Despite being a type of cancer that can largely be prevented with lifestyle changes and early diagnosis, colon cancer is the third biggest killer of men and women in Turkey, after breast cancer and lung cancer. However, with a global pandemic forcing many people into lockdown and hospitals becoming hotspots for coronavirus, many people have skipped their annual checks. Doctors now fear a significant increase in rates of colon cancer.
Speaking on the occasion of Colon Cancer Awareness Month, gastroenterology specialist Dr. Nurdan Tözün said that in addition to latent diagnoses, some common misconceptions about this disease also lead to deadly outcomes, oıften in cases that could have been saved if treated early.
Stating that 375,000 people are diagnosed with colon cancer every year in Europe and 170,000 of them die from this disease, Tözün said: “For the past year, many people aged 50 and over who would have been included in the cancer screening program this year and a significant portion of people who received colon cancer treatment but were in line for check-ups have failed to go to hospitals because of fears of COVID-19. This has and will continue to increase the probability of finding advanced colon cancer cases, as our experience and studies have shown."
A study conducted at the University of Bologna in Italy found that delaying colon cancer screening for 4-6 months increased advanced colon cancer by 3%, while a delay of more than 12 months increased this rate to 7%. Considering that there is no end yet in sight to the coronavirus pandemic, annual screenings should not be interrupted or postponed, stressed Tözün.
Colon cancer develops in 98% of cases that present polyps and polyps larger than 15 mm in diameter are 1.5 times more likely to turn cancerous. Stating that removing polyps via colonoscopy can prevent cancer, Tözün said that colon cancer screening programs based on various protocols are carried out in almost all European countries today, and a study conducted in 16 European countries between 2000 and 2016 found that the prevalence of colorectal cancer decreased significantly in countries that commenced screening at earlier ages.
With today's technology, early colon cancers and polyps can be better spotted with artificial intelligence-based imaging systems. Although colonoscopy is the gold standard in detecting polyps, the success of the procedure largely depends on the experience of the person performing the colonoscopy and their compliance with quality standards.
Tözün said that when it comes to colon cancer and colonoscopy, there are six misconceptions that are dangerous as they hinder early diagnosis and are often the reason why patients see a doctor when the disease is at a far too advanced stage.
Misconception #1: Rectal blood indicates hemorrhoids and is not a big deal.
Most patients are afraid of having a more serious disease and postpone going to a doctor by making excuses and thinking it is just hemorrhoids. In Turkey, many people turn to their friends and family for advice instead and take alternative medicine, which can mask the real symptoms. On the other hand, the physician may also falsely attribute the bleeding to hemorrhoids or anal fissures, especially in patients who are young and suffer from chronic constipation.
Bleeding from the anus can be the harbinger of cancer or a large polyp, and detailed examination is absolutely necessary, says Tözün.
Misconception #2: This disease is purely genetic, there is no cancer in my family.
Only 15% of cancers can be blamed on genetics. Having colon cancer in first-degree relatives (FDR) or having familial adenomatous polyposis (FAP) increases the risk of developing cancer. However, colon cancer may also develop in people with no family history of cancer. Recent studies have recommended genetic screening of the tumor tissue even in non-familial colon cancers.
Misconception #3: All prolonged constipation cases lead to cancer.
As one of the most common gastrointestinal complaints, being constipated does not mean you have colon cancer. There is no evidence that chronic constipation or irritable bowel syndrome causes colon cancer. However, when colon cancer or a large polyp grows large enough to narrow the intestinal cavity, you may suffer from constipation, bowel obstruction or rectal bleeding. It is always best to see a gastroenterologist when you have an unexpected change in your bowel habits, says Tüzün.
Misconception #4: Colonoscopies are a complicated and painful procedure and can be fatal.
Colonoscopy is a very low-risk procedure in the hands of an expert. The perforation of the intestines or bleeding during colonoscopy is seen in less than 1 in 1,000 cases. Before a colonoscopy, you should go through a thorough medical evaluation and be questioned about chronic diseases and the medications you take. You should let your doctor know if you are on antibiotics, blood thinners or anti-diabetic drugs, among many others.
The only uncomfortable part of a colonoscopy is the pre-procedural preparation when you will be asked to take laxative drugs to clear the intestinal tract. In Turkey, the most common way is via mixing sachets of laxative drugs in a few liters of water, which gives it a sweet taste similar to juice and will be consumed throughout the day or over a 2-day period. You may also be asked to simplify your diet 3-4 days before the procedure or consume only liquids.
During the colonoscopy, you will not feel pain because the procedure is performed under deep sedation and general anesthesia is only necessary in certain cases.
Misconception #5: I don't need to have a colonoscopy as I have no complaints.
A person's risk of developing colon cancer in their lifetime is 6%, which is a statistic that cannot be underestimated. Put in a simpler way, 1 in 18 people can develop colon cancer.
Studies have found that polyps and colon cancer are more common in obese people and smokers, those who regularly drink alcohol, those who eat processed food, have a history of colon cancer in their family and those who do not exercise regularly. However, the risk of death from colon cancer decreases by 45% with colonoscopy.
Misconception #6: There are drugs that can prevent colon cancer.
Although a lot of research has been done on this subject, there is no clear result. Although some studies have mentioned the anti-cancer effects of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, calcium, magnesium, folic acid, vitamin B6 and B12, vitamin D, statins and aspirin, this effect has not been confirmed in large studies.
Until more definitive results, it is best to eat a healthy and fiber-rich diet, exercise regularly, avoid smoking and drinking alcohol and not gain excess weight, according to Tözün.
Who should be prioritized in screening?
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