March is observed as colorectal cancer awareness and prevention month. This disease of the lower gastrointestinal tract touches both males and females equally in the Bahamian population at a significantly younger age and more aggressively than in most other countries. With the exception of breast and cervical cancers in women and prostate cancer in men, it is the most frequently occurring cancer in our country.
It is number two in men, after prostate cancer, and number three in women, after breast cancer at number one and cervical cancer at number two.
The awareness color for colorectal cancer is blue.
What is colorectal cancer?
Colorectal cancer, sometimes referred to as bowel cancer, is the result of rapid growth of cancer cells in the colon (large intestine) or rectum. This abnormal growth most often starts in the lining of the colon and if left undetected and untreated, can grow through the wall and spread to the surrounding tissues. When detected early, and treated effectively, people diagnosed with colorectal cancer, can go on to live normal, productive lives. The key, as in all cancers, is early detection, and early and effective treatment.
Signs and symptoms of colorectal cancer?
During the early stages of colon cancer there may be absolutely no symptoms. There may be no bad feelings; no swollen or distended abdomen; no unusual constipation and/or diarrhea. There are generally no signals to indicate that something is going terribly wrong inside. The common warning signs that may appear later include blood in the stool, change in bowel habits (for example, constipation or loose stool), loss of appetite, weight loss, anemia and abdominal pain.
Major risk factors for colorectal cancer
Colon cancer may occur in people with very low or no apparent risk factors. However, there are certain factors that place individuals at greater risk for developing the disease. Risk factors include a diet high in fat, alcohol and red meat, and low in fiber. Obesity, smoking and lack of regular physical exercise may also be contributing factors.
Additionally, people with inflammatory bowel disease (ulcerative colitis and Crohn's disease) are also at greater risk for colorectal cancer. The risk is greater the longer the individual has the disease and the worse the severity of their inflammation. People with inflammatory bowel disease make up less than two percent of colorectal cancer cases each year.
Family history also plays a role. People with a family history, where one or more first-degree relatives (parents, siblings) were diagnosed with the disease, have a risk of colorectal cancer that is two or three times greater than do people with no such family history. This group accounts for some 20 percent of all cases.
Age is also a factor. The risk of colorectal cancer is low in people who are younger than 40 years. The risk increases significantly in people who are older than 50 years.
Colorectal cancer diagnosis
Diagnosis is generally made as a result of an examination of the lower intestinal tract (the colon and rectum) and/or a stool test. Screening is generally recommended for all adults at age 50 years. There is some evidence to suggest that screening should begin at the age of 45 in blacks, or people of African descent. The best test to detect colon cancer and colon polyps is a colonoscopy. If your first colonoscopy is normal, it should be repeated every seven to 10 years. There are other methods used to diagnose colorectal cancer or to detect polyps.
With the stool test, the stool is examined in the laboratory, primarily for the presence of blood. This test is inexpensive and should be repeated every year.
With the barium enema test, the doctor puts a contrasting substance into the rectum, then takes a special x-ray of the large intestine and rectum, to see if there are any abnormalities. This test is relatively inexpensive and can be repeated every five years.
With the virtual colonoscopy, by means of computer-animated, three-dimensional images of the large intestine and rectum are generated to see if there are any precancerous growths, polyps or other diseases. This test can be repeated every five years. Its major shortcoming is that if any polyps are detected, it would not be possible to remove them during the procedure.
The treatment of colorectal cancer depends on how advanced the disease is. Colon polyps can be removed quite easily during a colonoscopy. Colon cancer may require surgery either by an open laparotomy or laparoscopically. Sometimes chemotherapy is used before surgery to shrink the tumor before attempting to remove it, or may be recommended after surgery if the surrounding tissues are involved.
However, when the cancer is detected at a more advanced stage, especially if multiple metastases are present, treatment is often directed more at extending life and keeping the individual comfortable. While radiation, in combination with chemotherapy, is sometimes used to treat rectal cancer, it is seldom used in the treatment of colon cancer.
Lowering the risk of colorectal cancer
Most of these cancers can be prevented through regular surveillance (screening) and improved lifestyle practices, in combination with certain medications, taken under a doctor's supervision.
Bahamians, both male and female, should have a baseline colorectal cancer test (stool, barium enema, virtual colonoscopy or colonoscopy), at age 45 years, then repeated at regular intervals as prescribed by their doctor. For those with a first-degree relative diagnosed with colon cancer before the age of 60 years, the baseline test should be done at age 40, or 10 years earlier than the age the relative was when diagnosed. For example, if a parent or sibling was diagnosed at age 42 years, the base-line test should be done at age 32 years, and then repeated at intervals as ordered by the doctor.
Current dietary recommendations for lowering the risk of colorectal cancer include increasing consumption of whole grains like brown rice, whole wheat bread and pasta; fruits and vegetables, especially leafy green vegetables, tomatoes, sweet potatoes and citrus fruits. And reducing our consumption of red meats and processed foods. Limiting alcohol consumption to no more than two glasses for men, and one for women daily. Stop smoking. Exercising daily, for at least half-an-hour.
Additionally, low-dose aspirin has been shown to lower the risk of colorectal cancer in people at high risk for the disease. But should only be taken under a doctor's guidance.
Colorectal cancer is the most frequently diagnosed, non-gender specific cancer in our country. Sadly, because there are often no symptoms in the early stages of this disease, it is often only detected at a very advanced stage. We can do much to prevent and effectively treat this very debilitating disease, by adopting a healthier lifestyle and having regular screening. Early detection is critical for effective treatment of colorectal cancer.
oFor more information, or to volunteer with the Cancer Society of The Bahamas, please call 323-2441 02 323-4482; or visit our website at cancersocietybahamas.org.
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