8 Things to know about Colorectal Cancer

Colorectal Cancer Awareness month may be over, but for us, it’s a year-round fight. We asked Consultant Oncologist and Haematologist Professor Gilian Wharfe to tell us eight key things about this disease.

1) It starts out small.

Colorectal cancer typically develops in the colon and rectum, also known as the large intestine. It begins as a small, noncancerous growth called a polyp. If these polyps are not removed, they can develop into cancerous tumours. Professor Wharfe explains: “The goal of regular screenings is for these growths to be identified early and removed before that happens.”

2) In its earliest stages, there are often no symptoms.

Even after a tumour develops, colorectal cancer may not cause any noticeable symptoms. Once it advances beyond stages 0 and I, certain symptoms may present, like constipation, diarrhoea, changes in the consistency and colour of stool, blood in the stool, abdominal pain or cramps.

3) It’s fairly common in Jamaica.

“Colorectal cancer is the third most common cancer amongst both males and females in Jamaica,” says Professor Wharfe. It is also the third-leading cause of cancer-related death, behind breast and prostate cancers.

4) Young people aren’t immune to the disease.

While increasing age is a risk factor for colorectal cancer, young people can be diagnosed with the disease. In fact, while the overall occurrence of the disease has decreased globally, there has been a steady rise in colorectal cancer patients under the age of 50 years. The Jamaica Cancer Society advises that persons should start getting regular screenings at 45 years of age. However, Professor Wharfe notes, “This may be earlier in patients with a family history of the disease”.

5) Your lifestyle can have a significant impact.

Two suggested reasons for the increase in occurrences among younger persons are diet and lifestyle. Certain diets and lifestyle choices are associated with an increased risk of developing colorectal cancer:

• Having a diet that is high in red meat, like beef, or processed meat, such as ham or bully beef

• Having a diet that is low in fibre, “which is obtained from fruits and vegetables,” Professor Wharfe says, and high in saturated fats

• Not exercising regularly

• Being overweight or obese

• Drinking alcohol

• Using tobacco

6) Having a healthy diet and lifestyle isn’t always enough.

“While a healthy lifestyle can reduce your risk of developing this disease,” Professor Wharfe says, “it does not eliminate it.” Simply having a colon and rectum are the foremost risk factors for developing colorectal cancer. Other non-modifiable risk factors include increasing age (as mentioned above), family history–23-39% of persons with early-onset colon cancer have a family history– and having an inflammatory bowel disease, like Crohn’s.

7) There are a number of ways to screen for it.

Unlike prostate, breast and cervical cancer, there are many screening options for colorectal cancer. The most common is a colonoscopy, where the patient is put to sleep, and a colonoscope is inserted into the rectum so your doctor can look for polyps or other abnormalities in both your rectum and colon so they can be removed before they develop into cancer.

From Professor Wharfe, “Other screening methods include providing stool samples to look for blood or changes in DNA in the stool, which will prompt colonoscopy if positive.”

“Another screening method, “CT Colonography or virtual colonoscopy, where a scan of the inside of the colon is obtained. This can identify growths, such as polyps in the bowel which will need to be biopsied. This does not require sedation.”

Importantly, “most of these screening methods, everything but testing for DNA in the stool, are available in Jamaica.”

8) Not enough Jamaicans get screened.

Part of this is a lack of access. “Unfortunately, there is no national screening programme,” Professor Wharfe explains. “As such, screening is limited in the public setting and thus not readily available.” However, there is also a lack of awareness about the importance of screening among Jamaicans.

How often you will need to get screened depends on a number of factors. "Factors include your age, family history, what is found during each colonoscopy and if you have a high-risk bowel disease, like ulcerative colitis."

For the general population (i.e. no family history or bowel diseases), "if you are between 45 and 60 years in age, and they find no polyps, you might be able to go once every ten years," Professor Wharfe explains. "However, even if your results are normal, the frequency will increase after you turn 60 years old to once every five years."

If you have a family history or personal medical history that puts you at risk, "like inherited cancer syndromes or any irritable bowel syndrome will need to be screened more often."

What is most important is that you get screened. “Getting screened is critical,” Professor Wharfe reiterates. “So, visit your primary medical provider or a general practitioner (like Dr Patrice Simmonds-Brooks). They can refer you to the appropriate doctor, like a gastroenterologist, for a scope.”