What is Colon and Rectal Cancer?

Colon and Rectal (Colorectal) Cancers are one of the most common cancers that afflict many people around the world. It is a growth that occurs in our large intestine. It is also commonly known as ‘Bowel Cancer’.

The Colon is commonly known as the large intestine (bowel), and it starts after the small intestine (near where the appendix arises) and ends at the Rectum. The Colon continues into the Rectum. The Rectum is the last part of the ‘Large Intestine’ and the Rectum ends at the anus.

A Cancer is a growth which is made up of abnormal cells that have ‘lost control’. Thus, cancers grow and can invade and spread to other organs. This uncontrolled growth makes cancers dangerous and life threatening.

How does Colorectal Cancer start?

We believe that many Colorectal Cancers begin as ‘Polyps’. Colorectal Polyps are growths that occur in the Colon and Rectum. Many polyps are benign (non-cancerous). However, some polyps, if left long enough, may change in nature, and transform into cancers. This is known as the ‘Polyp-Cancer Sequence’. Some Colorectal Cancers, however, do not go through this ‘Polyp-Cancer sequence’ and start off directly as cancers.

As in many cancers, we do not know the exact cause, but an individuals’ Genetic combination plays a very important role. Environmental and Lifestyle factors also play a significant role. We inherit genes from our parents. Although it does not mean that one will definitely get Colorectal Cancer if their parents have Colorectal Cancer, having parents or brothers or sisters with Colon or Rectal Cancer certainly increases the risk of a person also getting Colon or Rectal Cancer.

However, patients may also get Colon or Rectal Cancer, even if they have no family history of cancer. Thus, having no family history of Colorectal Cancer does not mean that one will not get Colorectal Cancer. In fact, the majority (about 70%) of patients afflicted with Colorectal Cancer do not have relatives with cancer.

Everyone is, thus, at risk.

Treatment of Early Stage Colorectal Cancer is associated with excellent outcomes achieving cure in many cases. However, many colorectal cancers are diagnosed at a later stage.

Increasing awareness and promoting Screening programs have been shown to increase early-stage detection. Advances in Surgical, as well as, Adjuvant (Additional), Neo-Adjuvant Treatment have also improved results of treatment.

Prevention of Colorectal Cancer

There is no definite one-preventive-method available. However, it is suggested that a diet low in animal fat and high in fiber may have a protective effect. It is also suggestive that the removal of polyps during screening Colonoscopy may prevent the progression of polyps to Colorectal Cancer, thus reducing the incidence of Colorectal Cancer occuring.

Screening / Early Detection for Colorectal Cancer

Many studies have shown benefit from screening of Colorectal Cancer. While the cost-benefit of population screening is contentious in less developed economies, the Screening of Increased (High) - Risk populations is undoubtedly worthwhile and recommended. Colonoscopy Screening is recommended for people who belong to Increased-Risk Groups. This includes people with a family history, especially first-degree relatives, of Colorectal cancer, a personal or family history of polyps.

Early investigation with colonoscopy is recommended for patients with any symptoms, even if the symptoms are mild or vague. A high index of suspicion should be cultivated in all clinicians when managing their patients. Stool tests cannot be used as a diagnostic or investigative tool for symptomatic patients. The investigation of choice is Colonoscopy. Colonoscopy when performed by experienced endoscopists is safe and comfortable.

Treatment for Colorectal Cancer

The main treatment of Colorectal Cancer is Surgery. Adjuvant/Additional treatment with Chemotherapy and Radiotherapy has added to the improved results and prognosis in many patients.

Many Colorectal Cancers can be removed surgically. Surgery by an experienced Surgeon is associated with Low Risks, Low Morbidity and Low Local Recurrence rates. Distant metastases are reduced with chemotherapy.

Anal Sphincter-Saving Surgery is another area where an experienced surgeon differs from an inexperienced one. The need for a permanent Colostomy is reduced tremendously by an Experienced Colorectal Surgeon. It would be safe to say that when a permanent colostomy is advised, one should ask for a second opinion by a surgeon who is well versed with Rectal Cancer Surgery before a patient agrees to one. However, in 5% of cases, a permanent colostomy is unavoidable.

Colorectal Cancer Surgery, especially for Rectal Cancers, should ideally be performed by trained and experienced Colorectal Surgeons.

Adjuvant / Additional Treatment for Colorectal Cancer

Chemotherapy for Colorectal Cancer has improved tremendously over the years. Presently, Chemotherapy achieves better results and is well tolerated by many patients. Newer forms of Immunotherapy also improve outcomes. Oncologists have many new treatment regimes in their armamentarium to address this very common cancer.

Neo-Adjuvant Chemotherapy and/or Radiotherapy is now recommended for some Rectal Cancers. In neo-adjuvant therapy, the patient is subject to chemotherapy and/or radiotherapy before surgery, especially when the cancer is larger and more advanced. Joint management and consultation with a Colorectal surgeon, medical oncologist and radiation oncologist is recommended to discuss options before treatment is commenced, especially, for rectal cancers.

Overall Outlook for Colorectal Cancer

The overall outlook for Colorectal Cancer is improving. Promoting Screening and Early Investigation will allow detection of Colorectal Cancer in its early stage. Early detection translates to improved survival.

Surgery by Experienced Colorectal Surgeons have a significant impact on the safety, morbidity, local recurrence, overall outcome and the decrease in permanent colostomies.

Newer chemotherapy/immunotherapy drugs and regimes have also improved the overall survival of patients with Colorectal Cancer.

With proper treatment by Experienced Colorectal Surgeons and Oncologists in a multi-disciplinary team, Colorectal Cancer Treatment is much improved.