Colorectal Cancer (CRC) is the third most common cancer worldwide, with approximately 1·8 million new cases in 2018

By : Mohamed Shawky

Non communicable diseases are having a huge impact on the health and economy of the world. Cancers are rising in incidence and prevalence. Colorectal Cancer (CRC) is the third most common cancer worldwide, with approximately 1·8 million new cases in 2018. Department of Health, Abu Dhabi( DOH) reports 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 under 40 years of age has been found to be relatively high. Normally, people above the age of 50 years are affected. However, there is an increasing CRC incidence in the patients younger than the age of 50, globally.

 “Prevention is better than cure, but when treating cancers – a balance has to be maintained between length of survival and quality of life.  As such it is imperative that people have thorough information on CRC,” said Dr.Narasimhaiah Srinivasaiah, Senior Consultant Colorectal surgeon, Apollo Hospitals.

Colon cancer arises 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 become cancerous. Some of the common symptoms for this form of cancer include change in bowel habit, rectal bleeding, sudden loss of weight and anaemia. Some may present with pain and abdominal distention.  Some of the common 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 include 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 remains the golden health standard for colon screening, diagnosis is done through 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 having undergone chemo-radiotherapy,he approached Apollo Hospitals for a restorative cancer surgery. He underwent 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 depends on the stage, location and the overall health of the patient. In the case of this patient, an early diagnosis helped 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,” added 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 includes surgical robotics are also gaining momentum in treating CRC.

While CRC is not entirely 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 seeking help when concerned. A routine check 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.