When one is told one has cancer, inevitably, one will be filled with terror and sorrow. One’s loved ones will be frightened on one’s behalf. Family members are grieving and feeling helpless and all they can do is hope for the best. It only takes a disease like cancer to blow apart the ordinary lives.

I came to know about cancer at the tender age of eleven years old. At that time I didn’t know much about cancer, yet I knew it could be devastating to have it. My two aunts who were stricken died in the same year. The following year, my maternal grandfather died of cancer too.

For a long time I wouldn’t dare to call it by its name. When I was older I called it the big C, for I read it was what John Wayne called it as he battled the big C for fifteen years before he succumbed to it. Whenever I heard that someone has fallen ill, the first thing that would come into my mind is, “Oh no, please don’t let it be cancer.”

Recently, it seems colorectal cancer has been making the news in my circle. It has happened to my sister’s friend, my husband’s ex-colleague, somebody’s friend’s wife and….. Gosh, it is so dreadful because when we visit the sick we have nothing else to offer except to appear optimistic. Privately, we have this awful thought of what if…..
this will happen to us one day.

Prevention is better than cure, we say. Hence, it’s high time we learnt about the colorectal cancer. Recently, I read an article in The Star (21 Feb 2007) by Dr Milton Lum who said that colorectal cancer is the most common in males and the third most common cancer in females in Malaysia. According to this good doctor, cancer can arise anywhere in the large intestine but commonly can be found in the descending and sigmoid colon or the rectum. The lining of the colon and rectum comprises cells which are constantly renewed. Sometimes there is an excessive growth of cells forming polyps. Most polyps are non-cancerous (benign). However, some polyps may, over time (usually years), develop into cancer.

If diagnosed and treated in its very early stages, colon and rectum cancers have a high rate of cure, therefore early detection is vital. The stages of colorectal cancer are: Stage 0- the cancer is found in the innermost lining of the large intestine only. Stage 1- the cancer has spread beyond the innermost lining to the second and third layers and involves the inside wall of the large intestine, but it has not spread to the outer wall or outside the large intestine. Stage 2- the cancer has spread outside the large intestine to nearby tissue but it has not spread to the lymph nodes. Stage 3- the cancer has spread to nearby lymph nodes but it has not spread to other parts of the body like liver or lungs. Stage 4- the cancer has spread to the other parts of the body like liver or lungs.

Symptoms: A change in bowel habits; diarrhea, constipation or a feeling of incomplete emptying; bright red or very dark blood in the stools; stools that are narrower than usual; general abdominal discomfort like bloating, fullness, frequent gas pains or cramps; unexplained weight loss; constant tiredness or vomiting. Any change in bowel habits that persists should signal the need for physician consultation.

Treatment: Fecal occult blood test examines the stools for hidden (occult) blood, i.e it cannot be seen by naked eye. This test doesn’t say whether the person has colorectal cancer as benign conditions like piles, anal tears and benign colonic polyps can also result in a positive test. However, its result will help the doctor decide whether an examination of the large intestine is needed.

Colonoscopy is a procedure in which a thin, lighted instrument is used to view the entire colon and rectum for cancerous or benign growths. Any polyp or abnormal areas seen are removed for microscopic examination. The procedure is usually carried out under sedation.

The basic treatment is the surgical removal of the cancer and the regional lymph nodes for localized disease. The procedures include local excision, which is the removal of very early cancer by colonoscopy; partial removal of the cancer and surrounding healthy tissues (colectomy) and lymph nodes with healthy parts stitched together (anastomosis); or colectomy and colostomy. If the two ends of the colon or rectum cannot be stitched back together, an opening (colostomy) is made on the outside of the body for the stools to pass through. Sometimes, the colostomy or stoma is needed only until the lower colon has healed and then it can be reversed. If the entire colon or rectum needs to be removed, then the colostomy will be permanent.

Even if all cancers that can be seen at the time of the operation are removed, some patients may be offered chemotherapy to destroy any cancer cells that may be left.

There appears to be a lower incidence of colon-rectal cancer among those who follow a diet high in fiber (vegetables, fruits and whole grains) than in those who follow a diet low in fiber and high in red meats, carbohydrates, fats and refined foods. Those at high risk with a family history of colon-rectal cancer; a history of non-cancerous polyps in colon; a history of ulcerative colitis; certain inherited conditions like familial adenomatous polyposis and hereditary non-cancerous polyposis colon cancer should be evaluated periodically for the disease.

Living with a stoma: According to Reader’s Digest Guide to Medical Cures and Treatment (my medical bible), a stoma is an opening in the lower, left abdomen through which the stools pass through. Patients who require a stoma must learn how to care for themselves and make some changes in daily routines. In time, they can resume the full range of normal activities, including work, sex, and most sports.
Here are some of the tips on making the adjustment: 1) Learn how to be proficient in all aspects of stoma care before leaving the hospital. Learn how to empty and change the ostomy pouch and how to care for the skin around the stoma. 2) Learn how to perform colostomy irrigation. This procedure, which takes time to master, involves instilling about one quart of water in the stoma to remove waste from the colon. If irrigation is performed every day or two, a colostomy pouch may be unnecessary; a gauze pad can be placed over the ostomy instead. 3) Use a specially formulated colostomy pouch deodorant to control odor. 4) Eat in moderation and on a fairly regular schedule. Try small servings of different foods to see if any one food causes problems. 5) Avoid fried products and foods that cause constipation, such as refined, low-fiber foods. 6) Limit consumption of foods that can cause diarrhea. Common offenders are beans, bran cereals, and raw fruits. 7) Wear regular clothes, but be sure that belts and waistbands are not directly over the stoma. Some men switch to suspenders to avoid discomfort from a belt. Ostomy pouches are made to lie flat against the body, so that they do not show. 8) Do not participate in rough contact sports such as football and ice hockey, and exercise caution in sports such as weight lifting and calisthenics, which may strain the abdominal muscles. 9) Empty the ostomy pouch before swimming and wear a wide-belted athletic supporter or girdle in the water. 10) Empty the ostomy pouch before any sexual activity.