Colorectal Cancer- All you need to know about prevention, screening and treatment.

What is Colorectal Cancer? Understanding the anatomy…!!!

Colon is part of our digestive system which absorbs nutrients such as vitamins, minerals, carbohydrates, fats, proteins and water from food and discards waste material out of our body. Our entire digestive system starts from mouth followed by esophagus, stomach, small intestine, colon and finally rectum and anal canal. Colon is about 5 feet long and rectum and anal canal together contribute last 6-8 inches. The anal canal ends as anus which is opening of our digestive system to the outside of the body.

What is the cause of Rising Colorectal cancer incidence in India?

There are many risk factors for colorectal cancers. These risk factors can be either modifiable or non-modifiable.

Non Modifiable risk factors: These factors are not under our control. However knowledge of these is important as early stages of cancer can be identified by regular screening which will lead to better survival.  These are

  1. Age: Above 50 years of age risk of colorectal cancer increases.
  2. Family history:A person’s risk of colorectal cancer almost doubles if a parent, brother, sister or child has colorectal cancer.
  3. Inherited cancers:Certain known genetic mutations like familial adenomatous polyposis(FAP) or hereditary nonpolyposis colon cancer (HNPCC or Lynch Syndrome) increase the risk of colorectal cancers significantly.
  4. Race: Increased risk of colorectal cancer and death in African Americans.
  5. Personal History of Cancers:
  • Previous history of colorectal cancer.
  • High-risk adenomatous polyps (1 cm or larger in size or that have cells that look abnormalunder a microscope).
  • Ovarian cancer.

What are Screening Modalities?

1.) Stool test :Guaiac FOBT (gFOBT) &Fecal Immune-chemical Test (FIT) 

Frequency of testing: Experts recommend sigmoidoscopy every 5 years for people at average risk who have had negative test results.

2.) Stool DNA Test

Frequency of testing: The current recommendation is once every three years. If positive on any of the occasions, endoscopic studies such as colonoscopy and sigmoidoscopy are recommended.

3.) Sigmoidoscopy

Screening frequency: Sigmoidoscopy should be performed at five-year intervals from baseline intervention, with gFOBT/FIT every three years.

3.) Colonoscopy

Screening frequency: Patients undergoing colonoscopy should have a 10-year interval between screening colonoscopies if the examination is negative and of adequate quality.

4.) Virtual Colonoscopy using CT scan

Screening frequency: Current USPSTF recommends Virtual colonoscopy with CT scan every five years from baseline CTC or optical colonoscopy. 

 

What are warning signs of colorectal cancer?

  • A persistent change in your bowel habits, including diarrheaor constipation or a change in the consistency of your stool.
  • Rectal bleedingor blood in your stool.
  • Persistent abdominal discomfort, such as cramps, gas or pain.
  • A feeling that your bowel doesn’t empty completely.
  • Weakness or fatigue.
  • Unexplained weight loss.

 

How is evaluation of colon cancer done?

 

Evaluation of colon cancer must include:

  1. Clinical evaluation
  2. Colonoscopy and biopsy
  3. Blood tests
  4. Workup for local spread and Metastasis (distant spread)

How to proceed with the treatment?

 

Treatment for colorectal cancer is primarily surgery. This can either be preceded by Chemotherapy/Radiotherapy to decrease the volume of disease or followed by Chemotherapy/Radiotherapy to increase the benefits of Surgery.

 

Is there an option of Laparoscopic Surgery for Colorectal Cancer?

 

Laparoscopic Surgery/ Key hole Surgery/ Minimally invasive surgery has now become the standard of care for colorectal cancer.

                               

Why do we need Laparoscopic surgery?

Cancer surgeries involves resection of multiple organs to achieve complete removal of disease. This requires good tissue exposure for which big incisions need to be taken over the body cavity. Also due to prolonged surgery the interior of our body is exposed to environment for a long time during surgery which leads to increased risk of infections. Keyhole/ Laparoscopic surgery provides very good vision due to recent advances in lens and camera system that we use and which can be inserted in the body cavity through less than 1 cm incisions. 

 

What are advantages of laparoscopy in cancer surgery?

 

Advantages for Surgeons:

 

Very good vision.

Minute details of surgery visible.

High precision surgery can be carried out due to camera magnification.

 

Advantages for the patient:

Less Blood loss.

Reduced rate of infection.

Decreased postoperative pain.

Early discharge from hospital.

Early resumption of normal day today activity.

Less incidence of post-operative incisional hernia

 

Does it require extra expertise/experience apart from conventional cancer surgery training?

Yes. It requires extensive skill based training after receiving conventional cancer surgery training. Not every surgeon is comfortable with advanced laparoscopic surgery. It requires dedicated extra hours of commitment and willingness to improve surgical skill using fine laparoscopic instruments. Remember “NOT ALL SURGEONS ARE CANCER SURGEONS AND NOT ALL CANCER SURGEONS ARE LAPAROSCOPIC SURGEONS” It takes years of training and experience in all three aspects- CANCER, SURGERY and LAPAROSCOPY.

 

 

For more information on Laparoscopic cancer surgery visit- https://laparoscopiccancersurgery.blogspot.com/2021/04/laparoscopiccancer-surgery-1.html

 

What happens after Surgery?

 

After a few days of post operative period depending upon the final histopathology the disease stage will be decide. Depending upon the stage and other clinical factors an accredited Tumor board will decide upon further treatment i.e. Chemotherapy/Radiotherapy/Targeted therapy.

 

How do I follow up after the treatment?

 

You need to follow up after 3 months of treatment completion with your cancer surgeon. After that every 3-6 months for the 1st two years and then 6-12 months for next 3 years and thereafter annually. At every visit a complete history taking and physical examination will be done. Also a few blood tests and Ultrasound abdomen/Pelvis or CECT/ PET CECT may be advised.

 

For more detailed discussion or queries on colorectal cancer treatment/ Laparoscopic Cancer Surgery mail drarvindlapsurgeon@gmail.com/drajeetramantiwari@gmail.com

Contact: Mob/Whatsapp: 9833984333/9818826423