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Colorectal Cancer 90% Curable Rate If Detected Early: Dr Chintamani Godbole

Colorectal cancer is a commonly reported cancer worldwide and is fortunately curable. Though the incidence rate is low in India when compared to overseas, the number of cases has witnessed an increase over the past few decades. To learn about colorectal cancer, team CancerMitr conversed with oncosurgeon Dr Chintamani Godbole.

In the following discussion, we will discuss more about colorectal cancer – from the challenges posed by the elusive early symptoms to the nuances of surgical interventions.

1. Tell us about yourself. How long have you worked in the field of surgical gastroenterology?

I am a qualified gastrointestinal surgeon who has been working in the field since 2015. My passion lies in the specialized treatment of colorectal cancer, where I have honed my skills in cutting-edge surgical techniques such as laparoscopy and robotic surgery. In addition to my surgical expertise, I have successfully administered Hyperthermic Intraperitoneal Chemotherapy (HIPEC), a promising treatment modality for individuals grappling with this formidable disease.

2. Ok. Let’s delve into the big “C.” The nerve-racking feature of GI tract cancers is that the early-stage symptoms may not show up. What symptoms do we need to pay attention to when it comes to early detection of GI tract cancers?

Detecting gastrointestinal tract cancers poses a unique challenge due to their internal nature, making it difficult to identify abnormalities until later stages. It is crucial to recognize symptoms associated with the digestive process, such as bloating, loss of appetite, and changes in bowel habits.

While GI cancers may not manifest noticeable physical symptoms early on, colorectal cancers present an opportunity for early detection. Paying attention to signs like alterations in bowel habits, accompanied by unusual pain, unexplained rectal bleeding, or the presence of blood in stools, as well as symptoms like anaemia, can be indicative. It’s important to note that these symptoms may initially be attributed to other conditions and treated accordingly.

Persistence of symptoms, especially lasting changes in bowel habits for more than 20 days, warrants screening. When I mention a “change” in bowel habits, I am not limited to constipation or diarrhoea; any unusual shift in stool colour or texture over an extended period should raise concern. Timely screening and awareness of these nuanced indicators are critical in the early diagnosis and effective management of colorectal cancers.

3. Is constipation an early-stage symptom of colorectal cancer?

Yes. 

Constipation is characterized by infrequent and uncomfortable bowel movements, leading to the passage of small, hard stools fewer than three times a week. It’s essential to recognize that normal bowel movement can be disrupted if there is a blockage, often attributed to tumour growth.

Persistent constipation lasting longer than two to three days raises a red flag, particularly when accompanied by severe pain or signs of anaemia. This combination of symptoms warrants prompt attention and investigation, as it may indicate an underlying issue potentially linked to tumorous growth. Staying vigilant about such indicators and seeking timely medical evaluation is crucial for early intervention and effective management.

4. At what stage are patients in when they come to you for treatment?

I have dealt with a mix of both early and late cancer detections.
Some patients approach me, having been diagnosed in the early stages, stage I or II. However, there are also cases where individuals, initially diagnosed early, progress to later stages due to local treatments or alternative therapies. This transition to later stages underscores the complexity of the disease trajectory.

Patients often hesitate due to concerns about the physical impact of treatment or constraints such as financial or social factors. The critical message, though, is the urgency to initiate treatment promptly. Colorectal cancer boasts a remarkable curability rate and the pivotal factor is not delaying, as timely intervention significantly enhances the likelihood of successful outcomes.

5. What factors, other than diet, influence the prevalence of GI tract cancers, especially colorectal cancer?

Family history plays a pivotal role in colorectal cancer risk. Individuals with a family member who has battled colorectal cancer are at an elevated risk of developing the disease themselves. Approximately 10% of all documented colorectal cancer cases stem from inherited genetic factors.

Moreover, the presence of precancerous conditions amplifies the risk. Conditions like ulcerative colitis, an inflammatory bowel disease, contribute to an increased likelihood of colorectal cancer. Specific conditions, such as familial adenomatous polyposis (FAP), further heighten the risk factor. Understanding and acknowledging these genetic and precancerous influences is crucial for proactive measures, regular screenings, and early intervention to mitigate the risk and enhance overall colorectal health.

6. Based on our research, the chances of developing colorectal cancer for those with FAP is 100%. So, if a person has colon polyps throughout their intestine, they have to undergo a transplant?

That’s correct. Familial adenomatous polyposis or FAP is a genetic condition that sees unusual growths called polyps or adenomas. Colon polyps can be removed effectively through surgery. It’s noteworthy that individuals below the age of 30 can develop colon polyps, often accompanied by symptoms such as constipation, abdominal pain, or bleeding.

