Colorectal cancer, the third most diagnosed type of cancer in Canada

Talking about colorectal cancer is talking about cancer of the colon or of the rectum, colon and rectum forming the final part of the large intestine, the latter having a common point, namely the intestinal mucosa, the starting point of this type of cancer. Please also note that colon cancers are far more common than the cancers of the rectum. Cancer strikes indiscriminately, in both men and women. It is extremely widespread particularly in North America. Canada is primarily affected by this scourge, with this type of cancer being the second highest cause of death for all types of cancers in this country. The following figures are only representative of 2014: nearly 24 000 Canadians were diagnosed with colorectal cancer, nearly 9 000 have died, about 25 deaths per day. Therefore, it is a malignant tumor (also called adenocarcinoma) whose evolution occurs over several years, even a decade and it is the result of genetic mutations. It is formed from the usually benign adenomatous polyps (the polyp is a benign tumor that has the aspect of growths), polyps located in the intestinal mucosa lining the inside wall of the intestine. Therefore, you understand the need to be diagnosed early in order to surgically remove these benign polyps before the cancer develops. If untreated, cancer can spread to other organs, especially in the liver and lungs. Therefore the chances of recovery disappear, but more importantly the patient’s life is severely compromised.

A cancer risk that increases with age, but not only!

There are several factors that favor this type of cancer:

• The main factor that exposes a person to this type of cancer is the age. It is indeed a cancer that mainly affects people over the age of 50.
• The presence of these notorious adenomatous polyps or benign tumors is also an aggravating factor because, as you know now, these polyps can develop into malignant tumors. Early detection remains the key in order to monitor and treat these polyps while they are still benign.
• A chronic inflammatory disease (Crohn’s disease among others) also creates a fertile ground for the emergence of this cancer.
• A type 2 diabetes  also calls for increased vigilance.
• The hereditary factor is also significant as the risk of this cancer increases in a family where cases of cancer have been diagnosed.
• Diet (regular and excessive consumption of animal fat and red meat and conversely a low consumption of fruits and vegetables) (note that foods rich in vitamin D are beneficial and protective against this cancer (salmon, cod liver oil, trout, herring …)) and physical inactivity (overweight, obesity, lack of exercise…) but also smoking or heavy alcohol consumption are aggravating factors. It is also not surprising that in countries where the culture of “healthy eating” is deeply ingrained in its population (e.g. Japan), we see very few affected by this type of cancer. Your lifestyle is paramount!

Disturbing symptoms that should alert you

Some symptoms, apart from all the aggravating factors mentioned, should urge you to perform a rapid screening test. In fact, have you seen one or more of these symptoms?

• Persistent digestive problems: diarrhea, constipation, the need to go to the bathroom several times a day, abdominal pain and / or pain in the anus?
• Great inexplicable fatigue?
• A significant and inexplicable loss of weight?
• Blood in stool, making it red (rectal bleeding) or black?

… All this must push you to perform screening!

Screening: it is finally possible to avoid a colonoscopy!

Getting tested after you have reached the age of 50 is above all being monitored and this is the key for this type of cancer whose symptoms are not always present from the very beginning. Indeed screening has a specific goal, namely surgically treating from an early stage benign polyps that could be problematic and hypothetically represent a cancer risk. Perform an early screening even before the occurrence of one or more symptoms, therefore avoiding the occurrence of this cancer and the inevitable spread of this disease with metastases together with all the extremely heavy treatments involved in this type of pathology: radiotherapy, chemotherapy, debilitating medication affecting your everyday life … Of course, if one or more symptoms occur, screening is a necessity so that the chances of recovery are the best.

Colonoscopy

When talking about testing/ screening, we immediately think of colonoscopy, a constraining examination performed under general anesthesia which allows to detect possible damage through a tube with a camera which is passed through the rectum and the colon to have a clear view of the large intestine. Any suspicious lesion will be taken for biopsy to perform a medical laboratory examination. Therefore, you should know that avoiding colonoscopy has been finally possible only recently, however this invasive medical examination will be required if the non-invasive screening test is positive to confirm 100% the presence of the colorectal cancer. Thus, what kind of test is it? The FIT test (fecal immunochemical test) or the faecal occult blood testing (RSOSI) Prescribed by your doctor, in the absence of a positive result, this test must be performed every two years to continue observation from the age of 50 until the age of 74. Again, even if you are healthy, performing a RSOSI test must become routine, no matter your gender. The major advantage of the FIT test (available to patients very recently, more precisely since September 2013 in Quebec) is that the patient can perform it at home, (without diet restrictions) which then protects him/her from the invasiveness of a colonoscopy. With a sampling kit (provided for free by both your doctor or your collection center with clear and accurate explanations, the patient will only have to follow the instructions and to remember to fill all the data relating to his/her identity and to the sample itself. The collection of stool (not mixed with urine; the test should be postponed in case of menstruation or in the presence of bleeding hemorrhoids) in the sampling tube is extremely simple, fast and efficient in detecting early cancers and polyps. A freshly made single sample is to be returned within 48 hours to the medical laboratory to be analyzed, the results then being transmitted to your doctor.

The different stages of the collection of stool

Follow these simple steps. It is important to respect the protocol for the results to be perfectly reliable.

• We recommend you to put a plastic wrap under the toilet seat and to fold the seat.
• Make a stool with the size of a green grape (small amount).
• The stool should neither come in contact with water from the toilet nor with urine.
• Close the plastic wrap and place in a small plastic bag.
• Keep the sample cool (cooler with ice or in a refrigerator).
• The nurse will come and will do the collection of the stool in question.

A positive test will result in a routine colonoscopy to confirm the diagnosis and to rule out cancer. A positive test is not always synonymous with cancer; the presence of blood in the stool can cause another more or less severe disease. As I am sure you have understood, screening is the only way to prevent this type of cancer!