March is colon cancer awareness month, and in the Philippines, much has to be done to educate and encourage Filipinos to know more about this deadly but preventable and curable disease. In the Philippine Cancer Facts and Estimates published by the Philippine Cancer Society in 2015, colon cancer was the third most common newly diagnosed cancer among Filipinos. This newly emerging trend has been attributed to the recent increase in Filipino affluence, increased consumption of processed food and the epidemic of obesity.
When found in the large intestine, a cancer is called colon cancer. Cancers of the colon most commonly begin as polyps, which are cellular new growths in the inner surface of the colon. Most polyps are slow-growing and benign, but some may change into cancer over several years. The slow growth of these pre-cancerous polyps explain why there is paucity of symptoms related to colon cancer. When patients do develop symptoms, it would usually mean that the cancer has grown to such an extent to cause symptoms. Symptoms may vary depending on the location of the cancer in the colon. Patients may experience changes in bowel habit like alternating constipation and diarrhea, narrowing of the stools, sensation of always wanting to defecate and passing out bloody stools. Non-specific symptoms such as abdominal pain, weakness, fatigue, pallor and unintentional weight loss may also be reported.
Several modifiable and non-modifiable risk factors have been associated with the development of colon cancer. Non-modifiable risk factors cannot be changed but can be used to predict the risk of colon cancer. These are, old age, prior history of colon cancer, having an inflammatory bowel disease, family history of colon cancer or adenomatous polyps, race and ethnicity, and having inherited syndromes with polyps in the colon. Modifiable risk factors are lifestyle-related and can be changed willingly. These include obesity, physical inactivity, smoking, heavy alcohol intake and diet rich in processed meats. Hence it is important to reiterate that balanced nutrition, cessation of smoking and alcohol intake, exercise and weight loss are important means to decrease the risk for colon cancer.
When detected early, colon cancer is curable and has good outcomes. Screening techniques that detect polyps through visualization such as colonoscopy and sigmoidoscopy, offer the benefit of polyp removal even before they become cancer. These tests, when timely employed may prevent colon cancer. Most guidelines recommend screening colonoscopy every 10 years among patients who are 50 years old and above. Other non-invasive options are available but are less specific.
The management of colon cancer involves a multidisciplinary team of specialists that include gastroenterologists, surgeons, medical, radiation and surgical oncologists. Treatment is tailored depending on the health of the patient and stage of the cancer. In general, when colon cancer is detected early, it is curable by surgery alone. As such, the importance of screening even on asymptomatic patients cannot be overly emphasized, as early detection dramatically affects treatment options and prognosis.