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Colon cancer: All you need to know

The world mourns the loss of a superhero. Chadwick Boseman, the actor that brilliantly portrayed T’Challa (Black Panther), the King of Wakanda, passed away at the age of 43 after a 4-year battle with colon cancer. This led to a renewed interest in colon cancer (more accurately known as colorectal cancer) even in the midst of the Covid-19 pandemic. Physicians, health organisations, cancer survivors and advocates have used the opportunity to shine a light on colorectal cancer (CRC).

What is colorectal cancer?

It is cancer that originates from the colon or rectum. The colon is also known as the large bowel. The rectum is the lowest part of the large bowel and connects the colon to the anus.

CRC is the 2nd leading cause of cancer death in the world according to the World Health Organisation.

According to a study published in the Journal of Cancer Science & Therapy in 2019, CRC is the 2nd most common cancer among Nigerian men and the 3rd most common cancer among Nigerian women.

In the United States, African Americans are twenty percent more likely to have colorectal cancer and are forty percent more likely to die from colorectal cancer.

On average, there are about 150,000 cases of CRC in the United States every year and more than 50,000 deaths per year from the disease.

CRC is increasingly being diagnosed in younger people. In 2020, about 18,000 (12percent) of all colorectal cancer cases in the U.S. will be diagnosed in people under 50. The reason for this rise in early-onset CRC is not completely known but environmental factors like processed food and obesity are suspected.

What causes colorectal cancer?

The cause of most colorectal cancers is unknown. It is said to be due to a combination of genetic and environmental factors. Environmental factors like smoking, excessive alcohol intake, obesity, foods like processed meat, red meat, processed grain like white bread, and sugary drinks. People with family history of colorectal polyps or cancer as well as certain genetic diseases are more likely to have CRC.

Can I inherit colorectal cancer?

Some CRC are inherited. It should be suspected in a person with CRC at a young age, multiple different cancers, more than ten precancerous colon polyps, multiple family members with CRC or a family with many different cancers across multiple generations.

About 3percent-5percent of all colorectal cancers are due to Lynch syndrome, an inheritable form of colorectal cancer.

What are the signs of colorectal cancer?

CRC can be asymptomatic. This is why screening is important. Some of the symptoms and signs of CRC include rectal bleeding or blood in the stool, change in bowel habits (constipation or diarrhea), change in stool caliber, abdominal pain, unexplained weight loss, fatigue, loss of appetite, and iron deficiency anemia.

What are the stages of colorectal cancer?

Colon cancer stage ranges from stage 0 in which the cancer is confined to the innermost layer (mucosa) of the colon to stage 4 in which cancer has spread to distant organs like the liver or lungs.

How is colorectal cancer treated?

Treatment depends on the stage of the cancer. Growths confined to the innermost layer of the colon can be removed during colonoscopy. Most require surgery alone or surgery in combination with chemotherapy and radiation.

Is colorectal cancer preventable?

Colorectal cancer is preventable. There are three simple ways to prevent CRC.

Know your family history

When and how often to screen for CRC depends on your family history. African-Americans should start at age 45 according to the American College of Gastroenterology. A person with one first degree relative with a history of CRC or adenomatous polyps before the age of 60 or two or more first-degree relatives at any age should start screening at age 40 or 10 years earlier than the age of the affected relative. Persons with a first-degree relative with a history of CRC or polyp at age 60 or older or two second-degree relatives with CRC should start screening at age 40. A person with familial adenomatous polyposis (FAP) should start screening at age 10-12. Persons with Lynch syndrome should start screening at age 20-25 or 10 years younger than the youngest affected immediate relative.

Get screened

There are several options for screening for colorectal cancer. These include guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), FIT-DNA test (Cologuard®) flexible sigmoidoscopy, CT colonography (virtual colonoscopy), and colonoscopy.

Colonoscopy is the gold standard because it allows the removal of precancerous polyp anywhere in the colon before it grows into cancer.

Adopt a healthy lifestyle

Do not smoke tobacco. Drink alcohol in moderation. Avoid excessive intake of processed meat, red meat, white bread, and sugary drinks. Eat more fruits and vegetables. Fiber is good for your colon health. Whole grains like oatmeal, brown rice, barley, millet and whole wheat bread are high in fiber. Exercise regularly and keep the weight off.

The best strategy against CRC is prevention through healthy lifestyle and screening. Next is early detection and treatment when symptoms are present. Colorectal cancer is preventable and treatable.

In a resource-limited country like Nigeria and in a world ravaged by COVID-19 and economic crisis, colorectal cancer takes on a new face with new challenges. Low-cost high value approach is needed. Do not abandon indigenous Nigerian meals rich in fiber and nutrients for highly processed western diets. If there is no gym, walk. Talk to family members about any history of cancer. If colonoscopy is not available or accessible, get a stool test. Check your stool for blood. If you are ill, seek medical attention from a qualified health professional.

Ajumobi, MD, MBA, FACP, FACG is a board-certified gastroenterologist. He is on faculty at the University of California, Riverside and Eisenhower Health, California. He has received the American College of Gastroenterology Service Award for Colorectal Cancer Outreach, Prevention & Year-Round Excellence (SCOPY) multiple times. He is the Founder and Editor of www.bowelprepguide.com and can be reached @ajumobiMD.

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