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All About Colorectal (Colon) Cancer in Jamaica

February 4, 2020

 

According to Globacon 2018, Colorectal cancer is the third most common cancer in Jamaican men and the second most common cancer in Jamaican women. It is the third most common cancer in Jamaica. And so today, World Cancer Day, Jamaica Moves will highlight vital information about Colorectal Cancer, and other cancers in Jamaica in an effort to encourage everyone to be vigilant and for those at risk to screen for the disease. 

 

We spoke with Veteran Gastroenterologist and Acting Director of Health Services, Planning and Integration at the Ministry of Health and Wellness, Dr. Naydene Williams about colorectal cancer in Jamaica. 

 

 

What is Colorectal Cancer? 

Cancer, put very simply is the end product of the unnatural multiplication of cells, sometimes due genetic causes (mutations). It can be growth or tumor. According to Dr. Williams, “colorectal cancer refers to a cancer or a cancerous process involving the gastrointestinal tract, which we call the bowel. The colon and rectum comprise the large intestine or the bowel...usually when people speak about colon cancer, they’re usually speaking about colorectal cancer.”

 

If you were to see a visual of the inside of the colon, a cancerous growth inside can continue to grow to the point of blocking the passage of the colon. If the colon, which is like a tube, gets blocked then the natural movements within it can be interfered with. 

 

What are the signs and symptoms of colorectal cancer?

 

Dr. Williams shares that signs and symptoms of colorectal cancer depend on where in the colon the cancer is. If the cancer is close to the end of the bowel, then often people present with: 

  • Blood in the stool (bright red)

  • Mucus (like slime) in their stool

  • Pain in the bottom 

  • Some may see/feel a mass in the bottom (if the tumour has grown large enough)

If the cancer is higher up in the colon (not at the end, rectum or near the anus):

  • Patients may still have blood in their stool 

  • Blood may not be seen or may not be as bright (microscopic blood in the stool)

Other signs and symptoms may include:

  • Pain in the abdomen/belly

  • Vomiting (due to blockage, no bowel movement)

  • Distended/swollen abdomen

  • Inability to pass air

Cancer related blockages in the colon tend to happen on the left side of the colon where the tube is smaller. It usually means that the cancer presents (can be diagnosed) earlier. If the cancer presents on the right side, where the tube is bigger, they may not present with a blockage; instead the cancer may bleed, it is not detected in the stool however they present with anemia (low blood count). 

 

When a person presents with anemia, especially with anemia where you are deficient in iron, and you don’t know why the person is anemic, then one of the investigations which is usually carried out to find out why (after you have determined the kind of anemia) is to look in the colon to see if there is any cancer growing in the colon.” 

 

 

Who is most at risk of developing colorectal cancer in Jamaica? 

 

Persons who are older are most at risk because with age come the genetic changes which will predispose to having cancers generally. 

 

What are the risk factors for Colorectal Cancer?  There are some general factors which put persons at risk:

  • Persons who smoke

  • Obesity

  • Persons with diabetes

  • Low fibre intake

  • Excess red meat

And then there are some factors that put people at increased risk for colorectal cancer. These include: 

  • A family history of colorectal cancer 

  • A family history of conditions which predispose to colorectal cancer such as some polyps, and some persons have familial syndromes where they have an increase of cancers; that person has a predisposition for cancers and colorectal cancer may be one of them. 

  • Persons with inflammatory bowel diseases; including crohn's disease and ulcerative colitis

 

Screening for Colorectal Cancer

According to Dr. Williams, population screening for colorectal cancer in Jamaica is pending. But in the interim, individual and opportunistic screening is done. 

  • One test is the fecal occult blood test, which tests the stool for blood. 

  • Tests can also look for components of blood in the stool.

  • Tests can look for abnormal DNA in the stool- which would be a part of the composition of the cancer.

  • Another test  is a sigmoidoscopy; this test, which allows doctors to look inside the colon, is limited as it does not look inside the entire colon. It looks from the anus to the descending colon

  • There is also a colonoscopy which looks inside the entire colon. 

 

In addition there is:

  • CT scan 

  • Barium enema; this is a special kind of X-ray (using dye). This is usually used for patients who have symptoms. 

Globally, it is recommended that persons who are at average risk of getting colorectal cancer (that is, persons who are not at increased risk; using the risk factors listed above) should start screening for colorectal cancer at 50 years old. 

 

Dr, Williams shares that “the sequence of events from the presentation of the first tiny bump or polyp to the cancer is usually about 10 years so the whole point of screening is to identify if the person has colon cancer...you want to pick up something that is not cancer but that can develop into cancer.” 

 

Colorectal cancer is one of the few cancers, if not the only cancer, where you can actually prevent the cancer.”

- Dr. Naydene Williams

 

What treatment options are available in Jamaica for colorectal cancer?

According to Dr. Williams, treatment can be accessed in all the four health regions and in most hospitals in Jamaica. 

 

The treatment options include:

Surgery

Surgery is for the removal of the cancer. This can be curative or it can be palliative which means that they cannot be cured but they can be treated and have a better quality of life. 

 

Chemotherapy

Chemotherapy is also one option used in the treatment of colorectal cancer. This usually refers to the administering of medication, orally or intravenously, that is intended to decrease the size of the cancer. Chemotherapy tends to be administered when there is a risk that the cancer might have spread.   

 

Radiotherapy

Radiotherapy is the administration of special radiation treatment specifically to areas that can be sensitive to the radiation. Radiation would most likely be administered when the patient has cancer of the rectum or anus. 

 

Kingston Public Hospital, through the St. Joseph’s Hospital and Cornwall Regional Hospital offer radiation therapy at the linear accelerator units. These units offer an advanced kind of radiation therapy. 

 

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