Dr. Henk Wassenaar about colorectal cancer

POSTED: 03/21/16 7:19 PM

St. Maarten News – Colorectal cancer is a cancerous growth throughout any part of the colon or rectum. It has devastating complications as may be: bleeding, obstruction of the colon, breaking down of the wall of the colon and spread to other organs especially the liver. Seventy percent of patients with colorectal cancer eventually may develop liver metastasis. Dr. Henk Wassenaar, oncologist at the St. Maarten Medical Center spoke about Colorectal Cancer on the Care Connect radio program on March 14.

While we don’t often hear about colon cancer, colon cancer is a most commonly occurring type of cancer in males and females. According to the World Cancer Research Fund International, it is the third most common cancer in the world.

Where is the colon? And what is the role of the colon?

The colon is located in the lower part of the digestive system: in the large intestines. The rectal area is the last part of the colon. The function of the colon is the last stage in the digestive system. It processes the waste of our food and prepares the waste for excretion via the rectum and anus.

How does colon cancer affect our digestive system?

Colon cancer can cause considerable discomfort in the digestive system and bowel movements. An individual may have a combination of symptoms as an effect of the cancer:

  • Abdominal pain
  • Blood in stool
  • Constipation
  • Diarrhea
  • Irregular bowel movements, change in the normal pattern of defecation
  • Weight loss

What is considered normal bowel movements?

Having frequent bowel movements prevents, lessens the occurring, of colorectal cancer. It is in fact better to defecate several times a day-not as diarrhea- than having to skip days. For some persons once, twice or three times a day is normal. It becomes irregular when you skip days or change your usual pattern.

Why and when should these symptoms be taken seriously?

One should seek immediate medical investigation even if blood appears in the stool only one time, as it could take several weeks or months before a second occurrence. It may happen that someone may have blood in the stool because of strain or hemorrhoids, but if someone has blood throughout the stool at the beginning or end of defecation, that is immediately reason for investigation.

You may notice constipation and diarrhea may both be symptoms, though quite opposite bowel symptoms. Diarrhea occasionally may be a symptom in the presence of a large tumor in the colon. Such irregularities should also be taken seriously, and lead to diagnostic action, meaning: go to the doctor.

For any cancer, weight loss is usually a symptom in progressed, worse stages. When unexplained weight loss is combined with abdominal pain and irregular bowel movements it definitely should not be taken lightly, and you must consult with a doctor.

Who is at risk?

In general, the risk for colorectal cancer increases with age. There are some groups that can be identified at higher risk.

  • Women with endometrial or breast cancer
  • Someone with first degree family members under the age of 50 with colorectal cancer
  • Someone with history of polyps- benign growth
  • Someone with history of inflammatory bowel disease
  • People after irradiation, radiotherapy of the abdomen (men after prostate therapy!)

What are polyps?

Polyps are benign (noncancerous) abnormal tissue growths. Someone with a lot of polyps or who has family members with polyps has increased risk for development colorectal cancer.

How is colorectal cancer diagnosed?

70% of colorectal cancers are lower in the rectum. A physician can feel with his finger (“rectal exam”) more than half of colorectal tumors. A colonoscopy is used to get a visual investigation. For this procedure the bowel is cleaned very well. It is in general a safe procedure. For persons who can’t have a colonoscopy, too weak or elderly, a CT scan can be used instead to get a visual. A biopsy, usually done during the colonoscopy, is always needed to make a diagnosis.

Are there steps someone can take to prevent colorectal cancer?

Persons who are at increased risk should be investigated. It is a good form of prevention to find a polyp or colorectal cancer at an early stage. If a patient is at risk for rapid progression of disease, having many polyps, screening should be performed more frequently.

In general there are some things that increase our risk for cancers, such as alcohol use, cigarette smoking, and (over-) consumption of red meat, too little exercise and obesity.

Some easy and cheap recommendations for prevention are:

  • Vegetables and Fiber rich foods-no white bread, rather: milti-grain
  • Folic acid extra intake is easy, and cheap, ask your pharmacist for assistance
  • Calcium rich diet or supplements
  • Selenium supplement

Aspirin, anti-inflammatory drugs and post-menopausal hormones do diminish the risk for colorectal cancer but this is usually only recommended for certain high risk persons.

Does colon cleansing help prevent or treat colorectal cancer?

Artificial colon cleansing is usually used in the alternative circle to medicine. It is not scientifically proven to decrease the risk of colorectal cancer, and certainly has no place in the presence of colorectal cancer as therapy.

What are treatment options for colorectal cancer at SMMC?

The tumor is removed by surgery. If the tumor is too large or cannot be easily removed, radiotherapy is used as a preoperative method. This can be done on Curacao, or elsewhere.

During surgery the goal is to remove the entire tumor, within the margins that have been taken away by the surgeon. Most frequently a hemi-colectomy is performed, where part of the colon is removed and in other cases a total colectomy or rectum amputation is performed. After this procedure, the person will need stoma, and will have to wear a bag on the outside to collect stool. A person with a stoma can participate in all normal activities in daily life.

Colorectal cancer is also treated with chemotherapy. Last year the outpatient department at the SMMC introduced chemo pumps for some patients. This allows them to receive chemotherapy treatment at home instead of having hospital stays. A so-called port (in short derived from the word “port-a-cath”) has to be installed, it means no patients are admitted nowadays for chemotherapy, unless their condition necessitates it.

Immunotherapy is another treatment that is provided in the hospital. It consists of some kind of drugs, with which the results have become better as to cancer long term survival.

What is your outlook for colorectal cancer and treatment in St. Maarten?

The frequency for these cancers is increasing on the island just as breast cancer. It is necessary to pay attention to not only the patient being treated for colorectal cancer but going a step further and paying attention to the family of that individual.

We should also give more attention to the psycho-social needs of the patients, having to deal with a life threatening illness and the impact it may have on the individual and family.

In general, the prognosis for colorectal cancer has much improved in the last few years. With the help of patient support groups we can work together to cover the other areas and aspects of care provided to these patients.

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