Non communicable diseases are having a wide effect on the health and economy of the world. Cancers are emerging in incidence and prevalence. Colorectal Cancer (CRC) is the third most common cancer globally, with about 1•8 million new cases in 2018. Department of Health, Abu Dhabi (DOH) states that CRC is the second most common cancer and the second highest cause of cancer deaths in the UAE.
In Gulf countries, such as Oman and Saudi Arabia, the incidence of colorectal cancer in people below 40 years of age has been found to be considerably high. Normally, people above the age of 50 years are affected. However, there is a rise CRC incidence in the patients younger than the age of 50, worldwide.
“Prevention is better than cure, but while treating cancers – stability has to be maintained between length of survival and quality of life. As such it is essential that people have thorough information on CRC,” stated Dr. Narasimhaiah Srinivasaiah, Senior Consultant Colorectal surgeon, Apollo Hospitals.
Colon cancer emerges from the lining of the colon and rectum. It consists of polyps, which are benign cellular lumps (on the lining of rectum and colon). Some polyps with time may change to emerge as cancerous. Some of the common symptoms for this form of cancer such as change in bowel habit, rectal bleeding, sudden loss of weight and anaemia. Some may present with pain and abdominal distention. Some of the general risk factors for CRC include age, lifestyle, tobacco, obesity, red meat, processed meat, high fat diet, lack of dietary fibre and fruits, etc. Additional risk factors such as inflammatory bowel diseases like Crohn's disease and ulcerative colitis; family history of cancer or polyps; familial adenomatous polyposis (FAP), a genetic syndrome; and Lynch syndrome, or an inherited condition that increase your risk of colon cancer.
While colonoscopy continues to be the golden health standard for colon screening, diagnosis is carried out by histopathology of the sample of the growth. If diagnosed and treated early, CRC can be managed well.
One such case is of a patient, who himself was a doctor. Hailing from Yemen the doctor showed history of change in bowel habits and per rectal bleeding. Investigations revealed that the patient had a very low rectal cancer involving the inside muscle of the back passage. After going through chemo-radiotherapy, he approached Apollo Hospitals for a restorative cancer surgery. He endures a Robotic Intersphincteric rectal resection and a temporary Ileostomy. Since then, his recovery has been eventful, and he’s scheduled for a reversal of Ileostomy soon. In the normal course of events or a non-specialised centre – this patient would have had a permanent stoma (Bag). But given the expertise and sub-speciality colorectal services – the patient underwent a successful restorative procedure.
“Once diagnosed, treatment relies upon the stage, location and the overall health of the patient. In the case of this patient, early diagnosis assistance saved his life. As such it is important, that high risk groups with inflammatory bowel diseases, family history of cancers, familial syndrome families and patients prone for polyps adhere to early and regular screening. Symptomatic patients need colonoscopy as a gold standard,” mentioned Dr Srinivasaiah.
Treatment options for CRC include surgery, chemotherapy, radiation, and targeted therapy. With advancement in medical science, precision medical oncology, targeted therapies and precision-based surgeries which include surgical robotics are also gaining momentum in treating CRC.
While CRC is not completely preventable, risk reduction can be done by adopting a healthy lifestyle, regular exercise, balanced diet with fruit, vegetables, whole grains and foods containing fibre, staying aware of the symptoms and looking for help when concerned. A frequent checks after the age of 40 years can be useful in certain high-risk groups or when symptomatic. A colonoscopy done at that point can remove pre-cancerous polyps or identify cancers at a very early stage.