Colon Cancer: Silent Killer in the Philippines


During a conference I attended last Wednesday at the Manila Diamond Hotel, it was discussed that the Philippines now ranks the fastest increase in mortality incidences because of Colon Cancer. Colon cancer based on my personal knowledge is when there is an uncontrolled growth of cells in the large intestine causing damages to healthy tissues near the tumor.


The above finding is one of the results of the study entitled Global Colon Cancer: Incidence and Mortality undertaken last year and recently published in Gut, an international gastroenterology journal.


“Colorectal cancer has certainly become a real concern in the Philippines.  The growing number of incidence and mortality worldwide have put the disease as the third most common type of cancer for both men and women men, after lung and breast cancers,’’ said Dr. Frederick Dy, gastrointestinal oncologist and a leading expert in endoscopy.

In the Philippines, colon cancer is the fifth most common type of cancer for both sexes, after breast, lung, liver, and cervix. It is the fourth leading cause of death overall.  According to the most recent statistics of World Health Organization’s (WHO) foremost cancer research and statistics project, GLOBOCAN, there were 4,901 deaths of the 8,553 incidences of colorectal cancer in the Philippines in 2012, which means that more than half of those diagnosed have died from the disease.  Worldwide, colorectal cancer accounts for about 8% of cancer-related deaths, with 774,000 deaths occurring in 2015, according to WHO. The estimated number of patients that will be affected by colon cancer is 2.2 million with 1.1 million deaths annually by 2030.

Interestingly, GLOBOCAN also said that most incidences of colorectal cancer occur in highly-developed countries like in North America, Western Europe, and Japan. But as more Filipinos suit up for a more western lifestyle and diet, they have become more susceptible to the disease now more than ever.


Unfortunately, the level of awareness about colorectal cancer is much lower than that for other types such as breast or lungs.  Doctors also find difficulty in urging patients to adopt lifestyle changes for the prevention of colorectal cancer.

“Colorectal cancer is influenced by both modifiable and non-modifiable risks, one of which is lifestyle and diet.  But as a lifestyle illness, it is also asymptomatic (displaying no symptoms) in the initial stage,’’ Dr. Dy says. 

Modifiable risk factors, he explains, are those that can be changed like obesity, cigarette smoking, alcoholic beverage intake, physical inactivity and increased consumption of red meat.  A diet rich in animal fat generally increases risk, while eating food rich in fiber and calcium may possibly reduce the risk. 

“An active lifestyle must be put in place as well as the stopping of vices in order to reduce the risk of acquiring this disease,” Dy adds.

WORSE THAN IT LOOKS

With the increase in incidences, colon cancer is now among the deadliest, and recent data show that it’s not slowing down either.

“The data we are looking at right now seem to indicate that there are more people developing colorectal cancer.  It’s not only here in the Philippines, but also in the Asia-Pacific region—we’re seeing a rise in the number,” Dy explained.  
Dy also stated the non-modifiable risks in colorectal cancer—factors that are inherent in a person like family history of the disease, and gender.  Colorectal cancer is more common in men than in women, and studies are still being undertaken to correlate colorectal cancer with other types of cancer.


“Examples of non-modifiable risk factors include gender, age, and family history.  These are factors that cannot be altered.  Some diseases like breast cancer patients or diabetes mellitus have also been associated to increase the probability of developing colorectal tumors,” said Dy.

PREVENTION IS BEST

Colon cancer, like breast cancer, is highly preventable for as long as the patient involves himself as much as possible in its prevention by ensuring a healthy lifestyle, and regularly going for medical check-ups, even before turning 50. According to Dy, the recommended age for screening for colorectal cancer is 50—this is the age when the appearance of polyps increases. 
“Colon cancer doesn’t begin as cancer immediately; it starts with pre-malignant precursors called polyps.  If left attended, these polyps grow over time, eventually becoming cancer. For young people, the risk is low, but they are not immune to it.  We have young adults developing colorectal cancer.  The occurrence is generally uncommon, but if someone has symptoms referable to colorectal cancer, no matter the age, they need to see their doctor or better if they consult a gastroenterologist. Most of colorectal cancer occurs sporadically but some have a strong genetic background.  There are also genetic syndromes that also develop a significant number of polyps at a younger age,” said Dy.



Dy explained that the when the polyps have become full-blown cancer, the common treatments are surgery, chemotherapy, and radiotherapy, modalities which are also used to treat other forms of cancer.  But preventing colorectal cancer is the best strategy and best achieved through colonoscopy where a tube with a camera is inserted into the digestion tract to look for abnormal tissue or tumors. These small growths can be removed without the need for surgery. This may be the reason why in some countries, at least in the United States where screening is advocated, the incidence of colorectal cancer is starting to drop.

RELUCTANCE 

The challenge now is to get people to take their gastrointestinal health seriously and to create a campaign which would inform and educate people about colorectal cancer as not another type of cancer.

Filipinos, especially the younger generations, are less concerned about their diet and their lifestyle, and this is reflected in a small number of Filipinos actually dedicating time going for yearly medical check-ups and follow-ups.  

Another factor is the fear of going through colonoscopy, as it becomes very private to the patient.

“I talk to my patients, and I tell them that these [colonoscopy] procedures should be done, and you can feel the resistance. This is understandable given the nature of the procedure, but some of them are willing. The problem is that further studies and screening cannot push on if people are reluctant, to begin with.  If colorectal cancer were symptomatic, then it would be easy.  Unfortunately, we’re talking about screening, which means that sometimes, people display no symptoms at all.  But they are nonetheless at risk,” said Dy. 

“In general, colonoscopy is not the only thing we do to detect colon cancer or precursor lesions, but it is probably the gold standard at the moment.  For example, we can do testing for stools for blood or fecal DNA. But if the tests show a positive result, then one should be ready for colonoscopy to clear the colon of any possible serious disease” Dy explained.
More people should be involved and be knowledgeable about colorectal cancer.  Current academic literature shows that the disease is becoming more pronounced with each passing year, with the Philippines having the highest increase in mortality rate in the world.  But this is mostly largely due to our passiveness to general medical check-ups. This is not a good sign as the disease is preventable.

“Most people tend to be reactive—they will only act when they feel that there is a change in how they feel.  The problem is, early stages of colorectal cancer is symptom-free, and as such, the individual must be proactive in taking steps to catch colorectal cancer before becoming full-blown and too difficult to cure.  More people should be aware of it, and more people should know how lifestyle affects it,” Dy said.  

As more Filipinos incline towards a more Western lifestyle and diet, colorectal cancer has become a real concern, it as risky and damaging as other types of cancer.  It is preventable if a proper screening test is performed for at-risk individuals.  The recent data and international health study are a wake-up call for Filipinos to take colon cancer as seriously as what other Western countries are currently doing and to consciously adopt a healthy lifestyle of proper diet and exercise.

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