Colon cancer awareness

1
Colon Cancer Awareness Month March every
year(WHO earmarked)

• Dr. Gurbilas P. Singh, FRCP (London)
• Gastro Physician in Chandigarh
• Endoscopist in Chandigarh
• Endoscopy services in Chandigarh

2
Indian population

• Largely remains rather non-aggressive in their
  attitudes towards health related issues
• Lack of awareness despite improving diagnostic
  and healthcare facilities
• The main reason for this seems to be the cost
  services are placed at.

3
Rectal bleeding and its management Indian
scenario

• Hide this symptom from all
• Finally when it stops there is a sigh of relief
  and it is never mentioned until it recurs.
• Speaks to a General Physician or a Gastro
  Physician.
• The number of episodes will decide how many
  physicians or surgeons see this patient (without
  doing a physical examination including a digital
  rectal examination) in their busy clinics.
• Some practitioners will point towards a
  colonoscopy
• The person sees an Endoscopist who offers a
  colonoscopy. The patient either never returns or
  dilly dallies.

4
Rectal bleeding UK scenario

• A person with rectal bleeding goes to his General
  Physician usually promptly.
• Assessed with blood tests as well as a digital
  rectal examination or even a rigid sigmoidoscopy.
  
• Referred to an endoscopy clinic to be seen asap
  (generally within 2 weeks) for a flexible
  sigmoidoscopy or a colonoscopy.
• A diagnosis is hence generally made and acted
  upon promptly if something needs doing.

5
Colon Cancer

• Affecting men and women almost equally.
• Third most common cancer in the world and fourth
  most common cause of death.
• Worldwide, it accounts for 9 of all cancers.
• High incidence areas are North America
  (particularly USA and Canada) and Australasia.
• Low incidence areas include China, India, Africa
  and South America.

6
Colon Cancer declining !?

• Incidence of colon cancer is declining steadily
  at the rate of over 2 per year since 1998
  because of screening programmes offering
  colonoscopy (lower gastrointestinal endoscopy)
  which in turn improves the detection of
  precancerous polyps.
• The overall burden of disease remains high and
  there is a change noted in demographics with
  Afro-Caribbean population now having a higher
  rate of incidence as compared to the white
  population. Interestingly the trend is opposite
  to what it was before 1980s.
•  The developed world accounts for well over 60
  of the cases but these rates are probably
  susceptible to ascertainment bias given the under
  reporting in developing countries.

7
Non modifiable factors

• Age
• Personal history of Adenomatous polyp
• Tubular and villous adenomata
• Personal history of Inflammatory Bowel Disease
  (upto 20 fold increased risk of colorectal
  cancer)
• Family history of Colorectal Cancer or
  Adenomatous Polyps
• (Two or more first degree relatives or one under
  the age of 60 years with history of cancer or
  polyps increase the risk strongly)
• Inherited Genetic Risk
• (Familial Adenomatous Polyposis and Hereditary
  Non Polyposis Colorectal Cancer have been linked
  to the genes and mutations.)

8
Modifiable factors

• Enviromental risk factors
• These include a wide range of vague cultural,
  social or lifestyle factors and interestingly it
  has been found that a migrant from low risk area
  would automatically pick up the risk of local
  population where one resides. These environmental
  factors become important as they are modifiable
  and theoretically should help in prevention. The
  incidence is higher in urban population,
  particularly in males and for colon rather than
  rectal cancer.

9
Modifiable factors

• Dietary factors - A diet high in fats and
  meats/animal products is known to increase the
  risk of colon cancer. Also a diet low in fruits
  and vegetables is also linked to it. This may
  signify that a high fibre diet which dilutes
  farcal content, increases bulk and reduces
  transit time is protective.
• Cigarette smoking - Whereas it is bad for health
  generally it is known to form and increase the
  size of the polyps (larger polyps are found in
  smokers). An earlier average age of having colon
  cancer is noted in smokers.
• Heavy alcohol consumptionAcetaldehyde, a
  metabolite of alcohol, can be carcinogenic. Also
  such individuals may have poor diet.
•  

10
Volume of problem

• Oesophageal Cancers 26,( M 13, F 13),
  Average age 58 years
• Stomach cancer 9 (M 5, F 4), Average age
  58.55 years
• Colon cancer 20 (M 9 , F 11 ), Average age
  54.55 years

11
Colon Cancer Awareness duty of all Gastro
Physicians, Endoscopists and other healthcare
workers

• This clearly depicts that colon cancer is not a
  rare entity and it is very important to highlight
  this point to catch the disease early to save
  lives. It is our duty to highlight this with the
  month of March, which is earmarked as the Colon
  Cancer Month by WHO, approaching.