Colorectal cancer is the 6th most common cancer in South Africa1 affecting both males and females. In a population of 59 308 690 there were 7354 new patients diagnosed in 2020 of which 3748 were men and 3606 were female.
What is colorectal cancer
Colorectal cancer occurs in the colon and rectum. The colon is the longest part of the large intestine. It is a tube-like organ which is connected to the small intestine at the one end and the anus/rectum at the other end. Fleshy growths called polyps can be found in the lining of the colon. These growths of tissue originate in the lining of the colon and grow into the centre of the colon and rectum. Polyps are normally found during routine colonoscopies and will be removed by the surgeon, most times they are non-cancerous however if left untreated can turn into colon cancer. In the early stages of colon cancer there are no obvious symptoms and thus diagnoses is often only made in the late stages of this disease by which time it may have spread to other parts of the body.
Signs and symptoms
These normally present as
- Change in bowel habits – a feeling the bowel does not empty completely, constipation or diarrhoea
- Stomach pain- cramps, gas or discomfort
- Rectal bleeding or blood in stools
- Weakness or fatigue
- Unexplained weight loss
The recommendation by CANSA2 is early detection and screening with colonoscopies from the age of 50 years which should be repeated every 10 years unless the patient has a high risk (family history or abnormal symptoms). Faecal Occult home stool tests are also available, should the test reflect a visible red line on the strip it is considered positive and the patient should then undergo a colonoscopy.
The prognosis will be made on how far the cancer has advanced. If cancer has spread to surrounding tissue, organs and/or lymph nodes, the 5 year survival rate is 72%, where as if the cancer has spread to distant parts of the body, it is reduced to 14%.3
Treatment options will depend on several factors such as type and stage of cancer, possible side effects and the patient’s general wellbeing. Treatment may include surgery, radiation and chemotherapy or a combination of therapies. In the treatment of cancers different types of doctors work together to provide a patients treatment plan, often combining different types of treatment. This is called a multidisciplinary team which may include a surgeon, medical oncologist, radiation oncologist and a gastroenterologist. You may also have the following included nurse practitioner’s, oncology nurses, social workers, pharmacists, dieticians and counsellors.
Surgery – this is the removal of the tumour and some surrounding healthy tissue and is the most common treatment for colorectal patients.
Radiation – is the use of high energy x-rays to destroy cancer cells. This treatment type is frequently used as often this kind of tumour reoccurs near to where it originated.
Medication – this form of treatment can be given via the bloodstream (systemic therapy) whereby it is able to reach cancer cells throughout the body and destroy them. Medication may also be given locally where it is given directly to the cancer or kept in a certain part of the body.
Chemotherapy – is a form of drug used to kill the cancer cells, this is done by stopping the cells from growing and dividing. A regimen will be determined and given via a number of cycles over a set time frame.
Targeted therapy – this is a treatment that specifically targets a cancers specific gene, proteins or tissue environment which allows the tumour to grow and thrive. This is an effective therapy that stops cell growth and minimises the damage to healthy cells.
Immunotherapy – this is a form of therapy which is also a biologic that has been designed to improve the body’s natural defences to fight the cancer.