 Good afternoon everyone. I am Dr. Harish Papurati N.A. consultant gastroenterologist at Manipal Hospital, Malaysia. Today I will be speaking on very important and very interesting topic of colon cancer. I chose this topic in the month of starting of April because the month of March has been widely celebrated as a colon cancer awareness throughout the world. It is very much prevalent in the countries of European countries and American countries. But in India off late we have been seeing that there is increasing prevalence of colonic polyps and colon cancer. So I decided to talk about this topic and to educate the public about this thing. As we know like colon cancer has become second leading most cause of cancer mortality in our country and it has been rapidly increasing in trend off late. We see very common in even in anger age groups also. So care for this colon cancer has become very important in three ways to early to basically to diagnose early and to prevent it. And also in a diagnosed cases it's always to give a good quality of care. As I told March month all over the world has been celebrated to create awareness among a public and to get them screened and treat in early stages and give them a good quality of life. Now to discuss about a colon basically colon basically like it's a very is a large part of a large intestine. It has a basically is a 1.5 centimeter 1.5 meters of large tube which has of different parts. We have a right side of colon which includes cecum and ascending colon and the middle part is a transverse colon and the left side we have descending colon and recto sigmoire and then motions come out from the anus. Basically colon serves very three important functions in the body. Whatever the food has been absorbed and digested in small intestine that goes into the large intestine and it gets converted into the stool. And also the stool formation and the storage of stool prominently occurs in the large intestine. And whatever the residual water and some of the compact mineral absorption also occurs through the intestine. And through the bacterial flora which is there in the large intestine it secretes the vitamin K. But the most important part of this talk is to create awareness among colon cancer. So I will be discussing about the risk factors basically to which are the who are those people who are at risk for developing this colonic polyps or colon cancer. The main important risk factors are age more than 50 years and those who have a family history of either colon cancers or those who have a history of the polyps. Basically it runs in a family with a history of a background genetics. Then those patients who are addicted to smoking and alcohol always have a risk of this developing colonic polyps following colon cancer. And those patients who lack physical activity or obese were a lot of sedentary lifestyle there at risk. And also the diet plays a very important role. Those who have a decreased fiber intake or increased red processed meat. These two things are very important in the risk factors in a day to day schedule. And we have a inflammatory bowel disease this ulcerative colitis and Crohn's disease. These diseases because of the background inflammation going on for a long time more than 8 or 10 years they do predispose these patients for a colonic cancer. Now coming to the symptoms like how does a patient present to a doctor or what are the symptoms one should suspect of having a colonic cancer basically. So the most easiest symptom which you can feel is the like tiredness basically like just a fatigue or a kind of a weakness just because like cancer developing in the intestine. Or most of these colonic cancers they start bleeding slowly like they use out a small amounts of blood because of which patient will develop a low hemoglobin. Because of that they can have these symptoms. The other common symptoms we see is patients especially the older people coming to us for a new onset of altered bowel habits. Sometimes they can have constipation, sometimes they can have a loose stool. Or a new onset of constipation itself is a risk factor to get screened for a colon cancer. Then sometimes the patients can have a frank bleeding once they develop an ulcer on these cancers. They can have a frank bleeding or some mucus kind of a thing can come out in the stools. And when the disease gets advanced most of the patients can present with a loss of weight, loss of appetite. And if at all the cancer has developed into a large size and it started obstructing the lumen of the intestine. Then they can present to us with the pain, abdomen, vomiting like something like subacute obstruction features. These are most commonly like easiest ways to like whenever you get a routine health checkup if there is anemia or you are feeling very tired of fatigue. It is always better to get screened for colon cancers. Now there are different types of colon cancers. These colon cancers predominantly like we can have right sided colon cancers or the left sided colon cancers. The right sided colon cancers are somewhat slow growing and they do have good prognosis. But this left sided ones in the sense we have this rectosigmoid and a descending colon. These malignancies are very aggressive and they are very fast growing and they have a very bad tumor biology. But of late we have been seeing the anger generation has been affected by this left sided colon cancers more than the older generations. Based on the morphology by the look of the cancer in the either colonoscopy or on the histopathology or like microscopy. We do have a variety of types of this colon cancers. Can it be like adenocarcinoma which is very common. Sometimes we do see the adenos squamous variant or sometimes very rarely we see even the neuroendocrine variant of the adenocarcinomas. And most important thing in colon cancer is always the genetics. The family history plays a very role. So many times when the anger generation are diagnosed with the anger people