In 2018, the World Health Organization (WHO) has reported 1.8 million colorectal cancer cases worldwide, with an accounted 862,000 deaths. In 2017, the Health Authority of Abu Dhabi (HAAD), revealed that the majority of colorectal cancer cases (63%) are detected at a late stage and 90% of them can be successfully cured if the disease is detected early.
As colorectal cancer affects both men and women, we recommend routine screening starting at age 45 years. Any patient with a new onset of bleeding, change in bowel habits, constipation, or abdominal pain should go to the doctor regardless of age or family history.
Dr. Maher A. Abbas is Colorectal Surgeon at Al Zahra Hospital Dubai and Fellow of the American Society of Colon and Rectal Surgeons. Today he will answer some of the most common questions on colorectal cancer.
THE INTERVIEW: DR. MAHER ABBAS
Which parts of the body does colorectal cancer affect exactly?
Colorectal cancer affects the large bowel which includes the colon and the rectum. The colon is responsible for water absorption from the stool and the rectum acts as a reservoir for feces.
What are the options when it comes to screening for colorectal cancer?
Colonoscopy examination remains the gold standard to screen the colon for polyps and cancer. Colonoscopy entails the use of a long tube with a small camera mounted on its tip to visualize the inside of the colon. The test is performed with the use of sedation. It is safe and normally well tolerated by the patient. Most colorectal cancers develop from non-cancerous polyps initially.
When detected early, polyps can be easily removed during a colonoscopy. Several other options are available to screen for colon cancer. Stool studies examine the presence of blood. The two most commonly used tests are the “Guaiac “stool test and the “Fecal Immunochemical Test (FIT test)”. Calprotectin is another helpful test that detects inflammation in the colon.
How important and effective is screening?
Screening for colorectal cancer saves lives. As a surgeon, I see firsthand every day the needless suffering of patients who have waited too long and present with advanced stages. This scenario is preventable if patients get routine screening for colorectal cancer.
When detected early, colorectal polyps and early cancer can be easily treated. Screening is highly advisable. The appropriate specialist to see is a colorectal surgeon or a gastroenterologist. They are professionally trained to perform colonoscopy for screening or to evaluate a patient for symptoms.
How often should the screenings be done?
For average-risk patients -the majority of the population-, screening for colorectal cancer should start at age 45 years. At a minimum, patients should get stool studies and ideally colonoscopy should be performed. The frequency of any subsequent colonoscopy would depend on the findings of the first one. For patients with normal examination results, the next colonoscopy is usually advisable between 5 to 10 years. For patients who are at increased risk for developing colorectal cancer, such as those with a strong family history of the disease or with a personal history of polyps, the doctor will decide on the frequency of the screening and could be more often.
COLORECTAL CANCER SYMPTOMS
What are the common signs?
Most patients with colorectal polyps or early cancer have no symptoms at all. When symptoms do develop they can range from a change in bowel habits to abdominal pain, bright red blood in the stool, black stools or unintentional weight loss. Other conditions can cause similar symptoms, including infection, inflammatory bowel disease, irritable bowel syndrome, and hemorrhoids. That is why it is important to get checked for the proper diagnosis to be made.
How dangerous is this cancer?
Colorectal cancer is the second to third leading cause of cancer-related deaths in the USA among cancers that affect both men and women. New cases are occurring at increasing rates in young and middle-aged adults even in the absence of positive family history. Therefore, I must insist on the importance of screening, considering this disease does not necessarily manifest symptoms until a later stage.
What are some of the risk factors?
A modern lifestyle increases the risk of developing colorectal cancer. Often a diet high in fat and processed food, smoking, inactive lifestyle, and/or being overweight predispose to colorectal cancer. In addition, conditions such as inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis) increase the risk of developing this type of cancer.
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