Written By: Prerna Mittra | Updated : November 1, 2023 7:31 PM IST
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Colorectal cancer (CRC) is one of the most common malignancies in the world. It is the fourth most common cancer among men in India, according to the Global Cancer Observatory (GLOBOCAN) data 2020.
Dr K. S. Somasekhar Rao, senior consultant gastroenterologist, hepatologist and advanced therapeutic endoscopist, Yashoda Hospitals Hyderabad points out that though the overall estimated numbers are low for a population of over 1.3 billion, the absolute numbers are "alarming".
"To add to this, the median age across multiple series is 50 years, which is less as compared to the Western patient population. A large database from a tertiary care hospital from southern India showed that the rectum (42 per cent) was the most common site, followed by rectosigmoid (21 per cent), colon (20 per cent), and anorectum (13 per cent)," he shares.
According to the doctor, a majority of these cases present in advanced stages. "The combination of delayed presentation and poor prognosis is not acceptable in a cancer that is largely preventable with effective screening methods," he says.
Dr Rao states that in the US, due to the adoption of screening, the incidence and mortality is reduced in the elderly population. "But, a worrisome epidemiological change is witnessed. Incidence of colon cancer among the younger population (<50 years) has increased by 63 per cent from 1988 to 2015 in the US; there has been an increase in mortality in this age group."
The doctor explains that rising incidence is largely due to change in diet patterns. "Western diet is enriched in red meat, processed sugars, refined grains, high sugar-containing drinks, lack of physical exercises, obesity, and smoking."
Hereditary non-polyposis colon cancer (Lynch syndrome) contributes to <5 per cent in the West, he adds. "Its prevalence in India is 10 15 per cent, higher than the Western world. The relative risk of colon cancer for overweight (body mass index [BMI] 25 29.9) individuals is 1.2 1.5 and for obese (BMI >30) individuals, it is 1.5 1.8."
According to the expert, alcohol consumption of more than 30 g/d is another risk factor.
"Early initiation and consumption of large quantities of alcohol are characteristics found in the growing Indian population. Along with this, adopting food habits and lifestyle patterns from the West is going to increase the incidence of CRC in India. Health awareness and screening can reduce the burden of this disease," he points out.
Symptoms are shared by other benign conditions like hemorrhoids, inflammatory bowel disease, and irritable bowel disease, such as blood in stool, either mixed with stools or separate from stools, altered bowel habits (a change in normal bowel habits should always be addressed), pain in the abdomen, loss of appetite, loss of weight.
"Screening with colonoscopy can detect colon cancer early. Polyps are removed, which otherwise take 10-15 years to develop into carcinoma. Polyps can be adenomatous, hyperplastic and inflammatory, or hamartomatous. Not all adenomas develop into cancer. Adenomatous polyps of >10 mm are at the highest risk for cancer transformation.
"Colonoscopy is a safe method of screening. It has proven survival benefits," he explains.
In conclusion, the doctor says that there are no formal screening guidelines on CRC in India. "There is a need to raise awareness on the rising incidence of colon cancer in younger people. Reducing the risk factors and adoption of a healthy lifestyle will reduce the cancer burden.
