The growing incidence of Colorectal Cancer (CC) worldwide has raised concerns among Cancer specialists. Sri Lanka is no exception. According to the latest data from the Sri Lanka National Cancer Control Programme, the incidence of colorectal cancer in Sri Lanka is significant, with a considerable number of cases reported each year and is reportedly the third most common cancer among both men and women in Sri Lanka,
The good news is that if colorectal cancer is detected early, it can often be cured. The key to successful treatment of colorectal cancer is early detection, as it is more easily treated and cured in its early stages.. Unfortunately, despite available resources many people still do not seek treatment early for various reasons compounded by myths and wrong beliefs about this particular cancer. Hence delay in seeking such help is one of the biggest challenges the NCCP faces in its program to reduce and prevent CC among all Lankans exposed to the risks of developing Colorectal Cancer.
The Sunday Observer spoke to Dr. Thusitha Kahaduwa of the Cancer Prevention and Early Detection unit of the NCCP to get more insights into this common and largely preventable disease and how it develops and impacts on our health, and most importantly how it can be prevented with early treatment.
Excerpts
 Dr. Thusitha Kahaduwa |
Q. Colorectal cancer (CC) has been recently cited as one of the most common cancers in both sexes. Yet many persons with CC are still very ignorant about basic facts concerning CC. So, tell us what exactly is Colorectal Cancer?
A. The Colon is commonly called the large intestine, which is the end piece of the human alimentary canal which connects to the rectum and exits through the anus. Cancers occurring in this segment are collectively called “colorectal cancer”. These are abnormal immortal cell growths occurring from various tissue types forming the alimentary canal.
Q. Could you mention some of the most common types of these cancers you find 1) globally and 2) in Sri Lanka, for the benefit of our readers ?
Carcinoid tumors – These develop in the cells that form the lining of the gastrointestinal tract. The tumors are relatively slow-growing. A patient can develop several of these at once. The most common type is adenocarcinoma, which forms in the mucus-secreting glands and accounts for the majority of all colon cancer diagnoses (90-95 percent).
Stromal tumors – these develop in the cells forming the autonomic nervous system and serve as “pacemakers” for the muscles in the intestine. However, these tumors, which are often referred to as GISTs, are not always cancerous; many are benign (noncancerous) and incapable of spreading.
Primary colorectal lymphomas – These develop in the lymphocytes, or immune system cells. Lymphomas of the colon are relatively rare and account for only a small fraction of all colon cancers.
Squamous cell carcinomas – These develop in the blood vessels or smooth muscle cells of the colon. There are several different carcinoma subtypes, including leiomyosarcomas and angiosarcomas. These cancers are among the least frequently diagnosed of all colon cancers.
Q. According to the latest data you have, what is the prevailing incidence of CC in Sri Lanka?
A. In 2020, 1676 females and 1620 males were diagnosed with CC.
Q. Is there an increase in the number of diagnosed new cases in the recent past?
A. Yes. The trend of CC incidence in Sri Lanka is increasing.
Q. What are the risk factors for developing CC?
A. There are multiple factors which increase the risk of CC. Some of them are;
A chronic inflammatory disease of the colon called Ulcerative colitis and Crohn’s disease
Familial or multiple polyposis syndrome: a disease occurring in some families causing multiple polyps of the colon which have a high probability to become a cancer.
Low fibre diet, causing digestion to be slowed and transit time through the bowel to be increased.
Patients having a history of colon or rectal cancer.
Patient having a history of colon or rectal polyps.
Family history of colorectal cancer or female genital cancer.
Lifestyle factors,
Lack of regular physical activity A diet low in fruit and vegetables.
A low-fibre and high-fat diet, or a diet high in processed meats.
Overweight and obesity.
Alcohol consumption.
Tobacco use.
Q. Is there a link between CC and environmental pollution from vehicular fumes and chemicals from factories?
A. No connection has so far been established
Q. What part of the body does CC usually start?
A. Any cell type in the colon or rectum
Q. How fast does it take for colorectal cancer to spread? Does this depend on the type of cancer and how far it has spread?
A. The spread and the severity of colorectal cancer mainly depend on the type of cancer. There are some cancers that are very slow to spread in nature.
Q. At what age is CC most common
A. More common over 50y age group
Q. Can children get CC? Or only adults?
A. Children also can get colorectal cancer although it is very rare (0.3 to 2 cases per million). It is usually associated with inherited genetic disorders.
Q. What are the early symptoms of CC?
A. change in bowel habits.
Blood in or on your stool (bowel movement).
