Colonal cancers pose a serious health problem in our country as well as all over the world. According to the statistics of the Ministry of Health, it is among the top 5 most common cancers. It ranks 3rd in cancer deaths in men and women. Although they can be seen at any age, they are most commonly observed after the age of 50. The average age of occurrence is 63. There is not much difference between men and women in terms of frequency. When large intestine cancers spread beyond the intestinal wall, they can first spread to the surrounding lymph nodes and then to other organs, especially the liver. For the success of the treatment, the intestines will need to be examined at regular intervals after the age of 50. Although it is possible to get rid of the disease in the early stages, unfortunately life-threatening problems may be encountered when it is late.
The exact cause of large intestine cancer is unknown. However, there are some environmental and genetic reasons that are effective in its formation. Nutritional habits have an important place in colon cancers. Especially the Western diet increases the risk of cancer. Research has shown that consumption of animal fats is effective in the development of colon cancer. Additionally, some chemicals are among the causes of cancer. The occurrence of colon cancer in industrial workers and those working in some factories reveals the effect of chemical substances.
There are some risk factors for colon cancer:
Polyps. : Polyps originate from the inner wall of the large intestine. It is common in people over 50 years of age. Although they are initially benign tumors, there is a possibility of them becoming cancerous over time. Due to the risk of cancer, polyps should be removed through colonoscopy and checked at regular intervals. Early diagnosis and removal of polyps reduces the risk of colon cancer.
Age: Colon cancers are generally seen in the elderly. 90% of patients are diagnosed after the age of 40. The average age is 60. The rate of colon cancer after the age of 40 doubles every 10 years.
Genetic disorders: Changes in certain genes. increases the risk of bowel cancer. Hereditary non-polyposis colon cancer (HNPCC) is the most common type of hereditary (genetic) colon cancer. It accounts for 2% of all colon cancer cases. This happens due to changes in the HNPCC gene. Colon cancer develops in 75% of patients with altered HNPCC genes, and the average age of cancer is 44.
Familial adenomatous polyposis (FAP) is a rare condition characterized by hereditary polyps in the large intestine. It is caused by changes in a special gene called APC. The treatment is to remove the entire large intestine. If FAP is not treated, colon cancer develops around the age of 40. FAP accounts for less than 1% of all colon cancer cases.
Family history of colon cancer: A history of colon cancer in a person's close relatives (mother, father, sibling, children). If present, the person's risk of contracting this disease at a younger age increases. These patients should be screened for cancer 10 years before the age at which their family members first got cancer.
Having had colon cancer before: In a person with a history of colon cancer, the colon cancer may occur again. cancer may develop. The risk of colon cancer is increased in women with a history of ovarian, uterine and breast cancer.
Ulcerative colitis or Crohn's disease: The risk of colon cancer is increased in those with the mentioned inflammatory disease in the intestine. These people have a 10-fold increased risk compared to the normal population.
Diet: The risk of colon cancer is increased in those who eat a diet rich in animal fat and low in calcium, folate and fiber. A diet low in fruits and vegetables also increases the risk. Consuming plenty of fish probably reduces your risk of developing bowel cancer. The risk of developing bowel cancer increases in people who consume 12.5 units of alcohol per week.
Aspirin and Nonsteroidal painkillers: Like aspirin and ibuprofen (Nurofen). non-steroidal anti-inflammatory drugs (NSAIDs) help protect against other cancers of the intestine and digestive system. In a 2010 evaluation study, low-dose aspirin was administered for several years. It has been shown that taking n reduces the risk of colon cancer, but does not affect the risk of cancer of the last part of the large intestine, called the rectum. Research is examining the use of drugs such as aspirin to protect against bowel cancer.
Smoking: The risk of polyps and colon cancer is increased in patients who smoke.
Obesity. :Scientific studies have shown that people with a body mass index above 40kg/m2 are more likely to have a large intestine than people of normal weight. It is claimed that exercise reduces the risk of colon cancer. We don't know how exercise works. It may be affecting hormone levels or changing your body's idling speed. It may even change the length of time food stays in your intestines. Obesity and lack of exercise increase the risk of colon cancer by 1.5-2 times.
