Medical Bytes with Dr. K
It was Saturday morning and John woke up excited to kick start his weekend. He looked outside the window. It was raining cats and dogs. He headed to the bathroom and as he opened his bowels he felt as though there was a sense of incomplete evacuation and his stools were appearing thinner. This had been happening for the past few weeks and he had not taken too much notice. He was feeling a bit more bloated as well and attributed it to the beans he had eaten a few days ago. John was a 55 years old single man who worked as an executive in a bank. He had lost his father 15 years ago to bowel cancer. John did not like seeing doctors and could not remember the last time he has seen one. Upon mentioning these symptoms to his close friend who was a pharmacist, his friend urged him to make an appointment to see a GP. After consultation with the doctor and various tests, John was advised to have a colonoscopy (insertion of a tube with a camera through the back passage to see inside the bowel). During the colonoscopy a tumor was found and he was diagnosed with bowel cancer, at stage two.He required surgery and then radiotherapy and chemotherapy. As these were not available locally, he had to travel to overseas for further treatment. On the other side of town lived 85 year old Seru with his 80 year old wife. Seru woke up at 3 am with a very severe pain in his abdomen. The cramps were so intense that he was moaning and groaning in pain. He vomited twice and was just not feeling right. His wife called the ambulance and Seru was taken to the hospital. He was given pain relief and an x-ray was done of his abdomen. It was discovered that he had a bowel obstruction (blockage of his bowel) with lots of stool throughout the intestines. This was not a surprise as he had been battling with constipation for the past few months. Seru was kept on a fast, given fluids through a drip while a tube was passed down into his stomach to get rid of the contents. He had a colonoscopy performed and the conclusion was that he had a very large cancer on the right side of his large intestine. Seru’s cancer was end stage and had spread to his lungs, liver and many other organs. The doctors performed surgery to remove the cancer, however the other options of radiotherapy and chemotherapy were not available in Fiji and hence Seru was given pain relief and kept comfortable. He died within a month of the diagnosis. Then there was 35 year old Rohini who was having bright red bleeding from the back passage and some pain in her lower abdomen. Alarmed by her symptoms she saw a doctor and was told that she had hemorrhoids and given a cream to use. This made no difference to her symptoms and she saw another doctor who thought that she may have irritable bowel syndrome as she had some change in her bowel habits as well. She was advised of dietary changes which also made no difference to her symptoms. She then went to another doctor who took a good history and examined her thoroughly. She advised her to have blood tests, a scan of her abdomen and then a colonoscopy. The colonoscopy showed a tumor and a biopsy showed she had an early cancer- stage one. Rohini then had surgery in which part of the bowel was removed. She recovered well and had no further issues. All the above people were of different ages, gender and racial background but had one thing in common - they were all victims of bowel cancer. In Australia 1-30 June is bowel cancer awareness month, an annual initiative of bowel cancer Australia to raise public awareness of a disease that claims the lives of 80 Australians every week. In Fiji we do not have a special month, however it’s an opportune time for us to consider bowel cancer which is common and easily treatable if detected early. Bowel or colon cancer makes it in the list of top five cancers in men in Fiji (Ministry of Health 2013 annual report). The annual death rate from colorectal cancer in Fiji in 2013 was 7.6 per 100,000 population, which was higher than the rest of the Oceania region at 6 per 100,000 population, although lower than the rest of the world at 10.8 per 100,000 population. Bowel cancer also known as colorectal cancer can affect any part of the large bowel (colon) or rectum. It usually grows very slowly over a period of up to 10 years before it starts to spread and affects other parts of the body. Most bowel cancers start as innocent growths -called polyps-on the wall of the bowels. Polyps are like small spots or cherries on stalk and do not produce any symptoms. Polyps are common as we get older and most polyps are not precancerous. One type of polyp called adenoma can however become cancerous. If left undetected the cancer cells will multiply to form a tumor in the bowel, causing pain, bleeding and other symptoms. If untreated, the tumor can grow into the wall of the bowel or back passage. Once cancer cells are in the wall, they can travel into the blood stream or lymph nodes and travel to other parts of the body. For bowel cancer, the most common place for spread is to the liver and the lungs. In its early stages bowel cancer may have no symptoms but many people experience blood in the stools or on the toilet paper, a change in bowel habits such as diarrhea, constipation or smaller more frequent bowel movements, a change in appearance or consistency of bowel movements such as narrower stools or mucus in the stools. Many experience a
feeling of fullness or bloating in the abdomen or a strange sensation in the rectum often during a bowel movement. There may also be a feeling that the bowel has not emptied completely after a bowel movement. There may be a lump in the back passage or even rectal or anal pain. The other general symptoms may include unexplained weight loss, weakness, fatigue and anemia. The exact cause of bowel cancer is not known, however people with certain risk factors are more likely to develop it. These include age over 50, multiple polyps, history of inflammatory bowel disease and a strong family history of bowel disease. Certain lifestyle factors also increase the risk such as being overweight, a diet high in red meat, drinking alcohol and smoking cigarettes. A screening test is available for bowel cancer. This is especially important as in its early stages, there may be no symptoms. This is the faecal occult blood test (stool test that looks for microscopic blood in the stool). If this test is positive then a colonoscopy is required (camera test from the back passage). The faecal occult blood test is recommended every 2 years for people over the age of 50. If there is a persistent change in bowel habits, it is strongly recommended that you visit your GP for a consultation. On most occasions, it will not be bowel cancer but if your doctor is suspicious, then he or she will organise further tests. You can reduce your risk of bowel cancer by maintaining a healthy weight, eating a healthy diet, regular exercise and not smoking.
“The annual death rate from colorectal cancer in Fiji in 2013 was 7.6 per 100,000 population, which was higher than the rest of the Oceania region...”
DR. KRUPALI RATHOD TAPPOO is an Australian qualified General Practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical Coordinator for Fiji-based NGO Sai Prema Foundation. Dr. Krupali is based at Mitchells Clinic in Tappoocity Suva and has a special interest in women and children’s health.