Cancer is a morbid topic for any discussion but only by keeping this affliction on the front burner can we ever hope to control its widening incidence. With the exception of cardiovascular events, cancer is the greatest killer of Canadians annually. It does not discriminate by gender, age, or ethnicity. Some forms attack in our youth, some in our senior years but too many attack in our prime. What is cancer? Plainly described it is an accelerated growth of the body’s cells along abnormal and dysfunctional lines the result of either genetic flaws such as the familial occurrence of bowel and breast cancer or external triggers such as the carcinogens in cigarettes. Cancer crosses all socioeconomic lines striking the impoverished equally with those aspiring to lead us. Case in point. Bowel cancer. It is diagnosed in a ratio of 3:2 men vs women. About 1 in 12 men will acquire bowel cancer in their lifetime and half of these will be fatal. For women, the statistic is 1 in 16 and half of these too will die. Bowel cancer or colorectal cancer as it is classified medically is described in “stages” with stage 0 limited to the inner surface of the bowel usually in the form of a polyp. In stage 1, the cancer has invaded the lining of the bowel but not through the muscle layer of the wall. In stage 2, the cancer has penetrated the muscle layer spreading in to nearby tissue but not yet to or in to the lymph nodes. Stage 4 is invasive to the lymph nodes and finally in stage 5 the cancer has metastasized to other major organs such as liver and lungs. Clearly, it behoves us to diagnose this affliction before the latter stages are reached. The large intestine in humans is approximately NINE feet in length terminating with the rectum at the anus. Colon cancer in its initial stages is silent and buried deep in the mass of abdominal tissues so how do we diagnose this hidden threat? First and foremost is family history. Colon cancer in grandparent, parent or sibling is always a red flag. So is a history of long term smoking and or alcohol use. People of both genders with a protracted history of inflammatory bowel diseases historically have a significantly elevated risk level. Clues to an evolving problem may be a subtle but persistent change in bowel habits especially narrowing of the stool or a sensation the bowel has not completely emptied. Blood, which may be bright red if the lesion is lower, or darker even black if the cancer is higher is always a red flag. Any persistent abdominal pain accompanied by bloating, cramping and alternating constipation then looser stools is another clue. In the early stages the first clues may be unexplained fatigue and/or weight loss possibly vomiting if the bowel becomes obstructed.
Colon cancer is unlikely to be found on physical examination in its early stages. Rectal examinations have minimal value except to differentiate the “rectal fullness” in men with enlarged prostates because the majority of cancers are more than a finger’s length from the bowel end. The GOLD STANDARD for bowel examination and biopsy is the colonoscopy usually done as an outpatient procedure with an intravenous hypnotic for anaesthesia and relaxation. If colon cancer runs in your family, colonoscopy may be recommended by your physician in mid thirty range. For the general population, mid forty is a safe starting point with a 5 to 10 year follow up dependent on risk factors. COLON cancer is the third commonest cancer in Canada and the second commonest fatal form. Don’t become one of these statistics. Heed the warning signs.
Dr. David Carll