Colorectal Cancer - In a Nutshell!

Colorectal cancer is otherwise known as cancer of the colon or the rectum. This can affect both men and women with age being a major risk factor. Majority of such cancers are seen to occur after age of 50 years.

1. Type: Colorectal cancers can present as one of the following types: 

   1. Adenocarcinomas are the most common type of colorectal cancers. These cancers begin in the cells making mucous and other fluids. Certain colorectal cancers begin as adenomatous polyps (adenomas) that turn cancerous over a period of time. This is precisely why the adenomas are regarded as pre-cancerous or pre-malignant.

   2. Gastrointestinal (GI) carcinoid tumors, GI stromal tumors, primary colorectal lymphoma, leiomyosarcoma, melanoma & squamous cell carcinoma are certain other colorectal cancers

      • Carcinoid tumors: start in specialized cells that produce hormones, in the intestine.

      • GI Stromal tumors: start in the interstitial cells of Cajal (ICC), in the wall of the colon.

      • Lymphomas: start typically in the lymph nodes but they may also start in colon or rectum.

      • Sarcomas: can start in the muscle and the connective tissue in the walls of the colon and rectum.

2. Gender: It affects both male and female populace.

3. Etiology: Mostly, the factors that are associated with increased risk of colorectal cancer include the following –

   1. Age exceeding 50 years.

   2. Racial & ethnic background such as African Americans, in the USA, are known to have the highest incidence of colorectal cancer, and mortality rates.

   3. Low fibre and high fat diet. Excessive consumption of red meat (e.g. goat meat, beef, pork, lamb, or liver), processed meats, butter, refined grains, sweets, sugary drinks etc all can increase the risk of colorectal cancer.

   4. Personal history of inflammatory bowel diseases (IBD) (e.g. ulcerative colitis), Crohn’s disease, adenomatous colorectal polyps, colorectal cancer etc all.

   5. Family history of colorectal cancer or adenomatous polyps etc all.

   6. Inherited syndromes such as familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC).

   7. Sedentary lifestyle/ associated Obesity.

   8. Type 2 diabetes.

   9. Tobacco and alcohol abuse.

4. Features or symptoms can vary from person to person depending on the size and location of the tumour. Following are the signs & symptoms mainly -

   1. Changes in bowel habits, diarrhea or constipation or an alternating diarrhea and constipation.

   2. Occult/ blood in the stool, and 

   3. Problems related to blood loss (e.g. anemia, weakness, fatigue, intolerance to exercise, shortness of breath, increased heart rate, chest pain etc all),

   4. Abdominal discomfort (frequent gas/ flatulence, bloating, fullness, cramps, and pain), vomiting etc.

   5. Unexplained weight loss,

   6. Pain with bowel movement,

   7. Feeling that bowel does not empty completely,

   8. Stools are narrower than usual.

5. Diagnosis: Following are the diagnostics employed. Abnormal blood test results may be indicative of malignancy, but a follow-up imaging/ biopsy is always the gold standard for accurate diagnosis.
   1. Blood: fecal occult blood test, Carcinoembryonic Antigen (CEA) assay values are raised, Hb/ RBC counts may be low.
   2. Imaging: Colonoscopy, Endorectal Scan/ CT Scan followed by Biopsy clinches the diagnosis and the nature of the disease.
   3. Apart from the above-mentioned barium enema X-Ray, USG, Chest X-ray, PET CT scan etc all help detect metastasis, if any. An increase in level of the serum tumor marker ‘CEA’ is indicative of metastatic spread/ proliferation that can be ascertained through a PET CT scan.
6. Treatment: Conventional treatment includes surgery, radiation and chemotherapy as contextually appropriate. Simultaneously, an adjunctive/ integrative naturopathic treatment with suitable complementary & alternative medicines (CAM)/ therapies too can help improve clinical outcomes and facilitate recovery as feasible contextually.

7. Prognosis: Preventive measures, earlier diagnosis and right early treatment is key for better prognosis and efficient/ effective therapeutic management. Usually, the chances of cure for an early stage cancer are more. Above-mentioned apart, recovery chances are influenced by the grade, stage of cancer, recurrence and the patient’s general health & vitality etc all too.

8. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an adherence to a Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising (for at least 30 minutes daily), de-stressing and relaxation is highly recommended for prevention or reducing the risks of colorectal cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. It is advisable to limit milk/ dairy, preferably of low fat content, to 1 to 2 servings max daily. Although alcohol is optional and is not for everyone, the consumption of the same, if any, has to be strictly in moderation, and is best avoided. Smoking is to be avoided as well. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly or are best avoided too. Apart from the generic preventive measures as mentioned above, certain pre-malignant conditions, of which adenomas are the most common, can be successfully treated with complementary and alternative medicines too.