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Over the last two decades, modern medicine has turned cancer from an incurable disease to that which can be treated. While awareness about the disease is increasing, there still exists ambiguity about certain types of cancer and their symptoms and treatments.

And, one such cancer is colorectal cancer (CRC). Read on to know more about this disease.

What is colorectal cancer?

In a person with colorectal cancer (CRC), the cells in the colon or rectum become abnormal and divide uncontrollably, forming a mass or a tumor. Most cases of this kind of cancer begin as a growth on the inner lining of the colon, called a polyp. Not all polyps turn cancerous, but some of them change into cancer over time. These manifest into a case of colorectal cancer.

Studies reveal that CRC is the third most common cancer in the world. Each year, there are 1.8 million new cases of this disease. While CRC concerns global health, its rise in India is worrisome as well.

A significant number of patients directly presents with stage IV or the metastatic colorectal cancer. About 25 percent of patients have what is called the de novo metastatic colorectal cancer, (mCRC). Studies also say that despite surgery, up to 50 percent patients develop mCRC. Therefore, it is also important to understand mCRC for the management of CRC.

Symptoms

People with CRC usually suffer from rectal bleeding, pain, or a change in bowel habits. Sometimes, patients will also have a large malignant bowel obstruction. However, depending on the case, symptoms may vary or change over a course of time. Only a minority of cases are associated with underlying genetic disorders.

Diagnosis

Once a patient is diagnosed with CRC, the doctor determines the cancer’s stage by taking a CT of the chest, abdomen, and pelvis. An MRI of the pelvis or an endoscopic ultrasound is also done. Additionally, labs are taken, such as the CEA (carcinoembryonic antigen – a protein that is found in cells associated with tumors) and biomarkers of the tumor that are obtained and studied for presence of cancerous cells.

Biomarkers in testing have been now been recognized to allow more specific diagnosis. To identify and treat metastatic colorectal cancer, (mCRC), epidermal growth factor receptor (EGFR) is being validated as a form of treatment. A study conducted by Humaid O Al Shamsi, Waleed Alhazzani, and Robert A. Wolff shows that the analysis of two predictive markers, KRAS and NRAS genes, can allow for a more accurate analysis to determine which patients can benefit from anti-EGFR treatment. This form of pre-analysis will help doctors personalize the treatment for patients.

Treatment

Based on the stage of the cancer and patient history, a doctor will recommend either the following or the combination of the following treatments: surgery, chemotherapy, radiotherapy, targeted therapy and immunotherapy. The decision of the treatment depends heavily on the location of the tumor, and on the patient’s condition. Family history plays a significant role at the diagnosis and treatment stage. Hence, an accurate diagnosis is extremely important.

A minimally invasive surgery is the most popular choice for both colon and rectal cancers. Additionally, robotic surgery is aiding surgeons in becoming more precise and dexterous. Multiple variations in chemotherapy promise better chances for patients today than 20 years ago. Regular screenings and early detection of a polyp can reduce the consequences of the disease, and with the aid of modern medicine, can help in faster treatment and recovery.

While chemotherapy is advised for patients with mCRC, the therapeutic aim is to prolong survival, control symptoms and maintain or improve quality of life.

The management of this disease has evolved from wide, non-specific kinds of treatment towards more patient specific and target specific. This is the era of personalized medicine. OS in metastatic colorectal cancer has seen a significant improvement with this kind of approach. It is an ideal strategy to test all patients of mCRC with RAS – which has proved to be a powerful predictive biomarker.

In the last decade alone, evolution of therapy for mCRC has been remarkable.

Although the above findings come out of an academic study, theory and study should not be your approach to detect the disease. If you or a loved one needs to be checked for CRC, see a doctor immediately.

Hopefully, all these measures will help us in fighting the disease in India.

This article is based on the research papers ‘Current Status and Future Directions in Colorectal Cancer’ for the Indian Association of Surgical Oncology’ by B. Meyer & Chandrakanth Are and ‘Metatstatic colorectal cancer-prolonging overall survival with targeted therapies’ by Satya Dattatreya.