Colorectal cancer (CRC) is a major killer both in the developed and the under-developed countries worldwide. The good news about it is that we can screen for CRC. Indeed starting from the age of 50, everyone is recommended to undergo a colonoscopy. Colonoscopy is the ‘gold standard’ method for CRC screening. This telescopic method of screening allows the doctor to have a good look at the inner surface of the whole length of the colon. If any polyps are detected, the polyps can be removed at the same time. (Colon polyps are the precursors of colon cancer.) If a colon cancer is detected, a biopsy can be taken for confirmation before performing the colon surgery. Anyone who has had a normal colonoscopy examination will only need a repeat scope 10 years later. (Of course, if you develop new bowel symptoms in the interval, you need to consult your doctor who might recommend a repeat colonoscopy before the 10 years is up.) If you have a family history of colorectal cancer, then your first colonoscopy should be at 45 years of age.

Before the advent of colonoscopy, screening for CRC was done with the use of a kit whereby a sample of faeces was tested to see if it contained an invisible amount of blood. This test is called the faecal occult blood test (FOBT). FOBT used to be the standard practice but now colonoscopy is considered the gold standard method for screening for CRC. However, FOBT is still a very useful method for screening. The English arm of the UK Bowel Cancer Screening Pilot Study used FOBT on a population of 187,777 individuals aged 50 – 69 years every six months. Researchers from the University Hospitals Coventry and Warwickshire NHS Trust analysed their results looking at the effects of the FOBT study on the emergency and elective colorectal cancer workload in the hospitals within the Trust over the period 1999 to 2004 (Gut 2007; 29th November epub). The report also examined the effect of the biennial FOBT upon Dukes staging (a well-known method for staging how advanced the cancer is at the time of surgery), mortality and stoma formation for emergency CRC admissions. The first year, 1999, was the baseline, pre-screening year. The screening years were 2000 to 2004.

Patients who had positive FOBT results underwent colonoscopy examination. About 2700 colonoscopies were performed and during the entire period 1236 new cases of CRC were diagnosed. In 1999, the pre-screening year, 29.4% of CRCs were admitted as emergencies. With screening, this emergency admission proportion was reduced to 15.8% by 2004. Consequently, there was a corresponding significant decrease in the number of emergency CRC procedures performed over the same period. The need to form a stoma (an opening on the abdominal wall for the discharge of faecal content into a bag) was also reduced. In 2000, 23 stomas were created while only 10 were created in 2004. The 30 – day operative mortality rate among patients undergoing emergency surgery also decreased from 48% in 1999 to 13% in 2004.

The study showed that the use of biennial FOBT in a population can lead to a reduction in the number of CRC patients who required emergency hospital admission. Patients with more locally advanced CRC tended to present as emergency cases. The morbidity and mortality rate among patients who undergo emergency surgery is much higher than those patients who have scheduled, non-emergency surgery. The fear of undergoing colonoscopy is understandable. However, this must not stop you from visiting your doctor for CRC screening. Your doctor can always use FOBT for initial screening. If it is negative, you do not need to face a colonoscopy but if it proves positive then you would be silly not to consider a colonoscopy.

While FOBT is not the gold standard method for CRC screening nowadays, it is still a very good, low tech method for those who are reluctant to choose the colonoscopy route. A non-gold standard method is still much better than no method at all!

A recent study from France looked at how a patient’s nutritional status will affect the outcome of cancer treatment (Am J Gastroenterol 2007; 102: 2557 – 2563). A total of 105 patients with locally advanced esophageal cancer (LAEC), that had not spread elsewhere, were treated with definitive chemoradiotherapy (CRT). Of these, 42 patients did not respond to CRT and 63 patients responded to the treatment. Analysis of various factors showed that serum albumin level > 35 g/L was the only factor which could predict complete response to CRT. That is to say, if your body’s albumin level is more than 35 g/L, you are likely to achieve complete response to CRT. The factors which predicted survival were body mass index (BMI) > 18 kg/m2, dysphagia (difficulty in swallowing) Atkinson score <2, the dose of radiotherapy > 50 Grays and complete response to CRT. What this study demonstrated is that if you start off with a body with reasonable reserve, you are likely to do better than someone with poor reserve. Thus, someone who has lost a significant amount of weight before the commencement of CRT (as reflected in low albumin level and low BMI) may not tolerate the treatment well. The side-effects of the treatment are likely to be more profound and the bone marrow side-effects from the chemotherapy may be more significant. These effects would then interrupt the treatment schedule and some may have to stop all forms of therapy before they can complete the full course of CRT.

Simplistically, cancer can be viewed as a parasite in your body. If it does not interfere with major blood vessels or crucial organs in your body, cancer takes life by sapping you of all your energy. Eventually, the very weakened body will have no reserve left to sustain basic bodily functions and you die. Quite often I hear patients telling me that they have stopped eating this and that after the diagnosis of their cancer. The idea is that starvation will deprive the cancer of essential nutrients and thus slow its growth. It is utter fallacy because the cancer will parasitise the reserve in your body and not rely on what you eat daily. When there is none left to parasitise, the person dies and the cancer dies with the person. I have also had cancer patients with stable disease who announced to me that they are going to embark on a special diet for two weeks which has been said to help fight cancer. Following the dietary escapade, I find the patient having lost weight and the cancer started to progress again.

Having a good nutritional status before, during and after your cancer treatment is crucial to your body and the immune system in their fight against the cancer. Restricting your diet now will not reverse the cancer nor will it slow it down. For those with the thought that the cause of their cancer may be related to something they have eaten, do remember that restricting your foodstuff after you have been diagnosed with cancer is a bit like closing the barn door after the horse has bolted.

So the next time you overhear someone giving the advice of starving the cancer, tell him / her why it is unlikely to work. It might actually make things worse.