Colorectal Cancer

Colorectal cancer is a disease in which malignant (cancer) cells form in the lining of the colon or the rectum; those together constitute the large intestine. How a cancer is named/ treated depends on where it started, even if it spreads outside the place it started.

Most of these start as polyps in the lining of the intestine which then become cancerous, growing into/ through the intestinal wall. Worldwide, it is the 3rd most common cancer (10% of all cancers), and is the 2nd leading cause of cancer related deaths. Mostly people diagnosed are aged 40 and above, but especially in India, up to a 3rd of the cases are in people younger than 40. Though incidence in India is lower than western societies, it is the country showing the greatest increase worldwide in the last decade, especially in the urban populations

Why? & How to prevent it

Other than genetic factors, these are the modifiable risk factors which predispose people to development of colorectal cancer

High intake of processed meats and fat, low intake of fruits and vegetables

Sedentary lifestyle, Obesity

Smoking and Alcohol consumption

So, healthy diet, regular physical activity and avoiding smoking and alcohol can decrease one’s risk of developing colorectal cancer

Colonoscopy, that is an endoscopic procedure to examine the lining of the large intestine, lets us remove polyps before they can turn into cancer

How does it show up

Asymptomatic individuals are discovered by routine screening, letting us detect these tumors in early stages

Suspicious symptoms and/or signs generally show up in advanced stages of the disease. These symptoms include bloody or black stools, abdominal pain, otherwise unexplained iron deficiency anemia, and/or a change in bowel habits

Emergency hospital admissions with intestinal obstruction, perforation, or rarely, severe bleeding can happen in more advanced cases. Loss of appetite and unintentional weight loss are also symptoms generally seen in advanced disease.

How is it treated

Surgical removal is the central aspect of all attempts to cure colorectal cancer, and it is the only treatment needed in early tumors.

In some advanced cases, especially in rectal cancer, we use chemotherapy and radiation before operating to give us the best chance of cure. In the past, a lot of patients with rectal cancer ended up getting a permanent colostomy, but now, we can offer most of these patients sphincter preserving surgery.

Using laparoscopic and robotic technologies, we are also able to get these patients to recover faster with less postoperative pain. During the operation, the segment of the intestine with the tumor along with the lymph nodes draining that segment are removed together.

Pathological examination of the tumor and the lymph nodes removed, along with genetic testing, helps us decide if we need to use additional treatments and what kind of treatments would best suit the situation. Even in some advanced cases when cancer has spread outside the colon, we are now able to treat it and sometimes even cure it, using the recent breakthroughs in colon cancer care.

Take Home Points

Incidence and impact of this disease can be reduced significantly by:

Implementing primary prevention strategies like adopting a healthy lifestyle and avoiding risk factors

Early detection through screening and getting a thorough evaluation of all abdominal symptoms