Roving colons raise cancer awareness
During March a number of inflatable colons (2.4m-high inflatable walk-through replicas of the human colon) were travelling across Europe to mark the 3rd European Colorectal Cancer Awareness Month (ECCAM).
Colorectal adenocarcinoma (colon 80%, rectum 20%) is the third most common malignant tumour worldwide, after lung and upper gastro-intestinal cancers, and the second most common in Europe after lung cancer. Despite modern treatment, 50% of patients are dead by five years, with around 16,000 deaths each year in the UK.
The symptoms include:
• Bleeding from the back passage (rectum) or blood in the stools.
• A lasting change in normal bowel habits towards diarrhoea or looser stools.
• A lump in the right side of the abdomen or in the rectum.
• A straining feeling in the rectum.
• Losing weight.
• Pain in the abdomen or rectum.
• Tiredness and breathlessness due to anaemia caused by the tumour bleeding.
Age at diagnosis is around 70, but the symptoms have non-cancerous causes, so litigation often involves alleged delayed or missed diagnosis.
Prevention can be achieved by between 15-20% of all colorectal cancers which are familial. They are:
• Hereditary non-polyposis colorectal cancer (HNPCC)
• Familial adenomatous polyposis (FAP)
People with two first-degree relatives with sporadic colorectal cancer or one first-degree relative diagnosed with sporadic colorectal cancer under 45 years should also be advised they have increased risk.
Screening using the faecal occult blood test occurs every two years for:
• Adults age 50-74 adults (Scotland and Wales).
• Adults age 60-69 adults (England and Northern Ireland).
Access to first treatment in England must be within two months of referral and agreed by a multi-disciplinary team. Staging is by ‘TNM’ staging, which determines prognosis and treatment and requires CT and MR scans (for rectal cancer) and the surgical removal of the cancer, a portion of the colon with the cancer and associated mesenteric lymph nodes.
Teams are audited for lymph-node harvests and total mesorectal excision (TME) for rectal cancers. Minimal access surgery and enhanced recovery programmes are best practice, reducing hospital stay and post-operative complications. Stomas are permanent (colostomies) in 15% of rectal cancer patients and temporary for around six months (ileostomies) in 30% of all patients.
Radiotherapy and chemotherapy are ‘ambulatory’ (outpatient). Pre-operative radiotherapy (with concomitant chemotherapy) is for patients with MR stages 3-4 rectal cancer. Stage 1-2 lower third rectal cancers are sometimes suitable for intra-luminal radiotherapy in supra-regional centres. Chemotherapy agents (including biologicals) are preventative (adjuvant) for patients with node-positive cancers and therapeutic (palliative) for patients with T+ (metastatic) disease.
Metastases occur most commonly in the liver, followed by lungs, bone and occasionally brain. Prognosis with metastases remains poor with a median survival rate of 50% at two years from diagnosis. Liver metastases are treated with liver resection or radio-frequency ablation (RFA) in specialist hepato-biliary centres following chemotherapy.
Research is active in colorectal cancer; there are currently 16 clinical trials recruiting in the UK.
Professor Roger James has 30 years experience as an NHS hospital consultant. He is co-author of over 140 peer-reviewed publications, including Governance and Revalidation: A Guide for Clinical Oncologists.