In a hypothetical scenario where 100 colon polyps exist, the removal of all 100 becomes a preventive measure against colorectal cancer. However, if the entire colon is affected, more radical procedures like colectomy (complete removal of the colon) or proctocolectomy (removal of both colon and rectum) may be necessary.

Remarkably, living without a large intestine is feasible, and individuals can lead close-to-normal lives after such surgical interventions. Interestingly, the small intestine, deemed more vital than the large intestine, is indispensable for a normal life. Nonetheless, it’s important to note that small intestine cancers are comparatively rare when juxtaposed with colorectal cancers. Understanding these dynamics underscores the significance of early detection, intervention, and the potential for maintaining a quality life even after surgical procedures.

7. Is it advisable for individuals with a family history of colon polyps or colorectal cancer to undergo HNPCC and FAP tests, and what role do genetics play in these conditions?

Certainly. 

Cancers attributed to familial adenomatous polyposis (FAP) or Lynch syndrome (HNPCC) collectively represent less than 5% of all reported colorectal cancers. For those with a familial history of these conditions, undergoing genetic tests becomes imperative, facilitating the planning of targeted early detection and intervention strategies.

The certainty of colorectal cancer in families with a history of the disease underscores the importance of routine screening to ensure early detection. Colorectal cancer stands out as one of the most curable cancers when identified at an early stage.

8. Is surgery the most sought-after option for cancer treatment, or can the disease be controlled with just chemotherapy and radiation therapy?

Yes. Controlling colorectal cancer is achievable, and there are instances of stage I patients entering remission after undergoing neoadjuvant chemotherapy or radiation therapy. While this approach is confined to a specialized subset of cases, as an expert, I recommend considering complete surgical removal of the tumour during its early stages when it has not yet spread. This approach offers the prospect of curing the disease.

In cases where cancer has progressed to involve the lymph nodes or has metastasized to different body parts, chemotherapy emerges as the primary option. Chemotherapy plays a pivotal role in controlling the disease and impeding its progression. The key lies in tailoring the treatment strategy to the specific stage and characteristics of colorectal cancer, ensuring a comprehensive and effective approach to disease management.

9. What is the expected recovery time following surgery and chemotherapy for colorectal cancer?

The duration of treatment varies based on the body’s response and the effective management of side effects. Typically, it spans from two to six months, emphasizing the individualized nature of the treatment process. Monitoring and optimizing the balance between treatment efficacy and side effect control are crucial elements in achieving the best possible outcome for the patient.

10. Is the use of a stoma bag after surgery a permanent or temporary measure for colorectal cancer patients?

Stoma bags serve as temporary solutions following the surgical removal of a tumour and the reconnection of the colon and rectum. They are typically removed once the surgical wounds have healed. In contrast, after radical surgeries involving the complete removal of the colon, stoma bags may become a permanent necessity. This underscores the tailored approach in post-surgical care, where the decision on the permanency of stoma bags is aligned with the extent of the surgical intervention and the individual patient’s needs.

11. What is robotic surgery? How does robotic surgery compare to traditional/manual surgery in the treatment of colorectal cancer?

Robotic surgery is a cutting-edge, minimally invasive approach where a robot assists the surgeon, enabling the performance of complex procedures with heightened precision, flexibility, and control. This advanced technology is particularly impactful in treating rectal cancer, where the precision required exceeds the capabilities of manual methods.

In contrast, laparoscopy involves a manual procedure executed by a surgeon through a small incision in the abdominal region. While both methods have their merits, robotic surgery stands out for its ability to enhance surgical capabilities, especially in cases demanding intricate precision and manoeuvrability that may surpass what traditional laparoscopy can achieve.

12. A recent news article revealed that cholesterol-lowering therapy may help in controlling aggressive colorectal cancer. What's your expert opinion on that?

To be honest, a full endorsement awaits further research, not just from me but from other medical professionals as well. But from my expert standpoint, metabolism plays a pivotal role in both the prevention and control of colorectal cancer. Effectively managing co-morbidities such as high cholesterol, blood sugar, and obesity emerges as a critical strategy in the comprehensive treatment of the disease. While ongoing research will undoubtedly refine our understanding, the current evidence suggests a compelling connection between metabolic health and colorectal cancer prevention and control.

13. So, what is your message to people in general when it comes to GI tract cancer and it's awareness?

Absolutely. 

Firstly, early detection saves lives, and as previously highlighted, colorectal cancer boasts a compelling 90% cure rate when identified at stages I or II. The critical pathway to this favourable outcome begins with regular screenings.

Secondly, it is imperative for individuals not to delay their treatment under any circumstances. Swift and decisive action in response to a diagnosis is paramount. This dual approach—early detection through screenings and prompt initiation of treatment—stands as a powerful strategy in the fight against colorectal cancer, significantly improving the chances of positive outcomes and long-term well-being.

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