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Dr. Kumardeep Dutta Choudhury

Colorectal cancer (CRC) is a common and lethal disease. Globally, CRC is the third most commonly diagnosed cancer in males and the second in females, with 1.8 million new cases and almost 8,61,000 deaths in 2018, according to the World Health Organization GLOBOCON data. Rates are substantially higher in males than in females.

Several specific genetic disorders like Familial Adenomatous Polyposis (FAP), hereditary breast and ovarian cancer syndrome, and Lynch syndrome are associated with a very high risk of developing colon cancer.

Family history is also an important risk factor even outside of the syndromes with a defined genetic predisposition. Low socio-economic status is also associated with an increased risk for the development of CRC. Potentially modifiable behaviors such as physical inactivity, unhealthy diet, alcohol, smoking, long-term consumption of red or processed meat, and obesity are thought to account for a substantial proportion of new-onset CRC.

Adult survivors of childhood malignancy who received abdominal radiation are at a significantly increased risk of subsequent gastrointestinal cancer. Patients with cystic fibrosis have an elevated risk of CRC.

A large number of factors have been reported to be associated with a decreased risk of CRC. These include regular physical activity, a diet high in fruits and vegetables, fiber, folic acid, Vit B6, Vit D, calcium, dairy products, magnesium, and fish. Compared to non-vegetarian dietary patterns, vegetarian patterns have also been associated with a significantly reduced risk of CRC.

Typical symptoms of CRC include blood in stool, abdominal pain, otherwise unexplained iron deficiency anemia, and/or a change in bowel habits. Less common symptoms include abdominal distention, and/or nausea and vomiting, which may be indicators of obstruction.

Once CRC is suspected, the next test can be a colonoscopy, barium enema, or computed tomography colonography. However, biopsy is required to establish the diagnosis, and this is usually accomplished by colonoscopy.

In India, the prevalence of CRC is predicted to rise approximately by 80% in 2035, with 114,986 new cases and 87,502 deaths. We should encourage more formal screening programs among people who are at a higher risk, such as those having a family history of CRC or suffering from inflammatory bowel disease.

We should also educate individuals about the risk factors. A multidisciplinary approach will help tackle the rising burden of CRC.

This article has been authored by Dr. Kumardeep Dutta Choudhury, Consultant, Dept Of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector V, Rohini.