[굿클리닉]Constipation and diarrhea, it turns out, because of colon cancer?… Early screening through colonoscopy is essential

[이데일리 이순용 기자] Mr. Choi, a 31-year-old male office worker, cannot forget the memory of receiving emergency surgery two years ago. Mr. Kim usually suffered from severe abdominal pain, but he was still young and thought it was just a simple stomach ulcer caused by work stress, so he didn’t worry too much. Then, the day after the dinner party, he visited the emergency medical center of Eunpyeong St. Mary’s Hospital with abdominal distension and unbearable abdominal pain.

Choi, who was examined by medical staff, had a very distended small intestine, and it was an emergency situation in which intestinal obstruction was observed due to a tumor at the junction of the small and large intestine. Immediately transferred to the operating room, Choi underwent emergency surgery to resect the right colon, and was diagnosed with stage 3 colorectal cancer in a postoperative biopsy. Kim, who completed 6 months of adjuvant chemotherapy, is undergoing follow-up examinations without recurrence or metastasis two years later, and is living a healthy life after re-employment at the company he used to work for.

The colon cancer clock is ticking up. Colorectal cancer is known to occur most often in people over the age of 50. However, according to a study recently published in an international medical journal, the incidence of colorectal cancer per 100,000 people in Korea aged 20 to 49 was 12.9, ranking first in the world.

Colorectal cancer is one of the most common cancers in overall cancer incidence statistics. According to the 2020 National Cancer Registration Statistics, colorectal cancer patients accounted for 11.2% of all cancer patients in Korea, the third most common. This is a step up from 4th place in 2019. Of the total 27,877 patients with colorectal cancer, 16,485 were male and 11,392 were female. In the case of females, they ranked third after breast cancer and thyroid cancer, which are representative female cancers. In men, it is also the most common after lung cancer, stomach cancer, and prostate cancer. Even when limited to the relatively young age group, 15 to 34 years old, the incidence of colorectal cancer was 3.6 per 100,000 population, ranking third. This means that there are more young colorectal cancer patients than well-known leukemia doctors (3.3).

◇ Meat-centered eating habits are risk factors

The large intestine is the last organ of the digestive tract located between the small intestine and the anus. The large intestine is largely divided into the colon and the rectum. The colon includes the cecum, ascending colon, transverse colon, descending colon, and S colon (a colon bent in the shape of the letter S). do. About 70% of all colorectal cancers occur in the rectum and the S colon, which is in contact with the rectum.

The causes of colorectal cancer are largely divided into environmental and genetic factors. As is well known, the environmental factors are westernized lifestyles such as high protein and high fat food intake, lack of exercise, and obesity. In particular, there is a report that the probability of cancer increases according to the amount of meat consumed, so a balanced diet is important to prevent colorectal cancer. Chronic diseases such as diabetes, obesity, and an overweight population under the age of 50 are also accelerating the rate of increase in young colorectal cancer.

Genetic factors also influence the risk of colorectal cancer. In particular, if there is a family member who has been diagnosed with colorectal cancer at a young age, or if there are several patients with stomach cancer, skin cancer, endometrial cancer, or ovarian cancer, Lynch syndrome, a genetic disease, can be suspected. Lynch syndrome refers to a genetic disease that has a higher chance of developing certain types of cancer before the age of 50 than the general population, and about 70 to 80% of Lynch syndrome patients develop colorectal cancer.

Professor Kim Hyung-jin of the Department of Colorectal Surgery at Eunpyeong St. Mary’s Hospital, Catholic University of Korea said, “Colorectal cancer caused by a genetic disease is quite young, in the early 40s, and especially in women, the probability of getting uterine cancer is as high as 40 to 50%.” “Lynch syndrome is Since the probability of passing it on to children reaches 50%, if there is a young colorectal cancer patient in the family, it is necessary to check the genetic factor,” he explained.

◇ Do not neglect symptoms in daily life such as constipation and diarrhea

The main symptoms of colorectal cancer are abdominal pain, bloody stools, and changes in bowel habits. These symptoms can appear at any time during life even if they are not related to colon cancer, so they are easy to overlook, but if there are sudden changes or symptoms persist, you need to pay attention.

