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Colorectal cancer, one of the most common cancers in the world, develops slowly and is therefore easy to remove and cure effectively for a long time. The first symptoms appear late, so the only chance to detect them is prophylaxis. Anyone aged 50 or over should perform colonoscopy. However, Poles still have not overcome the fear of this study, and neglect of prophylaxis means that colon cancer is one of the top three most dangerous killers in our country – next to breast cancer and lung cancer.
- Colorectal cancer may be asymptomatic for years. Most patients present when it is advanced and the chances of recovery are drastically reduced
- Doctors argue that in the case of this cancer, prevention is key. Unfortunately, Poles are reluctant to use colonoscopy
- Shame and fear – this is what doctors say discourages you from getting tested. «Going to a proctologist is a terrible stress for a patient, he can prepare himself for a visit for months. He comes up with various scenarios and often gives up at the last minute »- says Dr. Tchórzewski
- Colorectal cancer is the second most common cancer in Poland. It also ranks second in terms of mortality
- More information can be found on the TvoiLokony home page
Colon cancer. We don’t test ourselves out of fear and shame
To the proctologist, Dr. Marcin Tchórzewski, many patients with rectal cancer come too late. Cancer is often so advanced that there is not much that can be done.
It is puzzling, but Poles are not convinced of the prevention of colorectal cancer. The reason may be a cultural or a social factor. Anyway profound embarrassment related to the intimate areas, especially the large intestine and rectum, is, according to specialists, the main cause of the fatal cancer detection. We do not test ourselves out of reluctance, fear and shame. That is why the survival statistics for people with this cancer place us in the tail of Europe. It is worse only in Bulgaria and Latvia.
– It would seem that we are a reasonable civilized society, that we are aware of the risk associated with cancer – says Marcin Tchórzewski, MD, PhD, head of the General Surgery Department with the Proctology Division of the Solec Hospital in Warsaw. – Meanwhile, when it comes to colorectal cancer, we still have a lot to do.
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Doctors are wondering why colorectal cancer is not talked about as much as breast cancer. Women already know a lot about the prevention, diagnosis and treatment of this cancer. The public still doesn’t know much about colorectal cancer, but they don’t want to find out either. We do have screening tests, e.g. colonoscopy, but during the 10 years of the program, only 320 were covered. people. Compared to a population of almost 37 million, this is not much. The reluctance of compatriots to contact a specialist in anorectal, rectal and colon diseases needs to be overcome.
– Colorectal cancer is curable to a large extent – says Dr. Tchórzewski. – It is one of the few cancers that, when caught at the right moment, i.e. in the early stage, or in the precancerous stage, at the polyp stage, has a chance of being completely healed. With this awareness, we can eliminate our inhibitions. Polyps can be removed without any consequences for the patient during colonoscopy or other relatively simple procedures, and a tumor operated at an early stage often does not require further treatment.
Further part below the video.
Colon cancer. The gold standard is colonoscopy
Follow-up recommendations say that people with high risk factors should have colonoscopy every two years, with an average of every five years, and people who do not have risk factors should have a colonoscopy every 10 years.
– Such a time interval was dictated by our knowledge. About 10 years pass from the moment of the change visible in the colonoscopy to the appearance of the invasive neoplasm – emphasizes prof. dr hab. n. med. Tomasz Banasiewicz, head of the Department of General, Endocrine Surgery and Gastroenterological Oncology, Director of the Institute of Surgery at the Medical University of Poznań. “So we have a very long time to catch the tumor when it is completely harmless.
The colonoscopic examination remains the so-called the gold standard for many reasons. It’s about the accuracy, sensitivity, specificity and uniqueness of the result. Another test that may serve as a screening test is a laboratory test for occult blood in the stool.
– There is a big problem with this study, because it is often used in medically unjustified situations – says Prof. Banasiewicz. – It only makes sense in a person who is not burdened with risk factors and has no symptoms, and would like to make sure that nothing disturbing is happening in the intestine.
The test is effective in about 70%, although it is not completely specific, which means that a positive result does not mean a cancer diagnosis, but simply the need to consult a doctor and further tests, most often colonoscopy. The test should be performed 3-4 times with independent samples, this procedure is the basis for screening in some countries (eg Denmark, UK).
The tests are used to check who from the group without risk factors has a positive result repeated in subsequent tests. These people are undergoing a colonoscopy. In our clinic, tests are often ordered or performed by the patient after the appearance of bleeding as a symptom, and this is a total nonsense, because then anyway you have to do additional tests, usually a colonoscopy.
The occult blood test is reimbursed as a test ordered from your GP or specialist clinic. There are also screening programs that can be used.
