Colon Cancer status in India

SIGNS & SYMPTOMS

RISK FACTORS 

1. Age: There is an increased risk of developing colorectal cancer above 50 years of age due to physiological changes in the body6.
2. Inflammatory Bowel Disease: It is a type of chronic inflammation or swelling that can lead to excessive cell growth called dysplasia that can ultimately lead to the formation of a tumor leading to cancer7.
   
3. Ulcerative colitis:  It is a type of disease that leads to inflammation or swelling in the digestive tract that can pave a path for tumor growth7. 
   
4. Family History: It is possible if the patient has a history of colorectal cancer in a family who is below 50 years of age8.
   
5. Ethnicity: African Americans are proven to be at more risk8.
   
6. Cigarette Smoking: Cigarette contains a chemical called nicotine that can cause damage to the DNA leading to tumor formation in cancer8.
   
7. Long-term effect of insulin-like growth factors: Patients with diabetes mellitus due to insulin resistance are more prone to cancer.
   
8. Immunosuppression: Patients with organ transplantation most commonly renal transplantation are at more risk of the development of colorectal cancer than the normal population as the immune system of the body rejects the transplanted organ.
   
9. Physical inactivity: Physical inactivity leads to obesity in people which is associated with an increased risk of colorectal cancer due to increased hormone levels9.
   
10. Overweight or obese: If the patient is obese it results in increased levels of hormones called leptin in the blood that leads to excessive abnormal cell growth and hence tumor in the colon or rectum9. 
    
11. Red and processed meat consumption: Cooked red meat leads to the formation of toxic chemicals in the body which results in cell growth and hence tumor in the colon or rectum10.
    
12. Excessive alcohol consumption:  Excessive alcohol intake can cause DNA damage which can cause excess cell growth leading to colon cancer.
    
13. Genetic Mutation or changes in DNA
    

CLASSIFICATION OF COLORECTAL CANCER 

DIAGNOSIS

TREATMENT OPTIONS

• Avoid a fatty diet and take a more fibrous diet like green vegetables and fruits or easy bowel movements.
• Avoid eating red processed meat to avoid toxic chemical formation in the body leading to a tumor.
• Quit smoking to further prevent DNA damage and tumor on the colon.
• Decrease alcohol intake so that it does not produce toxic substances to damage the DNA that leads to cancer.
• Exercise up to the tolerated level to reduce body weight.
• Reduce stress by performing yoga or with the help of a psychologist.
• Treat diabetes as insulin resistance in the body can lead to colorectal cancer.
• Avoid protein product consumption and take plant products.
• Take a liquid diet for easy bowel movement.
• Drink plenty of water.

1. Operable disease: It includes initial surgery including or excluding adjuvant therapy.
2. Locally advanced disease: Chemotherapy is recommended before surgery.
3. Isolated to a confined area disease: It incorporates incision of primary tumor including or excluding adjuvant chemotherapy.
4. Widely spread disease: It is treated with chemotherapy and supportive care11.

TYPES OF COLORECTAL CANCER

1. Adenocarcinomas: This tumor is formed in the cells which produce mucus in the intestine and rectum. 
2. Lymphoma: This is the type of colon cancer in which a tumor is first formed in a body part called lymph nodes and then progresses to the rectum or intestine.
   
3. Sarcomas: This type of cancer occurs in soft tissues of the body like muscles in the intestine.

1. Stewart, B.; Wild, C.P. (Eds.) World Cancer Report 2014; International Agency for Research on Cancer (IARC): Lyon, France, 2014.
2. NCRP (2013) Three-year report of the population-based cancer registries- 2009-2011. National cancer registry program, Indian council of medical research (ICMR), Bangalore, India, 2013.
3. Kucherlapati, et al. "Comprehensive molecular characterization of colon and rectal cancer." Nature 487(2012): 330-337.
4. Maharaj R, Shukla PJ, Sakpal SV, Naraynsingh V,  Dan D, Hariharan S, The impact of hereditary colorectal cancer on the Indian population, 2014 Volume 51 (4) Page: 538-541
5. Sinha Rupal,  Doval DC, Hussain Showket, Kumar Kapil, Singh Shivendra, Basir SF, Bharadwaj Mausumi, Lifestyle and Sporadic Colorectal Cancer in India, Asian Pacific Journal of Cancer Prevention, Volume 16, 2015  Page 7683-7688.
6. Levin, B.; Lieberman, D.A.; McFarland, B.; Smith, R.A.; Brooks, D.; Andrews, K.S.; Dash, C.; Giardiello, F.M.; Glick, S.; Levin, T.R. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American cancer society, the US multi-society task force on colorectal cancer, and the American college of radiology. CA Cancer J.Clin. 2008 (58) 130–160. 
7. Eaden, J.A.; Abrams, K.R.; Mayberry, J.F. The risk of colorectal cancer in ulcerative colitis: A meta-analysis Gut 2001, 48, 526–535.
8. Johns, L.E.; Houlston, R.S. A systematic review and meta-analysis of familial colorectal cancer risk. Am. J. Gastroenterol. 2001, 96, 2992–3003.
9. Frezza E E,  Wachtel M S, Internati M Chiriva, Influence of obesity on the risk of developing colon cancer Gut. 2006 Feb; 55(2): 285–291.
10. Consensus Document for Management of Colorectal Cancer, Indian Council of Medical Research, Page 12.
11. https://www.healthline.com/health/colon-cancer#diagnosis
12. Elena Sancho, Molecular mechanisms involved in colorectal cancer initiation and progression, 2007 Scientific Report Oncology Programme page 118-121.