(Conclusion)
Afflicted persons can be asymptomatic, but often have occult blood loss. Later, they can present with rectal bleeding, anemia, fatigue, abdominal pain, change in bowel habits, constipation and weight loss. Colorecral cancer (CRC) screening invades the bowel wall and lymph nodes, and can metastasize to the distant organs.
When colon cancer is suspected, the test of choice is colonoscopy—a flexible tube with a camera is inserted through the rectum under mild anesthesia and carefully advanced to visualize the colon. When cancer is seen, the patient is sent for surgical resection, as surgery cures early cancer. Concurrent chemotherapy is recommended for patients with advanced disease.
CRC screening among Filipinos is recommended as: 1) CRC is the fourth most common cancer; 2) early and localized CRC is curable by surgical resection; 3) the slow growth of CRC allows the detection and removal of polyps before growing to cancer; 4) CRC screening reduces related mortality; 5) it is cost-effective. All these facts support the campaign for CRC screening in the Philippines.
In most countries, CRC screening is recommended for people aged 50 years and above. Earlier CRC screening is advocated for those with additional risk factors. Successful screening should be accompanied by programs to educate patients as well as to heighten physician awareness of the logistics involved.
Two main methods
There are two main methods of screening for average-risk patients that we recommend: 1) stool test called Fecal Immunochemical test (FIT) that detects occult blood done yearly; 2) colonoscopy every 10 years. FIT is specific for colon blood, and ideal for those who want a non-invasive test. With a +FIT, a colonoscopy is needed to examine the colon to rule out cancer. Colonoscopy is the gold standard and a powerful test because of its potential to remove precancerous lesions. It is invasive and has risks, though the rate is low under expert hands.
As a gastroenterologist who advocates CRC screening, I recommend a screening colonoscopy in individuals between 50 and 75 years of age who are healthy, and wherein the benefits of a colonoscopy outweigh the risks. The FIT is recommended to those who may be at high risk for colonoscopy, or not willing to undergo the test yet for a variety of reasons. A +FIT will need to be followed up with a colonoscopy, and a -FIT result will require repeated testing annually. I encourage an extensive discussion with the patient on these two options; the method will depend on patient’s preference and medical health. In the end, CRC screening can just save your life or the life of a loved one. As a physician, I dream of a colon cancer-free future in our country.
Dr. Jun R. Ruiz is a diplomate of the American Board of Internal Medicine in Gastroenterology and Philippine College of Physicians in Internal Medicine. He finished his gastroenterology fellowship at the George Washington University and was awarded as a Kaiser Physician Hero at Kaiser Permanente. He is also the first Filipino author of the Merck Manual. He is a consultant at the St. Luke’s Medical Center and can be contacted at junruizmd@gmail.com.