Gastrointestinal cancer-8-Colon

GASTROINTESTINAL CANCER PART-8

Welcome to the eighth part of educational series on GastroIntestinal Cancers. We learned in previous parts that early diagnosis, complete staging, multidisciplinary evaluation, pre and post operative chemotherapy in operable patients, trained surgeon in high volume center, use of standard regimens is what can provide best possible results in stomach cancer.

Question: Now Dr. Chiragbhai, what about cancer of Colon, the next subsite?

Answer: Colon cancer is very common, especially in West. It is perhaps the most well studied GI cancer. It is a very important example of early diagnosis, importance of family history, multidisciplinary treatment, and keeping hope alive even in metastatic disease, role of gene test to decide specific therapy, and other aspects.

Que: This sounds interesting, especially about “hope” that you have mentioned. We will definitely come back to that. But what leads to colon cancer?

Ans: Colon cancer is strongly linked to family history, and lifestyle, among the known factors. Similar to breast and prostate cancer, it is much more common in West and seems related to so called western lifestyle. As we have seen in earlier discussions, we in India have adopted many of those lifestyle changes, and are therefore increasingly vulnerable to these cancers. Some possible aspects are low fiber and more fat in diet.

Family history is well studied for Western population and includes people with mildly increased risk where there is no definite syndrome but higher risk compared to average population (mostly people having only one relative with colon cancer, but no other risk factors) AND people with significantly high risk e.g. syndromes such as FAP or HNPCC. People with multiple relatives having cancer or a relative having cancer at age <50 should definitely undergo genetic counseling.

Que: What should one do for early diagnosis?

Ans: Screening recommendations for India are not possible, since we have less incidence compared to West but no studies from India addressing this issue. Therefore, at the present time, most people here follow western guidelines i.e. stool for occult blood once daily for 3 days, once every year after age of 50 OR colonoscopy once every 10 years.

Most importantly, we should remember to investigate iron deficiency anemia to find underlying cause, and thoroughly investigate any GI bleed (overt or occult) with tests including endoscopy. By following later two, we and others have made many early diagnoses.

Bright red bleeding per rectum should not be assigned to “piles bleeding” without a thorough evaluation. Such bleeding even if once, needs detailed evaluation, as a malignant tumor or polyp may not bleed repeatedly. Therefore, if bleeding has stopped spontaneously, it is not an indication to stop evaluation. But rather a warning sign from nature, that we need to follow to find out the real reason. Remember that for a chest pain, even when it has stopped after few seconds or minutes, we get complete evaluation. Not all of them are cardiac pains, same is true for GI bleeds.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496

Diplomate American Board of Oncology and Hematology. Ahmedabad. drchiragashah@gmail.com

Shyam Hem-Onc Clinic. 402 Galaxy, Near Nehrunagar Circle, Ahmedabad.