Diarrhea, constipation, or feeling that the bowel does not empty all the way.
Abdominal pain, aches, or cramps that don’t go away.
Weight loss and you don’t know why.
Q. If detected early can you cure TC?
A. Yes, if colorectal cancer is detected early, it can often be cured. The key to successful treatment of colorectal cancer is early detection, as the cancer is more easily treated and cured in its early stages.
Q. What are these stages? How are they classified?
A. There are several types of classifications. But usual practice is to classify the cancer into 5 stages ranging from 0 to 4. Stage 0 includes early cancer and stage 4 includes late-stage cancers.
Q. What is the 5-year survival rate?
A. For localised cancer, which has not spread outside the origin it is over 90 percent.
Q. How do you treat -CC?
A. The treatment relies on several factors such as the type of colorectal cancer, stage at diagnosis, existing health conditions of the patient and the available facilities. However, the treatment may include surgery, chemotherapy and radiotherapy.
Q. Usually how long does it take for a healthy person without pre-existing diseases to recover?
A. It depends on many factors. Such time duration cannot be defined.
Q. Sri Lanka is still in the midst of Covid-19 pandemic and emerging new respiratory diseases as well. How vulnerable are persons with CC to these diseases?
A. In general cancer patients are susceptible to acquire communicable diseases due to their poor immunity and nutritional status. Therefore, they should take extra precautions.
Q. If a patient recovers from Colorectal Cancer does that mean she/he has recovered completely or is simply in remission like some other cancers?
A. That again depends on the type and the stage of the CC. There is always a chance of recurrence, . So proper follow up, is very important.
Q. When a patient reaches late stages how do you treat him/her?
A. Treatment modalities will be the same. But their prognosis can be poor because they have complicated cancer with distant metastasis.
Q. Some countries have introduced screening for colorectal cancer at national level. Does Sri Lanka have such a program?
A. At the moment, there is no national level population-based screening programme for colorectal cancer.
Q. What has the National Cancer Prevention Programme in recent years done to minimise the incidence and create more awareness of colorectal cancer?
A. The National Cancer Control Programme (NCCP) has developed a National Guideline on Early Detection of Common Cancers, which includes CC as well. Currently, the NCCP is also in the process of providing required training for the primary health care staff. Furthermore, as a routine, the NCCP conducts activities to raise public awareness about colorectal cancer. In addition, the NCCP is also currently working with experts to develop an Atlas on Human Carcinogens relevant to Sri Lanka which will provide guidelines on how to identify and take precautions against confirmed carcinogens.
Q. What has the NCCP done by way of raising more awareness among the public?
A. The Cancer Prevention and Early Detection Unit has been conducting many public awareness programs on cancer in general including colorectal cancer.
Q. Once a patient is discharged from a hospital after treatment for CC, are there any follow up programmes in state hospitals?
A. Yes. Follow up is an important component of the treatment. They are usually advised to undergo yearly colonoscopy checkups and other relevant investigations.
Q. Are these follow up and monitoring facilities available in hospitals across the country -Regional Provincial and District wise?
A. Yes. Now cancer treatment facilities have expanded up to district level. Main hospitals of every district have a cancer treatment unit with relevant consultants. However, certain specific treatment options may be limited to the main centres such as Apeksha Hospital Maharagama, Karapitiya and Kandy. But routine follow up can be done at district level.
Q. As we are now in a hi-tech age, are there any new advances in detecting and treating colorectal cancer early to ensure quicker recovery?
A. Yes, the diagnostic facilities are advancing daily. Currently, hospitals in the Government sector are equipped with required facilities to diagnose colorectal cancer accurately. The endoscopy facilities are widely available in the hospitals.
Q. What do you consider as gaps in delivering quality care for patients with colorectal cancer?
A. Expansion of the colonoscopy facilities to all base hospitals and uplifting the surgical care facilities.
Q. How would you like to see them filled?
A. Increasing the endoscopy facilities includes a significant capital investment of the instruments and infrastructure as well as developing the skilled human resource. Multiple stakeholders should work in unison with the Ministry of Health to make this a reality.
Q. Do you have a message for our readers on how they could minimise risks of exposure to CC risks?
A. Symptoms for CC are common and do not necessarily indicate cancer. Hence, if you have any suspicious symptoms mentioned earlier do not hesitate to get them checked out and tested., in one of our hospitals. Remember that early detection will always lead to a better prognosis. Definitive treatment options are available in the Government hospitals to cure most colorectal cancers. Hence, please do not follow unknown or unconfirmed treatment options which will lead to losing your money and life ultimately.