Rectal bleeding? Dark stools? Get yourself examined without delay | Sunday Observer
Colorectal cancer ranks 3rd in terms of incidence (new cases) and 2nd in terms of mortality globally

Rectal bleeding? Dark stools? Get yourself examined without delay

5 April, 2020

Last month was Colorectal Cancer awareness month. According to cancer specialists this is a largely preventable cancer and could be cured effectively with early treatment.

In this interview with the Sunday Observer, Consultant Community Physician, National Cancer Control Programme ( NCCP), Ministry of Health, Dr Nayana De Alwis explains why a whole month was dedicated by the UN for raising awareness on this subject, how patients can detect suspicious signs, the importance of early treatment and interventions by the NCCP.


Q: What is colorectal cancer?

A: Colorectal cancer is a cancer that starts in the colon (large bowel) or rectum (lowest part of the bowel). As colon and rectal cancers have many features in common they are grouped together as colorectal cancer. It is a malignant tumour that starts in the inner wall of the large intestine or rectum. In some instances, there are polyps persisting for long periods of time before it transforms into a cancer.

Q: Why dedicate an entire month for this particular cancer?

A: Because globally colorectal cancer ranks third in terms of incidence (new cases) and second in terms of mortality (deaths due to colorectal cancer).

Q: What triggers it?

A: Any cancer begins when healthy cells in the body develop changes (mutations) in their DNA. DNA in the cell contains a set of instructions which tell a cell what to do. Healthy cells grow and replace older cells in an orderly way, when the body needs them. When there are mutated genes within the cells this orderly pattern goes awry and cells divide continuously when new cells are not needed. These unnecessary cells accumulate and produce a tumour. With time these cancer cells grow into and destroy normal tissues nearby and cancerous cells can travel to other parts of the body to form deposits there (metastasis).

These mutations can be due to inherited or acquired reasons. Inherited mutations mean these mutations run through the family, therefore they are at a higher risk of developing colorectal cancer during their lifetime. However, this is a very small proportion compared to the large majority of patients who develop colorectal cancers due to acquired mutations. There is no definite single cause for the occurrence of acquired mutations but there are some proven risk factors which may increase the risk of mutation by acting alone or in combination.

Q: Risk factors?

A: Depending on the site and the type of cancer, risk factors are different for one cancer to another. But having a risk factor, or even many risk factors, does not mean you will get the disease, while some people who get the disease may not have any known risk factors.

Q: Those most vulnerable?

A: 1) Elders. While colorectal cancer can occur at any age, majority of the patients are older than 50 years. 2) Some chronic bowel diseases – Chronic inflammatory diseases of the colon such as ulcerative colitis and Crohn’s disease. 3) Low fibre and high fat diet – colorectal cancers may be associated with diets low in fibre and high in fat and calories. 4. Diet high in red meat and processed meat. 4). Lack of physical exercise – people with a more sedentary lifestyle may have increased risk of developing colorectal cancer compared to people who are engaged in regular physical exercise.

Q: Diabetes and obesity – is there a link?

A: People with diabetes have an increased risk of developing colorectal cancer. So does consumption of alcohol and smoking

Q: Is there a gender difference?

A: According to Sri Lankan data there is no significant gender difference in the incidence of colorectal cancer. For both males and females age standardized incidence rate of colorectal cancer is 6.9 per 100,000 population. There were a slightly higher number of female patients compared to male patients, as the former is slightly higher compared to the latter in the country. Many patients with colorectal cancers are either middle aged or older aged men or women. However, colorectal cancers run in families with genetically mutated genes inherited from parents. People with genetically mutated genes can develop colorectal cancer at a younger age.

Q: Early signs and symptoms?

A: Colorectal cancer at a very early stage may not have any signs or symptoms. Following are the common signs and symptoms once the cancer has grown to some extent.

• Changes in bowel movements – lasting more than two weeks such as diarrhoea, constipation, infrequent bowel movements.

• Pencil like stools – thin stools could be an indication that a tumour may be blocking bowel movements.

• Feeling of incomplete bowel emptying even after the bowel movement.

• Rectal bleeding – Bleeding from the rectum or blood in the stools.

• Dark coloured stools due to the presence of blood in the stools

• Abdominal pain, discomfort, having cramps or stomach pain can be a symptom

• Weakness /fatigue

• Unexplained weight loss

• Iron deficiency anaemia

Q: Compared to other cancers what is the survival rate?

A. Survival rate is very high when detected at the early stages and makes effective treatment easy. Early detection is the key.

Q. Diet -what role does a healthy diet play in preventing or minimizing risks?

A. Consuming a variety of fruits, vegetables and whole grains, as these contain vitamins, minerals, fibre and antioxidants that play a significant role in cancer prevention. Limit the consumption of red meats and avoid processed meat.

Q: Treatment?

A. Treatment depends on several factors including size, location and stage of the cancer. Age of the patient and patient’s other chronic illnesses also need to be considered when deciding treatment options. Surgery is the most common primary treatment modality but the treating consultant may decide the treatment which may include surgery, chemotherapy, radiotherapy separately or in combination depending on the above-mentioned factors.

Q: Where can such treatment be obtained?

A. If colorectal cancer is diagnosed at early stages and surgery is the main primary treatment option, facilities are available in all government hospitals which are Base hospitals and above where Consultant surgeons,/ Consultant onco surgeons,/ Gastrointestinal surgeons are available.

Patients with extensive disease and patients who have undergone surgery can be further treated at cancer treatment centres. There are nine main cancer treatment centres in the country one per province and another 15 district level hospitals where consultant oncologists are available to treat cancer patients.

Q: As the focal point of awareness raising and dissemination of information, what has the National Cancer Control Program done in recent years to educate the public not only of colorectal cancer but cancers in general?

A: The National Cancer Control Program is the national focal point in the Ministry of Health on prevention and control of cancers in the country. There are seven strategic directions on which the N C C P functions in regard to cancer control and prevention. They are:

• Ensuring primary prevention of cancers by addressing risk factors and determinants

• Advocating early detection of cancers

• Ensuring sustained and equitable access to diagnosis and treatment facilities for cancers

• Ensuring rehabilitation, survivorship and palliative care facilities

• Strengthening cancer information system and surveillance (cancer registry)

• Capacity building of all relevant health staff

• Promoting research on cancer and utilization of its findings

The NCCP coordinates with all cancer treatment centres, national level institutions of the Ministry of Health, Non-Communicable disease unit, Environment and Occupational Health unit and provincial health ministries to implement cancer control and prevention activities at national, regional and divisional levels.

To build the capacity of district level health officers and divisional level health officers including Medical Officers of Health training programs are conducted to disseminate information to the public. Awareness activities are carried out by the Medical Officers of Health and their staff during their routine day to day activities (clinics) and as special programs throughout the country. Necessary guidance, directions and the IEC (Information, Education and Communication) materials are developed and distributed by the National cancer Control Program, at national level including media programs.

Q: Your message to the public

A: Early detection is the key to better treatment outcomes and survival rates. Maintain healthy lifestyle habits e.g. stop smoking and alcohol consumption. Exercising 30 minutes a day for 5 days per week keeps you healthy not only from cancer but from other non-communicable diseases as well. Maintain a healthy weight – Obesity is one of the identified risk factors for certain cancers including colorectal cancers.