By Dr. Nikhil Nanjappa, Consultant Surgical, Gastroenterologist & Colorectal Surgeon, Aceso BKG Health Care, Mysuru
Colorectal Cancer (CRC) is a common and deadly disease that affects the colon and rectum. It can cause bleeding, pain, weight loss and fatigue. It is often mistaken for piles and not diagnosed early enough. CRC can be prevented by screening and through healthy habits.
CRC is the seventh most common cancer in India, with over 27,000 new cases and 19,000 deaths in 2018. It affects both men and women, mostly after 50 years of age.
The exact cause of CRC is unknown, but some factors increase the risk:
Age: Older people are more likely to get CRC.
Diet: Eating too much red meat, processed meat and fat can raise the risk.
Obesity: Being overweight or obese can make CRC more likely.
Smoking: Smoking can damage the DNA of the colon and rectum cells.
Alcohol: Drinking alcohol can affect how the body works.
Inactivity: Not exercising can increase the risk.
Inflammatory Bowel Disease: Having long-term inflammation of the intestines, such as Crohn’s disease or ulcerative colitis.
Family history: Having a relative who had CRC or polyps can make CRC more likely.
Polyps: CRC usually starts from a benign growth called a polyp on the colon or rectum lining. The most common type of polyp that can turn into CRC is an adenoma.
Diagnosis, Screening & Staging
The best way to prevent CRC is to find and remove polyps before they become cancerous. This can be done by regular screening tests that check the colon and rectum for any problem.
Diagnostic and screening tests
Consult colorectal surgeon: This is the first and best step. A colorectal surgeon is a specialist who has extensive training and experience in diagnosing and treating CRC.
Colonoscopy & biopsy: This test uses a tube with a camera to look at and remove any polyps or tumours in the colon and rectum. It is usually done under sedation or general anaesthesia to make it comfortable for the patient.
Screening tests can lower CRC cases and deaths by removing precancerous polyps and finding early-stage tumours that are easier to treat.
The stage of CRC shows how far it has spread in the body. This is done with scans such as CT or MRI. The stages go from 0 to 4, with higher numbers meaning worse disease. The stage affects the outlook and treatment options.
The treatment of CRC depends on many things, such as the type, grade, stage, location, and features of the tumour, as well as the patient’s health and choice. A team of colorectal experts is needed to ensure the best result. Each tumour is different and each patient is unique, hence an individualised treatment plan is chalked out by a robust multi-disciplinary team led by colorectal surgeons is vital.
A colorectal surgeon is a specialist who has extensive training and experience in performing surgery for CRC.
Surgery: This is the main treatment for most CRC cases. It involves removing the tumour, lymph nodes and some normal tissue around it. It can be done as open or laparoscopic and robotic methods. Minimal invasive techniques when carried out by specialists result in better patient satisfaction, early discharge, improved quality of life, lower blood loss, less pain, shorter hospital stay, faster recovery, lower risk of infection, lower risk of bleeding, lower risk of recurrence, lower risk of complications, etc.
Radiation therapy: This can be used before or after surgery to kill any cancer cells left behind. It works by using high-energy rays or particles to damage DNA. It can also help radiotherapy work better.
Chemotherapy: This is used for advanced or spread CRC that has reached other parts of the body. It works by using drugs that kill cancer cells or stop them from growing. It can also help radiotherapy work better.
Targeted therapy: This is by using drugs that target specific genes involved in CRC. They work by blocking or interfering with how these genes function. They can also help radiotherapy work better.
The five-year survival rate for CRC in India was around 50% in 2018. There is evidence that sub-specialisation in colorectal surgery improves outcomes.