Colon cancer

• What is colon cancer?
• Who is at risk?
• Colon cancer and its symptoms
• Colon cancer and stages of its severity
• Stool test
• Colonoscopy
• Prevention

Colon cancer is one of the most widespread types of cancer in the developed countries - worldwide. Cancer of the colon and rectal cancer are placed third in the male and fourth in the female population in terms of frequency of occurrence. However, this frequency differs across the world. It is common in western countries but rarely found in Asia and Africa. Research has shown that there is a higher incidence of the disease where western dietary practices have been adopted. It has been found that native populations that converted to western diets have an increased incidence of the cancer of the colon.

There is no one specific reason that causes cancer. Almost every case of colon cancer starts with non-cancerous (benign) polyps on the colon and these slowly develop into the disease. Approximately one hundred people are diagnosed with colon cancer every day and it is considered to be one of the major health problems.

Cancer of the colon and its symptoms may remain undetected for many years and in most cases the progress of the disease is very slow. In this article I would like to give you useful information, plus instructions and tips on how to avoid the disease and what to do in order to detect colon cancer or rectal cancer early on.

What is colon cancer?

The colon is that part of the digestive tract where the body stores its undigested material - waste. The colon ends in the rectum. Together they form a long tube. Benign tumours may appear on the inside of the tube; these mushroom-shaped growths are called polyps. They are not dangerous as long as they are removed on time. Polyps, being benign, are not able to attack other organs and tissues. Also, they do not spread to other parts of the body. The polyps on the colon or rectum are easily detected during an endoscopic gastroenterological exam called colonoscopy. Once found they are immediately surgically removed and no longer pose a risk to your health. However, if the benign polyps in the colon are not removed on time, they can degenerate and turn into colon cancer. It is assumed that in the majority of cases cancer of the colon and rectal cancer originates and develops from untreated polyps and those that have not been removed. Given time the polyps are transformed into malignant tumours. These tumours grow very fast and through the colon wall may attack other organs and tissue, even reaching distant parts of the body. Here they form new loci of cancer, the so called metastases; for example in the liver or in the lungs. Unfortunately, in 80 % of people cancer of the colon or rectal cancer is detected late and in this stage of the disease the treatment is very complex and complicated. Full recovery is rather improbable and most cases end needlessly in early death. Colon cancer and rectal cancer are also frequently grouped together under the designation colorectal carcinoma. It is further known as: colon/colonic carcinoma, malignant colon tumour or colonic tumour.

Who is at risk?

There is no single specific reason causing cancer. However, you may be at risk of colon cancer or rectal cancer if:

• you are over sixty.


• your diet consists predominantly of red or processed meat, too much fat and, on the other hand it lacks fresh vegetables and fibre.


• cancer is present somewhere in your body – e.g. you survived breast cancer or prostate cancer.


• you have polyps on the colon.


• there is a history of colon cancer in your family.


• you are suffering from inflammatory intestinal disease. (Crohn’s disease, ulcerative colitis)

Some genetic syndromes also increase the risk, most commonly familial adenomatous polyposis (FAP) and Lynch syndrome.
One of the greatest risks is having unhealthy eating habits; but this is something that everyone is able to influence. This is unequivocally supported by facts. Wherever unhealthy eating habits from western countries have been ingrained there is a higher occurrence of the disease. Along with too much fat, obesity, frequently accompanied by diabetes, is a factor endangering the colon. Moreover, drinking alcohol and smoking are risk factors as well.

Age also plays an important role in this respect. It has been found that about 90 % of the people diagnosed with colon cancer are over fifty.
If you have some of the mentioned risk factors, the worst option is to wait for the symptoms to show.

Colon cancer and its symptoms

In many cases of cancer of the colon there are no symptoms. However, the following symptoms may indicate the presence of the disease:

• Blood in the stool.


• Stomach pain and sensitivity in the lower part of the abdomen.


• Vomiting, diarrhoea, constipation, or other changes in the functioning of the intestine.


• Threadlike, thin stool


• Weight loss for no known reasons.


• Painful cramps.


• Anaemia.


• Weakness, excessive fatigue.

When the tumour is bleeding there is blood in the stool. The colour of the blood depends on the location of the tumour. If it is located at the end of the large intestine or in the rectum the blood is bright red and should be readily recognizable. However, if the tumour is situated in the upper part of the colon, at its starting point, the blood dries prior to getting out of the body and so is invisible to the naked eye.

Rectal cancer may cause very thin stools or constipation as it obstructs the evacuation of the stool. In other cases the tumour may totally block the colon. In such an instance nothing passes through the intestine and this causes serious and painful cramps. In a bad case scenario this may indicate that the intestinal wall is perforated necessitating immediate medical attention.

If you experience an unplanned weight loss this means that due to a tumour changes of metabolism have occurred in the body. A bleeding tumour, although not noticed, may precipitate further symptoms.

Long-term and persistent loss of blood lowers the level of iron in the blood causing anaemia and an insufficient amount of oxygen in the blood. This manifests itself as weakness and frequently also as excessive fatigue.

