Colorectal Cancer will be the focal point of discussions for the entire month starting from March 1 – 31 2024. While compared to western countries Sri Lanka has less numbers of cases and deaths from Colorectal Cancer, according to the latest data from the National Cancer Registry, a significant increase in the number of patients and deaths in recent years is evidence that more public awareness is urgently required on this specific cancer with the support of the community as a whole. The Sunday Observer spoke to Senior Registrar of the National Cancer prevention Programme (NCCP,) Dr Janaka Godewithanage, to get more insights as to what caused this surge in Colorectal Cancer, main obstacles facing the specialists in reaching out to the community, gaps in the present system on delivering quality care to all those with Colorectal cancer, as well as how it can be prevented with healthy diets, lifestyles changes, and early reporting of any suspicious symptoms to a qualified physician.
Excerpts:
Q. This whole month has been devoted to raising awareness on colorectal cancer. Why is this cancer of such importance that it requires an entire month of awareness raising among the public?
A. March of 2024 has been nominated as the colorectal cancer awareness month because it has been the third commonest cancer worldwide and the second leading cause of cancer-related death. And on the other hand, it is preventable and curable if identified during early stages.
Q. Compared to western countries, how does Sri Lanka compare with the number of patients suffering from his cancer? Has it increased in the recent decade according to your latest data?
Dr Janaka Godewithanage
A. Sri Lanka reports a lesser number of cases and deaths from colorectal cancer compared to western countries and the whole world. However, there is a significant increase in the number of colorectal cancer patients and deaths in the country. Alarmingly it has become the third most common cancer among both males and females in the country and the sixth and eighth cause of cancer-related deaths.
Q. What are the main causes that drive this cancer both globally and in Sri Lanka in particular?(elaborate)
A. There are no such direct causes for developing colorectal cancers. But according to the American Cancer Society several risk factors have been identified as leading to colorectal cancers.
Being overweight/obese, sedentary lifestyle, smoking, alcohol use and consumption of red meat and processed food and diet less in dietary fibers are the set of risk factors for colorectal cancers which can be changed or termed as modifiable risk factors.
On the other hand, a set of risk factors are there such as older age, genetic predisposition and having type 2 which cannot be changed and termed as non-modifiable risk factors
Q. Does having a pre-existing disease such as diabetes cause it?
A. Yes, having type II diabetes has been identified as a risk factor for developing colorectal cancers. The mechanism for developing cancer is not well established and it is suggested that several chemical compounds that get increased in a person with Type II diabetes are linked with the development of colorectal cancers.
Q. Lifestyle changes?
A. Having a sedentary or less active lifestyle has been identified as a risk factor for colorectal cancers.
Q. Poor diets?
A. Yes. Definitely.
Q. I understand that consumption of red meat can contribute to colorectal cancer. Right or wrong?
A. Avoiding red meats and refined processed food is highly advisable. .
Q. What about polluted environments where toxic chemicals have leached to the ground water
A. There is no such evidence to say that environment pollution and toxic chemicals in water is associated with colorectal cancers
Q. Are there early warning symptoms to look out for? If so, what are they?
A. Generally, colorectal cancer has no symptoms in the early stages. Regular screenings are important to catch the disease early and begin treatment. However, following symptoms are suggestive of a colorectal cancer
• Changes in bowel habits such as diarrhoea, constipation, or narrowing of the stool
• Blood in the stool (rectal bleeding), either bright red or dark and tar-like
• Abdominal cramps, pain or bloating that won’t go away
• Unexplained weight loss that is sudden and losing weight without trying
• Feeling constantly tired and lacking energy, even with enough rest
• Iron deficiency anaemia due to chronic bleeding, causing fatigue, weakness and paleness
Q. At what age should one look for the symptoms?
A. From 45 years onwards it should be looked for symptoms
Q. Genetics? Does it have a role? If someone has a family history of this cancer or any other cancer what are the chances of him/her getting it early?
A. Yes, a certain genetic predisposition has been found in the occurrence of colorectal cancers. However, this accounts for a small percentage (such as 3 percent) of colorectal cancers.
On the other hand, one in three colorectal cancer patients tend to have a family member with colorectal cancer.
In the bottom line if one’s family member had a colorectal cancer, it would be better to get screened or be vigilant on cancer symptoms mentioned above.
Q. Alcohol – can it increase the risks?
A. Yes definitely.
Q. Age wise and gender wise who are those most likely to develop colorectal cancer?
A. As I said earlier, all those from 45 years onwards should look out for symptoms
Q. Is there a vaccine to prevent it?
A. Unfortunately, there is no effective vaccine for colorectal cancers
Q. Can symptoms be delayed or managed with proper medication?
A. Yes, if diagnosed early and treated accordingly it can be cured
Q. How do you diagnose collateral cancer? With an Xray? Blood prick?
A. There are sets of tests that can be used to screen for colorectal cancers and diagnose colorectal cancers. The simplest screening test is stool for occult blood, and it detects blood in stool. But the presence of blood in stool does not necessarily mean you have colon cancer. There are more specific stool-based tests that can detect genetic material associated with colorectal cancer in stool as well. However, these stool-based tests should be followed up with colonoscopy and biopsy to confirm the diagnosis. Further, imaging studies like ultrasound scan (USS), computed tomography (CT) or magnetic resonance imaging (MRI) can be used to determine the spread of the disease.
