March is Colorectal Cancer Awareness Month. Colorectal cancer (CRC) ranks as the third most common cancer in the Philippines. In 2020, an estimated 17,364 patients in the country were reported to be diagnosed with either colon or rectal cancer. Despite it being one of the most treatable and preventable cancers, it is the second cancer-killer worldwide due to late diagnosis.
Over the last decade, there has been an increasing incidence of CRC in persons younger than age 50 (called as “early onset colorectal cancer”) in the United States. This disease was recently in the spotlight in 2020 after “Black Panther” star Chadwick Boseman died from the disease at the age of 43. Last week, the Philippine sports community was shocked when Barangay Ginebra San Miguel player Lewis Alfred aka LA Tenorio announced that he has been diagnosed with Stage 3 colon cancer at the age of 38.
Risk factors for colon cancer
CRC is a malignant tumor in the large intestine (either the colon or rectum). For advocacy purposes, the term is shortened to colon cancer. Almost all these cancers start as benign growths called polyps. These polyps grow slowly and take around 10 years for some polyps to develop into cancer. Thus, the removal of these polyps reduces the risk of developing cancer by as high as 70%.
Risk factors for CRC can be classified as modifiable or non-modifiable. Non-modifiable risk factors are usually individual-specific and include: 1) age 50 and above; 2) personal history of CRC or advanced polyps; 3) family history of CRC; 4) history of chronic colitis.
Age 50 and above is the most common risk factor for this cancer, as 90% occur after the age of 50. A family history of CRC increases the risk to 2 to 3 fold. However, the number of cases between the ages 45 to 50 has recently increased as previously stated. This early-onset CRC is characterized by a more advanced stage at diagnosis, and a left colon-sided location. Surprisingly, around half of these patients did not have risk factors, like hereditary cancer syndromes or family history.
Modifiable risk factors are those lifestyle habits that can contribute to this cancer, but can be altered by healthier practices. These include: 1) cigarette smoking; 2) alcohol consumption; 3) obesity; 4) a diet that has high saturated fat, high red meat consumption, and low fiber, and; 5) sedentary lifestyle and no exercise.
Living a healthy lifestyle by avoiding smoking, not consuming excessive alcohol, regular exercise, and eating the right food can lower your risk for CRC.
Symptoms
Some patients with CRC may experience no symptoms, especially in the early stages of the disease. These polyps and early cancer do not usually cause complaints. When symptoms occur, these may vary on the cancer's size and location.
The symptoms of CRC (Colorectal Cancer) may include rectal bleeding, recent change in bowel habits (either diarrhea or constipation), decrease in caliber of stools, abdominal pain, anemia, and unintentional weight loss.
Get screened
Screening is the process of looking for cancer or pre-cancerous lesions in people who have no symptoms of the disease. The high prevalence of CRC makes screening so much important as it is preventable and screenable cancer.
In almost all countries, CRC screening is recommended for average-risk patients starting the age of 50 years, except in the United States where it has been lowered to age 45. The Third Asia-Pacific Consensus Recommendations on CRC screening (2022) maintained the start of the screening age at 50 for average-risk, as the cost-effectivity of lowering this to 45 has not yet been demonstrated in Asia. Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with CRC, and in those with other additional risk factors.
There are two major methods for screening CRC. The gold standard is a colonoscopy as it can detect and remove polyps before these can potentially turn into cancer. The procedure involves a flexible fiber-optic scope with a camera that is inserted through the rectum and is carefully advanced to visualize the colon under mild anesthesia, but it is an invasive test.
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. 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.
This fight against the country’s third most common cancer has been an uphill battle. A majority of the population is still reluctant to undergo testing due to lack of medical awareness. The absence of a national population-based CRC screening program and the big financial burden of CRC screening on the individual patient are barriers to this campaign. In addition, several local health maintenance organizations (HMOs) still refuse to pay for CRC screening strategies.
In conclusion, screening for CRC is one of the most powerful tools in beating this preventable cancer. Screening can diagnose this cancer early, when there is the best chance for cure. My professional advice to our patient: if you are at risk for CRC or if you have alarm symptoms at any age, consult your physician at the soonest time. We will help you beat colon cancer!
For more information, contact The Medical City’s Augusto P. Sarmiento Cancer Institute at (+632) 8988-1000 or 8988-7000 loc. 6214.
Written by Dr. Jun R. Ruiz, M.D., FPCP, FPSG, FPSDE, MHM