those who are less than 50, less than 40. Whenever they are diagnosed with this colon cancers it is always better to screen them for the genetic mutations. Because it helps it in two ways. One way is to like you know to screen the siblings are a close family the blood related first degree relatives for a colon cancers. And second thing the mutations also help us help the oncologist to plan for their chemotherapy or whatever the newer targeted therapies are available. So all these different types are also important in the type of in the explaining the prognosis. Or to decide what exactly is the treatment required and also to plan for the screenings for the siblings and the first degree relatives in the family members. Now once patient comes to us with whatever symptoms whatever like you know like difficulties is having. The next question comes how to diagnose this colon cancers. See diagnosis of this colon cancers is simple OPD daycare kind of a procedure wherein we do a procedure called either sigmatoscopy or a colonoscopy to see your intestine. And then if at all we find any ulcer or any growth or any poly we take a small pieces of tissue from that called as a biopsies and send it for a histopathology. It's the easiest way of diagnosing this this is by just by colonoscopy and take a biopsies of it. And once we have seen the luminal site we need to know what is the extent of the cancer or whether it is spread to the other parts of the body or not. Based on that we either go for a CT scan or MRI CT scan is something which we usually perform. But if the cancer is very much lower down in the rectum and perianal area is involved or sigmat in those cases we always plan for an MRI pelvis and abdomen. Once we have done this diagnosis part then the important question comes is the staging. The staging is always done by a PET CT scan. It may not be necessary always if the disease is very limited to the localized intestinal part and CT scan doesn't show any extra intestinal spread then PET scan may not be required in every case. But once we feel the disease is advanced then it's always better to have a PET scan then only decide about the proper staging and based on the staging only the treatment will be discussed in the boards. Then once you have this tissue which has been sent for the biopsy in the same tissue we can do the genetic mutation analysis as I discussed in the past. The genetic mutation analysis is required for both prognosis also to decide the chemotherapy or the targeted therapy what regimen will suit which patient and also it helps for the family screening also. Next comes like what are the like once your diagnosis is done once you have done the staging of the cancer then comes what are the treatment options available for these patients who are diagnosed with colon cancers. The treatment options mostly based on the stages basically. If it is in the like early stages and it is easily like surgically resectable always that is the best treatment and the gold standard kind of treatment when you can completely exercise the tumor and join the parts of the intestine from where you are cut. Sometimes you may not be able to join the intestine by doing an ostomosis then the surgeon might just take out the part of a large intestine or a small intestine outside the abdomen to just convert as a conduit. So in some cases the chemotherapy and redot therapy plays very important role if the malignancy is very much lower down in the rectum the preferred treatment will be initially to give a chemotherapy or a redot therapy. The redot therapy followed by that a surgeon will be considered in that case we call it a new argument chemotherapy. Once the surgery part has been done this patient have to be closely followed up with oncology teams and the decision of chemotherapy and redot therapy has to be discussed and given according to patient to patient basis. But off late we do data we are in the oncology field has been progressing very fast and do have targeted therapies. This targeted therapies the advantages the side effects what you see with the chemo have come down to a significant and patients tolerance and the patients accept the chemotherapy in a much better way. And sometimes the cancers might have progressed to advanced stages wherein we cannot go for a definitive surgical treatment for a resection and an ostomosis. In those cases as a palliation sometimes we can just place a sense that is like a metal stain into the obstructing part in the large intestine that can be done through a colonoscopy itself. Then comes the most important topic of screening protocols what are the screening protocols available for this colon cancer and who are the patients who should go for a screening colonoscopy at earlier age. And in America and Europe it is now initially it was around 50 years for screening cutoff right now it is come to 45 years because of there has been a rapid rise in the increase in the polyps because of their dietary and the lifestyle changes. In India also off late we are seeing very rapid rise in the colonic cancers and also as well as the colonic polyps but as of now we don't have a definitive guidelines to screen for a general public or a population. But those patients who are at risk like in the risk in the sense those who have a family history of colorectal cancers or those who have history of polyps, colonic polyps in their previous colonoscopies or in the family history. Or those patients who have this ulcerative colitis or Crohn's disease. Ulcerative colitis and Crohn's disease once the disease duration crosses 8 years then we recommend them annual colonoscopy to screen for early colonic cancers and treat it accordingly. But in case like normal public in US and Europe it is now 45 years and if at all there is a family history then it is screening starts at the age of 40 years. And if any of the family member like a brother or siblings or a parents suffer from a colonic cancers from that age like 10 years before