Colorectal cancer (bowel and rectum): symptoms, causes and treatment

Definition

What is colorectal (large intestine / colon and / or rectum)?

The definition of colorectal cancer according to the Indonesian Ministry of Health in Guidelines for the Management of Colorectal Cancer is cancer originating in the large intestine (colon / colon) and rectum. That is, cancer can start in the colon alone or spread to the rectum, or vice versa.

Based on this understanding, this type of cancer is often called colon cancer or rectal cancer, depending on which part of the cells is experiencing abnormal function.

The colon itself is the longest part of the large intestine, which functions to absorb fluids and process body waste in the form of feces. Meanwhile, the rectum is the last small part of the large intestine before the anus, which serves as a temporary storage area for feces.

Colorectal cancer has several types, including:

• Adenocarcinoma. Nearly 96% of the most common colorectal cancers are of this type. This cancer comes from cells that produce mucus to lubricate the inside of the colon and anus.
• Carcinoid tumor. A type of cancer that attacks the hormone-making cells in the intestine.
• Gastrointestinal stromal tumor (GIST). A type of cancer that attacks special cells in the wall of the colon called the Cajal interstitial.
• Lymphoma. A type of cancer that attacks the lymph nodes in the colon or rectum.
• Sarcoma.Types of cancer that originate in the blood vessels, muscle layers, and connective tissue in the colon or rectum.

How common is this disease?

Colorectal cancer (colon and rectum) is a disease that can affect young and old people, although it is more often detected in people aged 50 years and over.

According to the Indonesian Ministry of Health, Riskesdas data shows the prevalence of cancer in Indonesia in 2018 to 1.79 per 1000 population, with colorectal cancer as the sixth largest type of cancer, quoted from Globocan in 2018.

That year also recorded 15,245 and 14,112 new cases of colon cancer and rectal cancer. With the death rate for colon cancer reaching 9,207 people and rectal cancer by 6,827 people.

Signs & symptoms

What are the signs and symptoms of colorectal cancer (colon / colon and / or rectum)?

In the early stages of cancer development, people who have colorectal cancer usually don't feel any symptoms. Symptoms will generally appear when the cancer has advanced to an advanced stage.

Because this cancer can attack the colon or rectum, allowing a person to feel different symptoms.

Symptoms of colorectal cancer that attacks the large intestine (colon) and rectum are:

• Continuous diarrhea or constipation or both alternating, but persistent.
• There is bleeding in the anus so that there is blood in the stool.
• The stomach feels pain like being pricked by needles.
• The stomach always feels full and is easily full.
• Weakness and weight loss for no apparent reason.

The severity of cancer symptoms also varies, depending on how widely the cancer cells have spread. Severe symptoms may be felt in people whose colon and rectum have developed cancer.

When to see a doctor?

The symptoms of colorectal cancer are almost the same as the health problems that attack the digestive system. In order to tell the difference, you can observe how long the symptoms appear.

If it's been more than 2 weeks, check with your doctor immediately. Especially the symptoms of bloody bowel movements. This is because cancer symptoms will not improve on their own or with home remedies.

Cause

What causes colorectal cancer (colon / colon and / or rectum)?

The cause of colorectal cancer (colon / colon and / or rectum) is not known with certainty. But in general, cancer growth begins when healthy cells in the intestines undergo mutations in DNA.

These mutations make cells that should be dividing regularly become abnormal. These cells do not die, even if they are not needed. Over time, there will be a buildup to form a tumor.

Colorectal cancer can also form from polyps (abnormal growths) in the lining of the colon or rectum. Several polyps over the years can turn into cancer, most commonly adenomatous polyps, hyperplastic polyps, and inflammatory polyps larger than 1 cm in size.

Polyps that turn into colorectal cancer can spread (metastasize) from the innermost layer (mucosa), grow out, and eventually attack all layers. When cancer cells are in the intestinal wall, cancer can spread to the blood vessels and lymph vessels.

Risk factors

What increases my risk for colorectal cancer (colon / colon and / or rectum)?

Although the cause of cancer that attacks the colon and / or rectum is not known with certainty, several factors can increase the risk of this disease, including:

• Age

This type of cancer can occur at any age, but tends to be more common in people aged 50 years and over.

• Heredity

People who have family members with colon cancer and colon polyps are at risk of developing similar diseases.

• There is inflammation in the intestines

Having a health problem that causes inflammation in the intestines, such as Crohn's disease and ulcerative colitis increases your risk of developing cancer.

• There is a syndrome affecting the large intestine

Lynch syndrome or familial adenomatous polyposis (FAP) can cause gene mutation problems that can lead to cancer.

