Despite years of campaigns and education to raise public awareness regarding colorectal cancer and its screening method, a number of Thai people still prefer to sweep the issue under the rug.
"A lot of Thais still do not understand the gravity of colon cancer. Many, especially those at risk, avoid being screened because they believe colonoscopy -- the standard screening for this type of cancer -- is scary and painful," said gastroenterologist Dr Surasak Aekpongpaisit.
According to Dr Surasak, high incidence and death rates for colorectal cancer have become a worry among medical practitioners, not just in Asia but also around the world.
The 2012 statistics from the World Health Organization (WHO) showed that colorectal cancer was responsible for around 694,000 deaths globally. In the same year, the colon and rectum was listed as one of the five most common body parts diagnosed as suffering from cancer, both among men and women. The World Cancer Research Fund International saw nearly 1.4 million new cases diagnosed worldwide as suffering colon cancer in 2012.
In Thailand, data collected in 2012 from the National Cancer Institute ranks colon cancer as the second most common cancer in men after lung cancer. In women, colon cancer comes in the third place after breast and cervical cancer.
Most colon cancer cases, added Dr Surasak, are reportedly those with no family history of the malignancy. Only 10-20% of all cases are found to be people with family members who have fallen prey to colon cancer before. And only about 5-10% of all colorectal cancers are caused by a known hereditary genetic defect.
The most significant point of concern when it comes to colon cancer, the specialist said, is the fact that symptoms of colon cancer will only be apparent when patients are already in cancerous stages. Most colon cancer cases are diagnosed when it reaches stage two to four where cancer may already spread to nearby organs.
"This means early detection is key. If the cancer is spotted in its first or second stage, then it is likely to be cured. But it is best if slight abnormality can be detected before it progresses into cancer," said Dr Surasak. Signs and symptoms of colorectal cancer include a change in bowel habits, blood in the stool, frequent gas pains, bloating, fullness or cramps, weight loss for no reason and vomiting.
The more risk factors a patient has, the more advisable the screening. Age is one of the most significant risk factors for colon cancer. "People above 50 years old should have a colonoscopy to check for colon cancer even without any other risk factors," the gastroenterologist recommended. Those suffering from obesity and fatty liver disease and those who regularly smoke and drink alcohol are more likely to fall prey to colon cancer than people who do not. People who usually eat diets high in fibre are less likely to have the cancer compared to those who eat a lot of red meat.
Especially after last year when the WHO's International Agency for Research on Cancer (IARC) categorised processed meat as carcinogenic to human and red meat as probably carcinogenic to human, medical specialists can be sure to a certain extent that such an eating habit is also responsible for the development of colon cancer.
"The consumption of 50g of red meat every day can increase the risk [of developing colorectal cancer]," he added.
State-of-the-art medical technology these days allows colon cancer screening methods like colonoscopy to be performed in a more efficient manner than in the past. Colonoscopies today will be carried out under sedation, meaning patients feel no pain during the entire procedure. It only takes 30 to 40 minutes for the whole process to be complete.
"Preparing for colonoscopy can also drive a lot of patients up the wall," the doctor commented. "In the past, patients were required to take a lot of laxative to clear their colon, which sometimes make them feel uncomfortable. But today new formulas of laxative are available. It takes them only four to six hours for bowel cleansing prior to colonoscopy."
Colonoscopy is not just a technique for a specialist to look closely into a patient's colon. In case colon polyps -- abnormal growths of tissue -- are found, the doctor can then take them out right away for further tests.
"Basically, a colonoscopy allows doctors to remove polyps found in colons before they turn cancerous," he noted.
People who get an "all-clear" after a colonoscopy screening do not require another one for at least five years, Dr Surasak explained. However, for cases in which 12-15 polyps are spotted or polyps are larger than 1cm, colonoscopy should be repeated every three years. "If, unfortunately, the polyps removed from the colon are found to be malignant, a colonoscopy must be carried out again one year afterwards."
Colonoscopy might sound complicated and costly, with prices ranging from 18,000-25,000 baht at a private hospital and 3,000-5,000 baht at a public hospital. But according to Dr Surasak, it is by far the most precise approach for colon cancer screening when compared to methods like blood or stool testing. "Just to discover cancer risks before it is too late, it is always worth it," he concluded.
Samitivej Hospital has launched Go Blue Stop Colon Cancer awareness campaign, which aims to provide a free colonoscopy for 100 underprivileged people nationwide within this year. Visit www.samitivejhospitals.com.
