"So this is Colorectal Cancer Awareness
Month and what have you done? Another year over and
a new one just begun" (apologies to John Lennon).
Last year, an estimated 20,000
Canadians were diagnosed with colorectal cancer (CRC)
with 8,500 CRC deaths. Only lung cancer caused more
cancer-related deaths. As physicians, we would like
to improve these statistics — but where to start?
By recognizing CRC risk factors
and counselling people to reduce their risk. Cigarette
smoking increases the risk of developing CRC while weight
loss reduces the risk as does avoiding excessive amounts
of red meat and following a diet with adequate calcium,
fruits, vegetables, vitamin D and fish. Counselling
in these areas should probably start in teenagers!
We should screen patients for CRC
and premalignant polyps. Some advocates champion fecal
occult blood testing, others prefer colonoscopies or
sigmoidoscopies, while barium enemas or virtual colonoscopies
get others' votes. Where there is universal agreement
is that any of these screening modalities is better
than no screening at all. Screening for CRC should be
discussed with every patient over the age of 50 and
earlier in patients with a family history. Hopefully,
there will be more data released on which is the optimal
screening modality and at what frequency. In the near
future, we will see emergence of new therapies for non-operable
CRC and see more widespread use of meso-rectal surgery
for the resection of rectal carcinomas and less invasive
laparoscopic resections of colon cancer.
"And so happy Colorectal Cancer
Awareness month. Let's hope it's a good one. Without
any fear..." — but with a firm resolve to capitalize
on what we know about CRC, how to prevent it, how to
screen for it and how best to treat it so more Canadians
will be happy and healthy in the coming years.
Dr Robert Fingerote, MD, MSc,
FRCPC
Gastroenterology, Richmond Hill, ON
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