• Diet low in fiber, but high in fat

A diet that focuses on red and processed meat but a small amount of vegetables or fruit can increase the risk of colon cancer.

• Obesity and diabetes

Excess weight and problems with insulin in the body can increase the risk of colon cancer .

• Bad lifestyle

Lazy movement, smoking, and drinking lots of alcohol can trigger irregular work of body cells, thereby increasing the risk of cancer.

Complications

What are the complications of colorectal cancer (colon / colon and / or rectum)?

Complications can occur in all diseases, including colorectal cancer. This condition may occur because people with colon or rectal cancer do not follow treatment routinely or are still violating taboos.

Possible complications of colorectal cancer include:

• The cancer comes back again because it still leaves certain cancer cells that are not removed, die, or disappear completely.
• The presence of a tumor that continues to grow causing a blockage in the intestine.
• Cancer attacks the surrounding tissues or organs, such as the pancreas, bile, lymph nodes, kidneys, and even the liver.

Diagnosis & Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

What are the usual tests for colorectal cancer (colon / colon and / or rectum)?

If you have symptoms that are suspected as signs, your doctor will recommend several medical tests to confirm the diagnosis of cancer of the colon or rectum, including:

• Colonoscopy

Colonoscopy is a test for cancer in the intestine using a long, flexible tube equipped with a small camera. Later, the camera will send pictures and show the condition of the intestine.

From this test, the doctor will find out the location and condition of the cancerous tumor in the intestine. Then, surgical instruments will be inserted to take tissue (biopsy) to determine whether the tumor is cancerous or not.

• Blood test

In a blood test, the doctor will observe the presence of a chemical produced by the body when colon cancer occurs, namely CEA (carcinoembryonic antigen). If these chemicals are present in the body, they can help the doctor make a diagnosis.

What are the drug options for colorectal cancer (colon / colon and / or rectum)?

Colon cancer must be treated immediately so as not to cause life-threatening complications. Some of the cancer treatments that doctors usually recommend include:

Small cancer surgery

Very small polyps (lumps) can be removed at once during a colonoscopy. This procedure is also known as a polypectomy.

When the polyp is bigger, the doctor will use a special tool called an endoscopic mucosal resection. This procedure can also be done while the colonoscopy is in progress.

If the two operations above cannot be removed, the doctor will switch to minimally invasive surgery (laparoscopic surgery). In this procedure, the doctor makes a small incision in the abdominal wall and inserts a special tool to remove cancer.

Large cancer surgery

If the colon cancer is much larger in size, a partial colectomy will be performed. During this procedure, the surgeon removes the part of your colon that contains cancer, along with normal tissue on both sides of the cancer.

The doctor will reconnect the healthy part of the colon or other parts. If this procedure is not possible, an ostomy will be performed.

This procedure is performed by making a hole in the abdominal wall from the remaining part of the large intestine to create a passage for stool to the anus. This treatment is usually temporary.

Therapy

In addition to colon cancer surgery, to kill cancer cells from growing back, therapy is usually used as a follow-up treatment. Various therapies for the treatment of colorectal cancer include:

• Chemotherapy. Cancer cell-destroying drug therapy that is given after surgery for cancer that is large in size or has spread to the lymph nodes.
• Radiation therapy.Radiation therapy uses X rays and protons to areas of the body that are affected by cancer. Usually done to shrink cancer before surgery or used as a combination chemotherapy.
• Immunotherapy.Treatment with drugs that aim to increase the body's immune system against cancer cells.

Home remedies

What are the home remedies and lifestyle changes that can be done to treat colorectal cancer (colon / colon and / or rectum)?

Cancer can be cured, but it can also recur. Therefore, during or after treatment, a healthy lifestyle for colorectal cancer patients must still be applied, such as:

• Follow colon cancer treatment, such as therapy as recommended by a doctor.
• Maintain a healthy lifestyle for colorectal cancer patients, such as diet, exercise, and adequate rest.
• Routinely perform screening for the presence of cancer cells if they grow back.
• Consult a doctor before using herbal colorectal cancer drugs that are sold in the market or formulated yourself.

Prevention

How to prevent colorectal cancer (colon / colon and / or rectum)?

There is no sure way to prevent cancer. However, you can still prevent colorectal cancer by lowering the risk in the following ways:

• Increase the consumption of foods rich in vitamins, minerals, fiber, protein and antioxidants, such as vegetables, fruit, nuts and seeds.
• Reduce the habit of drinking alcohol, which is no more than one small glass per day for both men and women.
• Do exercise regularly, at least 30 minutes per day and the intensity level is slowly.
• Stop smoking and adopt healthy eating habits, such as eating according to portions and staying active so that you don't gain weight easily.