Are you one of those who push away the plate of salad, or don’t care much for veggies? Well, here’s one another reason why you should have more of the high-fibre greens. According to cancer specialists in Delhi, colorectal cancer is now the fifth most common type of cancer in the country. This is significant news considering that in the past, it was hardly ever seen in India, unlike the West, where it has for long been the second most common type of cancer among both men and women.
A.K. Anand, senior consultant, radiation oncology, Rajiv Gandhi Cancer Institute, says Indians were thought to be less prone genetically to this type of cancer, but the increasing number of cases witnessed now suggests the heavy linkage between diet and lack of exercise, and colorectal cancer.
According to Deep Goel, consultant gastro intestinal (GI) and laproscopic surgery, Artemis Health Institute in Gurgaon, almost 400 such cases are treated every year in the National Capital Region alone. “Excessive smoking and drinking, eating fast food which has less fibre, and high consumption of red meat, are the main reasons behind this increase,” he says.
Says German doctor Hans Jochen Wilke, currently in India for conference on colorectal cancer, “Vegetarians are believed to have a kind of protection against this form of cancer.” Indeed, several studies have shown that increased intakes of fibre, starch and carotenoids tend to have a protective effect. On the other hand, red meat seems to have a harmful effect. Says Dr Goel: “In Jammu and Kashmir, where a large section of the population eats red meat this type of cancer is widespread.”
The colon, a 4ft-long organ extending from the end of the small bowel to the anus and the rectum, plays an important role in digesting and absorbing nutrients from food, and in concentrating fecal material by absorbing fluid. Dr Goel explains that most colorectal cancers arise from clusters of abnormal cells in the glands covering the inner wall of the colon.
Typically a disease of the elderly (only 5% cases include people younger than 40), an alarming trend is that “we are now beginning to see more and more young patients,” says Prof. Wilke. Usually, the symptoms start showing only when the tumour is fairly advanced. Change in bowel habits (either diarrhoea or constipation), abdominal pain, blood in the stool and decreased appetite are typical. However, routine screening is one way of ensuring early detection. Stool can be tested for occult blood—for accurate results, ideally, the test should be done after a person eats a high-fibre diet without red meat for three days. Doctors also advise a colonoscopy every year after the age of 50. For those with a genetic predisposition, tests should be done earlier.
Cancer of the colon, when diagnosed early and treated effectively, has a cure rate of nearly 70%. New targeted therapies and better surgical procedures have improved outcomes—and especially helped in post-operative rehabilitation.
Surgery first, followed by chemotherapy and radiation, is the most effective method of treating this cancer, according to Dr Anand. In India, several patients still go for chemotherapy and radiation first to shrink the tumour followed by surgery, although guidelines suggest the other way round gives better results. In addition, adding targeted therapies—such as Bevacizumab and Cetuximab to one of the chemotherapy regimens—can also help improve the results, especially where the cancer has spread to the liver.
Pointing to a recent study by Heidi Nelson, chief of colorectal surgery at Mayo Clinic, Minnesota, which says that laparoscopic surgery is far better than open surgery, Dr Goel says: “Though laparoscopic surgery is much safer and accurate as it can be effective for 10 years, 99% patients go for open surgery. This is because of lack of awareness.”
In the past, colorectal cancer left huge emotional disturbances in its wake as patients had to often deal with a colostomy (a permanent bag attached to the stomach to collect waste). But, with earlier detection and improved surgical procedures, especially laparoscopic techniques, the percentage of patients requiring permanent stoma (an opening to divert stool) has come down. Post-treatment rehabilitation is still a key issue in colorectal cancer, says Dr Anand—especially as patients are worried about issues such as sexual function and control over bowel functions. Of late, some support groups have emerged. (Chitra Narayanan)