By Vinita Oranrap, M.D. Gastroenterologist, Samitivej Sukhumvit Hospital
Diseases are affecting humans more than expected, and one of them is cancer, especially colon cancer which was ranked the third most common disease found among Thais. This disease poses a high risk of death because most patients acknowledge it when it’s too late.
The good news is that the death rate has declined thanks to modern technologies that help doctors detect and treat patients effectively.
What causes colon cancer?
Colon cancer is caused by a polyp generated from an abnormality in the colon and rectum. This polyp may not affect patients initially but may turn cancerous if left untreated and spread to other parts of the body.
Factors that cause colon cancer
• Age 45 years or above
• Excessive drinking, smoking, not drinking enough water, preferring to consume meat instead of fruits and vegetables, not exercising enough
• Chronic stomachache, especially in the lower abdomen
• Alternating between constipation and diarrhea
• Chronic diarrhea
• Black or blackish-red stools
• Reduction in stool size
• Feeling of incomplete defecation or pain in the anus
• Fatigue due to anaemia and iron deficiency
• Unexpected weight loss
The risk of developing colon cancer can be reduced by screening for the polyp before it turns into a cancer cell. Apart from reducing the risk of death, it also enables doctors to treat patients effectively. The severity of disease can be classified as follows:
• Aged 45 and above
• Have inflammatory bowel disease
• A family history of inflammatory bowel disease or diagnosed with polyp (considered a risk due to genetic disorder)
• Aged 45 and above
• No symptoms
• Inappropriate behaviour such as excessive drinking, smoking, drinking less water, preferring meat over fruits and vegetables, skipping exercise
Screening for colon cancer
Those in the high-risk group can go for the endoscopy method as it can detect and remove small polyps immediately. A study found that 90 per cent of colon cancer start as a polyp and can take five to 10 years before turning into a cancer cell.
Those in the moderate-risk group can opt for different screening methods, such as faecal immunochemical test, barium enema, CT scan or colonoscopy.
High-tech screening methods
Samitivej Hospital has partnered with Japan’s Sano Hospital, which is recognised for its expertise in the removal of large polyps in the colon at an early stage using gastrointestinal endoscopy techniques.
The medical team of Samitivej Hospital travelled to Japan to learn about the technique and hone their laparoscopic and surgical skills. Since 2015, doctors from Japan have been coming to Samitivej every year to share their knowledge and conduct case studies.
The Narrow Band Image (NBI) technique directs radiation to the intestinal wall where substances are absorbed, to see the image of the blood vessels on the surface of the gastrointestinal mucosa clearly. With this technique, the appearance of the epithelium is changed. The NBI technique also allows the detection of flat polyps that resemble the surface of the intestines.
Samitivej Hospital has applied the NBI technique together with AI-assisted colonoscopy technology, which helps improve the quality of lesions detection in gastrointestinal endoscopy. This technique, called ENDOBRAIN, makes the polyp 1.5 times more visible than conventional techniques.
The ENDOBRAIN technique is a real-time endoscopic capture, which enhances the visibility of small polyps or polyps that are difficult to spot. Once the polyps are spotted, doctors can cut them off immediately, which helps patients avoid pain and unnecessary surgery.
Colon cancer treatment
• Surgery can be performed at any stage of the disease. The doctor may consider surgery along with radiation and chemotherapy.
• Chemotherapy can be administered orally or via intravenous or intramuscular injections, so the drug can be absorbed into the bloodstream and inhibit the proliferation or destruction of cancer cells. It can be used before or after surgery in combination with radiation. Chemotherapy can have side effects on normal cells and the functioning of other organs in the body, resulting in nausea, vomiting, loss of appetite, and hair loss.
• Radiation with high energy waves can destroy or inhibit the growth of cancer cells and reduce the recurrence of the disease. This can be done in conjunction with chemotherapy to make the treatment more effective.
• Targeted therapy can be used for targeted treatment that kills cancer cells without damaging neighbouring cells, so there are few side effects. Most often it is used in conjunction with chemotherapy. It was found that this therapy can prolong the patient's life span.
• Immunotherapy drugs stimulate the patient's immune system to detect and kill cancer cells better, which increase the chance to live longer. It is most often used in groups with diffuse cancer and requires a thorough biopsy for effective results.
Care after treatment
Though colon cancer can be cured, there is a chance that it can return. Therefore, periodic monitoring of the disease is necessary. During the first two years, the doctor may schedule follow-up visits every two months, with colonoscopy every six months and abdominal X-rays every three to six months. If the cancer is not detected the doctor may switch to an annual cancer screening appointment within three years.
Which in addition to attending the screening, patients should also reduce risk factors, such as limiting the intake of red meat and high-fat foods and boosting the consumption of vegetables, fruits and fibre-rich foods to normalise excretion. Regular exercise and getting enough sleep are also required, including an annual health check-up.
Published : September 30, 2021