Cancer, as we all know, is the second leading cause of death globally. March is observed as the Colorectal Cancer Awareness Month. Receiving an early diagnosis when it comes to any cancer is crucial, but sometimes the symptoms can mimic signs of other stomach or issues with intestines. So how do we tell it apart? We spoke to Dr. Ramanjit Singh, Director and Head of Colorectal Surgery, GI Surgery, Medanta Gurugram to know more about the third most common cancer in India.

Are colorectal cancers on the rise?

Colorectal cancer is one of the common cancers in the body. Overall, it’s the third most common cancer of the body and each one of us has around 4-5 per cent lifetime risk of developing colorectal cancer. Moreover, initially it was thought that maybe it’s a white man’s disease. But now if you see, it’s actually the incidence is increasing like an epidemic. So just like diabetes, now we have an epidemic of colorectal cancers even in India. So that is the reason we all are interested in this topic and that is the reason for celebrating this month to make people aware about how we can prevent it, how we can treat it so that we can diagnose it early.

“I’m a surgeon. So for a surgeon, we usually see around 250-300 surgeries, patients who need surgery. So there are many patients who just have polyps, who have early cancer, they are even treated by the gastroenterologist by endoscopy only. And there are other cases which are diagnosed late. So those cases are treated by the medical oncologist with chemotherapy only. So if you ask about surgery, it’s around 250-300 cases of surgical patients.”

Signs of colon cancer people tend to miss

Yes, so there are actually features like a recent change in bowel habit. If somebody was having constipation, now suddenly develops diarrhea or somebody was having diarrhea since long 3-4 motions a day. Now he or she is constipated. So that is the most common symptom, recent change in bowel habit. Others include bleeding rectum, any patient with unexplained weight loss. So if you’re doing exercise and losing weight, that’s a different thing. So you’re not doing anything, you’re not doing any dietary restriction and still you’re having weight loss. So then it’s an indicator that we are missing something or any patient with unexplained anemia. So you get your routine test, your hemoglobin is 6 grams. So that means we are losing blood somewhere. So these are the most common features which are usually seen, recent change in bowel habit, unexplained weight loss, unexplained anemia or bleeding for rectum.

Anybody with these symptoms which we call as a worrisome symptoms or anybody who is at a high risk group should get tested. There are some patients who are more prone to colorectal cancer. So if you are in one of those categories, probably then you need screening in terms of a curled blood test, CEA or in terms of colonoscopy.

What puts you at risk?

Patients who have a family history of colorectal cancer, somebody like a father, mother, brother had colorectal cancer or there are patients who had some kind of a colonic polyp which has been excised, maybe early childhood or something are at risk. Other patients who have some inflammatory conditions of the intestine like ulcerative colitis, Crohn’s disease or there are some genetic syndromes like familial adenomatous polyposis. There is another HNPCC. So this is a kind of syndrome where colorectal cancer runs in the family. So the chances of a person developing colorectal cancer in these genetic syndromes is actually close to 100%. So if you are any of these high risk groups, it makes you a definite candidate for getting screened at an early stage.

Colorectal cancer is actually one of the cancers in the body which we call a lifestyle disease. So there are a lot of dietary factors, a lot of lifestyle factors which are associated with colorectal cancer. So if you see the lifestyle, obesity has been shown to increase the risk of colorectal cancer. So this assertion has actually been proven, especially in men, smoking, alcoholism, they also predispose one to colorectal cancer.

How can you protect yourself?

There is another study which has shown that a sedentary lifestyle increases the risk. There are studies which have shown that if you exercise four hours a week, vigorous activity, it has shown to have a protective effect. There are some other factors like dietary factors. So it is important to increase fiber intake, vitamin C, E, as they are all protective against colorectal cancer. And there are some dietary factors like red meat, processed meats, refined grains, high fat dairy products, starch, and sugar. All of these factors increase the risk of colorectal cancer.

Colorectal cancer is actually a disease of the elderly population. So anybody more than 60 is definitely more prone. But unfortunately, in recent years, we are now finding a young population, even less than 40 with colorectal cancer. And majority of these, they have a genetic, some kind of mutation. Otherwise, it was actually a disease of elderly population only.

Colorectal cancers are 100% curable

Among all other cancer, colorectal cancers, if diagnosed early, is 100% curable. So if you find a polyp, you excise it, the patient is cured. He does not even need a follow up. If it is diagnosed at an early stage, there is a good 90% survival rate, which is not seen in any cancer in the body. Even if it’s diagnosed late, suppose it’s a stage 3 cancer, we still have treatment options in the form of surgery. There are a lot of chemotherapy drugs to which colorectal cancer responds. And even if you have cancer, which is stage 4, and has spread to other parts of the body like liver, lungs, still we can treat them with chemotherapy and long term survival is still possible. So it’s not the case that if somebody gets colorectal cancer, he’s gone or it’s an analytic approach. That is not the case. So still, if you get early treatment, long term survival is possible in colorectal cancers.