In particular, if you have been constipated but suddenly have diarrhea, or if the opposite occurs, you need a test. It is also important to look at the thickness and color of stool whenever you visit the toilet. A tumor in the large intestine narrows the passage of stool, making the stool as thin as a pencil, or bloody stools may be seen due to bleeding.

Professor Kim emphasized, “It is common to misunderstand bloody stool as a symptom of hemorrhoids, but colonoscopy should be performed to confirm that there are no other causes.”

Colonoscopy is the most important test method for diagnosing colon cancer. Colorectal cancer usually starts as small wart-like bumps called colon polyps. Cancer can be prevented by removing these polyps that can develop into cancer in the future through endoscopy in the absence of symptoms. In addition, even if polyps are found to be cancerous, early detection at a time when there are no symptoms can result in an improved prognosis by setting up a customized treatment plan.

Professor Kim Hyung-jin said, “Currently, colorectal cancer screening is performed only for those over 50 years of age in the national health checkup, and colonoscopy is only required when abnormalities are found in this test, so awareness of the need for the test is low.” , If you feel bloody stool or changes in your bowel habits, we recommend that you get a colonoscopy early, regardless of your age.”

◇ Treatment considering quality of life, such as preservation of the anus and normalization of bowel function, is the key

The level of colorectal cancer treatment in Korea is world-class. The surgical method and multidisciplinary collaboration system have developed to such an extent that the prognosis of colorectal cancer patients in Korea is reported to be the best in global statistics. When colorectal cancer is diagnosed, additional CT or MRI examinations are performed to check for metastases to other organs such as the liver, lungs, and lymph nodes, as well as the local progress in the colon, and conduct multidisciplinary consultation. Collaboration to proceed with effective treatment in the most appropriate order according to the patient’s condition has recently become the most important strategy for colorectal cancer treatment.

In particular, in the case of rectal cancer, it is very difficult to treat because it is located inside the pelvis, right above the anus, and is adjacent to important structures such as the prostate, uterus, bladder, and pelvic nerves. Therefore, in order to preserve the anus and major structures while performing surgery, radiation therapy, and chemotherapy, it is essential for specialists in various fields to put their heads together to make a treatment plan.

In recent years, minimally invasive surgical methods such as laparoscopic surgery and robotic surgery have been rapidly developed, as well as preoperative and postoperative chemotherapy and radiation therapy.

Eunpyeong St. Mary’s Hospital is also operating a multidisciplinary collaboration system centering on the Colorectal Cancer Center to derive the best treatment results by effectively combining cutting-edge treatments. The Colorectal Cancer Collaborative Team, which consists of gastroenterology, oncology, colorectal surgery, radiation oncology, radiology, and pathology, holds a meeting once a week to discuss customized treatment plans for all colorectal cancer patients. In addition, it is equipped with state-of-the-art equipment such as the 3D laparoscopic surgery machine, the latest robotic surgery machine, Da Vinci Xi, and the dream cancer treatment machine, True Beam, and strives to obtain the best treatment results.

Professor Kim Hyung-jin said, “Even if colorectal cancer is detected at an early stage, additional chemotherapy or surgery may be required, so a systematic and diverse approach is needed.” We will discuss it at the cooperative meeting,” he said.

Due to the nature of treatment in which part of the colon is removed, colorectal cancer inevitably changes in bowel function after treatment. In the case of rectal cancer that develops in the area adjacent to the anus, not all patients can maintain normal bowel function even if the anus is preserved. This is because a number of factors, including rectal and pelvic nerves, as well as the anal sphincter, are required for normal bowel function.

These changes in bowel function significantly limit the patient’s quality of life, especially travel, outdoor activities, and work life. Accordingly, recently, in addition to research on the recovery of bowel function after colorectal cancer treatment, research on non-surgical treatment for rectal cancer patients who obtain good results from preoperative radiotherapy and chemotherapy has been actively conducted.

Professor Kim Hyung-jin said, “There are many patients who are unaware of the symptoms of colorectal cancer or neglect them and visit the hospital late.” If you consistently maintain and feel symptoms, regardless of your age, we recommend that you visit a hospital and consult a specialist.”