– We still have colorectal cancer markers (blood parameters), but they are used to monitor treatment, not to capture or pre-select neoplasms – explains Prof. Banasiewicz. – Abdominal tomography will also show changes, but the more advanced ones. Tomography is used to assess the stage of the cancer, i.e. the presence of metastases or the involvement of lymph nodes.
An alternative to colonoscopy is the so-called virtual colonoscopy, i.e. magnetic resonance colonoscopy or computed tomography – minimally invasive outpatient examination. Computed tomography colography is the treatment of choice for the large intestine. The patient prepares for this examination at home, just like for a colonoscopy, because the intestine must be empty. He is given a rectal infusion of contrast agent, which is somewhat of a discomfort but less than with a colonoscopy, and then undergoes a colonography of the abdomen. The examination allows to obtain a three-dimensional image of the intestine, enabling the diagnosis of polyps up to 0,5 cm in size, which is really early changes.
– Colonoscopy is not the only available method of cancer detection, for tumors located in the last part of the large intestine, shorter examinations, covering a smaller part of the intestine, which are definitely more accessible, may also be useful – says Dr. Tchórzewski. – I mean anoscopy, rectoscopy or even a simple simple finger examination. Of course, these tests do not cover the entire colon, but only about 25 cm of the final segment in the case of rectoscopy, but if they were common, there would already be progress, because statistically, if something happens in the large intestine, it most often takes place in its last segment.
As an alternative, it is also worth performing a Dispatch test for the concentration of calprotectin in the feces, the high level of which may indicate inflammation, polyps or intestinal cancer.
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Who is at risk of colorectal cancer?
The predisposition to developing colorectal cancer can be divided into several categories. First of all, direct genetic burden, i.e. the family history of many colorectal cancers, especially if the disease appeared at the younger age of 45-50 years. This burden is very important, so a group of people who have it should regularly check themselves, starting from the age of 50 at the latest.
Another category is indirect genetic burden, i.e. the presence of other neoplasms, e.g. breast, ovarian and prostate cancer, which increase the risk of colorectal cancer.
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Finally, a risk group associated with other diseases, e.g. inflammatory bowel diseases, in which the likelihood of colorectal cancer increases. The last category includes those who increase the risk of cancer through their lifestyle. These are people who are physically inactive, smokers, are overweight. Another risk factor is a diet consisting of a large amount of red and processed meat and highly processed foods.
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Symptoms of colon cancer
Colorectal cancer has the specificity that by the time symptoms appear, it is usually relatively advanced. The tumor grows for a few or a dozen years, transforming from a small polyp into a larger one, then into a tumor, and only when it begins to bleed or close the digestive tract, symptoms appear.
We focus on prophylaxis to prevent symptoms from occurring. If we do not undergo control tests, we should be concerned about any suddenly appearing differences in the gastrointestinal tract. If we suddenly have constipation problems or vice versa: if we have always had constipation and suddenly have more frequent bowel movements, mucous or watery diarrhea. If we see blood in the stool, if there is severe bloating and nothing like this happened before. These are the so-called flagship symptoms, also known as red flags, which should prompt us to do a quick test.
- See also: Red flags that the digestive system sends us. Never underestimate them!
Then the tumor is symptomatic, although its growth rate is so slow that medicine can treat it effectively.
– There is a large group of patients without significant ailments or with less specific ailments, who undergo colonoscopy and sometimes we find cancer in these situations – says Dr. Tchórzewski. – Patients are surprised. Like this, after all, there were no symptoms … Often, the first symptoms appear only when the stage of the disease is so advanced that there is not much the doctor can do. Hence the poor treatment results in our country. Man always associates disease with pain, and cancer does not hurt for a long time. Colorectal cancer does not hurt until it is large enough that it begins to infiltrate the surrounding structures that have sensory innervation, i.e. pain receptors. There are no such receptors in the large intestine, so cancer can grow freely until it attacks the organ that has them. Bleeding usually appears very late. Changing the nature and rhythm of bowel movements is a symptom that could be helpful if you think about it a bit because many of us suffer from chronic constipation. If we have constipation for 20 years and then suddenly within a few months our stools start to feel normal or looser, people will be happy, but it could be a symptom of an illness. Most colorectal cancers produce mucus which causes water to be retained in the intestine and the hard, constipated stools begin to become normal and regulate your bowel movements.
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- Read: The eight most common symptoms of colon cancer
How do we treat colon cancer?
The optimal method is the treatment of precancerous conditions, i.e. removal of polyps. This procedure can be performed endoscopically.
