Colorectal cancer is a disease specific to developed countries in North America, Europe, Australia and New Zealand. Its incidence is higher in these areas than in less developed countries in Africa, South America, or in some parts of Asia. Dr. Estera Jeledin?an gastroenterologist gives us reason for hope by telling us that this type of cancer is curable, if detected in its early stages.
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Colorectal cancer is quite common among both men and women, being the third most common in men and the second most common in women. The good news is that it has a survival rate after early diagnosis and treatment of 90%.
External factors There are a number of factors that cause cancer such as smoking, alcohol, diabetes, environmental carcinogens, a diet low in selenium, certain changes in the intestinal flora, low fiber diet and high consumption of animal products (especially red meat).
Genetics is added to external factors and increase the incidence. People with a family history of colorectal cancer or large polyps have a higher risk of developing colorectal cancer.
Some common symptoms include: frequent tiredness, constant abdominal pain and anemia. Anemia is caused by blood loss in the stool. "Right-sided colon tumours reach quite large sizes and bleed occultly, meaning the patient does not see the bleeding in the stool, the amounts are small and are mixed with the feces most of the time," explains Dr. Estera Jeledin?an, "There can also be massive bleeding, which the patient can easily notice because it colours the stool red or maroon. These visible symptoms are more typical of left-sided colon cancer, when the tumours are located on the left side and because this part of the colon is shorter and narrower, the tumours do not reach large sizes and quickly obstruct the intestinal lumen. Patients quickly feel severe pain with intestinal transit blockage, initially only for stool, later also for intestinal gases, which becomes a surgical emergency. This type of cancer usually causes constipation that suddenly worsens, alternating with diarrhea.”
Colonoscopy is the most accessible and most irelevant investigation regarding colorectal cancer. In addition, a biopsy is also performed on this occasion if the doctor finds the existence of polyps. Then, the anatomopathological examination helps the oncologist determine the type of treatment that the patient will follow. “Colonoscopy is later supplemented with imaging examinations - Computer Tomography (CT) or Magnetic Resonance Imaging (MRI) - to see the impact of the disease on the surrounding organs, and what medical measures need to be taken.”
After the diagnosis is established, the patient presents to the oncologist who will form a multidisciplinary team with the radiotherapist and surgeon and will establish the correct and effective order for treatment depending on the location of the cancer, staging, which other organs are involved, whether it is an advanced or incipient disease. Usually it starts with chemotherapy, then surgery or radiotherapy is performed in patients with rectal cancer. In short, the order of treatments applied is established.
"What we want as doctors and what patients should want too, is to discover the disease very early, or even before it appears. For colorectal cancer, the polyp-cancer sequence is proven. Every colorectal cancer was, 5-10-15 years ago, one or more small polyps, which could have been discovered through a simple colonoscopy, without major risks, and if they had been removed in time ten years ago, it would not have even reached colorectal cancer", emphasises dr. Jeledințan.
A healthy lifestyle and proper nutrition are the main ways to prevent cancer of any kind. Consequently, it is necessary to avoid a diet rich in red meat, processed meat, fats, but poor in fiber. The general recommendation is to consume fruits and vegetables of organic origin, fiber from natural cereals, not industrially processed. Lack of physical activity can be a problem, sedentary people have a higher risk of developing the disease, compared to active people. Normal weight is also a prevention factor in colon cancer, especially since the disease is more common in overweight or obese people. A special mention regarding smoking and alcohol consumption; both habits contributing to the occurrence of oncological diseases in general, not just colorectal cancer.
Colorectal cancer could be easily avoided if we had a colonoscopy, especially from the age of 50 and up. "I insist to the fact that patients should have a colonoscopy (preferably every five years, if there were no previous changes in the colon, annually, if there were problems), especially once they pass the age of 50. And if they also have first-degree relatives who had colorectal cancer before the age of 60 or with large polyps before this age, it would be a good idea to start having a colonoscopy right from the age of 40-45 onwards. That is, to start screening 10 years earlier than when the youngest relative in the family had colon cancer. If they had relatives who had this type of cancer at the age of 40, then they should start screening right from the age of 30. Colonoscopy highlights the occurrence of the disease, polyps are resected if they exist and a biopsy is performed at the same time, and this means getting rid of serious problems that may arise later in the absence of a colonoscopy”.
Patients with a family history of colorectal cancer can and should also have an annual test for occult bleeding in the stool. “Identifying blood in the stool, even if it does not necessarily mean cancer, alerts the patient and the doctor to the fact that there is a possible tumour in the digestive tract. Of course, gastritis or esophagitis also causes bleeding, but it is good to investigate the cause of that bleeding. Many times, following this test, we have discovered patients with polyps or incipient tumours”, says Dr. Estera Jeledin?an.
• Colorectal cancer can be avoided through a healthy lifestyle and regular screening;
• Colorectal cancer does not show any symptoms in its early stages, which is why colonoscopy is the best way to detect it early;
• Polyps that appear on the intestine and are not removed in time by colonoscopy grow in size and, in 5-10 years, can turn into cancer;
• Colorectal cancer diagnosed and treated on time is 90% curable.
