every 1-2 years
2. Flexible sigmoidoscopy: every five years
3. Colonoscopy: every ten years in high-risk individuals.

Colonoscopy

• Once the doctor finds a patient’s symptoms suggesting CRC, he advises a colonoscopy.
• Colonoscopy remains the most widely used method of CRC detection.
• The doctor can observe the entire length of the colorectal area via colonoscopy
• For detailed information on colonoscopy, read this article on the RxDx website

March is the Colorectal Cancer month. Let’s spread awareness on this deadly disease as far and wide we can. Read and share the correct information among your friends and family as you join in the fight against cancer. Do you think you are at risk of developing Colorectal Cancer? RxDx Whitefield branch has state-of-the-art colonoscopy facility conducted by Dr Amrutesh, MBBS, MD (General Medicine), DNB (Gastroenterology). Call # today to book an appointment.

Go for early screening. Prevent cancer.

For further details, please contact: 080-49261111, 6745-8111