Symptoms
The lumen of the first parts of the large intestine is wider. As you move towards the end, the lumen diameter decreases. Symptoms also vary depending on the location of the tumor. The tumor is less likely to block the lumen in the initial parts of the large intestine, which we call the right side. Therefore, symptoms appear over a longer period of time. In tumors located here, unnoticeable blood loss along with bleeding in the stool, and anemia, weakness, shortness of breath, easy fatigue, and changes in defecation habits due to this bleeding are observed. Other symptoms include occasional attacks of constipation and diarrhea, abdominal pain, abdominal bloating, and weight loss. The most common location of large intestine tumors is the left side, which is the narrow areas of the large intestine. That's why intestinal obstructions are more common in left-sided tumors. Apart from obstruction, blood in the stool may be seen in left-sided tumors. Sometimes, unfortunately, the patient or physician attributes this bleeding to hemorrhoid bleeding, causing treatment to be delayed. For this reason, every patient who has bleeding along with the stool should at least undergo a digital anal examination. As one of our retired professors said, "In order not to perform a finger examination on a bleeding patient, the physician must either have no fingers." k or the patient's anus.” A patient who could have fully recovered misses his golden period due to the patient's embarrassment or the physician's negligence of not performing a finger check. Changes in defecation habits, thinning of stool diameter, constipation, incomplete evacuation after defecation, and abdominal bloating are other observed findings. When these findings are suspected, a physician should be consulted. One of the undesirable conditions of late-stage colon cancer is complete obstruction of the intestine. In this case, emergency surgery may be necessary.
Approximately 3% of the patients have no complaints and colonoscopy, virtual colonoscopy, etc. It is determined randomly during examinations.
Protection from colon cancer
In addition to screening methods, there are some steps to reduce the risk of colon cancer. available. For example, physical exercise, losing excess weight, not smoking and drinking alcohol, and consuming high-fiber, low-fat foods are a few of them. In 2015, the World Health Organization included processed meat products such as salami, soudjouk, sausage and pastrami as definite carcinogens. It is also stated in the same announcement that excessive consumption of red meat increases the risk of colon cancer.
The way it is cooked is also very important in preventing colon cancer. Carcinogens may occur as a result of burning meat, especially in cooking methods such as barbecue. These carcinogens can trigger the development of stomach, pancreatic and colon cancer. Therefore, make sure that the meat is not closer than 15 cm to the fire. The longer the meat stays on the barbecue, the greater the risk of carcinogenic substance formation.
For patients who are not in risk groups, fecal occult blood screening should be performed starting from the age of 50, and for those over the age of 50, sigmoidoscopy should be performed at least every 5 years and thick colonoscopy should be performed every 10 years. It is recommended. Patients in the risk group; Patients who have had polyps removed before should have a colonoscopy again within 1-3 years after this procedure. Those whose close relatives, such as parents, have been diagnosed with colorectal cancer should start screening before the age of 40 or at the latest 8-10 years before the age at which the relative was diagnosed. Hereditary non-polyp Genetic testing should be done for colon cancer. People with the disease called familial adenomatous polyposis (FAP) should receive genetic counseling and be followed with a thick colonoscopy starting from the age of 10-15. People with breast and female genital organ cancer should have a thick colonoscopy periodically after the age of 40, and people with ulcerative colitis should have a thick colonoscopy periodically after diagnosis.
Diagnosis
Like other cancers, colorectal cancers do not cause symptoms until they grow well. Therefore, the aim should be to detect the tumor before there are any symptoms of cancer. Screening a person for cancer before symptoms develop helps in early recognition of polyps and cancer. Early recognition and removal of polyps can prevent colon cancer. When diagnosed early, treatment of colorectal cancer may be more effective. Therefore, people over the age of 50 should be monitored and people with an increased risk for colorectal cancer should be included in the screening program earlier.
Screening tests used in early diagnosis are:
Fecal occult blood test: Since cancers and polyps bleed, it is possible to detect a small amount of blood in the stool with this test. However, non-cancerous bleeding causes such as hemorrhoids may also cause a positivity in this test.
Finger examination of the rectum: The doctor lubricates the rectum with Vaseline and examines the rectum with his gloved finger.
Sigmoidoscopy: The rectum and the last 60 cm of the intestine, called the sigmoid colon, are visualized. If a polyp is detected, it allows it to be removed with a procedure called polypectomy.
Colonoscopy: The inner wall of the entire large intestine is visualized, and polyps, if any, can be removed.
Double contrast. barium colon radiograph: It allows showing the tumor with films taken after the white opaque substance is administered rectally. It is useful in showing large tumors, but is not as reliable as colonoscopy. For this reason, it is not used as much today as it used to be
New screening and diagnostic tests: New techniques are being tried for the detection of polyps and colon cancer. One of these is done on stool samples.
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