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Colon Cancer: Extraction Before Contraction

HIGHLIGHTS:

  • People who suffer from health condition, such as diabetes and fatty liver disease, have a higher chance of developing colon cancer.
  • We can currently screen a person’s risk of carrying genetically transferable colon cancer genes, even when the patient’s ancestors have not suffered from the cancer themselves.

 

Colon cancer is a major cause of death worldwide, with cases continuously on the rise. Thailand is no different in this regard, with the number of colon cancer patients steadily increasing. As there are very few symptoms in the early stages and as the true causes remain unclear, colon cancer is therefore considered a silent danger that can affect people of any age or gender.

However, every cloud has a silver lining, and this particular silver lining comes in the form of a statistic which shows that up to 90% of colon cancer cases begin with adenomatous polyps located in the large intestines, which – if identified early enough – can be removed before they develop into cancer.

Colonoscopy is seen as the best form of prevention because in cases where a polyp is found, doctors can remove the polyp straight away. The polyp is then sent away for laboratory analysis and if early stage cancer is identified, treatment to cure the disease can be carried out immediately.

Is it true that we should wait until we are 50 before undergoing a colonoscopy?

For people in general who are not exposed to any other risk factors, it is recommended that a colonoscopy is undertaken to screen for pre-cancerous polyps once they reach 50 years of age. However, due to colon cancer being a deadly disease which is affected by a person’s genetics, those who have a family history of the condition are at a greater risk of developing colon cancer than those who do not. This includes other forms of genetically transferable health conditions that may increase a person’s chances of developing colon cancer, for instance, familial adenomatous polyposis syndrome.

Moreover, patients with type 2 diabetes and a resistance to insulin – meaning their insulin levels are higher than in the general population – are considered to be at higher risk of developing colon cancer. This is because the insulin stimulates tissue and cell growth, therefore causing any polyps to expand and develop into cancer at faster rates than usual. Type 2 diabetes patients, therefore, are at a higher risk, first of the disease taking hold and then of it developing much more rapidly than in those who do not have type 2 diabetes.

Another high risk group are people with non-alcoholic fatty liver disease (NAFLD). This group will have 1.6-1.8 times lower life expectancy than people without the condition. They also have a greater risk of developing chronic liver disease, liver cirrhosis, liver cancer and, what’s more surprising, colon cancer.

Research carried out abroad found that from a sample group of 1,200 people who were closely monitored with regular endoscopic intestinal inspections (split into patients with fatty liver disease and those without), both males and females with fatty liver disease were at a higher risk of potentially cancerous adenoma polyps than those without fatty liver disease. This was therefore seen as confirmation that this group had a much higher tendency towards developing colon cancer.

Prevention is better than treatment

Colonoscopy is currently considered the best form of colon cancer prevention. However, an innovative new technique called oncogenetic screening is now available that can be carried out prior to such an inspection. Such screening takes into account a person’s family tree, including immediate family and blood relatives. The reason for this is that, if someone in a family is diagnosed with the disease, this can help other members of the same family prevent a repeat occurrence.

We are currently heralding a new era which relies on the principles of precision medicine, meaning that the focus is not solely on treatment but also on aiming to prevent the repetition of diseases and illnesses. This is because many people are unaware of genetic health disorders. For example, most may not realize that cancer can be transferred genetically, even though these people may also wonder why so many of their family have suffered from the disease. In such cases, why wait for the disease to carry on its reign of destruction, taking many of our loved ones with it?

The Thai medical industry has developed significantly in recent years. We are now able to screen for cancer ourselves, without the need for other countries to be involved in the analysis of tissue samples. We are also capable of screening for the 50 most common genes that are responsible for over 30 types of cancer. This means that where any risks are identified, doctors are able to offer lifestyle advice and create effective treatment plans.


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Assoc. Prof. Teerha Piratvisuth, M.D. Summary: Internal Medicine Gastroenterology