a family member should get a colonoscopy done. And based on that colonoscopy findings the next colonoscopy will be scheduled based on the number of polyps or the types of polyps the patient gets it. But if a colonoscopy is completely normal then the next colonoscopy will be after 10 years. Colonoscopy is the easiest and simple procedure which can be like as I told you it can go as OPD procedure and easiest ways to diagnose all the polyps. And also at the same time we can remove those polyps which in case they are left unattended they can tend to become further increase in size and become a colon cancer. And other way of screening is you can do some of the stool test but they are not as good and as specific and sensitive as colonoscopy. We do a fecal DNA test for colon cancers and there is a fecal immunochemical test FIT which is available for basically based on genetic mutations for screening of colon cancers. Next comes what do you expect during colonoscopy because colonoscopy itself sometimes the patients may not really accept the procedure but not to worry much about it. It is a simple daycare procedure it can be done under a mild sedation. Once you have come to OPD visit you can just you will be advised to take a colonoscopy preparation which is to drink around 1 liter of solution. After that the patients will go for a bowel movement from 5 to 6 times. Then once the bowel is cleaned a procedure will be done along tube similar to an endoscope which will be passed from the rectum and it will examine the entire large intestine. At the same time we do check for all the polyps in all the places we take almost to reach. It may take how much time but we examine while removing we observe for almost 6 minutes and see for all the polyps if the smaller polyps we remove it in the same setting. If the larger polyps then we may have to plan for additional procedures. Then once we diagnose this polyps most of the times if they are less than 1 centimeter we can remove by biopsy forceps only. If there are larger polyps then we have to use a snare or other devices to cut it and remove it. Then once like sometimes in the colonoscopy we can just by the look of it we can notice that this cancels our progress to advanced stage. Then we just take a biopsies and come out. Once a biopsy diagnosis is available then we go for a planning of physical staging by a CT or MRI followed by PET scan if required. Based on that the surgical colleagues and the uncle colleagues will be involved in the team and decide the best definitive treatment. These are the some of the images of the colon cancers in the colonoscopy and you can see the CT corresponding images. By the look of it it is very much advanced disease it requires a proper staging and a proper definitive treatment protocols. The next most important slide comes for the days how to prevent this colon cancer. Prevention is very very important because of the change in the lifestyle, change in the dietary food habits of the general public with the generations changing. These polyps rates have increased so always as we know like most of the time there is a lot of obesity which is very much common in the children of late and the younger generation. It is always better to promote a good physical activity on a day to day basis and maintain ideal body weight which helps in prevention of development of these polyps. And always it is better to avoid all the addictions which predispose in a way to develop these polyps or maybe the progress faster and development of colorectal cancers happen in the patients who are addicted to smoking or alcohol. And whenever there is a constipation especially with the age like around 50 or 55 with the coma of illnesses always better to take care of the constipation by true means of the diet also and also by means of laxatives if required. But it is better to visit your gastroenterologist once get it screened if there is no polyps nothing then just better maintain the constipation with the laxatives. Diet plays a very important role as I told you the red processed meat and the decreased fiber intake always predisposes to these polyps. So always better to include a lot of green leafy vegetables fruits and increased fiber intake on a day to day dietary basis. And also patients like the small dose of aspirin and other NSAIDs have been documented patient might be on prophylactic for other matter cardiac or stroke medicines that low dose of aspirin does help in prevention of development of this colonic polyps. So whenever patients undergo this colonoscopy and they are diagnosed with this polyps it is always better to remove them. Moreover just follow up those biopsy reports after the polyps with the consulting gastroenterologist and discuss regarding the surveillance like you know when will be the next colonoscopy required is it after 3 years or 5 years or 10 years. And sometimes it might be as early as 6 months to 1 year also that all depends upon the basically the morphology of the colon polyp what has been come up and nature of it. So this colonoscopy as a screening procedure has become a very important tool in a day to day practice to prevent this polyps further progressing into colonic cancers. So always as a old saying says announce of prevention is worth a pound of cav. So one thing we need to understand about this colon cancer is we have lot of tools to diagnose it very very early or even diagnose this polyps so that they never progress to become a cancer. And it is a very deadly disease in all the ways it can cripple the patients even in an anger age groups including 30 to 40 years. Thanks everyone for watching this video. I selected this topic because this colon cancer has been an increasing trend of late even in an anger generation and also those are in the age group of 40 to 60. So it is important to know about it and also educate your family and friends regarding the same and kindly to share this video. And if any doubts please drop it in the comment section.