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Who Is At Risk of Colon Cancer?

Related information:
Precision Medicine | Preconception Genetic Testing | Targeted Therapy for Cancers | Oncogenetic Screening


Colon cancer is the third leading cause of cancer-related deaths worldwide. Unfortunately, it is a silent killer that sometimes displays no warning signs. To add to that, we still do not know for sure what exactly causes it. However, we do know that a person’s risk of developing colon cancer increases based on certain factors, including age and family history.

Internationally, a colonoscopy is regarded as the standard screening to protect against colon cancer. Therefore, the American Cancer Society recommends that everyone over age 50 undergo a colonoscopy every 10 years thereafter. In the case that a person is considered to have high-risks, they should do it sooner and more frequently, as specified later in this article.

How colon cancer develops

Colon cancer results from when normal cells in the colon change and continuously reproduce until they can no longer be controlled. This process may take years. In the early stages, the cells may only appear as a normal polyp. However, if these polyps are allowed to grow further without treatment or removal, they can eventually become cancerous. Unfortunately, the exact cause of the disease is still not known, but we do know a person’s risk of developing colon and rectum cancer increases with age.  The condition is rare among adults aged 40 or less, but people aged 50 or more are two times more likely to develop colon cancer. Again, this does not mean that people below the age of 50 are at not a risk of developing colon cancer. In fact, statistics indicate that 1 in 7 patients receiving treatment for colon cancer treatment are younger than age 50.

Cancer Prevention with Oncogenic Screening

Samitivej Hospital is committed to offering the highest levels of patient care, and thus, aims to deliver ‘precision medicine’ as standard to all our patients. Our Oncogenetic Screening remains a core element of this precision approach to colon cancer prevention. This is because this breakthrough approach takes into consideration the personal situation of each patient including genes, lifestyle and environment.

Oncogenetic Screening is designed to identify pre-existing cancerous genes and hereditary by employing the most advanced Next Generation Sequencing Technology. This means it can sequence more than 95% of the human genome. Subsequently, it assists in the early identification of more than 50 different types of cancer, including two of the most common forms of cancers in both males and females i.e. lung and colon cancer. Such preventive treatment is particularly suitable for individuals with a family history of cancer. In addition, it is fitting for those who live in high cancer-risk environments.

Who is in the high-risk group for colon cancer?

  • Firstly, people who have direct relatives (e.g. mother, father, siblings) who have suffered from colon cancer are considered to have high-risk. They are 2 – 3 times more likely than the general population to develop colon cancer.
  • Secondly, those who have a history of other types of cancer in the family, such as uterine cancer, ovarian cancer or stomach cancer are also more likely to develop colon cancer. If a person has many family members who have suffered from these other cancers, then that person’s risk of developing colon cancer increases accordingly.
  • Lastly, those who suffer from chronic inflammatory bowel disease, and have had symptoms for several consecutive years are also in the high-risk category. They are 2 times more likely to develop colon cancer.

Symptoms of colon cancer

In some cases, colon cancer may not produce any identifiable symptoms. As a result, the patient might be unaware of the condition. In other cases, the symptoms of colon cancer may be identifiable but indistinguishable from symptoms caused by other diseases. Therefore, if you experience any of the following symptoms for more than two consecutive weeks you should meet with your doctor for a diagnostic screening promptly:

  • Bleeding from the rectum or blood in stools (seek immediate medical attention)
  • Diarrhea, constipation or bloating
  • Chronic stomach pain, especially in the lower abdomen
  • Feeling of constantly needing to pass stools or incomplete defecation (Tenesmus)
  • Change in bowel habits such as alternating between diarrhea and constipation
  • Changes in appearance of stool (separate hard lumps like nuts)
  • Feeling weak, fatigued or/and pallid
  • And/Or unexplained weight loss

What to screen for?

Doctors screen to check for any form of precancerous lesion known as an adenomatous polyp in the colon. Even if polyps found are small at first, they gradually grow larger, and eventually can become cancerous within 3 – 5 years. Nevertheless, if doctors detect it early, they can remove the polyp and prevent potential colon cancer.

When to get screened?

