It is important to create awareness regarding CRC since it is common and the incidence is on rise and as mentioned the most cases in Kashmir are detected at locally advanced stage.
The importance of awareness and screening lies in the fact that most colorectal cancers can be fairly diagnosed at an early stage and even prevented as the cancer precursors (polyps) can be removed.
The other reason why colorectal screening programs are included under national health screening in the western countries is that the screening is very cost effective i.e the resources needed for screening are way less than the amount of morbidity, mortality, loss of productive years and quality of a life of a patient if detected at late stages
Folks before we talk about colon cancer, Did you know that;
Colon cancer can be prevented.
One needs to be screened for colon cancer even in absence of symptoms.
Life style choices, habits have an impact on colon cancer risk.
Colon cancer can be prevented as well as treated endoscopically.
March is observed as Colorectal Cancer (CRC) Awareness month to spread awareness among people that colorectal cancer can happen to anyone and often symptoms are difficult to identify in the early stages and due to lack of awareness and strict health policy implementations cases are usually detected at very advanced stages of the disease.
This makes it all the more important for individuals to learn about the risk factors, symptoms, prevention, management, and treatment options.
What is Colorectal cancer?
Colorectal cancer is the cancer of rectum or colon (Large Intestine). These cancers can also be called colon cancer or rectal cancer, depending on where they start.
Colon cancer and rectal cancer are often grouped together because they have many features like risk factors, symptoms, prevention, diagnosis and management options in common.
How common is Colorectal Cancer?
Overall, the lifetime risk of developing colorectal cancer is: about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States.In the United States, colorectal cancer is the third leading cause of cancer-related deaths in men and in women, and the second most common cause of cancer deaths when men and women are combined. It’s expected to cause about 52,580 deaths during 2022.
It is the most common gastrointestinal malignancy and accounts for more than half of the cancers of all gastrointestinal tract.In India, it is the fifth most common cancer after breast, cervix/uterus, lip/oral cavity, and lung cancer. After a study in 12 cancer registries of India (Bengaluru, Barshi, Bhopal, Chennai, Delhi, Mumbai, Ahmedabad, Karunagappally, Kolkata, Nagpur, Pune, Mumbai, and Thiruvananthapuram), it was stated that the risk of CRC in India is significantly low, but has been rising slowly.
There is a significant difference in the incidence of colorectal cancer in different parts of the world, highest in Australia/New Zealand, North America and Europe and lowest in Western Africa and South Central Asia. The reason for the same is attributed to the typical Indian diet. Abundant in fruits and vegetables and lower in calories, this diet is healthier than that of most nations.This, combined with a moderate level of physical activity, results in a low rate of CRC in the country. However, with changing lifestyles and diets, and with lowering of mortality, ColoRectal Cancer is not to be taken for granted.
The rate of ColoRectal Cancer in India and other developing countries is on the rise. By 2035, Colorectal Cancer is expected to rise by a staggering 80 percent. It is also important to note that while patients of CRC display the same symptoms in India and the US, patients in India present with the cancer at a younger age and a later stage of the disease, the reason being lack of awareness among the people and lack of nation wide screening programmes for CRC.Kashmir Scenario: In 2011, a study from SKIMS Soura showed the crude incidence rate of colorectal cancer in both males and females at similar rates with rest of India with crude rates of 3.65/1 lakh population.
Srinagar had the highest number of cases and Kupwara the lowest. In 2019, department of Community Medicine, GMC Srinagar reported that Colo-Rectal cancer was the most common malignancy in females and second most common malignancy in males.
RISK FACTORS:
Well before knowing the risk factors, one should know that having a risk factor, or even many, does not mean that you will get the disease. And some people who get the disease may not have any known risk factors.Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer.If you are overweight or obese (very overweight), your risk of developing and dying from colorectal cancer is higher.
Being overweight raises the risk of colon and rectal cancer in both men and women, but the link seems to be stronger in men. Regular moderate to vigorous physical activityIf you’re not physically active, you have a greater chance can help lower your risk.A diet that’s high in red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some luncheon meats) raises your colorectal cancer risk.
Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk. It’s not clear how much this might increase your colorectal cancer risk.People who have smoked tobacco for a long time are more likely than people who don’t smoke to develop and die from colorectal cancer. Colorectal cancer has been linked to moderate to heavy alcohol use. Even light-to-moderate alcohol intake has been associated with some risk.If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large, if there are many of them, or if any of them show dysplasia.
If you’ve had colorectal cancer, even though it was completely removed, you are more likely to develop new cancers in other parts of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.
If you have inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease, your risk of colorectal cancer is increased- If you have IBD, you may need to start getting screened for colorectal cancer when you are younger and be screened more often. Please note: Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not appear to increase your risk for colorectal cancer.
Family History of colon cancer: Most colorectal cancers are found in people without a family history of colorectal cancer. Still, as many as 1 in 3 people who develop colorectal cancer have other family members who have had it. People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk.
The risk is even higher if that relative was diagnosed with cancer when they were younger than 50, or if more than one first-degree relative is affected. The reasons for the increased risk are not clear in all cases.
Cancers can “run in the family” because of inherited genes, shared environmental factors, or some combination of these.Having a low blood level of vitamin D may also increase your risk.Night shift work-Some studies suggest working a night shift regularly might raise the risk of rectal cancer.
This might be due to changes in levels of melatonin, a hormone that responds to changes in light.Previous treatment for certain cancers-Some studies have found that men who survive testicular cancer seem to have a higher rate of colorectal cancer and some other cancers. This might be because of the treatments they have received, such as radiation therapy.
Several studies have suggested that men who had radiation therapy to treat prostate cancer might have a higher risk of rectal cancer because the rectum receives some radiation during treatment.
Most of these studies are based on men treated in the 1980s and 1990s, when radiation treatments were less precise than they are today. The effect of more modern radiation methods on rectal cancer risk is not clear, but research continues to be done in this area. Diabetes mellitus.
The author is DM Gastroenterology and is presently working as Consultant Gastroenterologist and Therapeutic Endoscopist at Asian Institute of Gastroenterology Hyderabad.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.