Colorectal Cancer Treatment in Delhi, India

Colorectal cancer, also known as bowel cancer, is a type of cancer that starts in the colon or rectum. The colon and rectum are part of the large intestine, which is the final portion of the digestive system responsible for absorbing water and electrolytes from undigested food and storing waste until it is eliminated from the body.

Colorectal cancer typically develops from precancerous polyps, which are abnormal growths that form on the inner lining of the colon or rectum. Over time, some polyps can become cancerous if they are not detected and removed early. Colorectal cancer usually progresses slowly, allowing for early detection and treatment in many cases.

Here's a breakdown of the different types of colorectal cancer:

• Adenocarcinoma: This is the most common type of colorectal cancer, accounting for over 95% of all cases. It starts in the glandular cells that line the large intestine and is the type of cancer usually referred to when discussing colorectal cancer.
• Less common types: While adenocarcinomas are the most prevalent, other rarer types of colorectal cancer exist. These include:
• Gastrointestinal stromal tumours: These gastrointestinal stromal tumours (GISTs) develop in the supportive tissues of the GI tract, and can occur in the colon or rectum.
• Carcinoid tumours: These slow-growing tumours develop in the hormone-producing cells of the GI tract and can also occur in the colon or rectum.
• Lymphomas: These cancers start in the lymph nodes, including those in the colorectal area.
• Melanomas: These skin cancers can rarely develop in the rectum.

Colorectal cancer doesn't have a single, clear-cut cause. It's more like a combination of factors that raise your risk of developing the disease. Here's a breakdown of the two main categories:

Genetic Mutations

These are changes in the DNA of cells lining the colon or rectum. They can be:

• Inherited: Passed down from a family member with certain genes like Lynch syndrome (HNPCC) or Familial Adenomatous Polyposis (FAP) which significantly increase colorectal cancer risk.
• Acquired: Developed throughout your life due to environmental factors like exposure to carcinogens.

Risk Factors

Certain lifestyle choices and conditions can increase your risk. These include:

• Age: Risk goes up as you get older, with most cases diagnosed in people over 50.
• Diet: A diet low in fibre and high in red meat, processed meats, and unhealthy fats can contribute.
• Weight: Being overweight or obese is a risk factor.
• Physical inactivity: A sedentary lifestyle increases risk.
• Smoking: Smoking cigarettes and tobacco use are significant risk factors.
• Heavy alcohol consumption: Excessive alcohol intake can raise your risk.
• Inflammatory bowel disease (IBD): Chronic conditions like ulcerative colitis or Crohn's disease that inflame the bowel lining for extended periods can increase risk, especially if present for many years.

How these factors work together

• Genetic mutations can disrupt how cells grow and divide, potentially leading to uncontrolled growth and cancer development.
• Lifestyle choices like diet and exercise can influence these mutations and overall colonic health.

Having a risk factor doesn't guarantee colorectal cancer, and some people with no risk factors can still develop it. However, it is still important to be aware of these factors and take steps to mitigate them as it can significantly reduce one’s risk of developing colorectal cancer.

Colorectal cancer can present with various symptoms, but in its early stages, it might not cause any noticeable signs. As the cancer progresses, symptoms may become more apparent. Common symptoms of colorectal cancer include:

• Changes in Bowel Habits: Persistent changes in bowel habits, such as diarrhoea, constipation, narrowing of the stool, or a feeling that the bowel does not empty completely, may occur.
• Rectal Bleeding: Blood in the stool or rectal bleeding, which may appear as bright red blood on toilet paper, in the toilet bowl, or mixed with stool, can be a sign of colorectal cancer. However, not all cases of rectal bleeding are due to cancer.
• Abdominal Discomfort: Abdominal pain, cramping, bloating, or discomfort that persists and cannot be explained by other conditions may indicate colorectal cancer.
• Unexplained Weight Loss: Unintentional weight loss that cannot be attributed to changes in diet or physical activity may be a symptom of colorectal cancer.
• Fatigue: Persistent fatigue, weakness, or a general feeling of tiredness that does not improve with rest may occur as a result of colorectal cancer.
• Iron Deficiency Anaemia: Low red blood cell count (anaemia) due to chronic blood loss from the tumour can lead to symptoms such as fatigue, weakness, pale skin, and shortness of breath.
• Abdominal Mass or Lump: In advanced stages of colorectal cancer, a palpable mass or lump may be felt in the abdomen.
• Nausea and Vomiting: Nausea, vomiting, and loss of appetite may occur if the tumour obstructs the digestive tract or causes other complications.
• Change in Stool Consistency: Changes in the consistency of stool, such as pencil-thin stools, may occur due to partial obstruction of the colon by the tumour.

