If you lead an inactive life, you are more likely to develop colon cancer.(iStock)
If you lead an inactive life, you are more likely to develop colon cancer.(iStock)

Those with sedentary lifestyle more likely to develop colon cancer

The other modifiable risk factors include smoking and consumption of red or processed meat.
By By Dr.Tushar Patil
UPDATED ON MAR 12, 2020 08:44 AM IST

The world’s third most common cancer, colorectal cancer (CRC) is responsible for an estimated 694,000 annual deaths worldwide. Hence, the disease is a significant public health concern.

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.

Dr.Tushar Patil
Dr.Tushar Patil

Globocan, 2018 data shows new cases of CRC as 27,605 and deaths due to CRC as 19,548.

The total number of patients living with the disease is 53,700 (5 years prevalence for all ages). The mean age of rectal cancer (RC): around 40-45 yr.

Risk factors that you cannot change (non-modifiable risk factors)

Age: Your risk gets higher as you get older. Younger adults may also develop colorectal cancer but the chances increase markedly after you turn 50.

Personal history of colorectal polyps or colorectal cancer: If you have a history of certain types of polyps known as adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large or if they are more in number.

A personal history of inflammatory bowel disease (IBD): Having a history of ulcerative colitis or Crohn’s disease ( types of inflammatory bowel diseases) increases your risk of developing colorectal cancer. If you have IBD, you may need to start being screened regularly for colorectal cancer from a younger age.

Family history of colorectal cancer: If you have a history of colorectal cancer in a first-degree relative (parent, sibling, or child), you are at an increased risk. The risk is even higher if that relative developed cancer at an age younger than 45, or if more than one first-degree relative was affected.

Race or ethnic background: Being African American or Ashkenazi increases your risk.

Inherited syndromes that increase colon cancer risk: Certain genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (also known as Lynch syndrome).

Risk factors you can change (modifiable risk factors)

Obesity: If you are obese, you have an increased risk of colon cancer and an increased risk of developing colon cancer.

Smoking: If you who have smoked cigarettes for a long time, you are more likely to develop and die from colorectal cancer.

Type 2 diabetes: If you have diabetes, insulin resistance may have an increased risk of colon cancer.

Alcohol: Heavy use of alcohol may increase your risk of colon cancer

Sedentary lifestyle: If you lead an inactive life, you are more likely to develop colon cancer.

Certain types of diets: Consumption of red and processed meats can increase your risk for colorectal cancer.

Treatment of colorectal cancer

Surgery, chemotherapy and radiation are the established modalities of treatment of any cancer.

Surgery has undergone tremendous developments—from open to laparoscopic to robotic-assisted (pelvic organs). Another recent method is hyperthermic intraperitoneal chemotherapy (HIPEC), whereby heated chemotherapy drugs are delivered into the abdomen during surgery. The chemotherapy drugs are placed in direct contact with cancer cells in the abdomen, allowing for higher doses to be administered. Heating is also thought to improve drug absorption and destroy cancerous cells that remain after initial surgical procedures. Although an exciting emerging treatment possibility, HIPEC requires highly specialized equipment and healthcare professionals.

The use of robotics is also transpiring as a potentially beneficial advancement in CRC surgery. Robotic-assisted techniques were first utilized for CRC surgery in 2001 and have since been trialled in several reports. Robotic-assistance has clear advantages over traditional laparoscopic methods, for example, it provides a clearer view of the pelvic organs and facilitates tremor filtering to allow for increased dexterity. Additionally, the use of robotics may be associated with lower levels of post-operative bleeding and incisional pain, thereby providing a more practical solution to CRC treatment, especially in patients requiring several operations

Chemotherapy in colorectal cancer

Chemotherapy in colon cancer is used in two different settings: adjuvant (curative intent) and palliative (stage 4). Adjuvant chemotherapy in colorectal cancer administered in all stage 3 and a few high-risk, stage 2 cases.

A few recent trials have shown that not all patients are same in this stage 3 subgroup and a few can be given abbreviated chemotherapy of short duration of 3months depending upon the stage and risk factors involved.

Palliative chemotherapy is used to treat advanced stage cancers to decrease tumro burden, to relvie patient of smptoms of cancer thsu improving survival and improving quality of life.

Radiation therapy is established in treating locally advanced rectal cancer and as a palliative treatment of bone metastases.

Metastatic colorectal cancer

Although this has remained incurable in the last decade, we have witnessed an unprecedented outburst of new treatment approaches that ultimately evolved into the approval of five new drugs. We can subdivide these new drugs into three categories: anti-angiogenic, epidermal growth factor receptor (EGFR) blockers and multi-kinase inhibitors. All of them represent important advances in the fight against this deadly disease.

Most of these drugs target a particular protein overexpression in the tumor (which causes tumor to grow rapidly). Hence, they are selective for that particular target and damage to normal cells in nil/minimum. Various drugs in this category have evolved and many new drugs are in various phases of clinical trials. In the future, we will see a plethora of these drugs helping patients lead a disease-free life.

The emergence of immunotherapy has revolutionized oncology and colorectal cancer

Of all colorectal cancer patients, those with high levels of microsatellite instability (MSI) may be the most likely to benefit from immunotherapy. High-level microsatellite instability (MSI-H) is a characteristic mutation present in approximately 15% of colorectal cancer cases and typically indicates deficiencies in the mismatch repair system.

However, immunological therapies are currently yielding success in approximately 30% of MSI-H patients, representing only 5% of CRC cases in total.

Recommended tests for screening/early detection

Faecal occult blood test (FOBT): Stool sample is tested for the presence of blood, which may come from a polyp or cancer starting at the age of 50 years

Colonoscopy: A longer flexible tube is inserted to examine the entire colon up to the rectum for any polyps or growth, to start at age 50 year (baseline), then every 5-10 years.

Know more about colorectal cancer here.

This article has been written Dr. Tushar Patil, Consultant Medical Oncologist and Hemato-oncologist, Sahyadri Speciality Hospital, Pune.

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