COLORECTAL CANCER PART I: PREVENTION AND EARLY DETECTION

As I sip on my coffee pondering for this weeks article I think about the hybrid activities that make March a special month for me. Firstly it’s the birthday month of two of nieces who are very dear to me. Secondly we celebrate International Women’s Day on the 8thof March and I am a woman! This year in particular the Medical Women’s Association of Zambia (MWAZ) celebrated it with a bang by honouring our senior colleagues who have shaped the profession for us. Last but not the least important it’s colorectal cancer awareness month. Colorectal cancer awareness to me is synonymous with Patricia Jere*, the founder of the Patricia Jere Cancer Foundation (PJCF). She was also known as one of the best brains in drafting the laws of Zambia. She served as Permanent Secretary of Ministry of Justice and on many prestigious boards. To me Patricia was a cancer knight, a warrior of the highest order. I met Patricia shy to a year ago in my consultation room. She had a warm smile that never faded in the few months I had the privilege of knowing her, through each trying moment up until her last breath. The beauty that shone from the outside was definitely coming from the inside. Despite her many accolades in life her demeanour was humble and non-demanding, such that it evoked immediate respect and admiration from me. Such a beautiful soul I often wonder what it would have been to know her before this dark cloud of cancer hung above her. Patricia took this dark grey cloud and gave it a bright shiny silver lining, almost gold if you ask me! She decided to take a negative event (diagnosis of colorectal cancer) in her life and turn it into a positive one for thousands of people by establishing the Patricia Jere Cancer Foundation (PJCF) which was officially launched on 6thOctober 2017 at a colourful event at the Intercontinental Hotel graced by Ministry of Health Permanent Secretary Clinical Services Dr Jabin Mulwanda (see picture). She used her personal experience to touch the lives of those around her. I really miss her! The PJCF is dedicated to raising awareness on all cancers as evidenced in their work at the Cancer Diseases Hospital – donating hampers to all patients and entertaining the children in the paediatric oncology ward. However, Patricia herself told me that special mention of colorectal cancer must always be made. It is a silent killer that crept upon her unknowingly. Patricia often narrated to me, how at the time she was Permanent Secretary of Ministry of Justice, she would feel little aches and pains here and there but in her natural diligence, she pushed herself to work through it. She did this until the time everything came crashing down and she presented as an acute patient needing emergency surgery. Maybe if the symptoms of this cancer were well known to her and if she saw awareness messages more frequently she would have seen the warning signs. So in honour of Patricia Jere and the many patients who have fought the good fight against colorectal cancer allow me to raise the awareness voice of colorectal cancer above the noise of everyday life.

The colon is the distal part of our digestive system.  It is responsible for absorbing some nutrients and water from digested food as it makes it journey through the body. It also stores stool in the part called the rectum. Just as any other tissue in the body, cancer can arise from the colon and rectum. The most common type of cancer that arises from the colon is from the epithelial lining called a carcinoma. There are certain risk factors that increase a person’s risk of getting this cancer. These include age (>50years), family predisposition, personal predisposition with polyps and other inflammatory conditions of the colon (Crohns, Ulcerative colitis), a diet high in animal products and low in fruits and vegetables, smoking, excessive alcohol intake and obesity. Exercise and polyp removal is protective against colorectal cancer. You may find in literature other protective agents such as aspirin and combined hormone replacement, but I would recommend a one on one consultation with your health care provider before making a decision to adopt these measures as they have caveats on them.

Age. Global literature informs us that colorectal cancer is more common amongst people above the age of 50 years and it is from here that the recommendation for screening comes. However, like Patricia and many other patients I know colorectal cancer afflicted them well clear of that age. It is important to be self-aware and know the possible symptoms of colorectal cancer so as to seek timely medical attention.

Genetics. This knowledge ties in with the risk factor of family predisposition. If any first-degree relatives have suffered from colorectal cancer, it may be important for you to start your screening early. Certain genetic tests are available if a strong family history is evident. Ensure you see a health care provider if you have concerns. Family history of other types of cancers may point towards familial cancer syndromes such as Lynch, Cowden, Peutz-Jeghers and many others, which are all beyond the scope of my article today.

Personal Predisposition. A personal history of having suffered from colorectal or ovarian cancer, inflammatory diseases (Crohns, Ulcerative Colitis, Irritable Bowel Syndrome) and polyps can increase your risk of colorectal cancer. Certain measures including surgical resection may be necessary to prevent the affected area to progressing into a cancer.

Diet. The food we eat has a lot of implication on our health including colorectal cancer risk. It is said that a diet high in fruits and vegetables and low in animal products promotes a healthy gut microbiome. Microbiome is the mixture of bacteria that normally colonise our digestive tract. The good bacteria contribute to excellent immunity and mental health whilst the bad bacteria may contribute to a range of health complications including cancer. High fibre diet is food for good bacteria and provides an environment for them to thrive leaving no space for detrimental colonisation from bad bacteria, parasites and viruses that can be oncogenic directly and indirectly.

Smoking and alcohol are common thread in cancer risk. Alcohol promotes the formation of gut polyps, which are precursors of cancer in the long run.

What are the signs and symptoms of colorectal cancer? As mentioned before colorectal cancer is silent. Early symptoms include non-specific issues such as abnormal bowel habits (unexplained diarrhoea alternating with constipation), bloating, anaemia, which can be attributed to bleeding from the lesion. Late symptoms include severe abdominal pain due to obstruction or perforation and frank bleeding of fresh blood from the rectum.

Screening tests. Screening is recommended for patients above the age of 50 years. A stool for occult blood test is the first step and if it is positive a colonoscopy can further be undertaken. Another form of screening test is a digital colonoscopy, which is less invasive as a CT scanner is used.

Next week we shall tackle the treatment and survivorship aspect of a colorectal cancer diagnosis.

One of Patricia’s pre-occupation in her work with the foundation was cooperate outreach, as she understood fully the impact of a busy career. Please as you are quickly skimming through this newspaper to get back to your work, take time to think how we can come and engage your networks on colorectal cancer awareness. Reach out to us on dorothylombe@yahoo.com

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