HEALTH: BEAT Colon Cancer first before it beats you

Wilfredo grew up in a small town in Bansalan, Davao del Sur.  He used to eat vegetables, which his parents brought from their farm in Balutakay.  Being the eldest son of five siblings, he was groomed as the one who will bring them out from poverty.

He was an intelligent student, so it was not surprising that he was given a scholarship to study in one of the best universities in Davao. He took accounting as his course.  Since he was already far from his family, he started eating canned goods. 

Going out with his new-found friends, Wilfredo also started smoking and drinking alcoholic beverages.  There were times that he would go home at his boarding house drank. His landlady complained because he smoked even at his room.

He did graduate and was able to be employed in a bank, where he met his future wife.  They had already two children when he learned that his first-degree cousin was diagnosed of having a colon cancer. 

He had forgotten about his cousin when one night he observed dark stools after relieving himself.  There were moments also that he had this feeling of having a bowel movement but is not relieved.  He was also losing weight.

His wife, Mary Ann, observed that Wilfredo often went home feeling so tired.  So, she decided to bring him to a hospital.  “Let’s just have a physical check-up,” she suggested.  At first, her husband turned down the idea.  But she persisted and so he relented finally.

After a thorough check-up, the doctor found out something.  He never told them what he discovered but instead gave an address of another physician.  “Go and see him,” he said.  “He may be able to help you.”

They did go.  To make the long story short, Wilfredo was diagnosed of having a colon cancer.  “That cannot be,” he cried out loud.

Colorectal cancer (involving either the colon or rectum) is among the most common forms of cancer in the world.  Based on the 2012 data, colorectal cancer is the third most common cancer among Filipinos – after breast and lung.

Despite this fact, most Filipinos don’t know much about colon cancer.  “For many years, no one has really pushed hard enough for increasing awareness about colon cancer,” admitted Dr. Ira I. Yu, a member of the Philippine Society of Gastroenterology.

“We can that we remain a bit passive until someone close to us suffers and dies from that disease,” added Dr. Yu, who works at the National Kidney and Transplant Institute (NKTI).

“Among cancers, colon cancer stands out as a disease that can be largely prevented, but few people believe it will happen to them,” said Dr. Atenodoro Ruiz, Jr., a consultant at The Medical City and the head of the Colorectal Cancer Screening Task Force.

The earlier it is discovered, the better.  “If only people could be made aware that they could nip colorectal cancer in the bud, figuratively and literally, many lives could be spared from this dreaded disease,” wrote Dr. Rafael D. Castillo, editor-in-chief of Health and Lifestyle.

According to Dr. Ruiz, colon cancer, if discovered early, is preventable and treatable.  “If it is early stage and localized within the colon, the cure is 100 percent,” he said.  “If it had spread to lymph nodes or distant organs, the 5-year survival rate is much lower.”

Dr. Aaron I. Velasco, an internist and gastroenterologist who works in various hospitals in Davao City, said the 5-year survival rate of those diagnosed with stage 1 colon cancer is 92%.  It goes down to 63-80% for those with stage 2 and 50% with stage 3.  The chance of survival of those diagnosed with stage 4 is very minimal: 11%.

Some basic facts

In the past, colon cancer has been referred to as “a disease of the rich.”  But such is not the case anymore.  “Colorectal cancer is more common in richer countries, but its incidence is rising in some developing countries,” says the World Health Organization (WHO). 

Both colon and rectal cancers begin in the digestive system, which processes food for energy, and the last part of it absorbs fluid to form solid waste (stool) that then passes from the body.

The American Cancer Society (ACS) shares this information on how the digestive system works: “After food is chewed and swallowed, it travels to the stomach. There it is partly broken down and sent to the small intestine.”  The small intestine is the longest part of the digestive system – about 20 feet.

“The small intestine also breaks down the food and absorbs most of the nutrients.  It leads to the large intestine (also called the large bowel or colon),” explains the ACS.  “The colon absorbs water and nutrients from the food and also serves as a storage place for waste matter. The waste matter moves from the colon into the rectum, the last 6 inches of the digestive system.  From there, the waste passes out of the body.”

Until now, no one knows what causes colorectal cancer.  “Epidemiologic, human case-control, and animal studies support a strong association between colon cancer and a diet that has high-fat (usually saturated fat), low fiber, and high red meat consumption,” Dr. Ruiz said.

