By Dr. Eduardo G. Gonzales
It pained me a lot when I read that travel blogger and former Pinoy Big Brother housemate Wil Dasovich has been diagnosed with stage 3 cancer of the colon. Not that I am a big fan of his as I have yet to watch an episode of Pinoy Big Brother or any of Wil’s vlogs, but rather because I find it unfair that a guy who is so young (26 years old) and at the prime of his life as Wil has to suffer through chemotherapy, radiotherapy, and surgery for a malignancy that primarily affects older people—more than 90 percent of colon or colorectal cancers occur in people who are 50 years old or older. What’s more, it doesn’t look like he has any of the other risks factors for the disease.
Fortunately for Wil, however, cancer of the colon is now a highly curable disease, especially if diagnosed in its early stages. When localized to the bowel (stage 1), the five-year survival rate with treatment is about 92 percent. Unfortunately, relatively few colorectal cancers are found at this early stage. But even in advance colon cancer (stage IV), patients’ five-year survival rate is still 11 percent.
Why colon cancer is often diagnosed late?
The reason colon cancer is often diagnosed when already at an advanced stage, as in Wil’s case, is that the disease is usually asymptomatic in its early stages. Worse, when symptoms occur, they are often nonspecific.
Fresh (red) or digested (black) blood in the stool is one of the most common signs of colorectal cancer, but it is usually not an early but a late sign. Also, it is a nonspecific sign, less than 10 percent of people with blood in the stool have cancer, most have a benign condition like hemorrhoids, anal fissures or tears, or infections of the colon.
The other late-appearing and nonspecific signs and symptoms of colorectal cancer include weight loss, fatigue, weakness, shortness of breath, abdominal pain and cramps, bloating, and change in bowel habits such as narrow stools, diarrhea, or constipation.
What causes cancer of the colon?
We do not know for sure what causes colorectal cancer, but we know that one’s chances of getting the disease increases as one gets older. Also associated with increased risk for this malignancy are a family or personal history of colorectal cancer and polyps, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, and genetic syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer.
Some lifestyle factors such as a low-fiber and high-fat diet, a sedentary routine, heavy alcohol drinking, obesity, and smoking likewise increases one’s odds for this malignancy.
Hence, a diet that is high in fiber and low in fat, exercise, maintenance of a desirable body weight, nonsmoking, and abstaining from alcohol could reduce one’s risk, albeit minimally, for colon cancer.
Screening tests are the most powerful weapons against colon cancer
Screening tests that can reduce one’s risk of dying from colon cancer to practically zero are now available. They are currently routinely recommended only for people above 50 years old, although people at higher risk, such as those with a strong family history of colorectal cancer, might benefit from starting screening at a younger age. Public awareness about these tests is likewise still very low that is why only a handful of Filipinos who should get tested get the tests.
These screening tests are designed to detect polyps and early cancers. Finding and removing polyps, which are benign growths, are the most effective way of preventing colorectal cancer because virtually all colorectal cancers develop from polyps.
Who should get screened and what type of screening test is best?
The US Preventive Services Task Force (USPSTF) recommends that people who are 50 to 75 years old should undergo any one, just one, of the following screening procedures: 1) flexible sigmoidoscopy every five years; 2) colonoscopy every 10 years; 3) double-contrast barium enema every five years; 4) CT colonography (virtual colonoscopy) every five years.
The USPSTF also considers several other methods to be acceptable screening tests for colorectal cancer, including high-sensitivity fecal occult blood tests (FOBT), and stool DNA test (FTI-DNA).
To find out which method is best for you, consult and discuss the matter with your doctor who should preferably be a gastroenterologist.
Incidentally, after age 75, the decision to screen is based on the patient’s life expectancy, health status, co-morbid conditions, and prior screening results. Routine screening of people aged 86 years or older is not recommended.
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