The Tribune

By DR NEVEIN GIRGIS

What are the differences between colorectal cancer, colon cancer and rectal cancer?

Colorectal cancer is the term used to describe cancer of the colon and/or rectum. The two cancers are grouped together because they share many common characteristics. Together, the colon and rectum make up the large intestine, a question mark-shaped bowel four feet in length. Colon cancer develops in all but the last few inches of the large intestine, between the appendix and rectum. Rectal cancer develops in the rectum, the last few inches of the large intestine that attaches to the anus. Colon cancer is more common. An estimated 95,000 new cases of colon cancer are diagnosed each year, compared to 39,000 cases of rectal cancer, according to the American Cancer Society.

Signs and symptoms of colorectal cancer

Colorectal cancer may develop when benign polyps in the large intestine grow and become cancerous. There may be no symptoms of benign polyps or colorectal cancer in its earliest stages. As the cancer grows, symptoms may include abdominal pain or cramps; constipation or diarrhea; blood in the stool; bloating or a sense of not feeling empty after a bowel movement; flattened or ribbon-shaped stool and/or pain in the rectum. Signs of advanced colorectal cancer may include unexplained weight loss, fatigue, anaemia and loss of appetite.

Can colorectal cancer be prevented?

Even though we don’t know the exact cause of most colorectal cancers, we do know it’s possible to prevent many colorectal cancers.

Regular colorectal cancer screening is one of the most powerful weapons for preventing colorectal cancer. Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease.

Regular screening can help prevent colorectal cancer by finding abnormal colon growths (called polyps) so they can be removed before they have a chance to turn into cancer.

The risk factors for colorectal cancer may be reduced with regular checkups and lifestyle changes. The American Cancer Society recommends that men and women have a colonoscopy beginning at age 50. African Americans have a higher risk of colorectal cancer and should begin screening at the age of 45. If you have a family history of colorectal cancer, you should get screened 10 years earlier than when your family member was diagnosed. For example, if your father was diagnosed with colon cancer at 48, you should talk to your doctor about getting a colonoscopy at 38. Talk to your doctor about how often you should get a colonoscopy. The procedure may be able to help your doctor spot cancer in its early stages. And pre-cancerous polyps may be removed and biopsies performed during the procedure, if necessary.

Changes in your lifestyle may also help lower your colorectal cancer risk. Obesity, smoking, alcohol, diet and a sedentary lifestyle have been linked to increased risks for colorectal cancer.

There are many tests that can look for colorectal cancer. Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam).

Stool-based tests

• Yearly faecal immunochemical test

• Yearly guaiac-based faecal occult blood test

• Multi-targeted stool DNA test (MT-sDNA) every three years

• Visual (structural) exams of the colon and rectum

• Colonoscopy every 10 years

• CT colonography (virtual colonoscopy) every five years

• Flexible sigmoidoscopy every five years

If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy.

“I only need to get tested for colorectal cancer if something seems wrong, is that true?”

It’s important to get tested for colorectal cancer even if you feel OK. Testing before you feel bad can help prevent the disease or find it early, when it’s easier to treat.

Most people with early colorectal cancer don’t have symptoms. But if you have any of the following, see a health care provider:

• A change in bowel habits, such as diarrhoea, constipation, or narrowing of the stool, that lasts for more than a few days

• A feeling that you need to have a bowel movement that’s not relieved by doing so

• Rectal bleeding, dark stools, or blood in the stool (often though the stool will look normal)

• Cramping or belly pain

• Weakness and extreme tiredness that doesn’t get better with rest

• Unintended weight loss

Most of these symptoms are more often caused by other conditions, such as infection, haemorrhoids, irritable bowel syndrome, or inflammatory bowel disease, not colorectal cancer. Still, if you have any of these problems it’s important to see a health care provider right away so the cause can be found and treated, if needed.

Lifestyle choices like alcohol use, exercise and smoking have an impact on colorectal cancer risk.

Colorectal cancer has been linked to the heavy use of alcohol. Alcohol use should be limited to no more than two drinks a day for men and one drink a day for women.

If you are not physically active, you have a greater chance of developing colorectal cancer. Increasing activity may help reduce your risk.

Long-term smokers are more likely than non-smokers to develop and die from colorectal cancer. If you use any form of tobacco, stop!

Diet choices can also impact colorectal cancer risk. A diet that’s high in red meats (such as beef, lamb, or liver) and processed meats (hot dogs and some luncheon meats) can increase risk.

Cooking meats at very high temperatures (frying, broiling or grilling) creates chemicals that might increase cancer risk, too, but it’s not clear how much this might contribute to an increase in colorectal cancer risk. Diets high in vegetables, fruits, and whole grains have been linked to a decreased risk of colorectal cancer.

How will having colorectal cancer affect my quality of life?

This may depend on how advanced your cancer is, if surgery is required and to what extent, and what treatment options are available to you. If caught early, colorectal cancer treatments typically have strong long-term outcomes. Advanced or metastatic colorectal cancer often presents additional challenges. As with all cancers, drug therapies may produce side effects that impact your quality of life. In some cases, surgery may be needed and a colostomy required. Colostomies may be temporary to allow the bowel to heal after surgery. But they may be permanent in cases that require extensive surgery.