Beating Colorectal Cancer

BEATING COLORECTAL CANCER
By Dr. Jun R. Ruiz

March is Colorectal Cancer Awareness Month. This is an important campaign as colorectal cancer (CRC) is the fourth most common cancer among Filipinos. Breast, lung, and liver cancers are more prevalent in the Philippines.

The Colorectal Clinic and the Cancer Center at The Medical City aim to be at the forefront when Filipinos beat CRC. This cancer is preventable, treatable, and beatable. CRC screening can save lives, but not that many people are being screened. 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 take around 10 years for some polyps to develop into cancer. Not all polyps progress to cancer. The removal of these polyps reduces the risk of developing cancer.

These polyps and occasionally early cancer do not cause complaints, like rectal bleeding, constipation, and abdominal pain that are experienced by patients in later stages of cancer.

RISK FACTORS FOR COLORECTAL CANCER
The common individual-specific factors that increase risk for cancer in the colon and rectum are:
1. Age greater than 50;
2. Personal history of colorectal cancer or advanced polyps; and
3. Family history of cancer in the colon and rectum

Those who are more than 50 years of age is the most common risk factor for this cancer, as there is a 90% of this cancer occurring after the age of 50. A family history of a first-degree relative with CRC is increased two to three-fold.

There are also lifestyle habits that can be modified that could contribute to the formation of this cancer:
1. Cigarette smoking
2. Alcohol consumption
3. Obesity
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, regular exercise, and eating the right food can lower your risk for cancer in the colon and rectum.

BE SCREENED

In almost all 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 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 low potential to cause complications.

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.

As a gastroenterologist who advocates CRC screening, I recommend a screening colonoscopy in persons between 50 to 75 years of age who are healthy and in whom the complications are low. If the patient does not want to start with a colonoscopy, I suggest starting with FIT. After a discussion with his physician, the patient can choose his preferred screening test.

By undergoing either method of CRC screening, we would be able to beat colorectal cancer.

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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 is the Head of the Colorectal Cancer Screening Task Force of The Medical City.

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.

For inquiry, please contact the Colorectal Clinic and the Cancer Center of The Medical City, tel. number # (632) 988-1000 local 7789, 6214.