Colorectal Cancer: Preventable, Treatable, and Beatable

As March is colorectal cancer awareness month, we can use this month to raise awareness about colorectal cancer and take actions towards preventing it. Colorectal cancer is the third most common cancer in the world and there are increasing number of patients in Asia and South East Asia. In Thailand itself, the number is increasing both in women and men. Many colorectal cancers can be prevented through regular screening. Screening can find precancerous polyps, abnormal growths in the colon or rectum, so that they can be removed before they turn into cancer. Screening is crucial because when found early, colorectal cancer is highly treatable. Early stages of colorectal cancer usually presents no symptoms, as it tends to appear as the cancer progresses.

Risk factors

Researchers have found several risk factors that might increase a person’s chance of developing colorectal cancer.

  • Diet that is high in red meats and fatty meats
  • Diet that is high in processed meats (sausages, bacon, and ham)
  • Low fiber diet
  • Physical inactivity
  • Obesity
  • Smoking
  • Heavy alcohol consumption
  • Genetic – family history of colorectal cancer and polyps

Signs and symptoms

Many people with colorectal cancer experience no symptoms in the early stages of the disease. Signs and symptoms of colorectal cancer include:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • Abdominal pain – the pain characteristic depends on the size and location of the tumor

Tests to diagnose colorectal cancer

  • Colonoscopy
  • Radiography with contrast barium enema
  • Blood test for carcinoembryonic antigen (CEA)
  • Other investigations such as chest x-ray, CT-scan, MRI, EUS


The type of treatment your doctor recommends will depend largely on the stage of your cancer.

  • Stage 0 – Cancers have not grown beyond the inner lining of the colon, surgery to take out the cancer is often the only treatment needed.
  • Stage I and II – Cancers have grown deeper into the muscle layer of the colon wall, but they have not spread outside the colon wall itself or into the nearby lymph nodes. Surgery to remove the section of the colon containing the cancer along with nearby lymph nodes may be the only treatment needed. However, your doctor may recommend adjuvant chemotherapy (chemo after surgery) if the cancer has a higher risk of recurring. Genome testing will also be done.
  • Stage III – Cancers have spread to nearby lymph nodes, but they did not spread to other parts of the body. Treatment includes surgery to remove the section of the colon with the cancer along with nearby lymph nodes, followed by adjuvant chemotherapy or targeted therapy. Genome testing will also be done. Radiotherapy may be needed in patients with cancer in both colon and anus.
  • Stage IV – Cancers have spread from the colon to distant organs and tissues. Colon cancer most often spreads to the liver, but it can also spread to other places like the lungs, brain, peritoneum (the lining of the abdominal cavity), or to distant lymph nodes. Chemotherapy and radiotherapy may be given before surgery. If the tumors shrink, the doctor might be able to remove the tumors.

Laparoscopic surgery

In the past, the surgical treatment for colorectal cancer was open surgery. The surgical wound was around 6-12 inches or 15-30 centimeters depending on the size and location of the tumor. In the last two decades, laparoscopic surgery for colorectal cancer has undergone tremendous advancements. Only 4-5 small incisions (6-8 millimeters) are made to insert the surgical instruments. The largest surgical wound is around 4 centimeters. The size and number of surgical wounds depend on the size of the tumor.

The benefit of laparoscopic surgery is the smaller incision, less blood loss, less recovery time, and fewer complications. The patient will recover faster and get back to normal life quicker. However, the treatment option the doctor recommends will depend on the patient’s condition and cancer stage.

Colorectal cancer screening

Many colorectal cancers can be prevented through regular screening. It is recommended that people at average risk for colorectal cancer be screened regularly by colonoscopy starting at age 50. The screening should be done every 5-10 years. It’s recommended that people with a family history of colorectal cancer, begin screening at the age of 45.

In addition, you can take steps to reduce your risk of colorectal cancer by making changes in your everyday life – eat a variety of fruits, vegetables and whole grains, exercise regularly, and maintain a healthy weight.

Reference: Dr. Wutthi Sumetchotimaytha, a surgical oncologist, Wattanosoth hospital
For more information: Wattanosoth Hospital
Call 1719