NEW DELHI: Ramesh Kumar, 30, has a family history of colon cancer as he had lost his father to it. So, when Rakesh had recurrent constipation followed by loose stools, his world crashed when a growth was detected and a biopsy confirmed cancer. After undergoing surgery, followed by radiation and then chemotherapy, he is cancer-free today. But he never thought, even in his wildest dreams, that he would get colon cancer at this young age – even though he had a family history – as it is said to predominantly affect older individuals, with the majority of cases occurring in people aged 50 and above. But it is not so anymore.
“Lately, colon cancer incidence and death rates have fallen for individuals older than 50 years with an increase in screening tests like colonoscopy. However, the opposite is true for individuals younger than 50,” said Dr Pragya Shukla, head of oncology at Delhi State Cancer Institute (DSCI).
Highlighting the fact that colon cancer cases in India are seeing a sudden rise, Dr Amanjeet Singh, director and head of colorectal surgery, gestro-intestinal (GI) surgery, GI oncology and bariatric surgery, gastrosciences, Medanta, said although colorectal cancer has long been associated with older age groups, there is a concerning trend emerging in India as an increasing number of cases being diagnosed among younger individuals, including Millennial and Gen Z.
“We are seeing more and more young people below 40 years in our hospital, and the concerning part is that they are being detected at the end stage of cancer. Some of these cases also include young teens below 20 years of age,” he said. “This shift in demographics underscores the complex interplay of genetic predisposition and environmental factors contributing to the development of colorectal cancer,” he added. He said that there are various reasons for this rise – one is Covid-19, which hindered people from visiting hospitals to get themselves screened on time for colon cancer, while the other is lifestyle changes and genetic predispositions.
According to Globocan 2020, colon cancer – a type of cancer that starts in the large intestine (colon) or rectum - is ranked fourth in incidence and fifth in mortality in the world. In India, colon cancer, also known as colorectal cancer, ranks thirteenth in incidence as well as mortality. Colon cancer typically begins as small, noncancerous clumps of cells called polyps, which eventually develops into cancer if not detected and removed early.
Stressing that, unlike western countries, Indians get colorectal cancer at a younger age, Dr Sandeep Nayak P, director, department of surgical oncology and robotic and laparoscopic surgery, Fortis Hospital, Bannerghatta Road, Bengaluru, said several factors may increase one’s risk of colon cancer. Apart from age, personal and family history of colorectal cancer or polyps, other reasons include inflammatory intestinal conditions, inherited syndromes that increase colon cancer risk, red meat, sedentary lifestyle, diabetes, obesity, smoking, alcohol and radiation therapy for cancer.
“Colon cancer is more likely to go undetected as the condition typically has no symptoms, if at all, in its early stages,” said Dr Arun Kumar Giri, director of surgical oncology, Aakash Healthcare, New Delhi.
“When they do appear, symptoms vary in different individuals depending on the location in the intestine and size of the tumour. Weakness or fatigue, anaemia, unexplained weight loss along with changes in your bowel habits, abdominal discomfort and blood in your stool or from the rectum are some of the common symptoms of cancer of the colon. If any of the symptoms persist, it’s time to see a doctor,” he said.
Dr Shukla said that individuals with any of the colorectal cancer risk factors should start screening at an earlier age. Colon cancer treatment and even its detection have seen significant advancements in India.
Dr Vidyachandra Gandhi, consultant, gastrointestinal and HPB surgeon, Manipal Hospital, Kharadi, Pune, said surgery – open, laparoscopic, or Robotic – is the most common modality employed in treating colon cancer as it is effective in curing the disease at an early stage. “Surgical removal involves complete removal of the tumour and a healthy margin of the intestine and surrounding lymph nodes. Most of the rectal cancers would need chemotherapy and radiation before the surgery,” he said.
Even if cancer has spread to a part of the liver, the tumour, along with part of the liver, can be treated with surgery.
“There are other options to treat colorectal liver metastasis, like radiofrequency ablation, transarterial chemoembolisation and trans arterial radioembolisation,” Dr Gandhi added. Dr Nayak said that one of the most notable advancements is using minimally invasive techniques such as laparoscopic and robotic surgery. These techniques are less traumatic to the patients and more acceptable to them. “In the hands of expert cancer surgeons, the disease clearance is better than conventional open surgery. For cancers that are in the rectum, the use of robotic surgery has made a lot of difference in the outcome for the patient,” he said.
Dr Singh also said that this approach has become increasingly popular due to its ability to provide precise and effective tumour removal while minimising the impact on surrounding healthy tissue.
The introduction of precision radiation technology, such as CyberKnife, has also revolutionised radiation therapy by delivering targeted radiation directly to the tumour, minimising side effects and improving treatment outcomes. Advancements in colonoscopy techniques, including narrow-band imaging, have enhanced early detection capabilities, allowing for the identification and removal of precancerous polyps before they progress to cancer.
“These developments represent significant progress in the management of colorectal cancer in India, offering patients access to state-of-the-art treatment modalities and improving overall prognosis,” said Dr Singh.
Noting that as almost 25-30% of colon cancers are being diagnosed in people under 50 years of age, Dr Giri said the best way to prevent it is with lifestyle and dietary changes by reducing intake of fatty and processed food. “A healthy lifestyle can go a long way to reduce the risk of colon cancer. Making small changes in your day-to-day life can work wonders to keep you healthy and free from cancer.”