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Colon Cancer: A Worryingly Common Disease

HIGHLIGHTS:

  • People who overindulge in the following types of food are at a greater risk of colon cancer than the general population: fatty foods, large amounts of red meat, meat that has been grilled and charred, pickled marinated foods, salty foods and foods that are low in fiber.
  • If you experience any irregular symptoms, such as alternating between constipation and diarrhea or chronic constipation, it could be a signal that you are developing colon cancer. An appointment with a doctor is necessary to carry out a thorough diagnosis.
  • NBI (Narrow Band Imaging) technology involving a colonoscopy provides a highly detailed and accurate picture of the colon tissue, so that any abnormalities can be identified from the outset.

 

Increasing Incidences of Colon Cancer

From the latest statistics released in 2018, it was found that cancer is the 2nd biggest killer worldwide and the 3rd in new cases found*.

Additionally, it is estimated that more than 3,000 deaths per year resulting from colon cancer are not officially reported. Those aged 45 and above as well as those younger but with a family history of colon cancer are especially at risk.

These numbers are worrying. There needs to be an increase in colon cancer screening amongst Thai people. Otherwise, the aforementioned cancer rates could be doubling over the next decade.

We can prevent Colon cancer if we identify it early. Doctors can use colonoscopy to diagnose, and if they find precancerous polyp, they can remove it in up to 90% of cases. Alternatively, in cases of early stage cancer, treatment is available that can provide a cure for the disease.

In many cases, adenomatous polyps result in colon cancer. While it is still unclear why this happens, they usually affect those aged above 45. Hence, doctors recommend that people undergo regular screening for colon cancer. If the aforementioned polyps are identified early, doctors can remove them before they develop into cancer. Alternatively, where those polyps are its initial stages of cancer, you can receive treatment before the cancer spreads to other organs. 

Risk Factors

Many forms of cancer develop with no clear cause. Colon cancer is no different in this regard, although the factors that increases the risks are:

  • A previously diagnosed colonic polyp. If left untreated, it can potentially transform into colon cancer.
  • Being over the age of 45. This makes the risk of colon cancer twice as high. However, there is also a possibility of it occurring in young men and women, as well as teenagers.
  • Having a family history of colon cancer, especially if a relative younger than 60 was diagnosed with the disease. Research has found that hereditary nonpolyposis colorectal cancer (HNPCC), or Lynch syndrome, is a genetically transferable condition capable of causing colon cancer. This has the added the danger of developing into said cancer before the patient reaches the age of 45*. Additionally, familial adenomatous polyposis (FAP) is another genetically transferable disorder that increases the likelihood of developing colon cancer before the age of 40. Nevertheless, doctors can identify both FAP and HNPCC conditions through genetic screening, which is currently relatively simple to perform. Click here to read more
  • Having chronic constipation
  • Regularly eating fatty food, large amounts of red meat or chargrilled meats. Eating pickled or marinated, salty, or/and low-fibers foods also adds to the risk.
  • Being overweight and not exercising regularly
  • Smoking
  • Inflammatory bowel disease
  • Having diabetes. Diabetics who are resistant to insulin medication have an increased risk of developing colon cancer.

 Warning signs that should precipitate a consultation with a doctor

Early stage colon cancer tends not to display any symptoms. Patients often neglect the proper care of their colon and digestive system. Instead, if you experience any of the following irregular symptoms, please consult your doctor for a thorough diagnosis: 

  • Alternating between constipation and diarrhea, or chronic constipation that last over two weeks. 
  • Reduction in stool size
  • Bloody stools
  • Sudden and undiagnosed loss of weight
  • Nausea
  • Exhaustion or feeling overly tired.
  • Bleeding from the anus or bloody stools
  • Abdominal discomfort, such as cramps and severe indigestion

Colon cancer patients often do not experience any symptoms whatsoever during the disease’s early stages. Moreover, when there are symptoms, they can differ greatly from case to case, depending on the size and location of the cancer within the colon. Therefore, if one experiences any one one or more of these warnings consult a doctor immediately for colon cancer screening. This is especially important for those considered to have high risks.

