Reported as the second most common killer in other countries, but only affects around 6% of those who suffer from cancer in Sri Lanka, colorectal cancer is a cancer that has a overall survival rate of 60%, if detected between stages 1- 3. Daily Mirror spoke to Dr. Wasantha Ratnayake, a Consultant Clinical Oncologist attached to the Apeksha Hospital, Maharagama to educate you more on this topic.
The colorectal area contains the colon and the rectum. The colon is the final part of the digestive system. The rectum is situated at the end of the colon. Colorectal cancer occurs either in the rectum or colon and rarely at both areas at the same time. Cancers in this area take about 10 years to develop. Dr. Ratnayake revealed that colorectal cancers are usually caused by the growth of a grape like nodule called a ‘polyp’ in the lining of the mucosa, which can develop into a cancerous growth.
What is colorectal cancer?
“A cancer is caused when an epithelial cell becomes abnormal and starts dividing out of control. These cells cause pre malignant carcinoma and when unchecked, it could develop into cancer cells. In colorectal cancer, this occurs in the innermost tissues of the mucosa,” he stated.
Colorectal cancer occurs in either the colon or the rectum, and also has stages as other cancers.
Stage 1- Cancer is confined only to the colon/rectum
Stage 2- Cancer spreads just beyond the colonic wall structure
Stage 3- Cancer spreads to the surrounding structures
Stage 4- Cancer spreads throughout the body through distant metastasis
Causative factors
Dr. Ratnayake stated factors below as the main causes of colorectal cancer:
Genetics
- Low fibre containing dietary habit
- High fat containing dietary habit
- Smoking
- Lack of exercise (sedentary lifestyle)
- Dietary habit containing food with preservatives and additives
He explained that when there isn’t adequate fibre in the diet, it causes constipation and due to constipation and the longer time it takes for the stool to pass through the body- harmful constituents in the stool leak into the exposed cells of the mucosa. This could cause the cells to get damaged and start behaving like cancer cells.
He further explained that even a high fat diet and a dietary habit containing food with preservatives and additives also cause the same concerns.
Symptoms
- Persistent change in bowel habits (including diarrhoea and constipation)
- Streaks of blood on the surface of the stool
- Malaise
- Lethargic
- Fatigue
- Abdominal pain
- Unexplained weight loss
- Anaemia
- Itching
Screening for Colorectal Cancer
Dr. Ratnayake revealed that most victims of colorectal cancer are 50 years and above. “If colorectal cancer is detected in a person of younger age, then it could be inferred that the person has the genetic component that causes colorectal cancer. If anyone has a family history of colorectal cancer, it would be better for him or her to do a colonoscopy,” he advised.
He noted that in countries like the UK, everyone over the age of 60 has to undergo the Faecal Occult Blood Test (FOBT) where a scan is done to detect blood in the stool which eventually helps in the diagnosing of colorectal cancer. “In Sri Lanka, the public should be aware that after the age of 60, they too should take this test and also do a manual rectal test,” he informed.
He stated the best way to diagnose colorectal cancer is by carrying out a colonoscopy as the colonoscopy gives a clear idea of the colorectal area. Dr. Ratnayake said that after the colonoscopy, if any abnormality is noticed- a tissue from the area should be sent for a biopsy report.
Dr. Ratnayake also noted that those who’ve suffered from Inflammatory Bowel Disease too will join the screening process. “For those who have had IBS (Irritable Bowel Syndrome) and have not been cured of it, doing a colonoscopy would be helpful in assessing if the patient has colorectal cancer,” he stated.
Living with Colorectal Cancer
Colorectal cancer is one of the most curable cancers, with a mortality rate of only 6% in Sri Lanka. Dr. Ratnayake stated that there is a survival rate of 90% if the cancer is detected early on, but if the cancer is still in stages 1- 3, there is a survival rate of 60%.
“During stages 1- 3, our aim is to cure the cancer, but when a patient is diagnosed with stage 4, then we provide care to increase their quality of life,” stated Dr. Ratnayake.
He also went to explain that if the cancer is detected in the rectum, firstly a surgery will be conducted (depending on the tumour) followed by doses of radiotherapy and chemotherapy. If the cancer is detected in the colon, firstly chemotherapy will be conducted along with a surgery if necessary. Radiation therapy is not used in colonic cancer until the later stages.
Dr. Ratnayake also said that Stage 4 cancer is treated by chemotherapy, targeted therapy and immune therapy. “Immune therapy is the best, yet is not available in Sri Lanka. In the future, we are hoping to get down the necessary medication and infrastructure to carry out immune therapy,” he said. He revealed that when distant metastasis occurs in stage 4, the liver, lungs and brain get affected and that treatment had to be conducted separately for the affected organs.
Preventive measures
“Eat a balanced diet containing high fibre and low fat dietary options along with no preservatives or additives, avoid smoking and do exercise regularly,” said Dr. Ratnayake when asked about the preventive measures that can be taken to prevent developing colorectal cancer.
He also stressed on regular check ups if the person:
- Has a family history of colorectal cancer
- Is above 50 years of age
- Has had Inflammatory Bowel Disease
- Suffers from IBS
- Has suffered from unexplainable weight loss and is anaemic.
“Colorectal cancer is a curable cancer in Sri Lanka and if the patient gets the proper treatment, it can be easily cured. When we tell certain patients that we have to remove their rectum, most of them seek alternative medical practices and it endangers their lives. So, my message to the public is be aware of your body and seek the correct cure at the correct time because there is a very high survival rate in colorectal cancer,” Dr. Ratnayake concluded.
