A Family Doctor's Tale - COLON CANCER

DOC I HAVE COLON CANCER

Colorectal cancer has become the most common cancer in Singapore.
My own mother in law had it for 7 years before finally succumbing to it. She did not have any symptoms except for mild indigestion. One night she had severe abdominal cramps and was sent to hospital where she was operated and diagnosed with cancer of the colon with spread to the liver. She refused any chemotherapy and was well until 7 years later when another abdominal cramp strike her. Then the colonoscopy and MRI of the intestines showed spread throughout the whole abdomen. She was then put on palliative care(symptomatic relief of pain) because treatment would not help or cure her.
 

Colorectal cancer is one of the commonest cancer among males and females in the world.  Colon cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). Colorectal cancer can be effectively treated if detected early.

Colorectal cancer occurs when cells from the intestinal wall grow and spread uncontrollably. It may begin as polyps (growths) in the large intestine and rectum. Polyps should be monitored regularly and removed upon detection to prevent them from developing into cancer.

As with most cancers, the risk of developing colorectal cancer increases with age. People at high risk include those with:

a  family history of colorectal cancer
a personal history of endometrial, ovarian or breast cancer
a personal history or family history of gastrointestinal polyps
a history of inflammatory bowel disease such as chronic ulcerative colitis or Crohn's disease.
Colorectal polyps
Cancer elsewhere in the body
A family history of colon cancer
Ulcerative colitis
Crohn's disease
Personal history of breast cancer
Certain genetic syndromes also increase the risk of developing colon cancer.

What you eat may play a role in your risk of colon cancer. Colon cancer may be associated with a high-fat, low-fiber diet and red meat. However, some studies found that the risk does not drop if you switch to a high-fiber diet, so the cause of the link is not yet clear.

In its early stages, the cancer usually has no symptoms, which is why regular screening is important to see if it could be present. 

The most common symptom of colorectal cancer, especially if it is located in the lower part of the large intestine, is changes in bowel habits. For some, it may be an increase in the number of bowel visits to the toilet, and for others, it may be constipation. Still others may complain of constipation with overflow diarrhea, i.e., difficulty in passing motion but stools flow out without any control.

Other symptoms include bloody or black stools from bleeding of the tumor (blood appears black on digestion in the intestines), fatigue, appetite and weight loss, abdominal pains, cramps or bloating.
Diarrhea, constipation, or other change in bowel habits
Blood in the stool
Unexplained anemia
Abdominal pain and tenderness in the lower abdomen
Intestinal obstruction
Weight loss with no known reason
Narrow stools
With proper screening, colon cancer can be detected BEFORE the development of symptoms, when it is most curable.

Your doctor will perform a physical exam and press on your belly area. The physical exam rarely shows any problems, although an abdominal mass may be felt in late cases.. A rectal exam may reveal a mass in patients with rectal cancer, but not colon cancer.

People over the age of 50 years are advised to screen for colorectal cancer, even if they have no symptoms.  
A Faecal Occult Blood Test (FOBT) is recommended once every year.  If the results are positive, other tests like a sigmoidoscopy, barium enema and colonoscopy may be required.
A complete blood count may reveal show signs of anemia with low iron levels.

Those who have a high risk of getting colorectal cancer may need to go for screening at a younger age.  They should consult a doctor for advice on the recommended screening age and the test which is most appropriate for them.

 Surgery is the main treatment. In surgery, the part of the large intestine containing the cancer is removed.  In some cases, the two ends of the colon can be rejoined.  Sometimes an opening called a stoma has to be left in the abdominal for the removal of waste. This opening may be temporary or permanent.

 Radiation Therapy:
Radiation therapy to destroy cancerous tissue 
 
 Chemotherapy:
Chemotherapy medicines to kill cancer cells .
 
Chances of success depend on how soon the cancer was detected, how much the cancer has penetrated the wall of the large intestine, and whether the cancer has spread beyond the colon.

Staging of the Cancer:
If your doctor learns that you do have colorectal cancer, additional tests will be done to see if the cancer has spread. This is called staging.

Stage 0: Very early cancer on the innermost layer of the intestine
Stage I: Cancer is in the inner layers of the colon
Stage II: Cancer has spread through the muscle wall of the colon
Stage III: Cancer has spread to the lymph nodes
Stage IV: Cancer that has spread to other organs 

Treatment depends partly on the stage of the cancer. 
In general, treatments may include:
Radiation therapy to destroy cancerous tissue 
Chemotherapy medicines to kill cancer cells
Surgery to remove cancer cells