Colorectal cancer

How common is colorectal cancer?

It is the third most common cancer worldwide and the third most common cause of cancer death in both men and women. It is estimated that 1 in 22 men and 1 in 24 women will develop colorectal cancer in their lifetime.

Who are more likely to get colorectal cancer?

Most patients are diagnosed at the age of 60-65 years. In about 15% of patients there is a defect in a gene that is responsible for the development of the tumour, usually at a young age. The risk increases with age and with certain dietary habits associated with the western lifestyle. Studies conclude that a diet rich in red meat and animal fats and poor in dietary fibre predisposes to the development of colorectal cancer. Smoking, alcohol consumption, obesity, sedentary lifestyle and family history are also considered aggravating factors. People who have polyps in the bowel are at high risk of developing cancer, so bowel polyps should be removed. In addition, the risk is significantly increased in patients with ulcerative colitis and in those with familial adenomatous polyposis.

Is there a screening (check up) for colorectal cancer?

Because of the high incidence of colorectal cancer, scientific societies recommend that the general population should have a colonoscopy after the age of 50 and then, if there are no findings, every ten years, as well as a stool test annually for microscopic bleeding. In this way, it is possible to diagnose benign polyps before they develop into cancer, and to find early stage cancers where a cure is possible. If someone is in a high-risk group, they will need screening at a younger age and more regularly.

Are there any symptoms indicative of colorectal cancer?

The symptoms of colorectal cancer vary depending on the location of the tumour. Tumours located in the right part of the colon (right colon) sometimes present vague abdominal pain. More common is iron deficiency anaemia due to prolonged small blood loss from the tumour, which is not noticeable on stools, but which may be seen in the form of tarry stools (black stools). Cancer in the left colon usually causes abdominal pain with fluctuations (colic) and alternating stools (episodes of diarrhoea alternating with episodes of constipation). Loss of blood from the rectum and admixture of stool with blood is also common.

What tests does a patient with suspected colorectal cancer undergo?

If cancer is suspected, it is necessary to perform an endoscopic colonoscopy of the colon after appropriate preparation and take a biopsy of pathological lesions.

How is colorectal cancer diagnosed?

The definitive diagnosis of the disease will be made by histological examination of the lesion obtained by biopsy.

After a diagnosis of colorectal cancer, what happens next?

Staging of the disease (i.e. determining the extent of the disease, which precedes the treatment plan) is implemented by CT and/or MRI scan of the abdomen and CT scan of the chest and sometimes by PET-CT scan.

What is the carcinoembryonic antigen (CEA)?

The CEA cancer marker (carcinoembryonic antigen) is a protein that in many cases is produced by colon tumours and can be measured by blood test. However, it is not considered a reliable marker for diagnosing the disease, because on the one hand many cancer patients present perfectly normal CEA values, and on the other hand CEA may be elevated in other diseases, such as pancreatitis and inflammatory bowel diseases. Its main utility is as an indicator of response to treatment in cases where it was elevated at the diagnosis of the disease.

Do all colorectal cancer patients receive the same treatment?

The treatment plan is always determined by the stage of the disease and the patient’s general health condition. Thus, approach to each patient is individualized.

What is the therapeutic management of patients with early and locally advanced colorectal cancer?

In patients with early or locally advanced colorectal cancer, surgical resection of the tumour along with part of the bowel is indicated, usually followed by chemotherapy. In particular, depending on the size and other characteristics of the tumour (degree of differentiation, lymph node infiltration or not), it is decided whether the patient should receive adjuvant chemotherapy or chemo-radiotherapy in the case of rectal cancer.

What options are available if the disease cannot be treated surgically?

In cases of metastatic cancer, surgical cancellation of the tumour is only performed for palliative reasons (e.g. in bleeding tumours or to prevent bowel obstruction). Treatment options for advanced stage patients include chemotherapy, radiotherapy (mainly for anorectal cancer) and targeted therapies.