Anyone at high risk or has a family history of colon cancer should start screening from the age of 40. Alternatively, they should begin screening at an age that is 10 years younger than when the direct blood relative was diagnosed with colon cancer. To clarify, if a family member was diagnosed with colon cancer at the age of 65, then relatives should be screened at the age of 40, instead of 55. On the other hand, if the relative was 45 when diagnosed, then the family members should begin screening from the age of 35.

How to get screened?

Doctors can examine the inside of the rectum and entire colon using a long, lighted tube called a colonoscope. During this procedure, patients sleep under sedation. If doctors find precancerous polyps, they can simultaneously remove them during colonoscopy. Undoubtedly, as of now the colonoscopy is the most accurate of all diagnostic methods and offers the following benefits: no pain, no incision, and short time for preparation and procedure.

The frequency of screenings the American Cancer Society recommends is based on the number of polyps detected during a colonoscopy:

Number of Polyps Detected Recommended Frequency of Follow Up Screenings
1-2 polyps Every 5-10 years
3-10 polyps Every 3-5 years
> 10 polyps Within 3 years
1 polyp larger than 1cm Every 3 years
No polyps Every 10 years

Colonoscopy at Samitivej (in collaboration with Sano Hospital, Japan)

Samitivej has adopted Narrow-Band Imaging (NBI) International Colorectal Endoscopic classification (NICE). Indeed, it is the most validated classification system for colon cancer detection. This latest imaging technology can detect the polyps frequently missed with conventional white-light endoscopy equipment. Basically, it uses light from blue and green wavelengths to optimize the visibility of tissue structures. Hence, the technology is able to detect lesions earlier, even before the polyps develop. Subsequently, doctors can begin an appropriate treatment plan sooner.

  • Samitivej Sukhumvit Hospital performs more than 2,600 colonoscopies per year
  • There have been 0 complications during and after colonoscopies
  • Finally, we have a 57.5% Adenoma Detection Rate (ADR) versus the 25% industry average (as laid out by The American Society for Gastrointestinal Endoscopy)

*This above information was gathered by Samitivej in 2017.

Colonoscopy using the new ESD technique

During colonoscopy, if specialists find large flat polyps, they can apply the Endoscopic Submucosal Dissection (ESD) technique to remove polyps without the need for open surgery. This minimizes surgical risks, removes the need for abdominal incisions (scarless), shortens hospitalization, and allows patients to recover rapidly. As a result, all of this enables patients to return to their normal lifestyle more quickly, reduces complications and increases safety levels.

Samitivej Hospital collaborated with Sano Hospital, Japan’s leading private hospital specialized and advanced in gastrointestinal (GI) endoscopy for advanced diagnosis and therapeutic via endoscopy. As a result, we implemented ESD, a new scarless surgical technique.

Laparoscopic Colectomy

With timely identification, doctors can also quickly and easily treat colon cancer via a laparoscopic colectomy. This procedure involves removing either a section of, or the entire colon, to rid the body of the cancer. If caught early, patients often only need part of their colon removed, and will make a full recovery. However, for cancers caught at a later stage, patients may have to have a larger section of their colon removed. To read more, please click here.

A Better Choice of Cancer Treatments

With modern medical developments, there are now a wider variety of cancer treatment options. Even so, the most suitable treatment would depend on various factors including the type of cancer, the stage of the disease, and the conditions of the patient. When surgical interventions are required, minimally invasive surgery (MIS) is the preferred option. This is because it requires a smaller incision, leading to less pain and faster recovery times. In addition to MIS, Samitivej provides a full choice of cancer treatments, including chemotherapy, radiotherapy and immunotherapy.

However, the latest development in this field is Targeted Therapy. To elaborate, this therapy utilizes a combination of medications selected to target the cancerous cells in each patient and destroy the rapidly reproducing cancer cells. Unlike in chemotherapy, it leaves unaffected cells intact. Furthermore, the reduced side effects make this option suitable for elderly patients who could not undergo chemotherapy. To top that, Targeted therapy has an 80% response rate, compared to 30% in chemotherapy.

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Related information:
Precision Medicine | Preconception Genetic Testing | Targeted Therapy for Cancers | Oncogenetic Screening

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