What is the Colon Cancer
Colon cancer is one of the most common types of cancer in the world. According to the statistics of the Republic of
Turkey Ministery of
Health, colon cancer is among the top 5 most common types of cancer in our country. Although there is a risk of colon cancer occurring at any age, it is most often observed after the age of 50. When the distribution by gender is examined, colon cancer ranks second in women and third in men among all cancers.
What is Colon Cancer?
Colon cancer, a disease that develops in the region popularly known as the “large intestine” and is located in the last part of the digestive system, is observed in 1 out of every 20 people during their lifetime.
The colon and rectum are part of the digestive system. The large intestine is the organs that come after the small intestine and have an average length of 1.5 m. It begins with the blind intestine from the lower right side of the abdomen in the form of an inverted letter U, goes up and crosses the abdomen horizontally, making a turn under the liver. It comes under the spleen, which settles in the upper left corner, and merges with the rectum, again making a turn, heading down the left side. The rectum is the last part of the digestive system, which is on average 15 cm long and is formed as a result of the expansion of the large intestine.
Colon cancer begins in cells located in the colon. As the number of cells multiplies, it spreads circularly around the colon, like a napkin ring. If diagnosed at an early stage, cancer cells can be detected only limited to the inside of the colon. If it cannot be diagnosed at an early stage, the cancer can spread to nearby organs, lymph nodes, and the liver, lungs, and other organs through the bloodstream.
Early diagnosis is the most important criterion that brings success in the treatment of colon cancer. If colon or colon cancer is detected at an early stage, it is possible to completely get rid of the disease.
Colon Cancer Risk Factors
In developed countries, the rate of colon and rectal cancer is between 4 and 10 times higher than in developing countries. Causes of colorectal cancer can be listed as lifestyle, changes in environmental factors and hereditary genetic factors.
Genetic Factors
A person who has previously had colorectal cancer in their family has a high risk of cancer. Hereditary genetic factors increase the risk rate. Both familial adenomatous polyps in the large intestine and hereditary (family-to-children, familial) non-polyps colorectal cancer, also known as Lynch syndrome, increase the risk of colon cancer. Although genetic colorectal cancers account for only 5-10% of the disease, the age at which people carrying these genetic factors get sick is younger than other colon cancer patients and carries a greater vital risk.
Hereditary non-polyps colorectal cancer (Lynch syndrome) is the most common of genetic colorectal cancers. It is formed by an inherited gene mutation as a result of incompatible DNA matches. The average age of diagnosis is 45. This type of gene mutation predisposes to the formation of endometrium, ovarian, small intestine, ureteral and renal pelvis cancer.
Having a history of cancer in a person’s family and first-degree relatives seriously affects the appearance of the disease. People with colon cancer in their family should start having a colonoscopy 10 years before that, if colon cancer has been detected at the age of nearby. Completely healthy people who do not have a family history of colon cancer or do not have any complaints should have a colonoscopy at least once from the age of 50. Polyps Can Cause Colon Cancer
In the formation of colon cancer; excessive fat, red meat-weighted diet, obesity, smoking and alcohol consumption, as well as polyps are effective. During screening colonoscopies, when polyps appear in the large intestine, it is possible to prevent the disease by taking them without cancer. Having a history of breast and ovarian cancer in women also increases the risk of colon cancer in these people. People with breast and ovarian cancer are also recommended to be screened for colon cancer before the age of 50.
Polyps usually begin to give symptoms late, that is, when they turn into cancer. Only a small part of the polyps turns into cancer. But since the vast majority of cancers develop from polyps, this is an issue that needs to be considered. When we look at the general population, this rate is around 10-15%. Around the age of 50, about 25% of the population have different types of polyps. When we evaluate the age of 70, the incidence is close to 50%; In other words, the incidence of polyps increases with age.
Characteristics of polyps;
• It does not go away on its own.
• It has genetic characteristics. Colon cancer in first-degree relatives and patients with polyps detected in previous examinations are the risk group and close monitoring is required.
• Polyps are usually around 1cm. Larger than 2 cm can be dangerous and need to be removed.
• Symptoms such as severe pain, intestinal obstruction, weight loss are usually late-stage symptoms. Problems such as hemorrhoids and cracks in the anus may cause delays in the diagnosis and treatment of rectal cancer in some patients since they have similar symptoms. These symptoms can mislead both patients and rarely doctors. In general, the possibility of rectal and colon cancer should be well investigated for bleeding from the breech area at the age of 40 and older.
• It is not yet possible to prevent the formation of polyps. Those who have adopted sedentary lifestyles, over-stressed people, those who smoke and drink alcohol, obesity sufferers and those who eat predominantly red meat are at risk. But eating pulp foods, not smoking, that is, everything that regulates bowel movements, is an important factor in preventing the formation of polyps.