It's important to note that these symptoms can also be caused by other, less serious conditions such as haemorrhoids, inflammatory bowel disease, or infections. However, if any of these symptoms persist or worsen, or if you experience any concerning signs, it's essential to see a healthcare professional for evaluation and appropriate testing.

In diagnosing colorectal cancer, healthcare professionals typically utilise a variety of methods to assess symptoms, screen for abnormalities, and confirm the presence of cancerous cells. Here's how the diagnosis of colorectal cancer typically proceeds:

Medical History and Physical Examination

The healthcare provider will begin by taking a detailed medical history, including symptoms, family history of cancer, and any relevant risk factors. A physical examination, including a digital rectal exam, may also be performed to assess for signs of colorectal cancer.

Diagnostic Tests

• Colonoscopy: Colonoscopy is considered the gold standard for diagnosing colorectal cancer. During this procedure, a flexible tube with a camera is inserted into the rectum and guided through the colon to examine the lining for polyps, tumours, or other abnormalities. If suspicious areas are found, a biopsy may be performed to collect tissue samples for further analysis.
• Flexible Sigmoidoscopy: Similar to colonoscopy, but focusing on the lower part of the colon (sigmoid colon) and rectum. It may be used as an alternative to colonoscopy in certain cases.
• Imaging Studies: Imaging tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans may be used to evaluate the extent of the cancer and determine if it has spread to nearby lymph nodes or other organs.
• Faecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT): These tests detect blood in the stool, which can be a sign of colorectal cancer or precancerous polyps. Positive results may warrant further evaluation with colonoscopy.
• Stool DNA Test: This test detects specific DNA markers associated with colorectal cancer and precancerous polyps. It may be used as an alternative to colonoscopy in certain cases.

Biopsy

If suspicious areas are identified during colonoscopy or imaging studies, a biopsy may be performed to collect tissue samples for microscopic examination. A pathologist will analyse the tissue samples to confirm the presence of cancerous cells and determine the cancer's stage and grade.

Staging

Once colorectal cancer is diagnosed, staging is performed to determine the extent of the cancer's spread. Staging typically involves imaging tests such as CT scans, MRI, or PET scans, as well as examination of lymph nodes and other tissues to assess for metastasis (spread) of the cancer.

Genetic Testing

Genetic testing may be recommended for individuals with a personal or family history of colorectal cancer or certain hereditary cancer syndromes to identify genetic mutations associated with increased cancer risk.

Colorectal cancer treatment varies depending on the stage of cancer, its location, and the overall health of the patient. Here are some common treatment modalities:

Surgery

Surgery is often the primary treatment for localised colorectal cancer. It involves removing the tumour along with nearby lymph nodes and surrounding tissue. The type of surgery depends on the tumour's location and size. In some cases, minimally invasive techniques such as laparoscopic or robotic-assisted surgery may be used.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. It may be given before surgery (neoadjuvant chemotherapy) to shrink the tumour, after surgery (adjuvant chemotherapy) to reduce the risk of recurrence, or as the primary treatment for advanced colorectal cancer.

Radiation Therapy

Radiation therapy uses high-energy beams to target and destroy cancer cells. It may be used alone or in combination with chemotherapy, either before or after surgery. Radiation therapy is often used to shrink tumours, relieve symptoms, or improve the effectiveness of other treatments.

Targeted Therapy

Targeted therapy drugs target specific molecules or pathways involved in cancer growth. Drugs like cetuximab and bevacizumab may be used in combination with chemotherapy to treat advanced colorectal cancer. Targeted therapy can be particularly effective in tumours with specific genetic mutations.

Immunotherapy

Immunotherapy works by boosting the body's immune system to help it recognize and attack cancer cells. Drugs such as pembrolizumab and nivolumab may be used to treat advanced colorectal cancer that has certain genetic mutations or has not responded to other treatments.

It's essential for patients to work closely with their healthcare team to develop a personalised treatment plan that takes into account their specific cancer characteristics, overall health, and treatment goals. Early detection, timely intervention, and ongoing support are key to improving outcomes and quality of life for individuals with colorectal cancer.

Colorectal cancer prevention involves several strategies aimed at reducing the risk of developing this type of cancer. Here are some key approaches:

• Regular screening tests like colonoscopy detect colorectal cancer early when it's most treatable. Discuss screening guidelines with your healthcare provider.
• Maintain a balanced diet rich in fruits, vegetables, and whole grains. Exercise regularly and avoid smoking and excessive alcohol consumption.
• Strive to maintain a healthy weight through diet and exercise to lower your risk.
• Limit alcohol intake to moderate levels or avoid it altogether. Quit smoking to reduce your risk.
• Some research suggests aspirin or NSAIDs may lower colorectal cancer risk, but consult with a healthcare provider first.
• Effective management of inflammatory bowel diseases like Crohn's disease and ulcerative colitis can help reduce the risk.
• Individuals with a family history of colorectal cancer may benefit from genetic counselling and testing to inform personalised prevention strategies.

