Colorectal cancer (CRC) is a formidable health problem worldwide. It is the third most common cancer in men and the second most common in women. There were more than 1.9 million new cases of colorectal cancer in 2020. In India, the annual incidence rates (AARs) for colon cancer and rectal cancer in men are 4.4 and 4.1 per 1,00,000, respectively. The AAR for colon cancer in women is 3.9 per 1,00,000.
Early screening for colorectal cancer is essential
“Early screening is crucial because colorectal cancer often does not present symptoms in its early stages, and by the time symptoms appear, cancer may have already spread, making it more challenging to treat. Early screening for colorectal cancer is important because it can help detect and remove polyps that might otherwise become cancerous. It can also help find colorectal cancer early, when it may be more treatable. Screening can be done with stool-based tests or visual exams,” says Dr. Donald John Babu, Consultant, Surgical Oncology at Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai.
The American Cancer Society (ACS) recommends that people at average risk of colorectal cancer start regular screening at age 45. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer in adults using fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy, beginning at 50 years of age and continuing until 75 years of age.
People at increased or high risk of colorectal cancer might need to start screening before age 45, be screened more often, and/or get specific tests. These include those with inflammatory bowel disease, diet high in red or processed meats, lack of physical activity, obesity, alcohol consumption and tobacco use and a family history of colorectal cancer or polyps. However, routine screening for those above the age of 76 years is not recommended keeping in view the risks and benefits of the various screening methods.
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“Colorectal cancer is a type of cancer that affects the colon or rectum, which are part of the digestive system. It is one of the most common types of cancer worldwide, and early screening can help detect it at an early stage when it is most treatable. The recommended age for starting colorectal cancer screening is 50 for average-risk individuals without any family history or other risk factors. However, if there is a family history of colorectal cancer or other risk factors, screening may need to start earlier,” says Dr Rajesh Shinde, Consultant, GI & HPB Oncology and Robotic Services, Apollo Hospitals, Navi Mumbai.
Dr Shinde explains the early screening process
- Detecting cancer at an early stage: When colorectal cancer is detected early, it is highly treatable. The five-year survival rate for patients whose cancer is detected at an early stage is around 90%. However, when the cancer has spread to other parts of the body, the survival rate drops significantly.
- Identifying precancerous polyps: Screening can also detect precancerous polyps, which are growths in the colon that can turn into cancer over time. Removing these polyps during screening can prevent them from becoming cancerous.
- Identifying high-risk individuals: Screening can also identify individuals who are at a higher risk for colorectal cancer due to family history or other factors. These individuals may need to start screening at an earlier age or have more frequent screenings.
“The common screening methods include colonoscopy in which a thin, flexible tube with a camera is inserted into the rectum and the entire colon to look for polyps or cancer; flexible sigmoidoscopy that is similar to colonoscopy, but only examines the lower part of the colon,” adds Dr Babu.
Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) with a stool sample checked for tiny amounts of blood that cannot be seen visually; Stool DNA test in which the stool sample is checked for DNA changes and blood that could indicate cancer or polyps; and CT colonography (virtual colonoscopy) where a CT scan produces images of the colon and rectum that are examined for polyps or cancer.
Prevention
Dr Babu highlights the following lifestyle modifications that can help to lower the risk of developing colorectal cancer:
- Eating a healthy diet: Less of red and processed meat. Adopting a diet rich in fruits, vegetables, whole grains, and lean protein can lower your risk of colorectal cancer.
- Exercising regularly: Regular physical activity can help maintain a healthy weight, which in turn can lower your risk of colorectal cancer.
- Limiting alcohol consumption: Excessive alcohol consumption has been linked to an increased risk of colorectal cancer.
- Quitting smoking: Smoking has been linked to an increased risk of colorectal cancer, as well as other types of cancer and health problems.
- Periodic Screening as recommended by your doctor.
Symptoms
Dr Babu notes down the symptoms of colorectal cancer that may include:
- Changes in bowel habits such as diarrhoea, constipation or narrow, stringy stools.
- A feeling that bowel does not empty completely
- Rectal bleeding or blood in the stool
- Abdominal pain or cramping
- Unexplained weight loss
- Fatigue and weakness
However, these symptoms may also be caused by other conditions that are non-cancerous such as infections, haemorrhoids (piles) or irritable bowel syndrome, so it is important to consult a doctor before jumping to any conclusion.
Treatment
- The treatment of colorectal cancer depends on several factors, including the stage of the cancer, the location of the tumor, and the patient’s overall health. Dr Shinde shares the main treatment options for colorectal cancer that include:
- Surgery: Surgery is the most common and effective treatment for colorectal cancer. During surgery, the tumor and surrounding tissue including the lymph nodes are removed. In some cases, the entire colon or rectum may need to be removed.
- Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It may be used before surgery to shrink the tumor or after surgery to kill any remaining cancer cells.
- Radiation therapy: Radiation therapy uses high-energy radiation to kill cancer cells. It may be used before surgery to shrink the tumor or after surgery to kill any remaining cancer cells.
- Targeted therapy: Targeted therapy uses drugs that target specific proteins on cancer cells. It may be used in combination with chemotherapy or alone.
- Immunotherapy: Immunotherapy can boost the immune system’s ability to fight cancer.
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