Colorectal Cancer

Colorectal cancer affect the digestive system or the gastrointestinal system. The colon and the rectum, together, along with muscular tube-like structures, make up the large intestine, which is 1.5 meters in length.

Colorectal cancer starts in either the colon or the rectum and is often grouped together because of similar features that they share. This type of cancer begins when the healthy cells, in the lining of the colon or the rectum, start to divide abnormally, forming a mass of cells, called a tumour. These tumours can either be malignant (or cancerous) or benign. Malignant tumours can spread throughout the body.

Most of the colorectal cancers start in the inner linings of the structures, as a tumour. These tumours are known as polyps. Some of these polyps, over a period of time, can develop into cancerous cells. The different types of polyps are:

• Adenomatous polyps or Adenoma: These polyps have the tendency to change into cancerous cells. Therefore, adenomas are known as precancerous conditions. They are of three types- tubular, villous or tubulovillous Adenomas
• Hyperplastic polyps or inflammatory polyps: These types of polyps are usually non-cancerous. However, in patients with large hyperplastic polyps, with diameter more than 1 cm, colonoscopy is required for continuous checking.
• Sessile serrated polyps or traditional serrated polyps: These polyps are at a higher risk of developing into cancerous cells.

The most common type of colorectal cancers is adenosarcomas. Adenosarcoma starts in the mucus-producing cells of the inner lining of the colon or rectum.

Other types of colorectal cancers are relatively less common. These cancers types include:

• Carcinoid tumours: They are initiated in the hormone-producing cells of the intestine.
• Gastrointestinal stromal tumours: These start in the Cajal cells of the intestinal wall.

Other types of cancers such as Non-Hodgkin lymphoma (cancer in the immune cells, which starts in the lymph nodes of the body) or Sarcomas (cancer that initiates in the blood vessels, muscle layers or the connective tissues) can also be found in the colon or rectum and are treated in ways similar to colorectal cancer.

The signs and symptoms of colorectal cancer can include:

• Abdominal lumps
• Abdominal pain and bloating
• Any changes in bowel habits
• Blood from the rectum
• Blood in faces, making it look black
• Constipation
• Diarrhoea
• Fatigue
• A feeling of improper bowel movements
• Iron deficiency
• Loss of appetite
• Unexplained weight loss

If you have been experiencing any of these symptoms, we strongly recommend you to visit our specialist and get you tested. The symptoms may overlap with other digestive problems as well, but, if ignored, they may cause trouble later.

Screening and diagnosis of cancer include the following:

• Detailed personal and family medical history will be taken to confirm for any symptoms or diagnosis for any type of cancer or polyps.

Then following tests might be performed to check for and confirm the diagnosis:

• Colonoscopy: This test will allow our specialist to look inside the rectum and colon. This procedure is performed under sedation. A flexible, lighted tube is inserted inside the rectum to check for any kind of polyps.
• Sigmoidoscopy: This procedure also uses a flexible, lighted tube that is inserted through the rectum. This gives a view into the person’s rectum and lower colon to check for polyps, cancer or any other abnormalities. Our specialist will also remove a part of the polyp for biopsy, if needed, during the procedure itself.
• Fecal occult blood test: Also known as a faecal immunochemical test, this test is used to search for evidence of blood in the faeces. A positive test can indicate the presence of a polyp of the tumour.
• Double-contrast barium enema: This test is performed in patients where colonoscopy is not an option. Here, an enema, that contains barium is given to the patients which allow the colon and rectum to be visible clearly during an x-ray.
• Stool DNA tests: In these tests, DNA is extracted from a person’s stool, to check for cancer.

Factors that increase the risk of colon cancer may include:

• Older Age: Although colon cancer can be diagnosed at any age, individuals who are above 50 years of age are at a higher risk.
• Personal History: If an individual has already suffered from colorectal cancer or any form of polyps before, it is highly likely that he or she may suffer from it again.
• Inflammatory intestinal conditions: Chronic inflammatory conditions such as ulcerative colitis or Crohn’s disease that may affect the colon, increase the chances of having cancer.
• Inherited syndromes or genetic mutations can be passed from generations to generations and may or may not be expressed in each individual. Although, as suggested by studies, only a small percentage of colon cancers are associated with inherited conditions, these conditions do increase the risk of cancer. The most common known syndromes are the familial adenomatous polyposis, Lynch syndrome or the hereditary nonpolyposis cancer.
• Family history: If an immediate family member had suffered from colon cancer, it is possible that one will get cancer at a later stage in life.
• Low-fiber, high-fat diet: Diet plays an important role in our health. Diets, which are high in fibre, keep our digestive system healthy. However, diets that are high in fat make case health issues and changes in the digestive system.
• Lifestyle choices: An inactive or sedentary lifestyle choice increases the risk of an individual to get cancer. A healthy, active lifestyle choice keeps the body fit and disease-free.
• Diabetes: People dealing with diabetes or insulin resistance are also at an increased risk of developing cancer.
• Obesity: Overweight and obesity add to the risk of developing cancer.
• Smoking: Smoking has been found to be associated with an increased risk of cancer.
• Alcohol Consumption: Alcohol consumption in higher amounts is known to be associated with many cases of colon cancer.
• Radiation: Long exposures to radiations at the abdomen can increase a person’s risk of getting cancer.

To provide the best care possible, we have a multi-disciplinary team of doctors.. The team of doctors at our centre comprises of a surgeon, medical oncologist, radiation therapist and a gastroenterologist.

The treatment regimen given to the patient is based on a number of factors, such as:

• Type of cancer
• Stage of cancer
• Possible side effects of treatment
• Patient’s preference
• Patient’s health and medical conditions
• Concomitant medications
• Patient’s nutritional status

The treatment options for colorectal cancer include:

Surgery: Surgical procedures that will remove the tumour and a little of surrounding healthy tissue to get clean margins are performed by our specialists. This is known as surgical resection. It is likely that a few nearby lymph nodes will also be removed as a preventive measure.

Laparoscopic surgery and Robotic surgery: To perform surgical resections laparoscopically/Robotic, several viewing scopes are pushed into the abdomen through small incisions. The technique is performed under anaesthesia. The recovery time is less.

Colostomy: A colostomy is a surgical opening or a stoma, with the help of which the colon is connected to the abdomen to give a path for the waste to exit the body. A colostomy bag is attached to the patient’s body where this waste is collected. A colostomy may be temporary or permanent.

Radiofrequency ablation: Also known as, cryoablation, this technique utilizes high-energy radiofrequency waves to freeze and destroy the tumour.

Radiation therapy: It is the use of high-energy x-ray beams to target and destroys the cancerous cells. This is a common mode of treatment in rectal cancer because the tumour tends to recur near the point of initial origin.

Therapies using medication: Therapies that use medications to kill cancer cells are usually called systemic therapies. In systemic therapy, the medications are given through bloodstreams to reach the cancer cells. The medicines are given either intravenously or orally. There are following types of systemic therapies. These are:

• Chemotherapy: To inhibit the cancer cells from growing and dividing.
• Targeted therapy: To target the specific cancer genes and proteins that provide an environment for the growth of cancer cells.
• Immunotherapy: To boost the body’s natural defences to stop cancer.

Not all risk factors in colorectal cancers are preventable. However, certain measures can be taken to reduce the risk of cancer. These measures are:

• Avoid alcohol
• Avoid smoking
• Avoiding processed meats
• Decreasing the amount of fat intake
• Eating plant-based foods
• Keep a check on stress levels
• Keeping a check on the amount of red meat in the diet
• Maintaining a healthy weight
• Manage preexisting diabetes
• Regular exercises and physical activity.