Colon cancer and its management

In recent past, many of our young Nigerians have died or have been hospitalised due to colon cancer. We then ask the question, why?

Nobody likes to talk about bowel movements or cancer and nobody likes to get a colonoscopy, but according to the American Cancer Society, “Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women.” So, that makes it worth talking about. Even though some people find it embarrassing, it is important to become knowledgeable about colon cancer and testing for colon cancer.

According to Graham and Adeloye, the crude incidence of colorectal cancer (CRC) in sub-Saharan Africa has been found to be 4.04/100,000 population (4.38 per cent for men and 3.69 per cent for women). However, that of Nigeria has been estimated at 3.4 per 100,000 population.

Studies by Aliyu, S. and his group showed that there is an evident increase in the incidence of CRC in the North -East of Nigeria, like the rest of the country, with male preponderance and rectal cancer predominance.

Colorectal cancer is the third leading cause of cancer death and the third most common cancer in both sexes and the rates are rising alarmingly. This form of cancer doesn’t get the media attention that breast cancer, for example, does but it is more common and just as deadly. Even when it doesn’t kill, the consequences of bowel surgery can compromise the quality of life.

Although a family history of colon cancer increases the risk of colon cancer, it is estimated that 75 per cent of colon cancers occur in people who are 50 or older who have no family history. Most colon cancers originate in polyps found in the colon. These polyps are usually benign (not cancerous) but can become cancerous. Having a lot of polyps in the colon is a risk factor for colon cancer.

A colonoscopy is a colon cancer screening that checks for polyps in the colon and rectum. However, doctors tend not to recommend a colonoscopy as often as they should because of the embarrassment factor and because a colonoscopy is invasive and uncomfortable: a flexible tube with a tiny camera on it is inserted into the rectum and pushed up into the colon in order to look for polyps and other signs of cancer. There’s also an attachment that can snip off polyps if the doctor thinks this is necessary.

Despite the discomfort and embarrassment associated with a colonoscopy, everyone should have one when they turn 50, 60 and 70 years old.

There is another way to test for colon cancer. It is not as direct a test as a colonoscopy and it is not a substitute for a colonoscopy, but it is one that more people are willing to do more often, particularly since it is inexpensive and easy to do.

One of the most common warning signs of colon cancer is blood in the stool. However, there may not be enough blood visible until colon cancer is advanced. That is where the EZ Detect test comes in. It is a simple, inexpensive test that can detect even very small amounts of blood in the stool, and it is available over the counter for home use. These types of tests are called Fecal Occult Blood Tests.

Colon cancer has a 90 to 95 per cent cure rate when detected early. Many people have no symptoms until the cancer is advanced and that’s what makes it so deadly. Colon cancer is known as the “silent killer”.

Unfortunately, colon cancer rates are steadily rising. Early diagnosis (prior to symptoms) could save 90 per cent of people who die of colon cancer. Therefore, everybody should undertake early diagnostic tests.

If one waits until suggestive symptoms occur (blood in the stool, irregular bowel movements, pain, weight loss), the colon tumor is likely to be advanced and cure much less likely. Obviously, what is needed is a better, less intrusive, less expensive screening test for colon cancer. The Fecal Occult Blood Test can detect hidden blood in the stool, one of the first symptoms of colon cancer and they can be done at home once a year or more if you have colon cancer in ýour family. But by far, our best option is prevention. Fortunately, we know a lot about prevention. Diet is probably most important. Let’s take a closer look.

Eating to prevent colon cancer

In a nutshell, to prevent colon cancer, we need to increase our fiber intake, eat a variety of fresh vegetables, maintain good levels of antioxidants, avoid processed foods, drink plenty of good water and get some exercise. All of these factors have shown up again and again as preventive measures in studies of colon cancer. Exercise has been shown to prevent colon cancer more than any other cancer.

The colon is also known as the large intestine and it is the last area of the digestive tract that waste matter passes through before elimination. It is where your body re-absorbs water and minerals for recycling and where it absorbs vitamin B12 as well as fat-soluble vitamins A and E. The bacteria in the colon manufacture vitamin K, which plays a role in blood clotting. Fibre is what keeps all of these processes moving along in the bowel.

Fibre refers to the indigestible residue of plants. It consists of complex carbohydrates that we are unable to digest. They encompass a wide variety of molecular structures that differ in their degree of solubility in water. They add to the bulk of bowel contents and stimulate the passage of waste matter through the colon. Shorter transit times (time of ingestion of food until its elimination via defecation) are related to decreased incidence of colon cancer. In other words, constipation increases your risk of colon cancer and fiber prevents constipation. Drinking plenty of water also helps to prevent constipation.

Until the past six or seven generations, humans ate a diet filled with vegetable and grain fiber. With industrialisation, our diets changed radically: the processing of foods for commercial sale resulted in the loss of much of the fiber, especially of grain foods.  Comparing the illnesses occurring in industrialised and non-industrialised populations, it is apparent that many common illnesses rarely occur in less industrialised areas that eat high fibre diets. Such illnesses include diabetes, constipation, diverticulitis, colon cancer, heart disease, obesity, gallbladder disease and gallstones, pancreatitis, hiatus hernia, appendicitis, hemorrhoids, varicose veins and even breast cancer. There is an unmistakable epidemiologic relationship between these diseases and low dietary fibre.

Fibre reduces the conversion of primary bile acids into secondary bile acids which are potential cancer promoters; it absorbs more bile acids and dilutes them within a larger stool mass, thus protecting against colon cancer. With fibre, the bile itself is more soluble and less likely to form gallstones. Similarly, fibre protects against pancreatitis by preventing biliary sludge.

Fibre reduces fat absorption and lowers cholesterol levels. It even helps lower excess estrogen by speeding up transit time, thus reducing the likelihood that estrogen will be re-circulated back into the body.

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