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COLORECTAL CANCER: WHAT YOU NEED TO KNOW
Bankole, a 56 year old lawyer, had been having worrying symptoms that eventually made him book an appointment with his family physician last month.
When he mentioned the ongoing diarrhoea he had been experiencing months before he presented, the presence of blood in his stool and unexplained weight loss (he had lost over 15kg in less than 8 weeks), his physician had his suspicions, which he finally confirmed after a series of tests.
Colorectal cancer, he said and proceeded to outline a line of management for Bankole.
In the wake of the World Cancer Day, let’s talk about colorectal cancer for recent research carried out by Irabor (2017) showed that colorectal cancer has an estimated crude incidence rate of 4.04/100,000 of the population in Sub-Saharan Africa (SSA), which equals 4.38 men and 3.69 women.
According to Irabor (2017), majority of the available studies showed an average age of between 43 and 46 years with peak age of 50–60 years. Ghana was the exception as her average age is 58 years with peak age of 70–80 years).
So, what is it?
Colorectal cancer (CRC) refers to the uncontrolled growth of cells found in the colon and rectum. Although they can be separately grouped into colon and rectal cancer, cancers affecting the colon and rectum are commonly referred to as colorectal cancer because of the features they share.
But what are the colon and rectum?
The colon and rectum are organs of the gastrointestinal tract, specifically the large intestine or large bowel.
As parts of the large intestine, the colon is primarily responsible for absorbing water and salt from the products of digestion, which the small intestine sends to it. The rectum, on the other hand, receives the remnant, stores it for a while before passing it out through the anus.
Basically, the colon and rectum work to ensure that your poop normally comes out solid and not liquid.
The predominant types of cancers affecting the colon and rectum are:
About 96% of colorectal cancers are adenocarcinomas, which are cancers that originate in cells which produce mucus. As an aside, mucus lubricates the inner parts of the colon and rectum.
Signet ring and mucinous, which are subtypes of adenocarcinomas have a worse prognosis.
- CARCINOID TUMORS
Although less common than adenocarcinomas, carcinoid tumours begin from special hormone-making cells found in the intestine.
- Gastrointestinal Carcinoid Tumors (GISTs)
Also less common than adenocarcinomas, GISTs originate from the interstitial cells of Cajal, which are special cells found in the wall of the colon.
Lymphomas are cancers of the cells of the immune system. Although they often originate from the lymph nodes, lymphomas can also start in the colon, rectum or other organs.
Although rare in colon or rectum, sarcomas can start in blood vessels, muscle layers as well as other connective tissues in the wall of the colon and rectum.
1.3 SIGNS AND SYMPTOMS
Like many medical conditions, colorectal cancer isn’t without clinical manifestations, which are markers that let you know that something is off.
These clinical manifestations while not present in everybody, especially at the early stages, include:
- A change in your bowel routine.
Changes to be concerned about include diarrhoea, constipation or a variation in the consistency of your stool, which exceeds a period of four weeks.
- Prolonged abdominal problems like pain or cramps.
- Unexplained weight loss.
- Rectal bleeding often evidenced by the presence of blood in your stool.
- A sensation of a full bowel even after toilet use.
It is important that you see your physician should you observe any of the aforementioned symptoms.
1.4 CAUSES AND RISK FACTORS
Although the cause of CRC isn’t always known, we do understand that CRC can develop when an anomaly in the DNA of hitherto healthy colon and rectal cells lead them to grow and divide in an uncontrolled manner. As a result, the cells continually proliferate even when the body has no use for them and eventually form a tumour, which can be localised (remain at the primary site) or metastatic (able to spread to other sites).
Certain factors can increase your risk of developing CRC. These factors include:
- A family history of CRC.
- Consumption of a high fat-low fibre diet.
- Consumption of red meat and processed meat.
- Sedentary lifestyle.
People who are over the age of 50 have an increased risk of developing CRC.
- Alcohol consumption.
- A personal history of CRC or polyps.
- A personal history of chronic inflammatory intestinal conditions like Crohn’s disease and ulcerative colitis and Crohn’s disease.
- Family history of genetic syndromes like familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC) also known as Lynch syndrome.
FAP is a rare disorder that causes a person to develop thousands of polyps in the lining of his colon and rectum. When untreated, people living with FAP have a significantly increased risk of developing colon cancer before age 40.
HNPCC, on the other hand, raises the risk of colon cancer together with other cancers. People living with HNPCC tend to develop colon cancer before reach age 50.
- Diabetes Mellitus
People who have undergone radiotherapy, especially when directed at the abdomen, have an increased risk of developing CRC.
How can you significantly reduce your chances of developing colorectal cancer?
Here are helpful tips:
- Cut down on your intake of processed meat like sausages and hot dogs. Also limit your consumption of red meat and meat cooked at high temperatures.
- Embrace a diet rich in fibre. A simple way of doing this is by consuming fibre-rich fruits and veggies like apples, oranges, bananas, pumpkin leaves amongst others.
- Embrace a low sugar diet. A higher amount of calories is found in a diet high in sugar and this can lead to weight gain, which increases your chances of developing colorectal cancer.
- Quit smoking if you do because this increases your risk of developing colorectal cancer.
- Limit your intake of alcohol. Women are advised to take not more than one drink a day while men shouldn’t exceed two daily.
- Strive to maintain a healthy weight.
- Try to replicate a squatting position while moving your bowels by raising your leg with a small stool.
- Adopt an exercise regimen that works for you.
- Plan to go for a screening for colorectal cancer if you’re over the age of 50.
However, if you have a family history of colorectal cancer, which puts you at an increased risk, you should plan to get a screening earlier.
- Report symptoms like changes in your normal bowel habits, presence of blood in your stool, unintentional weight loss and abdominal cramps to your doctor ASAP.
What if you’re diagnosed with CRC? What will be your treatment options?
When it comes to treatment options, your physician and other members of the team are in the best place to formulate your plan of care.
However, for educational purposes, treatment for CRC may involve any of the following:
- LOCAL TREATMENTS:
This involves treatment of the tumour only.
Local treatments are often used or treat CRC when they are at the early stage, that is, when they haven’t spread.
Local treatment options include colon surgery, rectal surgery, ablation and embolisation, and radiotherapy.
- SYSTEMIC TREATMENTS:
This involves the use of drugs administered orally or directly into the systemic circulation
Systemic treatments have the ability to get to cancer cells throughout the body and include chemotherapy, immunotherapy, amongst others.
In all, it’s important to note that factors like the stage of the cancer play a role in the treatment approach your health team will propose.
- Irabor DO. Emergence of colorectal cancer in West Africa: Accepting the inevitable. Niger Med J [serial online] 2017 [cited 2019 Jan 31];58:87-91. Available from: http://www.nigeriamedj.com/text.asp?2017/58/3/87/234076
- Mayo Clinic Staff. Colon cancer. (2018, November 15). Retrieved from https://mayocl.in/2j8e9OM
- The American Cancer Society medical and editorial content team. What is colorectal cancer? (2018, February 21). Retrieved from https://bit.ly/2lsO7ls
- The American Cancer Society medical and editorial content team. Treating colorectal cancer. (2018, February 21). Retrieved from https://bit.ly/2HfxyV0
TOGETHER WE CAN FIGHT CANCER
- Chukukere Chidimma AdaugoMaryjane Okobi
LNA Media Team