Colon and Rectal Cancer : What to know?

The 21st century has seen the surgence of cancer as the major public health concern in India , with India as a single country contributing to 7.8 % of the global cancer burden. Cancer is the second and fourth leading cause of death in urban and rural India respectively , greatly contributing to increasing expenditure before death . 1.01 million new cases are diagnosed per year and is predicted to almost double by 2040 due to demographic changes. According to data released by National Centre for Disease Informatics and Research (NCDIR), an institute under Indian Council of Medical Research (ICMR), of 49,674 persons detected with cancer in Odisha in 2016. According to the cancer registry maintained at HCG Panda cancer hospital cuttack, 3242 and 2588 new cases were registered in 2018 and 2019 respectively. The most common cancer in Indian men are tobacco related , and that for women is breast cancer and cervical cancer.

Cancer of the colon and rectum ( large intestine) though not the most common cancers in India but contribute to a significant proportion of the total cancer burden and an increase in incidence in the near future is foreseeable due to changing lifestyle , dietary habits and urbanisation .Blood falling in stools though innocuous for some , however might be a harbinger of colorectal cancer.

These cancers however present at later stages because of the overlapping of their symptoms with certain non cancerous diseases like fissure or piles ; pursuance of alternate therapies , prolonged self negligence , thus leading to a delayed diagnosis. The common complaints being altered bowel habits, anal bleeding, constipation, diarrhoea, unexplained weight loss, with rectal / anal bleeding being the most important symptom.

The risk factors are mostly lifestyle related and in fact the links between colorectal cancer and obesity physical activity and diet are among the strongest among all cancers.

It is curable when detected early. Ninety-one percent of patients with localized colorectal cancer (confined to the large intestine) are alive five years after diagnosis. But only 37 percent of all colorectal cancers are diagnosed at this stage. The remaining 63 percent of patients come to the doctor when the disease has spread beyond the wall of the colon or rectum or to distant parts of the body. Strangely in approximately 75% of the cases this cancer happens to occur in persons without any identifiable risk factor except for age more than 50 years .

Even though a small fraction ; but those with a family history i.e with history of parents or close relatives with history of large intestine cancer need to undergo screening via colonoscopy at an earlier age . Other high risk groups are women with a family history of breast cancer , ovarian cancer , or endometrial cancer who should undergo screening at an earlier age.

Colonoscopy is a procedure in which the doctor visualises the entire large intestine using an endoscope. Sometimes certain small soft tissue outpouchings ( polyps) might be picked up which will need to be biopsied . Any other suspicious lesion also will need to be biopsied for further characterisation. There is a general misconception that biopsy causes tumor to spread. Though theoretical, the chances are minimal. Surgeons follow standard procedures, and use special methods and take many steps to prevent cancer cells from spreading during biopsies or surgery to remove tumors.

Another misconception being that solid tumors do not require surgery . Treatment for cancer is multimodality with surgical oncology , radiation oncology and medical oncology forming its pillars. The therapy for large intestine cancer also includes a combination of the above which depends on the location and stage of the tumor. Sometimes the other modalities might be required to shrink the tumor prior to surgical removal.

Cancer spread follows a predictable pattern of spread which has been demonstrated by studies.

During surgery the portion of large intestine with cancer and surrounding lymph nodes are removed and sent for final assessment by histopathology; which gives the final stage.

The options for a patient undergoing surgery for colorectal cancer are – conventional open surgery, laparoscopic surgery or robotic surgery. Conventional open surgery requires a large incision in the abdomen to remove cancers and any nearby lymph nodes. The downsides of this option is, in most cases, the development of significant scar tissue inside the abdomen , few cases might develop infection , or later on hernia at the incision site. In contrast the Common advantages of minimally invasive surgey (laparoscopic ,robotc) include less pain after the operation , shorter hospital stay ,quicker return to eating, drinking and bowel function (going to the toilet normally), quicker return to normal activity, and less scarring after the operation

Laparoscopic-assisted surgery involves the use of a slender viewing tube (laparoscope) and a tiny camera, which are inserted through the navel to examine the abdominal organs and perform surgery. With laparoscopic–assisted surgery, the incision in the abdomen is smaller than the one used in open surgery, but large enough that the large intestine can be lifted through it, so the surgery can be performed outside the body.

Robotic technology virtually extends the surgeon’s eyes and hands into the confines of the abdomen and pelvis. It empowers the surgeon with improved 3D vision , magnification and improved dexterity ; attributed to the wristed movements of the instruments.

Cancer Is Curable . What it requires is increased awareness and mass consciousness , early diagnosis , multimodality therapeutic approach and a diligent followup .

For any queries related to cancer write to us at teamprashantdas@gmail.com

MS Surgery, Mch Surgical Oncology, Fellowship in Minimal Access Surgery( FMAS) , Consultant Surgical Oncologist and Minimally Invasive Cancer Surgeon