SINGER Roel Cortez, who rose to fame with hit songs like “Nakapasakit Kuya, Eddie” and “Baleleng” in the 1980s, died on April 1 two years after suffering from colon cancer. Six seven earlier, President Corazon “Cory” Aquino likewise died of the same cancer.
In the Philippines, colon cancer is the fourth most common cancer, according to the Philippine Cancer Society Registry. It comes after breast, lung and liver cancers. But unlike the first three cancers, colon cancer is not openly discussed.
“Among cancers, colon cancer stands out as a disease that can be largely prevented, but few people believe it will happen to them,” said Dr. Atenodoro Ruiz, Jr., a gastroenterology consultant at The Medical City and a diplomate of the American Board of Internal Medicine in Gastroenterology and of the Philippine College of Physicians in Internal Medicine. If discovered early, colon cancer is preventable and treatable. “If it is early stage and localized within the colon, the cure is 100 percent,” said Dr. Ruiz. “If it had spread to lymph nodes or distant organs, the 5-year survival rate is much lower.”
Dr. Aaron I. Velasco, an internist and gastroentorologist who works in various hospitals in Davao City, said the 5-year survival rate of those diagnosed with stage 1 colon cancer is 92 percent. It goes down to 63 to 80 percent for those with stage 2 and 50 percent with stage 3. The chance of survival of those diagnosed with stage 4 is very minimal: 11 percent. In the past, colon cancer has been referred to as “a disease of the rich.”
But such is not the case anymore. “Colorectal cancer (cancer of the large intestine and rectum) is more common in richer countries, but its incidence is rising in some developing countries,” notes the World Health Organization (WHO). “The risk of developing those cancers that are typical of higher socioeconomic groups – cancers of the breast, colon, and rectum – can be expected to increase with economic development.”
Symptoms
According to the Johns Hopkins Colon Cancer Center in Baltimore, Maryland, the following symptoms could indicate colon cancer. If you’re over 50, don’t wait for these symptoms to develop before you get a screening test:
Change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days; feeling that you need to have a bowel movement that is not relieved by doing so; rectal bleeding or blood in the stool; cramping or steady abdominal (stomach area) pain; decreased appetite; weakness and fatigue; and jaundice (yellow-green discoloration of the skin and white part of the eyes). Other conditions such as infections, hemorrhoids, and inflammatory bowel disease can also cause these symptoms. But it is important to talk to the doctor since finding colorectal cancer early makes successful treatment more likely. It is also possible to have colon cancer and not have any symptoms. If the doctor suspects colon cancer, more tests will need to be done.
Beginning at age 50, both men and women should follow one of the three screening options below: yearly fecal occult blood test plus flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, double contrast barium enema every five to 10 years. Researchers have linked high red meat consumption to increased risk of colon cancer. As such, health experts recommend that you flip the proportions so that the meat is not the centerpiece of every meal.
“People ought to eat a diet that is lower in fat and higher in the amount and variety of fruits and vegetables,” advised Dr. John H. Bond, chairman of the National Colon Awareness Campaign for the American Digestive Health Foundation.
Dietary fiber has received considerable attention in recent years, and many studies appear to validate fiber’s preventive benefits. After reviewing the results of more than 100 previous studies on fiber, a panel of researchers convened in 1998 by the American Health Foundation concluded:
“Eating foods that contain an adequate amount of fiber – at least 25 grams total fiber per day for most adults—particularly from wheat bran or whole wheat, is an important component of a healthy-lifestyle program to help prevent colorectal cancer.”
Screening
In the Philippines, the awareness for colon cancer among Filipinos has been limited, as compared to lung and breast cancer.
In almost all countries, colon and rectal cancer screening is recommended for people starting the age of 50 years. “Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with colon and rectal cancer, and in those with other additional risk factors,” Ruiz says. The gold standard for colon and rectal cancer screening, according to Ruiz, is a colonoscopy as it can detect and remove early lesions like polyps. “The procedure involves a flexible fiberoptic scope with a camera that is inserted through the rectum and is carefully advanced to visualize the colon under mild anesthesia,” he explains. “However, it is, however, an invasive test and has low potential to cause complications.” There are some patients may not want to have an invasive test or may find the cost of a colonoscopy expensive. “A stool test called the Fecal Immunochemical test (FIT) is a good screening alternative,” Ruiz says. “FIT detects only human blood and is specific for bleeding in the colon. The test is repeated every year if the initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer.”
As a gastroenterologist who advocates colon and rectal cancer screening, Dr. Ruiz recommends a screening colonoscopy in persons between 50 to 75 years of age who are healthy and in whom the complications are low. “If the patient does not want to start with a colonoscopy, I suggest starting with FIT,” he writes. “After a discussion with his physician, the patient can choose his preferred screening test.” As stated earlier, colon cancer is treatable when discovered early. But if the cancer has already invaded other tissues, it may be too late. Emmy-winning American comedian and actor Milton Berle was told he had a cancerous colon tumor in 2001 but he refused surgery; he died in Los Angeles, California the following year.