– Even when the polyp already has early cancer, endoscopic removal is as safe as surgery – explains Prof. Banasiewicz. The ideal model for dealing with colorectal cancer would be to capture it at the polyp stage and remove the polyps endoscopically during a colonoscopy. However, this ideal has not been achieved anywhere in the world.
Therefore, in more advanced neoplasms, the only method is surgical excision of a fragment of the large intestine with the tumor and an appropriate margin. Increasingly, this is done with the help of laparoscopy, and the selection criteria are the experience of the center and the skills of the surgical team.
– A few large studies from 2004-2010 confirm that the laparoscopic procedure is oncologically as safe as the open procedure, so now in the world colorectal cancer is operated laparoscopically – says prof. Banasiewicz. – Open procedures, i.e. those with abdominal incision, are often a possibility in the case of more advanced lesions, when tumors infiltrate other organs, reach the bladder, abdominal wall or uterus.
After the surgery, chemotherapy is started, and in the case of rectal cancer, the patient additionally receives preoperative radiotherapy. Chemotherapy is individualized, it depends, inter alia, on the stage and type of cancer. Long and short cycles or oral therapy are possible. Sometimes they are maintenance therapies that last for years. They are low toxic, so they will not destroy the tumor, but will keep the patient comfortable for a good few years.
The prognosis depends on the stage of the cancer. In the case of stage one advancement, that is, in the early stage, the survival rate (over five years) is approximately ninety-some percent. If the cancer is diagnosed in the middle stage (stage II, III), the survival rate drops to approx. 70%. However, in the case of stage IV, i.e. advanced cancer, it is 40-50 percent.
Recurrences are also directly related to the stage of the tumor. If symptoms are overlooked or not checked, the disease may develop as a relapse or metastasis. Unfortunately, attempts to remove a recurrence are much more difficult and less effective.
As a support for the work of the intestines, it is worth using the Lactibiane Lactichoc Probiotic – protection of the PiLeJe intestinal microflora.
How to improve the situation of colorectal cancer patients?
In Poland, colorectal cancer is diagnosed much too late. Most often it happens when the cancer is well advanced.
– When it comes to the possibility of surgical treatment and access to specialist centers, we are below the average European level – says prof. Tomasz Banasiewicz. – The patient has to wait longer, especially after the pandemic. We do not appreciate specialist centers, we do not know how to organize care. There is chaos in management and lack of competences.
On the other hand, the level of surgical treatment in specialist centers does not differ from world standards. Oncology works well and this is also a largely global level. The only thing that is missing is comprehensive patient care.
– There is no such care system – notes prof. Banasiewicz. – Some of its elements, especially in the field of surgery, chemotherapy and radiotherapy, work well, but there is no coherent strategy, such as preparing the patient for surgery (pre-rehabilitation), which is a standard in the world. There, when a patient learns that he has cancer and is going to be operated on, he immediately receives recommendations: how to prepare in terms of nutrition, exercise, and body efficiency. He also gets psychological support. In our clinic, the patient waits for surgery for a few weeks as if he was sentenced, doing nothing, because no one tells him what to do.
– 70-80 percent symptoms of colon and rectal cancer, if they already occur, are attributed to other ailments, such as, for example, hemorrhoids, says Dr. Tchórzewski. – Therefore, a large number of patients with symptoms such as bleeding are not studied at all. They heal themselves or are treated by GPs for hemorrhoids that have not even been seen or examined. Rectal examination or viewing the area is not a problem after all. The finger examination should be part of the basic examination of the patient, as well as auscultation of the chest and heart.
– Honestly, I do not remember any educational program dealing with colon cancer research – says Dr. Tchórzewski. – I am a doctor with quite a long practice and I do not recall that this problem was widely publicized. More is said about the stoma, and yet colorectal cancer is the second most common cancer in our country and the second in terms of mortality.
The lack of reimbursement of anesthesia for colonoscopy seems to be a significant problem in the prevention of colon cancer. We have to pay for them, and a lot of it. The possibility of performing the test under anesthesia would certainly attract more candidates to specialists.
– I can see fear, great reluctance and uncertainty related to the study – says Dr. Tchórzewski. – Going to a proctologist is a terrible stress for a patient, he can prepare himself for a visit for months. He comes up with various scenarios and often quits at the last minute. People need to be made aware of the fact that examining this part of the body or colonoscopy is nothing terrible. The intestine in terms of diagnostics does not differ much from the rest of our body, it is a part of it and there is nothing to be ashamed of.
The availability of a colonoscopy is quite good. Worse with access to a specialist. In Poland, proctology is a niche specialty, it is not even a separate specialization in our health care system. However, we do have gastroenterologists and surgeons who specialize in colon cancer.