By Dr. Jun R. Ruiz
The Medical City
THE world celebrates Colorectal Cancer Awareness Month this month of March. This is an awareness campaign to promote colorectal cancer (CRC) screening. CRC is the third most common cancer among Filipinos with breast and lung cancers being more prevalent in the Philippines.
The Colorectal Clinic at The Medical City aims to be at the forefront of the Filipinos’ battle against colorectal cancer. Our message is that cancer screening can save lives, but not that many people are being screened. This strategy has been shown to reduce CRC risk by as high as 70 percent. As an advocate, I believe that now is the time to educate the general public and mobilize the health community to beat colorectal cancer.
Almost all of these cancers start as abnormal growths in the lining of the colon and rectum called polyps. These polyps grow slowly and some polyps take around 10 years to develop into cancer. Not all polyps, however, progress to cancer. The removal of these polyps reduces the risk of developing cancer. Additionally, polyps and early cancer usually do not have symptoms like rectal bleeding, constipation, and abdominal pain that are experienced by patients in the later stages of cancer.
Risk factors for colorectal cancer
The factors that increase the risk for cancer in the colon and rectum are:
1. age greater than 50
2. personal history of colorectal cancer or advanced polyps
3. family history of CRC
4. pre-existing diseases involving long-term inflammation of the colon
Those who are more than 50 years of age have a bigger chance of developing this cancer as 90% of the cases occur after the age of 50. A family history of a first-degree relative with CRC increases the chances of getting the disease two to three-fold. The risk is especially higher when the cancer occurred before the age of 60, or when two relatives have CRC.
There are also lifestyle factors that could contribute to the formation of cancer in the colon and rectum. These are:
1. cigarette smoking
2. alcohol consumption
4. a diet that has high saturated fat, low fiber, and high red meat consumption
Living a healthy lifestyle by avoiding smoking, not consuming excessive alcohol, exercising regularly, and eating the right food lower your risk for emphysema, cirrhosis of the liver, metabolic syndrome, diabetes, and heart disease. In addition, all these measures can lower your risk for cancer in the colon and rectum.
In several countries, CRC screening is recommended for people starting the age of 50 years. Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with colorectal cancer, and even earlier in those with other additional risk factors.
The gold standard for CRC screening is a colonoscopy as it can detect and remove early lesions like polyps. The procedure involves a flexible fiberoptic scope with a camera that is inserted through the rectum and is carefully advanced to visualize the colon under mild anesthesia. However, it is an invasive test and has the potential to cause complications (bleeding, puncturing the colon).
Some patients may not want to have an invasive test or may find the cost of a colonoscopy expensive. A stool test called the Fecal Immunochemical test (FIT) is a good screening alternative. FIT detects only human blood and is specific for bleeding in the colon. Persons who have a positive FIT are 12 to 40 times more likely to harbor cancer than those with a negative test. The test is repeated every year if the
initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer.
As a gastroenterologist who advocates CRC screening, I recommend a screening colonoscopy in persons between 50 to 75 years of age who are healthy unless the risk of the procedure is high in that patient.
If the person does not want to start with a colonoscopy, I suggest using the FIT. After a discussion with his gastroenterologist, the patient can choose his preferred screening test.
A shared-decision between the patient and his physician is very crucial. By undergoing either method of CRC screening, we would be able to beat colorectal cancer.
Dr. Jun Ruiz is a Diplomate of the American Board of Internal Medicine in Gastroenterology, and a consultant at The Medical City in Pasig, Metro Manila. He finished his Gastroenterology fellowship at the George Washington University in Washington D.C. and was an Attending at the Kaiser Permanente in California for 9 years. He is the first Filipino chapter author of the best-selling medical reference The Merck Manual. He can be contacted at the Colorectal Clinic of The Medical City, tel. #988-1000 local 7789.