سرطان القولون والمستقيم: أسئلة تطرحها على طبيبك

Colorectal cancer is a type of cancer that starts in the colon or rectum. Depending upon the exact location of cancer, they can be termed as colon cancer or rectal cancer; however, they are usually grouped together as they share some common features. 

Studies show that the prevalence of colorectal cancer is on the rise in recent years. As of 2020, it was estimated that there are 1.93 million new cases of colorectal cancer globally and 0.94 million deaths due to the same.  As of 2020, colorectal cancer has been identified as the third leading cause of cancer-related deaths in both genders worldwide. As several factors affect the risk of developing colorectal cancer, it is noted that the overall lifetime risk of developing it is about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for men.

To help you understand this particular type of cancer better and ask your doctor the right questions in case of a diagnosis, read on-

Understanding colorectal cancer

Before we learn how colorectal cancer develops, let us try to get a clearer picture of our digestive system. The colon is a muscular tube that is about 1.5 meters long which is divided into 4 sections. The fourth section, called the sigmoid colon joins the rectum, which then joins the anus. As part of the digestion process, the colon is tasked with the absorption of water and salt from the food matter that passes through it. The waste matter from the colon goes into the rectum, where it is stored until it is passed through the anus. A ring-shaped sphincter muscle found around the anus keeps the stool from coming out until it is relaxed during a bowel movement.

Proctologists note that most colorectal cancer starts as a growth, known as a polyp, on the inner lining of the colon or rectum. With time, some types of polyps turn malignant or cancerous. For instance, adenomatous polyps or adenomas are pre-cancerous polyps that have a higher chance of changing into cancer. On the other hand, certain types of polyps are more common than others. Hyperplastic polyps and inflammatory polyps are two such growths that are not considered precancerous. However, Proctology doctors generally recommend a follow-up colonoscopy for people with larger hyperplastic polyps, especially if they have serrated features. Of the different types of polyps, sessile serrated polyps cause the highest risk of colorectal cancer and are generally treated like adenomas.

So when are proctologists concerned that a polyp is cancerous or has a high chance of turning  malignant ? Usually, in case of polyps that are larger than 1 cm, multiple polyps (3 or more) or in the presence of dysplasia (the lining of colon or rectum showing abnormal cells) after polyp removal, individuals are considered to be at a higher risk of developing cancer. Dysplasia especially is considered precancerous. 

Once cancer forms in a polyp, it tends to grow and spread into the wall of the colon or rectum if left untreated.  Colorectal cancer starts in the innermost layer of mucosa, growing outward through the many layers of the colon or rectum. Over time, the cancerous cells spread into the blood or lymph vessels from the colon wall. As these vessels are spread throughout the body, the cancer cells find it easier to spread to the other parts of the body through the lymph or blood vessel network.

Just like various polyps can develop cancer, different types of cancer could affect the colon or rectum. The cancers are usually named for the organs or tissues where they form. In the case of colorectal cancer, the common ones are the adenocarcinomas that start in mucus-producing cells in the colon or rectum. There are less common types of tumors like carcinoid tumors, gastrointestinal stromal tumors, lymphomas, and sarcomas that can affect the colon and rectum.

Getting a diagnosis

Over the years, some of the best proctologists in the country have noted that men and women are at higher risk of developing colorectal cancer if they are older than 50. Other risk factors include a personal or family history of colorectal cancer or polyps, presence of inflammatory intestinal conditions, or some inherited syndromes such as familial adenomatous polyposis (FAP) and Lynch syndrome. Additionally, experts note that people who are diabetic, obese, eat a low fiber diet, lead a sedentary lifestyle, smoke, and drink alcohol are also at risk of developing colorectal cancer.

