What you need to know about colorectal cancer: symptoms, diagnosis, colonoscopy

March is Colorectal Cancer Awareness Month. TsI topic is quite taboo and stigmatized in society.

Colorectal cancer ranks first in the world in terms of causes of death from cancer among men and second among women under 50 years of age (data from the American Society of Oncology).

More than 11,000 cases of the disease were registered in Ukraine in 2022 (data National Chancery Register of Ukraine), and the number of established diagnoses is increasing every year despite the fact that modern medicine is ready for effective treatment of colorectal cancer in the early stages.

How to prevent colorectal cancer

The development of colorectal cancer is a long process that undergoes a series of successive transformations. The cell of the intestinal mucosa begins to divide uncontrollably and grows into a polyp, which can eventually progress into a malignant tumor. Early detection of polyps is crucial to prevent this disease.

The use of screening tests such as colonoscopy, fecal occult blood test, and fecal immunohistochemical test are considered effective methods to achieve this goal.

By using colonoscopy the doctor can examine the mucous membrane of the large intestine. The polyps detected during the procedure are removed by the endoscopist and sent for further histological analysis. Immediately after the examination, the doctor must give the patient a written conclusion and the examination protocol together with photos or videos.

If the doctor took a biopsy or removed a polyp during the colonoscopy, the patient will receive the results within 14 days by e-mail or in paper form in the endoscopy office. Also, the patient has the right to take away the paraffin blocks with the removed material in case he wants to recheck them in another laboratory.

Effective and successful colonoscopy depends on both the skills of the doctor and the responsibility of the patient, who needs to prepare the intestine for the examination, in particular, follow the recommendations regarding diet and taking special drugs that the doctor must prescribe.

Fecal occult blood test and immunohistochemical test of feces is a test of a stool sample for the presence of microscopic blood particles. These tests are non-invasive, but if the result causes concern, a colonoscopy should be performed to find the underlying cause.

Colorectal cancer can pass without symptoms, especially in the early stages. Instead, there are a number of symptoms, the occurrence of which should alert the patient, and which may become the basis for mandatory consultation with a doctor:

• change in bowel habits including diarrhea, constipation, change in size or appearance of stool;
• a feeling of incomplete emptying,
• weight loss that is not related to intentional weight loss,
• feeling of constant discomfort, abdominal pain,
• excessive weakness and fatigue that cannot be explained by the usual causes,
• the presence of blood in the stool, anemia.

It is recommended to undergo regular colorectal cancer screening for people over 45 years old, provided there are no additional risk factors:

• colorectal cancer in close relatives;
• inflammatory bowel diseases (Crohn’s disease or non-specific ulcerative colitis);
• the presence of genetic syndromes associated with colorectal cancer.

In all these cases, it is necessary to consult with a doctor about the need for screening before the specified age and to draw up an individual examination schedule.

How to undergo a colonoscopy for free

For people over 40 years of age, colonoscopy is free of charge in those medical institutions that have signed an agreement with the National Health Service of Ukraine (NHSHU). The presence of symptoms is optional, age is the decisive factor.

The basis for a free colonoscopy is an electronic referral from a family doctor or attending physician, for example, a gastroenterologist, proctologist, oncologist, etc.

With a referral, the patient must contact any medical institution of Ukraine that has a contract with the National Health Service for an endoscopic package (list of medical facilities in the Telegram chatbot “Calendar of healthy Ukrainians“)get a card and make an appointment for a colonoscopy.

A free colonoscopy involves a consultation with an endoscopist, an anesthesiologist regarding colonoscopy with anesthesia, taking a biopsy or removing a polyp followed by histopathological examination.

How to persuade an older person to undergo a colonoscopy

Motivating older people to undergo a colonoscopy is a challenge for the patient’s relatives and patient organizations, which debunk myths about colonoscopy. At the same time, the patient is primarily responsible for his own health.

The first and most important reason for refusing a colonoscopy is the lack of a culture of taking care of one’s health. Even the presence of glaring symptoms and discomfort is sometimes not enough for the patient to make an appointment with a doctor.

The fear of detecting a potential disease is the second reason, and the third is rounded off by the fear of a possible financial burden.

Also, the reasons for refusing a colonoscopy include a prejudiced attitude towards the doctor and potential pain during the procedure.

The presence of pain depends on the anatomical features of the body, the quality of the equipment and the skill of the endoscopist. However, increasingly, colonoscopy is performed under medical sedation, which greatly facilitates the process for both the patient and the doctor.

Bowel cancer is a topic that is not usually talked about. Everything “below the waist” is still taboo in our society. Such stigmatization leads to catastrophic the situation we are currently observing is the lack of routine examinations and a prejudiced attitude towards colonoscopy. As a result, the incidence rate of bowel cancer does not decrease.

What are the ways to solve the problem

Results of scientific researchconducted by an international group of doctors, show that the introduction of colorectal cancer screening in Ukraine will have a positive effect.

Among the three effective strategies considered in the study, colonoscopy every 10 years was the most cost-effective.

In addition, it is important to involve primary care physicians in disseminating information about colorectal cancer treatment, who would explain to patients the role of screening, the safety of the procedure, and coverage of the cost of the examination at the expense of taxpayers.

Nelya Melnychuk, oncologist surgeon Brigham and Women’s Hospital (Boston, USA), professor at Harvard Medical School

Julia Balan, co-founder of the support fund for adult cancer patients Inspiration Family

Ivan Gornik, endoscopist, scientific analyst GMKA

Publications in the “View” section are not editorial articles and reflect exclusively the author’s point of view.