Incorporating these measures into your lifestyle and seeking regular medical care can reduce your risk of colorectal cancer and improve overall health.

Can colorectal cancer be prevented completely?

While it's not always preventable, early detection through screening can greatly reduce risk and improve outcomes.

Is colorectal cancer hereditary?

In some cases, genetic factors can increase the risk, but most cases occur sporadically without a family history.

How often should I have a colonoscopy after a polyp removal?

Recommendations vary, but generally every 3 to 5 years, depending on the number and type of polyps removed.

Can I continue to work during colorectal cancer treatment?

It depends on treatment intensity and individual health, but many people find ways to continue working with accommodations.

Is there a link between colorectal cancer and certain lifestyle factors?

Yes, factors like smoking, excessive alcohol consumption, obesity, and a sedentary lifestyle can increase risk.

Can colorectal cancer metastasize to other parts of the body?

Yes, it can spread to nearby lymph nodes, liver, lungs, or other organs, which can affect treatment options and prognosis.

How can I support a loved one diagnosed with colorectal cancer?

Offer emotional support, help with daily tasks, accompany them to appointments, and encourage them to seek support groups or counselling.

Are there any clinical trials available for colorectal cancer treatment?

Yes, there are ongoing clinical trials testing new treatments and therapies for colorectal cancer. Discuss with your healthcare provider.

Can certain foods increase the risk of colorectal cancer?

Some studies suggest a link between red and processed meats, high-fat foods, and an increased risk, but more research is needed.

Can colorectal cancer affect young adults?

While less common, colorectal cancer can occur in younger adults, so it's essential to be aware of symptoms and risk factors regardless of age.

What are the stages of colorectal cancer?

Colorectal cancer is typically staged from stage 0 (early) to stage IV (advanced). Staging helps determine the extent of cancer spread and guides treatment decisions.

What is stage 0 colorectal cancer?

Stage 0 colorectal cancer, also known as carcinoma in situ or colorectal intraepithelial neoplasia (CIN), is the earliest stage, where cancerous cells are confined to the inner lining of the colon or rectum.

What is stage I colorectal cancer?

Stage I colorectal cancer indicates that cancer has grown through the inner lining of the colon or rectum into deeper layers, but has not spread beyond the wall of the colon or rectum.

What is stage II colorectal cancer?

Stage II colorectal cancer indicates cancer has spread beyond the colon or rectum wall into nearby tissues or organs, but has not yet spread to nearby lymph nodes or distant organs.

What is stage III colorectal cancer?

Stage III colorectal cancer suggests cancer has spread to nearby lymph nodes but has not metastasized to distant organs.

What is stage IV colorectal cancer?

Stage IV colorectal cancer is the most advanced stage, indicating cancer has spread to distant organs or tissues, such as the liver, lungs, or other parts of the body.

Are there specific dietary guidelines recommended for colorectal cancer survivors?

Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limiting red and processed meats, alcohol, and high-fat foods is beneficial for overall health and reducing the risk of cancer recurrence.

How can colorectal cancer survivors cope with long-term side effects of treatment?

Seek support from healthcare providers, participate in survivorship programs or support groups, adopt healthy lifestyle habits, and explore complementary therapies like acupuncture or massage.

What resources are available for individuals seeking financial assistance or support during colorectal cancer treatment?

Various resources, including nonprofit organisations, patient advocacy groups, government programs, and hospital financial assistance programs, provide financial assistance. Social workers or financial counsellors at healthcare facilities can offer guidance and support.

Can colorectal cancer affect fertility or reproductive health?

Colorectal cancer and its treatment may impact fertility and reproductive health. Discuss options with healthcare providers before starting treatment, especially if concerned about fertility preservation.

How can family members and caregivers support a loved one diagnosed with colorectal cancer?

Provide emotional support, help with daily tasks, accompany to medical appointments, and encourage participation in support groups. Caregivers should prioritise self-care and seek support from healthcare professionals or support groups to prevent burnout.

Reviewed by Dr. Himanshu Shukla, Senior Consultant - Surgical Oncology, Cancer Care / Oncology, Head & Neck Oncology, Gastrointestinal & Hepatobiliary Oncology, Gynecologic Oncology, Musculoskeletal Oncology, Robotic Surgery, Breast Cancer on 8-April-2024.

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