Colo-rectal cancer are cancers that involve the lowest part of the digestive system: the large intestine and the rectum. Colorectal cancer (CRC) is a common and lethal disease. It is sixth commonest cancer in India and its incidence is rising due to changes in dietary habits and lifestyle.

The most common symptoms of colon and rectal cancer include:

● Abdominal pain or distension

● Change in bowel habits (constipation or diarrhea)

● Blood in the bowel movements

● Feeling weak or tired

● Low iron level, commonly with anemia (iron deficiency anemia)

● Black or dark-colored stools.

Cancers growing within the large intestine and rectum can be seen during a colonoscopy, and a biopsy can be done, confirming the presence of a cancer.

Once a colorectal cancer is diagnosed, CT scan and PET CT are used for determining the extent and spread to other parts of body and assign the stage.

Earlier stages of disease (stages I through III) are generally treated with surgery, with or without chemotherapy.

During the surgery, the cancerous part of the colon and surrounding tissues and the lymph nodes are removed. Surgery can be performed by minimally invasive (laparoscopic) or by open methods.

The majority of rectal cancers are treated with a combination of surgery, radiotherapy and chemotherapy based on disease stage. However, for Stage I rectal cancers, surgery alone may cure the cancer. Sometimes anus is also removed along with the rectum depending on the location of tumor.

Stage IV cancer is called advanced colorectal cancer and is generally treated with chemotherapy with or without surgery. Newer targeted therapy is now available for treatment of advanced colon cancer in combination with chemotherapy.

Even after a colon cancer has been completely removed by surgery, cancer cells can still remain in the body, chemotherapy can eliminate these cancer cells and increase the chance of cure in stage III colon cancer and some stage II colon cancers.

After completing treatment, periodic follow up for a few years is required to monitor for signs of recurrence.

Inflammatory bowel disease, family history of colorectal disease and genetic syndromes of familial adenomatous polyposis and Lynch syndrome increases increase the risk of developing colorectal cancer.

Lack of regular physical activity, low fiber-high fat diet, overweight and obesity, alcohol consumption and smoking increase the risk of colorectal cancer. Avoiding these predisposing factors can prevent colorectal cancers.

with Dr. Arun Giri

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