Colorectal cancer and how to prevent it

Welcome to our new Health & Wellness series in our Monday edition where we aim to bring you all the latest information and advice to help you keep in your best health.  We begin with a discussion on colorectal cancer and how to prevent it.

Doctors Hospital and the Cayman Islands Cancer Society recognised March as Gastrointestinal and Colorectal Cancer Awareness Month in the Cayman Islands. Gastrointestinal cancer develops around the GI tract, which is known as the digestive tract. Colorectal Cancer, more specifically, is a cancer that begins in the large intestine.

Colorectal Cancer is statistically proven to affect 1 in 23 men and 1 in 25 women in America.

Colon cancer is the second leading cause of cancer-related deaths worldwide.  In 2020, more than 1.9 million new cases of colorectal cancer and more than 930,000 deaths due to colorectal cancer were estimated to have occurred worldwide.

Dr Darley Solomon, Chief of Surgery and General Surgeon at Doctors Hospital, answers some of our questions on the topic.

The American Cancer Society’s estimates for the number of colorectal cancers in the United States for 2024 are:

• About 106,590 new cases of colon cancer (54,210 in men and 52,380 in women)

• About 46,220 new cases of rectal cancer (27,330 in men and 18,890 in women)

The rate of people being diagnosed with colon or rectal cancer each year has dropped overall since the mid-1980s, mainly because more people are getting screened and changing their lifestyle-related risk factors.  From 2011 to 2019, incidence rates dropped by about 1% each year. But this downward trend is mostly in older adults. In people younger than 55 years of age, rates have been increasing by 1% to 2% a year since the mid-1990s, which led to the recommendation to lower initial screening age.

A colonoscopy is considered the ‘gold standard’ for colorectal cancer screening.  Precancerous polyps can be removed at the time of colonoscopy.  Early detection of colorectal cancer can improve treatment outcomes and increase the chance of successful treatment and survival.

Dr Solomon said that in 2018 screening recommendations for individuals with average risk for developing colorectal cancer was lowered from age 50 to 45 years old. 

“If there are risk factors such as family history or inflammatory bowel disease or certain genetic conditions screening may start earlier or be more frequent.  Usually, individuals are screened from age 45 to 75.  Frequency of screening usually ranges from 5 to 10 years, depending on risk factors and findings on prior colonoscopies,” he advised.

During a colonoscopy, doctors examine the lining of the colon and rectum using a small flexible, lighted tube with a camera (called a colonoscope).  They look for abnormalities such as polyps, tumours, inflammation, and/or signs of bleeding.  Polyps can be removed that can prevent the development of colorectal cancer.

“The challenging part of a colonoscopy is the bowel preparation or colon cleanse that is needed prior to the actual colonoscopy procedure,” Dr Solomon explained. “During the procedure, the patient receives sedation to ensure they do not feel anything and do not recall anything about the procedure.  The colonoscope is then inserted into the rectum and advances through the entire colon while the lining is inspected.  If polyps or abnormal findings are found, they can be removed or biopsied for evaluation under a microscope.”

While routine screening is essential for detecting colorectal cancer early, certain symptoms may indicate a need for a colonoscopy at any age.  These symptoms include:

-Persistent changes in bowel habits (diarrhoea, constipation, or narrowing of stool)

- Rectal bleeding or blood in the stool

- Abdominal pain/cramping

- Unexplained weight loss

- Weakness or fatigue

- Iron deficiency anaemia

If abnormalities such as polyps or tumours are discovered during the colonoscopy, the doctor may perform various interventions during the procedure, Dr Solomon explained. This could entail: removal of polyps with the use of special tools such as snares and biopsy forceps; a biopsy whereby tissue samples may be taken from suspicious areas for further examination and treatment planning; and/or, depending on the findings, the doctor will develop a treatment plan, which may include surveillance colonoscopies, additional testing, or referral for an operation.

What can you do to lower your risk?

Making changes in everyday life can reduce the risk of colorectal cancer.

To lower the risk of colorectal cancer:

• Eat a variety of fruits, vegetables, and whole grains. Fruits, vegetables, and whole grains have vitamins, minerals, fibre, and antioxidants, which may help prevent cancer. Choose a variety of fruits and vegetables so that you get a range of vitamins and nutrients.

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink to no more than one drink a day for women and two for men.

• Stop smoking. Talk to your health care team about ways to quit.

• Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you have been inactive, start slowly and build up gradually to 30 minutes. Also, talk with a health care professional before starting an exercise program.

• Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your health care team about healthy ways to achieve your goal. Aim to lose weight slowly by eating fewer calories and moving more.