Spotting a silent killer

Spotting a silent killer

After Chadwick Boseman's death from colon cancer, the medical community is raising awareness about the illness which is often diagnosed too late


When US actor Chadwick Boseman, best known for his portrayal of T'Challa in Marvel's Black Panther, died late last month due to colon cancer, his untimely demise sparked global discourse about the disease, its causes and treatments, and the changing landscape of who is being affected.

Boseman was just 43 when he passed away after a hushed four year battle with cancer. Among the topics of discussion that have come to light after the prolific actor's death is the steady rise of colon cancer, not just in the US but across the globe, including Thailand where 5,000 lives are lost each year as a result of the disease. Almost 5% to 10% of all colon cancer cases are reported to be the result of hereditary causes.

Medical oncologist Dr Thanate Dajsakdipon, who advocates screening for early detection as a way to remain one step ahead, noted that colon cancer develops when normal cells in the colon change and continuously reproduce until they can no longer be controlled, a process that may take years. In the early stages, the cells may appear as a normal polyp (small clump of cells), however, if these polyps are allowed to grow further without treatment or removal, they can eventually become cancerous.

"In relation to the leading causes of cancer-related deaths in the country, colon cancer is ranked in the top three, behind liver/bile duct cancer which is number one and lung cancer, which ranks second.

"Besides being a silent killer, colon cancer at times has no warning signs. Moreover, medical science still cannot say for sure what actually causes it. What we can attest to is the fact that a person's risk of developing colon cancer increases based on particular factors with the most predominant being genetic, which can indiscriminately attack younger individuals in their early 40s instead of the usual 50 years and above age bracket of most patients. In these scenarios, cancer can spread rather aggressively to other parts of the patient's body."

While diet, weight and exercise are more noteworthy risk factors for developing colon cancer, Dr Thanate said research has found that race and ethnic background also have some impact. In fact, the American Cancer Society (ACS) has gone as far as to suggest that in the US, African-Americans have a higher chance of developing colorectal cancer and the likelihood of dying from it is also significantly higher.

However, he also noted interestingly that when colorectal cancer is viewed on a global scale, Jewish people with Eastern European heritage have the highest risk of colorectal cancer.

As for Thailand, there is no data on hand to suggest how race and ethnic background impacts cancer cases.

Dr Thanate said Boseman's death has made the public more aware of this particular type of cancer and the need to stay more informed.

"What the public needs to keep abreast of is that a person's risk for developing colon and rectum cancer increases with age and family history. Even though patients aged 50 and over are twice as likely to develop colon cancer, younger adults aged 40 and below cannot remain complacent. In fact, stats show that one in seven patients receiving treatment for colon cancer is, in fact, younger than 50.''

As Thailand inches closer to becoming an ageing society, people need to urgently rectify their lax and carefree lifestyles where exercise and food consumption are not prioritised in order to help decrease the risk of developing colon cancer.

"A sedentary lifestyle with poor eating habits can prove detrimental in the long run as ageing makes you more vulnerable to sickness," said Dr Thanate.

"The high consumption of red meat coupled with cooking food at very high temperatures [frying, broiling or grilling] creates chemicals that raise your risk of developing cancer. Moreover, preserved foods should also be eaten with caution. It is essential to balance what you consume.

"Obesity, chronic constipation and family history of colon cancer are other risk factors society needs to pay special attention to."

Regarding the symptoms of colon cancer, Dr Thanate said that the disease may not necessarily produce any identifiable symptoms which means the patient could be unaware of their condition.

However, there are cases when the symptoms of colon cancer may be identifiable but are indistinguishable from symptoms caused by other diseases.

He said this is why if a person encounters any of the following symptoms for over a two week period, they should get a diagnostic screening as soon as possible.

It all starts with bleeding from the rectum or blood in stools, a condition that requires immediate medical attention. Other symptoms to note include diarrhoea, constipation and bloating. The constant sensation of needing to pass stool or incomplete defecation, which is medically known as tenesmus, is also another thing to take note of. Differences in the appearance of your stool may also be cause for concern if it is hard lumps like nuts. Also, constant changes in your bowels such as alternating between diarrhoea and constipation is also a condition to be watchful of.

All of this could contribute to fatigue and unexplained weight loss. Dr Thanate said the screening process is a straightforward procedure where the doctor examines the inside of the rectum and entire colon using a long tube called a colonoscope.

During the examination process, patients are sedated. In the event that a precancerous colon polyp is spotted, it is simultaneously removed during the colonoscopy, a medical procedure that he described as being the most accurate of all diagnostic methods and one which gives patients the most benefit without experiencing pain or any incision.

Since colonoscopy is globally regarded as the gold standard to protect against colon cancer, he said the test is recommended for anyone over age 50. One can undergo a colonoscopy every 10 years thereafter. However, for people in the high risks group, they should be under medical supervision more frequently.

Two of the other early screening methods for colorectal cancer include sigmoidoscopy and faecal occult blood tests.

Regarding the survival rate of colon cancer patients today, Dr Thanate said that patients in stages one to three have a survival rate of over five years, while stage four colon cancer patients only have a survival rate of one-and-a-half to two years.

With the advancement of medical technology, he said it is imperative to not look at cancer as a death sentence.

"I have observed over the years that the patients with a more positive attitude against fighting cancer tend to build their immune system better than the ones that don't. This is just based on my personal experience."

While advances in technology and new treatments for cancer are providing patients with hope for the future, screening for early detection should be prioritised.

He explained: "The earlier cancer can be detected the better it is as this means chances of survival are much higher because of the advancement of medical technology.

"Another thing worth mentioning here is immunotherapy for cancer. It is a type of treatment that utilises the body's immune system to fight the disease. We are seeing immunotherapy today being applied to a wide range of cancers. Time and time again, this treatment is being used in conjunction with other agents and clinical trials are exploring ways of improving and increasing its effectiveness. One especially positive form of immunotherapy is known as immune checkpoint inhibition, which makes use of antibodies to block proteins on cancer cells to avoid an immune system attack on the cells.

"While immunotherapy has been approved for treatment for various types of cancers, not all patients with these cancers are eligible for immunotherapy. A handful of factors -- the genetic make-up of the tumour cells, what stage of cancer a patient is in, and whether the patient has responded to previous treatments, for example -- determines if and when it may be used as part of standard treatment."

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