Colon cancer and stages of its severity

Accurate screening can detect colon cancer even before symptoms develop and appear. If you belong in a risk group you should definitely visit a doctor and undergo the necessary testing. Based on its severity cancer of the colon is divided into five stages (0, I, II, III, and IV):

• Stage 0: is the early phase, the cancer is on the surface of the inner layer of the intestinal wall.


• Stage I: the cancer has spread into the inner layers of the intestinal wall.


• Stage II: the cancer has spread further into the muscle tissue of the wall.


• Stage III: the cancer has spread into the lymph nodes.


• Stage IV: the cancer has spread into other organs; the formation of metastases.

It becomes really serious when colon cancer is not detected early and the cancer breaks through and spreads past the colon and metastases emerge.

It is important to realize that nowadays colon cancer is treatable. However, this is true only in those cases where the removed tumour is in its early stages (stage 0, I, at most stage II); that is, while it is still only within the colon. If it spreads into the areas adjacent to the colon surgery alone is not sufficient. Chemotherapy then becomes necessary, usually accompanied by numerous undesirable side-effects. This can last a long time (generally at least 6 months) and the sufferer has to overcome many hurdles. Even when treatment is successfully finished it is still necessary to attend regular follow-up visits.

Stool test

This is one of the basic screening tests to detect cancer. It is a faecal occult blood test, which detects small amounts of blood in the stool; the blood is invisible to the naked eye, but may indicate colon cancer. However, this test is frequently negative despite the fact that cancer of the colon may be present. For this reason it is important to undergo a concurrent exam like colonoscopy or sigmoidoscopy. It has to be underlined though that sigmoidoscopy only detects rectal cancer. Only colonoscopy shows the entire colon, including the rectum,and because of that it is the best screening test for detecting the precise stage of the development of the cancer.

It is also important to note here that a positive occult blood test does not necessarily mean that cancer is present in the body. Blood in the stool may occur due to the bursting of a stomach or duodenum ulcer, it may be a symptom of ulcerative colitis, or it may appear with the inflammation of the outpouchings/pockets - diverticulitis (for more see The stool indicates the condition of the digestive system).

Colonoscopy

This test is an important preventative measure, since it allows the doctor to directly observe and discover changes in the mucosa of the intestine and the rectum. Colonoscopy is essential when diagnosing serious diseases of the intestinal tract like bleeding, polyps, intestinal outpouchings/pockets – diverticula and muscle cramps. Moreover, colonoscopy is not only able to detect early symptoms of colon cancer and rectal cancer but also opens up the possibility of performing interventions, where previously an operation might have been necessary. If it does become necessary, the doctor takes a sample of the mucosa (biopsy) which is then examined. This may detect adenomatous polyps – tiny benign nodules containing atypical transformed/changed cells which are a source of malignant changes. Evidence shows that (depending on the location of the polyps ) not removing them early on, more than 80 % are transformed into a cancer of the colon or rectal cancer. It is only a matter of time - sometimes as long as 10 to 15 years. It also depends on the size of the polyps, their histological structure and the degree of the cellular changes.

And so responding to the question “When should one undergo colonoscopy?”, the answer is: “After reaching 50 years of age everyone should have a colonoscopy”. However, regardless of age and other risk factors, an immediate colonoscopy is required in cases when:

• seeking prevention, i.e. people with a high degree of risk.


• blood is present in the stool.


• sudden changes in the type of stool occur, e.g. alternating constipation and diarrhoea.


• anaemia combined with a significant weight loss.


• stomach pain.

Prevention

Colon cancer and rectal cancer are insidious because either one may develop during the course of several years with no noticeable problems. For this reason one has to take an active role in ensuring one’s health.

1. A wise person will consider regular preventive check-ups as part of their health routine, but this should be particularly pertinent for:
• people over the age of 50.


• someone with any of the risk factors (family history of colon cancer, polyps on the colon, an unhealthy diet with too much fat and not enough fibre, obesity, smoking, suffering from inflammatory intestinal diseases like diverticulitis, Crohn’s disease, ulcerative colitis, and diabetes).
2. Eat a balanced diet. Protect yourself by only eating a limited amount of fatty meat and meat products and eat more foods that are high in fibre and also lots of vegetables (raw or steamed). Further, eliminate foods that lead to diabetes (one of the risk factors).


3. Keep your weight in check. This is connected to the previous point. If you are obese and your body mass index (BMI) is 30 and higher you may be at risk of colon cancer. The best prevention in this case is to try to lower your weight.


4. Regular exercise. It has been proven that being physically active reduces the risk of cancer by 40 %!


5. Have genetic tests done if you are a member of a family with a history of cancer of the colon. People who carry a gene mutation connected to hereditary colon cancer are most at risk. Therefore, it is very useful to be aware of this fact beforehand and let your doctor know about it too.


6. Stop smoking. By smoking you deliberately bring carcinogens into your body. The carcinogens accelerate the cancer development process, the polyps become malignant and the growth of already existing tumours increases.

By adhering to this advice you will protect your colon and keep it healthy. Do not forget the value of prevention, since cancer of the colon and also rectal cancer can be treated successfully if either is detected early!

- Prof. Katharine Horak, Doctor of Natural Science

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