Lifestyle Disorders – Colorectal Cancer

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Cancer is a cluster of diseases distinguished by uncontrolled growth of cells and is caused by both internal factors (mutations, hormones) and external factors (diet, alcohol, radiation). It is one of the most important public health problems of the modern-day world and is the second most cause of death after cardiovascular diseases. In the US alone, cancer accounts for nearly 23% of the total deaths. It is estimated that by the year 2020, 15 million new cancer cases will be identified and around 12 million of them will be losing their lives due to the disease. The most common types of cancers are breast, liver, lung, thyroid, bowel, skin and pancreas etc. Colorectal cancer (CRC), among them is one such highly occurring cancer. As the name suggests, colorectal cancer takes its origination from the colon (large intestine). At an earlier stage, the tumors are benign, and are called polyps and they turn malignant in due course of time. Polyps are usually small, and are produced in fewer numbers. Hence, physicians advise to go for frequent screening tests for discovering polyps earlier and removing them before they turn carcinogenic. Colon cancer is also known as bowel cancer, colon cancer, and rectal cancer. Among women, is the second most leading causative agent of cancer deaths and is the third among men. As per the predictions of The American Cancer Society, 1 in 21 men and 1 in 21 women will have colon cancer in their lifetime.

(Source: https://www.cancer.org/research/infographics-gallery/colorectal-cancer-screening-guideline-for-men-and-women-at-average-risk.html)

How Common Are They?

Colorectal cancer is one of the major cancer-related deaths worldwide. As per the GLOBOCAN (Global Cancer Statistics 2018), 9.81% of men and 9.42% of women in India are at a cumulative risk of developing colorectal cancer. In countries like India, the incidence is a bit lower due to food patterns and lifestyles, and advancement of screening techniques. CRC is more common in the elderly than in the younger generation, and is seen more in men than in women. Recent studies reported that Indian migrants who are living in high prevalent areas like the US and Europe are prone to the disease than the native citizens. It is expected that, in 2019 alone, 51,020 deaths from colorectal cancer will occur worldwide. In comparison, the global death rate of CRC was less in 2016 was lesser (13.6/100,000) when compared with the date of 1970 (29.2/100,000). This is due to the change in food pattern, advanced screening techniques, and treatment procedures.

Vast majorities of CRC are asymptomatic and can be detected during the time of screening. Patients with the disease present with pain, bleeding and obstructive symptoms. Roughly 5-10% of the CRC is caused due to genetic factors. Since the patient numbers are very less in young people with CRC, it is suggested that physicians be taught to have a clear understanding of family history. Dietary assessment and drug therapy must also be included in the management of the disease as a good number of CRC patients are malnourished.

Clinical Features:

  • Pain in the abdomen
  • Intestinal obstruction
  • Change in bowel movements (diarrhea, constipation)
  • Rectal bleeding
  • Blood in the stool

 Colorectal Cancer – Risk Factors and Complications:

  • Lifestyle – consumption of red or processed meat, obesity, smoking, alcoholism, etc.
  • Low intake of fruits and vegetables, calcium and whole-grain fiber.
  • Prolonged use of non-steroidal anti-inflammatory drugs (NSAID) like aspirin, ibuprofen, naproxen.
  • Presence of colon polyps.
  • Family history of colorectal cancer, familial adenomatous polyposis (FAP) and Lynch syndrome.
  • Having a first-degree relative diagnosed with colorectal cancer before 40 years of age.

(Source: http://wavenewspapers.com/wp-content/uploads/2018/03/02-2018-colorectal-cancer-infographic.jpg)

Do Genes Have Anything To Do With It?

Genome wide association (GWAS) studies have discovered various genetic markers that are predictive of colorectal cancer risk. One of the most well studied markers is the SMAD7 gene region. This gene region is a participant in the TGF- β pathway that plays a crucial role in programmed cell death. Variations in this gene have been linked with increased risk for cancer development, due to suppressed gene activity and tumor progression.

The 8q24 region is associated with risk for multiple cancers – breast cancer, prostate cancer, colon cancer, kidney cancer, etc. Three different variants in the 8q24 region have been established as genetic risk factors for colorectal cancer.

Managing Colorectal Cancer: Risk- Diet and Lifestyle:

Therapeutic options depend on the stage of CRC, reaction of the patient to the treatment, rate of recurrence molecular structure of the tumor. Surgery is said to be the only efficient treatment option (stage I-III). An ideal team of surgeons treating CRC would have a surgeon, radiation oncologist, medical oncologist, and a gastroenterologist. The use of adjunct chemotherapy is considered useful for patients with stage III disease, but a bit controversial with its use in stage II patients. Treatment procedures in the recent times have progressed from using a mono-agent 5-fluorouracil (5-FU) to using a combination of 5-FU and irinotecan or oxaliplatin or both. Depending on the performance of the patient, clinicians have the option to use anti-VEGT inhibitors or anti-EGFR inhibitors in line with the chemotherapy. Very recently, the location of the cancer cell has proved to be a prediction for a possible clinical outcome. Research studies reported that tumors of hereditary non-polyposis have a high chance of being predicted in stage II and stage III disease states. Advanced scientific studies have to be conducted on molecular classification of cancer, with the aim of putting forth, molecularly defined sub-groups. (Stintzing, Sebastian, 2014).

How Can Mapmygenome Help you: 

At Mapmygenome, our focus is mainly on predictive risk assessment, maintaining a proper diet, adapting to a healthier lifestyle. A comprehensive wellness assessment like Genomepatri will give an insight into the weaknesses of your immunity, genetic predisposition to specific health conditions, drug efficiency and helps in pre-empting most of these risks. Genetic counseling is therefore recommended to obtain authenticated reviewing and recommending testing/screening options, diet/lifestyle interventions and educational and emotional support.

Tapping into your genes will assist you to know the real ‘YOU’. Genomepatri helps you find the best-suited route for yourself, and reiterates the importance of not following the crowd but forging a unique way of leading quality life. It is personalized, predictive, participatory, preventive, and POWERFUL!!!

References:

  1. Anand, Preetha, et al. “Cancer is a preventable disease that requires major lifestyle changes.” Pharmaceutical research25.9 (2008): 2097-2116.
  2. Leslie, Amy, and R. J. C. Steele. “Management of colorectal cancer.” Postgraduate medical journal 78.922 (2002): 473-478.
  3. Siegel, Rebecca L., Kimberly D. Miller, and Ahmedin Jemal. “Cancer statistics, 2019.” CA: a cancer journal for clinicians69.1 (2019): 7-34.
  4. Stintzing, Sebastian. “Management of colorectal cancer.”F1000prime reports 6 (2014).
  5. Tarver, Talicia. “Cancer facts & figures 2012. American cancer society (ACS) Atlanta, GA: American Cancer Society, 2012. 66 p., pdf. Available from.” (2012): 366-367.

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