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Dr. Preetam Jain

Here are a few facts about colorectal cancer:

  1. - It is the third most common cancer in men (6,63,000 cases, 10.0% of all cancer cases)
  2. - It is the second most common cancer in women (5,71,000 cases, 9.4% of all cancer cases)
  3. - Almost 60% of cases are encountered in developed countries.
  4. - The number of CRC-related deaths is estimated to be approximately 6,08,000 worldwide, accounting for 8% of all cancer deaths and making CRC the fourth most common cause of death.

Indian scenario

According to ICMR 2014 results,
  1. - The annual incidence rates (AARs) for colon cancer and rectal cancer in men are 4.4 and 4.1 per 1,00,000, respectively.
  2. - The AAR for colon cancer in women is 3.9 per 1,00,000.
  3. - Colon cancer ranks 8th and rectal cancer ranks 9th among men.
  4. - For women, rectal cancer does not figure in the top 10 cancers, whereas colon cancer ranks 9th.

Colorectal cancer is preventable, treatable, and beatable. It is imperative to detect this cancer at an early stage to give the best chances of prevention and treatment. This cancer is generally more common in males above 50 years of age.

Risk factors

  1. All above 50 years of age are at an average risk.
  2. Strong family history and genetic predisposition: people less than 40 years of age are at a risk
  3. Consumption of red and processed meat.
  4. Lack of physical activity
  5. Obesity
  6. Smoking and alcohol
  7. History of ulcerative colitis
  8. Diabetes mellitus with insulin resistance

So, how do we identify this lethal cancer? In the early stages, most of the patients do not exhibit any signs. It is mostly in the advanced stages that the symptoms show up.

Symptoms

  1. Change in the bowel habits such as alternating diarrhea and constipation
  2. Blood in the stool
  3. Unexplained weight loss
  4. Loss of appetite
  5. Abdomen discomfort

All those with the above symptoms should consult an oncologist.

I generally proceed with the following diagnostic criteria and investigations to diagnose colorectal cancer:

  1. History taking and physical examination
  2. Stool for occult blood and routine microscopy
  3. Proctoscopy and colonoscopy
  4. CEA (carcinoembryonic antigen) levels
  5. Imaging like CT scan of the abdomen and pelvis or PET CT scan
  6. Biopsy with immunohistochemistry and molecular studies

Treatment

Early stage: If the tumour is small, then it can be removed through surgery. If the tumour is large, then we give chemotherapy to downsize it and then make it amenable for surgery. The third modality of treatment is radiation, which is also used to treat rectal cancer.

Advanced stage: We carefully assess the curative intent in the advanced stage as surgery, chemotherapy and radiation therapy can still potentially cure this cancer. If the cancer is incurable, then the main form of treatment is chemotherapy and targeted therapy. These are medicines that are injected into the body to kill the cancer cells. These drugs have revolutionized the treatment methods for colorectal cancer.

What is the role of chemotherapy and targeted therapy in colorectal cancer?

These drugs have the following advantages:

  1. Significantly increase the overall survival rate
  2. Control the cancer spread
  3. Improve the quality of life

It is also imperative to opt for chemotherapy and targeted therapy from only a certified medical oncologist. In India, doctors with a D.M. Superspeciality degree in Medical Oncology (or equivalent degree) are qualified for the administration of the same.

Prevention

To lower the risk of getting the disease, you can do the following:

  1. Regularly exercising
  2. Consuming high-fibre foods, fruits, and green leafy vegetables
  3. Avoiding stress
  4. Avoid smoking and alcohol
  5. Identifying the genetic syndromes in the family

This article has been written by Dr.Preetam Jain, Consultant, Medical Oncology, Raheja Hospital, Mumbai.