Rectal Bleeding: Do Not Ignore!
Cancer is the second leading cause of death worldwide and at least one-third of common cancers are preventable. World Cancer Day is celebrated every year on the 4th
of February, as an empowering call to action urging for personal commitment and represents the power of the individual action taken now to impact the future. The theme for the World Cancer Day for the years 2019-2021 is “I Am and I Will”.
Colorectal cancer is an emerging problem among Indians, the rising rates of which may be attributed to the incorporation of lifestyle changes including consumption of calorie-rich and low-fibre diet, excessive use of red meat and processed foods, and physical inactivity. As per the National Cancer Registry Programme of India, the incidence of colorectal cancer increased by up to 20% from 2004 to 2014, and is projected to increase further with the risk of about 1 in every 300 persons developing this disease.
The only way to beat cancer is to detect it early and commence treatment at the earliest. Early detection of cancer is possible only if it is suspected. Thus, bleeding through anus or blood in stool, which can be a sign of colon cancer, should not be ignored. To add to this, is the frequently associated unexplained loss of weight and weakness, usually due to anaemia caused by chronic blood loss. All of these symptoms are inter-related and should be taken into consideration.
Early consultation and investigations can detect colorectal cancer in the treatable stages and lead to early intervention decreasing the morbidity and mortality associated with it. You should visit the Oncologist as soon as you develop these symptoms. You may be advised to undergo some baseline investigations, colonoscopy and biopsy, tumor markers and PET-CT Scan to confirm the presence of cancer, evaluate its stage and to detect the spread of the disease. The wall of the colon has four layers and the stage of the disease depends on the extent of invasion of these layers by the cancer cells. The stages range from Stage 0, where the cancer cells have not grown beyond the first layer of the colon wall, to Stage III where the cancer cells have progressively invaded all the four layers of the colon wall and also the nearby lymph nodes and fat, Stage IV where it has spread far away from the colon. Depending on the stage of the cancer, different types of treatment modalities may be combined at the same time or used one after the other. The 5-year survival rates are about 90% in localised cancers (Stage 0,I,II), about 70% in regional spread (Stage III) and about 15% in distant spread (Stage IV). This data reinforces the importance of early detection and treatment in colorectal cancers.
The various treatment approaches for colorectal cancer include local treatment, systemic treatment and combined modality approach. Local treatments treat the tumor without affecting the rest of the body and are usually used in early-stage caners. Surgery is usually the main stay of treatment in early stages of colon cancer. The type of surgery required depends on the site of the tumor in colon. For early (stage 0) and small cancers, removal of the pre-cancerous/cancerous polyp and ulcers is done during colonoscopy. For larger tumours, removal of a part of the large intestine may be required, which can be done either laparoscopically or by open surgery. On the basis of the site of the disease in the colon, the right, left, transverse or sigmoid part of colon may be surgically removed and the two ends of the remaining colon joined to each other. If the tumor involves multiple sites in the colon, a total removal of the large intestine may also be warranted. When the tumor blocks the colon causing constipation and distention of abdomen, few local procedures like stent placement or colostomy can be done. A Stent is a hollow expandable metal tube that is put inside the colon usually by colonoscopy, crossing through the blockage. Colostomy is making of a hole in the part of the colon before the blockage, which is then attached to an opening made in the skin of abdomen (stoma) through which the faeces come out.
The systemic modalities include chemotherapy, targeted therapy, and immunotherapy. During Chemotherapy, anti-cancer drugs are injected into the veins or taken by mouth. Chemotherapy may be given before the surgery, known as neo-adjuvant chemotherapy, or after the surgery, known as adjuvant chemotherapy. The goal of neo-adjuvant chemotherapy is to decrease the size of a large tumor so that it may be removed safely by surgery, while adjuvant chemotherapy is given after the surgery to kill any microscopic cancer cells to decrease the chances of recurrence. Targeted therapy uses drugs to either prevent the formation of blood vessels which supply and nourish a tumor, to inhibit the growth of tumor cells itself, or to inhibit the genes which help the tumor to grow. Immunotherapy is the use of medicines to help a person’s own immune system to better recognize and destroy the cancer cells. It can be used to treat those whose cancers cannot be removed surgically, has come back after treatment or spread to other parts of the body.
Radiotherapy is treatment using high energy rays or particles to destroy cancer cells. It is used more in rectal than colon cancer, and is often used simultaneously with chemotherapy.
Though there is no established way to prevent the occurrence of colorectal cancer, incorporating some healthy habits like maintain a healthy weight, consuming more fruits, vegetables, and whole grains in your diet, limiting the intake of red meat and processed foods, increasing the amount and intensity of physical activity and stopping smoking and alcohol consumption may lower your risk of developing this cancer. All persons above the age of 50 years should undergo screening for colorectal cancer. Colon cancers may also ruin families in some cases, and such people with close relatives suffering from colon cancers should also get screened and undergo genetic testing to detect cancer-favouring mutations. Those who are suffering from anal bleeding, blood in stools, chronic anaemia, unexplained weight loss or some hereditary cancer syndromes should visit the Oncologist at the earliest and undergo complete workup and staging. They should discuss and understand the risks and benefits of the various treatment modalities with the treating oncologist.
Dr Jalaj Baxi
Senior Consultant (Surgical Oncology)