In most cases, developing cancer can manifest with changes in bowel habits such as persistent diarrhea or constipation or a visible change in the consistency of your stool. This can be associated with abdominal pain, rectal bleeding and a feeling that your bowels do not empty. Patients may also complain of fatigue, weakness, and unexplained weight loss as cancer progresses. Unfortunately, people rarely experience any symptoms in the early stages of colorectal cancer, making it harder to get an early diagnosis. To combat this issue, proctology doctors often recommend high-risk individuals to undergo cancer screening. If you are at risk, your proctologist will order an endoscopy procedure or colonoscopy to detect the presence of polyps or precancerous growths in your digestive system. If polyps are found, the tissue (biopsy) is collected during the endoscopy/ colonoscopy and sent to the pathologist that will confirm or rule out the presence of cancerous cells.

Questions to ask your proctologist

Getting a cancer diagnosis can be overwhelming to many considering the nature of the disease. In any case, having cancer doesn’t immediately mean that your days are numbered. Early diagnosis, treatment, and management can increase your chances of survival. Studies show that the 5-year relative survival rate for colon cancer (localized) is 91% and for rectal cancer, it is 89%. If you get a diagnosis of colorectal cancer, the first thing you must do is to calm down and collect as much information as possible regarding the diagnosis, possible treatments, and expected results. To help you get the right information, here are some sample questions you can ask your proctologist on getting a colon or rectal cancer diagnosis.

• Understand your condition

1. Where is the cancer located?
2. Does cancer seem to be spreading?
3. What is the extent (stage) of cancer? What does it mean?
4. Do I require more tests to determine the best course of treatment?
5. Do I need to see other specialists regarding existing health concerns before starting treatment?
6. How will this diagnosis affect my life? Will I have to pause on other aspects of my life such as my job, daily routines, exercises, etc.?
7. Should I get a second opinion? 
8. Are there any support services available for me and my family?
9. Who will be leading my treatment?
10. Whom should I call in case of questions or concerns?

• Deciding on a treatment

1. What are my treatment options?
2. What do you recommend and why?
3. What is the goal of the treatment? What is the ideal outcome?
4. How should I get ready for the treatment?
5. How long will the treatment last? What will it be like?
6. How will I know that the treatment is working? 
7. Should I go on a specific type of diet during the treatment? Can I exercise during this time?
8. Will I have to stay in the hospital for my treatment? Or will it be on an outpatient basis?
9. Will this treatment affect my sex life? If so, for how long?
10. Will this treatment affect my ability to have children? Should I consult with a fertility specialist regarding the same?
11. How much experience do you have in treating and managing this type of cancer?
12. What are the chances that I will be cured of cancer after the recommended treatment?
13. What would be my options if cancer comes back even after the treatment?
14. Will I require surgery as part of my treatment? Can you describe the surgery I will be having?
15. What are you planning to remove during surgery? The colon, rectum, or lymph nodes?
16. Is a biopsy part of the surgery?
17. Will I require an ostomy? If so, will it be temporary or permanent? Who will help me teach to take care of it?
18. What will my recovery from surgery look like? How will my pain be controlled after the surgery?
19. Should I expect any side effects after the surgery?
20. I am worried about managing the treatment costs. Who can help me?

• After the treatment

1. Are there any limits on my daily routines and diet?
2. Are there any symptoms I should watch out for? How will I know if the cancer is recurring?
3. What kind of exercises should I do now?
4. What are the follow-ups that I need?
5. How often should I get an endoscopy/ colonoscopy?
6. Will I have other follow-up exams and tests? If so, how often should I get them done?
7. Are there any long-term or late effects after the treatment that I should be aware of?
8. Do I need to follow up care after 5 years? If so, how often?
9. How do I get a treatment summary and survivorship care plan to keep in my records?
10. Who should I reach out to in case of doubts regarding follow-up care?

These are some of the common questions that many patients have before, during, and after their cancer treatment. To get more personalized information, feel free to add more questions to this list to ask your proctologist. Also, remember that your proctology doctor alone is not the one who can give you the right answer. Take your questions to your oncologist, general surgeon, nurses, radiologists, and all other health care professionals who are involved in your case to get the most information regarding your condition and treatment. At the end of the day, making well-informed decisions will empower you as a patient and help you stay strong and mindful in your journey to recovery.

Looking for more information regarding colorectal cancer screening? Book your appointment with Dr. Antonio Privitera, renowned speaker and leading proctologist in Dubai today.