Colon cancer in India

Dr. Amanjeet Singh
It was not a very good morning for Ramesh Kumar, a 53-year-old senior       Government official, who was shocked       to see blood in his stool. He was also experiencing change in his bowel        movements with regular complaints        of diarrhea and constipation for a few days, accompanied by persistent weakness and fatigue, and unexplained weight loss, to which he was ignorant till now.
He reported it to his family doctor who, in view of his symptoms and risk factors, ordered some blood and stool testes, followed by colonoscopy subsequently biopsy. The final diagnosis came as a heartbreak to Mr. Kumar and his family. He was suffering from colorectal cancer!
The third most common cancer across the world, colorectal cancer accounts for nearly 1.4 million new cases and 694,000 deaths per year. Approximately,1 in 3cases of colorectal cancers is found to be localized in the rectum.
Overall, the lifetime risk of developing colorectal cancer, as studies report, isabout 4.7% and 4.4% for men and women respectively. Colorectal cancer affects colon or rectum;parts of the large intestine. In colorectal cancer, tumors develop in the lining of the large intestine.
“Like Diabetes, the incidence of colorectal cancers is increasing like an epidemic in India.While you can dolittle to control risk factors that include ageing (risk of colorectal cancer increases after 50 years of age), a personal history of colorectal polyps or colorectal cancer, a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease), and a family history of colorectal cancer;you can do a lot about lifestyle-related factors responsible to causecolorectal cancer.
What do youeat, how much do you weigh and what is your physical activity level – have a direct implication on your risk of developing colorectal cancer. As studies suggest, overweight or obese (very overweight) people may have a greater risk developing and dying of colorectal cancer. Though both men and women have the risk of developing colorectal cancer if they are obese, men seem to have it in greater proportion.
Being physically inactive increases the risk of developing colorectal cancer. According to researchers, lack of regular involvement in vigorous physical activity accounts for 12-14% cases of colon cancer. An estimated 3.5 to 4 hours of vigorous activity per week may be useful in decreasing the risk of colorectal cancer. Unhealthy diet is the most common risk factor that may contribute to colorectal cancer. The high intake of red meats including lamb, liver and pork; and processed meats such as hot dogs may increase the risk of colorectal cancer.
Talking about the treatment, surgical resection has been the most important treatment determinant for rectal cancer (especially locally advanced, stage II or III) in terms of a staging, curative resection (removal of the affected organ), prognosis, and follow-up therapies. The good news is prognosis of colorectal cancer has witnessed a significant improvement over last few years, thanks to the advances in techniques of laparoscopy.
Laparoscopic colorectal surgery allows safe and effective removal of sections of the colon (large intestine, large bowel) and rectum. This procedure requires making three or four small cuts in the abdominal wall through which the camera and operating instruments are inserted. After that, a moderate sized cut is made to allow the removal of the resected bowel.
Several studies advocate the use of laparoscopic technique for a number of benefits including shorter hospital stay, shorter time to bowel function, shorter recovery time, less pain from the incisions and better quality of life.7
Generally, patients recover within a fortnight post laparoscopic colorectal surgery. They may be able to perform most of the normal activities including showering, walking upstairs, driving and others within one to two weeks time. However, it is important to follow doctor’s advice for a fast post-operative recovery.
Although laparoscopic technique offers many advantages, it may not be fit for some patients. Depending on stage, symptoms, test reports and other individual factors, your doctor may suggest you the right treatment or a combination of treatments.
As they say, prevention is always better than cure. People who have a family history of colorectal cancer or who are exposed to environment factors (including obesity, smoking or unhealthy dietary habits) of developing colon cancer, it’s time to take the requisite precautions.
“Colorectal cancer is known to have associated with your diet and lifestyle. So it is advised to avoid or limit the consumption of red meats and processed meats. Add more vegetables, fruits, and whole grains to your diet as they are known to lower risk of colorectal cancer. And most importantly, make sure you are physically activity including frequent involvement in vigorous physical activity. Quit smoking if you haven’t yet as it is associated with different types of cancers including colorectal cancer,” concludes Dr.  Singh.
(The author is Associate Director, Gastrointestinal Surgery and Head, Colorectal Surgery at Medanta)