Colorectal cancer is the fourth most common cancers among in the world along with male preponderance, so also the incidence is on the rise in India as well.
The colon or the large intestine is responsible for absorption of water making fluid stools into solids especially the left colon while the rectum is a continuation of sigmoid colon ending at the anus which acts as a reservoir for stool storage before they are expelled out from the anus.
Earlier, colorectal cancer was presumed to occur in individuals above 50 years of age. However, a rising trend is now being observed in individuals who are in the second and third decades of their life.
This is a cause for concern as these cancers are more aggressive, poorly differentiated and associated with worse outcomes. The common symptoms associated with colorectal cancer are anaemia of unexplained cause.
Usually in the right colon, mass lesion, progressive constipation, abdominal cramps, sense of bloating along with altered bowel habits.
In the left colon and sense of incomplete evacuation and bleeding in rectal cancer.
However, a fraction of patients may be asymptomatic or misdiagnosed as irritable bowel syndrome or haemorrhoids etc. It is therefore imperative to understand the seriousness of symptoms and perform faecal
Occult blood and invasive colonoscopy to rule out the presence of lurking cancer.
The cause for early onset of colorectal cancer remains unknown. Various hypotheses have been put forward from changes in the gut microflora (the good bacteria replaced by bad ones) due to improper diet, prolonged intestinal transit due to associated constipation / low residue diet thus
allowing more contact with carcinogens and increased consumptions of undressed red meats with high-fat content may be responsible for colorectal cancer.
Youngsters today tend to binge on junk foods especially Chinese food with Ajinomoto, a pre-carcinogen, also increased consumption of alcohol and tobacco along with diet low in fibre, fresh fruits and vegetables is a major contributing factor.
All these bring about alterations in the homeostasis (internal balance) of the body that increase the risk of cancer genesis either by suppressing p53 cancer suppressor gene or activation of cancer promoter genes.
It is postulated 90% increase in the rates of colorectal cancer may be observed in individuals between 20 and 34 years of age.
What is an important cause of concern is as these cancers are more aggressive and associated with poor outcomes their symptom are not to be ignored. Awareness is the only key for early diagnosis and prevention of colorectal cancer.
Ninety per cent of patients diagnosed at an early stage survive beyond 5 years, as opposed to 11% survival rate when diagnosed in advanced stages.
While not every case of blood in stools, changes in bowel patterns, bleeding from the rectum, abdominal cramping may signify colorectal cancer, it is important to seek professional advice in case the symptoms persist for over 2 weeks.
The cancer may have a hereditary component although most cases are sporadic (sudden, without any known cause).
Management of colorectal cancer requires a different approach with joint decision between a multidisciplinary team comprising of surgeons, medical oncologist, radiation oncologist along with genetic counsellors, fertility experts and psychological counsellor. This is the need of the hour in tackling this menace appropriately.
The author is a Thoracic Onco-Surgeon at Zen Multi- Specialty Hospital
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