Colorectal cancer is one of the most treatable cancers when detected early, yet many Filipinos delay screening despite medical experts warning that early diagnosis can save lives.

What do Chadwick Boseman, Farrah Fawcett, Jack Lemmon, Robin Gibb, Eartha Kitt, Hajji Alejandro, Chinggoy Alonso, Chat Silayan, Charlie Davao, Letecia Ramos-Shahani, and Cory Aquino have one thing in common? They all died of colon cancer, that’s what.

Colon cancer is commonly recognized as a disease that impacts the colon (large intestine); however, it frequently also involves the rectum (the final straight segment of the large intestine). Consequently, the medical community refers to it as colorectal cancer (CRC).

Recent reports showed the CRC is the third most common cancer among Filipinos – after breast and lung. However, in contrast to these two types of cancer, CRC is not frequently addressed in public discussions. 

“Among cancers, CRC stands out as a disease that can be largely prevented, but few people believe it will happen to them,” said Dr. Atenodoro Ruiz, Jr., a gastroenterology consultant at St. Luke’s Medical Center and a diplomate of the American Board of Internal Medicine in Gastroenterology and of the Philippine College of Physicians in Internal Medicine.

If discovered early, CRC is preventable and treatable.  “If it is early stage and localized within the colon, the cure is 100 percent,” said Dr. Ruiz.  “If it had spread to lymph nodes or distant organs, the 5-year survival rate is much lower.”

Colon and rectal cancers begin in the digestive system, also called the gastrointestinal system. The digestive system processes food for energy, and the last part of it absorbs fluid to form solid waste (stool) that then passes from the body.

The American Cancer Society (ACS) shares this information on how the digestive system works:  “After food is chewed and swallowed, it travels to the stomach. There it is partly broken down and sent to the small intestine.”  The small intestine is the longest part of the digestive system – about 20 feet.

“The small intestine also breaks down the food and absorbs most of the nutrients.  It leads to the large intestine (also called the large bowel or colon),” the ACS explains.  “The colon absorbs water and nutrients from the food and also serves as a storage place for waste matter. The waste matter moves from the colon into the rectum, the last 6 inches of the digestive system.  From there, the waste passes out of the body.”

Cancer that starts in these different areas may cause different symptoms. But colon cancer and rectal cancer have many things in common. In most cases, colorectal cancers develop slowly over many years.

No one knows what causes CRC.  “Epidemiologic, human case-control, and animal studies support a strong association between colon cancer and a diet that has high-fat (usually saturated fat), low fiber, and high red meat consumption,” Dr. Ruiz said.

Risk factors that predispose a person to develop colon and rectal cancer include age, personal history of adenoma or carcinoma, family history of CRC, and pre-existing diseases, like inflammatory bowel disease.

“Age 50 is the most common risk factor for CRC as 90% of cancers occur after the age of 50,” said Dr. Ruiz.

Several lifestyle-related factors have been linked to colorectal cancer.  These include smoking, obesity, lack of physical activity, and alcohol intake.

In the past, CRC has been referred to as “a disease of the rich.”  But such is not the case anymore.  “(CRC) is more common in richer countries, but its incidence is rising in some developing countries,” the Geneva-based World Health Organization (WHO) reports.  “The risk of developing those cancers that are typical of higher socioeconomic groups – cancers of the breast, colon, and rectum – can be expected to increase with economic development.”

CRC tends to grow slowly and may be asymptomatic for years, according to Dr. Ruiz. “Afflicted persons often have occult blood loss from their tumors, before they complain of symptoms. They can present with rectal bleeding and anemia, leading to fatigue, shortness of breath, and weight loss,” he said.

Dr. Ruiz said cancers of the right colon tend to grow larger than those of the left colon before symptoms occur.  “Obstructive symptoms, like colicky abdominal pain, vague abdominal discomfort, change in bowel habits or stool caliber, and constipation, are found in advanced cases,” he added.

Early detection of the dreaded disease can be achieved by screening tests. “CRC screening has resulted in reduction of related mortality up to 60-70%,” Dr. Ruiz said.  “All methods have been proven to be cost-effective.”

As a gastroenterologist who advocates colorectal cancer screening, Dr. Ruiz recommends a screening colonoscopy in individuals between 50 to 75 years of age who are relatively healthy, and wherein the benefits of a colonoscopy outweigh the risks associated with the procedure.

“The patient has to understand that it requires a rigorous bowel preparation, and has more risks compared to the other alternative,” he explained.  “The FIT is recommended to patients who may be at high risk for complications of a colonoscopy, or not willing to undergo a colonoscopy yet because of a variety of reasons.”

A positive FIT will need to be followed up with a colonoscopy, and a negative FIT result will require repeated testing annually.  “FIT is a stool test for occult blood that comes from colon lesions, and is an alternative for colonoscopy as screening method, especially if colonoscopy is not available,” Dr. Ruiz said.

“The key here is screening patients who are already at risk for colon cancer, including patients who are 50 years or older,” Dr. Ruiz continues. “Patients may already have early cancer, even if they have no symptoms. We can also reduce the risk of colon cancer by removing pre-cancerous lesions (polyps) during a colonoscopy.  In the end, CRC screening can just save your life or the life of a loved one.”

Text and photographs by Henrylito D. Tacio