Prevention

The American Cancer Society recommends that everyone, especially at-risk patients, undergo screening from the age of 45 onwards. For patients with a family history of colon cancer, however, screening may need to begin earlier.

  • Eat a wide variety of vegetables, fruits and grains to provide your body with plenty of vitamins, minerals, dietary fiber and antioxidants. All of these play an important role in preventing colon cancer.
  • If you choose to consume alcohol, please do so in moderation. Women should not drink more than one glass per day, and men, not more than two.
  • Abstain from smoking. If need be, receive doctor’s consultation for guidance to stop smoking completely.
  • Exercise for at least 30 minutes every day.
  • Maintain a healthy weight.  

Colon cancer screening techniques

Screening for colon cancer during its initial stages is the most effective way to prevent or halt the disease. Doctors recommend that the following forms of screening should be carried out from the age of 45 onwards, regardless of gender:

  • Get a fecal occult blood test (FOBT) annually. The test takes a small fecal sample for analysis. For three days prior to the tests, patients should avoid consuming any meat or blood nourishing vitamin supplement.
  • Get a fecal immunochemical test (FIT) annually. The test requires a small fecal sample for analysis. Patients do not have to stop consumption of any types of food prior to the test.
  • Doctors recommend a sigmoidoscopy every five years. This form of screening involves insertion of an endoscopic device into the anus to check for any irregularities affecting the distal colon. Doctors can also use it to cut a small tissue sample to send for analysis.
  • A colonoscopy provides a full and clear image of the patient’s entire colon. It is also suitable for removing suspicious tissue samples for pathological examination.
  • Narrow Band Imaging (NBI) uses the latest endoscopic technology, providing a more accurate and detailed picture of colon tissue than ever before. The technique allows medical staff to identify any abnormalities in the tissue of the colon during its initial stages or when the polyp is smaller than 0.5 centimeter in length. Additionally, NBI gives doctors the opportunity to cut out any suspicious polyps immediately. Samitivej has been working in collaboration with SANO Hospital from Japan – an institution with world-leading expertise in all related GI endoscopies – to bring the Japanese technique to Thailand. This technique enables Samitivej to double the rate of accurate diagnoses, and remove the polyps before they develop into cancer.

 Colon cancer treatment

If a patient’s cancer is in the 1st stage, doctors will usually perform surgery to remove the cancerous tissue. However, if the cancer is in its 2nd or 3rd stages, with a higher chance of making a return, doctors usually consider chemotherapy medication and radiation therapy. Doctors can provide both these treatments either pre or post-surgery.

In addition to surgical removal of the cancer and radiation therapy, patients whose cancer is in the 4th stage may need to undergo supplementary courses of chemotherapy. Furthermore, if the cancer has spread to the surrounding organs, doctors will need to carefully consider on how they will treat those organs on a case-by-case basis.

 Treatment in the form of targeted therapy

We have seen that although the true causes of colon cancer remain unknown, the disease can affect any of us. Having said that, the risk factors mentioned above are the result of a person’s lifestyle. Therefore, the most effective form of prevention is to make suitable modifications to our diet and lifestyle habits. This means avoiding foods that are high in fat, increasing the amount of fiber we consume, drinking plenty of water and not forgetting to exercise regularly. Furthermore, training ourselves to excrete properly also helps prevent constipation.

People over the age of 45 or those with a heightened genetic risk of colon cancer should undergo annual screening assessments. The annual assessments should include FOBT, which has been proven to lower  colon cancer fatality rates. In addition, they should get colonoscopy examinations done every 10 years. All of these steps can help protect against colon cancer. If doctors can identify the condition in its initial stages, they can successfully treat it.

Reference*

http://www.nci.go.th/th/File_download/Nci%20Cancer%20Registry/HOSPITAL-BASED%202016%20Revise%204%20Final.pdf

 

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Pathipat Durongpongkasem, M.D. Summary: Internal Medicine Gastroenterology