Colorectal Cancer (CRC) is a formidable health problem worldwide. It is the third most common cancer in men (663000 cases, 10.0% of all cancer cases) i.e. 1 in 23 males and the second most common in women (571000 cases, 9.4% of all cancer cases) i.e. 1 in 25 females. The number of CRC-related deaths is estimated to be approximately 608000 worldwide, accounting for 8% of all cancer deaths and making CRC the fourth most common cause of death due to cancer.
MedPiper Technologies and JournoMed in association with GEM Hospital and Research Centre, Chennai had conducted a webinar titled ‘Awareness on Colorectal Cancer Screening and Treatment’ on 26th April 2022 where the speaker Dr. Pinak Dasgupta debunked some of the myths and misconceptions associated with the condition in order to create awareness. The month of March is considered as Colorectal Cancer (CRC) awareness month. Dr. Pinak Dasgupta is a Senior Consultant and Lead Surgeon in the Dept of Robotic Colorectal Hernia and Abdominal Wall Reconstruction at GEM Hospital and Research Centre, Chennai.
In India, the annual incidence rates (AARs) for colon cancer and rectal cancer in men are 4.4 and 4.1 per 100000, respectively. The AAR for colon cancer in women is 3.9 per 100000. Colon cancer ranks 8th and rectal cancer ranks 9th among men. For women, colon cancer ranks 9th. In the 2013 report, the highest AAR in men for CRCs was recorded in Thiruvananthapuram (4.1) followed by Bangalore (3.9) and Mumbai (3.7). The highest AAR in women for CRCs was recorded in Nagaland (5.2) followed by Aizwal (4.5). Dr. Dasgupta explained the various facets of Colorectal Cancer and how it manifests in the body by addressing some common myths related to the disorder.
What you can’t ignore?
We have millions of cells in our body. Cells die and regenerate on a daily basis. This is controlled by DNA and specific regulators in the cell cycle. Imbalanced cellular destruction and regeneration cycle causes uncontrolled cellular proliferation leading to formation of a tumour and that is what we call as cancer. Genetics and lifestyle are major contribution factors.
What is screening?
Screening applies to large population. Screening an asymptomatic population for any disease is worth if the disease represents a major health problem, has available effective therapies, has a sensitive and specific screening test for that is easy for both patients and physicians and is cost- effective. CRC fulfils all these conditions. The prolonged natural history of CRC affords time to detect and eliminate early neoplastic lesions before they reach an advances, incurable stage. Evidence strongly indicates that screening for CRC can reduce the mortality rate.
- Tests for cancer prevention, detect cancer and polyps:
- CT colonography
- Tests for cancer detection that mainly detect cancer
- Guaiac- based fecal occult blood testing (Hemoccult II and Hemoccult II SENSA)
- Fecal immunochemical test (FIT)
- Stool DNA
- Digital rectal examination
Why is it important to diagnose at an early stage?
Dr. Dasgupta emphasized on the fact that if detected early, 9 out of 10 cases can be treated and can survive for 5 years or even more. But if diagnosed during later stages (Stage IV) only 1 out of 10 cases have a chance of survival.
Who should do a screening test?
Individuals at or above 50 years of age or individuals with a family history of CRC even if you don’t have any symptoms.
How does CRC develop?
Polyp Formation: Polyps are uncontrolled, abnormal cell growth which starts in the colon or the rectum. These abnormal cells can form a mass of tissue. Polyps usually begin to grow as benign or non-cancerous that can, over time, become a cancerous tumour.
There are two types of Polyps: i) Flat/ sessile polyp ii) Pedunculated polyp or polyp with a stalk. If there is polyp formation, polypectomy treatment should be done followed by biopsy.
Risk Factors of CRC:
What can one do to prevent CRC occurrence?
One can reduce the risk by managing diet, weight (BMI 18-25) and undergoing physical activity and also by avoiding tobacco consumption.
- Aspirin when taken for atleast 5-10 years, decreases the risk of colon cancer and prevents the recurrence of adenomas.
- Other possible protective factors include Calcium and Vitamin D, high fibre and low fat diet.
What are the red flags that can identify the occurrence of CRC in an individual?
- A change in bowel habits
- A feeling of incomplete evacuation
- Rectal bleeding
- Unintended weight loss
- Cramping or abdominal pain
- Weakness and fatigue
- Surgery- Laproscopic or Robotic
- Radiation therapy
- Targeted therapy 9 in cases of metastases
Stage 1 &2- Surgery alone, Stage 3- Neo Adjuvant Chemoradiation + Surgery + Adjuvant Chemotherapy, Stage 4- Chemotherapy+ Radiation + Surgery
Various months of the year have been dedicated to various types of cancer in order to raise awareness. This awareness helps to nullify the misinformation surrounding cancer and will also encourage people to go to the specialists to investigate any of the warning signs. The early detection and timely treatment of cancer can help reduce the cancer inequity.