Michelle Madzudzo/ Mackintosh Chigumira
MOST often when people hear about cancer what comes to mind immediately is usually cervical, breast or prostate cancer.
They tend to forget that there are various other cancers like colorectal cancer which are given the cold shoulder. It is important to understand that cancer can originate from anywhere in the body and this includes colon and rectum (colorectal) which make up the large intestines.
Colorectal cancer can also be called colon cancer or rectal cancer, depending on where it starts but they are often grouped together since they have same presenting features.
In Zimbabwe, many people are diagnosed with colorectal cancer and it constitutes about 5% of all cancer deaths, coming sixth after kaposi sarcoma, cervical, prostate, breast and liver cancers respectively. Colon cancer often produces minimal or no symptoms, emphasising the need for screening and cancer awareness programmes. In case we have forgotten, some popular figures including Morgan Tsvangirai, the famous comedian Gringo (Lazarus Boora) and United States actor of the Black Panther (Chadwick Boseman) all succumbed to this disease. Colon cancer has no regard for individuals’ socio-economic status in case the elite thinks the disease only targets poor people. In fact, nothing warrants negligence hence the need to alert the public about this disease.
Now let us take a closer look and help answer some general questions people may have concerning this disease.
What are the risk factors of colorectal cancer?
Cancer has no known cause but there are several causes found from studies around the world which increase one’s probability of having the disease. Approximately 75% of cases of colorectal cancer occur in patients without specific risk factors. However, risks associated with the onset of colorectal cancer are:
- Having a family member or a relative (brother, sister, mother or father) with a history of colorectal cancer or any other colorectal cancer syndrome;
- A personal history of any other type of cancer like in the womb or breast;
- Age, as people age the risk of colorectal cancer increases due to exposure to mutagens over lifetime;
- Lifestyle behaviours, these include alcohol consumption, poor diet, physical inactivity and smoking.
How do I know I have colorectal cancer?
The clinical presentation of colorectal cancer is determined mainly by site of the tumour and usually its symptoms are non-specific. Symptoms of colorectal cancer are often diagnosed late and some of the symptoms are:
- Bleeding from the rectum
- Blood in the stool or in the toilet after having a bowel movement
- Dark or black stool
- A change in bowel habits or the shape of the stool (for example narrower than usual)
- Cramping or discomfort in the lower abdomen
- An urge to have a bowel movement when the bowel is empty
- Constipation or diarrhoea that lasts long
Persistence of these symptoms should be investigated.
Can colorectal cancer be screened?
Once there is persistence of the above-mentioned presenting symptoms, there is a need to seek medical attention before punishing the stomach with all sorts of self-invented concoctions. Many a time, the public seeks medical help when they have exhausted all sorts of alternatives and by that time the disease would have progressed beyond cure. Early screening is, therefore, necessary for an early management of the disease.
Fortunately, most cases of colorectal cancer are preventable if detected as precancerous cells and this can reduce incidence and mortality rate from the disease. Generally, the screening process comprises two steps:
l Test 1: This test involves the use of a colonoscopy that looks for growths called polyps in your entire colon (large intestine) and rectum. The doctor can remove these premalignant polyps and prevent the onset of colorectal cancer.
l Test 2: If previously done tests such as multi-target stool DNA are positive, a follow-up colonoscopy will be required as a second test to confirm presence of the disease for early management.
Adults aged 45 to 75 should get screened. Frequent and continuous screening should be personalised especially above 75 years. Generally, having a colonoscopy every 10 years starting at age 45 for average risk adults is recommended as a screening test or alternatively a stool fit test which should be done every year. Screening is vital since it helps to identify the presence of polyps before becoming malignant and saves lives. That signifies the power of prevention!
What are the treatment options for colorectal cancer?
Just like any other type of cancer, the probability of cure is dependent on the extent of its spread at diagnosis, the number of involved regional lymph nodes as well as the presence or absence of distant metastases.
The disease is usually managed through surgery, chemotherapy, targeted therapy and rarely radiotherapy. Surgery is often performed first to remove the bulk of the disease after which chemotherapy can be given. Chemotherapy is the major treatment method for many people with colorectal cancer and several studies are constantly being done to try and make it more effective and safer. Targeted therapy drugs can also be used and they work by affecting specific parts of cancer cells that make them different from normal cells.
The good news is that there is a 90% five-year survival rate for cancers detected at an early stage. Unfortunately, patients with more advanced stage cancers have poor outcomes, even though young patients tend to be fitter and may tolerate more aggressive oncological or surgical treatment. This confirms the need for screening so that it is detected early.
What I need to do to reduce the risk of colorectal cancer?
It is estimated that 75% of cases of colorectal cancer are a result of dietary and lifestyle factors that can be modified. Maintaining a healthy lifestyle and eating healthy may help to reduce chances of getting the disease. The primary concern is that diagnostic delay has a major impact on survival hence the need for a cancer aware nation.
As health practitioners specialised in dealing with cancer patients, it is paramount that awareness and education about cancer is improved to facilitate prompt presentation, diagnosis and treatment of the public. It is our mandate and one of our major goals to increase cancer literacy to the populace. We, therefore, call for unity in this fight and urge corporates to support our campaigns because we believe together, we can beat cancer.