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COLORECTAL CANCER (Part III)

By Indran B. Indrakrishnan, M.D. Email By Indran B. Indrakrishnan, M.D.
February 2005
COLORECTAL CANCER (Part III)

There are many diagnostic tests available to detect colorectal cancer and your physician will determine the most suitable investigation based on your symptoms, risks and health.

� Colonoscopy

Colonoscopy is a direct visual examination of the colon and rectum using a lighted flexible video endoscope. This outpatient procedure is done under sedation by a specialist and usually takes 15 minutes to complete it. Colonoscopy remains the gold standard for early detection of colon cancer and polyps and it is the only test that allows the specialist to directly visualize the colon, obtain biopsies and remove polyps at the same time. The complications ? very rare compared to the benefits ? include tearing of the colon, bleeding and side effects related to sedative medications.

� CT Colography

This is also known as virtual colonoscopy and was recently introduced as a relatively non- invasive test to detect colon cancer and polyps. As this does not involve sedation, patients may experience stomach discomfort and if polyps are found a subsequent real colonoscopy could be necessary to remove the same. Recent clinical studies have shown that this test may miss polyps and occasionally small cancers. This test is not approved by most of the insurance companies and has not yet been recognized as a standard colon cancer screening test by American Cancer Society and other national organizations.

� Double Contrast Barium Enema

This is an X-Ray of the colon and the rectum using a dye and is relatively inexpensive, but has limitations. Its sensitivity is low in detecting polyps and cancers. In addition, if they are detected, a follow-up colonoscopy will be necessary to remove the polyp or biopsy the cancer.

� Flexible Sigmoidoscopy

This is similar to colonoscopy, but examines only lower 1/3rd of the colon. As such, this is not a complete investigation and is currently not perceived as a good test by physicians.

� Fecal Occult Blood Test

This is the most simple and inexpensive test, where a small sample of stool is examined for hidden blood. Cancers and polyps bleed intermittently in very small amounts, which may not be recognized by people with their naked eye. This test, however, can give both false positive and false negative results based on the diet, location of cancer and other concurrent diseases in the colon.

Who should be tested?

1. All individuals above 50 years of age.

2. People who show the risk factors discussed in the previous issue.

It is a gross misconception that colon cancer is a disease of the western world and that people of Indian origin do not get this deadly cancer. Vegetarianism certainly gives some protection against colon cancer, but the incidence is alarmingly high among Asians, particularly those who migrated to the West.

Treatment options for colon cancer

The treatment will depend on the stages of the colon cancer. Early stages of cancer can be managed by minimal invasive surgery.

1. The simplest way is to remove the cancerous polyps by colonoscopy without undergoing open stomach surgery.

2. Surgical removal of colon cancer.

3. Chemotherapy by giving anti-cancer drugs to kill the cancer cells that have spread beyond the original site of the tumor.

4. Radiation therapy. This destroys the cancer in specific areas of the body.

5. Combination of surgery, chemotherapy and /or radiation therapy.

6. New experimental therapies for clinical trials.

Follow-up care after treatment for patients with colon polyps or cancer is important to insure that no new polyps develop or cancer returns in the colon. The check-up includes a physical examination, colonoscopy, x-rays and lab tests. The patient should report any changes in health to the physician as soon as they appear.

Prevention

Diet

Eat a diet rich in fiber, vegetables and fruits, but low in meats and fats. Antioxidants in vegetables and fruits can neutralize the free radicals that are thought to be promoters of cancer.

Folic Acid

At least 400mg of supplement a day appears to have a protective effect on colon cancer/ polyps.

Calcium

1-1.5g per day of calcium supplement may prevent colon polyps and cancer development.

Aspirin

A chemical known as prostaglandin may promote abnormal cell line growth in the colon. Aspirin blocks the prostaglandins and this may account for the beneficial effect on colon polyps/ cancer.

Regular Exercise

Stop smoking

Nicotine is associated with high incidence of colon cancer.

The above healthy lifestyle changes along with screening colonoscopy and removal of colon polyps at the appropriate time determined by your physician can certainly reduce the incidence of colon cancer.

- Indran B. Indrakrishnan, M.D.


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