Heart to Heart Talk
Colonoscopy
By Dr. Philip S. Chua
Cebu Daily News
First Posted 15:39:00 04/21/2008
The recent news about the discovery of colon cancer in former President Cory Aquino has put the spotlight on a dreaded disease which, today, could be detected early with a relatively simple diagnostic regimen, which includes colonoscopy.
What is colonoscopy?
Colonoscopy is a procedure where a flexible endoscope (malleable tube like a telescope), equipped with fiberoptic lighting and (video CCD) camera, is passed through the anus, to view and examine the inner walls of the colon (large bowels) and distal part of the small bowels for any abnormality, like bleeding, ulcers, or the presence of benign poly(s), or cancer. Through the colonoscope, excision of polyps, or biopsies may also be performed for a definitive microscopic tissue diagnosis. A sigmoidoscope is another scope that examines the final two feet of the colon, while the colonoscope examines the rest of the entire colon which is about four to five feet long. Many times it is done in conjunction with colonoscopy.
How common is cancer of the colon and rectum?
Colorectal cancer is the third-most common cancer in humans, topped only by cancer of the lungs and female breasts. More than 150,000 people in the United States each year discover they have cancer of the colon or rectum, and approximately 46,000 will die from it this year alone. The incidence starts to rise at the age 40 and the peak is between ages 60 to 75. Colon cancer is more common among women and cancer of the rectum among men. About 5 percent of the patients have both (synchronous cancer).
Are meat-eaters more prone to colorectal cancer?
It appears to be so, because colorectal cancer is found more prevalent in populations whose diet is low in fiber and high in animal proteins, fats, and refined carbohydrates. The incidence of colorectal cancer is indeed high among those who eat red meat (pork, beef, etc) compared to those who eat high fiber diets (vegetables, fruits, wheat, bran, etc) and fish. The other predisposing factors include chronic ulcerative colitis, ganulomatous colitis, and familial polyposis. The older the person is, the higher the risk. Smoking, in general, severely increases the risk for cancer formation of the lungs and various organs in the body, not to mention pulmonary diseases, heart attack and stroke.
What are the signs and symptoms of colorectal cancer?
The person may not have symptoms at all. It could be so subtle, like fatigue and anemia. Blood in the stool (black or bloody red stools) is one common sign. The others include change in the bowel habits, diarrhea or constipation, stools more slender or flatter than usual, stomach discomfort, bloating, fullness, abdominal cramps, frequent gas pains, unexplained weight loss, a sensation that the rectum does not empty completely. Not all these symptoms and signs need to be present, or necessary, to suspect possible presence colorectal cancer. Any one of these, if persistent, should alert one to seek medical help.
When should colonoscopy be done?
Everyone 50 years old and older should have an annual fecal occult blood test (FOBT), a rectal digital exam, and a prophylactic colonoscopy every 3 to 5 years. Since blood in the feces is one of the earliest signs of colorectal cancer, testing for blood in the stools yearly among those 50 and older is essential, and could be lifesaving. And so with prophylactic rectal digital examination and colonoscopy.
How do we prevent colorectal cancer?
As alluded to above, a high-fiber (fruits and vegetables, bran, oat, wheat) and fish diet will tremendously reduce the risk of colorectal cancer. Therefore, staying away from animal protein, like red meat (pork, beef and anything made of these) is a big factor in preventing the development of colorectal cancer, besides heart attack and stroke. Daily exercises make our body healthier and more resistant to illnesses. Abstinence from tobacco is a must. Checking your stools for blood every time you defecate and reporting any warning signs listed above to your physician will help. Recta Exam and colonoscopy are strongly recommended as stipulated above.
What is the treatment for colorectal cancer?
Depending on the stage and location of the colorectal cancer, the primary strategy is wide surgical resection of the cancer and regional lymphatic drainage. Cure is possible in 75 percent of surgical patients. For cancer limited to the mucosa (surface lining of the wall of the colon), 5-year survival is about 90 percent; those cancer going deeper into the mucularis propia (muscle-layer of colon), 80 percent; those with positive lymph nodes, meaning cancer already spreading to the lymph nodes, 30 percent. Other modalities of treatment include pre-operative radiotherapy, adjuvant radiotherapy, chemotherapy. When surgery and/or any of these other modalities are indicated will depend on the location, extent and stage of the colorectal cancer.
What is the outlook for colorectal cancer patients?
There is no question that the outlook for colorectal cancer, and most other cancers in general, is much better today, depending on their stages when first diagnosed. This is why we cannot overemphasize the common-sense wisdom that prevention is the best “treatment,” especially when dealing with any potentially deadly disease like cancer, heart attack, stroke, AIDS, etc. New hopes for cancer victims are in the pipeline of dozens of research/clinical laboratories in the United States and other countries around the world. Before the advent of the oral medications for pulmonary tuberculosis, this disease acted like cancer, spreading from the lungs to the brain, bones, liver, kidneys, spleen, lymph nodes, etc. We predict that someday, hopefully in the not too distant future, many forms of cancers, if not all, will be cured by simply taking anti-cancer pills. In the meantime, it behooves each one of us to play an active role in protecting ourselves from becoming cancer victims by living a healthy lifestyle and by being ever-vigilant about our health and that of our loved ones.
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