Colorectal cancer

Colorectal Cancer: A Silent Yet Deadly Threat

Imagine a silent killer lurking within your body, slowly but surely growing without you even knowing it. That’s the reality of colorectal cancer, a disease that affects millions worldwide and can strike anyone at any age. But what exactly is this insidious threat? Colorectal cancer refers to the development of cancer from the colon or rectum, with signs and symptoms including blood in the stool, changes in bowel movements, weight loss, abdominal pain, and fatigue.

Risk Factors: A Web of Hazards

So, what puts you at risk? Lifestyle habits such as diet, smoking, and lack of physical activity are major culprits. But did you know that genetic disorders like inflammatory bowel disease can also increase your chances? For instance, Streptococcus gallolyticus, a bacterium associated with colorectal cancer, has been linked to 25-80% of cases where the patient had concomitant tumors. This highlights how intertwined our environment and genetics are in this deadly disease.

The Diagnosis: A Journey Through the Colon

Diagnosis typically begins with a sigmoidoscopy or colonoscopy, followed by medical imaging to determine if the cancer has spread. Screening starting at age 45 is recommended to prevent and decrease deaths from colorectal cancer. Early detection can make all the difference in treatment outcomes.

The Genetics of Colorectal Cancer

Colorectal cancer, often referred to as the third most common type globally, accounts for 10% of all cases. Its incidence varies by country and demographic, with classic warning signs including worsening constipation, blood in the stool, and loss of appetite. Around 50% of people do not report symptoms until late stages, making early detection crucial.

The Wnt Signaling Pathway: A Key Player

Colorectal cancer originates from epithelial cells lining the colon or rectum, primarily resulting from genetic mutations in the Wnt signaling pathway. This pathway is normally important for maintaining the normal function of these cells. Mutations can occur in genes such as APC and CTNNB1, which lead to high levels of β-catenin protein accumulation. This causes cancer due to over-expression of proto-oncogenes.

Epigenetic Factors: A Silent Influence

Epigenetic factors play a significant role in the development of colorectal cancer through abnormal DNA methylation of tumor suppressor promoters. For instance, hypermethylation or hypomethylation of CpG islands and alterations in histones and chromosomal architecture are common epigenetic alterations seen in colorectal cancers.

Screening and Prevention: A Lifesaving Strategy

The importance of screening cannot be overstated. Regular screenings can detect polyps, preventing cancer through removal. Screening has the potential to reduce colorectal cancer deaths by 60%. The three main screening tests are colonoscopy, fecal occult blood testing (FOBT), and flexible sigmoidoscopy.

Staging: A Critical Step in Treatment

The TNM system is used for staging cancer, considering tumor spread and metastases. Early-stage colorectal cancer may be removed during a colonoscopy using techniques like endoscopic mucosal resection or partial colectomy. Surgery is the preferred treatment for localized cancer, with an attempt to achieve a cure.

Treatment Options: A Multifaceted Approach

Chemotherapy may be used before surgery to shrink the cancer, particularly in stages III and IV colon cancer. Surgery techniques include endoscopic resection, partial colectomy, open laparotomy, laparoscopy, colon reconnection, colostomy, and cytoreductive surgery. Chemotherapy drugs may be used in combination to treat widely metastatic or unresectable cancer.

Psychological Impact: A Hidden Battle

The psychological impact of colorectal cancer cannot be ignored. Depression and anxiety are highly prevalent among CRC patients, with a 51% higher risk of depression compared to the general population. Post-treatment distress is common, resulting from lifestyle changes such as bowel issues, incontinence, and changes to sexual functioning.

Support: A Path Forward

Palliative care can be used at the same time as cancer treatment, improving quality of life by relieving symptoms, anxiety, and preventing hospital admissions. Surgical options for colorectal cancer include non-curative removal of tissue, bypassing part of the intestines, and stent placement to alleviate symptoms such as bleeding and pain.

Conclusion: A Call to Action

The fight against colorectal cancer is a battle that requires vigilance, early detection, and comprehensive treatment. By understanding its risk factors, recognizing the signs, and embracing preventive measures, we can significantly reduce the burden of this deadly disease. Remember, knowledge is power, and taking proactive steps today could save lives tomorrow.