Other Colon (Colorectal Cancer) Risk Factors
Age: although it can occur at any age, it is mostly seen in people over the age of 50. The risk of colon cancer increases with age. Patients over the age of 60 are 10 times more likely to develop colon and rectal cancers than people under the age of 40.
Intestinal inflammation: there are mainly two types of intestinal inflammation. First, an ulcer that occurs in the mucous membrane of the colon due to infection, that is, ulcerative colitis. Second, Crohn’s disease, which occurs with intermittent inflammation in any part of the digestive system from the mouth to the anus, or in several different parts at the same time. Although it is a long-lasting, inveterate disease, its treatment is possible. Because of the high risk of cancer, colorectal cancer screening tests should be performed more often.
Nutrition: colon and rectal cancers are very high, especially in the United States and European countries where fast food consumption is common. Food consumption without pulp increases constipation, causing the stool to remain in the intestine for a long time and the cancer of that area. Deli products, brines, smoked meats, barbecue type foods and roasts are constipation foods. In addition, it has been determined that consuming foods rich in fruits, vegetables, legumes, chicken and grains reduces the risk rate.
Obesity: regardless of whether a woman or a man, excess weight increases the risk of colon cancer.
Smoking: many studies have indicated an association between cigarette consumption and colon cancer.
What Are The Symptoms of Colon Cancer?
‘What are the symptoms of colon (colon cancer) cancer?’ The question can be answered as follows. The most common signs of colon cancer are persistent diarrhea and constipation, thinning of stool that always comes in a normal thickness, blood coming from the anus and blood in the stool, albugineous in the stool. In cases where colon (large intestine) cancer progresses and obstructs the intestine, swelling and pain occur in the abdomen. It is important for those with such complaints to consult a doctor for early diagnosis.
• Feeling that the intestines are not empty enough,
• Difficulty defecating
• Painful defecation
• Unexplained weight loss
• Vomiting
These symptoms are among the most important symptoms of colon cancer, also known as colorectal cancer. Colon cancer involving the right side of the intestine and colon cancer involving the left side may give different symptoms. Because the left side of the intestine is a narrower area, cancers of this area experience more complaints such as thinning of the stool, bleeding, changes in the order of the stool, while on the right side, the bowel is wider, the cancer progresses insidiously here, taking longer to give symptoms. The patient has symptoms such as weakness, anemia, loss of appetite and abdominal pain. Painful defecation, iron-deficient anemia, feeling of mass in the abdomen are important symptoms of colon cancer. Diagnosis of colon cancer before the disease progresses greatly increases the chances of life. For this reason, it is very important to monitor the symptoms of colon cancer for early diagnosis.
Colon Cancer Diagnosis
Colon cancer is a type of cancer that is included in screening programs. The most effective way to protect against cancer or detect the disease at an early stage is regular endoscopic examinations. Colonoscopy comes first among these. Colonoscopy is a procedure that can both detect an existing tumor at an early stage and detect polyps and similar problems that can lead to cancer before they become cancerous and protect a person from the development of cancer. Each person over the age of 50 is recommended to undergo colonoscopic examination at intervals of 2-5 years according to their risk status, personal health history, and family history. The preparation and application of colonoscopy has become much easier and more comfortable for the patient today. New colonoscopes are applied extremely easily and the desired results are obtained without discomfort to the patient.
Colon cancer is diagnosed with some tests led by specialist doctors. After the patient’s doctor and physical examination, the following tests are performed respectively;
• Examination of hidden blood in stool: This is an extremely simple test; small amounts of stool samples are examined in the laboratory.
• Radiological examinations: double contrast colon graph and computed tomography are performed.
• Laboratory tests: complete blood count, biochemical tests are performed. Among them, the study of CEA (carcinoembryonic antigen) is one of the tests that can rise in the blood in colon cancer and help diagnose it.
• Endoscopic examinations for definitive diagnosis: Rectoscopy, sigmoidoscopy, colonoscopy and biopsy are performed. A part of the lesion is removed and examined by a pathologist.
If a person has a case of colon cancer in their family before the age of 50, it is necessary to have a colonoscopy from the age of 40. It is very important to repeat the colonoscopy once every 5 years. In addition, once a year, the examination of hidden blood in the stool is also very important for the determinant and early diagnosis of cancer. If a person does not have colon cancer in their family, it is appropriate to have a colonoscopy regularly every 5 years from the age of 50.
A classic colonoscopy allows you to diagnose the presence of a polyp or cancer, as well as have the property of treating it and preventing the formation of cancer if the patient has a polyp. It should not be difficult for the patient to do this once every 5 years. Because colonoscopy is now a procedure performed by providing patient relief with an intravenous needle, made more tolerable with sedation and painkillers.
What Are The Treatment Options For Colon Cancer?
