THINK ON THESE: War Against Colorectal Cancer

Colorectal cancer (CRC) – which involves either the colon or rectum – is among the most common forms of cancer in the world. Only very few are aware that CRC is “an increasingly prevalent malignancy in the Philippines today,” to quote the words of Prof. Jose D. Sollano, a doctor who teaches medicine at the University of Santo Tomas.

“CRC is already the most common cancer of the gastrointestinal tract among Filipinos,” pointed out Prof. Sollano. Two famous Filipinas who died of it were President Corazon C. Aquino and Rio Diaz. Singer Roel Cortez also succumbed to it. Hollywood actresses Audrey Hepburn and Farrah Fawcett and British singer Robin Gibb also died of the dreaded disease.

“It is a deadly disease – currently, the fourth most common cause of cancer deaths in the Philippines,” said Prof. Sollano, a member of the Asia-Pacific Working Group on Colorectal Cancer.

The Philippine Cancer Facts and Estimates of 2005 placed colon as the third leading cancer site in males and the fourth in women in the country. In the United States, CRC is the second leading cause of cancer-related deaths in men and third in women.

To be diagnosed of having a cancer seems to be a death sentence already. Although CRC is deadly, “it is a highly preventable cancer, and survival rates are high when tumors are detected and removed in its early stages,” assured Prof. Sollano.

In the past, no one has really pushed hard enough for increasing awareness about CRC. But thanks to the Philippine Society of Gastroenterology, it has changed in recent years. “Majority of those we asked know very little about the disease,” said Dr. Ira I. Yu, the society’s press relation officer. “This is a bit worrisome considering that colon cancer ranks as one of the common cancers.”

Like most cancers, CRC shows some signs and symptoms. “It may be present as changes in bowel habits (constipation or diarrhea), rectal bleeding, vague abdominal pain and bloating, unintentional weight loss, abdominal distention, anemia on complete blood count,” says Dr. Judith D. Gapasin-Tongco, who had her fellowship training in gastroenterology at St. Luke’s Medical Center.

In some instances, a person may not experience any symptoms at all.

One of the risk factors for CRC is age. “Nine out of 10 people with colon cancer are at least 50 years old,” says Dr. Gapasin-Tongco, adding that younger adults may also develop the disease.

Family history is another risk factor. “If you have a family history of colorectal cancer (although it can occur among individuals without family history of colon cancer too), or if you have relatives who have had cancers that occur at a younger age than usual (these are inherited gene defects), then you may want to discuss this with your doctor,” Dr. Gapasin-Tongco says.

Other risk factors include: history of adenomatous polyps, history of inflammatory bowel disease, a diet high in red meat and processed meats, obesity, smoking, sedentary lifestyle and heavy alcohol use.

“Despite knowing all these risk factors, we still encounter patients without any of the above developing colon cancer,” Dr. Gapasin-Tongco says. “We still do not know the exact cause of most colorectal cancers, what we do know is that it can be prevented and screening saves lives.”

Most colon cancers arise from benign colonic polyps, from which if they are allowed to grow (usually without symptoms) undergo malignant transformation.

“Screening refers to testing/examining individuals who have characteristics which may suggest polyps or early cancer,” Prof. Sollano explained. “Screening for, and subsequent removal of these pre-malignant polyps are key strategies toward colon cancer prevention.”

Among the tests available for CRC screening are fecal immunochemical test (FIT) and colonoscopy, which are now available in the Philippines.

“Detection of human blood in the stools with the stool FIT test is the simplest and most inexpensive test to detect colonic tumors,” Prof. Sollano said. “Colonoscopy, which involves insertion of an endoscopic instrument to visualize the entire colon, has also the capacity to remove colonic polyps without an abdominal incision/operation.”

CRC screening has been shown to reduce cancer risk by as high as 70%. “In the Philippines, the awareness for CRC has been increasing in the last few years,” said Dr. Atenodoro Ruiz, Jr., a gastroenterology consultant at The Medical City and a diplomate of the American Board of Internal Medicine in Gastroenterology and of the Philippine College of Physicians in Internal Medicine.

As a gastroenterologist who advocates colon and rectal cancer screening, Dr. Ruiz recommends 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. But if the cancer has already invaded other tissues, it may be too late.

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.