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Colorectal cancer a silent killer with no early warning symptoms

<p><span style="font-family: helvetica;"> <img src="/nairobi/PublishingImages/Dr%20sitna%20body%20image.jpg" alt="" style="margin: 5px;"/></span> </p><div><em style="font-family: helvetica;">Dr Sitna Mwanzi making a presentation at the 5th International Cancer Conference 2018</em></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Colorectal cancer is among the top ten cancers in Kenya. This type of cancer can either start at the colon or the rectum otherwise called the large intestine. According to recent Globocan data, there were 1,354 estimated new cases and 937 deaths from colorectal cancer in 2018 in Kenya. There are probably more cases and deaths from colorectal cancer that were not reported or diagnosed.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Healthy cells in the lining of the colon or rectum can change and grow out of control, forming a mass called a <g class="gr_ gr_49 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="49" data-gr-id="49">tumor</g> which can be cancerous/malignant or benign. A cancerous/malignant <g class="gr_ gr_52 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="52" data-gr-id="52">tumor</g> is a <g class="gr_ gr_53 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="53" data-gr-id="53">tumor</g> that can grow and spread to other parts of the body. A benign <g class="gr_ gr_55 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="55" data-gr-id="55">tumor</g> means the <g class="gr_ gr_57 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="57" data-gr-id="57">tumor</g> can grow but will not spread. </span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Colorectal cancer sometimes begins as a polyp, a non-cancerous growth that may develop on the inner wall of the colon or rectum as people age. If not treated or removed, a polyp can become a potentially life-threatening cancer. Finding and removing pre-cancerous polyps can prevent colorectal cancer.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">As with many cancers, age is a risk factor for colon cancer especially for those over 50 years. However, we have encountered cases in younger patients in their 30s and 40s and rarely in their 20s. Other risk factors include a family history of colorectal cancer, changes in the genes, smoking, excessive alcohol intake, poor nutrition, lack of physical activity and obesity. In other cases, no obvious risk factor is identified.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Common symptoms of colorectal cancer include a change in bowel habits with stool thinner than normal, constipation, bright red or very dark blood in the stool, <g class="gr_ gr_66 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="66" data-gr-id="66">diarrhea</g>, constant fatigue, and discomfort in the abdomen with bloating and frequent gas pain. When the disease has spread to other organs, other symptoms include weight loss, bone pain, yellowness of eyes and urine amongst others. Anyone with these symptoms lasting for more than 2 weeks should seek medical assistance for evaluation.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Although there is no proven way to completely prevent this disease, one may be able to lower their risk. Observing a diet rich in fruits and vegetables and low in red meat, reducing alcohol intake and smoking cessation are important in reducing the risk of colon cancer. Screening from the age of 50 years under the guidance of a clinician is also recommended. Screening can be done using stool tests and/or colonoscopy to visualise the inside part of the colon. A biopsy which involves the removal of a small amount of tissue for examination under a microscope can make a definite diagnosis of colorectal cancer.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Treatment for colorectal cancer depends on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Treatment can be in form of surgery to remove the <g class="gr_ gr_59 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="59" data-gr-id="59">tumor</g> and some surrounding healthy tissue during <g class="gr_ gr_51 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-del replaceWithoutSep" id="51" data-gr-id="51">an operation</g>, radiation therapy, chemotherapy, targeted therapy and immunotherapy which involves the use of materials made either by the body or in a laboratory to boost the body&#39;s natural <g class="gr_ gr_60 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="60" data-gr-id="60">defenses</g> to fight <g class="gr_ gr_54 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-del replaceWithoutSep" id="54" data-gr-id="54">the cancer</g>. In some cases, a combination of these therapies <g class="gr_ gr_58 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="58" data-gr-id="58">are</g> used.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Even in the stage where the disease has spread to other organs, treatments are available to shrink the <g class="gr_ gr_63 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="63" data-gr-id="63">tumor</g> and relieve symptoms for the patient. With the advances in medical therapy, patients with advanced disease are surviving longer and with good quality of life. Throughout the treatment journey, whether in early or advanced disease, it is important to support the patient with his or her physical, emotional, and social needs. Health care costs also need to be addressed.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Just like efforts and resources have been put in place to address breast, cervical and prostate cancers by both public and private stakeholders in healthcare, similar investment for colorectal cancer and emphasis on regular screening is vital for early diagnosis at manageable and treatable stages especially because colorectal cancer may not show any symptoms during the early stages. </span></div><div><span style="font-family: helvetica;">
<em>By Dr Sitna Mwanzi, Consultant Medical Oncologist, Aga Khan University Hospital, Nairobi</em></span></div>