Delayed diagnosis of colorectal cancer prevents proper treatment

I would like to share two important facts about colorectal cancer with you. First, unlike many other cancers, colorectal cancer can be cured if caught early. Second, in India this cancer is mostly diagnosed at an advanced stage. Delayed diagnosis can be attributed to a general lack of awareness about the disease; lack of medical consensus regarding the age and frequency of screening;

similarities between symptoms of colorectal cancer with other conditions; and a fear at the thought of colonoscopies. So how do we move past these factors to improve screening for colorectal cancer and reduce the delay in diagnosis? In my view, we need to increase disease awareness, inform people about their risk and tell them more about screening procedures.

What is Colorectal Cancer?

It is cancer in the large intestine. It can start with something simple like a ‘polyp’ which is a small growth on the inner lining of the colon or rectum, which can be completely harmless or it can become cancerous. Once cancerous, these polyps, if left undetected, go on to invade neighboring body tissue and spread to other parts of the body.

Screening is necessary for us to detect the polyps and check on their benign or malignant status. The doctor can then surgically remove these polyps from the digestive system and prevent colorectal cancer or start treatment at the earliest to improve prognosis.'

Who is at risk?

Researchers are still trying to identify a causal link between certain lifestyle, environmental and genetic factors that can lead to colorectal cancer.

These include:

• Age (50 years and above)
• Family history (immediate family member with colorectal cancer)
• Presence of other medical conditions such as ovarian cancer or inflammatory bowel disease
• Excessive alcohol consumption (more than 3 servings of alcohol a day)
• Smoking
• Obesity

These factors have been linked not just to colorectal cancer but to other life threatening diseases including other types of cancer. They do however provide an excellent framework for risk assessment and should not be ignored. Consulting your doctor and keeping a close watch on your overall health profile is always a good idea.

Signs to keep in mind

Diagnosing colorectal cancer can be tricky because its signs and symptoms can also be ascribed to other conditions. Some common signs that people should be aware of include: persistent digestive problems, rectal bleeding, bloody stools, unexplained weight loss, fatigue and noticeable changes in bowel movement.

A word about early screening

While most medical groups recommend routine screening after the age of 50, many oncologists now urge that those at risk get screened earlier. The most common screening tests for colorectal cancer are high-sensitivity fecal occult blood tests, which check for tiny amounts of blood in the feces;

the stool DNA test, which in addition to detecting blood in feces, also checks for nine DNA biomarkers in three genes linked to colorectal cancer; a lower colon exam called flexible sigmoidos copy; and a colonoscopy test,which examines the colon and rectum through a flexible lit tube.

Treat it to beat it

Surgery is usually the first and most common treatment option for colorectal cancer. Other options include chemotherapy, immunotherapy and targeted therapy, all of which work in different ways to inhibit or destroy cancer cells. Another treatment option gaining prominence is the use of biosimilars, which are less expensive versions of original molecules and just as safe and effective.

Ultimately the choice of treatment rests with the doctor, who makes the final decision based on the individual’s case history. As I said earlier, colorectal cancer is one of the few cancers that can be cured when caught early and so we must do all it takes to create more awareness and understanding of the condition.

The Author is a Senior Consultant, Medical Oncology and Haemato Oncology at Omega Hospitals, Hyderabad

By Dr P Satya Dattatreya