Colorectal Cancer

90% of colorectal cancer cases are diagnosed at age 50 or older; this also means that up to 10% of colorectal cancer occurs in those who are fairly young - below the age of 50.

In those who develop colorectal cancer before 50 years old, genetic factors rather than environmental factors are likely to play a bigger role. It is likely that a young person developing colorectal cancer has a genetic mutation that is inherited from birth, conferring a ‘head start’ in cancer development.

An individual who has at least one of the following traits should consider genetic screening for colorectal cancer:

• Strong family history of 3 of more colorectal cancers affecting 2 or more generations
• Strong family history of multiple relatives with cancers in other organs such as the uterus, ovary, small intestine, bladder and kidneys
• Personal or family history of colorectal cancer or polyps diagnosed before 50 years
• Family history with known hereditary conditions:
  • Familial Adenomatous Polyposis (FAP)
  • Lynch Syndrome
  • Puertz-Jegher’s Syndrome (PJS)
  • Cowden’s Syndrome
• Multiple polyps in the colon, rectum or the rest of the gastrointestinal tract
• Your managing physician believes there is a possible hereditary component to your colorectal cancer.

A genetic screening is an examination of a person’s genes to look out for patterns of mutations that may indicate a genetic condition or to predict the chance that a person will develop a specific disease or condition in the future.

Having the knowledge can empower a person and his family members to make significant life planning decisions including treatment options that may affect the overall disease outcome, prognosis and the future health status of himself and his family.

Most colorectal cancers, unfortunately, do most display obvious symptoms. By the time colorectal cancer is detected, 60% of patients would be in the more advanced stages of cancer (stages 3 or 4). Some of the more common symptoms include:

• Change in bowel patterns
• Blood or mucus in stools
• Unexplained and persistent abdominal pain or distension/bloating
• Unexplained loss of weight and appetite

It is important that those who have higher risks undergo regular screening for colorectal cancer before any symptoms develop.

Screening for colorectal cancer has been proven to save lives. In the United States and northern European countries, colorectal cancer mortality has been falling and this can be attributed to screening, early detection and prevention by polyp removal before they turn cancerous.

As a rule of thumb, colonoscopy screening should start at 50 years old or 10 years younger than the age of onset of cancer in the family. For example, individuals with a strong family history - defined as having multiple first-degree relatives with colorectal cancer or polyps - should schedule regular colonsoscopy starting at 40 years old or 10 years younger than the age of the youngest diagnosed individual in the family, whichever is earlier.

Most people, and even some physicians, hold the belief that colorectal cancer only develops in people below the age of 50. This low index of suspicion often leads to a delay in consulting a doctor and a possible delay in diagnosis.

A young patient saw several doctors when she was just 27 years old for vague abdominal pain and bloating, but was dismissed as just irritable bowel syndrome without further evaluation even though her symptoms were new and fairly persistent. Eventually she presented with complete colonic obstruction with perforation from a colon cancer 6 months later and had to undergo emergency surgery.

Fortunately for her, despite the delayed diagnosis, she recovered well and is now happily married. These examples illustrate the high-index of suspicion needed in diagnosing colon cancer in the young.

Surgery is the only curative option for colorectal cancers. Depending on the size, location and stage of the cancer, radiotherapy and/or chemotherapy are sometimes needed to increase the chance of long term survival. A MRI (Magnetic Resonance Imaging) or CT scan is sometimes done before surgery to better demonstrate the anatomy of the tumour and its surrounding structure.

Colorectal surgery can be performed via traditional open approach (with a long cut/incision down the abdomen), laparoscopically (keyhole) or robotically. Most tumours, unless they are very big, can be resected using the keyhole approach, although the da Vinci robotic systems offer superb dexterity and superior visualisation for rectal cancers within the narrow confines of the pelvis.