Risk factors that predispose a person to develop colon and rectal cancer include age, personal history of adenoma or carcinoma, family history of colorectal cancer, and pre-existing diseases, like inflammatory bowel disease.  “Age 50 is the most common risk factor for CRC as 90% of cancers occur after the age of 50,” said Dr. Ruiz.

Social and lifestyle habits also contribute; these include smoking, excessive alcohol intake and physical inactivity.

Symptoms

“Colon cancer usually begins as an area of abnormal cells (lesion),” informs the Mayo Clinic in Minnesota.  “Most of these abnormal lesions begin as tiny polyps — raised clumps of non-cancerous (benign) cells growing on the inner lining of the large intestine. Another type of precancerous lesion (non-polypoid lesion) forms as a flat or recessed area on the wall of the colon. Non-polypoid lesions are less common than polyps.”

It takes about 10 years for some of these polyps to develop into cancer.  “Given the long process of this transformations, screening for and removal of colorectal polyps before these potentially turn into cancer in patients that are at risk can reduce the probability of developing colorectal cancer,” Dr. Ruiz pointed out.

Like most cancers, many cases of colon cancer have no symptoms. However, the following symptoms may indicate colon cancer: diarrhea, constipation, or other change in bowel habits; blood (either bright red or very dark) in the stool; unexplained anemia; abdominal pain and tenderness in the lower abdomen; intestinal obstruction; weight loss with no known reason; feeling very tired; and vomiting.

“The most common first symptom of rectal cancer is bleeding during a bowel movement,” The Merck Manual of Medical Information says.  “Whenever the rectum bleeds, even if the person is known to have hemorrhoids or diverticular disease, doctors must consider cancer as part of their differential diagnosis.

“Painful bowel movement and a feeling that the rectum has not been completely emptied are other symptoms of rectal cancer,” the Merck manual continues.  “Sitting may be painful, but otherwise the person usually feels no pain from the cancer itself unless it spreads to tissue outside the rectum.”

Since colorectal cancer doesn’t have early warning signs, it’s very important to get screened, according to Dr. Velasco.  Most experts believe that symptoms appear only after the cancer has grown or spread.  When this happens, treating it becomes harder.

Screening

“Colorectal cancer is an ideal target for early detection and prevention through screening,” Dr. Ruiz said.  “Screening has been shown to reduce cancer risk by as high as 70%.” 

In almost all countries, colorectal cancer screening is recommended for people starting the age of 50 years. “Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with colon and rectal cancer, and in those with other additional risk factors,” Dr. Ruiz suggested.

The gold standard for colon and rectal cancer screening, according to Dr. Ruiz, is a colonoscopy as it can detect and remove early lesions like polyps. “The procedure involves a flexible fiberoptic scope with a camera that is inserted through the rectum and is carefully advanced to visualize the colon under mild anesthesia,” he explained. “However, it is, however, an invasive test and has low potential to cause complications.”

There are some patients may not want to have an invasive test or may find the cost of a colonoscopy expensive. “A stool test called the Fecal Immunochemical test (FIT) is a good screening alternative,” Dr. Ruiz said. “FIT detects only human blood and is specific for bleeding in the colon. The test is repeated every year if the initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer.”

As a gastroenterologist who advocates colorectal cancer screening, Dr. Ruiz recommended a screening colonoscopy in persons between 50 to 75 years of age who are healthy and in whom the complications are low. “If the patient does not want to start with a colonoscopy, I suggest starting with FIT,” he said.  “After a discussion with his physician, the patient can choose his preferred screening test.”

As stated earlier, colon cancer is treatable when discovered early.  “Colon cancer when caught in the early stages is approximately 90% curable,” assured Dr. Yu.

Singer Roel Cortez, who rose to fame with hit songs like “Nakapasakit Kuya, Eddie” and “Baleleng” in the 1980s, died on April 1 last year after suffering from colon cancer.  Six years earlier, President Corazon “Cory” Aquino likewise died of the same cancer.

Other famous people who died of colon cancer include Audrey Hepburn, Farrah Fawcett, Claude Debussy, Rio Diaz and Robin Gibb.

Emmy-winning American comedian and actor Milton Berle was told he had a cancerous colon tumor in 2001 but he refused surgery; he died in Los Angeles, California the following year.