Check this awareness point and some important information about colon cancer. Which is very useful to know for your health purpose.

1. Colon Cancer Awareness Month –
March every year
(WHO earmarked)
Dr. Gurbilas P. Singh, FRCP (London)
Gastro Physician in Chandigarh
Endoscopist in Chandigarh
Endoscopy services in Chandigarh

2. Indian population
• Largely remains rather non-aggressive in their attitudes towards
health related issues
• Lack of awareness despite improving diagnostic and healthcare
facilities
• The main reason for this seems to be the cost services are placed at.

3. Rectal bleeding and its management – Indian
scenario
• Hide this symptom from all
• Finally when it stops there is a sigh of relief and it is never mentioned
until it recurs.
• Speaks to a General Physician or a Gastro Physician.
• The number of episodes will decide how many physicians or
surgeons see this patient (without doing a physical examination
including a digital rectal examination) in their busy clinics.
• Some practitioners will point towards a colonoscopy
• The person sees an Endoscopist who offers a colonoscopy. The
patient either never returns or dilly dallies.

4. Rectal bleeding – UK scenario
• A person with rectal bleeding goes to his General Physician usually
promptly.
• Assessed with blood tests as well as a digital rectal examination or
even a rigid sigmoidoscopy.
• Referred to an endoscopy clinic to be seen asap (generally within 2
weeks) for a flexible sigmoidoscopy or a colonoscopy.
• A diagnosis is hence generally made and acted upon promptly if
something needs doing.

5. Colon Cancer
• Affecting men and women almost equally.
• Third most common cancer in the world and fourth most common
cause of death.
• Worldwide, it accounts for 9% of all cancers.
• High incidence areas are North America (particularly USA and
Canada) and Australasia.
• Low incidence areas include China, India, Africa and South America.

6. Colon Cancer declining !?
• Incidence of colon cancer is declining steadily at the rate of over 2% per year since
1998 because of screening programmes offering colonoscopy (lower gastrointestinal
endoscopy) which in turn improves the detection of precancerous polyps.
• The overall burden of disease remains high and there is a change noted in
demographics with Afro-Caribbean population now having a higher rate of incidence as
compared to the white population. Interestingly the trend is opposite to what it was
before 1980s.
The developed world accounts for well over 60% of the cases but these rates are probably
susceptible to ascertainment bias given the under reporting in developing countries.

7. Non modifiable factors
• Age
• Personal history of Adenomatous polyp
• Tubular and villous adenomata
• Personal history of Inflammatory Bowel Disease (upto 20 fold increased risk of
colorectal cancer)
• Family history of Colorectal Cancer or Adenomatous Polyps
(Two or more first degree relatives or one under the age of 60 years with history of cancer or polyps increase the risk strongly)
• Inherited Genetic Risk
(Familial Adenomatous Polyposis and Hereditary Non Polyposis Colorectal Cancer have been linked to the genes and mutations.)

8. Modifiable factors
• Enviromental risk factors :
These include a wide range of vague cultural, social or lifestyle factors and
interestingly it has been found that a migrant from low risk area would
automatically pick up the risk of local population where one resides. These
environmental factors become important as they are modifiable and theoretically
should help in prevention. The incidence is higher in urban population,
particularly in males and for colon rather than rectal cancer.

9. Modifiable factors
• Dietary factors - A diet high in fats and meats/animal products is known to
increase the risk of colon cancer. Also a diet low in fruits and vegetables is also
linked to it. This may signify that a high fibre diet which dilutes farcal content,
increases bulk and reduces transit time is protective.
Cigarette smoking - Whereas it is bad for health generally it is known to form
and increase the size of the polyps (larger polyps are found in smokers). An
earlier average age of having colon cancer is noted in smokers.
Heavy alcohol consumption:Acetaldehyde, a metabolite of alcohol, can be
carcinogenic. Also such individuals may have poor diet.

10. Volume of problem
• Oesophageal Cancers – 26,( M =13, F = 13), Average age = 58 years
• Stomach cancer – 9 (M =5, F = 4), Average age = 58.55 years
• Colon cancer – 20 (M =9 , F =11 ), Average age = 54.55 years

11. Colon Cancer Awareness – duty of all Gastro
Physicians, Endoscopists and other healthcare
workers
This clearly depicts that colon cancer is not a rare entity and it is very
important to highlight this point to catch the disease early to save lives.
It is our duty to highlight this with the month of March, which is
earmarked as the Colon Cancer Month by WHO, approaching.