The lowdown on colorectal cancer

MANILA, Philippines - Colorectal cancer is the third most common malignancy worldwide,” says Dr. Manuel Francisco T. Roxas, president of the Philippine Society of Colorectal Surgery and director of The Medical City cancer program. “Two-thirds of colorectal cancer are located somewhere in the colon. This type of cancer is a leading cause of cancer death, although it is curable when detected and treated early.”

“Most cases of colon cancer begin as small, benign clumps, popularly known as polyps,” Dr. Roxas explains. “Unfortunately, these polyps may be small and produce few symptoms, if any. Regular screening tests can help prevent colon cancer by identifying polyps before they become cancerous.”

There are certain symptoms that may indicate the presence of colon cancer. These include: recent changes in bowel habits, such as diarrhea or constipation; blood in the stool; persistent abdominal discomfort, such as cramps or gas pain; a feeling that your bowel doesn’t empty completely; unexplained anemia, weakness or fatigue; and weight loss with no known reason. Many patients with rectal cancer attribute their symptoms to hemorrhoids, causing them to delay consultation.

Both colon cancer, which is cancer of the large intestine or the lowest part of the digestive system, and rectal cancer, which is cancer of the last 15 centimeters of the colon, lying within the pelvis and connecting the colon to the anus, may be associated with a diet low in fiber and high in fat, calories, red meat, and processed foods. Other risk factors are a sedentary lifestyle, obesity, smoking, alcohol, diabetes, as well as a personal or family history of colon polyps or colorectal cancer.

Age is also a risk factor. “About 90 percent of people diagnosed with colon cancer are older than 50,” says Dr. Roxas, “although it can also occur in younger people, but much less frequently.” Thus, Dr. Roxas strongly recommends regular screening for those 50 years old and above.

“Colon cancer is best detected early, when it is most curable, before the development of symptoms,” he says. This is achieved through screening tests such as colonoscopy, which views the entire colon; fecal occult blood test with flexible sigmoidoscopy, which views the lower half of the colon; barium enema; and CT virtual colonoscopy. Various options for colorectal cancer screening are available at The Medical City Cancer Center. Routine screening is highly recommended, as follows: 1) fecal occult blood test yearly with flexible sigmoidoscopy every three years, or 2) colonoscopy every five to 10 years, or 3) virtual CT colonography every three to five years.  

“The Philippine Society of Colorectal Surgeons (PSCRS) is intent on becoming the main venue by which surgeons can keep themselves abreast with the rapid advances in colorectal surgery,” notes Dr. Roxas. At the First National Convention on Colorectal Surgery, which PSCRS held recently, Dr. Roxas debunked certain popular myths about surgery for colorectal cancer.

“Many have the mistaken notion that surgery worsens the disease or has no benefit,” says Dr. Roxas. “On the contrary, surgery provides thebest chance for cure.”

The main treatment for colon cancer is surgery. This entails removing the segment of the colon involved.

Another common myth is that surgery is disfiguring, always resulting in a colostomy, and that surgery necessitates large wounds, resulting in much pain. “The truth is, with proper training and expertise, surgeons can save the anus and avoid a permanent colostomy in almost 90 percent of patients, while assuring good cancer cure,” Dr. Roxas points out. “If the cancer is small and detected early, minimally invasive laparoscopic surgery can be done with smaller incisions, less pain, and faster recovery.”

Many think that all surgeons are the same and therefore produce the same results, but the truth is, results vary between surgeons in terms of cancer cure, avoiding permanent colostomies, utilizing minimally-invasive surgery, and post-operative complications. There are only a small number of experienced colorectal surgeons in the country.

“Every patient has the right to ask his/her surgeon how many cases he has performed, his complication rates, and his outcomes,” Dr. Roxas reveals. “For cancer, specialization is crucial. Surgery for colorectal cancer must be done by surgeons who specialize in colorectal cancer surgery, working as a team with expert multidisciplinary oncologists.”