2023-04-25 10:28:57
Colorectal cancer is the most commonly diagnosed tumor in our country, adding both sexes. A tumor that is produced by the abnormal growth of the cells that form the tissues of the final tract of the digestive system and which, according to estimates by the Spanish Society of Medical Oncology (SEOM), will be registered this year 42,721 new cases.
In addition, it is the second most lethal cancer after lung cancer, causing the death of 15,038 Spaniards in 2021 alone. However, and contrary to what happens with other tumors such as lung or breast cancer, this cancer does not seem to worry the population too much. Or so it can be understood when a high percentage of citizens at risk age, that is, between 50 and 69 years, choose not to submit to the tests that allow their early detection. Nor to the health authorities given their decision to exclude a large part of these citizens from the screening programs. What can have fatal consequences since the probability of cure rises to 90% when it is detected in its initial phases.
Faced with this reality, the ABC Salud Forum has delved, with the collaboration of the Spanish Association Against Cancer (AECC) and the medical advice of the Hospital MD Anderson Cancer Center Madrid, into the keys to improve the prevention and approach of colorectal cancer. A multidisciplinary analysis carried out by top-level experts in the field of oncological diseases: Dr. mariluz amadormedical director of the AECC, and five specialists from MD Anderson Madrid: Dr. Jose Ignacio Martin Valades, head of the Digestive Tumors Section; the doctor Mercedes Garcia Casas, member of the Gastroenterology Service; the doctor Pedro Jose Robledo Saenz, head of the Clinical Nutrition and Diet Unit; the doctor Oscar Alonso Casado, Chief of Hepatobiliopancreatic Surgery; and the doctor Cristina Garrán del Ríoof the Radiation Oncology Service.
Prevention
The main risk factors for the development of colorectal cancer are age, sex -more frequent in men-, family history -around 5% of cases are hereditary- and having suffered digestive pathologies or other tumors, This risk can be reduced by adopting healthy lifestyle habits: diet rich in vegetables and physical exercise. “Obesity increases the probability of a tumor in the colon and/or rectum by 20-40%,” explains Dr. Martín Valadés. As well as avoiding carcinogens such as tobacco and alcohol. Likewise, certain microbiota bacteria could help improve intestinal transit and, therefore, protect against tumors of the digestive tract, including those of the colon and rectum. So, has a specific diet been identified that prevents its appearance? Well no, “there is only consensus on the existence of products that can contribute to its development, such as convenience foods and red meat», says Dr. Robledo Saenz. Nor in the case of the type of exercise, although “it is not necessary to go to the gym: just walk every day or climb stairs. And to all this is added a real challenge in today’s world: reducing stress. A study carried out by the AECC reveals that “the population between 50 and 69 years of age is unaware of the risk factors and, therefore, does not perceive any type of need to participate in screening programmes”, warns Dr. Amador.
Early diagnostic
Given the absence of symptoms In its initial phases, early diagnosis of colorectal cancer is only possible through population screening with the fecal occult blood test (TSOH). A totally innocuous test and indicated in the asymptomatic population whose only risk factor is age, which, if a positive result is obtained, would be complemented with a colonoscopy, which “in addition to diagnosis, also allows prevention by making it possible to detect polyps and remove them.” , preventing them from turning into a tumor over the years”, points out Dr. García Casas.
The problem is not that citizens of risk age are not aware of the existence of these screening programs: up to 87% claim to know about the TSOH. The problem is that 37.5% admit to never having had the test, the main causes being the ‘expected’ absence of symptoms (39.6%) and forgetfulness or neglect (28.6%). And most worryingly, not having received the letter with which their Ministry of Health invited them to take the test (39.9%). Although tumor screening has been in the common portfolio of SNS services for nine years now, “access to it – denounces Dr. Amador – depends on the place of residence. The coverage level should be 100%, that is, the letter should reach the entire population at risk age. And although we have autonomous communities such as the Basque Country and Navarra with very high levels of coverage, we also have black spots. Even so, the invitation is useless if the patient chooses to ignore it. But it is clear that the greater the coverage, the greater the participation. In short, points out Dr. Santiago González Moreno, medical director of MD Anderson Madrid, “greater awareness is required regarding prevention, healthy habits and screening, which will help us allow us to diagnose these tumors very early, when they are still potentially curable”.
Treatment
Once the diagnosis has been established, what are the available treatment options? They depend on the stage of the tumor, being possible in about 60% of the patients, in whom the diagnosis was made at an early stage, cure the disease with local techniques, endoscopies or surgery. And in the rest? If the tumor is ‘localized’ and has not spread to other organs, a surgical interventionalthough in some cases it is added chemotherapy and/or radiotherapy to prevent its recurrence. On the contrary, if the cancer has reached other organs, chemotherapy is non-negotiable.
Advances in diagnosis and treatment have made it possible for survival has doubled in just two decades. Advances such as those achieved in surgery, hand in hand with robotics, which allow the surgeon to perform operations with minimally invasive techniques, which in addition to efficiency improves patient recovery. It is the case of the pioneer robotic surgery ‘Da Vinci’, carried out successfully at the MD Anderson Madrid hospital and which, says Dr. Óscar Alonso Casado, “allows tumor extraction through the anus in very early rectal tumors, or even in polyps that cannot be removed by endoscopists.”
Radiotherapy has also undergone notable advances that have largely limited the radiation doses on tumors, leaving healthy organs aside. A “therapeutic revolution -says Dr. Garrán del Río- with which better cure rates are achieved with much less toxicity. And it is that what was previously known about radiation were the side effects, which were very important, but we have improved a lot ».
At this point, is there no place for immunotherapy in this type of cancer? “Colorectal cancer is what we call a ‘cold tumor’, that is, it is not very sensitive to immunotherapy except for a type of tumor with specific characteristics and which accounts for less than 5% of the total,” says Dr. Martín Valadés. The patient is no longer a passive subject waiting to be treated. Once all the information has been received, he participates together with the multidisciplinary team in making decisions about the best therapeutic option. And he follows a self-care protocol to arrive in the best conditions for treatment.
An ever younger cancer
As with all tumors, colorectal cancer is associated with age, which is why the population at risk is that which has already celebrated its 50th birthday. However, specialists have spent years observing an increase of up to 3% per year, according to some international studies, of new cases in a younger population, which is why the suitability of advancing the age of tumor screening to 40-45 years. In addition, this trend could worsen in the near future due to a lack of physical exercise, practically eradicated in secondary education, combined with a diet in which rice, hamburgers and soft drinks prevail. Not surprisingly, warns Dr. Martín Valadés, “consumption of two sugary drinks a day can increase the risk of developing colorectal cancer by 50%.”
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