In colon cancer, surgery may not be required on polyps taken during colonoscopy when the cancer is caught at an early stage. It is only closely monitored. Colonoscopy is of great importance in the diagnosis of polyps at an early stage, without turning into cancer. In recent studies, it has been shown that colon cancer can be largely prevented by removing polyps at an early stage by performing a colonoscopy. For this reason, every man after the age of 45 and every woman after the age of 50 should have hidden blood screening and colonoscopy in the stool. Great attention is paid to patient comfort during colonoscopy. For this reason, the patient is made semi-unconscious with a mild intravenous painkiller called “Conscious Sedation”. First, the intestine must be completely emptied by various methods. It is then entered into the intestine with a fiberoptic camera and all the polyps seen are removed. But the experience of the doctor who performs colonoscopy here, the disinfection of the device used, and the high degree of image quality are of great importance.
In advanced colon cancer, the standard treatment option is surgery, which means that the tumor area is removed from the environment along with some intact tissue and lymph nodes. Studies show that operations performed in accordance with the principles of oncology and by experienced surgeons are the most important factor for the patient’s future. After colon cancer surgery, additional, protective chemotherapy is applied according to the stage of the disease. For example, in “Stage III” cases where the tumor bounces off the lymph nodes adjacent to the intestine, “adjuvant” chemotherapy (which prevents the spread of the disease) is now a standardized practice all over the world.
In colon cancer, in tumors very close to the anus, canceling the anus and moving from the abdomen to defecation (with colostomy bags) can sometimes be inevitable. But in recent years, chemotherapy combined with preoperative radiation therapy can significantly ensure the protection of the anus. In patients who have spread to other organs (metastatic), all three treatment methods (surgery, chemotherapy, radiation therapy) are applied depending on the patient’s general condition, age, and degree of prevalence of the disease. The aim is to improve the life expectancy and quality of patients. Thanks to new targeted biological drug treatments found in the last few years, success rates in treatment are increasing day by day.
Diet and screening tests are of great importance in protecting people who have not had colon cancer. It is important to consume plenty of fibrous foods such as vegetables, fruits and grains, and to get enough calcium and vitamin D. In addition, early diagnosis with screening tests as a secondary prevention measure has a separate importance. For this, it is recommended to conduct screening tests starting at the age of 50 in both sexes. In people with colon cancer in their family, screening tests should be started at an earlier age.
What Should Be Taken Into Consideration To Protect From Colon Cancer
Although it is not yet possible to prevent colon cancer, it can reduce the risk of colon cancer by paying attention to harmful habits such as diet, sedentary life, obesity, smoking and alcohol that are not suitable for daily life. For this, some life changes must be made. These are;
• Diet: eating foods rich in fruits, vegetables and legumes helps reduce the risk of colon cancer. Consumption of red meat and alcohol should be measured, as it increases the risk of colon cancer. A healthy diet and eating low-fat foods will help maintain a certain amount of weight.
• Exercise: research has shown that regular exercise reduces the risk of colon and rectal cancer, as well as many types of cancer. It is necessary to consult a doctor before starting an exercise program. The doctor will help the person with the appropriate exercise program. 5 days a week or more than 5 days, 30 minutes of exercise is recommended. Exercise from 45 min to 1 hour can provide more benefits. Moderate activities; brisk walking, cycling on flat terrain… active activities; climbing and running • Anti-inflammatory drugs that do not have a Steroid structure (such as Aspirin): research has finally suggested that these types of colon drugs reduce the risk of cancer. They have potential benefits if used regularly. However, when it comes to a potential risk of colon cancer, it will be in your best interest to use it with a doctor’s check. Otherwise, there may be a risk of stomach bleeding and damage.
• Calcium: it can be of little benefit for colon cancer. 1200 mg of calcium consumed daily is known to reduce colorectal adenoma form by 20% and advanced adenoma form by 45%. Beyond this, vitamin D and calcium consumed together have been found to reduce the adenoma form together.
• Vitamin D is a fat-soluble vitamin and is found in dietary products containing certain types of fish, such as fortified milk, corn flakes, mackerel, salmon, tuna, and in sunlight. Vitamin D is assumed to play an important role in preventing certain types of cancer, including colon cancer.
• Screening and treatment of precancerous (polyps that can lead to cancer) polyps: screening tests applied in cancer types, especially in breast cancer, do not prevent the development of cancer, but increase the success rate of treatment by benefiting from early diagnosis. The development of cancer can be prevented thanks to screening tests performed in the determination of precancerous polyps. Removal of detected polyps can prevent cancer that will develop later.
• Preventive surgery: preventive surgery may be recommended for people at high risk of colorectal cancer. In this operation, before the development of cancer is observed, the colon is sometimes removed from the rectum and other related organs. However, this type of surgery can only apply to patients at high risk of colon and rectal cancer. It is important to discuss the benefits and consequences with your doctor before deciding about surgery.