Q. Who can diagnose it? A GP or a specialist?
A. A GP can detect blood in stool. But the proper diagnosis of colorectal cancer should be done by the specialist after the microscopic examination of a part of suspected cancerous growth.
Q. Does it have to be in a hospital setting?
A. Yes, colonoscopy examination and getting a sample of suspected cancerous growth should be done at a hospital with such a facility.
Q. Once diagnosed what is the procedure?
A. Once diagnosed the extent of the spread should be determined as the stage of cancer. It is usually done with imaging studies like ultrasound scan (USS), computed tomography (CT) or magnetic resonance imaging (MRI). After the stage of cancer is determined treatment is initiated accordingly.
Q. Treatment- what is the usual treatment of a patient confirmed with the disease?
A. Treatment entirely depends on the stage of cancer. If the cancer is in its early-stage colorectal cancer (i.e., tumor limited to the bowel or local lymph nodes, with no metastatic dissemination to distant organs) is surgical removal of the tumor and nearby lymph nodes.
The specific surgical procedure depends on the location of the tumour. Additionally, chemotherapy and radiotherapy can be given to destroy undetected cancer cells following the surgery.
In the advanced stage where the cancer has spread to distant organs chemotherapy and radiotherapy is given. In some cases, surgical removal of cancer can be done to relieve symptoms of intestinal obstruction and local compression from the tumor.
Q. What happens if a patient delays coming for screening for some reason?
A. If a patient comes for screening with a delay, the disease will be in the late stage. A late stage disease will be difficult to treat and the outcome will be poor and fatality will be more.
Q. Is colorectal cancer fatal?
A. It is not necessarily fatal but diagnosis at a late stage is associated with more fatalities.
Q. Are there different stages of the progress of this cancer?
A. Yes, in the early stage of cancer, it is limited to the colon and adjacent lymph nodes and in late-stage cancer is spread to distant organs like liver, lungs, bones, brain or spinal cord.
Q. What happens at the final stage?
A. In the late stages there can be symptoms of cancer mass itself and distant organ metastasis. With the growth of cancer mass, it can result in bowel obstruction. Sometimes it may compress on other organs like ureter and urethra causing urine obstructions. In spreading to distant organs like the liver it may result in liver dysfunction as well.
Q. What are the recent interventions that the NCCP has put into raising e awareness among the public?
A. Awareness campaigns on cancer risk factors are being conducted throughout the country and health promotion intervention to reduce behavioral risk factors is conducted. Initial discussions have started on starting screening for colorectal cancers.
Q. Since we are in a high-tech era how have we benefited from this new technology by way of early detection, treatment and most importantly prevention?
A. With the advancement of technology there are more sensitive tests for screening. Instead of stool for occult blood, newer tests are available to detect blood in stool. There are new tests available to detect cancer related DNA in stool as well. On the other hand, colonoscopy is supplemented with the ability to remove masses from the colon and get the accurate diagnosis quickly.
Q. What is the theme for this year’s awareness month?
A. The theme of this year’s colorectal cancer awareness month goes as “colorectal cancer: can be prevented.” It mainly focuses on strengthening screening for colorectal cancers.
Q. What are the main obstacles you face in it? Are myths about the disease one of them? If so, what are the most common in Sri Lanka?
A. No such myths on colorectal cancers are prevailing in the country. But the main obstacle is the lack of awareness on risk factors, the prevalence of risky behaviours (such as sedentary life, unhealthy diet, alcohol and smoking) are among main challenges. On the other hand, lack of screening services and awareness on screening is another obstacle in prevention of colorectal cancer burden in the country
Q. Are there circulars to the public in all three languages on do’s and don’t for preventing risks?
A. An awareness campaign on common risk factors for all non-communicable diseases have been implemented through the different agencies working on non-communicable diseases and health education and promotion like National Cancer Control Programme, Non-communicable disease unit and Health Promotion bureau.
Q. Gaps you see in the present health system that needs to be filled to ensure quality care for patients with colorectal cancer?
A. The main gaps are the lack of screening and diagnostic facilities and the unavailability of treatments at government health system
Q. How would you like to close them?
A. Continuous awareness programs are being conducted throughout the country. And discussions are going around whether to start or not the screening.
Q. Your message for all vulnerable persons out there on preventing Colorectal Cancer?
A. If you have a modifiable risk factor avoid that risk behaviour. If you or your relative have a history of colorectal cancer, screen yourself for colorectal cancer. Finally if you have any of symptoms mentioned above, quickly consult a qualified doctor for further evaluation
